Modelling uncertainty with generalized credal sets: application to conjunction and decision

NASA Astrophysics Data System (ADS)

Bronevich, Andrey G.; Rozenberg, Igor N.

2018-01-01

To model conflict, non-specificity and contradiction in information, upper and lower generalized credal sets are introduced. Any upper generalized credal set is a convex subset of plausibility measures interpreted as lower probabilities whose bodies of evidence consist of singletons and a certain event. Analogously, contradiction is modelled in the theory of evidence by a belief function that is greater than zero at empty set. Based on generalized credal sets, we extend the conjunctive rule for contradictory sources of information, introduce constructions like natural extension in the theory of imprecise probabilities and show that the model of generalized credal sets coincides with the model of imprecise probabilities if the profile of a generalized credal set consists of probability measures. We give ways how the introduced model can be applied to decision problems.

Value-based medicine: concepts and application.

PubMed

Bae, Jong-Myon

2015-01-01

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

Value-based medicine: concepts and application

PubMed Central

Bae, Jong-Myon

2015-01-01

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

[Glocalization: the outlook for Taiwan evidence based health care].

PubMed

Chen, Chiehfeng

2014-12-01

Public attention to evidence-based health care (EBHC) has increased significantly in recent years. Key problems related to applying EBHC in current healthcare practice include the timely update of up-to-date knowledge and skills and the methodology used to implement EBHC in clinical settings. EBHC has been introduced to the Taiwan healthcare system for the past two decades. The annual EBM (Evidence based medicine) National Competition is a unique and important EBHC activity in Taiwan. EBHC has been promoted widely in medicine, nursing, pharmacy, public health and other professions, and EBHC-related organizations such as the Taiwan Evidence Based Medicine Association (TEBMA), and Taiwan Evidence Based Nursing Association (TEBNA), have increased in number and grown in membership. In addition to domestic developments, Taiwan is also actively involved in global organizations, such as the Cochrane Collaboration, East Asian Cochrane Alliance (EACA), and the International Society for Evidence Based Health Care (ISEHC). In Taiwan, most medical professionals work cooperatively to promote EBHC, which facilitates the gradual improvement of healthcare quality.

Criterion Noise in Ratings-Based Recognition: Evidence from the Effects of Response Scale Length on Recognition Accuracy

ERIC Educational Resources Information Center

Benjamin, Aaron S.; Tullis, Jonathan G.; Lee, Ji Hae

2013-01-01

Rating scales are a standard measurement tool in psychological research. However, research has suggested that the cognitive burden involved in maintaining the criteria used to parcel subjective evidence into ratings introduces "decision noise" and affects estimates of performance in the underlying task. There has been debate over whether…

Evidence-Based Policymaking Commission Act of 2014

THOMAS, 113th Congress

Sen. Murray, Patty [D-WA

2014-11-20

Senate - 11/20/2014 Read twice and referred to the Committee on Homeland Security and Governmental Affairs. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Experiments in Inquiry.

ERIC Educational Resources Information Center

Galus, Pamela

2001-01-01

Introduces an inquiry-based lab design in which students try to find evidence on a particular problem. Investigates the effects of decreases in the pH level on the environment. Includes students' hypotheses and research results. (YDS)

Education and learning: what's on the horizon?

PubMed

Pilcher, Jobeth

2014-01-01

Numerous organizations have called for significant changes in education for health care professionals. The call has included the need to incorporate evidence-based as well as innovative strategies. Previous articles in this column have focused primarily on evidence-based teaching strategies, including concept mapping, brain-based learning strategies, methods of competency assessment, and so forth. This article shifts the focus to new ways of thinking about knowledge and education. The article will also introduce evolving, innovative, less commonly used learning strategies and provide a peek into the future of learning.

Evidence-based practice of transfusion medicine: is it possible and what do the words mean?

PubMed

Vamvakas, Eleftherios C

2004-10-01

Evidence-based medicine (EBM) optimizes clinical decision making by dictating that clinical decisions be based on the best available research evidence and by integrating best research evidence with clinical expertise and patient values. Several rankings of the strength of the evidence generated from different types of clinical research designs have been presented, and, in addressing a particular problem, clinicians can base their decision making on the types of clinical reports that have been published, along with an assessment of the strengths and weaknesses of each study. At a policy level, the concept of EBM would dictate that policy decisions also be made based on the best available research evidence. In transfusion medicine, however, decisions are based on a broader range of inputs, and the criteria for evaluating the efficacy and/or cost-effectiveness of proposed interventions differ from those used in other areas. Reasons why policy decisions are often based on considerations other than the best research evidence include public expectations about transfusion safety and proposals for applying the precautionary principle to transfusion medicine. Using the debate over the appropriateness of introducing universal white-cell reduction as an example, this review describes 2 perspectives for assessing evidence and/or making clinical or policy decisions: the evidence-based approach and the precautionary-principle approach; and also considers whether decisions in transfusion medicine can be truly evidence based.

Web-based elective courses for medical students: an example in pain.

PubMed

Puljak, Livia; Sapunar, Damir

2011-06-01

Online learning is an efficient new educational method that is able to link teachers with geographically dispersed students and capture the interest of students with interactive materials. Our objective was to describe curricula of new Web-based electives about pain for undergraduate medical education. We created three interactive Web-based elective courses about pain targeted to medical and dental students. "The Puzzle of Pain" course introduced basic concepts of pain and neurobiology of pain. The humanities-based curriculum of "Empathy and Pain" taught students about emotional aspects of pain and empathetic responses. "The Cochrane Library and Pain" course introduced students to the concept of evidence-based medicine, critical appraisal of the literature, and the hierarchy of evidence in medicine. We measured program effectiveness with a pretest/posttest instrument and student satisfaction survey. Mean knowledge scores increased significantly after the program and overall evaluations were positive. Delivering the pain electives for medical students in an online format was an efficient educational method, with high student satisfaction scores. Medical educators should consider online electives for medical students in pain studies as well as in other content areas. Wiley Periodicals, Inc.

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

PubMed

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

2015-01-01

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

Experiential Learning in Revolutionary and Post-Revolutionary China.

ERIC Educational Resources Information Center

Kraft, Richard J.

Experience-based learning has been evident in the Chinese educational system since the 1930s. Following the Long March in 1934-35, the Chinese Communists introduced a nonformal, experience-based educational system in North Shensi province. This system included drama groups in the countryside to educate peasants, classes in factories, and…

Immunology and Homeopathy. 4. Clinical Studies—Part 1

PubMed Central

Bellavite, Paolo; Ortolani, Riccardo; Pontarollo, Francesco; Piasere, Valeria; Benato, Giovanni; Conforti, Anita

2006-01-01

The evidence-based research of the effectiveness of homeopathic medicines in common immunologic disorders is reviewed. In part 1, we introduce methodological issues of clinical research in homeopathy, and criteria utilized to evaluate the literature. Then 24 studies (12 randomized and 12 non-randomized) on common upper respiratory tract infections and otorhinolaryngologic complaints are described. In part 2, the focus will be on allergic diseases and the effectiveness of homeopathy will be globally evaluated and discussed using the criteria of evidence-based medicine. PMID:16951713

Adopting a Brief, Web-Based Feedback Approach to Counter High School Drinking: Considerations for Professional School Counselors

ERIC Educational Resources Information Center

Doumas, Diana M.; Esp, Susan; Turrisi, Rob; Schottelkorb, April

2015-01-01

Adolescent drinking represents a significant problem in the United States. Although high school juniors and seniors are particularly vulnerable to the negative consequences associated with alcohol use, evidence-based interventions for this age group are limited. The purpose of this article is to introduce a Web-based alcohol intervention with…

Evidence-based Nursing Education - a Systematic Review of Empirical Research

PubMed Central

Reiber, Karin

2011-01-01

The project „Evidence-based Nursing Education – Preparatory Stage“, funded by the Landesstiftung Baden-Württemberg within the programme Impulsfinanzierung Forschung (Funding to Stimulate Research), aims to collect information on current research concerned with nursing education and to process existing data. The results of empirical research which has already been carried out were systematically evaluated with aim of identifying further topics, fields and matters of interest for empirical research in nursing education. In the course of the project, the available empirical studies on nursing education were scientifically analysed and systematised. The over-arching aim of the evidence-based training approach – which extends beyond the aims of this project - is the conception, organisation and evaluation of vocational training and educational processes in the caring professions on the basis of empirical data. The following contribution first provides a systematic, theoretical link to the over-arching reference framework, as the evidence-based approach is adapted from thematically related specialist fields. The research design of the project is oriented towards criteria introduced from a selection of studies and carries out a two-stage systematic review of the selected studies. As a result, the current status of research in nursing education, as well as its organisation and structure, and questions relating to specialist training and comparative education are introduced and discussed. Finally, the empirical research on nursing training is critically appraised as a complementary element in educational theory/psychology of learning and in the ethical tradition of research. This contribution aims, on the one hand, to derive and describe the methods used, and to introduce the steps followed in gathering and evaluating the data. On the other hand, it is intended to give a systematic overview of empirical research work in nursing education. In order to preserve a holistic view of the research field and methods, detailed individual findings are not included. PMID:21818237

Paediatric obesity research in early childhood and the primary care setting: the TARGet Kids! research network.

PubMed

Morinis, Julia; Maguire, Jonathon; Khovratovich, Marina; McCrindle, Brian W; Parkin, Patricia C; Birken, Catherine S

2012-04-01

Primary paediatric health care is the foundation for preventative child health. In light of the recent obesity epidemic, paediatricians find themselves at the frontline of identification and management of childhood obesity. However, it is well recognized that evidence based approaches to obesity prevention and subsequent translation of this evidence into practice are critically needed. This paper explores the role of primary care in obesity prevention and introduces a novel application and development of a primary care research network in Canada--TARGet Kids!--to develop and translate an evidence-base on effective screening and prevention of childhood obesity.

Paediatric Obesity Research in Early Childhood and the Primary Care Setting: The TARGet Kids! Research Network

PubMed Central

Morinis, Julia; Maguire, Jonathon; Khovratovich, Marina; McCrindle, Brian W.; Parkin, Patricia C.; Birken, Catherine S.

2012-01-01

Primary paediatric health care is the foundation for preventative child health. In light of the recent obesity epidemic, paediatricians find themselves at the frontline of identification and management of childhood obesity. However, it is well recognized that evidence based approaches to obesity prevention and subsequent translation of this evidence into practice are critically needed. This paper explores the role of primary care in obesity prevention and introduces a novel application and development of a primary care research network in Canada—TARGet Kids!—to develop and translate an evidence-base on effective screening and prevention of childhood obesity. PMID:22690197

The obesity penalty in the labor market using longitudinal Canadian data.

PubMed

Chu, Filmer; Ohinmaa, Arto

2016-12-01

A Canadian study of weight discrimination also known as the obesity wage-penalty. This paper adds to the limited Canadian literature while also introducing a causal model, which can be applied to future Canadian studies. A general working-class sample group is utilized with personal income, which removes many biases introduced in other studies. The evidence suggests that a 1-unit increase in lagged BMI is associated with a 0.7% decrease in personal for obese Canadian females. Similar to other studies, the male results are inconsistent. The evidence brought forward in this study can provide an effective financial incentive for health promotion among Canadians for law and policy makers. Beyond health reasons, these results can also be applied as empirical evidence of gender discrimination based on body image perception. The evidence suggests that male physique is not a contributing factor in income, but larger female physique is associated with lower personal income. Copyright © 2016 Elsevier B.V. All rights reserved.

Sexual Orientation and School Discipline: New Evidence from a Population-Based Sample

ERIC Educational Resources Information Center

Mittleman, Joel

2018-01-01

Sexual minorities' risk for exclusionary discipline is a commonly cited indicator of the challenges that these students face. The current study addresses this issue by introducing a new data source for research on sexual minority students: the Fragile Families and Childhood Wellbeing Study. In this geographically diverse, population-based sample,…

Managing Stuttering beyond the Preschool Years

ERIC Educational Resources Information Center

Nippold, Marilyn A.; Packman, Ann

2012-01-01

Purpose: This prologue serves to introduce a research forum composed of studies that address the topic of stuttering in school-age children and adolescents. Researchers are encouraged to continue to build the knowledge base that sustains evidence-based practice in this area. Method: The nature of stuttering as it evolves from early childhood into…

Evidence-Based Toxicology.

PubMed

Hoffmann, Sebastian; Hartung, Thomas; Stephens, Martin

Evidence-based toxicology (EBT) was introduced independently by two groups in 2005, in the context of toxicological risk assessment and causation as well as based on parallels between the evaluation of test methods in toxicology and evidence-based assessment of diagnostics tests in medicine. The role model of evidence-based medicine (EBM) motivated both proposals and guided the evolution of EBT, whereas especially systematic reviews and evidence quality assessment attract considerable attention in toxicology.Regarding test assessment, in the search of solutions for various problems related to validation, such as the imperfectness of the reference standard or the challenge to comprehensively evaluate tests, the field of Diagnostic Test Assessment (DTA) was identified as a potential resource. DTA being an EBM discipline, test method assessment/validation therefore became one of the main drivers spurring the development of EBT.In the context of pathway-based toxicology, EBT approaches, given their objectivity, transparency and consistency, have been proposed to be used for carrying out a (retrospective) mechanistic validation.In summary, implementation of more evidence-based approaches may provide the tools necessary to adapt the assessment/validation of toxicological test methods and testing strategies to face the challenges of toxicology in the twenty first century.

45 CFR 508.6 - Résumé of hearing, preparation of.

Code of Federal Regulations, 2010 CFR

2010-10-01

... which the hearing was based, and including a list of documents and contents and other items relative to the issues that were introduced as evidence. A brief analysis of oral testimony will also be prepared...

Evidence-based Research in Complementary and Alternative Medicine I: History

PubMed Central

2005-01-01

Contemporary Western medicine has witnessed a fragmentation of our conceptualization of the medical endeavor into ‘traditional medicine’ and ‘non-traditional medicine’. The former is meant to refer to the Western medical tradition, the latter encompasses both ‘complementary’ and ‘alternative’ medical practices. Complementary medicine complements conventional medical treatments, and alternative modes of medical interventions are meant to replace traditional Western medicine. Evidence-based research must be directed at establishing the best available evidence in complementary and alternative medicine. This paper is the first of a set of four ‘lectures’ that reviews the process of evidence-based research, and discusses its implications and applications for the early decades of the 21st century. The purpose of this paper is to introduce the series by examining some of the historical and philosophical foundations of this research endeavor. PMID:16322801

Feedback informed treatment: evidence-based practice meets social construction.

PubMed

Tilsen, Julie; McNamee, Sheila

2015-03-01

This article explores the challenges presented by the mandate for evidence-based practice for family therapists who identify with the philosophical stance of social construction. The history of psychotherapy outcome research is reviewed, as are current findings that provide empirical evidence for an engaged, dialogic practice. The authors suggest that the binary between empiricism and social construction may be unhinged by understanding empiricism as a particular discursive frame (i.e., a particular way of talking, acting, and being in the world), one of many available as a way of understanding and talking about our work. Through a case vignette, the authors introduce the evidence-based practice of Feedback Informed Treatment as an elaboration of social construction, and as an example of bridging the gap between the discursive frames of empiricism and social construction. © 2014 Family Process Institute.

Rural Doctors' Views on and Experiences with Evidence-Based Medicine: The FrEEDoM Qualitative Study.

PubMed

Hisham, Ranita; Liew, Su May; Ng, Chirk Jenn; Mohd Nor, Kamaliah; Osman, Iskandar Firzada; Ho, Gah Juan; Hamzah, Nurazira; Glasziou, Paul

2016-01-01

Evidence-based medicine is the integration of individual clinical expertise, best external evidence and patient values which was introduced more than two decades ago. Yet, primary care physicians in Malaysia face unique barriers in accessing scientific literature and applying it to their clinical practice. This study aimed to explore the views and experiences of rural doctors' about evidence-based medicine in their daily clinical practice in a rural primary care setting. Qualitative methodology was used. The interviews were conducted in June 2013 in two rural health clinics in Malaysia. The participants were recruited using purposive sampling. Four focus group discussions with 15 medical officers and three individual in-depth interviews with family medicine specialists were carried out. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked and analyzed using a thematic approach. Key themes identified were: (1) doctors viewed evidence-based medicine mainly as statistics, research and guidelines, (2) reactions to evidence-based medicine were largely negative, (3) doctors relied on specialists, peers, guidelines and non-evidence based internet sources for information, (4) information sources were accessed using novel methods such as mobile applications and (5) there are several barriers to evidence-based practice, including doctor-, evidence-based medicine-, patient- and system-related factors. These included inadequacies in knowledge, attitude, management support, time and access to evidence-based information sources. Participants recommended the use of online services to support evidence-based practice in the rural settings. The level of evidence-based practice is low in the rural setting due to poor awareness, knowledge, attitude and resources. Doctors use non-evidence based sources and access them through new methods such as messaging applications. Further research is recommended to develop and evaluate interventions to overcome the identified barriers.

Taking a new biomarker into routine use – A perspective from the routine clinical biochemistry laboratory

PubMed Central

Sturgeon, Catharine; Hill, Robert; Hortin, Glen L; Thompson, Douglas

2010-01-01

There is increasing pressure to provide cost-effective healthcare based on “best practice.” Consequently, new biomarkers are only likely to be introduced into routine clinical biochemistry departments if they are supported by a strong evidence base and if the results will improve patient management and outcome. This requires convincing evidence of the benefits of introducing the new test, ideally reflected in fewer hospital admissions, fewer additional investigations and/or fewer clinic visits. Carefully designed audit and cost-benefit studies in relevant patient groups must demonstrate that introducing the biomarker delivers an improved and more effective clinical pathway. From the laboratory perspective, pre-analytical requirements must be thoroughly investigated at an early stage. Good stability of the biomarker in relevant physiological matrices is essential to avoid the need for special processing. Absence of specific timing requirements for sampling and knowledge of the effect of medications that might be used to treat the patients in whom the biomarker will be measured is also highly desirable. Analytically, automation is essential in modern high-throughput clinical laboratories. Assays must therefore be robust, fulfilling standard requirements for linearity on dilution, precision and reproducibility, both within- and between-run. Provision of measurements by a limited number of specialized reference laboratories may be most appropriate, especially when a new biomarker is first introduced into routine practice. PMID:21137030

An Evidence-Based Course in Complementary Medicines

PubMed Central

Hughes, Jeff

2012-01-01

Objective. To evaluate the impact of an evidence-based course in complementary medicines on the attitudes, knowledge, and professional practice behavior of undergraduate pharmacy students. Design. A required 12-week evidence-based complementary medicine course was designed and introduced into the third-year undergraduate pharmacy curriculum. The course included a combination of traditional lectures, interactive tutorial sessions, and a range of formal assessments. Assessment. Pre- and post-course survey instruments were administered to assess changes in students’ attitudes, perceptions, knowledge, and the likelihood they would recommend the use of complementary medicines in a pharmacy practice environment. Conclusion. Completion of a required evidence-based complementary medicines course resulted in a positive change in pharmacy students’ perceptions of the value of various complementary medicines as well as in their willingness to recommend them, and provided students with the required knowledge to make patient-centered recommendations for use of complementary medicines in a professional pharmacy practice setting. These findings support the need for greater evidence-based complementary medicine education within pharmacy curricula to meet consumer demand and to align with pharmacists’ professional responsibilities. PMID:23275665

The Impact of Library Tutorials on the Information Literacy Skills of Occupational Therapy and Physical Therapy Students in an Evidence-Based Practice Course: A Rubric Assessment.

PubMed

Schweikhard, April J; Hoberecht, Toni; Peterson, Alyssa; Randall, Ken

2018-01-01

This study measures how online library instructional tutorials implemented into an evidence-based practice course have impacted the information literacy skills of occupational and physical therapy graduate students. Through a rubric assessment of final course papers, this study compares differences in students' search strategies and cited sources pre- and post-implementation of the tutorials. The population includes 180 randomly selected graduate students from before and after the library tutorials were introduced into the course curriculum. Results indicate a statistically significant increase in components of students' searching skills and ability to find higher levels of evidence after completing the library tutorials.

Integrating critical thinking and evidence-based dentistry across a four-year dental curriculum: a model for independent learning.

PubMed

Marshall, Teresa A; Straub-Morarend, Cheryl L; Handoo, Nidhi; Solow, Catherine M; Cunningham-Ford, Marsha A; Finkelstein, Michael W

2014-03-01

Introducing critical thinking and evidence-based dentistry (EBD) content into an established dental curriculum can be a difficult and challenging process. Over the past three years, the University of Iowa College of Dentistry has developed and implemented a progressive four-year integrated critical thinking and EBD curriculum. The objective of this article is to describe the development and implementation process to make it available as a model for other dental schools contemplating introduction of critical thinking and EBD into their curricula. The newly designed curriculum built upon an existing problem-based learning foundation, which introduces critical thinking and the scientific literature in the D1 year, in order to expose students to the rationale and resources for practicing EBD in the D2 and D3 years and provide opportunities to practice critical thinking and apply the EBD five-step process in the D2, D3, and D4 years. All curricular content is online, and D3 and D4 EBD activities are integrated within existing clinical responsibilities. The curricular content, student resources, and student activities are described.

Activity-based funding for National Health Service hospitals in England: managers' experience and expectations.

PubMed

Sussex, Jonathan; Farrar, Shelley

2009-05-01

Activity-based funding of hospital services has been introduced progressively since 2003 in the National Health Service (NHS) in England, under the name 'Payment by Results' (PbR). It represents a major change from previous funding arrangements based on annual "block" payments for large bundles of services. We interviewed senior local NHS managers about their experience and expectations of the impact of PbR. A high degree of 'NHS solidarity' was apparent, and competition between NHS hospitals was muted. PbR has been introduced against a background of numerous other efficiency incentives, and managers did not detect a further PbR-specific boost to efficiency. No impact on care quality, either positive or negative, is yet evident.

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

PubMed

Edens, John F; Cox, Jennifer

2012-01-01

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

Proton Pump Inhibitors and Risk of Rhabdomyolysis.

PubMed

Duncan, Scott J; Howden, Colin W

2017-01-01

Proton pump inhibitors (PPIs) have been associated with a variety of adverse events, although the level of evidence for many of these is weak at best. Recently, one national regulatory authority has mandated a change to the labeling of one PPI based on reports of possible associated rhabdomyolysis. Thus, in this review we summarize the available evidence linking PPI use with rhabdomyolysis. The level of evidence is insufficient to establish a causal relationship and is largely based on sporadic case reports. In general, patients with suspected PPI-associated rhabdomyolysis have not been re-challenged with a PPI after recovery. The mechanism whereby PPIs might have been associated with rhabdomyolysis is unclear but possibly related to interaction with concomitantly administered drugs such as HMG-CoA reductase inhibitors (statins). For patients with rhabdomyolysis, a careful search must be made for possible etiological factors. In patients who recover from an episode of possible PPI-related rhabdomyolysis but do not have a genuine requirement for PPI treatment, the PPI should not be re-introduced. For those with a definite indication for ongoing PPI treatment, the PPI can be re-introduced but should preferably not be administered with a statin.

Personnel and Welfare: The Case of the Problem Drinker at Work.

ERIC Educational Resources Information Center

Hyman, J.; Beaumont, P. B.

1985-01-01

Presents evidence of welfare activity in a number of work organizations based in Scotland that have introduced recovery programs for employees with alcohol-related problems. The study points to extensive involvement by personnel specialists in the operation of these policies. (CT)

Updates in the management of stable chronic obstructive pulmonary disease.

PubMed

Narsingam, Saiprasad; Bozarth, Andrew L; Abdeljalil, Asem

2015-01-01

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease state characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory process. It is increasingly recognized as a major public health problem, affecting more than 20 million adults in the US. It is also recognized as a leading cause of hospitalizations and is the fourth leading cause of death in the US. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) operates to promote evidence-based management of COPD, increase awareness and encourage research. In 2011, GOLD published a consensus report detailing evidence-based management strategies for COPD, which were last updated in 2015. In recent years, newer strategies and a growing number of new pharmacologic agents to treat symptoms of COPD have also been introduced and show promise in improving the management of COPD. We aim to provide an evidence-based review of the available and upcoming pharmacologic and non-pharmacologic treatment options for stable COPD, with continued emphasis on evidence-based management.

Scoping meta-review: introducing a new methodology.

PubMed

Sarrami-Foroushani, Pooria; Travaglia, Joanne; Debono, Deborah; Clay-Williams, Robyn; Braithwaite, Jeffrey

2015-02-01

For researchers, policymakers, and practitioners facing a new field, undertaking a systematic review can typically present a challenge due to the enormous number of relevant papers. A scoping review is a method suggested for addressing this dilemma; however, scoping reviews present their own challenges. This paper introduces the "scoping meta-review" (SMR) for expanding current methodologies and is based on our experiences in mapping the field of consumer engagement in healthcare. During this process, we developed the novel SMR method. An SMR combines aspects of a scoping review and a meta-review to establish an evidence-based map of a field. Similar to a scoping review, an SMR offers a practical and flexible methodology. However, unlike in a traditional scoping review, only systematic reviews are included. Stages of the SMR include: undertaking a preliminary nonsystematic review; building a search strategy; interrogating academic literature databases; classifying and excluding studies based on titles and abstracts; saving the refined database of references; revising the search strategy; selecting and reviewing the full text papers; and thematically analyzing the selected texts and writing the report. The main benefit of an SMR is to map a new field based on high-level evidence provided by systematic reviews. © 2014 Wiley Periodicals, Inc.

Use of Research Evidence in State Policymaking for Childhood Obesity Prevention in Minnesota

PubMed Central

Kite, Hanna A.; Benning, Sara J.; Callanan, Rachel A.; Weisman, Susan R.; Nanney, Marilyn S.

2014-01-01

Objectives. We describe how scientific evidence about obesity has been used in Minnesota legislative materials to understand how research evidence might more effectively be translated into policymaking. Methods. We selected 13 obesity-related bills introduced from 2007 to 2011 in Minnesota. Using state archives, we collected all legislative committee meeting materials and floor testimony related to each bill. We used a coding instrument to systematically analyze the content of a sample of 109 materials for their use of research evidence and non–research-based information. Results. Research evidence was mentioned in 41% of all legislative materials. Evidence was often used to describe the prevalence or consequences of obesity or policy impacts but not to describe health disparities. In 45% of materials that cited evidence, no source of evidence was indicated. By contrast, 92% of materials presented non–research-based information, such as expert beliefs, constituent opinion, political principles, and anecdotes. Conclusions. Despite an abundance of available research evidence on obesity, less than half of legislative materials cited any such evidence in discussions around obesity-related bills under consideration in Minnesota. PMID:25122015

Use of research evidence in state policymaking for childhood obesity prevention in Minnesota.

PubMed

Gollust, Sarah E; Kite, Hanna A; Benning, Sara J; Callanan, Rachel A; Weisman, Susan R; Nanney, Marilyn S

2014-10-01

We describe how scientific evidence about obesity has been used in Minnesota legislative materials to understand how research evidence might more effectively be translated into policymaking. We selected 13 obesity-related bills introduced from 2007 to 2011 in Minnesota. Using state archives, we collected all legislative committee meeting materials and floor testimony related to each bill. We used a coding instrument to systematically analyze the content of a sample of 109 materials for their use of research evidence and non-research-based information. Research evidence was mentioned in 41% of all legislative materials. Evidence was often used to describe the prevalence or consequences of obesity or policy impacts but not to describe health disparities. In 45% of materials that cited evidence, no source of evidence was indicated. By contrast, 92% of materials presented non-research-based information, such as expert beliefs, constituent opinion, political principles, and anecdotes. Despite an abundance of available research evidence on obesity, less than half of legislative materials cited any such evidence in discussions around obesity-related bills under consideration in Minnesota.

mEBT: multiple-matching Evidence-based Translator of Murine Genomic Responses for Human Immunity Studies.

PubMed

Tae, Donghyun; Seok, Junhee

2018-05-29

In this paper, we introduce multiple-matching Evidence-based Translator (mEBT) to discover genomic responses from murine expression data for human immune studies, which are significant in the given condition of mice and likely have similar responses in the corresponding condition of human. mEBT is evaluated over multiple data sets and shows improved inter-species agreement. mEBT is expected to be useful for research groups who use murine models to study human immunity. http://cdal.korea.ac.kr/mebt/. jseok14@korea.ac.kr. Supplementary data are available at Bioinformatics online.

Introducing a Chair-Side Novel Approach to Reach Evidence-based Periodontal Information in the Daily Periodontal Practice

PubMed Central

Dannan, Aous

2009-01-01

Background Evidence-based healthcare is not an easier approach to patient management, but should provide both clinicians and patients with greater confidence and trust in their mutual relationship. The intellectual embrace of evidence-based methods, coupled with clinical expertise and consideration of the patients individual uniqueness and requirements, is needed for all periodontal therapists if optimum care is the goal. One important element of evidence-based decision making in periodontology is the systematic review. Systematic reviews usually provide the periodontist with the highest level of evidence which should be taken into consideration when constructing any treatment plan in the dental clinic. However, reaching systematic reviews might be a time-consuming procedure that needs further personal skills. Methods In this paper, a chair-side novel approach to facilitate the incorporation of systematic reviews into daily periodontal practice is presented. It is based on three simple tools, namely, a list of suitable periodontics-related key words, a data bank of all up-to-date published systematic reviews in periodontology, and hand-made paper sheets to match the key words with their related systematic review statements. Results and Conclusions A primary validation of this method indicated the simplicity in learning and application. Keywords Chair-side; Evidence-based medicine; Periodontology; Systematic review PMID:22461868

Synthesizing Quantitative Evidence for Evidence-based Nursing: Systematic Review.

PubMed

Oh, Eui Geum

2016-06-01

As evidence-based practice has become an important issue in healthcare settings, the educational needs for knowledge and skills for the generation and utilization of healthcare evidence are increasing. Systematic review (SR), a way of evidence generation, is a synthesis of primary scientific evidence, which summarizes the best evidence on a specific clinical question using a transparent, a priori protocol driven approach. SR methodology requires a critical appraisal of primary studies, data extraction in a reliable and repeatable way, and examination for validity of the results. SRs are considered hierarchically as the highest form of evidence as they are a systematic search, identification, and summarization of the available evidence to answer a focused clinical question with particular attention to the methodological quality of studies or the credibility of opinion and text. The purpose of this paper is to introduce an overview of the fundamental knowledge, principals and processes in SR. The focus of this paper is on SR especially for the synthesis of quantitative data from primary research studies that examines the effectiveness of healthcare interventions. To activate evidence-based nursing care in various healthcare settings, the best and available scientific evidence are essential components. This paper will include some examples to promote understandings. Copyright © 2016. Published by Elsevier B.V.

Rural Doctors’ Views on and Experiences with Evidence-Based Medicine: The FrEEDoM Qualitative Study

PubMed Central

Hisham, Ranita; Liew, Su May; Ng, Chirk Jenn; Mohd Nor, Kamaliah; Osman, Iskandar Firzada; Ho, Gah Juan; Hamzah, Nurazira; Glasziou, Paul

2016-01-01

Background Evidence-based medicine is the integration of individual clinical expertise, best external evidence and patient values which was introduced more than two decades ago. Yet, primary care physicians in Malaysia face unique barriers in accessing scientific literature and applying it to their clinical practice. Aim This study aimed to explore the views and experiences of rural doctors’ about evidence-based medicine in their daily clinical practice in a rural primary care setting. Methods Qualitative methodology was used. The interviews were conducted in June 2013 in two rural health clinics in Malaysia. The participants were recruited using purposive sampling. Four focus group discussions with 15 medical officers and three individual in-depth interviews with family medicine specialists were carried out. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked and analyzed using a thematic approach. Results Key themes identified were: (1) doctors viewed evidence-based medicine mainly as statistics, research and guidelines, (2) reactions to evidence-based medicine were largely negative, (3) doctors relied on specialists, peers, guidelines and non-evidence based internet sources for information, (4) information sources were accessed using novel methods such as mobile applications and (5) there are several barriers to evidence-based practice, including doctor-, evidence-based medicine-, patient- and system-related factors. These included inadequacies in knowledge, attitude, management support, time and access to evidence-based information sources. Participants recommended the use of online services to support evidence-based practice in the rural settings. Conclusion The level of evidence-based practice is low in the rural setting due to poor awareness, knowledge, attitude and resources. Doctors use non-evidence based sources and access them through new methods such as messaging applications. Further research is recommended to develop and evaluate interventions to overcome the identified barriers. PMID:27031700

Translating evidence based violence and drug use prevention to obesity prevention: development and construction of the pathways program.

PubMed

Sakuma, Kari-Lyn K; Riggs, Nathaniel R; Pentz, Mary Ann

2012-04-01

Effective school-based obesity prevention programs are needed to prevent and reduce the growing obesity risk among youth. Utilizing the evidence-rich areas of violence and substance use prevention, translation science may provide an efficient means for developing curricula across multiple health behaviors. This paper introduces Pathways to Health, a school-based obesity prevention program that was developed by translating from evidence-based violence and drug use prevention programs, Promoting Alternative THinking Strategies and the Midwestern Prevention Project STAR (STAR). We illustrate how a hypothesized underlying behavior change mechanism in two domains of risk behavior, violence and substance use, can be applied to obesity prevention. A 4-step translational process is provided and may be relevant for use in developing other curricula to address multiple health risk behaviors. Practical application and decision points are also provided.

Translating evidence based violence and drug use prevention to obesity prevention: development and construction of the Pathways program

PubMed Central

Sakuma, Kari-Lyn K.; Riggs, Nathaniel R.; Pentz, Mary Ann

2012-01-01

Effective school-based obesity prevention programs are needed to prevent and reduce the growing obesity risk among youth. Utilizing the evidence-rich areas of violence and substance use prevention, translation science may provide an efficient means for developing curricula across multiple health behaviors. This paper introduces Pathways to Health, a school-based obesity prevention program that was developed by translating from evidence-based violence and drug use prevention programs, Promoting Alternative THinking Strategies and the Midwestern Prevention Project STAR (STAR). We illustrate how a hypothesized underlying behavior change mechanism in two domains of risk behavior, violence and substance use, can be applied to obesity prevention. A 4-step translational process is provided and may be relevant for use in developing other curricula to address multiple health risk behaviors. Practical application and decision points are also provided. PMID:21987475

Boundary-to-Marker Evidence-Controlled Segmentation and MDL-Based Contour Inference for Overlapping Nuclei.

PubMed

Song, Jie; Xiao, Liang; Lian, Zhichao

2017-03-01

This paper presents a novel method for automated morphology delineation and analysis of cell nuclei in histopathology images. Combining the initial segmentation information and concavity measurement, the proposed method first segments clusters of nuclei into individual pieces, avoiding segmentation errors introduced by the scale-constrained Laplacian-of-Gaussian filtering. After that a nuclear boundary-to-marker evidence computing is introduced to delineate individual objects after the refined segmentation process. The obtained evidence set is then modeled by the periodic B-splines with the minimum description length principle, which achieves a practical compromise between the complexity of the nuclear structure and its coverage of the fluorescence signal to avoid the underfitting and overfitting results. The algorithm is computationally efficient and has been tested on the synthetic database as well as 45 real histopathology images. By comparing the proposed method with several state-of-the-art methods, experimental results show the superior recognition performance of our method and indicate the potential applications of analyzing the intrinsic features of nuclei morphology.

An Evaluation of Knowledge Transfer from Microworld Programming to Conventional Programming

ERIC Educational Resources Information Center

Xinogalos, Stelios

2012-01-01

Programming microworlds are being used for introducing students to programming for many years. Although many professors and school teachers report positive results from using programming microwords, these results are usually based on anecdotal evidence rather than rigorous empirical evaluation. A question that has not been answered yet with…

Evolutionary Biology Digital Dissection Project: Web-Based Laboratory Learning Opportunities for Students

ERIC Educational Resources Information Center

Fabian, Carole Ann

2004-01-01

A university in Buffalo introduced its students to evolution by providing them with information on evidence of evolution, mechanisms for evolution, principles of genetics, selection, adaptation, evolution and sociobiology. This method of teaching with technology enabled students to improve and expand their learning opportunities.

Evidence-based causation in toxicology: A 10-year retrospective.

PubMed

James, R C; Britt, J K; Halmes, N C; Guzelian, P S

2015-12-01

We introduced Evidence-based Toxicology (EBT) in 2005 to address the disparities that exist between the various Weight-of-Evidence (WOE) methods typically applied in the regulatory hazard decision-making arena and urged toxicologists to adopt the evidence-based guidelines long-utilized in medicine (i.e., Evidence-Based Medicine or EBM). This review of the activities leading to the adoption of evidence-based methods and EBT during the last decade demonstrates how fundamental concepts that form EBT, such as the use of systematic reviews to capture and consider all available information, are improving toxicological evaluations performed by various groups and agencies. We reiterate how the EBT framework, a process that provides a method for performing human chemical causation analyses in an objective, transparent and reproducible manner, differs significantly from past and current regulatory WOE approaches. We also discuss why the uncertainties associated with regulatory WOE schemes lead to a definition of the term "risk" that contains unquantifiable uncertainties not present in this term as it is used in epidemiology and medicine. We believe this distinctly different meaning of "risk" should be clearly conveyed to those not familiar with this difference (e.g., the lay public), when theoretical/nomologic risks associated with chemical-induced toxicities are presented outside of regulatory and related scientific parlance. © The Author(s) 2015.

Multiple sparse volumetric priors for distributed EEG source reconstruction.

PubMed

Strobbe, Gregor; van Mierlo, Pieter; De Vos, Maarten; Mijović, Bogdan; Hallez, Hans; Van Huffel, Sabine; López, José David; Vandenberghe, Stefaan

2014-10-15

We revisit the multiple sparse priors (MSP) algorithm implemented in the statistical parametric mapping software (SPM) for distributed EEG source reconstruction (Friston et al., 2008). In the present implementation, multiple cortical patches are introduced as source priors based on a dipole source space restricted to a cortical surface mesh. In this note, we present a technique to construct volumetric cortical regions to introduce as source priors by restricting the dipole source space to a segmented gray matter layer and using a region growing approach. This extension allows to reconstruct brain structures besides the cortical surface and facilitates the use of more realistic volumetric head models including more layers, such as cerebrospinal fluid (CSF), compared to the standard 3-layered scalp-skull-brain head models. We illustrated the technique with ERP data and anatomical MR images in 12 subjects. Based on the segmented gray matter for each of the subjects, cortical regions were created and introduced as source priors for MSP-inversion assuming two types of head models. The standard 3-layered scalp-skull-brain head models and extended 4-layered head models including CSF. We compared these models with the current implementation by assessing the free energy corresponding with each of the reconstructions using Bayesian model selection for group studies. Strong evidence was found in favor of the volumetric MSP approach compared to the MSP approach based on cortical patches for both types of head models. Overall, the strongest evidence was found in favor of the volumetric MSP reconstructions based on the extended head models including CSF. These results were verified by comparing the reconstructed activity. The use of volumetric cortical regions as source priors is a useful complement to the present implementation as it allows to introduce more complex head models and volumetric source priors in future studies. Copyright © 2014 Elsevier Inc. All rights reserved.

Appraisal of comparative single-case experimental designs for instructional interventions with non-reversible target behaviors: Introducing the CSCEDARS ("Cedars").

PubMed

Schlosser, Ralf W; Belfiore, Phillip J; Sigafoos, Jeff; Briesch, Amy M; Wendt, Oliver

2018-05-28

Evidence-based practice as a process requires the appraisal of research as a critical step. In the field of developmental disabilities, single-case experimental designs (SCEDs) figure prominently as a means for evaluating the effectiveness of non-reversible instructional interventions. Comparative SCEDs contrast two or more instructional interventions to document their relative effectiveness and efficiency. As such, these designs have great potential to inform evidence-based decision-making. To harness this potential, however, interventionists and authors of systematic reviews need tools to appraise the evidence generated by these designs. Our literature review revealed that existing tools do not adequately address the specific methodological considerations of comparative SCEDs that aim to compare instructional interventions of non-reversible target behaviors. The purpose of this paper is to introduce the Comparative Single-Case Experimental Design Rating System (CSCEDARS, "cedars") as a tool for appraising the internal validity of comparative SCEDs of two or more non-reversible instructional interventions. Pertinent literature will be reviewed to establish the need for this tool and to underpin the rationales for individual rating items. Initial reliability information will be provided as well. Finally, directions for instrument validation will be proposed. Copyright © 2018 Elsevier Ltd. All rights reserved.

Evidence-based safety (EBS) management: A new approach to teaching the practice of safety management (SM).

PubMed

Wang, Bing; Wu, Chao; Shi, Bo; Huang, Lang

2017-12-01

In safety management (SM), it is important to make an effective safety decision based on the reliable and sufficient safety-related information. However, many SM failures in organizations occur for a lack of the necessary safety-related information for safety decision-making. Since facts are the important basis and foundation for decision-making, more efforts to seek the best evidence relevant to a particular SM problem would lead to a more effective SM solution. Therefore, the new paradigm for decision-making named "evidence-based practice (EBP)" can hold important implications for SM, because it uses the current best evidence for effective decision-making. Based on a systematic review of existing SM approaches and an analysis of reasons why we need new SM approaches, we created a new SM approach called evidence-based safety (EBS) management by introducing evidence-based practice into SM. It was necessary to create new SM approaches. A new SM approach called EBS was put forward, and the basic questions of EBS such as its definition and core were analyzed in detail. Moreover, the determinants of EBS included manager's attitudes towards EBS; evidence-based consciousness in SM; evidence sources; technical support; EBS human resources; organizational culture; and individual attributes. EBS is a new and effective approach to teaching the practice of SM. Of course, further research on EBS should be carried out to make EBS a reality. Practical applications: Our work can provide a new and effective idea and method to teach the practice of SM. Specifically, EBS proposed in our study can help safety professionals make an effective safety decision based on a firm foundation of high-grade evidence. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

Update in feline therapeutics: clinical use of 10 emerging therapies.

PubMed

Whitehouse, William; Viviano, Katrina

2015-03-01

The field of veterinary medicine is constantly evolving. New medications are being introduced into clinical practice, and novel uses for established medications are frequently being discovered as new information comes to light. Therapeutic options for our feline patients can be restricted based on inadequate clinical evidence, adverse effects and patient compliance concerns. Additionally, with the reduced availability of commonly used medications in some regions, clinicians are forced to utilize alternatives with which they may have limited experience. This review article is directed towards primary care veterinarians working with feline patients. The selection of medications discussed is based on many of the clinical challenges commonly encountered in practice. The evidence for use of some of these medications is limited due to their novelty. Known mechanisms of action, pharmacokinetic and pharmacodynamics data, adverse effects and clinical uses are reviewed where possible, with clinical recommendations made based on the evidence of data available. © ISFM and AAFP 2015.

A rule-based named-entity recognition method for knowledge extraction of evidence-based dietary recommendations

PubMed Central

2017-01-01

Evidence-based dietary information represented as unstructured text is a crucial information that needs to be accessed in order to help dietitians follow the new knowledge arrives daily with newly published scientific reports. Different named-entity recognition (NER) methods have been introduced previously to extract useful information from the biomedical literature. They are focused on, for example extracting gene mentions, proteins mentions, relationships between genes and proteins, chemical concepts and relationships between drugs and diseases. In this paper, we present a novel NER method, called drNER, for knowledge extraction of evidence-based dietary information. To the best of our knowledge this is the first attempt at extracting dietary concepts. DrNER is a rule-based NER that consists of two phases. The first one involves the detection and determination of the entities mention, and the second one involves the selection and extraction of the entities. We evaluate the method by using text corpora from heterogeneous sources, including text from several scientifically validated web sites and text from scientific publications. Evaluation of the method showed that drNER gives good results and can be used for knowledge extraction of evidence-based dietary recommendations. PMID:28644863

Analysis of Data Contained in "School District Basic Fiscal Data, 1974-1975" and "New York State Consolidated Data Base, 1974-1975." Revised Edition.

ERIC Educational Resources Information Center

Berks, Joel S.; Moskowitz, Jay H.

A revision of a report introduced as evidence in the school finance case Levittown v. Nyquist, this report analyzes the way educational revenues are raised and distributed in New York State and demonstrates the impact of these methods on educational services. The study was based on 1974-75 official New York State data and utilized analytic…

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

PubMed

Nakayama, Takeo

2012-01-01

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

Teacher Adoption of a Web-Based Instructional Planning System

ERIC Educational Resources Information Center

Saldivar, Manuel Gerardo

2012-01-01

Many policymakers, administrators, and other K-12 stakeholders have long advocated the use of computers and information technology in schools. Even in settings where such technologies have been introduced, however, evidence suggests that the impact on student outcomes has been mixed. In some cases, teachers simply do not adopt the new…

Brazilian peppertree (Schinus terebinthifolius) in Florida and South America: Evidence of a possible niche shift driven by hybridization

USDA-ARS?s Scientific Manuscript database

Brazilian peppertree (Schinus terebinthifolius Raddi, Anacardiaceae) was introduced into Florida from South America in the 1800s and commercialized as an ornamental plant. Based on herbaria records and available literature, it began to escape cultivation and invade ruderal and natural habitats in t...

A Clinician's Guide to Co-Occurring ADHD among Adolescent Substance Users: Comorbidity, Neurodevelopmental Risk, and Evidence-Based Treatment Options

ERIC Educational Resources Information Center

Hogue, Aaron; Evans, Steven W.; Levin, Frances R.

2017-01-01

This article introduces neurodevelopmental and clinical considerations for treating adolescents with co-occurring attention deficit hyperactivity disorder (ADHD) and adolescent substance use (ASU) in outpatient settings. We first describe neurobiological impairments common to ADHD and ASU, including comorbidity with conduct disorder, that evoke a…

Success for All and Comprehensive School Reform: Evidence-Based Policies for Urban Education.

ERIC Educational Resources Information Center

Slavin, Robert E.; Madden, Nancy A.

This paper discusses comprehensive school reform (CSR), which accepts the importance of standards and accountability but adds to these strategies for introducing innovations in curriculum, instruction, school organization, governance, parent interactions, and other core features of practice. The paper reviews research on the nature and quality of…

Comparing Effects of School Inspections in Sweden and Austria

ERIC Educational Resources Information Center

Kemethofer, David; Gustafsson, Jan-Eric; Altrichter, Herbert

2017-01-01

In recent years, school inspections have been newly introduced or adapted to the evidence-based governance logic in many European countries. So far, empirical research on the impact of school inspections has produced inconclusive results. Methodologically, it has mainly focussed on analysis of a national inspection model and used cross-sectional…

Practical Guidelines for the Use of New Generation Antipsychotic Drugs (except Clozapine) in Adult Individuals with Intellectual Disabilities

ERIC Educational Resources Information Center

de Leon, Jose; Greenlee, Brian; Barber, Jack; Sabaawi, Mohamed; Singh, Nirbhay N.

2009-01-01

New generation antipsychotic (NGA) drugs introduced to the US market after clozapine (aripiprazole, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone) are frequently used in individuals with intellectual disabilities (ID). However, there is very limited research to fully establish evidence-based or personalized medicine approaches…

Additive, Multi-Component Treatment of Emerging Refusal Topographies in a Pediatric Feeding Disorder

ERIC Educational Resources Information Center

Sharp, William G.; Jaquess, David L.; Bogard, Jennifer D.; Morton, Jane F.

2010-01-01

This case study describes inter-disciplinary treatment of chronic food refusal and tube dependency in a 2-year-old female with a pediatric feeding disorder. Evidence-based behavioral components--including escape extinction (EE), differential reinforcement of alterative mealtime behavior (DRA), and stimulus fading--were introduced sequentially as…

Introducing evidence-based dentistry to dental students using histology.

PubMed

Lallier, Thomas E

2014-03-01

The expansion of evidence-based dentistry (EBD) is essential to the continued growth and development of the dental profession. Expanding EBD requires increased emphasis on critical thinking skills during dental education, as noted in the American Dental Education Association's Competencies for the New General Dentist. In order to achieve this goal, educational exercises must be introduced to increase the use of critical thinking skills early in the dental curriculum, with continued reinforcement as students progress through subsequent years. Described in this article is one approach to increasing student exposure to critical thinking during the early basic science curriculum-specifically, within the confines of a traditional histology course. A method of utilizing the medical and dental research literature to reinforce and enliven the concepts taught in histology is described, along with an approach for using peer-to-peer presentations to demonstrate the tools needed to critically evaluate research studies and their presentation in published articles. This approach, which could be applied to any basic science course, will result in a stronger foundation on which students can build their EBD and critical thinking skills.

Introducing solid foods to preterm infants in developed countries.

PubMed

Palmer, D J; Makrides, M

2012-01-01

The addition of solid foods to an infant's diet is required to provide adequate nutrition, as eventually an infant will be unable to consume a sufficient volume of breast milk to meet their nutritional needs. The timing of this important dietary change for infants born preterm (<37 weeks of gestation) should take into consideration their delayed early gross motor developmental progress, increased nutritional requirements, organ immaturity, increased gut permeability and increased risk of hospitalization from infections. Good head control is important for safe eating of solid foods: this developmental milestone may be delayed in preterm infants up to 3 months of corrected age. One randomized controlled trial has demonstrated improved nutritional intakes with the introduction of nutrient-dense solid foods from 13 weeks of uncorrected age, resulting in improved nutritional iron status and greater rate of growth during infancy. There is neither current evidence for an increased infection rate with an early introduction of solid foods in developed countries, nor is there evidence that in preterm infants maturation of renal function is reduced. However, one observational study has determined that preterm infants who had 4 or more solid foods introduced prior to 17 weeks of corrected age, or who had any solid foods introduced prior to 10 weeks of corrected age, had an increased risk of eczema development. A compromise is needed to balance the nutritional benefits of commencing solid foods from 13 weeks of uncorrected age with the risks of increased eczema development, along with ensuring developmental readiness. Based on the current evidence, 3 months (13 weeks) of corrected age seems to be an appropriate age to commence nutrient-dense solid foods for most preterm infants. Further research, with an emphasis on immediate as well as longer-term consequences, would be valuable to provide more specific evidence-based guidelines regarding the introduction of solid food for preterm infants. Copyright © 2012 S. Karger AG, Basel.

Integrating the Principles of Effective Intervention into Batterer Intervention Programming: The Case for Moving Toward More Evidence-Based Programming.

PubMed

Radatz, Dana L; Wright, Emily M

2016-01-01

The majority of batterer intervention program (BIP) evaluations have indicated they are marginally effective in reducing domestic violence recidivism. Meanwhile, correctional programs used to treat a variety of offenders (e.g., substance users, violent offenders, and so forth) that adhere to the "principles of effective intervention" (PEI) have reported significant reductions in recidivism. This article introduces the PEI-the principles on which evidence-based practices in correctional rehabilitation are based-and identifies the degree to which they are currently integrated into BIPs. The case is made that batterer programs could be more effective if they incorporate the PEI. Recommendations for further integration of the principles into BIPs are also provided. © The Author(s) 2015.

A medical social work perspective on rehabilitation.

PubMed

Fugl-Meyer, Kerstin Sjögren

2016-10-12

This paper introduces a biopsychosocial model for use as a tool by medical social workers and other rehabilitation professionals for the descriptive analysis of the case history and follow-up of patients needing rehabilitative support. The model is based on action theory and emphasizes the demands on evidence-based clarification of the interplay between a subject's contextual life situation, their ability to act in order to realize their goals, and their emotional adaptation. Using clinical experience and literature searches, a standard operations procedure to adequately document the case history in clinical practice is suggested, thus providing strategies through which the work of medical social workers can be based on evidence. Some specific areas of concern for the medical social worker within the rehabilitation of disabled people are highlighted.

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

PubMed Central

2010-01-01

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

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

PubMed

McCaughey, Deirdre; Bruning, Nealia S

2010-05-26

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

A Quality Improvement Collaborative Program for Neonatal Pain Management in Japan

PubMed Central

Yokoo, Kyoko; Funaba, Yuuki; Fukushima, Sayo; Fukuhara, Rie; Uchida, Mieko; Aiba, Satoru; Doi, Miki; Nishimura, Akira; Hayakawa, Masahiro; Nishimura, Yutaka; Oohira, Mitsuko

2017-01-01

Background: Neonatal pain management guidelines have been released; however, there is insufficient systematic institutional support for the adoption of evidence-based pain management in Japan. Purpose: To evaluate the impact of a collaborative quality improvement program on the implementation of pain management improvements in Japanese neonatal intensive care units (NICUs). Methods: Seven Japanese level III NICUs participated in a neonatal pain management quality improvement program based on an Institute for Healthcare Improvement collaborative model. The NICUs developed evidence-based practice points for pain management and implemented these over a 12-month period. Changes were introduced through a series of Plan-Do-Study-Act cycles, and throughout the process, pain management quality indicators were tracked as performance measures. Jonckheere's trend test and the Cochran-Armitage test for trend were used to examine the changes in quality indicator implementations over time (baseline, 3 months, 6 months, and 12 months). Findings: Baseline pain management data from the 7 sites revealed substantial opportunities for improvement of pain management, and testing changes in the NICU setting resulted in measurable improvements in pain management. During the intervention phase, all participating sites introduced new pain assessment tools, and all sites developed electronic medical record forms to capture pain score, interventions, and infant responses to interventions. Implications for Practice: The use of collaborative quality improvement techniques played a key role in improving pain management in the NICUs. Implications for Research: Collaborative improvement programs provide an attractive strategy for solving evidence-practice gaps in the NICU setting. PMID:28114148

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

PubMed

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

2008-06-01

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

Innovative teaching methods for capacity building in knowledge translation

PubMed Central

2011-01-01

Background In some current healthcare settings, there is a noticeable absence of national institutions committed to the synthesis and use of evidence in healthcare decision- and policy-making. This absence creates a need to broaden the responsibilities of healthcare providers to include knowledge brokering and advocacy in order to optimize knowledge translation to other stakeholders, especially policy-makers. However, this process requires practitioners and researchers to acquire certain types of knowledge and skills. This article introduces two innovative methods for capacity building in knowledge translation (KT). Methods During a workshop aimed at preparing 21 trainers in evidence-based medicine, two innovative methods were used: (1) debate and (2) a knowledge translation project (KTP). The main objective of the debates approach was to strengthen participants' critical thinking abilities by requiring them to search for and appraise evidence and defend their arguments. The KTP was used to introduce participants to the essential steps of knowledge translation and to suggest an extended role for healthcare practitioners, i.e., using evidence to manage not only individual patients but also to a community of patients. Participants' performances were assessed according to a pre-designed scheme. At the end of the workshop, participants' opinions and experiences with the innovative teaching methods were evaluated based on their answers to a questionnaire and the results of small-group discussions. Results The participants performed well in both the debate and KTP methods. During post-workshop group discussions, they indicated that the debate approach had added a new dimension to their evidence-based medicine skills by adding purpose and motivation. However, they felt that their performances would have been better if they had been offered practical demonstrations of how to conduct the debate. The participants indicated that the KTP enhanced their understanding of the relationships between evidence and implementation, and motivated them to investigate public health problems in addition to individual patient problems. However, some participants maintained that these issues fell outside the scope of their role as doctors. Conclusion Debates and evidence implementation through KTP are generally well accepted by healthcare practitioners as methods by which they can improve their skills in KT. PMID:21999174

Innovative teaching methods for capacity building in knowledge translation.

PubMed

Wahabi, Hayfaa A; Al-Ansary, Lubna A

2011-10-14

In some current healthcare settings, there is a noticeable absence of national institutions committed to the synthesis and use of evidence in healthcare decision- and policy-making. This absence creates a need to broaden the responsibilities of healthcare providers to include knowledge brokering and advocacy in order to optimize knowledge translation to other stakeholders, especially policy-makers. However, this process requires practitioners and researchers to acquire certain types of knowledge and skills. This article introduces two innovative methods for capacity building in knowledge translation (KT). During a workshop aimed at preparing 21 trainers in evidence-based medicine, two innovative methods were used: (1) debate and (2) a knowledge translation project (KTP). The main objective of the debates approach was to strengthen participants' critical thinking abilities by requiring them to search for and appraise evidence and defend their arguments. The KTP was used to introduce participants to the essential steps of knowledge translation and to suggest an extended role for healthcare practitioners, i.e., using evidence to manage not only individual patients but also to a community of patients. Participants' performances were assessed according to a pre-designed scheme. At the end of the workshop, participants' opinions and experiences with the innovative teaching methods were evaluated based on their answers to a questionnaire and the results of small-group discussions. The participants performed well in both the debate and KTP methods. During post-workshop group discussions, they indicated that the debate approach had added a new dimension to their evidence-based medicine skills by adding purpose and motivation. However, they felt that their performances would have been better if they had been offered practical demonstrations of how to conduct the debate. The participants indicated that the KTP enhanced their understanding of the relationships between evidence and implementation, and motivated them to investigate public health problems in addition to individual patient problems. However, some participants maintained that these issues fell outside the scope of their role as doctors. Debates and evidence implementation through KTP are generally well accepted by healthcare practitioners as methods by which they can improve their skills in KT.

Belief Inhibition in Children's Reasoning: Memory-Based Evidence

ERIC Educational Resources Information Center

Steegen, Sara; Neys, Wim De

2012-01-01

Adult reasoning has been shown as mediated by the inhibition of intuitive beliefs that are in conflict with logic. The current study introduces a classic procedure from the memory field to investigate belief inhibition in 12- to 17-year-old reasoners. A lexical decision task was used to probe the memory accessibility of beliefs that were cued…

Motion and Marking in Reflective Practice: Artifacts, Autobiographical Narrative and Sexuality

ERIC Educational Resources Information Center

Risner, Doug

2017-01-01

This paper introduces a reflective methodology of the body as a resource for reflective practice based on an analysis of my personal response and experience of autobiographical narrative. It offers an approach in which the movements and markings of the body serve as important sites for collecting additional evidence of the daily practices that…

Rhythmic Alternation and the Optional Complementiser in English: New Evidence of Phonological Influence on Grammatical Encoding

ERIC Educational Resources Information Center

Lee, Ming-Wei; Gibbons, Julie

2007-01-01

In a recall-based spoken production experiment, native English-speaking participants' variable use of the complementiser "that" to introduce the sentential complement in sentences like "Henry knew (that) Lucy/Louise washed the dishes" was found to be related to whether "that" inclusion/omission resulted in an alternating sequence of stressed and…

Temporal Rends of Triclorosan in Dated Sediment Cores from Four Urbanized Estuaries: Evidence of Preservation and Accumulation

EPA Science Inventory

Triclosan is an antimicrobial agent present in a wide array of consumer based goods such as soaps, skin creams and dental care products. It has also been incorporated into textiles and plastics due to its effectiveness as a biocide in solid material. It is introduced into munic...

Enhancing Social Work Students' Knowledge and Attitudes Regarding Substance-Using Clients through SBIRT Training

ERIC Educational Resources Information Center

Senreich, Evan; Ogden, Lydia P.; Greenberg, Joy Pastan

2017-01-01

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based protocol that addresses both moderate-risk and high-risk substance use problems for individuals. In an urban college's master's and bachelor's social work programs with 218 students, SBIRT training was introduced into core course curricula, with many students…

The Dangerous Myth of Emerging Adulthood: An Evidence-Based Critique of a Flawed Developmental Theory

ERIC Educational Resources Information Center

Côté, James E.

2014-01-01

This article examines the theory of emerging adulthood, introduced into the literature by Arnett (2000), in terms of its methodological and evidential basis, and finds it to be unsubstantiated on numerous grounds. Other, more convincing, formulations of variations in the transition to adulthood are examined. Most flawed academic theories are…

Do Tuition Fees Affect the Mobility of University Applicants? Evidence from a Natural Experiment

ERIC Educational Resources Information Center

Dwenger, Nadja; Storck, Johanna; Wrohlich, Katharina

2012-01-01

Several German states recently introduced tuition fees for university education. We investigate whether these tuition fees influence the mobility of university applicants. Based on administrative data of applicants for medical schools in Germany, we estimate the effect of tuition fees on the probability of applying for a university in the home…

Informing One-to-One Computing in Primary Schools: Student Use of Netbooks

ERIC Educational Resources Information Center

Larkin, Kevin; Finger, Glenn

2011-01-01

Although one-to-one laptop programs are being introduced in many schools, minimal research has been conducted regarding their effectiveness in primary schools. Evidence-based research is needed to inform significant funding, deployment and student use of computers. This article analyses key findings from a study conducted in four Year 7 classrooms…

"Mathematics Is Just 1 + 1 = 2, What Is There to Argue About?": Developing a Framework for Argument-Based Mathematical Inquiry

ERIC Educational Resources Information Center

Fielding-Wells, Jill

2016-01-01

One potential means to develop students' contextual and conceptual understanding of mathematics is through Inquiry Learning. However, introducing a problem context can distract from mathematical content. Incorporating argumentation practices into Inquiry may address this through providing a stronger reliance on mathematical evidence and reasoning.…

Trophic interactions between native and introduced fish species in a littoral fish community.

PubMed

Monroy, M; Maceda-Veiga, A; Caiola, N; De Sostoa, A

2014-11-01

The trophic interactions between 15 native and two introduced fish species, silverside Odontesthes bonariensis and rainbow trout Oncorhynchus mykiss, collected in a major fishery area at Lake Titicaca were explored by integrating traditional ecological knowledge and stable-isotope analyses (SIA). SIA suggested the existence of six trophic groups in this fish community based on δ(13)C and δ(15)N signatures. This was supported by ecological evidence illustrating marked spatial segregation between groups, but a similar trophic level for most of the native groups. Based on Bayesian ellipse analyses, niche overlap appeared to occur between small O. bonariensis (<90 mm) and benthopelagic native species (31.6%), and between the native pelagic killifish Orestias ispi and large O. bonariensis (39%) or O. mykiss (19.7%). In addition, Bayesian mixing models suggested that O. ispi and epipelagic species are likely to be the main prey items for the two introduced fish species. This study reveals a trophic link between native and introduced fish species, and demonstrates the utility of combining both SIA and traditional ecological knowledge to understand trophic relationships between fish species with similar feeding habits. © 2014 The Fisheries Society of the British Isles.

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

PubMed Central

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

2002-01-01

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

Using Brain Imaging for Lie Detection: Where Science, Law and Research Policy Collide.

PubMed

Langleben, Daniel D; Moriarty, Jane Campbell

2013-05-01

Progress in the use of functional magnetic resonance imaging (fMRI) of the brain to evaluate deception and differentiate lying from truth-telling has created anticipation of a breakthrough in the search for technology-based methods of lie detection. In the last few years, litigants have attempted to introduce fMRI lie detection evidence in courts. This article weighs in on the interdisciplinary debate about the admissibility of such evidence, identifying the missing pieces of the scientific puzzle that need to be completed if fMRI-based lie detection is to meet the standards of either legal reliability or general acceptance. We believe that the Daubert's "known error rate" is the key concept linking the legal and scientific standards. We posit that properly-controlled clinical trials are the most convincing means to determine the error rates of fMRI-based lie detection and confirm or disprove the relevance of the promising laboratory research on this topic. This article explains the current state of the science and provides an analysis of the case law in which litigants have sought to introduce fMRI lie detection. Analyzing the myriad issues related to fMRI lie detection, the article identifies the key limitations of the current neuroimaging of deception science as expert evidence and explores the problems that arise from using scientific evidence before it is proven scientifically valid and reliable. We suggest that courts continue excluding fMRI lie detection evidence until this potentially useful form of forensic science meets the scientific standards currently required for adoption of a medical test or device. Given a multitude of stakeholders and, the charged and controversial nature and the potential societal impact of this technology, goodwill and collaboration of several government agencies may be required to sponsor impartial and comprehensive clinical trials that will guide the development of forensic fMRI technology.

Using Brain Imaging for Lie Detection: Where Science, Law and Research Policy Collide

PubMed Central

Langleben, Daniel D.; Moriarty, Jane Campbell

2012-01-01

Progress in the use of functional magnetic resonance imaging (fMRI) of the brain to evaluate deception and differentiate lying from truth-telling has created anticipation of a breakthrough in the search for technology-based methods of lie detection. In the last few years, litigants have attempted to introduce fMRI lie detection evidence in courts. This article weighs in on the interdisciplinary debate about the admissibility of such evidence, identifying the missing pieces of the scientific puzzle that need to be completed if fMRI-based lie detection is to meet the standards of either legal reliability or general acceptance. We believe that the Daubert’s “known error rate” is the key concept linking the legal and scientific standards. We posit that properly-controlled clinical trials are the most convincing means to determine the error rates of fMRI-based lie detection and confirm or disprove the relevance of the promising laboratory research on this topic. This article explains the current state of the science and provides an analysis of the case law in which litigants have sought to introduce fMRI lie detection. Analyzing the myriad issues related to fMRI lie detection, the article identifies the key limitations of the current neuroimaging of deception science as expert evidence and explores the problems that arise from using scientific evidence before it is proven scientifically valid and reliable. We suggest that courts continue excluding fMRI lie detection evidence until this potentially useful form of forensic science meets the scientific standards currently required for adoption of a medical test or device. Given a multitude of stakeholders and, the charged and controversial nature and the potential societal impact of this technology, goodwill and collaboration of several government agencies may be required to sponsor impartial and comprehensive clinical trials that will guide the development of forensic fMRI technology. PMID:23772173

Development and Characterization of Sr-Containing Glass-Ceramic Composites Based on Biogenic Hydroxyapatite

NASA Astrophysics Data System (ADS)

Kuda, Oleksii; Pinchuk, Nataliia; Bykov, Oleksandr; Tomila, Tamara; Olifan, Olena; Golovkova, Maryna

2018-05-01

Composite materials based on hydroxyapatite are widely used for bone tissue engineering. There is evidence of a positive effect of the presence of strontium in osteoplastic materials in the case of a Ca/Sr certain ratio. To examine the effect of the addition of Sr2+, a study was made by introducing it into the material composition based on biogenic hydroxyapatite and sodium borosilicate glass (50/50% wt.). The strontium was introduced into the composition in an amount of 1% wt. Composite materials were obtained at final sintering temperatures of 780 °C and a sintering time of 1 h. The effect of additions of glass phase and strontium affect changes in the crystal lattice of biogenic hydroxyapatite was investigated with the help of X-ray phase analysis, IR spectroscopy. Also the behavior of composites in vitro in physiological solution was studied.

Causal pathways linking Farm to School to childhood obesity prevention.

PubMed

Joshi, Anupama; Ratcliffe, Michelle M

2012-08-01

Farm to School programs are rapidly gaining attention as a potential strategy for preventing childhood obesity; however, the causal linkages between Farm to School activities and health outcomes are not well documented. To capitalize on the increased interest in and momentum for Farm to School, researchers and practitioners need to move from developing and implementing evidence informed programs and policies to ones that are evidence-based. The purpose of this article is to outline a framework for facilitating an evidence base for Farm to School programs and policies through a systematic and coordinated approach. Employing the concepts of causal pathways, the authors introduce a proposed framework for organizing and systematically testing out multiple hypotheses (or potential causal links) for how, why, and under what conditions Farm to School Inputs and Activities may result in what Outputs, Effects, and Impacts. Using the causal pathways framework may help develop and test competing hypotheses, identify multicausality, strength, and interactions of causes, and discern the difference between catalysts and causes. In this article, we introduce causal pathways, present menus of potential independent and dependent variables from which to create and test causal pathways linking Farm to School interventions and their role in preventing childhood obesity, discuss their applicability to Farm to School research and practice, and outline proposed next steps for developing a coordinated research framework for Farm to School programs.

32 CFR 935.104 - Sentence after a plea of guilty.

Code of Federal Regulations, 2010 CFR

2010-07-01

... counsel may make any reasonable statement he wishes in mitigation or of previous good character. The prosecution may introduce evidence in aggravation, or of bad character if the accused has introduced evidence of good character. The Court shall then impose any lawful sentence that it considers proper. ...

78 FR 62683 - Mark G. Medinnus, D.D.S.; Decision and Order

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-22

... called four witnesses to testify and introduced documentary evidence. [Transcript (``Tr.'') Volume I-II]. The Respondent called two witnesses to testify, including himself, and introduced documentary evidence... five years. [Resp. Exh. A86]. In addition, on June 23, 2004, the Office of Personnel Management (``OPM...

77 FR 45656 - Decision and Order; Perry T. Dobyns, M.D.

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-01

...]. At the hearing, counsel for the DEA called one witness to testify and introduced documentary evidence. The Respondent testified and introduced documentary evidence. [Transcript (``Tr.'') Volume I]. After...-weekly for a period of time and to see a psychiatrist for medication management. [Resp. Exh. D; Tr. 69-70...

LIQUID: an-open source software for identifying lipids in LC-MS/MS-based lipidomics data

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

Kyle, Jennifer E.; Crowell, Kevin L.; Casey, Cameron P.

2017-01-31

We introduce an open-source software, LIQUID, for semi-automated processing and visualization of LC-MS/MS based lipidomics data. LIQUID provides users with the capability to process high throughput data and contains a customizable target library and scoring model per project needs. The graphical user interface provides visualization of multiple lines of spectral evidence for each lipid identification, allowing rapid examination of data for making confident identifications of lipid molecular species.

The pearls of using real-world evidence to discover social groups

NASA Astrophysics Data System (ADS)

Cardillo, Raymond A.; Salerno, John J.

2005-03-01

In previous work, we introduced a new paradigm called Uni-Party Data Community Generation (UDCG) and a new methodology to discover social groups (a.k.a., community models) called Link Discovery based on Correlation Analysis (LDCA). We further advanced this work by experimenting with a corpus of evidence obtained from a Ponzi scheme investigation. That work identified several UDCG algorithms, developed what we called "Importance Measures" to compare the accuracy of the algorithms based on ground truth, and presented a Concept of Operations (CONOPS) that criminal investigators could use to discover social groups. However, that work used a rather small random sample of manually edited documents because the evidence contained far too many OCR and other extraction errors. Deferring the evidence extraction errors allowed us to continue experimenting with UDCG algorithms, but only used a small fraction of the available evidence. In attempt to discover techniques that are more practical in the near-term, our most recent work focuses on being able to use an entire corpus of real-world evidence to discover social groups. This paper discusses the complications of extracting evidence, suggests a method of performing name resolution, presents a new UDCG algorithm, and discusses our future direction in this area.

Epidemiology as a liberal art: from graduate school to middle school, an unfulfilled agenda.

PubMed

Bracken, Michael B

2014-03-01

Calls by Lilienfeld, Fraser, and others some three decades ago to introduce epidemiology into undergraduate college education remain largely unfulfilled. Consideration of epidemiology as a "liberal art" has also led to exploring possibilities for introducing epidemiology into early education: to high and even middle schools. Adding epidemiology to school curricula should help educate the public to understand science-based evidence concerning the causes and treatments of disease, help inoculate them against a tsunami of biased and fraudulent media messaging, and permit advancing postgraduate education in epidemiology to even higher levels of scholarship. Copyright © 2014 Elsevier Inc. All rights reserved.

Achieving Full Scope of Practice Readiness Using Evidence for Psychotherapy Teaching in Web and Hybrid Approaches in Psychiatric Mental Health Advanced Practice Nursing Education.

PubMed

McCoy, Kathleen T

2018-01-01

Radical changes in role, education, and practice have affected how education of advance practice nurses and practice deliverables occur. This article examines the effects of distance education upon the teaching/learning of psychotherapy in integrating Web-based technology and platforms. With the advent and proliferation of online programs of study, the question begs: How do distance-linked programs successfully introduce, practice, and supervise one-to-one and group psychotherapy training? By employing evidence-based education strategies, technology, and strong interpersonal skills and evidence-based therapies, a charter Psychiatric Mental Health Nurse Practitioner Doctor of Nursing Practice program paved an innovative and successful path. In that program, they prepared their students for full scope of practice, upon graduation, inclusive of psychotherapy as well as the other highly demanding and compressed requirements of the 3-year program. This article explores that journey and its recommendations for application derived from this 2010 cohort. © 2017 Wiley Periodicals, Inc.

Extended Importance Sampling for Reliability Analysis under Evidence Theory

NASA Astrophysics Data System (ADS)

Yuan, X. K.; Chen, B.; Zhang, B. Q.

2018-05-01

In early engineering practice, the lack of data and information makes uncertainty difficult to deal with. However, evidence theory has been proposed to handle uncertainty with limited information as an alternative way to traditional probability theory. In this contribution, a simulation-based approach, called ‘Extended importance sampling’, is proposed based on evidence theory to handle problems with epistemic uncertainty. The proposed approach stems from the traditional importance sampling for reliability analysis under probability theory, and is developed to handle the problem with epistemic uncertainty. It first introduces a nominal instrumental probability density function (PDF) for every epistemic uncertainty variable, and thus an ‘equivalent’ reliability problem under probability theory is obtained. Then the samples of these variables are generated in a way of importance sampling. Based on these samples, the plausibility and belief (upper and lower bounds of probability) can be estimated. It is more efficient than direct Monte Carlo simulation. Numerical and engineering examples are given to illustrate the efficiency and feasible of the proposed approach.

Therapist self-report of evidence-based practices in usual care for adolescent behavior problems: factor and construct validity.

PubMed

Hogue, Aaron; Dauber, Sarah; Henderson, Craig E

2014-01-01

This study introduces a therapist-report measure of evidence-based practices for adolescent conduct and substance use problems. The Inventory of Therapy Techniques-Adolescent Behavior Problems (ITT-ABP) is a post-session measure of 27 techniques representing four approaches: cognitive-behavioral therapy (CBT), family therapy (FT), motivational interviewing (MI), and drug counseling (DC). A total of 822 protocols were collected from 32 therapists treating 71 adolescents in six usual care sites. Factor analyses identified three clinically coherent scales with strong internal consistency across the full sample: FT (8 items; α = .79), MI/CBT (8 items; α = .87), and DC (9 items, α = .90). The scales discriminated between therapists working in a family-oriented site versus other sites and showed moderate convergent validity with therapist reports of allegiance and skill in each approach. The ITT-ABP holds promise as a cost-efficient quality assurance tool for supporting high-fidelity delivery of evidence-based practices in usual care.

Indicators: Wetland Vegetation (Introduced Species)

EPA Pesticide Factsheets

Introduced plants are indicators of the ecological integrity of waters and evidence of increased human-caused disturbance in the watershed. Introduced species that cause economic or environmental harm, or harm to human health, are called invasive species.

Implementation of a Curriculum-Integrated Computer Game for Introducing Scientific Argumentation

NASA Astrophysics Data System (ADS)

Wallon, Robert C.; Jasti, Chandana; Lauren, Hillary Z. G.; Hug, Barbara

2017-11-01

Argumentation has been emphasized in recent US science education reform efforts (NGSS Lead States 2013; NRC 2012), and while existing studies have investigated approaches to introducing and supporting argumentation (e.g., McNeill and Krajcik in Journal of Research in Science Teaching, 45(1), 53-78, 2008; Kang et al. in Science Education, 98(4), 674-704, 2014), few studies have investigated how game-based approaches may be used to introduce argumentation to students. In this paper, we report findings from a design-based study of a teacher's use of a computer game intended to introduce the claim, evidence, reasoning (CER) framework (McNeill and Krajcik 2012) for scientific argumentation. We studied the implementation of the game over two iterations of development in a high school biology teacher's classes. The results of this study include aspects of enactment of the activities and student argument scores. We found the teacher used the game in aspects of explicit instruction of argumentation during both iterations, although the ways in which the game was used differed. Also, students' scores in the second iteration were significantly higher than the first iteration. These findings support the notion that students can learn argumentation through a game, especially when used in conjunction with explicit instruction and support in student materials. These findings also highlight the importance of analyzing classroom implementation in studies of game-based learning.

Seeds of Myth: Exotic Disease Theory and Deconstructing the Australian Narrative of Indigenous Depopulation

ERIC Educational Resources Information Center

Blyton, Greg

2009-01-01

The theory that the rapid depopulation of Indigenous people post-colonisation was largely caused by European introduced or exotic disease to which Indigenous people had no immunity resonates through most narratives of the early years of colonisation. The question of whether this narrative is based on sound medical evidence or is better placed in…

Funding big research with small money.

PubMed

Hickey, Joanne V; Koithan, Mary; Unruh, Lynn; Lundmark, Vicki

2014-06-01

This department highlights change management strategies that maybe successful in strategically planning and executing organizational change initiatives.With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools,and resources that mobilize and sustain organizational change initiatives.In this article, the guest authors introduce crowd sourcing asa strategy for funding big research with small money.

Ad-Hoc Numbers Forming Provision and Policy: Round and Round of Universal Access in an Australian Preschool

ERIC Educational Resources Information Center

Millei, Zsuzsa; Gallagher, Jannelle

2017-01-01

Australian early childhood education still labours with the achievement of universal access and the production of comprehensive and consistent data to underpin a national evidence base. In this article, we attend to the processes led by numbers whereby new practices of quantification, rationalization and reporting are introduced and mastered in a…

The Role of a Reusable Assessment Framework in Designing Computer-Based Learning Environments.

ERIC Educational Resources Information Center

Park, Young; Bauer, Malcolm

This paper introduces the concept of a reusable assessment framework (RAF). An RAF contains a library of linked assessment design objects that express: (1) specific set of proficiencies (i.e. the knowledge, skills, and abilities of students for a given content or skill area); (2) the types of evidence that can be used to estimate those…

The Science of Enhanced Student Engagement and Employability: Introducing the Psychology Stream of the Inaugural HEA STEM Conference

ERIC Educational Resources Information Center

Hulme, Julie; Taylor, Jacqui; Davies, Mark N. O.; Banister, Peter

2012-01-01

The Higher Education Academy (HEA) is committed to enhancing the quality of learning and teaching for all university students in the UK, and the inaugural conference for the Science, Technology, Engineering and Mathematics (STEM) subjects, held in April 2012 at Imperial College, London, aimed to showcase research and evidence-based educational…

A model of differential amygdala activation in psychopathy.

PubMed

Moul, Caroline; Killcross, Simon; Dadds, Mark R

2012-10-01

This article introduces a novel hypothesis regarding amygdala function in psychopathy. The first part of this article introduces the concept of psychopathy and describes the main cognitive and affective impairments demonstrated by this population; that is, a deficit in fear-recognition, lower conditioned fear responses and poor performance in passive avoidance, and response-reversal learning tasks. Evidence for amygdala dysfunction in psychopathy is considered with regard to these deficits; however, the idea of unified amygdala function is untenable. A model of differential amygdala activation in which the basolateral amygdala (BLA) is underactive while the activity of the central amygdala (CeA) is of average to above average levels is proposed to provide a more accurate and up-to-date account for the specific cognitive and emotional deficits found in psychopathy. In addition, the model provides a mechanism by which attentional-based models and emotion-based models of psychopathy can coexist. Data to support the differential amygdala activation model are provided from studies from both human and animal research. Supporting evidence concerning some of the neurochemicals implicated in psychopathy is then reviewed. Implications of the model and areas of future research are discussed. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Impact of organizational change on organizational culture: implications for introducing evidence-based practice.

PubMed

Austin, Michael J; Claassen, Jennette

2008-01-01

Evidence-based practice (EBP) seeks to integrate the expertise of individual practitioners with the best available evidence within the context of the values and expectations of clients. Prior to implementing EBP, it is important to understand the significance that organizational change and organizational culture play. This article seeks to explore the literature associated with both organizational change and organizational culture. The analysis of organizational culture and change draw upon findings from both the private, for-profit sector, and the public, non-profit field. It is divided into four sections: organizational change and innovation, organizational culture, managing organizational culture and change, and finally, applying the findings to the implementation of EBP. While the audience for this analysis is managers in public and nonprofit human service organizations who are considering implementing EBP into their work environment, it is not intended to provide a "how to" guide, but rather a framework for critical thinking.

Can Western quality improvement methods transform the Russian health care system?

PubMed

Tillinghast, S J

1998-05-01

The Russian health care system largely remains the same system that was in place during the existence of the Soviet Union. It is almost entirely state owned and operated, although ownership and management have developed from the central government to the oblast (province). The ZdravReform (Health Reform) Program (ZRP) in Russia, which began in 1993, included the goal of improving the quality and cost-effectiveness of the health care system. Work on introducing continuous quality improvement (CQI), evidence-based practice guidelines, and indicators of quality was conducted in 1995-1996. INTRODUCING EVIDENCE-BASED MEDICINE: As a result of the poor quality of Russian-language medical journals and the inability to gain access to the knowledge available in Western medical literature, Russian medical practices have not kept up with the rapid evolution of evidence-based medical practice that has begun transforming Western medicine. A number of evidence-based clinical practice guidelines were translated and disseminated to Russian-speaking physicians working in facilities participating in ZRP in Russia and Central Asia. Given the limitations of existing measures of the quality of care, indicators were developed for participating ambulatory polyclinics in several oblasts in Siberia. Russian physicians responsible for quality of care for their respective oblasts formed a working group to develop the indicators. A clinical information system that would provide automated collection and analysis of the indicator data-as well as additional patient record information-was also developed. CQI activities, entailing a multidisciplinary, participatory team approach, were conducted in four oblasts in western Siberia. Projects addressed the management of community-acquired pneumonia and reduction of length of stay after myocardial infarction (MI). One of the oblasts provided an example of a home-grown evidence-based protocol for post-MI care, which was adopted in the other three oblasts. Evidence-based medicine is critically needed to improve the quality of research and publications, medical education, and medical practice. Physicians everywhere are data driven; they change their practices when convinced by good data. The key to successful introduction of evidence-based medicine is understanding the fundamentals of good scientific method as applied to medicine. The Russian health care system's experience in reporting to higher authorities' process and outcomes data that resemble our modern indicators can provide the basis for accurate and valid measures of quality. In contrast with American expectations that a significant cultural change in an organization could take years, even with great effort, Russian physicians and other clinicians rapidly assimilated the new concepts of QI and put them to use. More on-site assistance by international medical consultants will still be needed for several years to hasten the process of change and ensure that it does not become stalled.

Cost-effectiveness of pneumococcal conjugate vaccination in Georgia.

PubMed

Komakhidze, T; Hoestlandt, C; Dolakidze, T; Shakhnazarova, M; Chlikadze, R; Kopaleishvili, N; Goginashvili, K; Kherkheulidze, M; Clark, A D; Blau, J

2015-05-07

Financial support from the Global Alliance for Vaccines and Immunization (GAVI) to introduce the 10-valent pneumococcal conjugate vaccine (PCV10) into the routine childhood immunization schedule in Georgia is ending in 2015. As a result, the Interagency Coordination Committee (ICC) decided to carry out a cost-effectiveness analysis to gather additional evidence to advocate for an appropriate evidence-based decision after GAVI support is over. The study also aimed to strengthen national capacity to conduct cost-effectiveness studies, and to introduce economic evaluations into Georgia's decision-making process. A multidisciplinary team of national experts led by a member of the ICC carried out the analysis that compared two scenarios: introducing PCV10 vs no vaccination. The TRIVAC model was used to evaluate 10 cohorts of children over the period 2014-2023. National data was used to inform demographics, disease burden, vaccine coverage, health service utilization, and costs. Evidence from clinical trials and the scientific literature was used to estimate the impact of the vaccine. A 3+0 schedule and a vaccine price increasing to US$ 3.50 per dose was assumed for the base-case scenario. Alternative univariate and multivariate scenarios were evaluated. Over the 10-year period, PCV10 was estimated to prevent 7170 (8288 undiscounted) outpatient visits due to all-cause acute otitis media, 5325 (6154 undiscounted) admissions due to all-cause pneumonia, 87 (100 undiscounted) admissions due to pneumococcal meningitis, and 508 (588 undiscounted) admissions due to pneumococcal non-pneumonia and non-meningitis (NPNM). In addition, the vaccine was estimated to prevent 41 (48 undiscounted) deaths. This is equivalent to approximately 5 deaths and 700 admissions prevented each year in Georgia. Over the 10-year period, PCV10 would cost the government approximately US$ 4.4 million ($440,000 per year). However, about half of this would be offset by the treatment costs prevented. The discounted cost-effectiveness ratio was estimated to be US$ 1599 per DALY averted with scenarios ranging from US$ 286 to US$ 7787. This study led to better multi-sectoral collaboration and improved national capacity to perform economic evaluations. Routine infant vaccination against Streptococcus pneumoniae would be highly cost-effective in Georgia. The decision to introduce PCV10 was already made some time before the study was initiated but it provided important economic evidence in support of that decision. There are several uncertainties around many of the parameters used, but a multivariate scenario analysis with several conservative assumptions (including no herd effect in older individuals) shows that this recommendation is robust. This study supports the decision to introduce PCV10 in Georgia. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Obstacles perceived by nurses for evidence-based practice: a qualitative study].

PubMed

Sánchez-García, Inmaculada; López-Medina, Isabel M; Pancorbo-Hidalgo, Pedro L

2013-01-01

To examine the obstacles perceived by nurses to implement an evidence-based clinical practice. A qualitative study through semi-structured interviews conducted in 2010-2011 including 11 nurses purposively selected from public hospitals and community centres in Jaén and Córdoba (Spain). A content analysis was performed, using Miles and Huberman as a reference and comprising the following steps: data reduction, data presentation, and data conclusion/verification. Data saturation was reached in these categories (obstacles). The obstacles perceived by nurses to introduce an evidence-based clinical practice (EBCP) were grouped into 3 major categories: obstacles related with professionals (routine-based practice, unwilling and stagnant attitudes, and lack of training in EBCP), obstacles related to the social context (reluctance from other professionals and from patients or families), and obstacles related to the organization (obsolete cultures that do not promote innovation in nursing care). This study highlights the persistence of various factors that hinder the use of research findings in clinical practice. The results underline the need to change the culture of healthcare organizations, to motivate professionals, and to break some of the resistance attitudes that hinder the implementation of evidence-based practice. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Fundamentals in Biostatistics for Research in Pediatric Dentistry: Part I - Basic Concepts.

PubMed

Garrocho-Rangel, J A; Ruiz-Rodríguez, M S; Pozos-Guillén, A J

The purpose of this report was to provide the reader with some basic concepts in order to better understand the significance and reliability of the results of any article on Pediatric Dentistry. Currently, Pediatric Dentists need the best evidence available in the literature on which to base their diagnoses and treatment decisions for the children's oral care. Basic understanding of Biostatistics plays an important role during the entire Evidence-Based Dentistry (EBD) process. This report describes Biostatistics fundamentals in order to introduce the basic concepts used in statistics, such as summary measures, estimation, hypothesis testing, effect size, level of significance, p value, confidence intervals, etc., which are available to Pediatric Dentists interested in reading or designing original clinical or epidemiological studies.

Sustainability in Health care by allocating resources effectively (SHARE) 1: introducing a series of papers reporting an investigation of disinvestment in a local healthcare setting.

PubMed

Harris, Claire; Green, Sally; Ramsey, Wayne; Allen, Kelly; King, Richard

2017-05-04

This is the first in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE). The SHARE Program is an investigation of concepts, opportunities, methods and implications for evidence-based investment and disinvestment in health technologies and clinical practices in a local healthcare setting. The papers in this series are targeted at clinicians, managers, policy makers, health service researchers and implementation scientists working in this context. This paper presents an overview of the organisation-wide, systematic, integrated, evidence-based approach taken by one Australian healthcare network and provides an introduction and guide to the suite of papers reporting the experiences and outcomes.

A second order derivative scheme based on Bregman algorithm class

NASA Astrophysics Data System (ADS)

Campagna, Rosanna; Crisci, Serena; Cuomo, Salvatore; Galletti, Ardelio; Marcellino, Livia

2016-10-01

The algorithms based on the Bregman iterative regularization are known for efficiently solving convex constraint optimization problems. In this paper, we introduce a second order derivative scheme for the class of Bregman algorithms. Its properties of convergence and stability are investigated by means of numerical evidences. Moreover, we apply the proposed scheme to an isotropic Total Variation (TV) problem arising out of the Magnetic Resonance Image (MRI) denoising. Experimental results confirm that our algorithm has good performance in terms of denoising quality, effectiveness and robustness.

The research-design interaction: lessons learned from an evidence-based design studio.

PubMed

Haq, Saif; Pati, Debajyoti

2010-01-01

As evidence-based design (EBD) emerges as a model of design practice, considerable attention has been given to its research component. However, this overshadows another essential component of EBD-the change agent, namely the designer. EBD introduced a new skill set to the practitioner: the ability to interact with scientific evidence. Industry sources suggest adoption of the EBD approach across a large number of design firms. How comfortable are these designers in integrating research with design decision making? Optimizing the interaction between the primary change agent (the designer) and the evidence is crucial to producing the desired outcomes. Preliminary to examining this question, an architectural design studio was used as a surrogate environment to examine how designers interact with evidence. Twelve students enrolled in a healthcare EBD studio during the spring of 2009. A three-phase didactic structure was adopted: knowing a hospital, knowing the evidence, and designing with knowledge and evidence. Products of the studio and questionnaire responses from the students were used as the data for analysis. The data suggest that optimization of the research-design relationship warrants consideration in four domains: (1) a knowledge structure that is easy to comprehend; (2) phase-complemented representation of evidence; (3) access to context and precedence information; and (4) a designer-friendly vocabulary.

Utilizing DMAIC six sigma and evidence-based medicine to streamline diagnosis in chest pain.

PubMed

Kumar, Sameer; Thomas, Kory M

2010-01-01

The purpose of this study was to quantify the difference between the current process flow model for a typical patient workup for chest pain and development of a new process flow model that incorporates DMAIC (define, measure, analyze, improve, control) Six Sigma and evidence-based medicine in a best practices model for diagnosis and treatment. The first stage, DMAIC Six Sigma, is used to highlight areas of variability and unnecessary tests in the current process flow for a patient presenting to the emergency department or physician's clinic with chest pain (also known as angina). The next stage, patient process flow, utilizes DMAIC results in the development of a simulated model that represents real-world variability in the diagnosis and treatment of a patient presenting with angina. The third and final stage is used to analyze the evidence-based output and quantify the factors that drive physician diagnosis accuracy and treatment, as well as review the potential for a broad national evidence-based database. Because of the collective expertise captured within the computer-oriented evidence-based model, the study has introduced an innovative approach to health care delivery by bringing expert-level care to any physician triaging a patient for chest pain anywhere in the world. Similar models can be created for other ailments as well, such as headache, gastrointestinal upset, and back pain. This updated way of looking at diagnosing patients stemming from an evidence-based best practice decision support model may improve workflow processes and cost savings across the health care continuum.

Increasing the odds: applying emergentist theory in language intervention.

PubMed

Poll, Gerard H

2011-10-01

This review introduces emergentism, which is a leading theory of language development that states that language ability is the product of interactions between the child's language environment and his or her learning capabilities. The review suggests ways in which emergentism provides a theoretical rationale for interventions that are designed to address developmental language delays in young children. A review of selected literature on emergentist theory and research is presented, with a focus on the acquisition of early morphology and syntax. A significant method for developing and testing emergentist theory, connectionist modeling, is described. Key themes from both connectionist and behavioral studies are summarized and applied with specific examples to language intervention techniques. A case study is presented to integrate elements of emergentism with language intervention. Evaluating the theoretical foundation for language interventions is an important step in evidence-based practice. This article introduces three themes in the emergentist literature that have implications for language intervention: (a) sufficiency of language input, (b) active engagement of the child with the input, and (c) factors that increase the odds for correctly mapping language form to meaning. Evidence supporting the importance of these factors in effective language intervention is presented, along with limitations in that evidence.

University community partnerships that promote evidence-based macro practice.

PubMed

Mulroy, Elizabeth A

2008-01-01

This article articulates three dimensions of EBP grounded in theory for macro practice: intention toward social change, planning and decision-making, and civic participation. These dimensions are then applied to university community partnerships that are complex community interventions. The goals of these partnerships are to improve the social environment in low-income neighborhoods through community development and reform the university as a social institution from neighborhood bystander to responsible, engaged citizen. Finally, the article introduces the concept of a planning triangle, a framework linking evidence derived from community assessments and practice-relevant research to decisive and timely action in the field.

An AI-based communication system for motor and speech disabled persons: design methodology and prototype testing.

PubMed

Sy, B K; Deller, J R

1989-05-01

An intelligent communication device is developed to assist the nonverbal, motor disabled in the generation of written and spoken messages. The device is centered on a knowledge base of the grammatical rules and message elements. A "belief" reasoning scheme based on both the information from external sources and the embedded knowledge is used to optimize the process of message search. The search for the message elements is conceptualized as a path search in the language graph, and a special frame architecture is used to construct and to partition the graph. Bayesian "belief" reasoning from the Dempster-Shafer theory of evidence is augmented to cope with time-varying evidence. An "information fusion" strategy is also introduced to integrate various forms of external information. Experimental testing of the prototype system is discussed.

Opportunities for improving legislative public health policy in Rhode Island through evidence-based education.

PubMed

Bourdeau, Moise; Winter, Ronald; Marshall, Robert

2013-10-01

The Rhode Island General Assembly considers nearly 3000 bills yearly--spanning the entire range of issues related to state government and legislative policy. This review analyzes the modest number of 40 "health-related" bills introduced during the 2009 session. It is often not clear to what extent these proposals consistently received analysis by both informed and independent organizations or experts regarding their "evidence-based" foundations. Only 25 of these bills received a committee hearing, and eventually become law. Hence, there may be a reasonable opportunity for expert, non-partisan organizations to provide the General Assembly with information related to proposed legislation on a routine or "as requested" basis. This study provides a systematic analysis of this degree of effort based on data regarding health- related legislation proposed during the 2009 session of the RI General Assembly.

Reflection Paper on a Ubiquitous English Vocabulary Learning System: Evidence of Active/Passive Attitude vs. Usefulness/Ease-of-Use

ERIC Educational Resources Information Center

Lim, Jeff

2013-01-01

"A ubiquitous English vocabulary learning system: evidence of active/passive attitudes vs. usefulness/ease-of-use" introduces and develops "Ubiquitous English Vocabulary Learning" (UEFL) system. It introduces to the memorization using the video clips. According to their paper the video clip gives a better chance for students to…

[Which research is needed to support clinical decision-making on integrative medicine? Can comparative effectiveness research close the gap?].

PubMed

Witt, Claudia M; Huang, Wen-jing; Lao, Lixing; Berman, Brian M

2013-08-01

In clinical research on complementary and integrative medicine, experts and scientists have often pursued a research agenda in spite of an incomplete understanding of the needs of end users. Consequently, the majority of previous clinical trials have mainly assessed the efficacy of interventions. Scant data is available on their effectiveness. Comparative effectiveness research (CER) promises to support decision makers by generating evidence that compares the benefits and harms of best care options. This evidence, more generalizable than evidence generated by traditional randomized clinical trials (RCTs), is better suited to inform real-world care decisions. An emphasis on CER supports the development of the evidence base for clinical and policy decision-making. Whereas in most areas of complementary and integrative medicine data on CER is scarce, available acupuncture research already contributes to CER evidence. This paper will introduce CER and make suggestions for future research.

Which research is needed to support clinical decision-making on integrative medicine?- Can comparative effectiveness research close the gap?

PubMed

Witt, Claudia M; Huang, Wen-jing; Lao, Lixing; Bm, Berman

2012-10-01

In clinical research on complementary and integrative medicine, experts and scientists have often pursued a research agenda in spite of an incomplete understanding of the needs of end users. Consequently, the majority of previous clinical trials have mainly assessed the efficacy of interventions. Scant data is available on their effectiveness. Comparative effectiveness research (CER) promises to support decision makers by generating evidence that compares the benefits and harms of the best care options. This evidence, more generalizable than the evidence generated by traditional randomized controlled trials (RCTs), is better suited to inform real-world care decisions. An emphasis on CER supports the development of the evidence base for clinical and policy decision-making. Whereas in most areas of complementary and integrative medicine data on comparative effectiveness is scarce, available acupuncture research already contributes to CER evidence. This paper will introduce CER and make suggestions for future research.

An Evidence Framework for Off-Patent Pharmaceutical Review (EFOR) for Health Technology Assessment in Emerging Markets.

PubMed

Brixner, Diana; Kaló, Zoltán; Maniadakis, Nikos; Kim, Kyoo; Wijaya, Kalman

2018-03-29

This article introduces an Evidence Framework for Off-Patent Pharmaceutical Review (EFOR), which establishes value-based criteria in a template that manufacturers use to provide evidence showing how their products meet those criteria. Health authorities in emerging markets can then use the evidence presented in the EFOR to evaluate off-patent pharmaceuticals (OPPs) in a consistent, transparent, and evidence-based manner to support policy decisions, including pricing, reimbursement, formulary listing, and drug procurement. A literature search found no multi-criteria evidence framework for evaluating OPPs in emerging markets. An International Outcomes Research Board (IORB) of academia and industry experts conducted extensive research, meetings, and workshops to define high-priority criteria to incorporate into an evidence-based health technology assessment (HTA) tool using the multi-criteria decision analysis (MCDA) technique. The resulting framework was further tailored for country-specific needs in workshops in three emerging countries (Kazakhstan, Vietnam, and Indonesia). The IORB defined nine criteria four categories (Product, Manufacturing, Service, and Value Assessment), which OPP manufacturers can use to provide evidence for reimbursement and health policy decision making. Then the IORB developed the EFOR as a base case document, which can be adapted and used as a template by health authorities in emerging countries. Emerging countries have a significant need for an HTA tool that balances affordability with accurate evidence showing the value differentiation of OPPs. The value attributes in this setting often are different from those in developed markets, which emphasize new products and have high regulation and manufacturing standards. The EFOR is an easy-to-use, adaptable framework that emerging countries can use to increase the consistency, transparency, and effectiveness of drug decision making. The open source EFOR is available as Supplemental Materials. Copyright © 2018. Published by Elsevier Inc.

Early Evidence for Zika Virus Circulation among Aedes aegypti Mosquitoes, Rio de Janeiro, Brazil

PubMed Central

Ayllón, Tania; Campos, Renata de Mendonça; Brasil, Patrícia; Morone, Fernanda Cristina; Câmara, Daniel Cardoso Portela; Meira, Guilherme Louzada Silva; Tannich, Egbert; Yamamoto, Kristie Aimi; Carvalho, Marilia Sá; Pedro, Renata Saraiva; Cadar, Daniel; Ferreira, Davis Fernandes; Honório, Nildimar Alves

2017-01-01

During 2014–2016, we conducted mosquito-based Zika virus surveillance in Rio de Janeiro, Brazil. Results suggest that Zika virus was probably introduced into the area during May–November 2013 via multiple in-country sources. Furthermore, our results strengthen the hypothesis that Zika virus in the Americas originated in Brazil during October 2012–May 2013. PMID:28628464

Leaning in: lessons for leadership career development.

PubMed

Shirey, Maria R

2013-11-01

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author introduces the book Lean In and presents applicable lessons for nursing leadership career development.

Assessing the Relationship between Teacher Performance on Washington State's ProTeach Portfolio and Student Test Performance. CEDR Working Paper. WP #2014-­2

ERIC Educational Resources Information Center

Cowan, James; Goldhaber, Dan

2014-01-01

As part of Washington State's efforts to ensure and improve the quality of the teacher workforce, the Professional Educator Standards Board (PESB), with assistance from Educational Testing Services (ETS), has recently introduced a new, evidence-based assessment of teachers called the ProTeach Portfolio. The development of ProTeach was mandated by…

Precise genotyping and recombination detection of Enterovirus

PubMed Central

2015-01-01

Enteroviruses (EV) with different genotypes cause diverse infectious diseases in humans and mammals. A correct EV typing result is crucial for effective medical treatment and disease control; however, the emergence of novel viral strains has impaired the performance of available diagnostic tools. Here, we present a web-based tool, named EVIDENCE (EnteroVirus In DEep conception, http://symbiont.iis.sinica.edu.tw/evidence), for EV genotyping and recombination detection. We introduce the idea of using mixed-ranking scores to evaluate the fitness of prototypes based on relatedness and on the genome regions of interest. Using phylogenetic methods, the most possible genotype is determined based on the closest neighbor among the selected references. To detect possible recombination events, EVIDENCE calculates the sequence distance and phylogenetic relationship among sequences of all sliding windows scanning over the whole genome. Detected recombination events are plotted in an interactive figure for viewing of fine details. In addition, all EV sequences available in GenBank were collected and revised using the latest classification and nomenclature of EV in EVIDENCE. These sequences are built into the database and are retrieved in an indexed catalog, or can be searched for by keywords or by sequence similarity. EVIDENCE is the first web-based tool containing pipelines for genotyping and recombination detection, with updated, built-in, and complete reference sequences to improve sensitivity and specificity. The use of EVIDENCE can accelerate genotype identification, aiding clinical diagnosis and enhancing our understanding of EV evolution. PMID:26678286

Identification of largemouth bass virus in the introduced Northern Snakehead inhabiting the Chesapeake Bay watershed.

PubMed

Iwanowicz, L; Densmore, C; Hahn, C; McAllister, P; Odenkirk, J

2013-09-01

The Northern Snakehead Channa argus is an introduced species that now inhabits the Chesapeake Bay. During a preliminary survey for introduced pathogens possibly harbored by these fish in Virginia waters, a filterable agent was isolated from five specimens that produced cytopathic effects in BF-2 cells. Based on PCR amplification and partial sequencing of the major capsid protein (MCP), DNA polymerase (DNApol), and DNA methyltransferase (Mtase) genes, the isolates were identified as Largemouth Bass virus (LMBV). Nucleotide sequences of the MCP (492 bp) and DNApol (419 pb) genes were 100% identical to those of LMBV. The nucleotide sequence of the Mtase (206 bp) gene was 99.5% identical to that of LMBV, and the single nucleotide substitution did not lead to a predicted amino acid coding change. This is the first report of LMBV from the Northern Snakehead, and provides evidence that noncentrarchid fishes may be susceptible to this virus.

Identification of largemouth bass virus in the introduced Northern snakehead inhabiting the Cheasapeake Bay watershed

USGS Publications Warehouse

Iwanowicz, Luke R.; Densmore, Christine L.; Hahn, Cassidy M.; McAllister, Phillip; Odenkirk, John

2013-01-01

The Northern Snakehead Channa argus is an introduced species that now inhabits the Chesapeake Bay. During a preliminary survey for introduced pathogens possibly harbored by these fish in Virginia waters, a filterable agent was isolated from five specimens that produced cytopathic effects in BF-2 cells. Based on PCR amplification and partial sequencing of the major capsid protein (MCP), DNA polymerase (DNApol), and DNA methyltransferase (Mtase) genes, the isolates were identified as Largemouth Bass virus (LMBV). Nucleotide sequences of the MCP (492 bp) and DNApol (419 pb) genes were 100% identical to those of LMBV. The nucleotide sequence of the Mtase (206 bp) gene was 99.5% identical to that of LMBV, and the single nucleotide substitution did not lead to a predicted amino acid coding change. This is the first report of LMBV from the Northern Snakehead, and provides evidence that noncentrarchid fishes may be susceptible to this virus.

Structured dyadic behavior therapy processes for ADHD intervention.

PubMed

Curtis, David F

2014-03-01

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) present significant problems with behavioral disinhibition that often negatively affect their peer relationships. Although behavior therapies for ADHD have traditionally aimed to help parents and teachers better manage children's ADHD-related behaviors, therapy processes seldom use peer relationships to implement evidence-based behavioral principles. This article introduces Structured Dyadic Behavior Therapy as a milieu for introducing effective behavioral techniques within a socially meaningful context. Establishing collaborative behavioral goals, benchmarking, and redirection strategies are discussed to highlight how in-session dyadic processes can be used to promote more meaningful reinforcement and change for children with ADHD. Implications for improving patient care, access to care, and therapist training are also discussed.

How Market Structure Drives Commodity Prices

NASA Astrophysics Data System (ADS)

Li, Bin; Wong, K. Y. Michael; Chan, Amos H. M.; So, Tsz Yan; Heimonen, Hermanni; Saad, David

To understand how market structure drives commodity price trends with respect to resource availability we introduce an agent-based model, in which agents set their prices to maximize profit. At steady state the market self-organizes into three groups: excess producers, consumers and balanced agents. When resources are scarce prices rise sharply below a turning point marking the disappearance of excess producers. By introducing an elasticity parameter to mitigate noise and long-term changes in commodities data, we confirm the trend of rising prices, provide evidence for turning points, and indicate yield points for less essential commodities. This work is supported by Research Grants Council of Hong Kong (Grant Numbers 604512, 605813, and 16322616) and the Leverhulme Trust RPG-2013-48.

Evidence of indirect impacts of introduced trout on native amphibians via facilitation of a shared predator

Treesearch

Karen L. Pope; Justin M. Garwood; Hartwell H. Welsh Jr.; Sharon P. Lawler

2008-01-01

Hyperpredation occurs when non-native prey facilitate invasive predators, which then suppress native prey. Direct impacts of introduced fish on amphibians are well studied, but the role of fish in supporting shared predators has not been considered. We present evidence for indirect effects of trout on amphibians through snake predation. Analyses of the diet,...

Theories of behaviour change synthesised into a set of theoretical groupings: introducing a thematic series on the theoretical domains framework.

PubMed

Francis, Jill J; O'Connor, Denise; Curran, Janet

2012-04-24

Behaviour change is key to increasing the uptake of evidence into healthcare practice. Designing behaviour-change interventions first requires problem analysis, ideally informed by theory. Yet the large number of partly overlapping theories of behaviour makes it difficult to select the most appropriate theory. The need for an overarching theoretical framework of behaviour change was addressed in research in which 128 explanatory constructs from 33 theories of behaviour were identified and grouped. The resulting Theoretical Domains Framework (TDF) appears to be a helpful basis for investigating implementation problems. Research groups in several countries have conducted TDF-based studies. It seems timely to bring together the experience of these teams in a thematic series to demonstrate further applications and to report key developments. This overview article describes the TDF, provides a brief critique of the framework, and introduces this thematic series.In a brief review to assess the extent of TDF-based research, we identified 133 papers that cite the framework. Of these, 17 used the TDF as the basis for empirical studies to explore health professionals' behaviour. The identified papers provide evidence of the impact of the TDF on implementation research. Two major strengths of the framework are its theoretical coverage and its capacity to elicit beliefs that could signify key mediators of behaviour change. The TDF provides a useful conceptual basis for assessing implementation problems, designing interventions to enhance healthcare practice, and understanding behaviour-change processes. We discuss limitations and research challenges and introduce papers in this series.

Theories of behaviour change synthesised into a set of theoretical groupings: introducing a thematic series on the theoretical domains framework

PubMed Central

2012-01-01

Behaviour change is key to increasing the uptake of evidence into healthcare practice. Designing behaviour-change interventions first requires problem analysis, ideally informed by theory. Yet the large number of partly overlapping theories of behaviour makes it difficult to select the most appropriate theory. The need for an overarching theoretical framework of behaviour change was addressed in research in which 128 explanatory constructs from 33 theories of behaviour were identified and grouped. The resulting Theoretical Domains Framework (TDF) appears to be a helpful basis for investigating implementation problems. Research groups in several countries have conducted TDF-based studies. It seems timely to bring together the experience of these teams in a thematic series to demonstrate further applications and to report key developments. This overview article describes the TDF, provides a brief critique of the framework, and introduces this thematic series. In a brief review to assess the extent of TDF-based research, we identified 133 papers that cite the framework. Of these, 17 used the TDF as the basis for empirical studies to explore health professionals’ behaviour. The identified papers provide evidence of the impact of the TDF on implementation research. Two major strengths of the framework are its theoretical coverage and its capacity to elicit beliefs that could signify key mediators of behaviour change. The TDF provides a useful conceptual basis for assessing implementation problems, designing interventions to enhance healthcare practice, and understanding behaviour-change processes. We discuss limitations and research challenges and introduce papers in this series. PMID:22531601

Improving quality of care for depression: the German Action Programme for the implementation of evidence-based guidelines.

PubMed

Härter, Martin; Bermejo, Isaac; Ollenschläger, Günter; Schneider, Frank; Gaebel, Wolfgang; Hegerl, Ulrich; Niebling, Wilhelm; Berger, Mathias

2006-04-01

Depressive disorders are of great medical and political significance. The potential inherent in achieving better guideline orientation and a better collaboration between different types of care is clear. Throughout the 1990s, educational initiatives were started for implementing guidelines. Evidence-based guidelines on depression have been formulated in many countries. This article presents an action programme for structural, educational, and research-related measures to implement evidence-based care of depressive disorders in the German health system. The starting points of the programme are the 'Guidelines Critical Appraisal Reports' of the 'Guideline Clearing House' and measures from the 'Competence Network on Depression and Suicidality' (CNDS) funded by the Federal Ministry of Education and Research. The article gives an overview of the steps achieved as recommended by the Guidelines Critical Appraisal Reports and the ongoing transfer process into the German health care system. The action programme shows that comprehensive interventions to develop and introduce evidence-based guidelines for depression can achieve benefits in the care of depression, e.g. in recognition, management, and clinical outcome. It was possible to implement the German Action Programme in selected care settings, and initial evaluation results suggest some improvements. The action programme provides preliminary work, materials, and results for developing a future 'Disease Management Programme' (DMP) for depression.

Science, politics, and the play of chance in recent Australian drinking law changes.

PubMed

Kypri, Kypros

2016-11-01

Regulating late-night alcohol sales to prevent violence continues to be hotly debated in Australia. From July this year, Queensland required premises to stop serving alcohol (last drinks) by 3 am in entertainment precincts and by 2 am in the rest of the state. The Government made legislative provision for 1 am lockouts in entertainment precincts but at the time of writing has not committed to introducing them. Lockouts, also known as one-way-doors, permit patrons to remain drinking in premises until last drinks but deny entry to new patrons. In Newcastle, New South Wales, lockouts and earlier closing of licensed premises were introduced in 2008. Evidence that these produced large reductions in assault informed the 2014 Sydney restrictions that are currently under review. The global research evidence for last drinks regulations is compelling: trading extensions of as little as one h increase harm, and similarly modest restrictions reduce harm. In contrast, the effectiveness of lockouts, a phenomenon unique to Australasia, is uncertain. The Newcastle, Sydney and Queensland reforms are a stepwise progression in alcohol harm countermeasures, a welcome example of evidence-based public policy. However, the aetiologies of these policy changes were complex. I present accounts of each and offer commentary on the interplay between scientific evidence, public health advocacy, politics, and chance occurrences that preceded these significant changes. © 2016 Australasian Professional Society on Alcohol and other Drugs.

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

PubMed

Sarker, Abeed; Mollá, Diego; Paris, Cécile

2015-06-01

Evidence-based medicine practice requires practitioners to obtain the best available medical evidence, and appraise the quality of the evidence when making clinical decisions. Primarily due to the plethora of electronically available data from the medical literature, the manual appraisal of the quality of evidence is a time-consuming process. We present a fully automatic approach for predicting the quality of medical evidence in order to aid practitioners at point-of-care. Our approach extracts relevant information from medical article abstracts and utilises data from a specialised corpus to apply supervised machine learning for the prediction of the quality grades. Following an in-depth analysis of the usefulness of features (e.g., publication types of articles), they are extracted from the text via rule-based approaches and from the meta-data associated with the articles, and then applied in the supervised classification model. We propose the use of a highly scalable and portable approach using a sequence of high precision classifiers, and introduce a simple evaluation metric called average error distance (AED) that simplifies the comparison of systems. We also perform elaborate human evaluations to compare the performance of our system against human judgments. We test and evaluate our approaches on a publicly available, specialised, annotated corpus containing 1132 evidence-based recommendations. Our rule-based approach performs exceptionally well at the automatic extraction of publication types of articles, with F-scores of up to 0.99 for high-quality publication types. For evidence quality classification, our approach obtains an accuracy of 63.84% and an AED of 0.271. The human evaluations show that the performance of our system, in terms of AED and accuracy, is comparable to the performance of humans on the same data. The experiments suggest that our structured text classification framework achieves evaluation results comparable to those of human performance. Our overall classification approach and evaluation technique are also highly portable and can be used for various evidence grading scales. Copyright © 2015 Elsevier B.V. All rights reserved.

Evidence based mental healthcare and service innovation: review of concepts and challenges.

PubMed

Kouimtsidis, Ch; John-Smith, St; Kemp, P; Ikkos, G

2013-01-01

Health provision systems in the developed western nations are currently facing major financial challenges. In order to meet these challenges, a number of new approaches used to assist the provision of health have been introduced, including the practice of health professionals. These approaches utilize specific methods of data capture and summarization such as: evidence based medicine (EBM) and practice guidelines. Evidence is generated from systematic clinical research as well as reported clinical experience and individually case based empirical evidence. All types of research though (quantitative or qualitative) have limitations. Similarly all types of evidence have advantages and disadvantages and can be complimentary to each other. Evidencebased individual decision (EBID) making is the commonest evidence-based medicine as practiced by the individual clinician in making decisions about the care of the individual patient. It involves integrating individual clinical expertise with the best available external clinical evidence from systematic research. However this sort of evidence-based medicine, focuses excessively on the individual (potentially at the expense of others) in a system with limited budgets. Evidence-based guidelines (EBG) also support the practice of evidence-based medicine but at the organizational or institutional level. The main aim is to identify which interventions, over a range of patients, work best and which is cost-effective in order to guide service development and provision at a strategic level. Doing this effectively is a scientific and statistical skill in itself and the quality of guidelines is based primarily on the quality research evidence. It is important to note that lack of systematic evidence to support an intervention does not automatically mean that an intervention must instantly be abandoned. It is also important that guidelines are understood for what they are, i.e. not rules, or complete statements of knowledge. EBM will never have enough suitable evidence for all and every aspects of health provision in every locality. Innovation signifies a substantial positive change compared to gradual or incremental changes. Innovation using inductive reasoning has to play a major role within health care system and it is applicable to all three level of service provision: clinical practice, policy and organisation structure. The aim of this paper is to examine critically the above concepts and their complimentary role in supporting provision of health care systems which are suitable for the requirements of the population, affordable, deliverable, flexible and adaptable to social changes.

Development of a Guided Internet-based Psycho-education Intervention Using Cognitive Behavioral Therapy and Self-Management for Individuals with Chronic Pain.

PubMed

Perry, Jennifer; VanDenKerkhof, Elizabeth G; Wilson, Rosemary; Tripp, Dean A

2017-04-01

Evidence-based chronic pain treatment includes nonpharmacologic therapies. When addressing barriers to treatment, there is a need to deliver these therapies in a way that is accessible to all individuals who may benefit. To develop a guided Internet-based intervention for individuals with chronic pain, program content and sequence of evidence-based treatments for chronic pain, traditionally delivered via in-person sessions, were identified to be adapted for Internet delivery. With consideration to historical barriers to treatment, and through use of a concept map, therapeutic components and educational material were situated, in an ordered sequence, into six modules. An Internet-based chronic pain intervention was constructed to improve access to evidence-based chronic pain therapies. Research using this intervention, in the form of a pilot study for intervention refinement, was conducted, and a large-scale study to assess effectiveness is necessary prior to implementation. As clients may face barriers to multimodal treatment for chronic pain, nurses could introduce components of education, cognitive behavioral therapy and self-management to clients and prepare them for the "work" of managing chronic pain, through use of this Internet-based intervention. Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

The effects of herbal medicine on epilepsy

PubMed Central

Pan, Zhenxiang; Leng, Yashu; Lv, Jiayin; Li, Bingjin

2017-01-01

Traditional herbal medicine plays a significant role in the treatment of epilepsy. Though herbal medicine is widely used in antiepileptic treatment, there is a lack of robust evidence for efficacy and toxicity of most herbs. Besides, the herbal medicine should be subject to evidence-based scrutiny. In this context, we present a review to introduce the effects of herbal medicine on epilepsy. However, hundreds of herbal medicines have been investigated in the available studies. Some commonly used herbal medicines for epilepsy have been listed in our study. The overwhelming majority of these data are based on animal experiments. The lack of clinical data places constraints on the clinical recommendation of herbal medicine. Our study may conduct further studies and provide some insight on the development of anti-epileptic drugs. PMID:28423368

The effects of herbal medicine on epilepsy.

PubMed

Liu, Wei; Ge, Tongtong; Pan, Zhenxiang; Leng, Yashu; Lv, Jiayin; Li, Bingjin

2017-07-18

Traditional herbal medicine plays a significant role in the treatment of epilepsy. Though herbal medicine is widely used in antiepileptic treatment, there is a lack of robust evidence for efficacy and toxicity of most herbs. Besides, the herbal medicine should be subject to evidence-based scrutiny. In this context, we present a review to introduce the effects of herbal medicine on epilepsy. However, hundreds of herbal medicines have been investigated in the available studies. Some commonly used herbal medicines for epilepsy have been listed in our study. The overwhelming majority of these data are based on animal experiments. The lack of clinical data places constraints on the clinical recommendation of herbal medicine. Our study may conduct further studies and provide some insight on the development of anti-epileptic drugs.

Amyloid PET in clinical practice: Its place in the multidimensional space of Alzheimer's disease☆

PubMed Central

Vandenberghe, Rik; Adamczuk, Katarzyna; Dupont, Patrick; Laere, Koen Van; Chételat, Gaël

2013-01-01

Amyloid imaging is currently introduced to the market for clinical use. We will review the evidence demonstrating that the different amyloid PET ligands that are currently available are valid biomarkers for Alzheimer-related β amyloidosis. Based on recent findings from cross-sectional and longitudinal imaging studies using different modalities, we will incorporate amyloid imaging into a multidimensional model of Alzheimer's disease. Aside from the critical role in improving clinical trial design for amyloid-lowering drugs, we will also propose a tentative algorithm for when it may be useful in a memory clinic environment. Gaps in our evidence-based knowledge of the added value of amyloid imaging in a clinical context will be identified and will need to be addressed by dedicated studies of clinical utility. PMID:24179802

Everyday Excellence: A Framework for Professional Nursing Practice in Long-Term Care

PubMed Central

Lyons, Stacie Salsbury; Specht, Janet Pringle; Karlman, Susan E.

2009-01-01

Registered nurses make measurable contributions to the health and wellness of persons living in nursing homes. However, most nursing homes do not employ adequate numbers of professional nurses with specialized training in the nursing care of older adults to positively impact resident outcomes. As a result, many people never receive excellent geriatric nursing while living in a long-term care facility. Nurses have introduced various professional practice models into health care institutions as tools for leading nursing practice, improving client outcomes, and achieving organizational goals. Problematically, few professional practice models have been implemented in nursing homes. This article introduces an evidence-based framework for professional nursing practice in long-term care. The Everyday Excellence framework is based upon eight guiding principles: Valuing, Envisioning, Peopling, Securing, Learning, Empowering, Leading, and Advancing Excellence. Future research will evaluate the usefulness of this framework for professional nursing practice. PMID:20077966

The motivation of health professionals to explore research evidence in their practice: An intervention study.

PubMed

Henderson, Amanda; Winch, Sarah; Holzhauser, Kerri; De Vries, Sue

2006-12-01

To assess the impact of multifaceted clinically focused educational strategies that concentrated on introducing dementia care research evidence on health professionals' awareness and inclination to use research findings in their future practice. The promise of evidence-based practice is slow to materialize with the limitations of adopting research findings in practice readily identifiable. A pre- and post-test quasi experimental design. The study involved the administration of: a pretest (baseline), an intervention phase, and a post-test survey, the same research utilization survey. TOOL: The Edmonton Research Orientation Survey (EROS), a self-report tool that asks participants about their attitudes toward research and about their potential to use research findings, was used to determine health professionals' orientation to research. The introduction of dementia care research evidence through multifaceted clinically focused educational strategies to improve practice. This was achieved through a resource team comprising a Clinical Nurse Consultant, as a leader and resource of localized evidence-based knowledge in aged care; an experienced Registered Nurse to support the introduction of strategies and a further experienced educator and clinician to reinforce the importance of evidence in change. Across all the four subscales that are measured in the Edmonton Research Orientation Survey, statistical analysis by independent samples t-test identified that there was no significant change between the before and after measurements. Successful integration of changes based on evidence does not necessarily mean that staff become more aware or are more inclined to use research findings in future to address problems.

Teaching thoughtful practice: narrative pedagogy in addictions education.

PubMed

Vandermause, Roxanne K; Townsend, Ryan P

2010-07-01

Preparing practitioners for this rapidly changing and demanding health care environment is challenging. A surge in knowledge development and scientific advancement has placed a priority on technical skill and a focus on content driven educational processes that prepare students for evidence-based practice. However, the most difficult health care scenarios require thinking-in-action and thoughtfulness as well as didactic knowledge. It is our contention that interpretive educational methods, like narrative pedagogy, will promote judgment-based practice that includes use of evidence and delivery of thoughtful care. In this article, we describe and interpret a narrative approach to addictions content and teaching thoughtful practice. We present our pedagogical process, including observations and field notes, to show how interpretive pedagogies can be introduced into nursing curricula. By presenting this process, the reader is invited to consider interpretive methods as a way to inspire and habituate thoughtful practice and judgment-based care. Copyright 2009 Elsevier Ltd. All rights reserved.

Study protocol: DEcisions in health Care to Introduce or Diffuse innovations using Evidence (DECIDE).

PubMed

Turner, Simon; Morris, Stephen; Sheringham, Jessica; Hudson, Emma; Fulop, Naomi J

2016-04-05

A range of evidence informs healthcare decision-making, from formal research findings to 'soft intelligence' or local data, as well as practical experience or tacit knowledge. However, cultural and organisational factors often prevent the translation of such evidence into practice. Using a multi-level framework, this project will analyse how interactions between the evidence available and processes at the micro (individual/group) and meso (organisational/system) levels influence decisions to introduce or diffuse innovations in acute and primary care within the National Health Service in the UK. This study will use a mixed methods design, combining qualitative and quantitative methods, and involves four interdependent work streams: (1) rapid evidence synthesis of relevant literature with stakeholder feedback; (2) in-depth case studies of 'real-world' decision-making in acute and primary care; (3) a national survey and discrete choice experiment; and (4) development of guidance for decision-makers and evaluators to support the use of evidence in decision-making. This study will enhance the understanding of decision-makers' use of diverse forms of evidence. The findings will provide insights into how and why some evidence does inform decisions to introduce healthcare innovations, and why barriers persist in other cases. It will also quantify decision-makers' preferences, including the 'tipping point' of evidence needed to shift stakeholders' views. Practical guidance will be shared with healthcare decision-makers and evaluators on uses of evidence to enable the introduction and diffusion of innovation.

Health Informatics 3.0 and other increasingly dispersed technologies require even greater trust: promoting safe evidence-based health informatics. Contribution of the IMIA Working Group on Technology Assessment & Quality Development in Health Informatics.

PubMed

Rigby, M; Ammenwerth, E; Talmon, J; Nykänen, P; Brender, J; de Keizer, N

2011-01-01

Health informatics is generally less committed to a scientific evidence-based approach than any other area of health science, which is an unsound position. Introducing the new Web 3.0 paradigms into health IT applications can unleash a further great potential, able to integrate and distribute data from multiple sources. The counter side is that it makes the user and the patient evermore dependent on the 'black box' of the system, and the re-use of the data remote from the author and initial context. Thus anticipatory consideration of uses, and proactive analysis of evidence of effects, are imperative, as only when a clinical technology can be proven to be trustworthy and safe should it be implemented widely - as is the case with other health technologies. To argue for promoting evidence-based health informatics as systems become more powerful and pro-active yet more dispersed and remote; and evaluation as the means of generating the necessary scientific evidence base. To present ongoing IMIA and EFMI initiatives in this field. Critical overview of recent developments in health informatics evaluation, alongside the precedents of other health technologies, summarising current initiatives and the new challenges presented by Health Informatics 3.0. Web 3.0 should be taken as an opportunity to move health informatics from being largely unaccountable to one of being an ethical and responsible science-based domain. Recent and planned activities of the EFMI and IMIA working groups have significantly progressed key initiatives. Concurrent with the emergence of Web 3.0 as a means of new-generation diffuse health information systems comes an increasing need for an evidence-based culture in health informatics.

Assessing and Improving Student Understanding of Tree-Thinking

NASA Astrophysics Data System (ADS)

Kummer, Tyler A.

Evolution is the unifying theory of biology. The importance of understanding evolution by those who study the origins, diversification and diversity life cannot be overstated. Because of its importance, in addition to a scientific study of evolution, many researchers have spent time studying the acceptance and the teaching of evolution. Phylogenetic Systematics is the field of study developed to understand the evolutionary history of organisms, traits, and genes. Tree-thinking is the term by which we identify concepts related to the evolutionary history of organisms. It is vital that those who undertake a study of biology be able to understand and interpret what information these phylogenies are meant to convey. In this project, we evaluated the current impact a traditional study of biology has on the misconceptions students hold by assessing tree-thinking in freshman biology students to those nearing the end of their studies. We found that the impact of studying biology was varied with some misconceptions changing significantly while others persisted. Despite the importance of tree-thinking no appropriately developed concept inventory exists to measure student understanding of these important concepts. We developed a concept inventory capable of filling this important need and provide evidence to support its use among undergraduate students. Finally, we developed and modified activities as well as courses based on best practices to improve teaching and learning of tree-thinking and organismal diversity. We accomplished this by focusing on two key questions. First, how do we best introduce students to tree-thinking and second does tree-thinking as a course theme enhance student understanding of not only tree-thinking but also organismal diversity. We found important evidence suggesting that introducing students to tree-thinking via building evolutionary trees was less successful than introducing the concept via tree interpretation and may have in fact introduced or strengthened a misconception. We also found evidence that infusing tree-thinking into an organismal diversity course not only enhances student understanding of tree-thinking but also helps them better learn organismal diversity.

The first ever Cochrane event in Russia and Russian speaking countries - Cochrane Russia Launch - Evidence-based medicine: Achievements and barriers (QiQUM 2015) International Conference, Kazan, December 7-8, 2015.

PubMed

Ziganshina, Liliya Eugenevna; Jørgensen, Karsten Juhl

2016-01-01

Kazan hosted Russia's second International Conference QiQUM 2015 on Cochrane evidence for health policy, which was entirely independent of the pharmaceutical or other health industry, bringing together 259 participants from 11 countries and 13 regions of the Russian Federation. The Conference was greeted and endorsed by world leaders in Evidence-based medicine, health and pharmaceutical information, policy and regulation, and the World Health Organization. Participants discussed the professional and social problems arising from biased health information, unethical pharmaceutical promotion, misleading reporting of clinical trials with consequent flaws in health care delivery and the role of Cochrane evidence for informed decisions and better health. The first in history Cochrane workshop, facilitated jointly by experts from Cochrane and the WHO, with 40 participants from Kazakhstan, Kyrgyzstan, Tajikistan and Russia introduced the concept of Cochrane systematic review and the Use of Cochrane evidence in WHO policy setting. Websites document conference materials and provide interface for future collaboration: http://kpfu.ru/biology-medicine/struktura-instituta/kafedry/kfikf/konferenciya/mezhdunarodnaya-konferenciya-39dokazatelnaya.html and http://russia.cochrane.org/news/international-conference.

Poststernotomy mediastinitis: a classification to initiate and evaluate reconstructive management based on evidence from a structured review.

PubMed

van Wingerden, Jan J; Ubbink, Dirk T; van der Horst, Chantal M A M; de Mol, Bas A J M

2014-11-23

Early recognition and, where possible, avoidance of risk factors that contribute to the development of poststernotomy mediastinitis (PSM) form the basis for successful prevention. Once the presence of PSM is diagnosed, the known risk factors have been shown to have limited influence on management decisions. Evidence-based knowledge on treatment decisions, which include the extent and type of surgical intervention (other than debridement), timing and others is available but has not yet been incorporated into a classification on management decisions regarding PSM. Ours is a first attempt at developing a classification system for management of PSM, taking the various evidence-based reconstructive options into consideration. The classification is simple to introduce (there are four Types) and relies on the careful establishment of two variables (sternal stability and sternal bone viability and stock) prior to deciding on the best available reconstructive option. It should allow better insight into why treatment decisions fail or have to be altered and will allow better comparison of treatment outcomes between various institutions.

Dynamics of Markets

NASA Astrophysics Data System (ADS)

McCauley, Joseph L.

2004-06-01

Standard texts and research in economics and finance ignore the absence of evidence from the analysis of real, unmassaged market data to support the notion of Adam Smith's stabilizing Invisible Hand. In stark contrast, this text introduces a new empirically-based model of financial market dynamics that explains the volatility of prices options correctly and clarifies the instability of financial markets. The emphasis is on understanding how real markets behave, not how they hypothetically 'should' behave.

Use of a business case model for organizational change.

PubMed

Shirey, Maria R

2011-01-01

This department highlights change management strategies that may be successful in strategically planning and executing organizational change initiatives. With the goal of presenting practical approaches helpful to nurse leaders advancing organizational change, content includes evidence-based projects, tools, and resources that mobilize and sustain organizational change initiatives. In this article, the author discusses the concept of a business case and introduces a 3-phase business case model for organizational change.

A Preliminary Study on the Use of Mind Mapping as a Visual-Learning Strategy in General Education Science Classes for Arabic Speakers in the United Arab Emirates

ERIC Educational Resources Information Center

Wilson, Kenesha; Copeland-Solas, Eddia; Guthrie-Dixon, Natalie

2016-01-01

Mind mapping was introduced as a culturally relevant pedagogy aimed at enhancing the teaching and learning experience in a general education, Environmental Science class for mostly Emirati English Language Learners (ELL). Anecdotal evidence suggests that the students are very artistic and visual and enjoy group-based activities. It was decided to…

Translating Knowledge Into Practice Through an Academic-Practice Partnership for Exploring Barriers That Impact Management of Homebound Patients With Heart Failure.

PubMed

Echevarria, Mercedes

A knowledge translation project involving an academic-practice partnership and guided by action-oriented research was used for exploring barriers that impact management of homebound heart failure patients. The intervention process followed an action research model of interaction, self-reflection, response, and change in direction. External facilitators (academia) and internal facilitators (practice) worked with clinicians to identify a topic for improvement, explore barriers, locate the evidence compare current practice against evidence-based practice recommendations, introduce strategies to "close the gap" between actual practice and the desired practice, develop audit criteria, and reevaluate the impact.

Contingency management: New directions and remaining challenges for an evidence-based intervention

PubMed Central

Rash, Carla J.; Stitzer, Maxine; Weinstock, Jeremiah

2016-01-01

This article introduces the special issue on contingency management (CM), an efficacious intervention for the treatment of substance use disorders with low uptake in clinical settings that is not commensurate with evidence for efficacy. In this special issue of the Journal of Substance Abuse Treatment, we present 16 articles representing the latest research in efficacy, implementation, and technological advances related to CM. Combined, this collection of articles highlights the diverse populations, settings, and applications of CM in the treatment of substance use disorders. We conclude by highlighting directions for future research, particularly those that may increase CM’s appeal and uptake in routine clinical care. PMID:27746057

Interpreting drinking water quality in the distribution system using Dempster-Shafer theory of evidence.

PubMed

Sadiq, Rehan; Rodriguez, Manuel J

2005-04-01

Interpreting water quality data routinely generated for control and monitoring purposes in water distribution systems is a complicated task for utility managers. In fact, data for diverse water quality indicators (physico-chemical and microbiological) are generated at different times and at different locations in the distribution system. To simplify and improve the understanding and the interpretation of water quality, methodologies for aggregation and fusion of data must be developed. In this paper, the Dempster-Shafer theory also called theory of evidence is introduced as a potential methodology for interpreting water quality data. The conceptual basis of this methodology and the process for its implementation are presented by two applications. The first application deals with the interpretation of spatial water quality data fusion, while the second application deals with the development of water quality index based on key monitored indicators. Based on the obtained results, the authors discuss the potential contribution of theory of evidence as a decision-making tool for water quality management.

Adding small differences can increase similarity and choice.

PubMed

Kim, Jongmin; Novemsky, Nathan; Dhar, Ravi

2013-02-01

Similarity plays a critical role in many judgments and choices. Traditional models of similarity posit that increasing the number of differences between objects cannot increase judged similarity between them. In contrast to these previous models, the present research shows that introducing a small difference in an attribute that previously was identical across objects can increase perceived similarity between those objects. We propose an explanation based on the idea that small differences draw more attention than identical attributes do and that people's perceptions of similarity involve averaging attributes that are salient. We provide evidence that introducing small differences between objects increases perceived similarity. We also show that an increase in similarity decreases the difficulty of choice and the likelihood that a choice will be deferred.

Beyond the usual suspects: using political science to enhance public health policy making.

PubMed

Fafard, Patrick

2015-11-01

That public health policy and practice should be evidence based is a seemingly uncontroversial claim. Yet governments and citizens routinely reject the best available evidence and prefer policies that reflect other considerations and concerns. The most common explanations of this paradox emphasise scientific disagreement, the power of 'politics', or the belief that scientists and policymakers live in two separate communities that do not communicate. However, another explanation may lie in the limits of the very notion of evidence-based policy making. In fact, the social science discipline of political science offers a rich body of theory and empirical evidence to explain the apparent gap between evidence and policy. This essay introduces this literature with a particular emphasis on a recent book by Katherine Smith, Beyond evidence-based policy in public health: the interplay of ideas. As the title suggests, Smith argues that what matters for public health policy is less scientific evidence and much more a more complex set of ideas. Based on detailed case studies of UK tobacco and health inequality policy, Smith offers a richly textured alternative account of what matters for policy making. This excellent book is part of a small but growing body of political science research on public health policy that draws on contemporary theories of policy change and governance more generally. This essay provides a window on this research, describes some examples, but emphasises that public health scholars and practitioners too often retain a narrow if not naive view of the policy-making process. 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.

A Not-So-Gentle Refutation of the Defence of Homeopathy.

PubMed

Zawiła-Niedźwiecki, Jakub; Olender, Jacek

2016-03-01

In a recent paper, Levy, Gadd, Kerridge, and Komesaroff attempt to defend the ethicality of homeopathy by attacking the utilitarian ethical framework as a basis for medical ethics and by introducing a distinction between evidence-based medicine and modern science. This paper demonstrates that their argumentation is not only insufficient to achieve that goal but also incorrect. Utilitarianism is not required to show that homeopathic practice is unethical; indeed, any normative basis of medical ethics will make it unethical, as a defence of homeopathic practice requires the rejection of modern natural sciences, which are an integral part of medical ethics systems. This paper also points out that evidence-based medicine lies at the very core of modern science. Particular arguments made by Levy et al. within the principlist medical ethics normative system are also shown to be wrong.

Therapeutic orthosis and electrical stimulation for upper extremity hemiplegia after stroke: a review of effectiveness based on evidence.

PubMed

Aoyagi, Yoichiro; Tsubahara, Akio

2004-01-01

Upper extremity hemiplegia after stroke is common and disabling. Apart from conventional physical and occupational therapy, a number of additional approaches that use devices such as orthoses, prostheses, electrical stimulation, and robots have been introduced. The purpose of this review was to assess the clinical efficacy of such devices used for the affected upper extremities of acute, subacute, and chronic stroke patients. Assessments of their effectiveness and recommendations were based on the weight of published scientific evidence. The amount of evidence with respect to hand splints and shoulder slings is limited. Further study with a well-designed randomized controlled trial (RCT) is required to investigate accurately their short- and long-term efficacy. A number of studies suggested that the use of electrical stimulation for reducing shoulder subluxation or improving the function of wrist and finger extensors is effective during or shortly after the daily treatment period. The robotic approach to hemiplegic upper extremities appears to be a novel therapeutic strategy that may help improve hand and arm function. However, the longer term effectiveness after discontinuation as well as the motor recovery mechanism of electrical stimulation or robotic devices remains unclear. More research is needed to determine the evidence-based effectiveness of electrical stimulation or other devices for stroke survivors.

Characterising bias in regulatory risk and decision analysis: An analysis of heuristics applied in health technology appraisal, chemicals regulation, and climate change governance.

PubMed

MacGillivray, Brian H

2017-08-01

In many environmental and public health domains, heuristic methods of risk and decision analysis must be relied upon, either because problem structures are ambiguous, reliable data is lacking, or decisions are urgent. This introduces an additional source of uncertainty beyond model and measurement error - uncertainty stemming from relying on inexact inference rules. Here we identify and analyse heuristics used to prioritise risk objects, to discriminate between signal and noise, to weight evidence, to construct models, to extrapolate beyond datasets, and to make policy. Some of these heuristics are based on causal generalisations, yet can misfire when these relationships are presumed rather than tested (e.g. surrogates in clinical trials). Others are conventions designed to confer stability to decision analysis, yet which may introduce serious error when applied ritualistically (e.g. significance testing). Some heuristics can be traced back to formal justifications, but only subject to strong assumptions that are often violated in practical applications. Heuristic decision rules (e.g. feasibility rules) in principle act as surrogates for utility maximisation or distributional concerns, yet in practice may neglect costs and benefits, be based on arbitrary thresholds, and be prone to gaming. We highlight the problem of rule-entrenchment, where analytical choices that are in principle contestable are arbitrarily fixed in practice, masking uncertainty and potentially introducing bias. Strategies for making risk and decision analysis more rigorous include: formalising the assumptions and scope conditions under which heuristics should be applied; testing rather than presuming their underlying empirical or theoretical justifications; using sensitivity analysis, simulations, multiple bias analysis, and deductive systems of inference (e.g. directed acyclic graphs) to characterise rule uncertainty and refine heuristics; adopting "recovery schemes" to correct for known biases; and basing decision rules on clearly articulated values and evidence, rather than convention. Copyright © 2017. Published by Elsevier Ltd.

Learning from History to Increase Positive Public Reception and Social Value Alignment of Evidence-Based Science Communication

PubMed Central

Tetro, Jason A.

2018-01-01

For effective science communication, three general objectives should be taken into consideration: 1) accurate conveyance of the scientific evidence; 2) warm public reception of the communicator; and 3) alignment of the information with social values. An examination of both successful and failed science communication efforts over the course of history can reveal strategies to better meet these objectives. This article looks back at influential moments of science communication over the past two millennia in the context of the objectives and, using lessons learned from these events as a guide, introduces a five-element approach to improve the potential for attaining the objectives. PMID:29904548

[Relevance of medical rehabilitation in disease management programmes].

PubMed

Lüngen, M; Lauterbach, K W

2003-10-01

Disease management programmes will increasingly be introduced in Germany due to the new risk adjustment scheme. The first disease management programmes started in 2003 for breast cancer and diabetes mellitus type II. German rehabilitation will have to face several challenges. Disease management programmes are strongly based on the notion of Evidence so that proof of the efficacy of a care giving task should be present. Verification of the evidence of the specifically German rehabilitation treatments must therefore be given. However, integration of rehabilitation in disease management programmes could lead to changes in the alignment of German rehabilitation. The essence of German rehabilitation, notably its holistic approach, could get lost with integration in disease management programmes.

Polyurethane Foam Wound Dressing Technique for Areola Skin Graft Stabilization and Nipple Protection After Nipple-Areola Reconstruction.

PubMed

Satake, Toshihiko; Muto, Mayu; Nagashima, Yu; Haga, Shoko; Homma, Yuki; Nakasone, Reiko; Kadokura, Marina; Kou, Seiko; Fujimoto, Hiroshi; Maegawa, Jiro

2018-04-01

We describe a new wound management technique using a soft dressing material to stabilize the areola skin graft and protect the nipple after nipple-areola reconstruction at the final stage of breast reconstruction. We introduced a center-fenestrated multilayered hydrocellular polyurethane foam dressing material that provides adequate pressure and retains a moist environment for a smooth skin graft "take." Moreover, the reconstructed nipple can be monitored at any time through the fenestrated window for adequate blood circulation. Altogether, this simple and inexpensive wound dressing technique improves the clinical outcome. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Multiplexed Imaging of Protein Phosphorylation on Membranes Based on Ti(IV) Functionalized Nanopolymers.

PubMed

Iliuk, Anton; Li, Li; Melesse, Michael; Hall, Mark C; Tao, W Andy

2016-05-17

Accurate protein phosphorylation analysis reveals dynamic cellular signaling events not evident from protein expression levels. The most dominant biochemical assay, western blotting, suffers from the inadequate availability and poor quality of phospho-specific antibodies for phosphorylated proteins. Furthermore, multiplexed assays based on antibodies are limited by steric interference between the antibodies. Here we introduce a multifunctionalized nanopolymer for the universal detection of phosphoproteins that, in combination with regular antibodies, allows multiplexed imaging and accurate determination of protein phosphorylation on membranes. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

[In Process Citation].

PubMed

Akner, Gunnar; Järhult, Bengt

2016-05-17

The international trend »value-based care« (VbC) started with a book by Porter and Olmsted Teisberg in 2006 followed by Porter's 7-point proposal for value-based reform of health care in 2009. VbC may have relevance for delimited, procedure-related health problems with a foreseeable course of development. Most health problems in health care, however, do not involve such delimited problems. VbC is probably not suited as a steering model for chronic health conditions or for multiple health problems. VbC is being rapidly introduced to steer health care without scientific evidence.

Capacity limits in list item recognition: evidence from proactive interference.

PubMed

Cowan, Nelson; Johnson, Troy D; Saults, J Scott

2005-01-01

Capacity limits in short-term recall were investigated using proactive interference (PI) from previous lists in a speeded-recognition task. PI was taken to indicate that the target list length surpassed working memory capacity. Unlike previous studies, words were presented either concurrently or sequentially and a new method was introduced to increase the amount of PI. On average, participants retrieved about four items without PI. We suggest an activation-based account of capacity limits.

Effectiveness of the implementation of an evidence-based nursing model using participatory action research in oncohematology: research protocol.

PubMed

Abad-Corpa, Eva; Meseguer-Liza, Cristobal; Martínez-Corbalán, José Tomás; Zárate-Riscal, Lourdes; Caravaca-Hernández, Amor; Paredes-Sidrach de Cardona, Antonio; Carrillo-Alcaraz, Andrés; Delgado-Hito, Pilar; Cabrero-García, Julio

2010-08-01

To generate changes in nursing practice introducing an evidence-based clinical practice (EBCP) model through a participatory process. To evaluate the effectiveness of the changes in terms of nurse-sensitive outcome (NSO). For international nursing science, it is necessary to explore the reasons for supporting EBCP and evaluate the real repercussions and effectiveness. A mixed methods study with a sequential transformative design will be conducted in the bone marrow transplant unit of a tertiary-level Spanish hospital, in two time periods >12 months (date of approval of the protocol: 2006). To evaluate the effectiveness of the intervention, we will use a prospective quasi-experimental design with two non-equivalent and non-concurrent groups. NSO and patient health data will be collected: (a) impact of psycho-social adjustment; (b) patient satisfaction; (c) symptom control; (d) adverse effects. All patients admitted during the period of time will be included, and all staff working on the unit during a participatory action research (PAR). The PAR design will be adopted from a constructivist paradigm perspective, following Checkland's "Soft Systems" theoretical model. Qualitative techniques will be used: 2-hour group meetings with nursing professionals, to be recorded and transcribed. Field diaries (participants and researchers) will be drawn up and data analysis will be carried out by content analysis. PAR is a rigorous research method for introducing changes into practice to improve NSO.

Understanding the roles of faith-based health-care providers in Africa: review of the evidence with a focus on magnitude, reach, cost, and satisfaction.

PubMed

Olivier, Jill; Tsimpo, Clarence; Gemignani, Regina; Shojo, Mari; Coulombe, Harold; Dimmock, Frank; Nguyen, Minh Cong; Hines, Harrison; Mills, Edward J; Dieleman, Joseph L; Haakenstad, Annie; Wodon, Quentin

2015-10-31

At a time when many countries might not achieve the health targets of the Millennium Development Goals and the post-2015 agenda for sustainable development is being negotiated, the contribution of faith-based health-care providers is potentially crucial. For better partnership to be achieved and for health systems to be strengthened by the alignment of faith-based health-providers with national systems and priorities, improved information is needed at all levels. Comparisons of basic factors (such as magnitude, reach to poor people, cost to patients, modes of financing, and satisfaction of patients with the services received) within faith-based health-providers and national systems show some differences. As the first report in the Series on faith-based health care, we review a broad body of published work and introduce some empirical evidence on the role of faith-based health-care providers, with a focus on Christian faith-based health providers in sub-Saharan Africa (on which the most detailed documentation has been gathered). The restricted and diverse evidence reported supports the idea that faith-based health providers continue to play a part in health provision, especially in fragile health systems, and the subsequent reports in this Series review controversies in faith-based health care and recommendations for how public and faith sectors might collaborate more effectively. Copyright © 2015 Elsevier Ltd. All rights reserved.

Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: CHEST Guideline and Expert Panel Report.

PubMed

Wahidi, Momen M; Herth, Felix; Yasufuku, Kazuhiro; Shepherd, Ray Wesley; Yarmus, Lonny; Chawla, Mohit; Lamb, Carla; Casey, Kenneth R; Patel, Sheena; Silvestri, Gerard A; Feller-Kopman, David J

2016-03-01

Endobronchial ultrasound (EBUS) was introduced in the last decade, enabling real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures and parabronchial lung masses. The many publications produced about EBUS-TBNA have led to a better understanding of the performance characteristics of this procedure. The goal of this document was to examine the current literature on the technical aspects of EBUS-TBNA as they relate to patient, technology, and proceduralist factors to provide evidence-based and expert guidance to clinicians. Rigorous methodology has been applied to provide a trustworthy evidence-based guideline and expert panel report. A group of approved panelists developed key clinical questions by using the PICO (population, intervention, comparator, and outcome) format that addressed specific topics on the technical aspects of EBUS-TBNA. MEDLINE (via PubMed) and the Cochrane Library were systematically searched for relevant literature, which was supplemented by manual searches. References were screened for inclusion, and well-recognized document evaluation tools were used to assess the quality of included studies, to extract meaningful data, and to grade the level of evidence to support each recommendation or suggestion. Our systematic review and critical analysis of the literature on 15 PICO questions related to the technical aspects of EBUS-TBNA resulted in 12 statements: 7 evidence-based graded recommendations and 5 ungraded consensus-based statements. Three questions did not have sufficient evidence to generate a statement. Evidence on the technical aspects of EBUS-TBNA varies in strength but is satisfactory in certain areas to guide clinicians on the best conditions to perform EBUS-guided tissue sampling. Additional research is needed to enhance our knowledge regarding the optimal performance of this effective procedure. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Feeding in the first year of life - emerging benefits of introducing complementary solids from 4 months.

PubMed

Symon, Brian; Bammann, Michael

2012-04-01

Current World Health Organization guidelines recommend exclusive breastfeeding for the first 6 months of life. Breastfeeding conveys clear benefits to both mother and child. These benefits are likely to be amplified by prolonged feeding. This article outlines the emerging evidence that suggests possible benefits from introducing complementary solids from 4 months of age in developed countries. The human gut may have a critical early window during which it has an opportunity to develop immunological tolerance. Introducing complementary solids from 4 months of age may decrease the risk of food allergy and coeliac disease - immunological illnesses that have become a public health priority. The new draft National Health and Medical Research Council guidelines recommend introducing solids at around 6 months (22-26 weeks). However, given recent evidence, it may be appropriate to recommend the introduction of solids from 4 months of age in the Australian context.

Introducing memory and association mechanism into a biologically inspired visual model.

PubMed

Qiao, Hong; Li, Yinlin; Tang, Tang; Wang, Peng

2014-09-01

A famous biologically inspired hierarchical model (HMAX model), which was proposed recently and corresponds to V1 to V4 of the ventral pathway in primate visual cortex, has been successfully applied to multiple visual recognition tasks. The model is able to achieve a set of position- and scale-tolerant recognition, which is a central problem in pattern recognition. In this paper, based on some other biological experimental evidence, we introduce the memory and association mechanism into the HMAX model. The main contributions of the work are: 1) mimicking the active memory and association mechanism and adding the top down adjustment to the HMAX model, which is the first try to add the active adjustment to this famous model and 2) from the perspective of information, algorithms based on the new model can reduce the computation storage and have a good recognition performance. The new model is also applied to object recognition processes. The primary experimental results show that our method is efficient with a much lower memory requirement.

Robotics: The next step?

PubMed

Broeders, Ivo A M J

2014-02-01

Robotic systems were introduced 15 years ago to support complex endoscopic procedures. The technology is increasingly used in gastro-intestinal surgery. In this article, literature on experimental- and clinical research is reviewed and ergonomic issues are discussed. literature review was based on Medline search using a large variety of search terms, including e.g. robot(ic), randomized, rectal, oesophageal, ergonomics. Review articles on relevant topics are discussed with preference. There is abundant evidence of supremacy in performing complex endoscopic surgery tasks when using the robot in an experimental setting. There is little high-level evidence so far on translation of these merits to clinical practice. Robotic systems may appear helpful in complex gastro-intestinal surgery. Moreover, dedicated computer based technology integrated in telepresence systems opens the way to integration of planning, diagnostics and therapy. The first high tech add-ons such as near infrared technology are under clinical evaluation. Copyright © 2014 Elsevier Ltd. All rights reserved.

The adaptive safety analysis and monitoring system

NASA Astrophysics Data System (ADS)

Tu, Haiying; Allanach, Jeffrey; Singh, Satnam; Pattipati, Krishna R.; Willett, Peter

2004-09-01

The Adaptive Safety Analysis and Monitoring (ASAM) system is a hybrid model-based software tool for assisting intelligence analysts to identify terrorist threats, to predict possible evolution of the terrorist activities, and to suggest strategies for countering terrorism. The ASAM system provides a distributed processing structure for gathering, sharing, understanding, and using information to assess and predict terrorist network states. In combination with counter-terrorist network models, it can also suggest feasible actions to inhibit potential terrorist threats. In this paper, we will introduce the architecture of the ASAM system, and discuss the hybrid modeling approach embedded in it, viz., Hidden Markov Models (HMMs) to detect and provide soft evidence on the states of terrorist network nodes based on partial and imperfect observations, and Bayesian networks (BNs) to integrate soft evidence from multiple HMMs. The functionality of the ASAM system is illustrated by way of application to the Indian Airlines Hijacking, as modeled from open sources.

Current issues in the economics of vaccination against dengue.

PubMed

Tozan, Yesim

2016-01-01

Dengue is a major public health concern in tropical and subtropical areas of the world. The prospects for dengue prevention have recently improved with the results of efficacy trials of a tetravalent dengue vaccine. Although partially effective, once licensed, its introduction can be a public health priority in heavily affected countries because of the perceived public health importance of dengue. This review explores the most immediate economic considerations of introducing a new dengue vaccine and evaluates the published economic analyses of dengue vaccination. Findings indicate that the current economic evidence base is of limited utility to support country-level decisions on dengue vaccine introduction. There are a handful of published cost-effectiveness studies and no country-specific costing studies to project the full resource requirements of dengue vaccine introduction. Country-level analytical expertise in economic analyses, another gap identified, needs to be strengthened to facilitate evidence-based decision-making on dengue vaccine introduction in endemic countries.

Neonatal Feeding Behavior as a Complex Dynamical System.

PubMed

Goldfield, Eugene C; Perez, Jennifer; Engstler, Katherine

2017-04-01

The requirements of evidence-based practice in 2017 are motivating new theoretical foundations and methodological tools for characterizing neonatal feeding behavior. Toward that end, this article offers a complex dynamical systems perspective. A set of critical concepts from this perspective frames challenges faced by speech-language pathologists and allied professionals: when to initiate oral feeds, how to determine the robustness of neonatal breathing during feeding and appropriate levels of respiratory support, what instrumental assessments of swallow function to use with preterm neonates, and whether or not to introduce thickened liquids. In the near future, we can expect vast amounts of new data to guide evidence-based practice. But unless practitioners are able to frame these issues in a systems context larger than the individual child, the availability of "big data" will not be effectively translated to clinical practice. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

ICU nurses' oral-care practices and the current best evidence.

PubMed

DeKeyser Ganz, Freda; Fink, Naomi Farkash; Raanan, Ofra; Asher, Miriam; Bruttin, Madeline; Nun, Maureen Ben; Benbinishty, Julie

2009-01-01

The purpose of this study was to describe the oral-care practices of ICU nurses, to compare those practices with current evidence-based practice, and to determine if the use of evidence-based practice was associated with personal demographic or professional characteristics. A national survey of oral-care practices of ICU nurses was conducted using a convenience sample of 218 practicing ICU nurses in 2004-05. The survey instrument included questions about demographic and professional characteristics and a checklist of oral-care practices. Nurses rated their perceived level of priority concerning oral care on a scale from 0 to 100. A score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the current best evidence. This score was then statistically analyzed using ANOVA to determine differences of EBP based on demographic and professional characteristics. The most commonly used equipment was gauze pads (84%), followed by tongue depressors (55%), and toothbrushes (34%). Chlorhexidine was the most common solution used (75%). Less than half (44%) reported brushing their patients' teeth. The majority performed an oral assessment before beginning oral care (71%); however, none could describe what assessment tool was used. Only 57% of nurses reported documenting their oral care. Nurses rated oral care of intubated patients with a priority of 67+/-27.1. Wide variations were noted within and between units in terms of which techniques, equipment, and solutions were used. No significant relationships were found between the use of an evidence-based protocol and demographic and professional characteristics or with the priority given to oral care. While nurses ranked oral care a high priority, many did not implement the latest evidence into their current practice. The level of research utilization was not related to personal or professional characteristics. Therefore attempts should be made to encourage all ICU nurses to introduce and use evidence-based, oral-care protocols. Practicing ICU nurses in this survey were often not adhering to the latest evidence-based practice and therefore need to be educated and encouraged to do so in order to improve patient care.

Contemporary evolution during invasion: evidence for differentiation, natural selection, and local adaptation.

PubMed

Colautti, Robert I; Lau, Jennifer A

2015-05-01

Biological invasions are 'natural' experiments that can improve our understanding of contemporary evolution. We evaluate evidence for population differentiation, natural selection and adaptive evolution of invading plants and animals at two nested spatial scales: (i) among introduced populations (ii) between native and introduced genotypes. Evolution during invasion is frequently inferred, but rarely confirmed as adaptive. In common garden studies, quantitative trait differentiation is only marginally lower (~3.5%) among introduced relative to native populations, despite genetic bottlenecks and shorter timescales (i.e. millennia vs. decades). However, differentiation between genotypes from the native vs. introduced range is less clear and confounded by nonrandom geographic sampling; simulations suggest this causes a high false-positive discovery rate (>50%) in geographically structured populations. Selection differentials (¦s¦) are stronger in introduced than in native species, although selection gradients (¦β¦) are not, consistent with introduced species experiencing weaker genetic constraints. This could facilitate rapid adaptation, but evidence is limited. For example, rapid phenotypic evolution often manifests as geographical clines, but simulations demonstrate that nonadaptive trait clines can evolve frequently during colonization (~two-thirds of simulations). Additionally, QST-FST studies may often misrepresent the strength and form of natural selection acting during invasion. Instead, classic approaches in evolutionary ecology (e.g. selection analysis, reciprocal transplant, artificial selection) are necessary to determine the frequency of adaptive evolution during invasion and its influence on establishment, spread and impact of invasive species. These studies are rare but crucial for managing biological invasions in the context of global change. © 2015 John Wiley & Sons Ltd.

Hybrid Evidence Theory-based Finite Element/Statistical Energy Analysis method for mid-frequency analysis of built-up systems with epistemic uncertainties

NASA Astrophysics Data System (ADS)

Yin, Shengwen; Yu, Dejie; Yin, Hui; Lü, Hui; Xia, Baizhan

2017-09-01

Considering the epistemic uncertainties within the hybrid Finite Element/Statistical Energy Analysis (FE/SEA) model when it is used for the response analysis of built-up systems in the mid-frequency range, the hybrid Evidence Theory-based Finite Element/Statistical Energy Analysis (ETFE/SEA) model is established by introducing the evidence theory. Based on the hybrid ETFE/SEA model and the sub-interval perturbation technique, the hybrid Sub-interval Perturbation and Evidence Theory-based Finite Element/Statistical Energy Analysis (SIP-ETFE/SEA) approach is proposed. In the hybrid ETFE/SEA model, the uncertainty in the SEA subsystem is modeled by a non-parametric ensemble, while the uncertainty in the FE subsystem is described by the focal element and basic probability assignment (BPA), and dealt with evidence theory. Within the hybrid SIP-ETFE/SEA approach, the mid-frequency response of interest, such as the ensemble average of the energy response and the cross-spectrum response, is calculated analytically by using the conventional hybrid FE/SEA method. Inspired by the probability theory, the intervals of the mean value, variance and cumulative distribution are used to describe the distribution characteristics of mid-frequency responses of built-up systems with epistemic uncertainties. In order to alleviate the computational burdens for the extreme value analysis, the sub-interval perturbation technique based on the first-order Taylor series expansion is used in ETFE/SEA model to acquire the lower and upper bounds of the mid-frequency responses over each focal element. Three numerical examples are given to illustrate the feasibility and effectiveness of the proposed method.

[Evidence-based medicine: modern scientific methods for determining usefulness].

PubMed

Schmidt, J G

1999-01-01

For quite some time, clinical epidemiology has introduced the art of critical appraisal of evidence as well as the methods of how to design sound clinical studies and trials. Almost unnoticed by most medical institutions a new hierarchy of evidence has emerged which puts well thought out trials, able to document unbiased treatment benefit in terms of patient suffering, above pathophysiological theory. Many controlled trials have shown, in the meantime, that the control of laboratory or other kind of pathologies and the correction of anatomical abnormalities do not necessarily mean a benefit for the patient. Concepts relating to this dissection of evidence include: Surrogate fallacy ("cosmetics" of laboratory results or ligament or cartilage "cosmetics" in surgery), confounding (spurious causal relationships), selection bias (comparison with selected groups) as well as lead-time bias (mistaking earlier diagnosis as increase of survival), length bias (overlooking differences in the aggressiveness of diseases as determinants of disease stage distributions) and overdiagnosis bias (mistaking the increasing detection of clinically silent pathologies as improvement of prognosis). Moreover, absolute instead of relative risk reduction needs to be used to measure patient benefit. The incorporation of decision-analysis and of the concepts or clinical epidemiology will improve the efficiency and quality of medicine much more effectively than the sole focus on technical medical performance. Evidence based medicine is the systematic and critical appraisal of medical interventions, based on the understanding how to avoid the fallacies and biases mentioned.

Is life satisfaction hump-shaped with alcohol consumption? Evidence from Russian panel data.

PubMed

Massin, Sophie; Kopp, Pierre

2014-04-01

There has been a growing interest in the study of the shape of the relationship between alcohol consumption and psychological well-being in recent years. Overall, evidence is however still mixed and debated, the type of measures and methods of analysis having been emphasized as key elements in these studies. This paper contributes to this debate by providing new evidence relying on a large-scale population-based study. We used the Russia Longitudinal Monitoring Survey to build an unbalanced panel of 17,953 individuals providing 97,973 observations throughout 10 rounds. We studied the shape of the relationship between alcohol consumption (defined in grams of pure alcohol consumed in the last 30 days) and life satisfaction (measured by a five-item scale) by running a set of regressions. We successively introduced a large number of control variables (age, gender, marital status, occupation, income, health condition, education, living area, smoking status, and body mass index) and individual fixed effects in order to take both potential confounders and unobserved individual heterogeneity into account. Unadjusted analyses indicated a clear hump-shaped relationship between life satisfaction and alcohol use. The association was inverse J-shaped among men and inverse U-shaped among women. When control variables and individual fixed effects were introduced, the hump-shaped curve became increasingly flattened in all samples. Among women, all specifications (linear, quadratic and based on quartile dummies) turned non-significant. The quadratic specification for alcohol use remained however significant in the full sample and among men. In addition, in these two samples, being a fourth quartile drinker was negatively associated with satisfaction. Copyright © 2014 Elsevier Ltd. All rights reserved.

Evidence-Based Policy and Practice Leads to Changes in the Criteria for MSM to Donate Blood.

PubMed

Slowther, Anne; Watkins, Nicholas A; Kelly, Deirdre

2013-06-01

On November 7, 2011, the permanent deferral from blood donation of men who have sex with men (MSM) changed in England, Scotland and Wales, to a 12-month deferral since last relevant sexual contact. This change was made following an evidence-based policy review by the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO). The review concluded that the available evidence supported the introduction of a 12-month fixed period deferral and that the risks associated with a 12-month deferral of MSM were equivalent to a permanent deferral. The permanent deferral for MSM was introduced in 1985 in response to the spread of acquired immunodeficiency syndrome (AIDS) caused by HIV. The change was supported by new data on the level of compliance with the permanent deferral, advances in the testing and processing of donated blood, changes in the epidemiology of sexually transmitted infections (STIs) and improved scientific knowledge. This review discusses how the decision to change the deferral period was reached and highlights some of the remaining issues relating to this contentious matter.

Physician-perceived contradictions in end-of-life communication: toward a self-report measurement scale.

PubMed

Amati, Rebecca; Hannawa, Annegret F

2015-01-01

Communication is undoubtedly a critical element of competent end-of-life care. However, physicians commonly lack communication skills in this particular care context. Theoretically grounded, evidence-based guidelines are needed to enhance physicians' communication with patients and their families in this important time of their lives. To address this need, this study tests and validates a Contradictions in End-of-Life Communication (CEOLC) scale, which disentangles the relational contradictions physicians commonly experience when communicating with end-of-life patients. Exploratory factors analysis confirmed the presence of eight physician-perceived dialectical tensions, reflecting three latent factors of (1) integration, (2) expression, and (3) dominance. Furthermore, a number of significant intercultural differences were found in cross-cultural comparisons of the scale in U.S., Swiss, and Italian physician samples. Thus, this investigation introduces a heuristic assessment tool that aids a better understanding of the dialectical contradictions physicians experience in their interactions with end-of-life patients. The CEOLC scale can be used to gather empirical evidence that may eventually support the development of evidence-based guidelines and skills training toward improved end-of-life care.

The role of the physical environment in crossing the quality chasm.

PubMed

Henriksen, Kerm; Isaacson, Sandi; Sadler, Blair L; Zimring, Craig M

2007-11-01

Evidence-based design findings are available to help inform hospital decision makers of opportunities for ensuring that quality and safety are designed into new and refurbished facilities. The Institute of Medicine's six quality aims of patient centeredness, safety, effectiveness, efficiency, timeliness, and equity provide an organizing framework for introducing a representative portion of the evidence. Design improvements include single-bed and variable-acuity rooms; electronic access to medical records; greater accommodation for families and visitors; handrails to prevent patient falls; standardization (room layout, equipment, and supplies for improved efficiencies); improved work process flow to reduce delays and wait times; and better assessment of changing demographics, disease conditions, and community needs for appropriately targeted health care services. A recent analysis of the business case suggests that a slight, one-time incremental cost for ensuring safety and quality would be paid back in two to three years in the form of operational savings and increased revenues. Hospitals leaders anticipating new construction projects should take advantage of evidence-based design findings that have the potential of raising the quality of acute care for decades to come.

Evolving reimbursement and pricing policies for devices in Europe and the United States should encourage greater value.

PubMed

Sorenson, Corinna; Drummond, Michael; Burns, Lawton R

2013-04-01

Rising health care costs are an international concern, particularly in the United States, where spending on health care outpaces that of other industrialized countries. Consequently, there is growing desire in the United States and Europe to take a more value-based approach to health care, particularly with respect to the adoption and use of new health technology. This article examines medical device reimbursement and pricing policies in the United States and Europe, with a particular focus on value. Compared to the United States, Europe more formally and consistently considers value to determine which technologies to cover and at what price, especially for complex, costly devices. Both the United States and Europe have introduced policies to provide temporary coverage and reimbursement for promising technologies while additional evidence of value is generated. But additional actions are needed in both the United States and Europe to ensure wise value-based reimbursement and pricing policies for all devices, including the generation of better pre- and postmarket evidence and the development of new methods to evaluate value and link evidence of value to reimbursement.

Development and impact of computerised decision support systems for clinical management of depression: A systematic review.

PubMed

Triñanes, Yolanda; Atienza, Gerardo; Louro-González, Arturo; de-las-Heras-Liñero, Elena; Alvarez-Ariza, María; Palao, Diego J

2015-01-01

One of the proposals for improving clinical practice is to introduce computerised decision support systems (CDSS) and integrate these with electronic medical records. Accordingly, this study sought to systematically review evidence on the effectiveness of CDSS in the management of depression. A search was performed in Medline, EMBASE and PsycInfo, in order to do this. The quality of quantitative studies was assessed using the SIGN method, and qualitative studies using the CASPe checklist. Seven studies were identified (3 randomised clinical trials, 3 non-randomised trials, and one qualitative study). The CDSS assessed incorporated content drawn from guidelines and other evidence-based products. In general, the CDSS had a positive impact on different aspects, such as the screening and diagnosis, treatment, improvement in depressive symptoms and quality of life, and referral of patients. The use of CDSS could thus serve to optimise care of depression in various scenarios by providing recommendations based on the best evidence available and facilitating decision-making in clinical practice. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

Mixed methods research in music therapy research.

PubMed

Bradt, Joke; Burns, Debra S; Creswell, John W

2013-01-01

Music therapists have an ethical and professional responsibility to provide the highest quality care possible to their patients. Much of the time, high quality care is guided by evidence-based practice standards that integrate the most current, available research in making decisions. Accordingly, music therapists need research that integrates multiple ways of knowing and forms of evidence. Mixed methods research holds great promise for facilitating such integration. At this time, there have not been any methodological articles published on mixed methods research in music therapy. The purpose of this article is to introduce mixed methods research as an approach to address research questions relevant to music therapy practice. This article describes the core characteristics of mixed methods research, considers paradigmatic issues related to this research approach, articulates major challenges in conducting mixed methods research, illustrates four basic designs, and provides criteria for evaluating the quality of mixed methods articles using examples of mixed methods research from the music therapy literature. Mixed methods research offers unique opportunities for strengthening the evidence base in music therapy. Recommendations are provided to ensure rigorous implementation of this research approach.

Teaching Vectors Through an Interactive Game Based Laboratory

NASA Astrophysics Data System (ADS)

O'Brien, James; Sirokman, Gergely

2014-03-01

In recent years, science and particularly physics education has been furthered by the use of project based interactive learning [1]. There is a tremendous amount of evidence [2] that use of these techniques in a college learning environment leads to a deeper appreciation and understanding of fundamental concepts. Since vectors are the basis for any advancement in physics and engineering courses the cornerstone of any physics regimen is a concrete and comprehensive introduction to vectors. Here, we introduce a new turn based vector game that we have developed to help supplement traditional vector learning practices, which allows students to be creative, work together as a team, and accomplish a goal through the understanding of basic vector concepts.

Constraint-Induced Movement Therapy after Stroke

PubMed Central

Kwakkel, Gert; Veerbeek, Janne M.; van Wegen, Erwin E.H.; Wolf, Steven L.

2015-01-01

Constraint-induced movement therapy (CIMT) was developed to overcome upper limb impairments after stroke and is the most investigated intervention for treating stroke patients in the previous decades. This review describes the current evidence regarding: original CIMT and modified versions of CIMT (mCIMT). Meta-analysis showed strong evidence favoring both types of CIMT in terms of motor function, arm-hand activities and self-reported arm-hand functioning in daily life, immediately after treatment and at long-term follow-up, whereas no evidence was found for constraining alone (Forced Use (FU) therapy). No evidence was found that type of CIMT, intensity of practice or timing did affect outcome. Although the underlying mechanism that drive (m)CIMT is still poorly understood, recent kinematic conducted studies suggests that improvements introduced by original CIMT or mCIMT are mainly based on adaptation by learning to optimize the use of intact end-effectors by selecting patients with some voluntary motor control of wrist and finger extensors post stroke. PMID:25772900

Promoting physical therapists' of research evidence to inform clinical practice: part 1--theoretical foundation, evidence, and description of the PEAK program.

PubMed

Tilson, Julie K; Mickan, Sharon

2014-06-25

There is a need for theoretically grounded and evidence-based interventions that enhance the use of research evidence in physical therapist practice. This paper and its companion paper introduce the Physical therapist-driven Education for Actionable Knowledge translation (PEAK) program, an educational program designed to promote physical therapists' integration of research evidence into clinical decision-making. The pedagogical foundations for the PEAK educational program include Albert Bandura's social cognitive theory and Malcolm Knowles's adult learning theory. Additionally, two complementary frameworks of knowledge translation, the Promoting Action on Research Implementation in Health Services (PARiHS) and Knowledge to Action (KTA) Cycle, were used to inform the organizational elements of the program. Finally, the program design was influenced by evidence from previous attempts to facilitate the use of research in practice at the individual and organizational levels. The 6-month PEAK program consisted of four consecutive and interdependent components. First, leadership support was secured and electronic resources were acquired and distributed to participants. Next, a two-day training workshop consisting of didactic and small group activities was conducted that addressed the five steps of evidence based practice. For five months following the workshop, participants worked in small groups to review and synthesize literature around a group-selected area of common clinical interest. Each group contributed to the generation of a "Best Practices List" - a list of locally generated, evidence-based, actionable behaviors relevant to the groups' clinical practice. Ultimately, participants agreed to implement the Best Practices List in their clinical practice. This, first of two companion papers, describes the underlying pedagogical theories, knowledge translation frameworks, and research evidence used to derive the PEAK program - an educational program designed to promote the use of research evidence to inform physical therapist practice. The four components of the program are described in detail. The companion paper reports the results of a mixed methods feasibility analysis of this complex educational intervention.

42 CFR 426.440 - Evidence.

Code of Federal Regulations, 2013 CFR

2013-10-01

... proprietary data, but must maintain it under seal. (d) The ALJ may permit the parties to introduce the... other evidence offered or taken for the record are open to examination by all parties. ...

Weaning Time in Preterm Infants: An Audit of Italian Primary Care Paediatricians.

PubMed

Baldassarre, Maria Elisabetta; Di Mauro, Antonio; Pedico, Annarita; Rizzo, Valentina; Capozza, Manuela; Meneghin, Fabio; Lista, Gianluca; Laforgia, Nicola

2018-05-15

According to the 2016 Italian National Institute of Statistics (Istat) data in Italy, about 6.7% of all newborns are born prematurely. Due to the lack of data on current complementary feeding in preterm infants in Italy, the aim of the survey was to evaluate individual attitudes of primary care paediatricians, concerning the introduction of complementary foods in preterm infants. An internet-based survey was conducted among primary care paediatricians, working in Italy, regarding (1) timing of the introduction of complementary foods to preterm newborns; (2) type of complementary foods introduced; (3) vitamin D and iron supplementations. A total of 347 primary care Italian paediatricians answered the questionnaire; 44% of responders based the timing of the introduction of solid food exclusively on an infant's age, 18% on an infant's neurodevelopmental status and 4% on the body weight; the remaining 34% based the timing on two or more of these aspects. The type of complementary foods did not comply with an evidence-based sequence; 98% of participants promoted vitamin D supplementation and 89% promoted iron supplementation with great diversity in timing and doses. Due to limited evidence, there is a great heterogeneity in the attitudes of primary care paediatricians concerning the introduction of complementary foods to preterm newborns. Further research is needed to provide evidence-based guidelines regarding weaning preterm newborns.

Introducing Information Literacy Competency Standards for Nursing.

PubMed

Phelps, Sue F; Hyde, Loree; Planchon Wolf, Julie

2015-01-01

The Association for College and Research Libraries published the Information Literacy Competency Standards for Nursing (ILCSN) in January 2014, written by a task force of the Health Sciences Interest Group of the American Library Association. The ILCSN describes skills ranging from basic to advanced information research competencies for students enrolled in nursing programs at all levels and for professional nurses. This article guides administrators and faculty in use of the standards to design programs and coursework in information skills to support evidence-based practice.

Stimulating a Culture of Improvement: Introducing 
an Integrated Quality Tool for Organizational Self-Assessment.

PubMed

Coleman, Cathy

2015-06-01

As leaders and systems-level agents of change, oncology nurses are challenged by opportunities to guide organizational transformation from the front line to the board room. Across all care settings, reform and change initiatives are constants in the quest to optimize quality and healthcare outcomes for individuals, teams, populations, and organizations. This article describes a practical, evidence-based, integrated quality tool for initiating organizational self-assessment to prioritize issues and stimulate a culture of continuous improvement.

Introducing early medical abortion in Australia: there is a need to update abortion laws.

PubMed

de Costa, Caroline M; Russell, Darren B; de Costa, Naomi R; Carrette, Michael; McNamee, Heather M

2007-12-01

Recent changes to Federal Therapeutic Goods Administration legislation have seen the limited introduction of the drug mifepristone to Australia for the purpose of early medical abortion. At the same time it has become evident that both methotrexate and misoprostol, licenced and available for other indications, are being used safely and appropriately for early abortion by Australian medical practitioners. Early medical abortion is widely practiced overseas where its safety and effectiveness are well supported by current evidence. However, abortion law in many states is still contained within the Criminal Codes and does not reflect current evidence-based abortion practice. In other states and territories restrictions on where abortions may be performed pose potential barriers to the introduction of mifepristone for medical abortion. There is an urgent need for abortion law to be clarified and made uniform across the country so that the best possible services can be provided to Australian women.

39 CFR 3001.25 - Discovery-general policy.

Code of Federal Regulations, 2010 CFR

2010-07-01

... only from the Postal Service. Discovery requests of this nature are permissible only for the purpose of... participant from introducing designated matters in evidence, or strike the evidence, complaint or pleadings or...

Executive and Perceptual Distraction in Visual Working Memory

PubMed Central

2017-01-01

The contents of visual working memory are likely to reflect the influence of both executive control resources and information present in the environment. We investigated whether executive attention is critical in the ability to exclude unwanted stimuli by introducing concurrent potentially distracting irrelevant items to a visual working memory paradigm, and manipulating executive load using simple or more demanding secondary verbal tasks. Across 7 experiments varying in presentation format, timing, stimulus set, and distractor number, we observed clear disruptive effects of executive load and visual distraction, but relatively minimal evidence supporting an interactive relationship between these factors. These findings are in line with recent evidence using delay-based interference, and suggest that different forms of attentional selection operate relatively independently in visual working memory. PMID:28414499

Einstein's conversion from his static to an expanding universe

NASA Astrophysics Data System (ADS)

Nussbaumer, Harry

2014-02-01

In 1917 Einstein initiated modern cosmology by postulating, based on general relativity, a homogenous, static, spatially curved universe. To counteract gravitational contraction he introduced the cosmological constant. In 1922 Alexander Friedman showed that Albert Einstein's fundamental equations also allow dynamical worlds, and in 1927 Georges Lemaître, backed by observational evidence, concluded that our universe was expanding. Einstein impetuously rejected Friedman's as well as Lemaître's findings. However, in 1931 he retracted his former static model in favour of a dynamic solution. This investigation follows Einstein on his hesitating path from a static to the expanding universe. Contrary to an often advocated belief the primary motive for his switch was not observational evidence, but the realisation that his static model was unstable.

Modern adjuncts and technologies in microsurgery: an historical and evidence-based review.

PubMed

Pratt, George F; Rozen, Warren M; Chubb, Daniel; Whitaker, Iain S; Grinsell, Damien; Ashton, Mark W; Acosta, Rafael

2010-11-01

While modern reconstructive surgery was revolutionized with the introduction of microsurgical techniques, microsurgery itself has seen the introduction of a range of technological aids and modern techniques aiming to improve dissection times, anastomotic times, and overall outcomes. These include improved preoperative planning, anastomotic aides, and earlier detection of complications with higher salvage rates. Despite the potential for substantial impact, many of these techniques have been evaluated in a limited fashion, and the evidence for each has not been universally explored. The purpose of this review was to establish and quantify the evidence for each technique. A search of relevant medical databases was performed to identify literature providing evidence for each technology. Levels of evidence were thus accumulated and applied to each technique. There is a relative paucity of evidence for many of the more recent technologies described in the field of microsurgery, with no randomized controlled trials, and most studies in the field comprising case series only. Current evidence-based suggestions include the use of computed tomographic angiography (CTA) for the preoperative planning of perforator flaps, the intraoperative use of a mechanical anastomotic coupling aide (particularly the Unilink® coupler), and postoperative flap monitoring with strict protocols using clinical bedside monitoring and/or the implantable Doppler probe. Despite the breadth of technologies introduced into the field of microsurgery, there is substantial variation in the degree of evidence presented for each, suggesting the role for much future research, particularly from emerging technologies such as robotics and modern simulators. Copyright © 2010 Wiley-Liss, Inc.

Larvivorous fish for preventing malaria transmission

PubMed Central

Walshe, Deirdre P; Garner, Paul; Abdel-Hameed Adeel, Ahmed A; Pyke, Graham H; Burkot, Tom

2013-01-01

Background Adult anopheline mosquitoes transmit Plasmodium parasites that cause malaria. Some fish species eat mosquito larvae and pupae. In disease control policy documents, the World Health Organization includes biological control of malaria vectors by stocking ponds, rivers, and water collections near where people live with larvivorous fish to reduce Plasmodium parasite transmission. The Global Fund finances larvivorous fish programmes in some countries, and, with increasing efforts in eradication of malaria, policy makers may return to this option. We therefore assessed the evidence base for larvivorous fish programmes in malaria control. Objectives Our main objective was to evaluate whether introducing larvivorous fish to anopheline breeding sites impacts Plasmodium parasite transmission. Our secondary objective was to summarize studies evaluating whether introducing larvivorous fish influences the density and presence of Anopheles larvae and pupae in water sources, to understand whether fish can possibly have an effect. Search methods We attempted to identify all relevant studies regardless of language or publication status (published, unpublished, in press, or ongoing). We searched the following databases: the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE; EMBASE; CABS Abstracts; LILACS; and the metaRegister of Controlled Trials (mRCT) until 18 June 2013. We checked the reference lists of all studies identified by the above methods. We also examined references listed in review articles and previously compiled bibliographies to look for eligible studies. Selection criteria Randomized controlled trials and non-randomized controlled trials, including controlled before-and-after studies, controlled time series and controlled interrupted time series studies from malaria-endemic regions that introduced fish as a larvicide and reported on malaria in the community or the density of the adult anopheline population. In the absence of direct evidence of an effect on transmission, we carried out a secondary analysis on studies that evaluated the effect of introducing larvivorous fish on the density or presence of immature anopheline mosquitoes (larvae and pupae forms) in community water sources to determine whether this intervention has any potential in further research on control of malaria vectors. Data collection and analysis Three review authors screened abstracts and examined potentially relevant studies by using an eligibility form. Two review authors independently extracted data and assessed risk of bias of included studies. If relevant data were unclear or were not reported, we wrote to the trial authors for clarification. We presented data in tables, and we summarized studies that evaluated the effects of fish introduction on anopheline immature density or presence, or both. We used GRADE to summarize evidence quality. We also examined whether the authors of included studies reported on any possible adverse impact of larvivorous fish introduction on non-target native species. Main results We found no reliable studies that reported the effects of introducing larvivorous fish on malaria infection in nearby communities, on entomological inoculation rate, or on adult Anopheles density. For the secondary analysis, we examined the effects of introducing larvivorous fish on the density and presence of anopheline larvae and pupae in community water sources. We included 12 small studies, with follow-up from 22 days to five years. Studies were conducted in a variety of settings, including localized water bodies (such as wells, domestic water containers, fishponds, and pools; six studies), riverbed pools below dams (two studies), rice field plots (three studies), and water canals (two studies). All studies were at high risk of bias. The research was insufficient to determine whether larvivorous fish reduce the density of Anopheles larvae and pupae (nine studies, unpooled data, very low quality evidence). Some studies with high stocking levels of fish seemed to arrest the increase in immature anopheline populations, or to reduce the number of immature anopheline mosquitoes, compared with controls. However, this finding was not consistent, and in studies that showed a decrease in immature anopheline populations, the effect was not consistently sustained. Larvivorous fish may reduce the number of water sources withAnopheles larvae and pupae (five studies, unpooled data, low quality evidence). None of the included studies reported effects of larvivorous fish on local native fish populations or other species. Authors' conclusions Reliable research is insufficient to show whether introducing larvivorous fish reduces malaria transmission or the density of adult anopheline mosquito populations. In research examining the effects on immature anopheline stages of introducing fish to potential malaria vector breeding sites (localized water bodies such as wells and domestic water sources, rice field plots, and water canals) weak evidence suggests an effect on the density or presence of immature anopheline mosquitoes with high stocking levels of fish, but this finding is by no means consistent. We do not know whether this translates into health benefits, either with fish alone or with fish combined with other vector control measures. Our interpretation of the current evidence is that countries should not invest in fish stocking as a larval control measure in any malaria transmission areas outside the context of carefully controlled field studies or quasi-experimental designs. Research could also usefully examine the effects on native fish and other non-target species. PLAIN LANGUAGE SUMMARY Fish that feed on mosquito larvae for preventing malaria transmission Plasmodium parasites cause malaria and are transmitted by adult Anopheles mosquitoes. Programmes that introduce fish into water sources near where people live have been promoted. The theory is that these fish eat the Anopheles mosquito larvae and pupae, thus decreasing the adult mosquito population and reducing the number of people infected with Plasmodium parasites. In this review, we examined the research that evaluated introducing larvivorous fish to Anopheles mosquito breeding sites in areas where malaria was common, published up to 18 June 2013. We did not find any studies that looked at the effects of larvivorous fish on adult Anopheles mosquito populations or on the number of people infected with Plasmodium parasites. We included 12 studies that examined the effects of larvivorous fish on Anopheles larvae and pupae in different breeding sites, including localized water bodies (such as wells, domestic water containers, fishponds, and pools; six studies), riverbed pools below dams (two studies), rice field plots (three studies), and water canals (two studies). Research evidence is insufficient to show whether introduction of larvivorous fish reduces the number of Anopheles larvae and pupae in water sources (nine studies, unpooled data, very low quality evidence). However, larvivorous fish may reduce the number of water sources withAnopheles mosquito larvae and pupae (five studies, unpooled data, low quality evidence). None of the included studies examined the effects of introducing larvivorous fish on other native species present, but these studies were not designed to do this. Before much is invested in this intervention, better research is needed to determine the effect of introducing larvivorous fish on adult Anopheles populations and on the number of people infected with malaria. Researchers need to use robust controlled designs with an adequate number of sites. Also, researchers should explore whether introducing these fish affects native fish and other non-target species. PMID:24323308

High variability impairs motor learning regardless of whether it affects task performance.

PubMed

Cardis, Marco; Casadio, Maura; Ranganathan, Rajiv

2018-01-01

Motor variability plays an important role in motor learning, although the exact mechanisms of how variability affects learning are not well understood. Recent evidence suggests that motor variability may have different effects on learning in redundant tasks, depending on whether it is present in the task space (where it affects task performance) or in the null space (where it has no effect on task performance). We examined the effect of directly introducing null and task space variability using a manipulandum during the learning of a motor task. Participants learned a bimanual shuffleboard task for 2 days, where their goal was to slide a virtual puck as close as possible toward a target. Critically, the distance traveled by the puck was determined by the sum of the left- and right-hand velocities, which meant that there was redundancy in the task. Participants were divided into five groups, based on both the dimension in which the variability was introduced and the amount of variability that was introduced during training. Results showed that although all groups were able to reduce error with practice, learning was affected more by the amount of variability introduced rather than the dimension in which variability was introduced. Specifically, groups with higher movement variability during practice showed larger errors at the end of practice compared with groups that had low variability during learning. These results suggest that although introducing variability can increase exploration of new solutions, this may adversely affect the ability to retain the learned solution. NEW & NOTEWORTHY We examined the role of introducing variability during motor learning in a redundant task. The presence of redundancy allows variability to be introduced in different dimensions: the task space (where it affects task performance) or the null space (where it does not affect task performance). We found that introducing variability affected learning adversely, but the amount of variability was more critical than the dimension in which variability was introduced.

42 CFR 426.540 - Evidence.

Code of Federal Regulations, 2011 CFR

2011-10-01

... data, but must maintain it under seal. (d) The Board may permit the parties to introduce the testimony..., all documents and other evidence offered or taken for the record is open to examination by all parties. ...

42 CFR 426.540 - Evidence.

Code of Federal Regulations, 2013 CFR

2013-10-01

... proprietary data, but must maintain it under seal. (d) The Board may permit the parties to introduce the..., all documents and other evidence offered or taken for the record is open to examination by all parties. ...

How market structure drives commodity prices

NASA Astrophysics Data System (ADS)

Li, Bin; Wong, K. Y. Michael; Chan, Amos H. M.; So, Tsz Yan; Heimonen, Hermanni; Wei, Junyi; Saad, David

2017-11-01

We introduce an agent-based model, in which agents set their prices to maximize profit. At steady state the market self-organizes into three groups: excess producers, consumers and balanced agents, with prices determined by their own resource level and a couple of macroscopic parameters that emerge naturally from the analysis, akin to mean-field parameters in statistical mechanics. When resources are scarce prices rise sharply below a turning point that marks the disappearance of excess producers. To compare the model with real empirical data, we study the relationship between commodity prices and stock-to-use ratios in a range of commodities such as agricultural products and metals. By introducing an elasticity parameter to mitigate noise and long-term changes in commodities data, we confirm the trend of rising prices, provide evidence for turning points, and indicate yield points for less essential commodities.

Implementing scientific evidence to improve the quality of Child Protection

PubMed Central

Cowley, Laura; Tempest, Vanessa; Maguire, Sabine; Mann, Mala; Naughton, Aideen; Wain, Laura; Kemp, Alison

2013-01-01

In contrast to other areas of medical practice, there was a lack of a clear, concise and accessible synthesis of scientific literature to aid the recognition and investigation of suspected child abuse, and no national training program or evidence based guidelines for clinicians. The project's aim was to identify the current scientific evidence for the recognition and investigation of suspected child abuse and neglect and to disseminate and introduce this into clinical practice. Since 2003 a comprehensive program of Systematic Reviews of all aspects of physical abuse, emotional abuse, and neglect of children, has been developed. Based on NHS Centre for Reviews and Dissemination standards, methodology was devised and reviewers trained. Dissemination was via peer reviewed publications, a series of leaflets highlighting key points in a Question and Answer format, and a website. To date, 21 systematic reviews have been completed, generating 28 peer reviewed publications, and six leaflets around each theme (eg fractures, bruising). More than 250,000 have been distributed to date. Our website generates more than 10,000 hits monthly. It hosts primary reviews that are updated annually, links to all included studies, publications, and detailed methodology. The reviews have directly informed five national clinical guidelines, and the first evidence based training in Child Maltreatment. Child abuse is every health practitioner's responsibility, and it is vital that the decisions made are evidence based, as it is expected in all other fields of medicine. Although challenging, this project demonstrates that it is possible to conduct high quality systematic reviews in this field. For the first time a clear concise synthesis of up to date scientific evidence is available to all practitioners in a range of accessible formats. This has underpinned high quality national guidance and training programs. It ensures all professionals have the appropriate knowledge base in this difficult and challenging field. PMID:26734183

Standardised (plain) packaging: the time for implementation has come.

PubMed

Hoek, Janet; Edwards, Richard; Daube A O, Mike

2015-07-03

Although a growing number of countries have passed legislation to introduce standardised (or 'plain') packaging, New Zealand's legislation is currently stalled. The research evidence supporting standardised packaging is strong. Furthermore, evaluations from Australia, the first country to introduce this measure, show standardised packaging is reducing the appeal of smoking. Tobacco consumption in Australia has also fallen since the introduction of standardised packaging. The government should reassert its commitment to New Zealand's Smokefree 2025 goal by recognising the Australian evidence and passing and implementing standardised packaging as soon as possible.

Human Inspired Self-developmental Model of Neural Network (HIM): Introducing Content/Form Computing

NASA Astrophysics Data System (ADS)

Krajíček, Jiří

This paper presents cross-disciplinary research between medical/psychological evidence on human abilities and informatics needs to update current models in computer science to support alternative methods for computation and communication. In [10] we have already proposed hypothesis introducing concept of human information model (HIM) as cooperative system. Here we continue on HIM design in detail. In our design, first we introduce Content/Form computing system which is new principle of present methods in evolutionary computing (genetic algorithms, genetic programming). Then we apply this system on HIM (type of artificial neural network) model as basic network self-developmental paradigm. Main inspiration of our natural/human design comes from well known concept of artificial neural networks, medical/psychological evidence and Sheldrake theory of "Nature as Alive" [22].

An introduced Asian parasite threatens northeastern Pacific estuarine ecosystems

USDA-ARS?s Scientific Manuscript database

We test a prevalent assumption in marine ecology that species are native to where they are found until contrary evidence appears. The native assumption significantly biases interpretations of marine community and ecosystem dynamics if it results in oversight of critically important introduced specie...

Developing evidence-based librarianship: practical steps for implementation.

PubMed

Crumley, Ellen; Koufogiannakis, Denise

2002-06-01

Evidence-based librarianship (EBL) is a relatively new concept for librarians. This paper lays out a practical framework for the implementation of EBL. A new way of thinking about research in librarianship is introduced using the well-built question process and the assignment of librarian research questions to one of six domains specific to librarianship. As a profession, librarianship tends to reflect more qualitative, social sciences/humanities in its research methods and study types which tend to be less rigorous and more prone to bias. Randomised controlled trials (RCT) do not have to be placed at the top of an evidence 'hierarchy' for librarianship. Instead, a more encompassing model reflecting librarianship as a whole and the kind of research likely to be done by librarians is proposed. 'Evidence' from a number of disciplines including health sciences, business and education can be utilized by librarians and applied to their practice. However, access to and availability of librarianship literature needs to be further studied. While using other disciplines (e.g. EBHC) as a model for EBL has been explored in the literature, the authors develop models unique to librarianship. While research has always been a minor focus in the profession, moving research into practice is becoming more important and librarians need to consider the issues surrounding research in order to move EBL forward.

Inherited proclivity: When should neurogenetics mitigate moral culpability for purposes of sentencing?

PubMed Central

Segal, J Bradley

2016-01-01

Certain genes and neurobiology (‘neurogenetics’) may predispose some people to violent behavior. Increasingly, defendants introduce neurogenetic evidence as a mitigating factor during criminal sentencing. Identifying the cause of a criminal act, biological or otherwise, does not necessarily preclude moral or legal liability. However, valid scientific evidence of an inherited proclivity sometimes should be considered when evaluating whether a defendant is less morally culpable for a crime and perhaps less deserving of punishment. This Note proposes a two-pronged test to understand whether and when neurogenetic evidence should be considered to potentially mitigate an individual's culpability for criminal behavior. The first prong normatively assesses whether a defendant meets a threshold of having meaningfully managed his risk of harming others based on what he knew, or should have known, about his own proclivities to violence. The second prong considers the admissibility of the evidence based on whether the specific neurogenetic proclivity claimed by the defendant is relevant and adequately supported by science so as to be reliable. This proposed two-pronged test, beginning with an ethical threshold and followed by a scientific hurdle, can help judges and juries establish when to accept arguments for neurogenetic mitigation at sentencing, and when to reject them. PMID:27774246

Developing a semantic web model for medical differential diagnosis recommendation.

PubMed

Mohammed, Osama; Benlamri, Rachid

2014-10-01

In this paper we describe a novel model for differential diagnosis designed to make recommendations by utilizing semantic web technologies. The model is a response to a number of requirements, ranging from incorporating essential clinical diagnostic semantics to the integration of data mining for the process of identifying candidate diseases that best explain a set of clinical features. We introduce two major components, which we find essential to the construction of an integral differential diagnosis recommendation model: the evidence-based recommender component and the proximity-based recommender component. Both approaches are driven by disease diagnosis ontologies designed specifically to enable the process of generating diagnostic recommendations. These ontologies are the disease symptom ontology and the patient ontology. The evidence-based diagnosis process develops dynamic rules based on standardized clinical pathways. The proximity-based component employs data mining to provide clinicians with diagnosis predictions, as well as generates new diagnosis rules from provided training datasets. This article describes the integration between these two components along with the developed diagnosis ontologies to form a novel medical differential diagnosis recommendation model. This article also provides test cases from the implementation of the overall model, which shows quite promising diagnostic recommendation results.

[Evidence-based practice in nursing curricula: the experience of nursing degree course of Reggio Emilia. A pilot study].

PubMed

Finotto, Stefano; Chiesi, Ivens; Mecugni, Daniela; Casali, Patrizia; Doro, Lucia Maria Grazia; Lusetti, Simona

2010-01-01

Given the lack of evidence in literature concerning the presence of Evidence-Based Practice (EBP) in nursing curricula, but considering its importance in order to educate future nurses to use critical thinking and to base their practice on scientific evidence, tutors and nursing teachers of the Nursing Degree Course of Reggio Emilia (Università degli Studi di Modena e Reggio Emilia), have decided to introduce a three-year laboratory of EBP. The purposes of this project are: to describe the three-year EBP laboratory of Nursing Degree, its objectives, its structure, its integration with practical training and nursing subjects and its students evaluation strategies; to get students verify the perception of the usefulness of the three-year EBP laboratory regarding the elaboration of the graduation thesis, the search for appropriatem answers for patients met during clinical trainings and the usefulness of the EBP process in view of the development of their professional career. The design of research of this pilot study is correlation-descriptive. It has been selected a sample of convenience consisting of 56 nurses graduated in the autumn session of the academic year 2007-2008. For data collection we have used an electronic questionnaire (Microsoft Word with closed fields) structured for the purpose. The laboratory has been effective in learning to use the database to search for evidences and to use the database to search for evidences related to nursing problems met in training placements. Finally, graduated nurses consider the EBP process an essential element of professional nursing luggage. Although the sample is restricted the results indicates the good educational choice made by our Nursing Degree Course of integrating the EBP Laboratory in the curriculum.

Well-Being and the Social Environment of Work: A Systematic Review of Intervention Studies.

PubMed

Daniels, Kevin; Watson, David; Gedikli, Cigdem

2017-08-16

There is consistent evidence that a good social environment in the workplace is associated with employee well-being. However, there has been no specific review of interventions to improve well-being through improving social environments at work. We conducted a systematic review of such interventions, and also considered performance as an outcome. We found eight studies of interventions. Six studies were of interventions that were based on introducing shared social activities into workgroups. Six out of the six studies demonstrated improvements in well-being across the sample (five studies), or for an identifiable sub-group (one study). Four out of the five studies demonstrated improvements in social environments, and four out of the five studies demonstrated improvements in indicators of performance. Analysis of implementation factors indicated that the interventions based on shared activities require some external facilitation, favorable worker attitudes prior to the intervention, and several different components. We found two studies that focused on improving fairness perceptions in the workplace. There were no consistent effects of these interventions on well-being or performance. We conclude that there is some evidence that interventions that increase the frequency of shared activities between workers can improve worker well-being and performance. We offer suggestions for improving the evidence base.

Counselor Attitudes toward and Use of Evidence-based Practices in Private Substance Use Disorder Treatment Centers: A Comparison of Social Workers and Non–Social Workers

PubMed Central

Bride, Brian E.; Kintzle, Sara; Abraham, Amanda J.; Roman, Paul M.

2012-01-01

The purpose of this study was to examine factors that may be associated with variation in social workers' perceptions of effectiveness, perceptions of acceptability, and use of psychosocial evidence-based practices (EBPs) for the treatment of substance use disorders (SUD) in comparison to other SUD counselors who are non–social workers. A national sample of 1,140 counselors in private SUD treatment settings completed a mailed survey. Overall, counselors perceive both motivational interviewing (MI) and contingency management (CM) to be effective and acceptable interventions, with MI perceived to be both more effective and more acceptable than CM. The results of this study also shed light on the factors associated with perceptions of effectiveness and acceptability of MI and CM. The results of this study underscore the importance of exposure to EBPs in the development of positive attitudes toward and use of EBPs. In particular, professional networks are an important route to introduce social workers to EBPs, as is professional training on specific EBPs. Efforts to increase the uptake of evidence-based SUD interventions should not be limited to dissemination of information regarding effectiveness; rather, efforts should also be expended to expose social workers to EBPs. PMID:23193729

Well-Being and the Social Environment of Work: A Systematic Review of Intervention Studies

PubMed Central

Gedikli, Cigdem

2017-01-01

There is consistent evidence that a good social environment in the workplace is associated with employee well-being. However, there has been no specific review of interventions to improve well-being through improving social environments at work. We conducted a systematic review of such interventions, and also considered performance as an outcome. We found eight studies of interventions. Six studies were of interventions that were based on introducing shared social activities into workgroups. Six out of the six studies demonstrated improvements in well-being across the sample (five studies), or for an identifiable sub-group (one study). Four out of the five studies demonstrated improvements in social environments, and four out of the five studies demonstrated improvements in indicators of performance. Analysis of implementation factors indicated that the interventions based on shared activities require some external facilitation, favorable worker attitudes prior to the intervention, and several different components. We found two studies that focused on improving fairness perceptions in the workplace. There were no consistent effects of these interventions on well-being or performance. We conclude that there is some evidence that interventions that increase the frequency of shared activities between workers can improve worker well-being and performance. We offer suggestions for improving the evidence base. PMID:28813009

Counselor attitudes toward and use of evidence-based practices in private substance use disorder treatment centers: a comparison of social workers and non-social workers.

PubMed

Bride, Brian E; Kintzle, Sara; Abraham, Amanda J; Roman, Paul M

2012-08-01

The purpose of this study was to examine factors that may be associated with variation in social workers' perceptions of effectiveness, perceptions of acceptability, and use of psychosocial evidence-based practices (EBPs) for the treatment of substance use disorders (SUD) in comparison to other SUD counselors who are nonsocial workers. A national sample of 1,140 counselors in private SUD treatment settings completed a mailed survey. Overall, counselors perceive both motivational interviewing (MI) and contingency management (CM) to be effective and acceptable interventions, with MI perceived to be both more effective and more acceptable than CM. The results of this study also shed light on the factors associated with perceptions of effectiveness and acceptability of MI and CM. The results of this study underscore the importance of exposure to EBPs in the development of positive attitudes toward and use of EBPs. In particular, professional networks are an important route to introduce social workers to EBPs, as is professional training on specific EBPs. Efforts to increase the uptake of evidence-based SUD interventions should not be limited to dissemination of information regarding effectiveness; rather, efforts should also be expended to expose social workers to EBPs.

Introducing risk adjustment and free health plan choice in employer-based health insurance: Evidence from Germany.

PubMed

Pilny, Adam; Wübker, Ansgar; Ziebarth, Nicolas R

2017-12-01

To equalize differences in health plan premiums due to differences in risk pools, the German legislature introduced a simple Risk Adjustment Scheme (RAS) based on age, gender and disability status in 1994. In addition, effective 1996, consumers gained the freedom to choose among hundreds of existing health plans, across employers and state-borders. This paper (a) estimates RAS pass-through rates on premiums, financial reserves, and expenditures and assesses the overall RAS impact on market price dispersion. Moreover, it (b) characterizes health plan switchers and investigates their annual and cumulative switching rates over time. Our main findings are based on representative enrollee panel data linked to administrative RAS and health plan data. We show that sickness funds with bad risk pools and high pre-RAS premiums lowered their total premiums by 42 cents per additional euro allocated by the RAS. Consequently, post-RAS, health plan prices converged but not fully. Because switchers are more likely to be white collar, young and healthy, the new consumer choice resulted in more risk segregation and the amount of money redistributed by the RAS increased over time. Copyright © 2017 Elsevier B.V. All rights reserved.

Teaching evidence-based practice: developing a curriculum model to foster evidence-based practice in undergraduate student nurses.

PubMed

Finotto, Stefano; Carpanoni, Marika; Turroni, Elena Casadei; Camellini, Riccarda; Mecugni, Daniela

2013-09-01

For the nature of the Evidence-Based Practice (EBP) and its relevance to nursing, the skills that it requires should be a component in the basic Nursing degree courses. For this reason, the EBP process should be introduced early on in nursing education to develop students' independence and ability to self-learning. the aim of this study is to describe the perception that newly graduated nurses have relative to the benefits of the skills learned during the laboratory's three-year EBP in consideration of the construction of the thesis, the research of evidence and usefulness of the EBP process for the development of their professional career. A descriptive study with a sample of 300 newly graduated nurses from the Degree Course in Nursing of the University of Modena and Reggio Emilia, venue of Reggio Emilia. The data collection instrument was an anonymous questionnaire. It was possible to answer through a 10 Likert scale. The sample considers effective the research of evidence carried out (mean 6, SD 2), related to the problems of patients (mean 7, SD 2); the sample considered the skills acquired during the laboratory's three-year EBP to be useful for career development (mean 7, SD 2). the decision to include the laboratory's three-year EBP in the curriculum of the Nursing degree promotes the development of skills relating to the use of the EBP process, competence that in the literature is indicated as one of the core competencies that all health professionals should develop and maintain throughout their professional career. Copyright © 2013 Elsevier Ltd. All rights reserved.

Pedagogical strategies to teach bachelor students evidence-based practice: A systematic review.

PubMed

Aglen, B

2016-01-01

The aim of this study is to review international scientific articles about pedagogical strategies to teach nursing students at bachelor degree evidence-based practice (EBP). A literature review including peer reviewed, original, empirical articles describing pedagogical interventions aimed at teaching bachelor's degree nursing students EBP in the period 2004-2014. Theories of discretion, knowledge transfer and cognitive maturity development are used as analytical perspectives. The main challenge teaching evidence based practice is that the students fail to see how research findings contribute to nursing practice. The pedagogical strategies described are student active learning methods to teach the students information literacy and research topics. Information literacy is mainly taught according to the stages of EBP. These stages focus on how to elaborate evidence from research findings for implementation into nursing practice. The articles reviewed mainly use qualitative, descriptive designs and formative evaluations of the pedagogical interventions. Although a considerable effort in teaching information literacy and research topics, nursing students still struggle to see the relevance evidence for nursing practice. Before being introduced to information literacy and research topics, students need insight into knowledge transfer and their own epistemic assumptions. Knowledge transfer related to clinical problems should be the learning situations prioritized when teaching EBP at bachelor level. Theoretical perspectives of cognitive maturity development, knowledge transfer and discretion in professional practice give alternative ways of designing pedagogical strategies for EBP. More research is needed to develop and test pedagogical strategies for EBP in light of these theories. Copyright © 2015. Published by Elsevier Ltd.

An evidence synthesis of the international knowledge base for new care models to inform and mobilise knowledge for multispecialty community providers (MCPs).

PubMed

Turner, Alison; Mulla, Abeda; Booth, Andrew; Aldridge, Shiona; Stevens, Sharon; Battye, Fraser; Spilsbury, Peter

2016-10-01

NHS England's Five Year Forward View (NHS England, Five Year Forward View, 2014) formally introduced a strategy for new models of care driven by simultaneous pressures to contain costs, improve care and deliver services closer to home through integrated models. This synthesis focuses on a multispecialty community provider (MCP) model. This new model of care seeks to overcome the limitations in current models of care, often based around single condition-focused pathways, in contrast to patient-focused delivery (Royal College of General Practitioners, The 2022 GP: compendium of evidence, 2012) which offers greater continuity of care in recognition of complex needs and multimorbidity. The synthesis, an innovative combination of best fit framework synthesis and realist synthesis, will develop a "blueprint" which articulates how and why MCP models work, to inform design of future iterations of the MCP model. A systematic search will be conducted to identify research and practice-derived evidence to achieve a balance that captures the historical legacy of MCP models but focuses on contemporary evidence. Sources will include bibliographic databases including MEDLINE, PreMEDLINE, CINAHL, Embase, HMIC and Cochrane Library; and grey literature sources. The Best Fit synthesis methodology will be combined with a synthesis following realist principles which are particularly suited to exploring what works, when, for whom and in what circumstances. The aim of this synthesis is to provide decision makers in health and social care with a practical evidence base relating to the multispecialty community provider (MCP) model of care. PROSPERO CRD42016039552 .

The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 3: The Clinical Guidelines.

PubMed

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

2017-02-01

The current paper introduces the actual International College of Neuro-Psychopharmacology clinical guidelines for the treatment of bipolar disorder. The current clinical guidelines are based on evidence-based data, but they also intend to be clinically useful, while a rigid algorithm was developed on the basis of firm evidence alone. Monotherapy was prioritized over combination therapy. There are separate recommendations for each of the major phases of bipolar disorder expressed as a 5-step algorithm. The current International College of Neuro-Psychopharmacology clinical guidelines for the treatment of bipolar disorder are the most up-to-date guidance and are as evidence based as possible. They also include recommendations concerning the use of psychotherapeutic interventions, again on the basis of available evidence. This adherence of the workgroup to the evidence in a clinically oriented way helped to clarify the role of specific antidepressants and traditional agents like lithium, valproate, or carbamazepine. The additional focus on specific clinical characteristics, including predominant polarity, mixed features, and rapid cycling, is also a novel approach. Many issues need further studies, data are sparse and insufficient, and many questions remain unanswered. The most important and still unmet need is to merge all the guidelines that concern different phases of the illness into a single one and in this way consider BD as a single unified disorder, which is the real world fact. However, to date the research data do not permit such a unified approach. © The Author 2016. Published by Oxford University Press on behalf of CINP.

The Lidcombe Program of early stuttering intervention for Malaysian families: Four case studies.

PubMed

Vong, Etain; Wilson, Linda; Lincoln, Michelle

2016-09-01

This study investigated the outcomes of implementing the Lidcombe Program, an evidence-based early intervention for stuttering, with four preschool children in Malaysia. Early stuttering intervention is currently underdeveloped in Malaysia, where stuttering treatment is often more assertion-based than evidence-based. Therefore, introducing an evidence-based early stuttering intervention is an important milestone for Malaysian preschoolers who stutter. The participants ranged from 3 years 3 months to 4 years 9 months at the start of the study. Beyond-clinic speech samples were obtained at 1 month and 1 week pretreatment and immediately post-Stage 1, and at 1 month, 3 months, 6 months and 12 months post-Stage 1. Two participants, who were bilingual, achieved near-zero levels of stuttering at 12 months posttreatment. Near zero levels of stuttering were also present in their untreated languages. One participant withdrew due to reasons not connected with the research or treatment. The remaining participant, who presented with severe stuttering, completed Stage 1 but had some relapse in Stage 2 and demonstrated mild stuttering 12 months post-Stage 1. The outcomes were achieved without the need to significantly adapt Lidcombe Program procedures to Malaysian culture. Further research to continue evaluation of the Lidcombe Program with Malaysian families and to estimate proportion of those who will respond is warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

Evidence-based interpretation of liver biopsies.

PubMed

Crawford, James M

2006-04-01

'Evidence based medicine' is a paradigm introduced in the 1990s in which collection of clinical data in a reproducible and unbiased way is intended to guide clinical decision-making. This paradigm has been promulgated across the spectrum of medicine, but with more limited critical analysis in the realm of pathology. The 'evidence base' in support of our practices in Anatomic Pathology is a critical issue, given the key role that such diagnoses play in patient management decisions. The question is, 'On what basis are diagnostic opinions rendered in Anatomic Pathology?' The operative question becomes, 'What is the published literature that supports our anatomic pathology interpretations?' This second question was applied to the published literature in Hepatopathology, by identifying the 'citation classics' of this discipline. Specifically, the top 150 most-cited liver pathology articles were analyzed for: authorship; journal of publication; type of publication; and year of publication. Results are as follows. First, it is indeed true that the preeminent hepatopathologists of the age are the most cited authors in the 'top 150'. Second, the most cited articles in hepatopathology are not published in the pathology literature, but are instead published in much higher impact clinical journals. Third, the pathology of viral hepatitis is demonstrated to be extraordinarily well-grounded in 'evidence based medicine'. Much of the remainder of the hepatopathology literature falls into a 'narrative based' paradigm, which is the rigorous reporting of case experience without statistical clinical outcomes validation. Finally, the years of publication reflect, on the one hand, a vigorous recent literature in the pharmaceutical treatment of viral hepatitis, and on the other, a broadly distributed set of 'narrative' articles from the 1960s, 1970s, 1980s, and 1990s. In conclusion, the discipline of hepatopathology appears to be well-grounded in 'evidence based medicine' in the realm of viral hepatitis. The remainder of our discipline rests predominantly upon the time-honored identification of disease process through the publication of narrative case series.

Empirical assessment of fish introductions in a subtropical wetland: An evaluation of contrasting views

USGS Publications Warehouse

Trexler, J.C.; Loftus, W.F.; Jordan, F.; Lorenz, J.J.; Chick, J.H.; Kobza, Robert M.

2000-01-01

We summarized data from eight quantitative fish surveys conducted in southern Florida to evaluate the distribution and relative abundance of introduced fishes across a variety of habitats. These surveys encompassed marsh and canal habitats throughout most of the Everglades region, including the mangrove fringe of Florida Bay. Two studies provided systematically collected density information over a 20-year period, and documented the first local appearance of four introduced fishes based on their repeated absence in prior surveys. Those species displayed a pattern of rapid population growth followed by decline, then persistence at lower densities. Estuarine areas in the southern Everglades, characterized by natural tidal creeks surrounded by mangrove-dominated marshes, and canals held the largest introduced-fish populations. Introduced fishes were also common, at times exceeding 50% of the fish community, in solution holes that serve as dry-season refuges in short-hydroperiod rockland habitats of the eastern Everglades. Wet prairies and alligator ponds distant from canals generally held few individuals of introduced fishes. These patterns suggest that the introduced fishes in southern Florida at present may not be well-adapted to persist in freshwater marshes of the Everglades, possibly because of an interaction of periodic cold-temperature stress and hydrologic fluctuation. Our analyses indicated low densities of these fishes in central or northern Everglades wet-prairie communities, and, in the absence of experimental data, little evidence of biotic effects in this spatially extensive habitat. There is no guarantee that this condition will be maintained, especially under the cumulative effects of future invasions or environmental change.

Teaching Evidence-Based Approaches to Suicide Risk Assessment and Prevention that Enhance Psychiatric Training

PubMed Central

Zisook, Sidney; Anzia, Joan; Atri, Ashutosh; Baroni, Argelinda; Clayton, Paula; Haller, Ellen; Lomax, Jim; Mann, J. John; Oquendo, Maria A.; Pato, Michele; Perez-Rodriguez, M. Mercedes; Prabhakar, Deepak; Sen, Srijan; Thrall, Grace; Yaseen, Zimri S.

2012-01-01

This report describes one in a series of National Institute of Health (NIH) supported conferences aimed at enhancing the ability of leaders of psychiatry residency training to teach research literacy and produce both clinician-scholars and physician-scientists in their home programs. Most psychiatry training directors would not consider themselves research scholars or even well-schooled in evidence based practice. Yet they are the front line educators to prepare tomorrow’s psychiatrists to keep up with, critically evaluate, and in some cases actually participate in the discovery of new and emerging psychiatric knowledge. This annual conference is meant to help psychiatry training directors become more enthusiastic, knowledgeable and pedagogically prepared to create research-friendly environments at their home institutions, so that more trainees will, in turn, become research literate, practice evidence-based psychiatry, and enter research fellowships and careers. The overall design of each year’s meeting is a series of plenary sessions introducing participants to new information pertaining to the core theme of that year’s meeting, integrated with highly interactive small group teaching sessions designed to consolidate knowledge and provide pragmatic teaching tools appropriate for residents at various levels of training. The theme of each meeting, selected to be a compelling and contemporary clinical problem, serves as a vehicle to capture training directors’ attention while teaching relevant brain science, research literacy and effective pedagogy. This report describes the content and assessment of the 2011 annual pre-meeting, “Evidence-based Approaches to Suicide Risk Assessment and Prevention: Insights from the Neurosciences and Behavioral Sciences for use in Psychiatry Residency Training.” PMID:22995449

Time-series intervention analysis of pedestrian countdown timer effects.

PubMed

Huitema, Bradley E; Van Houten, Ron; Manal, Hana

2014-11-01

Pedestrians account for 40-50% of traffic fatalities in large cities. Several previous studies based on relatively small samples have concluded that Pedestrian Countdown Timers (PCT) may reduce pedestrian crashes at signalized intersections, but other studies report no reduction. The purposes of the present article are to (1) describe a new methodology to evaluate the effectiveness of introducing PCT signals and (2) to present results of applying this methodology to pedestrian crash data collected in a large study carried out in Detroit, Michigan. The study design incorporated within-unit as well as between-unit components. The main focus was on dynamic effects that occurred within the PCT unit of 362 treated sites during the 120 months of the study. An interrupted time-series analysis was developed to evaluate whether change in crash frequency depended upon of the degree to which the countdown timers penetrated the treatment unit. The between-unit component involved comparisons between the treatment unit and a control unit. The overall conclusion is that the introduction of PCT signals in Detroit reduced pedestrian crashes to approximately one-third of the preintervention level. The evidence for this reductionis strong and the change over time was shown to be a function of the extent to which the timers were introduced during the intervention period. There was no general drop-off in crash frequency throughout the baseline interval of over five years; only when the PCT signals were introduced in large numbers was consistent and convincing crash reduction observed. Correspondingly, there was little evidence of change in the control unit. Copyright © 2014. Published by Elsevier Ltd.

The effect of English-language restriction on systematic review-based meta-analyses: a systematic review of empirical studies.

PubMed

Morrison, Andra; Polisena, Julie; Husereau, Don; Moulton, Kristen; Clark, Michelle; Fiander, Michelle; Mierzwinski-Urban, Monika; Clifford, Tammy; Hutton, Brian; Rabb, Danielle

2012-04-01

The English language is generally perceived to be the universal language of science. However, the exclusive reliance on English-language studies may not represent all of the evidence. Excluding languages other than English (LOE) may introduce a language bias and lead to erroneous conclusions. We conducted a comprehensive literature search using bibliographic databases and grey literature sources. Studies were eligible for inclusion if they measured the effect of excluding randomized controlled trials (RCTs) reported in LOE from systematic review-based meta-analyses (SR/MA) for one or more outcomes. None of the included studies found major differences between summary treatment effects in English-language restricted meta-analyses and LOE-inclusive meta-analyses. Findings differed about the methodological and reporting quality of trials reported in LOE. The precision of pooled estimates improved with the inclusion of LOE trials. Overall, we found no evidence of a systematic bias from the use of language restrictions in systematic review-based meta-analyses in conventional medicine. Further research is needed to determine the impact of language restriction on systematic reviews in particular fields of medicine.

Family Environment and Childhood Obesity: A New Framework with Structural Equation Modeling

PubMed Central

Huang, Hui; Wan Mohamed Radzi, Che Wan Jasimah bt; Salarzadeh Jenatabadi, Hashem

2017-01-01

The main purpose of the current article is to introduce a framework of the complexity of childhood obesity based on the family environment. A conceptual model that quantifies the relationships and interactions among parental socioeconomic status, family food security level, child’s food intake and certain aspects of parental feeding behaviour is presented using the structural equation modeling (SEM) concept. Structural models are analysed in terms of the direct and indirect connections among latent and measurement variables that lead to the child weight indicator. To illustrate the accuracy, fit, reliability and validity of the introduced framework, real data collected from 630 families from Urumqi (Xinjiang, China) were considered. The framework includes two categories of data comprising the normal body mass index (BMI) range and obesity data. The comparison analysis between two models provides some evidence that in obesity modeling, obesity data must be extracted from the dataset and analysis must be done separately from the normal BMI range. This study may be helpful for researchers interested in childhood obesity modeling based on family environment. PMID:28208833

Family Environment and Childhood Obesity: A New Framework with Structural Equation Modeling.

PubMed

Huang, Hui; Wan Mohamed Radzi, Che Wan Jasimah Bt; Salarzadeh Jenatabadi, Hashem

2017-02-13

The main purpose of the current article is to introduce a framework of the complexity of childhood obesity based on the family environment. A conceptual model that quantifies the relationships and interactions among parental socioeconomic status, family food security level, child's food intake and certain aspects of parental feeding behaviour is presented using the structural equation modeling (SEM) concept. Structural models are analysed in terms of the direct and indirect connections among latent and measurement variables that lead to the child weight indicator. To illustrate the accuracy, fit, reliability and validity of the introduced framework, real data collected from 630 families from Urumqi (Xinjiang, China) were considered. The framework includes two categories of data comprising the normal body mass index (BMI) range and obesity data. The comparison analysis between two models provides some evidence that in obesity modeling, obesity data must be extracted from the dataset and analysis must be done separately from the normal BMI range. This study may be helpful for researchers interested in childhood obesity modeling based on family environment.

A model for ionic polymer metal composites as sensors

NASA Astrophysics Data System (ADS)

Bonomo, C.; Fortuna, L.; Giannone, P.; Graziani, S.; Strazzeri, S.

2006-06-01

This paper introduces a comprehensive model of sensors based on ionic polymer metal composites (IPMCs) working in air. Significant quantities ruling the sensing properties of IPMC-based sensors are taken into account and the dynamics of the sensors are modelled. A large amount of experimental evidence is given for the excellent agreement between estimations obtained using the proposed model and the observed signals. Furthermore, the effect of sensor scaling is investigated, giving interesting support to the activities involved in the design of sensing devices based on these novel materials. We observed that the need for a wet environment is not a key issue for IPMC-based sensors to work well. This fact allows us to put IPMC-based sensors in a totally different light to the corresponding actuators, showing that sensors do not suffer from the same drawbacks.

Design and Analysis of Cognitive Interviews for Comparative Multinational Testing

PubMed Central

Fitzgerald, Rory; Padilla, José-Luis; Willson, Stephanie; Widdop, Sally; Caspar, Rachel; Dimov, Martin; Gray, Michelle; Nunes, Cátia; Prüfer, Peter; Schöbi, Nicole; Schoua-Glusberg, Alisú

2011-01-01

This article summarizes the work of the Comparative Cognitive Testing Workgroup, an international coalition of survey methodologists interested in developing an evidence-based methodology for examining the comparability of survey questions within cross-cultural or multinational contexts. To meet this objective, it was necessary to ensure that the cognitive interviewing (CI) method itself did not introduce method bias. Therefore, the workgroup first identified specific characteristics inherent in CI methodology that could undermine the comparability of CI evidence. The group then developed and implemented a protocol addressing those issues. In total, 135 cognitive interviews were conducted by participating countries. Through the process, the group identified various interpretive patterns resulting from sociocultural and language-related differences among countries as well as other patterns of error that would impede comparability of survey data. PMID:29081719

How to write a critically appraised topic (CAT).

PubMed

Sadigh, Gelareh; Parker, Robert; Kelly, Aine Marie; Cronin, Paul

2012-07-01

Medical knowledge and the volume of scientific articles published have expanded rapidly over the past 50 years. Evidence-based practice (EBP) has developed to help health practitioners get more benefit from the increasing volume of information to solve complex health problems. A format for sharing information in EBP is the critically appraised topic (CAT). A CAT is a standardized summary of research evidence organized around a clinical question, aimed at providing both a critique of the research and a statement of the clinical relevance of results. In this review, we explain the five steps involved in writing a CAT for a clinical purpose ("Ask," "Search," "Appraise," "Apply," and "Evaluate") and introduce some of the useful electronic resources available to help in creating CATs. Copyright © 2012 AUR. Published by Elsevier Inc. All rights reserved.

No evidence for increased performance of a specialist psyllid on invasive French broom

NASA Astrophysics Data System (ADS)

Herrera, Angelica M.; Carruthers, Raymond I.; Mills, Nicholas J.

2011-03-01

Some invasive plants perform better in their area of introduction than in their native region. This may be a consequence of rapid evolutionary change due to different selection pressures encountered in introduced regions. The Evolution of Increased Competitive Ability hypothesis (EICA) suggests that release from natural enemies results in selection of more vigorous plant genotypes as a result of plants allocating resources away from costly herbivore-resistance traits and toward increased growth. We tested the prediction that introduced plant genotypes of Genista monspessulana (Fabaceae) are less resistant to herbivory by a specialist psyllid, Arytinnis hakani (Hemiptera: Psyllidae) by measuring and comparing A. hakani performance on plants from native (southern France) and introduced (California, U.S.) populations. A. hakani performed equally well on plants from the native and introduced regions; there were no significant differences in psyllid egg and nymphal development, nymphal survival rates, female longevity or fecundity between the test plants. Egg survival rates were significantly higher on native populations, but the difference was minimal. These results provide preliminary evidence that native and introduced G. monspessulana populations are equally resistant to A. hakani and do not support the EICA hypothesis prediction of reduced investment in defense in introduced plant populations. Possible explanations for the lack of effects found in this study include the type of parameters measured and the feeding ecology of the herbivore used to test EICA, and finally, that evolutionary changes in plant defense in introduced G. monspessulana populations may not have occurred.

Is a PBL curriculum a better nutrient medium for student-generated learning issues than a PBL island?

PubMed

Gehlhar, K; Wüller, A; Lieverscheidt, H; Fischer, M R; Schäfer, T

2010-12-01

Problem based learning (PBL) is often introduced in curricula in form of short segments. In the literature the value of these PBL-islands is doubted. In order to gain more insight in this curricular approach, we compared student generated learning issues, from a 7-week PBL-island introduced in a traditional curriculum (PBL-I), with the gold standard of a PBL-based model-curriculum (PBL-B) existing in parallel at the same University (Ruhr-University Bochum, Germany). Both tracks use five identical PBL-cases. Thousand seven hundred and three student-generated learning issues of 252 tutorial groups (193 PBL-I and 59 PBL-B groups with six to seven students per group) were analysed in seven different categories. Results showed that overall there were no substantial differences between both curricula. PBL-B students generated more problem-related and less basic science clinical learning issues than PBL-I students, but in both groups learning issues were related to the same number of different subjects. Furthermore, students in the PBL-curriculum tend to generate little less but slightly better phrased issues. Taken together, we found no substantial evidence with respect to student-generated learning issues that could prove that students cannot work with the PBL-method, even if it is introduced later in the curriculum and last only for a short period of time.

[Towards DSM 5.1. Proposals for schizophrenia.

PubMed

Niolu, Cinzia; Bianciardi, Emanuela; Ribolsi, Michele; Siracusano, Alberto

2016-11-01

Schizophrenia is a debilitating illness, present in approximately 1% of the global population. It is manifested through positive symptoms including delusions, hallucinations, disorganized thoughts and negative symptoms such as avolition, alogia, and apathy. In 2013 the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has been released and some changes were introduced to make diagnosis of schizophrenia more accurate and precise, but researchers are already studying how to improve again the diagnostic criteria of this disorder. To this regard, we hypothesize two types of schizophrenia: poor adherence and good adherence to treatment schizophrenia. Our supposition is based on the evidence of reduced relapses, rehospitalisations, and better long-term course of illness in those patients with schizophrenia who are non-adherent to treatment. Given that adherence to therapy strongly influences patients attitude to medication, quality of life, and subjective well-being, the hypothesis of introducing adherence as a new schizophrenia specifier is compelling.

Market mechanisms and the management of health care. The UK model and experience.

PubMed

Lapsley, I

1997-01-01

Examines recent reforms of the UK's National Health Service (NHS), and explores the pressures for change in the pursuit of an efficient NHS and the conflicts which this causes in an organization which was based on the aim of equity. In particular, addresses the "false revolutions" of managerial change introduced after the Griffiths Report (1983) and the accounting changes introduced in the wake of the Griffiths proposals. Evidence shows that these intended revolutions were limited in impact. The result of these failures has been the introduction of the "real revolution"--the internal market in health care. This is a radical change in both the NHS management arrangements and in service delivery, with the division of the NHS into purchasers (health authorities and GP fund holders) and providers (hospital and community services, whether provided by private, voluntary or state-owned facilities.

The Quality Improvement Demonstration Study: An example of evidence-based policy-making in practice

PubMed Central

Shimkhada, Riti; Peabody, John W; Quimbo, Stella A; Solon, Orville

2008-01-01

Background Randomized trials have long been the gold-standard for evaluating clinical practice. There is growing recognition that rigorous studies are similarly needed to assess the effects of policy. However, these studies are rarely conducted. We report on the Quality Improvement Demonstration Study (QIDS), an example of a large randomized policy experiment, introduced and conducted in a scientific manner to evaluate the impact of large-scale governmental policy interventions. Methods In 1999 the Philippine government proposed sweeping reforms in the National Health Sector Reform Agenda. We recognized the unique opportunity to conduct a social experiment. Our ongoing goal has been to generate results that inform health policy. Early on we concentrated on developing a multi-institutional collaborative effort. The QIDS team then developed hypotheses that specifically evaluated the impact of two policy reforms on both the delivery of care and long-term health status in children. We formed an experimental design by randomizing matched blocks of three communities into one of the two policy interventions plus a control group. Based on the reform agenda, one arm of the experiment provided expanded insurance coverage for children; the other introduced performance-based payments to hospitals and physicians. Data were collected in household, hospital-based patient exit, and facility surveys, as well as clinical vignettes, which were used to assess physician practice. Delivery of services and health status were evaluated at baseline and after the interventions were put in place using difference-in-difference estimation. Results We found and addressed numerous challenges conducting this study, namely: formalizing the experimental design using the existing health infrastructure; securing funding to do research coincident with the policy reforms; recognizing biases and designing the study to account for these; putting in place a broad data collection effort to account for unanticipated findings; introducing sustainable policy interventions based on the reform agenda; and providing results in real-time to policy makers through a combination of venues. Conclusion QIDS demonstrates that a large, prospective, randomized controlled policy experiment can be successfully implemented at a national level as part of sectoral reform. While we believe policy experiments should be used to generate evidence-based health policy, to do this requires opportunity and trust, strong collaborative relationships, and timing. This study nurtures the growing attitude that translation of scientific findings from the bedside to the community can be done successfully and that we should raise the bar on project evaluation and the policy-making process. PMID:18364050

Brain-dead patients are not cadavers: the need to revise the definition of death in Muslim communities.

PubMed

Rady, Mohamed Y; Verheijde, Joseph L

2013-03-01

The utilitarian construct of two alternative criteria of human death increases the supply of transplantable organs at the end of life. Neither the neurological criterion (heart-beating donation) nor the circulatory criterion (non-heart-beating donation) is grounded in scientific evidence but based on philosophical reasoning. A utilitarian death definition can have unintended consequences for dying Muslim patients: (1) the expedited process of determining death for retrieval of transplantable organs can lead to diagnostic errors, (2) the equivalence of brain death with human death may be incorrect, and (3) end-of-life religious values and traditional rituals may be sacrificed. Therefore, it is imperative to reevaluate the two different types and criteria of death introduced by the Resolution (Fatwa) of the Council of Islamic Jurisprudence on Resuscitation Apparatus in 1986. Although we recognize that this Fatwa was based on best scientific evidence available at that time, more recent evidence shows that it rests on outdated knowledge and understanding of the phenomenon of human death. We recommend redefining death in Islam to reaffirm the singularity of this biological phenomenon as revealed in the Quran 14 centuries ago.

A biased opinion: Demonstration of cognitive bias on a fingerprint matching task through knowledge of DNA test results.

PubMed

Stevenage, Sarah V; Bennett, Alice

2017-07-01

One study is presented which explores the biasing effects of irrelevant contextual information on a fingerprint matching task. Bias was introduced by providing the outcomes of a DNA test relating to each fictitious case under consideration. This was engineered to suggest either a match, no match, or an inconclusive outcome, and was thus either consistent, misleading or unbiased depending on the ground truth of each fingerprint pair. The results suggested that, when the difficulty of the fingerprint matching task was measurably increased, participants became more vulnerable to the biasing information. Under such conditions, when performance was good, misleading evidence lowered accuracy, and when performance was weaker, consistent evidence improved accuracy. As such, the results confirmed existing demonstrations of cognitive bias from contextual information in the fingerprint task. Moreover, by taking a process-based approach, it became possible to articulate the concerns, and the potential solutions, at each stage of the workflow. The results offer value for the forensic science community in extending the evidence-base regarding cognitive bias, and in articulating routes to improve the credibility of fingerprint decisions. Copyright © 2017. Published by Elsevier B.V.

Mass-casualty triage: time for an evidence-based approach.

PubMed

Jenkins, Jennifer Lee; McCarthy, Melissa L; Sauer, Lauren M; Green, Gary B; Stuart, Stephanie; Thomas, Tamara L; Hsu, Edbert B

2008-01-01

Mass-casualty triage has developed from a wartime necessity to a civilian tool to ensure that constrained medical resources are directed at achieving the greatest good for the most number of people. Several primary and secondary triage tools have been developed, including Simple Treatment and Rapid Transport (START), JumpSTART, Care Flight Triage, Triage Sieve, Sacco Triage Method, Secondary Assessment of Victim Endpoint (SAVE), and Pediatric Triage Tape. Evidence to support the use of one triage algorithm over another is limited, and the development of effective triage protocols is an important research priority. The most widely recognized mass-casualty triage algorithms in use today are not evidence-based, and no studies directly address these issues in the mass-casualty setting. Furthermore, no studies have evaluated existing mass-casualty triage algorithms regarding ease of use, reliability, and validity when biological, chemical, or radiological agents are introduced. Currently, the lack of a standardized mass-casualty triage system that is well validated, reliable, and uniformly accepted, remains an important gap. Future research directed at triage is recognized as a necessity, and the development of a practical, universal, triage algorithm that incorporates requirements for decontamination or special precautions for infectious agents would facilitate a more organized mass-casualty medical response.

What's in a norm? Sources and processes of norm change.

PubMed

Paluck, Elizabeth Levy

2009-03-01

This reply to the commentary by E. Staub and L. A. Pearlman (2009) revisits the field experimental results of E. L. Paluck (2009). It introduces further evidence and theoretical elaboration supporting Paluck's conclusion that exposure to a reconciliation-themed radio soap opera changed perceptions of social norms and behaviors, not beliefs. Experimental and longitudinal survey evidence reinforces the finding that the radio program affected socially shared perceptions of typical or prescribed behavior-that is, social norms. Specifically, measurements of perceptions of social norms called into question by Staub and Pearlman are shown to correlate with perceptions of public opinion and public, not private, behaviors. Although measurement issues and the mechanisms of the radio program's influence merit further testing, theory and evidence point to social interactions and emotional engagement, not individual education, as the likely mechanisms of change. The present exchange makes salient what is at stake in this debate: a model of change based on learning and personal beliefs versus a model based on group influence and social norms. These theoretical models recommend very different strategies for prejudice and conflict reduction. Future field experiments should attempt to adjudicate between these models by testing relevant policies in real-world settings.

Performance of 68Ga-PSMA PET/CT for Prostate Cancer Management at Initial Staging and Time of Biochemical Recurrence.

PubMed

Bailey, Jason; Piert, Morand

2017-09-09

Recently introduced Gallium-68 labeled PSMA-ligands such as HBED-CC ( 68 Ga-PSMA) have shown promise for unmet diagnostic needs in prostate cancer. 68 Ga-PSMA has demonstrated improved detection rates and specificity for prostate cancer compared to standard imaging approaches. In the setting of primary disease, 68 Ga-PSMA appears to preferentially identify treatment-relevant intermediate and high-risk prostate cancer. There is also a growing evidence that 68 Ga-PSMA positron emission tomography (PET) outperforms alternative conventional imaging methods including choline-based radiotracers for the localization of disease sites at biochemical recurrence, particularly at lower prostate-specific antigen (PSA) levels (< 1 ng/mL). However, the majority of published work lacks rigorous verification of imaging results. 68 Ga-PSMA offers significant promise for both, primary disease and biochemically recurrent prostate cancer. The evidence base to support 68 Ga-PSMA is however still underdeveloped, and more rigorous studies substantiating efficacy are needed.

Caring for people with dementia in residential aged care: successes with a composite person-centered care model featuring Montessori-based activities.

PubMed

Roberts, Gail; Morley, Catherine; Walters, Wendy; Malta, Sue; Doyle, Colleen

2015-01-01

Person-centered models of dementia care commonly merge aspects of existing models with additional influences from published and unpublished evidence and existing government policy. This study reports on the development and evaluation of one such composite model of person-centered dementia care, the ABLE model. The model was based on building the capacity and ability of residents living with dementia, using environmental changes, staff education and organizational and community engagement. Montessori principles were also used. The evaluation of the model employed mixed methods. Significant behavior changes were evident among residents of the dementia care Unit after the model was introduced, as were reductions in anti-psychotic and sedative medication. Staff reported increased knowledge about meeting the needs of people with dementia, and experienced organizational culture change that supported the ABLE model of care. Families were very satisfied with the changes. Copyright © 2015 Elsevier Inc. All rights reserved.

Beyond Physical Activity: The Importance of Play and Nature-Based Play Spaces for Children's Health and Development.

PubMed

Herrington, Susan; Brussoni, Mariana

2015-12-01

The reduction of child obesity continues to be a challenge worldwide. Research indicates that playing outdoors, particularly in natural play spaces, boosts children's physical activity, potentially decreasing childhood obesity. We present evidence that natural play spaces also provide for more diverse forms of play for children of varying ages and competencies. This is crucial because play spaces designed expressly for physical activity may not increase physical activity among less active children. Moreover, when researchers only examine physical activity in play, they overlook the valuable contributions that play makes to other aspects of children's health and development. To enhance research on children and their play environments, we introduce the theory of play affordances. To assist in the creation of more natural play spaces, we describe the Seven Cs, an evidence-based approach for designing children's play spaces that promotes diverse play. We end with some preliminary insights from our current research using the Seven Cs to illustrate the connections between play, nature, and children's healthy development.

Peri-operative interventions producing better functional outcomes and enhanced recovery following total hip and knee arthroplasty: an evidence-based review

PubMed Central

2013-01-01

The increasing numbers of patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA), combined with the rapidly growing repertoire of surgical techniques and interventions available have put considerable pressure on surgeons and other healthcare professionals to produce excellent results with early functional recovery and short hospital stays. The current economic climate and the restricted healthcare budgets further necessitate brief hospitalization while minimizing costs. Clinical pathways and protocols introduced to achieve these goals include a variety of peri-operative interventions to fulfill patient expectations and achieve the desired outcomes. In this review, we present an evidence-based summary of common interventions available to achieve enhanced recovery, reduce hospital stay, and improve functional outcomes following THA and TKA. It covers pre-operative patient education and nutrition, pre-emptive analgesia, neuromuscular electrical stimulation, pulsed electromagnetic fields, peri-operative rehabilitation, modern wound dressings, standard surgical techniques, minimally invasive surgery, and fast-track arthroplasty units. PMID:23406499

Electronic access to scientific nursing knowledge: the Virginia Henderson International Nursing Library.

PubMed

Graves, J R

2001-02-01

To inform oncology nurses about the electronic knowledge resources offered by the Sigma Theta Tau International Virginia Henderson International Nursing Library. Published articles and research studies. Clinical nursing research dissemination has been seriously affected by publication bias. The Virginia Henderson International Nursing Library has introduced both a new publishing paradigm for research and a new knowledge indexing strategy for improving electronic access to research knowledge (findings). The ability of oncology nursing to evolve, as an evidence-based practice, is largely dependent on access to research findings.

Improving Nursing Communication Skills in an Intensive Care Unit Using Simulation and Nursing Crew Resource Management Strategies: An Implementation Project.

PubMed

Turkelson, Carman; Aebersold, Michelle; Redman, Richard; Tschannen, Dana

Effective interprofessional communication is critical to patient safety. This pre-/postimplementation project used a multifaceted educational strategy with high-fidelity simulation to introduce evidence-based communication tools, adapted from Nursing Crew Resource Management, to intensive care unit nurses. Results indicated that participants were satisfied with the education, and their perceptions of interprofessional communication and knowledge improved. Teams (n = 16) that used the communication tools during simulation were more likely to identify the problem, initiate key interventions, and have positive outcomes.

[Psychobiosocial interventions for autism].

PubMed

Bölte, S

2011-05-01

A multitude of interventions is offered for the treatment of autism spectrum disorders (ASD). However, only few have demonstrated scientific evidence, and even the evaluated methods need further examination of their mechanisms and scope. This article provides a brief summary of the premises and principles of successful psychobiosocial ASD intervention. ABA, TEACCH, PECS, social skills and cognitive training are described as examples for established approaches to ASD. Training of μ-suppression using neurofeedback and reanimation of the fusiform gyrus and amygdala using computer-aided facial affect recognition training are introduced as neurobiologically based ASD interventions.

Honoring children, mending the circle: cultural adaptation of trauma-focused cognitive-behavioral therapy for American Indian and Alaska native children.

PubMed

BigFoot, Dolores Subia; Schmidt, Susan R

2010-08-01

American Indians and Alaska Natives are vulnerable populations with significant levels of trauma exposure. The Indian Country Child Trauma Center developed an American Indian and Alaska Native (AI/AN) adaptation of the evidence-based child trauma treatment, trauma-focused cognitive-behavioral therapy. Honoring Children, Mending the Circle (HC-MC) guides the therapeutic process through a blending of AI/AN traditional teachings with cognitive-behavioral methods. The authors introduced the HC-MC treatment and illustrated its therapeutic tools by way of a case illustration.

A consortium-driven framework to guide the implementation of ICH M7 Option 4 control strategies.

PubMed

Barber, Chris; Antonucci, Vincent; Baumann, Jens-Christoph; Brown, Roland; Covey-Crump, Elizabeth; Elder, David; Elliott, Eric; Fennell, Jared W; Gallou, Fabrice; Ide, Nathan D; Jordine, Guido; Kallemeyn, Jeffrey M; Lauwers, Dirk; Looker, Adam R; Lovelle, Lucie E; McLaughlin, Mark; Molzahn, Robert; Ott, Martin; Schils, Didier; Oestrich, Rolf Schulte; Stevenson, Neil; Talavera, Pere; Teasdale, Andrew; Urquhart, Michael W; Varie, David L; Welch, Dennie

2017-11-01

The ICH M7 Option 4 control of (potentially) mutagenic impurities is based on the use of scientific principles in lieu of routine analytical testing. This approach can reduce the burden of analytical testing without compromising patient safety, provided a scientifically rigorous approach is taken which is backed up by sufficient theoretical and/or analytical data. This paper introduces a consortium-led initiative and offers a proposal on the supporting evidence that could be presented in regulatory submissions. Copyright © 2017 Elsevier Inc. All rights reserved.

Using Coaching to Provide Ongoing Support and Supervision to Out-of-School Time Staff. Part 3 in a Series on Implementing Evidence-Based Practices in Out-of-School Time Programs: The Role of Frontline Staff. Research-to-Results Brief. Publication #2009-06

ERIC Educational Resources Information Center

Burkhauser, Mary; Metz, Allison J. R.

2009-01-01

Although skills needed by out-of-school time practitioners can be introduced during training, many skills can only really be learned on the job with ongoing support and supervision provided by a "coach." Research from both the education and out-of-school time fields supports the value of staff coaching as a professional development tool, and staff…

A New Document on Smallpox Vaccination.

PubMed

Tayarani-Najaran, Zahra; Tayarani-Najaran, Nilufar; Sahebkar, Amirhossein; Emami, Seyed Ahmad

2016-12-01

Modern medicine owes much to the invaluable heritage of the practices of past generations and their achievements that have now become medical rules. In the case of vaccination, there is evidence that the nomads of Baluchistan (Southeast Iran) demonstrated natural immunization against cowpox, a practice that was later introduced to the medical community by Edward Jenner. Although the discoveries of scientists cannot be ignored, they are certainly based on the traditional and indigenous experiences that have been transferred from generation to generation until reaching us. Copyright © 2016. Published by Elsevier B.V.

Multi-alternative decision-making with non-stationary inputs.

PubMed

Nunes, Luana F; Gurney, Kevin

2016-08-01

One of the most widely implemented models for multi-alternative decision-making is the multihypothesis sequential probability ratio test (MSPRT). It is asymptotically optimal, straightforward to implement, and has found application in modelling biological decision-making. However, the MSPRT is limited in application to discrete ('trial-based'), non-time-varying scenarios. By contrast, real world situations will be continuous and entail stimulus non-stationarity. In these circumstances, decision-making mechanisms (like the MSPRT) which work by accumulating evidence, must be able to discard outdated evidence which becomes progressively irrelevant. To address this issue, we introduce a new decision mechanism by augmenting the MSPRT with a rectangular integration window and a transparent decision boundary. This allows selection and de-selection of options as their evidence changes dynamically. Performance was enhanced by adapting the window size to problem difficulty. Further, we present an alternative windowing method which exponentially decays evidence and does not significantly degrade performance, while greatly reducing the memory resources necessary. The methods presented have proven successful at allowing for the MSPRT algorithm to function in a non-stationary environment.

An Updated Meta-Analysis of Laparoscopic Versus Open Repair for Perforated Peptic Ulcer.

PubMed

Zhou, Chunhua; Wang, Weizhi; Wang, Jiwei; Zhang, Xiaoyu; Zhang, Qun; Li, Bowen; Xu, Zekuan

2015-09-09

Laparoscopic repair (LR) for perforated peptic ulcer (PPU) has been introduced since 1990. Although many studies comparing LR with open repair (OR) have been published, controversy remains regarding the clinical utility of laparoscopic techniques for the treatment of PPU. Thus, it is necessary for us to broaden our knowledge on this subject with the newly published articles. Twenty-four nonrandomized controlled studies (NRS) and five randomized controlled trails (RCTs) were included in our meta-analyses, which comprised 5,268 patients (1,890 in the LR group and 3,378 in the OR group). In the analysis of high quality NRS and RCTs, compared with OR, high quality evidence suggested that LR was associated with a lower incidence of overall postoperative complications; moderate evidence showed that the two procedures had the similar reoperation rate; based on the low quality evidence, LR had reduced hospital mortality and similar operative time; Moreover, LR was observed having the advantages of earlier resumption of oral intake, shorter hospital stay and less analgesic use, which were supported by very low evidence. All the evidences suggest that LR is better than OR for PPU, but more high-quality RCTs are still needed for further validation.

An Updated Meta-Analysis of Laparoscopic Versus Open Repair for Perforated Peptic Ulcer

PubMed Central

Zhou, Chunhua; Wang, Weizhi; Wang, Jiwei; Zhang, Xiaoyu; Zhang, Qun; Li, Bowen; Xu, Zekuan

2015-01-01

Laparoscopic repair (LR) for perforated peptic ulcer (PPU) has been introduced since 1990. Although many studies comparing LR with open repair (OR) have been published, controversy remains regarding the clinical utility of laparoscopic techniques for the treatment of PPU. Thus, it is necessary for us to broaden our knowledge on this subject with the newly published articles. Twenty-four nonrandomized controlled studies (NRS) and five randomized controlled trails (RCTs) were included in our meta-analyses, which comprised 5,268 patients (1,890 in the LR group and 3,378 in the OR group). In the analysis of high quality NRS and RCTs, compared with OR, high quality evidence suggested that LR was associated with a lower incidence of overall postoperative complications; moderate evidence showed that the two procedures had the similar reoperation rate; based on the low quality evidence, LR had reduced hospital mortality and similar operative time; Moreover, LR was observed having the advantages of earlier resumption of oral intake, shorter hospital stay and less analgesic use, which were supported by very low evidence. All the evidences suggest that LR is better than OR for PPU, but more high-quality RCTs are still needed for further validation. PMID:26350958

Tissue Engineering Considerations in Dental Pulp Regeneration

PubMed Central

Nosrat, Ali; Kim, Jong Ryul; Verma, Prashant; S. Chand, Priya

2014-01-01

Regenerative endodontic procedure is introduced as a biologically based treatment for immature teeth with pulp necrosis. Successful clinical and radiographic outcomes following regenerative procedures have been reported in landmark case reports. Retrospective studies have shown that this conservative treatment allows for continued root development and increases success and survival rate of the treated teeth compared to other treatment options. Although the goal of treatment is regeneration of a functional pulp tissue, histological analyses show a different outcome. Developing predictable protocols would require the use of key elements for tissue engineering: stem cells, bioactive scaffolds, and growth factors. In this study we will review the evidence based steps and outcomes of regenerative endodontics. PMID:24396373

Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma

PubMed Central

Coskun, H. Hakan; Medina, Jesus E.; Robbins, K. Thomas; Silver, Carl E.; Strojan, Primož; Teymoortash, Afshin; Pellitteri, Phillip K.; Rodrigo, Juan P.; Stoeckli, Sandro J.; Shaha, Ashok R.; Suçrez, Carlos; Hartl, Dana M.; de Bree, Remco; Takes, Robert P.; Hamoir, Marc; Pitman, Karen T.; Rinaldo, Alessandra; Ferlito, Alfio

2016-01-01

Neck dissection is an important treatment for metastases from upper aerodigestive carcinoma; an event that markedly reduces survival. Since its inception, the philosophy of the procedure has undergone significant change from one of radicalism to the current conservative approach. Furthermore, nonsurgical modalities have been introduced, and, in many situations, have supplanted neck surgery. The refinements of imaging the neck based on the concept of neck level involvement has encouraged new philosophies to evolve that seem to benefit patient outcomes particularly as this relates to diminished morbidity. The purpose of this review was to highlight the new paradigms for surgical removal of neck metastases using an evidence-based approach. PMID:24623715

Evaluating video digitizer errors

NASA Astrophysics Data System (ADS)

Peterson, C.

2016-01-01

Analog output video cameras remain popular for recording meteor data. Although these cameras uniformly employ electronic detectors with fixed pixel arrays, the digitization process requires resampling the horizontal lines as they are output in order to reconstruct the pixel data, usually resulting in a new data array of different horizontal dimensions than the native sensor. Pixel timing is not provided by the camera, and must be reconstructed based on line sync information embedded in the analog video signal. Using a technique based on hot pixels, I present evidence that jitter, sync detection, and other timing errors introduce both position and intensity errors which are not present in cameras which internally digitize their sensors and output the digital data directly.

Promoting physical therapists’ of research evidence to inform clinical practice: part 1 - theoretical foundation, evidence, and description of the PEAK program

PubMed Central

2014-01-01

Background There is a need for theoretically grounded and evidence-based interventions that enhance the use of research evidence in physical therapist practice. This paper and its companion paper introduce the Physical therapist-driven Education for Actionable Knowledge translation (PEAK) program, an educational program designed to promote physical therapists’ integration of research evidence into clinical decision-making. The pedagogical foundations for the PEAK educational program include Albert Bandura’s social cognitive theory and Malcolm Knowles’s adult learning theory. Additionally, two complementary frameworks of knowledge translation, the Promoting Action on Research Implementation in Health Services (PARiHS) and Knowledge to Action (KTA) Cycle, were used to inform the organizational elements of the program. Finally, the program design was influenced by evidence from previous attempts to facilitate the use of research in practice at the individual and organizational levels. Discussion The 6-month PEAK program consisted of four consecutive and interdependent components. First, leadership support was secured and electronic resources were acquired and distributed to participants. Next, a two-day training workshop consisting of didactic and small group activities was conducted that addressed the five steps of evidence based practice. For five months following the workshop, participants worked in small groups to review and synthesize literature around a group-selected area of common clinical interest. Each group contributed to the generation of a “Best Practices List” - a list of locally generated, evidence-based, actionable behaviors relevant to the groups’ clinical practice. Ultimately, participants agreed to implement the Best Practices List in their clinical practice. Summary This, first of two companion papers, describes the underlying pedagogical theories, knowledge translation frameworks, and research evidence used to derive the PEAK program – an educational program designed to promote the use of research evidence to inform physical therapist practice. The four components of the program are described in detail. The companion paper reports the results of a mixed methods feasibility analysis of this complex educational intervention. PMID:24965501

Is It Benign or Is It a Pariah? Empirical Evidence for the Impact of the Common Myna (Acridotheres tristis) on Australian Birds

PubMed Central

Grarock, Kate; Tidemann, Christopher R.; Wood, Jeffrey; Lindenmayer, David B.

2012-01-01

There is widespread concern over the impact of introduced species on biodiversity, but the magnitude of these impacts can be variable. Understanding the impact of an introduced species is essential for effective management. However, empirical evidence of the impact of an introduced species can be difficult to obtain, especially when the impact is through competition. Change in species abundance is often slow and gradual, coinciding with environmental change. As a result, negative impacts on native species through competition are poorly documented. An example of the difficulties associated with obtaining empirical evidence of impact due to competition comes from work on the Common Myna (Acridotheres tristis). The species is listed in the World’s top 100 worst invaders, despite a lack of empirical evidence of its negative impacts on native species. We assessed the impact of the Common Myna on native bird abundance, using long-term data both pre and post its invasion. At the outset of our investigation, we postulated that Common Myna establishment would negatively affect the abundance of other cavity-nesting species and bird species that are smaller than it. We found a negative relationship between the establishment of the Common Myna and the long-term abundance of three cavity-nesting species (Sulphur-crested Cockatoo, Crimson Rosella, Laughing Kookaburra) and eight small bird species (Striated Paradoxes, Rufous Whistler, Willie Wagtail, Grey Fantail, Magpie-lark, House Sparrow, Silvereye, Common Blackbird). To the best of our knowledge, this finding has never previously been demonstrated at the population level. We discuss the key elements of our success in finding empirical evidence of a species impact and the implications for prioritisation of introduced species for management. Specifically, prioritization of the Common Myna for management over other species still remains a contentious issue. PMID:22808210

Implementing an early childhood school-based mental health promotion intervention in low-resource Ugandan schools: study protocol for a cluster randomized controlled trial.

PubMed

Huang, Keng-Yen; Nakigudde, Janet; Calzada, Esther; Boivin, Michael J; Ogedegbe, Gbenga; Brotman, Laurie Miller

2014-12-01

Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs, but this region has limited access to mental health workers and resources to address these needs. Despite the successes of numerous school-based interventions for promoting child mental health, most evidence-based interventions are not available in SSA. This study will investigate the transportability of an evidence-based program from a developed country (United States) to a SSA country (Uganda). The approach includes task-shifting to early childhood teachers and consists of professional development (five days) to introduce strategies for effective behavior management and positive teacher-student interactions, and group-based consultation (14 sessions) to support adoption of effective practices and tailoring to meet the needs of individual students. The design of this study is guided by two implementation frameworks, the Consolidated Framework for Implementation Research and the Teacher Training Implementation Model, that consider multidimensional aspects of intervention fidelity and contextual predictors that may influence implementation and teacher outcomes. Using a cluster randomized design, 10 schools in Uganda will be randomized to either the intervention group (five schools) or the waitlist control group (five schools). A total of 80 to 100 early childhood teachers will be enrolled in the study. Teacher utilization of evidence-based strategies and practices will be assessed at baseline, immediate post-intervention (six months after baseline), and at seven months post-intervention (during a new academic year). Fidelity measures will be assessed throughout the program implementation period (during professional development and consultation sessions). Individual teacher and contextual factors will be assessed at baseline. Data will be collected from multiple sources. Linear mixed-effect modeling, adjusting for school nesting, will be applied to address study questions. The study will produce important information regarding the value of an evidence-based early intervention, and a theory-guided implementation process and tools designed for use in implementing early childhood evidence-based programs in SSA countries or resource-constrained community settings. This trial was registered with ClinicalTrials.gov (registration number: NCT097115) on 15 May 2013.

Genetic evidence that butternut canker was recently introduced into North America

Treesearch

Glenn R. Furnier; Allison M. Stoiz; Raka M. Mustaphi; Michael E. Ostry

1999-01-01

Butternut (Juglans cinerea) is seriously threatened by a canker disease caused by Sirococens clavigignenti-juglandacearum, a fungus with no known sexual stage. This pathogen was first reported in 1967 and is now found throughout the native range of butternut, suggesting that it was introduced into North America. We used randomly...

The Healthcare Improvement Scotland evidence note rapid review process: providing timely, reliable evidence to inform imperative decisions on healthcare.

PubMed

McIntosh, Heather M; Calvert, Julie; Macpherson, Karen J; Thompson, Lorna

2016-06-01

Rapid review has become widely adopted by health technology assessment agencies in response to demand for evidence-based information to support imperative decisions. Concern about the credibility of rapid reviews and the reliability of their findings has prompted a call for wider publication of their methods. In publishing this overview of the accredited rapid review process developed by Healthcare Improvement Scotland, we aim to raise awareness of our methods and advance the discourse on best practice. Healthcare Improvement Scotland produces rapid reviews called evidence notes using a process that has achieved external accreditation through the National Institute for Health and Care Excellence. Key components include a structured approach to topic selection, initial scoping, considered stakeholder involvement, streamlined systematic review, internal quality assurance, external peer review and updating. The process was introduced in 2010 and continues to be refined over time in response to user feedback and operational experience. Decision-makers value the responsiveness of the process and perceive it as being a credible source of unbiased evidence-based information supporting advice for NHSScotland. Many agencies undertaking rapid reviews are striving to balance efficiency with methodological rigour. We agree that there is a need for methodological guidance and that it should be informed by better understanding of current approaches and the consequences of different approaches to streamlining systematic review methods. Greater transparency in the reporting of rapid review methods is essential to enable that to happen.

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

PubMed

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

2016-11-01

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

Biomechanics of the thorax – research evidence and clinical expertise

PubMed Central

Lee, Diane Gail

2015-01-01

Understanding the biomechanics of the thorax is critical for understanding its role in multiple conditions since the thorax is part of many integrated systems including the musculoskeletal, respiratory, cardiac, digestive and urogynecological. The thorax is also an integrated system within itself and an element of the whole body/person. Therefore, understanding the biomechanics of the thorax is fundamental to all forms of treatment for multiple conditions. The interpretation of movement examination findings depends on one's view of optimal biomechanics and the influential factors. This article will provide a synopsis of the current state of research evidence as well as observations from clinical experience pertaining to the biomechanics of the thorax in order to help clinicians organise this knowledge and facilitate evidence-based and informed management of the, often complex, patient with or without thoracic pain and impairment. The integrated systems model (ISM) will be introduced as a way to determine when the noted biomechanical findings are relevant to a patient's clinical presentation. PMID:26309383

Biomechanics of the thorax - research evidence and clinical expertise.

PubMed

Lee, Diane Gail

2015-07-01

Understanding the biomechanics of the thorax is critical for understanding its role in multiple conditions since the thorax is part of many integrated systems including the musculoskeletal, respiratory, cardiac, digestive and urogynecological. The thorax is also an integrated system within itself and an element of the whole body/person. Therefore, understanding the biomechanics of the thorax is fundamental to all forms of treatment for multiple conditions. The interpretation of movement examination findings depends on one's view of optimal biomechanics and the influential factors. This article will provide a synopsis of the current state of research evidence as well as observations from clinical experience pertaining to the biomechanics of the thorax in order to help clinicians organise this knowledge and facilitate evidence-based and informed management of the, often complex, patient with or without thoracic pain and impairment. The integrated systems model (ISM) will be introduced as a way to determine when the noted biomechanical findings are relevant to a patient's clinical presentation.

[Clinical Practice Guide for Early Detection, Diagnosis and Treatment of the Acute Intoxication Phase in Patients with Alcohol Abuse or Dependence: Part II: Evaluation and Management of Patients with Acute Alcohol Intoxication].

PubMed

de la Espriella Guerrero, Ricardo; de la Hoz Bradford, Ana María; Zárate, Alina Uribe-Holguín; Lee, Patricia Rodríguez; Menéndez, Miguel Cote; Rentería, Ana María Cano; Hernández, Delia Cristina; Cardeño, Carlos; Barré, Michelle Cortés; Kunzel, Gabriel Hernández; Gómez-Restrepo, Carlos

2012-12-01

Worldwide, alcohol is the second most-used psychotropic substance and the third risk factor for early death and disability. Its noxious use is a world public health problem given its personal, labor, family, economic and social impact. The identification of acute alcohol intoxication is extremely important, as well as the alcohol withdrawal syndrome and its complications, such as delirium tremens and Wernicke's encephalopathy in order to grant a timely treatment for those patients. This article introduces the evidence found so as to face and treat these clinic manifestations. Systematic revision of the evidence available together with an evaluation of pertinent guidelines found in literature so as to decide whether to adopt or adapt the existing recommendation for each question or to develop de novo recommendations. For de novo recommendations as well as those adapted, it was carried out an evidence synthesis, together with evidence tables and formulation of recommendations based on the evidence. Evidence was found and recommendations were made for the diagnosis and treatment of acute alcohol intoxication, withdrawal syndrome, delirium tremens and Wernicke's encephalopathy. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Comparative genomics in the Asteraceae reveals little evidence for parallel evolutionary change in invasive taxa.

PubMed

Hodgins, Kathryn A; Bock, Dan G; Hahn, Min A; Heredia, Sylvia M; Turner, Kathryn G; Rieseberg, Loren H

2015-05-01

Asteraceae, the largest family of flowering plants, has given rise to many notorious invasive species. Using publicly available transcriptome assemblies from 35 Asteraceae, including six major invasive species, we examined evidence for micro- and macro-evolutionary genomic changes associated with invasion. To detect episodes of positive selection repeated across multiple introductions, we conducted comparisons between native and introduced genotypes from six focal species and identified genes with elevated rates of amino acid change (dN/dS). We then looked for evidence of positive selection at a broader phylogenetic scale across all taxa. As invasive species may experience founder events during colonization and spread, we also looked for evidence of increased genetic load in introduced genotypes. We rarely found evidence for parallel changes in orthologous genes in the intraspecific comparisons, but in some cases we identified changes in members of the same gene family. Using among-species comparisons, we detected positive selection in 0.003-0.69% and 2.4-7.8% of the genes using site and stochastic branch-site models, respectively. These genes had diverse putative functions, including defence response, stress response and herbicide resistance, although there was no clear pattern in the GO terms. There was no indication that introduced genotypes have a higher proportion of deleterious alleles than native genotypes in the six focal species, suggesting multiple introductions and admixture mitigated the impact of drift. Our findings provide little evidence for common genomic responses in invasive taxa of the Asteraceae and hence suggest that multiple evolutionary pathways may lead to adaptation during introduction and spread in these species. © 2014 John Wiley & Sons Ltd.

Interviewing Suspects in Denial: On How Different Evidence Disclosure Modes Affect the Elicitation of New Critical Information

PubMed Central

May, Lennart; Granhag, Pär Anders; Tekin, Serra

2017-01-01

This study examines how different evidence disclosure modes affect the elicitation of new critical information. Two modes derived from the Strategic Use of Evidence (SUE) framework were compared against an early disclosure mode (i.e., the evidence was disclosed at the outset of the interview). Participants (N = 88) performed a mock crime consisting of several actions before they were interviewed as suspects. In both SUE conditions the interviewer elicited and disclosed statement-evidence inconsistencies in two phases after an introductory phase. For the SUE-Confrontation (SUE-C) condition, the interview was introduced in a business-like manner, and the interviewer confronted the suspects with the in/consistencies without giving them a chance to comment on these. For the SUE-Introduce-Present-Respond (SUE-IPR) condition, the interviewer introduced the interview in a non-guilt-presumptive way, presented the in/consistencies and allowed the suspects to comment on these, and then responded to their comments; at all times in a non-judgmental manner. Both SUE conditions generated comparatively more statement-evidence inconsistencies. The SUE-IPR condition resulted in more new critical information about the phase of the crime for which the interviewer lacked information, compared to the Early disclosure condition. A likely explanation for this was that (for the SUE-IPR condition) the interviewer used the inconsistencies to create a fostering interview atmosphere and made the suspects overestimate the interviewer's knowledge about the critical phase of the crime. In essence, this study shows that in order to win the game (i.e., obtaining new critical information), the interviewer needs to keep the suspect in the game (i.e., by not being too confrontational and judgmental). PMID:28769829

Interviewing Suspects in Denial: On How Different Evidence Disclosure Modes Affect the Elicitation of New Critical Information.

PubMed

May, Lennart; Granhag, Pär Anders; Tekin, Serra

2017-01-01

This study examines how different evidence disclosure modes affect the elicitation of new critical information. Two modes derived from the Strategic Use of Evidence (SUE) framework were compared against an early disclosure mode (i.e., the evidence was disclosed at the outset of the interview). Participants ( N = 88) performed a mock crime consisting of several actions before they were interviewed as suspects. In both SUE conditions the interviewer elicited and disclosed statement-evidence inconsistencies in two phases after an introductory phase. For the SUE-Confrontation (SUE-C) condition, the interview was introduced in a business-like manner, and the interviewer confronted the suspects with the in/consistencies without giving them a chance to comment on these. For the SUE-Introduce-Present-Respond (SUE-IPR) condition, the interviewer introduced the interview in a non-guilt-presumptive way, presented the in/consistencies and allowed the suspects to comment on these, and then responded to their comments; at all times in a non-judgmental manner. Both SUE conditions generated comparatively more statement-evidence inconsistencies. The SUE-IPR condition resulted in more new critical information about the phase of the crime for which the interviewer lacked information, compared to the Early disclosure condition. A likely explanation for this was that (for the SUE-IPR condition) the interviewer used the inconsistencies to create a fostering interview atmosphere and made the suspects overestimate the interviewer's knowledge about the critical phase of the crime. In essence, this study shows that in order to win the game (i.e., obtaining new critical information), the interviewer needs to keep the suspect in the game (i.e., by not being too confrontational and judgmental).

Chimpanzees (Pan troglodytes) Flexibly Use Introduced Species for Nesting and Bark Feeding in a Human-Dominated Habitat.

PubMed

McCarthy, Maureen S; Lester, Jack D; Stanford, Craig B

2017-01-01

As habitat loss and fragmentation place growing pressure on endangered nonhuman primate populations, researchers find increasing evidence for novel responses in behavior. In western Uganda between the Budongo and Bugoma Forests, chimpanzees ( Pan troglodytes schweinfurthii ) inhabit a mosaic landscape comprising forest fragments, human settlements, and agricultural land. We recorded nests and feeding evidence of unhabituated chimpanzees in this region over a 12-mo period. We found extensive evidence of nesting in introduced tree species, including eucalyptus ( Eucalyptus grandis ), guava ( Psidium guajava ), cocoa ( Theobroma cacao ), and Caribbean pine ( Pinus caribaea ). In addition, we found instances of ground nesting, nest reuse, and composite nests constructed from branches of multiple trees. This evidence may indicate a lack of suitable nesting trees or attempts by chimpanzees to nest in areas of riparian forest that allow them to avoid human detection. We also found new evidence for eucalyptus bark feeding by chimpanzees. Such evidence suggests chimpanzees respond flexibly to mitigate anthropogenic pressures in human-dominated landscapes. The limits of such flexibility remain unknown. Further research is needed to examine systematically the factors influencing the use of such resources and to understand better the extent to which chimpanzees can persist while relying on them.

Infection prevention and control strategies in the era of limited resources and quality improvement: a perspective paper.

PubMed

Vandijck, Dominique; Cleemput, Irina; Hellings, Johan; Vogelaers, Dirk

2013-11-01

This paper aims to describe, using an evidence-based approach, the importance of and the resources necessary for implementing effective infection prevention and control (IPC) programmes. The intrinsic and explicit values of such strategies are presented from a clinical, health-economic and patient safety perspective. Policy makers and hospital managers are committed to providing comprehensive, accessible, and affordable healthcare of high quality. Changes in the healthcare system over time accompanied with variations in demographics and case-mix have considerably affected the availability, quality and ultimately the safety of healthcare. The main goal of an IPC programme is to prevent and control healthcare-associated infections (HAI). Many patient-, healthcare provider-, and organizational factors are associated with an increased risk for acquiring HAIs and may impact both the quality and outcome of patient care. Evidence has been published in support of having an effective IPC programme. It has been estimated that about one-third of HAIs could be prevented if key elements of the evidence-based recommendations for IPC are adequately introduced and followed. However, several healthcare agencies from over the world have reported deficits in the essential resources and components of current IPC programmes. To meet its main goal, staffing, training, and infrastructure requirements are needed. Nevertheless, and given the economic crisis, policy makers and hospital managers may be tempted to not increase or even to reduce the budget as it consumes resources and does not generate sufficient visible revenue. IPC is a critical issue in patient safety, as HAIs are by far the most common complication affecting admitted patients. The significant clinical and health-economic burden HAIs place on the healthcare system speak to the importance of getting introduced effective IPC programmes. Copyright © 2013 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Community-based primary care: improving and assessing diabetes management.

PubMed

Gannon, Meghan; Qaseem, Amir; Snow, Vincenza

2010-01-01

Morbidity and mortality associated with diabetes make it a prime target for quality improvement research. Quality gaps and racial/gender disparities persist throughout this population of patients necessitating a sustainable improvement in the clinical management of diabetes. The authors of this study sought (1) to provide a population perspective on diabetes management, and (2) to reinforce evidence-based clinical guidelines through a Web-based educational module.The project also aimed to gain insight into working remotely with a community of rural physicians. This longitudinal pre-post intervention study involved 18 internal medicine physicians and included 3 points of medical record data abstraction over 24 months. A Web-based educational module was introduced after the baseline data abstraction. This module contained chapters on clinical education, practice tools, and self-assessment. The results showed a sustained improvement in most clinical outcomes and demonstrated the effectiveness of using Web-based mediums to reinforce clinical guidelines and change physician behavior.

76 FR 66986 - Shawn M. Gallegos, D.D.S., Decision and Order

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-28

... introduced documentary evidence. Respondent elected not to testify. After the hearing, both parties filed... credible. Her testimony was internally consistent, corroborated by documentary evidence of record and the... responsibilities such as ``management, payroll * * * accounts receivable and accounts payable, as well as...

Three stages in the evolution of the genetic code

NASA Technical Reports Server (NTRS)

Baumann, U.; Oro, J.

1993-01-01

A diversification of the genetic code based on the number of codons available for the proteinous amino acids is established. Three groups of amino acids during evolution of the code are distinguished. On the basis of their chemical complexity those amino acids emerging later in a translation process are derived. Codon number and chemical complexity indicate that His, Phe, Tyr, Cys and either Lys or Asn were introduced in the second stage, whereas the number of codons alone gives evidence that Trp and Met were introduced in the third stage. The amino acids of stage 1 use purine-rich codons, while all the amino acids introduced in the second stage, in contrast, use pyrimidines in the third position of their codons. A low abundance of pyrimidines during early translation is derived. This assumption is supported by experiments on non-enzymatic replication and interactions of hairpin loops with a complementary strand. A back extrapolation concludes a high purine content of the first nucleic acids, which gradually decreased during their evolution. Amino acids independently available from prebiotic synthesis were thus correlated to purine-rich codons. Implications on the prebiotic replication are discussed also in the light of recent codon usage data.

Empirical Evidence Supporting Frequent Cryptic Speciation in Epiphyllous Liverworts: A Case Study of the Cololejeunea lanciloba Complex

PubMed Central

Yu, Ying; Heinrichs, Jochen; Zhu, Rui-Liang; Schneider, Harald

2013-01-01

Cryptic species are frequently recovered in plant lineages, and considered an important cause for divergent of morphological disparity and species diversity. The identification of cryptic species has important implications for the assessment of conservation needs of species aggregates. The mechanisms and processes of the origin of cryptic species diversity are still poorly understand based on the lack of studies especially in context of environment factors. Here we explored evidence for cryptic species within the epiphyllous liverworts Cololejeunea lanciloba complex based on two loci, the plastid trnL-F region and the nuclear ribosomal ITS region. Several analytic approaches were employed to delimit species based on DNA sequence variation including phylogenetic reconstruction, statistical parsimony networks analysis and two recently introduced species delimitation criteria: Rosenberg’s reciprocal monophyly and Rodrigo’s randomly distinct. We found evidence for thirteen genetically distinct putative species, each consisting of more than one haplotype, rather than four morphologically-circumscribed species. The results implied that the highly conserved phenotypes are not congruent with the genetic differentiation, contributing to incorrect assessments of the biodiversity of epiphyllous liverworts. We hypothesize that evolution of cryptic species recovered may be caused by selection of traits critical to the survival in epiphyllous habitats combined with limited developmental options designed in the small body. PMID:24367634

Pragmatic prevention of preterm birth and evidence based medicine.

PubMed

Hoyme, Udo B

2016-07-01

Effective prevention of preterm birth is one of the unsolved problems in modern medicine. In the Thuringia campaign 2000 based on a simple screening with intravaginal pH self-measurements, adequate medical diagnosis and immediate antimicrobial therapy of genital infection, the rate of newborns <1000 g was reduced to 0.38 %, the lowest incidence ever seen in any of the German states. Therefore, the regime should be implicated as a necessary step of optimizing and rationalizing the health care system. However, in the discussion we had to learn that the best way to inhibit progress is to cope with problems by preferring the most complicated policies under persistent renunciation of simple solutions. As long as we do not have other alternative safe, simple and cheap methods, do we really have to wait even more decades to come for a prospectively randomized double-blinded almost impracticable study to convince the latest skeptical scientist that we have plenty of evidence-based means to reduce the incidence of premature birth, now, by decreasing infectious morbidity in pregnancy and by the same action childbed fever as well? Insisting scholastically on nothing but the 100 % pure evidence sometimes can hamper innovations and potential benefit. Would a similar caution ever had allowed us for instance to introduce handwashing according to Semmelweis? Good news, the Government of the State of Thuringia has decided this year to reestablish a pH selfcare screening programme.

Redesigning Radiotherapy Quality Assurance: Opportunities to Develop an Efficient, Evidence-Based System to Support Clinical Trials

PubMed Central

Bekelman, Justin E.; Deye, James A.; Vikram, Bhadrasain; Bentzen, Soren M.; Bruner, Deborah; Curran, Walter J.; Dignam, James; Efstathiou, Jason A.; FitzGerald, T. J.; Hurkmans, Coen; Ibbott, Geoffrey S.; Lee, J. Jack; Merchant, Timothy E.; Michalski, Jeff; Palta, Jatinder R.; Simon, Richard; Ten Haken, Randal K.; Timmerman, Robert; Tunis, Sean; Coleman, C. Norman; Purdy, James

2012-01-01

Background In the context of national calls for reorganizing cancer clinical trials, the National Cancer Institute (NCI) sponsored a two day workshop to examine the challenges and opportunities for optimizing radiotherapy quality assurance (QA) in clinical trial design. Methods Participants reviewed the current processes of clinical trial QA and noted the QA challenges presented by advanced technologies. Lessons learned from the radiotherapy QA programs of recent trials were discussed in detail. Four potential opportunities for optimizing radiotherapy QA were explored, including the use of normal tissue toxicity and tumor control metrics, biomarkers of radiation toxicity, new radiotherapy modalities like proton beam therapy, and the international harmonization of clinical trial QA. Results Four recommendations were made: 1) Develop a tiered (and more efficient) system for radiotherapy QA and tailor intensity of QA to clinical trial objectives. Tiers include (i) general credentialing, (ii) trial specific credentialing, and (iii) individual case review; 2) Establish a case QA repository; 3) Develop an evidence base for clinical trial QA and introduce innovative prospective trial designs to evaluate radiotherapy QA in clinical trials; and 4) Explore the feasibility of consolidating clinical trial QA in the United States. Conclusion Radiotherapy QA may impact clinical trial accrual, cost, outcomes and generalizability. To achieve maximum benefit, QA programs must become more efficient and evidence-based. PMID:22425219

Building a Unit-Level Mentored Program to Sustain a Culture of Inquiry for Evidence-Based Practice.

PubMed

Breckenridge-Sproat, Sara T; Throop, Meryia D; Raju, Dheeraj; Murphy, Deborah A; Loan, Lori A; Patrician, Patricia A

2015-01-01

This study tested the effectiveness of a dynamic educational and mentoring program, facilitated by unit-level mentors, to introduce, promote, and sustain an evidence-based practice (EBP) culture among nurses in a military healthcare setting. The need to identify gaps in practice, apply principles of EBP, and advance scientific applications in the pursuit of quality nursing care is as important to military healthcare as it is in the civilian sector. The Advancing Research through Close Collaboration Model guided the intervention and study. Three instruments were used: the Organizational Readiness for System-wide Integration of Evidence-Based Practice, EBP Beliefs, and EBP Implementation scales. The study took place in 3 military hospitals simultaneously undergoing facility and staff integration. Data were collected from staff nurses in the inpatient nursing units before and after a facilitated education and mentoring intervention. Three hundred sixty nurses (38%) completed baseline, and 325 (31%) completed follow-up surveys. Scores improved on all 3 measures following implementation of the program; however, the differences were statistically significant only for the Organizational Readiness for System-wide Integration of Evidence-Based Practice scale (70.96 vs 77.63, t = -3.95, P < .01). In the paired individual pretest/posttest subsample (n = 56), scores improved significantly on all 3 instruments. Despite typically high turnover rates of military personnel and restructuring of 3 facilities during the study period, the readiness for, beliefs about, and implementation of EBP improved. This study suggests that a commitment to an EBP culture may diffuse among individuals in an organization, even while experiencing significant change. It also demonstrates that a unit-level mentored EBP program is sustainable despite changes in organizational structure and workforce composition.

Audit of an inpatient liaison psychiatry consultation service.

PubMed

Lyne, John; Hill, Michelle; Burke, Patricia; Ryan, Martina

2009-01-01

The purpose of this paper is to examine an audit that was performed of all patients referred to a liaison psychiatry inpatient consultation service which sought to establish a baseline for demographics, type of referral, and management of referrals, with a view to introducing improved evidence-based treatments. It also aims to examine timeliness of response to referrals benchmarked against published standards. All inpatient referrals to a liaison psychiatry service were recorded over a six-month period, including demographics, diagnosis, management and timeliness of response to referrals. The data were retrospectively analysed and compared against international standards. A total of 172 referrals were received in the six months. Commonest referral reasons included assessments regarding depressive disorders (23.8 per cent), delirium/other cognitive disorders (19.2 per cent), alcohol-related disorders (18.6 per cent), anxiety disorders (14.5 per cent), and risk management (12.2 per cent). Evidence-based practices were not utilised effectively for a number of different types of presentations. A total of 40.1 per cent of referrals were seen on the same day, 75.4 per cent by the end of the next day, and 93.4 per cent by the end of the following day. Use of a hospital protocol for management of delirium may improve outcomes for these patients. Evidence-based techniques, such as brief intervention therapies, may be beneficial for referrals involving alcohol dependence. Referrals were seen reasonably quickly, but there is room for improvement when compared with published standards. This paper provides valuable information for those involved in management of liaison psychiatry consultation services, providing ideas for development and implementation of evidence based practices.

Anatomy of a public health agency turnaround: the case of the general health district in Mahoning County.

PubMed

Honoré, Peggy A; Stefanak, Matthew; Dessens, Scott

2012-01-01

A turnaround describes an organization's ability to recover from successive periods of decline. Current and projected declines in US economic conditions continue to place local public health departments at risk of fiscal exigency. This examination focused on turnaround methodologies used by a local public health department to reverse successive periods of operational and financial declines. Illustrations are provided on the value added by implementing financial ratio and trend analysis in addition to using evidence-based private sector turnaround strategies of retrenchment, repositioning, and reorganization. Evidence has shown how the financial analysis and strategies aided in identifying operational weakness and set in motion corrective measures. The Public Health Uniform Data System is introduced along with a list of standards offered for mainstreaming these and other routine stewardship practices to diagnose, predict, and prevent agency declines.

Cell phone camera ballistics: attacks and countermeasures

NASA Astrophysics Data System (ADS)

Steinebach, Martin; Liu, Huajian; Fan, Peishuai; Katzenbeisser, Stefan

2010-01-01

Multimedia forensics deals with the analysis of multimedia data to gather information on its origin and authenticity. One therefore needs to distinguish classical criminal forensics (which today also uses multimedia data as evidence) and multimedia forensics where the actual case is based on a media file. One example for the latter is camera forensics where pixel error patters are used as fingerprints identifying a camera as the source of an image. Of course multimedia forensics can become a tool for criminal forensics when evidence used in a criminal investigation is likely to be manipulated. At this point an important question arises: How reliable are these algorithms? Can a judge trust their results? How easy are they to manipulate? In this work we show how camera forensics can be attacked and introduce a potential countermeasure against these attacks.

Assessing fidelity in individual and family therapy for adolescent substance abuse.

PubMed

Hogue, Aaron; Dauber, Sarah; Chinchilla, Priscilla; Fried, Adam; Henderson, Craig; Inclan, Jaime; Reiner, Robert H; Liddle, Howard A

2008-09-01

This study introduces an observational measure of fidelity in evidence-based practices for adolescent substance abuse treatment. The Therapist Behavior Rating Scale-Competence (TBRS-C) measures adherence and competence in individual cognitive-behavioral therapy and multidimensional family therapy for adolescent substance abuse. The TBRS-C assesses fidelity to the core therapeutic goals of each approach and also contains global ratings of therapist competence. Study participants were 136 clinically referred adolescents and their families observed in 437 treatment sessions. The TBRS-C demonstrated strong interrater reliability for goal-specific ratings of treatment adherence, and modest reliability for goal-specific and global ratings of therapist competence, evidence of construct validity, and discriminant validity with an observational measure of therapeutic alliance. The utility of the TBRS-C for evaluating treatment fidelity in field settings is discussed.

GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale.

PubMed

Welch, Vivian A; Akl, Elie A; Guyatt, Gordon; Pottie, Kevin; Eslava-Schmalbach, Javier; Ansari, Mohammed T; de Beer, Hans; Briel, Matthias; Dans, Tony; Dans, Inday; Hultcrantz, Monica; Jull, Janet; Katikireddi, Srinivasa Vittal; Meerpohl, Joerg; Morton, Rachael; Mosdol, Annhild; Petkovic, Jennifer; Schünemann, Holger J; Sharaf, Ravi N; Singh, Jasvinder A; Stanev, Roger; Tonia, Thomy; Tristan, Mario; Vitols, Sigurd; Watine, Joseph; Tugwell, Peter

2017-10-01

This article introduces the rationale and methods for explicitly considering health equity in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology for development of clinical, public health, and health system guidelines. We searched for guideline methodology articles, conceptual articles about health equity, and examples of guidelines that considered health equity explicitly. We held three meetings with GRADE Working Group members and invited comments from the GRADE Working Group listserve. We developed three articles on incorporating equity considerations into the overall approach to guideline development, rating certainty, and assembling the evidence base and evidence to decision and/or recommendation. Clinical and public health guidelines have a role to play in promoting health equity by explicitly considering equity in the process of guideline development. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

[From Evidence to Health Policy Making: Pre-Exposure Prophylaxis for HIV Prevention].

PubMed

Ko, Nai-Ying

2016-12-01

Pre-exposure prophylaxis (PrEP), in combination with traditional prevention strategies (such as condom use, voluntary HIV counseling and testing, and treatment for sexually transmitted infections), has been shown to effectively prevent HIV infection. As of September 2015, the World Health Organization recommends that people at substantial risk of HIV infection should be offered PrEP as an additional prevention choice, as part of comprehensive prevention. This article introduces how to apply a systematic review using the methodology of Grading of Recommendations Assessment, Development and Evaluation (GRADE) to write clinical guidelines. With support from the Taiwan Centers for Disease Control, the Taiwan AIDS Society published clinical guidelines for oral pre-exposure prophylaxis in Taiwan. Nurses are responsible to apply evidence-based knowledge and to use their professional influence to shape health policies related to HIV prevention.

Frequent frames as a cue for grammatical categories in child directed speech.

PubMed

Mintz, Toben H

2003-11-01

This paper introduces the notion of frequent frames, distributional patterns based on co-occurrence patterns of words in sentences, then investigates the usefulness of this information in grammatical categorization. A frame is defined as two jointly occurring words with one word intervening. Qualitative and quantitative results from distributional analyses of six different corpora of child directed speech are presented in two experiments. In the analyses, words that were surrounded by the same frequent frame were categorized together. The results show that frequent frames yield very accurate categories. Furthermore, evidence from behavioral studies suggests that infants and adults are sensitive to frame-like units, and that adults use them to categorize words. This evidence, along with the success of frames in categorizing words, provides support for frames as a basis for the acquisition of grammatical categories.

Cooperative runtime monitoring

NASA Astrophysics Data System (ADS)

Hallé, Sylvain

2013-11-01

Requirements on message-based interactions can be formalised as an interface contract that specifies constraints on the sequence of possible messages that can be exchanged by multiple parties. At runtime, each peer can monitor incoming messages and check that the contract is correctly being followed by their respective senders. We introduce cooperative runtime monitoring, where a recipient 'delegates' its monitoring task to the sender, which is required to provide evidence that the message it sends complies with the contract. In turn, this evidence can be quickly checked by the recipient, which is then guaranteed of the sender's compliance to the contract without doing the monitoring computation by itself. A particular application of this concept is shown on web services, where service providers can monitor and enforce contract compliance of third-party clients at a small cost on the server side, while avoiding to certify or digitally sign them.

Longitudinal Analysis of the Impact and Cost of Person-Centered Planning for People with Intellectual Disabilities in England

ERIC Educational Resources Information Center

Robertson, Janet; Emerson, Eric; Hatton, Chris; Elliott, Johan; McIntosh, Barbara; Swift, Paul; Krinjen-Kemp, Emma; Towers, Christine; Romeo, Renee; Knapp, Martin; Sanderson, Helen; Routledge, Martin; Oakes, Peter; Joyce, Theresa

2006-01-01

Person-centered planning is central to United Kingdom policies regarding the support of people with intellectual disabilities. However, little evidence exists on the impact or cost of introducing person-centered planning. We examined the efficacy, effectiveness, and costs of introducing person-centered planning for 93 people with intellectual…

Introducing E-Portfolios to Pre-Service Teachers as Tools for Reflection and Growth: Lessons Learnt

ERIC Educational Resources Information Center

Oakley, Grace; Pegrum, Mark; Johnston, Shannon

2014-01-01

E-portfolios are being introduced into initial teacher education programmes internationally to help pre-service teachers build records of their learning journeys and develop into reflective practitioners; to allow them to assemble collections of evidence of their achievements against graduate standards, which can function as digital CVs; and to…

A Systematic Review on the Impact of Point-of-Sale Tobacco Promotion on Smoking

PubMed Central

McGee, Rob; Marsh, Louise; Hoek, Janet

2015-01-01

Introduction: The tobacco retail environment is a crucial marketing medium for the industry. A 2009 review found evidence of a positive association between exposure to point-of-sale (POS) tobacco promotion and increased smoking and smoking susceptibility, though limitations in the evidence base were identified. Aim and Methods: We reviewed and critically appraised recent evidence documenting the influence of POS tobacco promotion, and POS tobacco display bans, on smoking-related behavior and cognitions. We reviewed original quantitative and qualitative research that examined the relationship between POS tobacco promotion and smoking prevalence, individual-level smoking and quitting and tobacco purchasing behavior, smoking susceptibility, and smoking-related cognitions. Results: Twenty peer-reviewed studies (18 quantitative and 2 qualitative) met the inclusion criteria; each study reported findings consistent with a positive association between exposure to POS tobacco promotion and smoking or smoking susceptibility. Several studies met key criteria for causality: 4 indicated a dose–response association, 2 prospective studies were identified, and evidence from intervention studies supported the reversibility of the association. Findings were consistent across different study designs, settings, and measures. Conclusions: The existing evidence supports a positive association between exposure to POS tobacco promotion and smoking. This review provides evidence to support the continuation of POS tobacco display bans in those jurisdictions where such legislation has been introduced and strengthens the evidence encouraging similar policies in jurisdictions without a POS display ban. PMID:25173775

29 CFR 458.77 - Rights of parties.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR STANDARDS OF CONDUCT STANDARDS... witnesses, and to introduce into the record documentary or other relevant evidence, except that the...) copies of documentary evidence shall be submitted and a copy furnished to each of the other parties...

Larvivorous fish for preventing malaria transmission.

PubMed

Walshe, Deirdre P; Garner, Paul; Abdel-Hameed Adeel, Ahmed A; Pyke, Graham H; Burkot, Tom

2013-12-10

Adult anopheline mosquitoes transmit Plasmodium parasites that cause malaria. Some fish species eat mosquito larvae and pupae. In disease control policy documents, the World Health Organization includes biological control of malaria vectors by stocking ponds, rivers, and water collections near where people live with larvivorous fish to reduce Plasmodium parasite transmission. The Global Fund finances larvivorous fish programmes in some countries, and, with increasing efforts in eradication of malaria, policy makers may return to this option. We therefore assessed the evidence base for larvivorous fish programmes in malaria control. Our main objective was to evaluate whether introducing larvivorous fish to anopheline breeding sites impacts Plasmodium parasite transmission. Our secondary objective was to summarize studies evaluating whether introducing larvivorous fish influences the density and presence of Anopheles larvae and pupae in water sources, to understand whether fish can possibly have an effect. We attempted to identify all relevant studies regardless of language or publication status (published, unpublished, in press, or ongoing). We searched the following databases: the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE; EMBASE; CABS Abstracts; LILACS; and the metaRegister of Controlled Trials (mRCT) until 18 June 2013. We checked the reference lists of all studies identified by the above methods. We also examined references listed in review articles and previously compiled bibliographies to look for eligible studies. Randomized controlled trials and non-randomized controlled trials, including controlled before-and-after studies, controlled time series and controlled interrupted time series studies from malaria-endemic regions that introduced fish as a larvicide and reported on malaria in the community or the density of the adult anopheline population. In the absence of direct evidence of an effect on transmission, we carried out a secondary analysis on studies that evaluated the effect of introducing larvivorous fish on the density or presence of immature anopheline mosquitoes (larvae and pupae forms) in community water sources to determine whether this intervention has any potential in further research on control of malaria vectors. Three review authors screened abstracts and examined potentially relevant studies by using an eligibility form. Two review authors independently extracted data and assessed risk of bias of included studies. If relevant data were unclear or were not reported, we wrote to the trial authors for clarification. We presented data in tables, and we summarized studies that evaluated the effects of fish introduction on anopheline immature density or presence, or both. We used GRADE to summarize evidence quality. We also examined whether the authors of included studies reported on any possible adverse impact of larvivorous fish introduction on non-target native species. We found no reliable studies that reported the effects of introducing larvivorous fish on malaria infection in nearby communities, on entomological inoculation rate, or on adult Anopheles density.For the secondary analysis, we examined the effects of introducing larvivorous fish on the density and presence of anopheline larvae and pupae in community water sources. We included 12 small studies, with follow-up from 22 days to five years. Studies were conducted in a variety of settings, including localized water bodies (such as wells, domestic water containers, fishponds, and pools; six studies), riverbed pools below dams (two studies), rice field plots (three studies), and water canals (two studies). All studies were at high risk of bias.The research was insufficient to determine whether larvivorous fish reduce the density of Anopheles larvae and pupae (nine studies, unpooled data, very low quality evidence). Some studies with high stocking levels of fish seemed to arrest the increase in immature anopheline populations, or to reduce the number of immature anopheline mosquitoes, compared with controls. However, this finding was not consistent, and in studies that showed a decrease in immature anopheline populations, the effect was not consistently sustained. Larvivorous fish may reduce the number of water sources with Anopheles larvae and pupae (five studies, unpooled data, low quality evidence).None of the included studies reported effects of larvivorous fish on local native fish populations or other species. Reliable research is insufficient to show whether introducing larvivorous fish reduces malaria transmission or the density of adult anopheline mosquito populations.In research examining the effects on immature anopheline stages of introducing fish to potential malaria vector breeding sites (localized water bodies such as wells and domestic water sources, rice field plots, and water canals) weak evidence suggests an effect on the density or presence of immature anopheline mosquitoes with high stocking levels of fish, but this finding is by no means consistent. We do not know whether this translates into health benefits, either with fish alone or with fish combined with other vector control measures. Our interpretation of the current evidence is that countries should not invest in fish stocking as a larval control measure in any malaria transmission areas outside the context of carefully controlled field studies or quasi-experimental designs. Research could also usefully examine the effects on native fish and other non-target species.

Discussion on wound care in the 21st century.

PubMed

Harrison, Mary

In June of this year, Liverpool John Moores University was the venue for the Advancing Wound Care conference. Experts in wound healing from both the university and from the Royal Liverpool and Broadgreen University Hospital NHS Trust gave keynote speeches aimed at informing, improving and advancing healthcare knowledge on such topics as: wound healing in the 21st century; evidence-based practice for superficial burns; infected and complex wounds; and the use of silver in wound care. This paper introduced the conference and considered some of the complex issues involved in clinical decision making for wound management.

Moral injury: A new challenge for complementary and alternative medicine.

PubMed

Kopacz, Marek S; Connery, April L; Bishop, Todd M; Bryan, Craig J; Drescher, Kent D; Currier, Joseph M; Pigeon, Wilfred R

2016-02-01

Moral injury represents an emerging clinical construct recognized as a source of morbidity in current and former military personnel. Finding effective ways to support those affected by moral injury remains a challenge for both biomedical and complementary and alternative medicine. This paper introduces the concept of moral injury and suggests two complementary and alternative medicine, pastoral care and mindfulness, which may prove useful in supporting military personnel thought to be dealing with moral injury. Research strategies for developing an evidence-base for applying these, and other, complementary and alternative medicine modalities to moral injury are discussed. Published by Elsevier Ltd.

Meeting the 2015 Millennium Development Goals with new interventions for abused women.

PubMed

Karmaliani, Rozina; Shehzad, Shireen; Hirani, Saima Shams; Asad, Nargis; Akbar Ali Hirani, Shela; McFarlane, Judith

2011-12-01

In a developing country such as Pakistan, where illiteracy, poverty, gender differences, and health issues are prevalent, violence against women is a commonly observed phenomenon. The rising incidences of abuse among women indicate a need to introduce evidence-based community-derived interventions for meeting Millennium Developmental Goals by 2015. This article discusses the application of counseling, economic skills building, and microcredit programs as practical and effective interventions to improve the health outcomes of abused women and, therefore, improving maternal and child health in the Pakistani society. Copyright © 2011 Elsevier Inc. All rights reserved.

Computers can't listen--algorithmic logic meets patient centredness.

PubMed

Pearce, Christopher; Trumble, Steve

2006-06-01

The doctor-patient relationship is crucial to the practice of medicine and yet the rise of science in the 19th and 20th centuries shifted doctors' focus away from the patient toward another entity: the disease. Slowly, the medical profession is rediscovering the importance of the doctor-patient relationship. General practice has contributed significantly by developing the patient centred clinical method, and further models have been introduced that take into account both the doctor's and the patient's perspectives. More recent changes in medicine--particularly computerisation and the introduction of evidence based medicine--may once again threaten this emphasis on patient centredness.

Interlaminar stresses in composite laminates: A perturbation analysis

NASA Technical Reports Server (NTRS)

Hsu, P. W.; Herakovich, C. T.

1976-01-01

A general method of solution for an elastic balanced symmetric composite laminate subject to a uniaxial extension was developed based upon a perturbation analysis of a limiting free body containing an interfacial plane. The solution satisfies more physical requirements and boundary conditions than previous investigations, and predicts smooth continuous interlaminar stresses with no instabilities. It determines the finite maximum intensity for the interlaminar normal stress in all laminates, provides mathematical evidences for the singular stresses in angle-ply laminates, suggests the need for the experimental determination of an important problem parameter, and introduces a viable means for solving related problems of practical interest.

Kernel approach to molecular similarity based on iterative graph similarity.

PubMed

Rupp, Matthias; Proschak, Ewgenij; Schneider, Gisbert

2007-01-01

Similarity measures for molecules are of basic importance in chemical, biological, and pharmaceutical applications. We introduce a molecular similarity measure defined directly on the annotated molecular graph, based on iterative graph similarity and optimal assignments. We give an iterative algorithm for the computation of the proposed molecular similarity measure, prove its convergence and the uniqueness of the solution, and provide an upper bound on the required number of iterations necessary to achieve a desired precision. Empirical evidence for the positive semidefiniteness of certain parametrizations of our function is presented. We evaluated our molecular similarity measure by using it as a kernel in support vector machine classification and regression applied to several pharmaceutical and toxicological data sets, with encouraging results.

Current philosophy in the surgical management of neck metastases for head and neck squamous cell carcinoma.

PubMed

Coskun, H Hakan; Medina, Jesus E; Robbins, K Thomas; Silver, Carl E; Strojan, Primož; Teymoortash, Afshin; Pellitteri, Phillip K; Rodrigo, Juan P; Stoeckli, Sandro J; Shaha, Ashok R; Suárez, Carlos; Hartl, Dana M; de Bree, Remco; Takes, Robert P; Hamoir, Marc; Pitman, Karen T; Rinaldo, Alessandra; Ferlito, Alfio

2015-06-01

Neck dissection is an important treatment for metastases from upper aerodigestive carcinoma; an event that markedly reduces survival. Since its inception, the philosophy of the procedure has undergone significant change from one of radicalism to the current conservative approach. Furthermore, nonsurgical modalities have been introduced, and, in many situations, have supplanted neck surgery. The refinements of imaging the neck based on the concept of neck level involvement has encouraged new philosophies to evolve that seem to benefit patient outcomes particularly as this relates to diminished morbidity. The purpose of this review was to highlight the new paradigms for surgical removal of neck metastases using an evidence-based approach. © 2014 Wiley Periodicals, Inc.

Interpersonal psychotherapy for depressed adolescents (IPT-A).

PubMed

Brunstein-Klomek, Anat; Zalsman, Gil; Mufson, Laura

2007-01-01

Recently the Food and Drug Administration (FDA) published a black box warning on the use of serotonin receptor reuptake inhibitors for adolescent depression. This situation makes the non-pharmacological therapeutic alternatives more relevant than ever before. The aim of this review is to introduce the theoretical formulation, practical application and efficacy studies of Interpersonal Psychotherapy for depressed adolescents (IPT-A). A review is offered of published papers in peer-reviewed journals, books and edited chapters using Medline and PsychInfo publications between 1966 and February 2005. IPT-A is an evidence-based psychotherapy for depressed adolescents in both hospital-based and community outpatient settings. IPT-A is a brief and efficient therapy for adolescent depression. Training programs for child psychologists and psychiatrists are recommended.

What Constitutes Science and Scientific Evidence: Roles of Null Hypothesis Testing

ERIC Educational Resources Information Center

Chang, Mark

2017-01-01

We briefly discuss the philosophical basis of science, causality, and scientific evidence, by introducing the hidden but most fundamental principle of science: the similarity principle. The principle's use in scientific discovery is illustrated with Simpson's paradox and other examples. In discussing the value of null hypothesis statistical…

Mobile health use in low- and high-income countries: an overview of the peer-reviewed literature

PubMed Central

Bastawrous, Andrew; Armstrong, Matthew J

2013-01-01

The evolution of mobile phone technology has introduced new possibilities to the field of medicine. Combining technological advances with medical expertise has led to the use of mobile phones in all healthcare areas including diagnostics, telemedicine, research, reference libraries and interventions. This article provides an overview of the peer-reviewed literature, published between 1 August 2006 and 1 August 2011, for the application of mobile/cell phones (from basic text-messaging systems to smartphones) in healthcare in both resource-poor and high-income countries. Smartphone use is paving the way in high-income countries, while basic text-messaging systems of standard mobile phones are proving to be of value in low- and middle-income countries. Ranging from infection outbreak reporting, anti-HIV therapy adherence to gait analysis, resuscitation training and radiological imaging, the current uses and future possibilities of mobile phone technology in healthcare are endless. Multiple mobile phone based applications are available for healthcare workers and healthcare consumers; however, the absolute majority lack an evidence base. Therefore, more rigorous research is required to ensure that healthcare is not flooded with non-evidence based applications and is maximized for patient benefit. PMID:23564897

Not so sweet refrain: sugar-sweetened beverage taxes, industry opposition and harnessing the lessons learned from tobacco control legal challenges.

PubMed

George, Anita

2018-05-21

As a growing number of countries implement, or announce plans to introduce, a sugar-sweetened beverage (SSB) tax, this paper explores the public health rationale for such a tax and provides an overview of the international normative and policy instruments supporting the introduction of fiscal measures on sugary drinks. After examining parallels between the legal arguments raised by the food and beverage industry in opposition to SSB taxes and those raised by the tobacco industry in response to tobacco control measures, this paper draws four key lessons that will assist countries to design effective and robust SSB tax measures and counter food and beverage industry opposition: regulatory distinctions in tax coverage should be based on bona fide, evidence-based reasoning; evidence-based measures need to be tailored to a country's public health objectives as part of a comprehensive strategy to address unhealthy diet consumption; procedural requirements and due process should be observed in the drafting and implementation of the measure; and regulatory space exists within domestic constitutions, laws and international trade and investment agreements recognising the sovereign right of states to regulate in the interests of public health.

Spatial variability and macro‐scale drivers of growth for native and introduced Flathead Catfish populations

USGS Publications Warehouse

Massie, Danielle L.; Smith, Geoffrey; Bonvechio, Timothy F.; Bunch, Aaron J.; Lucchesi, David O.; Wagner, Tyler

2018-01-01

Quantifying spatial variability in fish growth and identifying large‐scale drivers of growth are fundamental to many conservation and management decisions. Although fish growth studies often focus on a single population, it is becoming increasingly clear that large‐scale studies are likely needed for addressing transboundary management needs. This is particularly true for species with high recreational value and for those with negative ecological consequences when introduced outside of their native range, such as the Flathead Catfish Pylodictis olivaris. This study quantified growth variability of the Flathead Catfish across a large portion of its contemporary range to determine whether growth differences existed between habitat types (i.e., reservoirs and rivers) and between native and introduced populations. Additionally, we investigated whether growth parameters varied as a function of latitude and time since introduction (for introduced populations). Length‐at‐age data from 26 populations across 11 states in the USA were modeled using a Bayesian hierarchical von Bertalanffy growth model. Population‐specific growth trajectories revealed large variation in Flathead Catfish growth and relatively high uncertainty in growth parameters for some populations. Relatively high uncertainty was also evident when comparing populations and when quantifying large‐scale patterns. Growth parameters (Brody growth coefficient [K] and theoretical maximum average length [L∞]) were not different (based on overlapping 90% credible intervals) between habitat types or between native and introduced populations. For populations within the introduced range of Flathead Catfish, latitude was negatively correlated with K. For native populations, we estimated an 85% probability that L∞ estimates were negatively correlated with latitude. Contrary to predictions, time since introduction was not correlated with growth parameters in introduced populations of Flathead Catfish. Results of this study suggest that Flathead Catfish growth patterns are likely shaped more strongly by finer‐scale processes (e.g., exploitation or prey abundances) as opposed to macro‐scale drivers.

Hemodynamics-Driven Deposition of Intraluminal Thrombus in Abdominal Aortic Aneurysms

PubMed Central

Di Achille, P.; Tellides, G.; Humphrey, J.D.

2016-01-01

Accumulating evidence suggests that intraluminal thrombus plays many roles in the natural history of abdominal aortic aneurysms. There is, therefore, a pressing need for computational models that can describe and predict the initiation and progression of thrombus in aneurysms. In this paper, we introduce a phenomenological metric for thrombus deposition potential and use hemodynamic simulations based on medical images from six patients to identify best-fit values of the two key model parameters. We then introduce a shape optimization method to predict the associated radial growth of the thrombus into the lumen based on the expectation that thrombus initiation will create a thrombogenic surface, which in turn will promote growth until increasing hemodynamically induced frictional forces prevent any further cell or protein deposition. Comparisons between predicted and actual intraluminal thrombus in the six patient-specific aneurysms suggest that this phenomenological description provides a good first estimate of thrombus deposition. We submit further that, because the biologically active region of the thrombus appears to be confined to a thin luminal layer, predictions of morphology alone may be sufficient to inform fluid-solid-growth models of aneurysmal growth and remodeling. PMID:27569676

Special investigative actions in the criminal procedural law of Bosnia and Herzegovina, and their purposefulness in law

NASA Astrophysics Data System (ADS)

Rodic, V.

2017-05-01

Special investigative actions are a novelty in the criminal procedure legislation BiH. In our legislation this has been introduced only in 2003. These are actions that need to assist prosecutors to effectively reveal the perpetrators and the evidence of serious and complex crimes, especially organized crime. There are criminal offenses in whose execution included a larger number of people in different locations and which are carried out with the help of new communication technologies, so that it is not possible to prove the classic means of evidence (documents, physical evidence, witnesses). Unfortunately, criminals are often better organized than the state and in their criminal activities are introduced various technological developments. Therefore, the legislator extended the powers of the prosecutor and gave them into the hands of more effective mechanisms for discovering the perpetrators of these crimes. Special investigative measures are listed in the Penal Code.

Monogeneans in introduced and native cichlids in México: evidence for transfer.

PubMed

Jiménez-García, M I; Vidal-Martínez, V M; López-Jiménez, S

2001-08-01

We examined 2 cichlid fish species native to México, Cichlasoma callolepis and C. fenestratum, and 2 introduced African cichlids, Oreochromis aureus and O. niloticus, from 3 localities in southeastern México for monogeneans. Six monogenean species infected the African cichlids: Cichlidogyrus haplochromii, C. dossoui, C. longicornis longicornis, C. sclerosus, C. tilapiae, and Enterogyrus malmbergi. We found all these parasite species, except C. haplochromii and C. dossoui, on the native C. fenestratum and C. callolepis. Prevalences of Cichlidogyrus spp. were 3-10% and abundances ranged from 0.03 +/- 0.2 to 0.1 +/- 0.3 for native cichlids. We only recovered a single E. malmbergi from 1 C. callolepis. We found Sciadicleithrum bravohollisae, a monogenean of native Cichlasoma spp., on the gills of the introduced O. aureus from Lake Catemaco (prevalence 3%, abundance 0.03 +/- 0.2). Although prevalence and abundance in atypical hosts were fairly low, the present findings provide evidence of monogenean transfer from African to American cichlids and vice versa. This is the first record of exotic monogeneans in the genus Cichlidogyrus and Enterogyrus infecting native American cichlid fish. It is also the first record from southeastern México of a native American monogenean infecting introduced African cichlids.

Integrative veterinary medical education and consensus guidelines for an integrative veterinary medicine curriculum within veterinary colleges

PubMed Central

Memon, M.A.; Shmalberg, J.; Adair, H.S.; Allweiler, S.; Bryan, J.N.; Cantwell, S.; Carr, E.; Chrisman, C.; Egger, C.M.; Greene, S.; Haussler, K.K.; Hershey, B.; Holyoak, G.R.; Johnson, M.; Jeune, S. Le; Looney, A.; McConnico, R.S.; Medina, C.; Morton, A.J.; Munsterman, A.; Nie, G.J.; Park, N.; Parsons-Doherty, M.; Perdrizet, J.A.; Peyton, J.L.; Raditic, D.; Ramirez, H.P.; Saik, J.; Robertson, S.; Sleeper, M.; Dyke, J. Van; Wakshlag, J.

2016-01-01

Integrative veterinary medicine (IVM) describes the combination of complementary and alternative therapies with conventional care and is guided by the best available evidence. Veterinarians frequently encounter questions about complementary and alternative veterinary medicine (CAVM) in practice, and the general public has demonstrated increased interest in these areas for both human and animal health. Consequently, veterinary students should receive adequate exposure to the principles, theories, and current knowledge supporting or refuting such techniques. A proposed curriculum guideline would broadly introduce students to the objective evaluation of new veterinary treatments while increasing their preparation for responding to questions about IVM in clinical practice. Such a course should be evidence-based, unbiased, and unaffiliated with any particular CAVM advocacy or training group. All IVM courses require routine updating as new information becomes available. Controversies regarding IVM and CAVM must be addressed within the course and throughout the entire curriculum. Instructional honesty regarding the uncertainties in this emerging field is critical. Increased training of future veterinary professionals in IVM may produce an openness to new ideas that characterizes the scientific method and a willingness to pursue and incorporate evidence-based medicine in clinical practice with all therapies, including those presently regarded as integrative, complementary, or alternative. PMID:27200270

Comparative effectiveness research: what to do when experts disagree about risks.

PubMed

Lie, Reidar K; Chan, Francis K L; Grady, Christine; Ng, Vincent H; Wendler, David

2017-06-19

Ethical issues related to comparative effectiveness research, or research that compares existing standards of care, have recently received considerable attention. In this paper we focus on how Ethics Review Committees (ERCs) should evaluate the risks of comparative effectiveness research. We discuss what has been a prominent focus in the debate about comparative effectiveness research, namely that it is justified when "nothing is known" about the comparative effectiveness of the available alternatives. We argue that this focus may be misleading. Rather, we should focus on the fact that some experts believe that the evidence points in favor of one intervention, whereas other experts believe that the evidence favors the alternative(s). We will then introduce a case that illustrates this point, and based on that, discuss how ERCs should deal with such cases of expert disagreement. We argue that ERCs have a duty to assess the range of expert opinions and based on that assessment arrive at a risk judgment about the study under consideration. We also argue that assessment of expert disagreement is important for the assignment of risk level to a clinical trial: what is the basis for expert opinions, how strong is the evidence appealed to by various experts, and how can clinical trial monitoring affect the possible increased risk of clinical trial participation.

Knowledge Translation in Audiology

PubMed Central

Kothari, Anita; Bagatto, Marlene P.; Seewald, Richard; Miller, Linda T.; Scollie, Susan D.

2011-01-01

The impetus for evidence-based practice (EBP) has grown out of widespread concern with the quality, effectiveness (including cost-effectiveness), and efficiency of medical care received by the public. Although initially focused on medicine, EBP principles have been adopted by many of the health care professions and are often represented in practice through the development and use of clinical practice guidelines (CPGs). Audiology has been working on incorporating EBP principles into its mandate for professional practice since the mid-1990s. Despite widespread efforts to implement EBP and guidelines into audiology practice, gaps still exist between the best evidence based on research and what is being done in clinical practice. A collaborative dynamic and iterative integrated knowledge translation (KT) framework rather than a researcher-driven hierarchical approach to EBP and the development of CPGs has been shown to reduce the knowledge-to-clinical action gaps. This article provides a brief overview of EBP and CPGs, including a discussion of the barriers to implementing CPGs into clinical practice. It then offers a discussion of how an integrated KT process combined with a community of practice (CoP) might facilitate the development and dissemination of evidence for clinical audiology practice. Finally, a project that uses the knowledge-to-action (KTA) framework for the development of outcome measures in pediatric audiology is introduced. PMID:22194314

Developing an evidence base for interdisciplinary learning: a systematic review.

PubMed

Cooper, H; Carlisle, C; Gibbs, T; Watkins, C

2001-07-01

The overall aim of the study was to explore the feasibility of introducing interdisciplinary education within undergraduate health professional programmes. This paper reports on the first stage of the study in which a systematic review was conducted to summarize the evidence for interdisciplinary education of undergraduate health professional students. Systematic reviews integrate valid information providing a basis for rational decision making about health care which should be based on empirical and not anecdotal evidence. The accepted principles for systematic reviews were adapted in order to allow integration of the literature to produce recommendations for educational practice and guidelines for future research. The literature on interdisciplinary education was found to be diverse, including relatively small amounts of research data and much larger amounts of evaluation literature. Methodological rating schemes were used to test for confounding influences in the research studies. The number of studies found was 141 but only 30 (21%) were included in the analysis because of lack of methodological rigour in the research and poorly developed outcome measures. Student health professionals were found to benefit from interdisciplinary education with outcome effects primarily relating to changes in knowledge, skills, attitudes and beliefs. Effects upon professional practice were not discernible and educational and psychological theories were rarely used to guide the development of the educational interventions.

Population screening for genetic disorders in the 21st century: evidence, economics, and ethics.

PubMed

Grosse, S D; Rogowski, W H; Ross, L F; Cornel, M C; Dondorp, W J; Khoury, M J

2010-01-01

Proposals for population screening for genetic diseases require careful scrutiny by decision makers because of the potential for harms and the need to demonstrate benefits commensurate with the opportunity cost of resources expended. We review current evidence-based processes used in the United States, the United Kingdom, and the Netherlands to assess genetic screening programs, including newborn screening programs, carrier screening, and organized cascade testing of relatives of patients with genetic syndromes. In particular, we address critical evidentiary, economic, and ethical issues that arise in the appraisal of screening tests offered to the population. Specific case studies include newborn screening for congenital adrenal hyperplasia and cystic fibrosis and adult screening for hereditary hemochromatosis. Organizations and countries often reach different conclusions about the suitability of screening tests for implementation on a population basis. Deciding when and how to introduce pilot screening programs is challenging. In certain cases, e.g., hereditary hemochromatosis, a consensus does not support general screening although cascade screening may be cost-effective. Genetic screening policies have often been determined by technological capability, advocacy, and medical opinion rather than through a rigorous evidence-based review process. Decision making should take into account principles of ethics and opportunity costs. Copyright 2009 S. Karger AG, Basel.

Japanese Guideline for Allergic Rhinitis 2014.

PubMed

Okubo, Kimihiro; Kurono, Yuichi; Fujieda, Shigeharu; Ogino, Satoshi; Uchio, Eiichi; Odajima, Hiroshi; Takenaka, Hiroshi

2014-09-01

Like asthma and atopic dermatitis, allergic rhinitis is an allergic disease, but of the three, it is the only type I allergic disease. Allergic rhinitis includes pollinosis, which is intractable and reduces quality of life (QOL) when it becomes severe. A guideline is needed to understand allergic rhinitis and to use this knowledge to develop a treatment plan. In Japan, the first guideline was prepared after a symposium held by the Japanese Society of Allergology in 1993. The current 7th edition was published in 2013, and is widely used today. To incorporate evidence based medicine (EBM) introduced from abroad, the most recent collection of evidence/literature was supplemented to the Practical Guideline for the Management of Allergic Rhinitis in Japan 2013. The revised guideline includes assessment of diagnosis/treatment and prescriptions for children and pregnant women, for broad clinical applications. An evidence-based step-by-step strategy for treatment is also described. In addition, the QOL concept and cost benefit analyses are also addressed. Along with Allergic Rhinitis and its Impact of Asthma (ARIA), this guideline is widely used for various clinical purposes, such as measures for patients with sinusitis, childhood allergic rhinitis, oral allergy syndrome, and anaphylaxis and for pregnant women. A Q&A section regarding allergic rhinitis in Japan was added to the end of this guideline.

Post-Traumatic Stress Disorder: Evidence-Based Research for the Third Millennium

PubMed Central

2005-01-01

The stress that results from traumatic events precipitates a spectrum of psycho-emotional and physiopathological outcomes. Post-traumatic stress disorder (PTSD) is a psychiatric disorder that results from the experience or witnessing of traumatic or life-threatening events. PTSD has profound psychobiological correlates, which can impair the person's daily life and be life threatening. In light of current events (e.g. extended combat, terrorism, exposure to certain environmental toxins), a sharp rise in patients with PTSD diagnosis is expected in the next decade. PTSD is a serious public health concern, which compels the search for novel paradigms and theoretical models to deepen the understanding of the condition and to develop new and improved modes of treatment intervention. We review the current knowledge of PTSD and introduce the role of allostasis as a new perspective in fundamental PTSD research. We discuss the domain of evidence-based research in medicine, particularly in the context of complementary medical intervention for patients with PTSD. We present arguments in support of the notion that the future of clinical and translational research in PTSD lies in the systematic evaluation of the research evidence in treatment intervention in order to insure the most effective and efficacious treatment for the benefit of the patient. PMID:16322808

[Authentication of Trace Material Evidence in Forensic Science Field with Infrared Microscopic Technique].

PubMed

Jiang, Zhi-quan; Hu, Ke-liang

2016-03-01

In the field of forensic science, conventional infrared spectral analysis technique is usually unable to meet the detection requirements, because only very a few trace material evidence with diverse shapes and complex compositions, can be extracted from the crime scene. Infrared microscopic technique is developed based on a combination of Fourier-transform infrared spectroscopic technique and microscopic technique. Infrared microscopic technique has a lot of advantages over conventional infrared spectroscopic technique, such as high detection sensitivity, micro-area analysisand nondestructive examination. It has effectively solved the problem of authentication of trace material evidence in the field of forensic science. Additionally, almost no external interference is introduced during measurements by infrared microscopic technique. It can satisfy the special need that the trace material evidence must be reserved for witness in court. It is illustrated in detail through real case analysis in this experimental center that, infrared microscopic technique has advantages in authentication of trace material evidence in forensic science field. In this paper, the vibration features in infrared spectra of material evidences, including paints, plastics, rubbers, fibers, drugs and toxicants, can be comparatively analyzed by means of infrared microscopic technique, in an attempt to provide powerful spectroscopic evidence for qualitative diagnosis of various criminal and traffic accident cases. The experimental results clearly suggest that infrared microscopic technique has an incomparable advantage and it has become an effective method for authentication of trace material evidence in the field of forensic science.

Comparing Mindfulness-Based Group Therapy With Treatment as Usual for Opioid Dependents: A Pilot Randomized Clinical Trial Study Protocol.

PubMed

Imani, Saeed; Atef Vahid, Mohammad Kazem; Gharraee, Banafsheh; Habibi, Mojtaba; Bowen, Sarah; Noroozi, Alireza

2015-03-01

In response to high burden of opioid abuse in Iran, Ministry of Health has launched a large-scale opioid maintenance treatment program, delivered through a network of certified drug treatment centers. To promote opioid pharmacotherapies, there is an urgent need to develop and introduce evidence-based psychosocial interventions into the network. This is a randomized clinical trial (RCT) to investigate feasibility and effectiveness of adding mindfulness-based group therapy to opioid pharmacotherapies as compared to opioid pharmacotherapies alone. The primary outcomes were treatment retention and percentage of weekly morphine, methamphetamine, and benzodiazepine negative tests. This is the first RCT that explores the effectiveness of mindfulness-based relapse prevention group therapy among opioid dependent clients in Iran. The feasibility of group therapy and comparison of outcomes in intervention and control groups should be discussed in the outcome article.

The implementation of DRG-based hospital reimbursement in Switzerland: A population-based perspective.

PubMed

Busato, André; von Below, Georg

2010-10-16

Switzerland introduces a DRG (Diagnosis Related Groups) based system for hospital financing in 2012 in order to increase efficiency and transparency of Swiss health care. DRG-based hospital reimbursement is not simultaneously realized in all Swiss cantons and several cantons already implemented DRG-based financing irrespective of the national agenda, a setting that provides an opportunity to compare the situation in different cantons. Effects of introducing DRGs anticipated for providers and insurers are relatively well known but it remains less clear what effects DRGs will have on served populations. The objective of the study is therefore to analyze differences of volume and major quality indicators of care between areas with or without DRG-based hospital reimbursement from a population based perspective. Small area analysis of all hospitalizations in acute care hospitals and of all consultations reimbursed by mandatory basic health insurance for physicians in own practice during 2003-2007. The results show fewer hospitalizations and a relocation of resources to outpatient care in areas with DRG reimbursement. Overall burden of disease expressed as per capita DRG cost weights was almost identical between the two types of hospital reimbursement and no distinct temporal differences were detected in this respect. But the results show considerably higher 90-day rehospitalization rates in DRG areas. The study provides evidence of both desired and harmful effects related to the implementation of DRGs. Systematic monitoring of outcomes and quality of care are therefore essential elements to maintain in the Swiss health system after DRG's are implemented on a nationwide basis in 2012.

Attachment-based interventions for families with young children.

PubMed

Woodhouse, Susan S

2018-05-21

Given a large body of research indicating links between child attachment and later mental health outcomes, interventions that promote children's secure attachment to their caregivers have the potential to contribute to prevention of psychopathology and promotion of well-being. A number of attachment-based interventions have been developed to support parents, enhance caregiving quality, and promote children's attachment security with the aim of improving children's mental health. There is now a growing evidence base to support the efficacy of a number of these interventions. The present literature review and introduction to the special issue on attachment-based interventions for families with young children describes key aspects of attachment theory and research that form the theoretical and empirical background for attachment-based interventions, and introduces seven case studies illustrating five different attachment-based interventions. The case studies represent a variety of attachment-based models, including both group and individual treatments, and show applications across a range of caregiver contexts. © 2018 Wiley Periodicals, Inc.

Perspectives on econometric modelling to inform policy: a UK qualitative case study of minimum unit pricing of alcohol

PubMed Central

Bond, Lyndal; Hilton, Shona

2014-01-01

Background: Novel policy interventions may lack evaluation-based evidence. Considerations to introduce minimum unit pricing (MUP) of alcohol in the UK were informed by econometric modelling (the ‘Sheffield model’). We aim to investigate policy stakeholders’ views of the utility of modelling studies for public health policy. Methods: In-depth qualitative interviews with 36 individuals involved in MUP policy debates (purposively sampled to include civil servants, politicians, academics, advocates and industry-related actors) were conducted and thematically analysed. Results: Interviewees felt familiar with modelling studies and often displayed detailed understandings of the Sheffield model. Despite this, many were uneasy about the extent to which the Sheffield model could be relied on for informing policymaking and preferred traditional evaluations. A tension was identified between this preference for post hoc evaluations and a desire for evidence derived from local data, with modelling seen to offer high external validity. MUP critics expressed concern that the Sheffield model did not adequately capture the ‘real life’ world of the alcohol market, which was conceptualized as a complex and, to some extent, inherently unpredictable system. Communication of modelling results was considered intrinsically difficult but presenting an appropriate picture of the uncertainties inherent in modelling was viewed as desirable. There was general enthusiasm for increased use of econometric modelling to inform future policymaking but an appreciation that such evidence should only form one input into the process. Conclusion: Modelling studies are valued by policymakers as they provide contextually relevant evidence for novel policies, but tensions exist with views of traditional evaluation-based evidence. PMID:24367068

Current trends in multimodality treatment of esophageal and gastroesophageal junction cancer - Review article.

PubMed

Klevebro, Fredrik; Ekman, Simon; Nilsson, Magnus

2017-09-01

Multimodality treatment has now been widely introduced in the curatively intended treatment of esophageal and gastroesophageal junction cancer. We aim to give an overview of the scientific evidence for the available treatment strategies and to describe which trends that are currently developing. We conducted a review of the scientific evidence for the different curatively intended treatment strategies that are available today. Relevant articles of randomized controlled trials, cohort studies, and meta analyses were included. After a systematic search of relevant papers we have included 64 articles in the review. The results show that adenocarcinomas and squamous cell carcinomas of the esophagus and gastroesophageal junction are two separate entities and should be analysed and studied as two different diseases. Neoadjuvant treatment followed by surgical resection is the gold standard of the curatively intended treatment today. There is no scientific evidence to support the use of chemoradiotherapy over chemotherapy in the neoadjuvant setting for esophageal or junctional adenocarcinoma. There is reasonable evidence to support definitive chemoradiotherapy as a treatment option for squamous cell carcinoma of the esophagus. The evidence base for curatively intended treatments of esophageal and gastroesophageal junction cancer is not very strong. Several on-going trials have the potential to change the gold standard treatments of today. Copyright © 2017 Elsevier Ltd. All rights reserved.

Population-based dietary approaches for the prevention of noncommunicable diseases.

PubMed

Somasundaram, Noel P; Kalupahana, Nishan Sudheera

2016-04-01

As the incidence of noncommunicable diseases such as diabetes continues to rise at an alarming rate in South-East Asia, it is imperative that urgent and population-wide strategies are adopted. The most important contributors to the rise in noncommunicable disease are a rise in mean caloric intake and a decrease in physical activity. The evidence for population-based dietary approaches to counter these factors is reviewed. Several structural and cohesive interdepartmental coordination efforts are required for effective implementation of prevention strategies. Since low- and middle-income countries may lack the frameworks for effective and integrated multi-stakeholder intervention, implementation of population-based dietary and physical-activity approaches may be delayed and may be too late for effective prevention in current at-risk cohorts. Evidence-based strategies to decrease energy intake and increase physical activity are now well established and their urgent adoption by Member States of the World Health Organization South-East Asia Region is essential. In the context of Sri Lanka, for example, it is recommended that the most effective and easy-to-implement interventions would be media campaigns, restrictions on advertisement of unhealthy foods, taxation of unhealthy foods, subsidies for production of healthy foods, and laws on nutrition labelling that introduce colour coding of packaged foods.

A web-based decision support tool for prognosis simulation in multiple sclerosis.

PubMed

Veloso, Mário

2014-09-01

A multiplicity of natural history studies of multiple sclerosis provides valuable knowledge of the disease progression but individualized prognosis remains elusive. A few decision support tools that assist the clinician in such task have emerged but have not received proper attention from clinicians and patients. The objective of the current work is to implement a web-based tool, conveying decision relevant prognostic scientific evidence, which will help clinicians discuss prognosis with individual patients. Data were extracted from a set of reference studies, especially those dealing with the natural history of multiple sclerosis. The web-based decision support tool for individualized prognosis simulation was implemented with NetLogo, a program environment suited for the development of complex adaptive systems. Its prototype has been launched online; it enables clinicians to predict both the likelihood of CIS to CDMS conversion, and the long-term prognosis of disability level and SPMS conversion, as well as assess and monitor the effects of treatment. More robust decision support tools, which convey scientific evidence and satisfy the needs of clinical practice by helping clinicians discuss prognosis expectations with individual patients, are required. The web-based simulation model herein introduced proposes to be a step forward toward this purpose. Copyright © 2014 Elsevier B.V. All rights reserved.

Polarization-based and specular-reflection-based noncontact latent fingerprint imaging and lifting

NASA Astrophysics Data System (ADS)

Lin, Shih-Schön; Yemelyanov, Konstantin M.; Pugh, Edward N., Jr.; Engheta, Nader

2006-09-01

In forensic science the finger marks left unintentionally by people at a crime scene are referred to as latent fingerprints. Most existing techniques to detect and lift latent fingerprints require application of a certain material directly onto the exhibit. The chemical and physical processing applied to the fingerprint potentially degrades or prevents further forensic testing on the same evidence sample. Many existing methods also have deleterious side effects. We introduce a method to detect and extract latent fingerprint images without applying any powder or chemicals on the object. Our method is based on the optical phenomena of polarization and specular reflection together with the physiology of fingerprint formation. The recovered image quality is comparable to existing methods. In some cases, such as the sticky side of tape, our method shows unique advantages.

Beyond the vent: New perspectives on hydrothermal plumes and pelagic biology

NASA Astrophysics Data System (ADS)

Phillips, Brennan T.

2017-03-01

Submarine hydrothermal vent fields introduce buoyant plumes of chemically altered seawater to the deep-sea water column. Chemoautotrophic microbes exploit this energy source, facilitating seafloor-based primary production that evidence suggests may transfer to pelagic consumers. While most hydrothermal plumes have relatively small volumes, there are recent examples of large-scale plume events associated with periods of eruptive activity, which have had a pronounced effect on water-column biology. This correlation suggests that hydrothermal plumes may have influenced basin-scale ocean chemistry during periods of increased submarine volcanism during the Phanerozoic eon. This paper synthesizes a growing body of scientific evidence supporting the hypothesis that hydrothermal plumes are the energetic basis of unique deep-sea pelagic food webs. While many important questions remain concerning the biology of hydrothermal plumes, this discussion is not present in ongoing management efforts related to seafloor massive sulfide (SMS) mining. Increased research efforts, focused on high-resolution surveys of midwater biology relative to plume structures, are recommended to establish baseline conditions and monitor the impact of future mining-based disturbances to the pelagic biosphere.

Avian magnetite-based magnetoreception: a physiologist's perspective

PubMed Central

Cadiou, Hervé; McNaughton, Peter A.

2010-01-01

It is now well established that animals use the Earth's magnetic field to perform long-distance migration and other navigational tasks. However, the transduction mechanisms that allow the conversion of magnetic field variations into an electric signal by specialized sensory cells remain largely unknown. Among the species that have been shown to sense Earth-strength magnetic fields, birds have been a model of choice since behavioural tests show that their direction-finding abilities are strongly influenced by magnetic fields. Magnetite, a ferromagnetic mineral, has been found in a wide range of organisms, from bacteria to vertebrates. In birds, both superparamagnetic (SPM) and single-domain magnetite have been found to be associated with the trigeminal nerve. Electrophysiological recordings from cells in the trigeminal ganglion have shown an increase in action potential firing in response to magnetic field changes. More recently, histological evidence has demonstrated the presence of SPM magnetite in the subcutis of the pigeon's upper beak. The aims of the present review are to review the evidence for a magnetite-based mechanism in birds and to introduce physiological concepts in order to refine the proposed models. PMID:20106875

Researching the psychological therapies in prison: considerations and future recommendations.

PubMed

Gee, Joanna; Bertrand-Godfrey, Betty

2014-01-01

The psychological therapies are widely considered within the forensic literature as holding a useful role in the prison system, however, despite this, very little research into the psychological therapies has taken place. Further, where research is carried out, it is often associated with the need for evidence-based practice (EBP), involving quantification and randomization. The paper aims to discuss these issues. This paper will initially introduce the importance of research into the psychological therapies in prison, followed by a consideration of EBP which can be thought of as the current movement governing research in the psychological therapies in the UK. However, in providing a focused critique of EBP, particularly within prisons, this paper will attempt to pave the way for a consideration of alternative research methodologies and resultant methods in researching the psychological therapies in prisons in the UK. Through this it is argued that research within the prison setting should act not to promote interventions and create an evidence-based as such, but to provide an accessible body of knowledge for the psychological therapists working in prisons in the UK.

Assessing the Metabolic Impact of Nitrogen Availability Using a Compartmentalized Maize Leaf Genome-Scale Model1[C][W][OPEN

PubMed Central

Simons, Margaret; Saha, Rajib; Amiour, Nardjis; Kumar, Akhil; Guillard, Lenaïg; Clément, Gilles; Miquel, Martine; Li, Zhenni; Mouille, Gregory; Lea, Peter J.; Hirel, Bertrand; Maranas, Costas D.

2014-01-01

Maize (Zea mays) is an important C4 plant due to its widespread use as a cereal and energy crop. A second-generation genome-scale metabolic model for the maize leaf was created to capture C4 carbon fixation and investigate nitrogen (N) assimilation by modeling the interactions between the bundle sheath and mesophyll cells. The model contains gene-protein-reaction relationships, elemental and charge-balanced reactions, and incorporates experimental evidence pertaining to the biomass composition, compartmentalization, and flux constraints. Condition-specific biomass descriptions were introduced that account for amino acids, fatty acids, soluble sugars, proteins, chlorophyll, lignocellulose, and nucleic acids as experimentally measured biomass constituents. Compartmentalization of the model is based on proteomic/transcriptomic data and literature evidence. With the incorporation of information from the MetaCrop and MaizeCyc databases, this updated model spans 5,824 genes, 8,525 reactions, and 9,153 metabolites, an increase of approximately 4 times the size of the earlier iRS1563 model. Transcriptomic and proteomic data have also been used to introduce regulatory constraints in the model to simulate an N-limited condition and mutants deficient in glutamine synthetase, gln1-3 and gln1-4. Model-predicted results achieved 90% accuracy when comparing the wild type grown under an N-complete condition with the wild type grown under an N-deficient condition. PMID:25248718

Phylogeny and ancient DNA of Sus provides insights into neolithic expansion in Island Southeast Asia and Oceania

PubMed Central

Larson, Greger; Cucchi, Thomas; Fujita, Masakatsu; Matisoo-Smith, Elizabeth; Robins, Judith; Anderson, Atholl; Rolett, Barry; Spriggs, Matthew; Dolman, Gaynor; Kim, Tae-Hun; Thuy, Nguyen Thi Dieu; Randi, Ettore; Doherty, Moira; Due, Rokus Awe; Bollt, Robert; Djubiantono, Tony; Griffin, Bion; Intoh, Michiko; Keane, Emile; Kirch, Patrick; Li, Kuang-Ti; Morwood, Michael; Pedriña, Lolita M.; Piper, Philip J.; Rabett, Ryan J.; Shooter, Peter; Van den Bergh, Gert; West, Eric; Wickler, Stephen; Yuan, Jing; Cooper, Alan; Dobney, Keith

2007-01-01

Human settlement of Oceania marked the culmination of a global colonization process that began when humans first left Africa at least 90,000 years ago. The precise origins and dispersal routes of the Austronesian peoples and the associated Lapita culture remain contentious, and numerous disparate models of dispersal (based primarily on linguistic, genetic, and archeological data) have been proposed. Here, through the use of mtDNA from 781 modern and ancient Sus specimens, we provide evidence for an early human-mediated translocation of the Sulawesi warty pig (Sus celebensis) to Flores and Timor and two later separate human-mediated dispersals of domestic pig (Sus scrofa) through Island Southeast Asia into Oceania. Of the later dispersal routes, one is unequivocally associated with the Neolithic (Lapita) and later Polynesian migrations and links modern and archeological Javan, Sumatran, Wallacean, and Oceanic pigs with mainland Southeast Asian S. scrofa. Archeological and genetic evidence shows these pigs were certainly introduced to islands east of the Wallace Line, including New Guinea, and that so-called “wild” pigs within this region are most likely feral descendants of domestic pigs introduced by early agriculturalists. The other later pig dispersal links mainland East Asian pigs to western Micronesia, Taiwan, and the Philippines. These results provide important data with which to test current models for human dispersal in the region. PMID:17360400

Supplementary feeding restructures urban bird communities

PubMed Central

Galbraith, Josie A.; Jones, Darryl N.; Stanley, Margaret C.

2015-01-01

Food availability is a primary driver of avian population regulation. However, few studies have considered the effects of what is essentially a massive supplementary feeding experiment: the practice of wild bird feeding. Bird feeding has been posited as an important factor influencing the structure of bird communities, especially in urban areas, although experimental evidence to support this is almost entirely lacking. We carried out an 18-mo experimental feeding study at 23 residential properties to investigate the effects of bird feeding on local urban avian assemblages. Our feeding regime was based on predominant urban feeding practices in our region. We used monthly bird surveys to compare avian community composition, species richness, and the densities of local species at feeding and nonfeeding properties. Avian community structure diverged at feeding properties and five of the commonest garden bird species were affected by the experimental feeding regime. Introduced birds particularly benefitted, with dramatic increases observed in the abundances of house sparrow (Passer domesticus) and spotted dove (Streptopelia chinensis) in particular. We also found evidence of a negative effect on the abundance of a native insectivore, the grey warbler (Gerygone igata). Almost all of the observed changes did not persist once feeding had ceased. Our study directly demonstrates that the human pastime of bird feeding substantially contributes to the structure of avian community in urban areas, potentially altering the balance between native and introduced species. PMID:25941361

Warnings on alcohol containers and advertisements: international experience and evidence on effects.

PubMed

Wilkinson, Claire; Room, Robin

2009-07-01

In light of possible introduction of alcohol warning labels in Australia and New Zealand, this paper discusses the international experience with and evidence of effects of alcohol warning labels. The report describes international experience with providing information and warnings concerning the promotion or sale of alcoholic beverages, and considers the evidence on the effects of such information and warnings. The experience with and evaluations of the effects of tobacco warning labels are also considered. The most methodologically sound evaluations of alcohol warning labels are based on the US experience. Although these evaluations find little evidence that the introduction of the warning label in the USA had an impact on drinking behaviour, there is evidence that they led to an increase in awareness of the message they contained. In contrast, evaluations of tobacco warning labels find clear evidence of effects on behaviour. There is a need and opportunity for a rigorous evaluation of the impacts of introducing alcohol warning labels to add to the published work on their effectiveness. The experience with tobacco labels might guide the way for more effective alcohol warning labels. Alcohol warning labels are an increasingly popular alcohol policy initiative. It is clear that warning labels can be ineffective, but the tobacco experience suggests that effective warning labels are possible. Any introduction of alcohol warning labels should be evaluated in terms of effects on attitudes and behaviour.

Introducing the National Library for Health Skin Conditions Specialist Library.

PubMed

Grindlay, Douglas; Boulos, Maged N Kamel; Williams, Hywel C

2005-04-26

This paper introduces the new National Library for Health Skin Conditions Specialist Library http://www.library.nhs.uk/skin. The aims, scope and audience of the new NLH Skin Conditions Specialist Library, and the composition and functions of its core Project Team, Editorial Team and Stakeholders Group are described. The Library's collection building strategy, resource and information types, editorial policies, quality checklist, taxonomy for content indexing, organisation and navigation, and user interface are all presented in detail. The paper also explores the expected impact and utility of the new Library, as well as some possible future directions for further development. The Skin Conditions Specialist Library is not just another new Web site that dermatologists might want to add to their Internet favourites then forget about it. It is intended to be a practical, "one-stop shop" dermatology information service for everyday practical use, offering high quality, up-to-date resources, and adopting robust evidence-based and knowledge management approaches.

Inference for High-dimensional Differential Correlation Matrices.

PubMed

Cai, T Tony; Zhang, Anru

2016-01-01

Motivated by differential co-expression analysis in genomics, we consider in this paper estimation and testing of high-dimensional differential correlation matrices. An adaptive thresholding procedure is introduced and theoretical guarantees are given. Minimax rate of convergence is established and the proposed estimator is shown to be adaptively rate-optimal over collections of paired correlation matrices with approximately sparse differences. Simulation results show that the procedure significantly outperforms two other natural methods that are based on separate estimation of the individual correlation matrices. The procedure is also illustrated through an analysis of a breast cancer dataset, which provides evidence at the gene co-expression level that several genes, of which a subset has been previously verified, are associated with the breast cancer. Hypothesis testing on the differential correlation matrices is also considered. A test, which is particularly well suited for testing against sparse alternatives, is introduced. In addition, other related problems, including estimation of a single sparse correlation matrix, estimation of the differential covariance matrices, and estimation of the differential cross-correlation matrices, are also discussed.

Introducing the National Library for Health Skin Conditions Specialist Library

PubMed Central

Grindlay, Douglas; Boulos, Maged N Kamel; Williams, Hywel C

2005-01-01

Background This paper introduces the new National Library for Health Skin Conditions Specialist Library . Description The aims, scope and audience of the new NLH Skin Conditions Specialist Library, and the composition and functions of its core Project Team, Editorial Team and Stakeholders Group are described. The Library's collection building strategy, resource and information types, editorial policies, quality checklist, taxonomy for content indexing, organisation and navigation, and user interface are all presented in detail. The paper also explores the expected impact and utility of the new Library, as well as some possible future directions for further development. Conclusion The Skin Conditions Specialist Library is not just another new Web site that dermatologists might want to add to their Internet favourites then forget about it. It is intended to be a practical, "one-stop shop" dermatology information service for everyday practical use, offering high quality, up-to-date resources, and adopting robust evidence-based and knowledge management approaches. PMID:15854224

Searching for Judy: How small mysteries affect narrative processes and memory

PubMed Central

Love, Jessica; McKoon, Gail; Gerrig, Richard J.

2010-01-01

Current theories of text processing say little about how author’s narrative choices, including the introduction of small mysteries, can affect readers’ narrative experiences. Gerrig, Love, and McKoon (2009) provided evidence that one type of small mystery—a character introduced without information linking him or her to the story—affects readers’ moment-by-moment processing. For that project, participants read stories that introduced characters by proper name alone (e.g., Judy) or with information connecting the character to the rest of the story (e.g., our principal Judy). In an on-line recognition probe task, responses to the character’s name three lines after his or her introduction were faster when the character had not been introduced with connecting information, suggesting that the character remained accessible awaiting resolution. In the four experiments in this paper, we extended our theoretical analysis of small mysteries. In Experiments 1 and 2, we found evidence that trait information (e.g., daredevil Judy) is not sufficient to connect a character to a text. In Experiments 3 and 4, we provide evidence that the moment-by-moment processing effects of such small mysteries also affect readers’ memory for the stories. We interpret the results in terms of Kintsch’s Construction-Integration model (1988) of discourse processing. PMID:20438273

Searching for Judy: how small mysteries affect narrative processes and memory.

PubMed

Love, Jessica; McKoon, Gail; Gerrig, Richard J

2010-05-01

Current theories of text processing say little about how authors' narrative choices, including the introduction of small mysteries, can affect readers' narrative experiences. Gerrig, Love, and McKoon (2009) provided evidence that 1 type of small mystery-a character introduced without information linking him or her to the story-affects readers' moment-by-moment processing. For that project, participants read stories that introduced characters by proper name alone (e.g., "Judy") or with information connecting the character to the rest of the story (e.g., "our principal Judy"). In an online recognition probe task, responses to the character's name 3 lines after his or her introduction were faster when the character had not been introduced with connecting information, suggesting that the character remained accessible awaiting resolution. In the 4 experiments in this article, we extend our theoretical analysis of small mysteries. In Experiments 1 and 2, we found evidence that trait information (e.g., "daredevil Judy") is not sufficient to connect a character to a text. In Experiments 3 and 4, we found evidence that the moment-by-moment processing effects of such small mysteries also affect readers' memory for the stories. We interpret the results in terms of Kintsch's (1988) construction-integration model of discourse processing. PsycINFO Database Record (c) 2010 APA, all rights reserved.

Bargaining for health: a case study of a collective agreement-based health program for manual workers.

PubMed

Pedersen, Morten Saaby; Arendt, Jacob Nielsen

2014-09-01

This paper examines the short- and medium-term effects of the PensionDanmark Health Scheme, the largest privately administered health program for workers in Denmark, which provides prevention and early management of work-related injuries. We use a difference-in-differences approach that exploits a natural variation in the program rollout across collective agreement areas in the construction sector and over time. The results show only little evidence of an effect on the prevention of injuries requiring medical attention in the first 3 years after the program was introduced. Despite this, we find evidence of significant positive effects on several labor market outcomes, suggesting that the program enables some work-injured individuals to maintain their work and earnings capacity. In view of its low costs, the program appears to be cost-effective overall. Copyright © 2014 Elsevier B.V. All rights reserved.

Uncomfortable realities: the challenge of creating real change in Europe's consolidating hospital sector.

PubMed

Jeurissen, Patrick; Duran, Antonio; Saltman, Richard B

2016-05-24

This article examines uncomfortable realities that the European hospital sector currently faces and the potential impact of wide-spread rationalization policies such as (hospital) payment reform and privatization. Review of relevant international literature. Based on the evidence we present, rationalization policies such as (hospital) payment reform and privatization will probably fall short in delivering better quality of care and lower growth in health expenses. Reasons can be sought in a mix of evidence on the effectiveness of these rationalization policies. Nevertheless, pressures for different business models will gradually continue to increase and it seems safe to assume that more value-added process business and facilitated network models will eventually emerge. The overall argument of this article holds important implications for future research: how can policymakers generate adequate leverage to introduce such changes without destroying necessary hospital capacity and the ability to produce quality healthcare.

Larvivorous fish for preventing malaria transmission.

PubMed

Walshe, Deirdre P; Garner, Paul; Adeel, Ahmed A; Pyke, Graham H; Burkot, Thomas R

2017-12-11

Adult female Anopheles mosquitoes can transmit Plasmodium parasites that cause malaria. Some fish species eat mosquito larvae and pupae. In disease control policy documents, the World Health Organization (WHO) includes biological control of malaria vectors by stocking ponds, rivers, and water collections near where people live with larvivorous fish to reduce Plasmodium parasite transmission. In the past, the Global Fund has financed larvivorous fish programmes in some countries, and, with increasing efforts in eradication of malaria, policymakers may return to this option. Therefore, we assessed the evidence base for larvivorous fish programmes in malaria control. To evaluate whether introducing larvivorous fish to anopheline larval habitats impacts Plasmodium parasite transmission. We also sought to summarize studies that evaluated whether introducing larvivorous fish influences the density and presence of Anopheles larvae and pupae in water sources. We searched the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE (PubMed); Embase (Ovid); CABS Abstracts; LILACS; and the metaRegister of Controlled Trials (mRCT) up to 6 July 2017. We checked the reference lists of all studies identified by the search. We examined references listed in review articles and previously compiled bibliographies to look for eligible studies. Also we contacted researchers in the field and the authors of studies that met the inclusion criteria for additional information regarding potential studies for inclusion and ongoing studies. This is an update of a Cochrane Review published in 2013. Randomized controlled trials (RCTs) and non-RCTs, including controlled before-and-after studies, controlled time series, and controlled interrupted time series studies from malaria-endemic regions that introduced fish as a larvicide and reported on malaria in the community or the density of the adult anopheline population. In the absence of direct evidence of an effect on transmission, we performed a secondary analysis on studies that evaluated the effect of introducing larvivorous fish on the density or presence of immature anopheline mosquitoes (larvae and pupae forms) in water sources to determine whether this intervention has any potential that may justify further research in the control of malaria vectors. Two review authors independently screened each article by title and abstract, and examined potentially relevant studies for inclusion using an eligibility form. At least two review authors independently extracted data and assessed risk of bias of included studies. If relevant data were unclear or were not reported, we contacted the study authors for clarification. We presented data in tables, and we summarized studies that evaluated the effects of introducing fish on anopheline immature density or presence, or both. We used the GRADE approach to summarize the certainty of the evidence. We also examined whether the included studies reported any possible adverse impact of introducing larvivorous fish on non-target native species. We identified no studies that reported the effects of introducing larvivorous fish on the primary outcomes of this review: malaria infection in nearby communities, entomological inoculation rate, or on adult Anopheles density.For the secondary analysis, we examined the effects of introducing larvivorous fish on the density and presence of anopheline larvae and pupae in community water sources, and found 15 small studies with a follow-up period between 22 days and five years. These studies were undertaken in Sri Lanka (two studies), India (three studies), Ethiopia (one study), Kenya (two studies), Sudan (one study), Grande Comore Island (one study), Korea (two studies), Indonesia (one study), and Tajikistan (two studies). These studies were conducted in a variety of settings, including localized water bodies (such as wells, domestic water containers, fishponds, and pools (seven studies); riverbed pools below dams (two studies)); rice field plots (five studies); and water canals (two studies). All included studies were at high risk of bias. The research was insufficient to determine whether larvivorous fish reduce the density of Anopheles larvae and pupae (12 studies, unpooled data, very low certainty evidence). Some studies with high stocking levels of fish seemed to arrest the increase in immature anopheline populations, or to reduce the number of immature anopheline mosquitoes, compared with controls. However, this finding was not consistent, and in studies that showed a decrease in immature anopheline populations, the effect was not always consistently sustained. In contrast, some studies reported larvivorous fish reduced the number of water sources withAnopheles larvae and pupae (five studies, unpooled data, low certainty evidence).None of the included studies reported effects of larvivorous fish on local native fish populations or other species. We do not know whether introducing larvivorous fish reduces malaria transmission or the density of adult anopheline mosquito populations.In research studies that examined the effects on immature anopheline stages of introducing fish to potential malaria vector larval habitats, high stocking levels of fish may reduce the density or presence of immature anopheline mosquitoes in the short term. We do not know whether this translates into impact on malaria transmission. Our interpretation of the current evidence is that countries should not invest in fish stocking as a stand alone or supplementary larval control measure in any malaria transmission areas outside the context of research using carefully controlled field studies or quasi-experimental designs. Such research should examine the effects on native fish and other non-target species.

Experimental Evidence for the Role of Intonation in Evidential Marking.

PubMed

Vanrell, Maria Del Mar; Armstrong, Meghan E; Prieto, Pilar

2017-06-01

This paper investigates the role of intonation in the marking of directly-perceived information in Majorcan Catalan polar questions. We conducted a perception experiment in which a total of 72 participants were introduced to a set of twins who were exposed to different types of evidence for a given p(roposition). One twin inferred p based on direct sensory information (via one of the five senses), while the other had been told that p by a third party, that is, reported information. Participants listened to a set of discourse contexts that ended in critical stimuli with three attested combinations of particle/intonation in this variety of Catalan: (1) polar questions produced with a falling nuclear contour ¡H+L* L%; (2) polar questions headed with the particle que 'that' produced with ¡H+L* L%; and (3) polar questions headed with the particle que and produced with a rise-fall L+H* L%. After hearing the stimulus, participants had to decide which of the twins had uttered the question-the one who inferred a proposition ( p) based on direct sensory information or the one who had been told p by a third party. The results show that listeners very consistently associate the que + L+H* L% combination with inferences drawn from direct sensory evidence as opposed to reported evidence. This shows that particles may work in tandem with intonation to convey the information source. Importantly, we show that intonation is a part of grammar that may be recruited for evidential strategies.

20 CFR 725.497 - Procedures in special claims transferred to the fund.

Code of Federal Regulations, 2010 CFR

2010-04-01

... development of the additional evidence concerning the procedural history of the claim necessary to such... concluded at the earliest possible time and in no event shall an operator or carrier participate as a... additional documentary evidence which the parties wish to introduce and briefs of the parties, if desired. In...

76 FR 72463 - Self-Regulatory Organizations; Financial Industry Regulatory Authority, Inc.; Notice of Filing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-23

... Officer copies of documentary exhibits the parties intend to introduce and the names of the witnesses each party intends to present at a hearing. Currently, pre-hearing, proposed documentary evidence submitted... change amends FINRA Rule 9261(a) to establish that documentary evidence submitted prior to a hearing...

The Online Student Connectedness Survey: Evidence of Initial Construct Validity

ERIC Educational Resources Information Center

Zimmerman, Tekeisha; Nimon, Kim

2017-01-01

The Online Student Connectedness Survey (OSCS) was introduced to the academic community in 2012 as an instrument designed to measure feelings of connectedness between students participating in online degree and certification programs. The purpose of this study was to examine data from the instrument for initial evidence of validity and reliability…

Modified Penile Augmentation by Dermal-Fat Graft in Post-Hypospadias Adults.

PubMed

Xu, Lisi; Zhao, Muxin; Yang, Zhe; Chen, Wen; Li, Yangqun; Ma, Ning; Wang, Weixin; Feng, Jun; Liu, Qiyu; Ma, Tong

2016-02-01

Although a considerable part of patients desire further improvement in penile size after hypospadias repairs, penile augmentation is only considered in patients with congenital penile hypoplasia or acquired penile retraction. Modified penile augmentation by free dermal-fat graft is introduced to satisfy these patients and improve surgical safety. From April 2012 to December 2014, a total of 15 male adults after hypospadias repairs, aged 18-24 years, underwent modified penile augmentation which involved girth enhancement by a free dermal-fat graft and penile elongation (suprapubic skin advancement-ligamentolysis). A specially designed tunneling instrument was introduced to facilitate pericavernous thickening without degloving. Outcome evaluation was mainly based on objective penile measurements and results of the Male Genital Image Scale. With 6 months' follow-up, all patients had achieved excellent cosmetic results, with a significant average dimensional increase of 1.53 ± 0.23 cm in flaccid girth and 1.67 ± 0.24 cm in flaccid length. No erection deficiencies or urinary fistula occurred. Patients' perception of male genitalia improved postoperatively, with the average MGIS score rising from 31.73 ± 4.86 to 40.20 ± 4.54. This modified technique is safe and effective in enlarging penile size. The use of the specially designed tunneling instrument simplifies penile girth enhancement, avoiding unnecessary trauma to the neo-urethra and neurovascular bundle. It is confirmed that physical dimensional enhancement does contribute to improving their underestimation of penile size. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Should general practitioners purchase health care for their patients? The total purchasing experiment in Britain.

PubMed

Wyke, Sally; Mays, Nicholas; Street, Andrew; Bevan, Gwyn; McLeod, Hugh; Goodwin, Nick

2003-09-01

Until relatively recently, general practitioners (GPs) have been allowed to work independently, with no requirement to consider the resource implications of their referral and prescribing decisions. In order to align the interests of GPs with the overall objectives of health systems a number of countries have introduced primary care based capitation, funds pooling and budget holding either as experiments or as an overall policy. Are these experiments and policies likely to work? This paper presents evidence from the UK total purchasing experiment, which was the first major quasi-market development in the NHS to be independently evaluated from the outset. Total purchasing gave volunteer groups of practices freedom to purchase all hospital and community health services for their patients. The evidence suggests that whilst GPs have great potential as purchasers, they also have considerable limitations. The expectation that they will be able to improve the quality of patient experience of care, or to alter the use of resources, may not be generally realised. GP-based purchasing may be more appropriate where the task is to alter the balance or location of care between hospital and extramural settings. However, budgetary incentives are not 'magic potions' which have similar effects on behaviour wherever they are introduced. Holding budgets and having independent contracts, while important pre-requisites for being taken seriously in a quasi-market, were not sufficient for effective total purchasing. The paper concludes that health systems should not only value innovation and experimentation and encourage learning from evaluative research; they should also recognise the importance of supportive circumstances for any innovation to effect real and sustained change.

An overview of a free-market approach to climate change and conservation.

PubMed

Sandor, Richard L; Bettelheim, Eric C; Swingland, Ian R

2002-08-15

This paper describes the convergence of environmental and financial markets, reviews the evolution of market-based environmental programmes as an example of the seven-stage evolutionary process witnessed in a variety of markets and summarizes the emergence of greenhouse-gas-mitigation markets and their potential role in advancing land stewardship, biodiversity and other environmental services. Emissions trading has been developed to meet the demand to reduce pollution while avoiding economic disruption. Consistent with the seven-stage pattern of market evolution, the US programme to reduce the damage from acid rain established a standardized environmental commodity, developed 'evidence of ownership' necessary for financial instruments and provided the infrastructure to efficiently transfer title. The success of the system in reducing pollution at low cost has provided a model for other market-based environmental protection initiatives. The demand for cost-effective action to reduce the threat of climate change has initiated the same evolutionary process for markets to reduce greenhouse-gas emissions. Many of the land- and forest-management practices that can capture and store atmospheric CO(2) can also provide other environmental benefits, such as biodiversity preservation and enhanced water quality. The presence of a carbon-trading market will introduce a clear financial value for capture and mitigation of CO(2) emissions, thus introducing a new source of funding for land stewardship and forest rehabilitation. The market is now emerging through a variety of 'bottom-up' developments being undertaken through governmental, multilateral, private-sector and non-governmental-organization initiatives. The extension of markets to other emerging environmental issues is now underway, and the linkages between environmental sustainability and capital markets are being more deeply understood. The early evidence indicates that environmental sustainability can be compatible with maximization of shareholder value.

Value-at-risk estimation with wavelet-based extreme value theory: Evidence from emerging markets

NASA Astrophysics Data System (ADS)

Cifter, Atilla

2011-06-01

This paper introduces wavelet-based extreme value theory (EVT) for univariate value-at-risk estimation. Wavelets and EVT are combined for volatility forecasting to estimate a hybrid model. In the first stage, wavelets are used as a threshold in generalized Pareto distribution, and in the second stage, EVT is applied with a wavelet-based threshold. This new model is applied to two major emerging stock markets: the Istanbul Stock Exchange (ISE) and the Budapest Stock Exchange (BUX). The relative performance of wavelet-based EVT is benchmarked against the Riskmetrics-EWMA, ARMA-GARCH, generalized Pareto distribution, and conditional generalized Pareto distribution models. The empirical results show that the wavelet-based extreme value theory increases predictive performance of financial forecasting according to number of violations and tail-loss tests. The superior forecasting performance of the wavelet-based EVT model is also consistent with Basel II requirements, and this new model can be used by financial institutions as well.

An overview on cellulose-based material in tailoring bio-hybrid nanostructured photocatalysts for water treatment and renewable energy applications.

PubMed

Mohamed, Mohamad Azuwa; Abd Mutalib, Muhazri; Mohd Hir, Zul Adlan; M Zain, M F; Mohamad, Abu Bakar; Jeffery Minggu, Lorna; Awang, Nor Asikin; W Salleh, W N

2017-10-01

A combination between the nanostructured photocatalyst and cellulose-based materials promotes a new functionality of cellulose towards the development of new bio-hybrid materials for various applications especially in water treatment and renewable energy. The excellent compatibility and association between nanostructured photocatalyst and cellulose-based materials was induced by bio-combability and high hydrophilicity of the cellulose components. The electron rich hydroxyl group of celluloses helps to promote superior interaction with photocatalyst. The formation of bio-hybrid nanostructured are attaining huge interest nowadays due to the synergistic properties of individual cellulose-based material and photocatalyst nanoparticles. Therefore, in this review we introduce some cellulose-based material and discusses its compatibility with nanostructured photocatalyst in terms of physical and chemical properties. In addition, we gather information and evidence on the fabrication techniques of cellulose-based hybrid nanostructured photocatalyst and its recent application in the field of water treatment and renewable energy. Copyright © 2017 Elsevier B.V. All rights reserved.

Transportability of an Evidence-Based Early Childhood Intervention in a Low-Income African Country: Results of a Cluster Randomized Controlled Study.

PubMed

Huang, Keng-Yen; Nakigudde, Janet; Rhule, Dana; Gumikiriza-Onoria, Joy Louise; Abura, Gloria; Kolawole, Bukky; Ndyanabangi, Sheila; Kim, Sharon; Seidman, Edward; Ogedegbe, Gbenga; Brotman, Laurie Miller

2017-11-01

Children in Sub-Saharan Africa (SSA) are burdened by significant unmet mental health needs. Despite the successes of numerous school-based interventions for promoting child mental health, most evidence-based interventions (EBIs) are not available in SSA. This study investigated the implementation quality and effectiveness of one component of an EBI from a developed country (USA) in a SSA country (Uganda). The EBI component, Professional Development, was provided by trained Ugandan mental health professionals to Ugandan primary school teachers. It included large-group experiential training and small-group coaching to introduce and support a range of evidence-based practices (EBPs) to create nurturing and predictable classroom experiences. The study was guided by the Consolidated Framework for Implementation Research, the Teacher Training Implementation Model, and the RE-AIM evaluation framework. Effectiveness outcomes were studied using a cluster randomized design, in which 10 schools were randomized to intervention and wait-list control conditions. A total of 79 early childhood teachers participated. Teacher knowledge and the use of EBPs were assessed at baseline and immediately post-intervention (4-5 months later). A sample of 154 parents was randomly selected to report on child behavior at baseline and post-intervention. Linear mixed effect modeling was applied to examine effectiveness outcomes. Findings support the feasibility of training Ugandan mental health professionals to provide Professional Development for Ugandan teachers. Professional Development was delivered with high levels of fidelity and resulted in improved teacher EBP knowledge and the use of EBPs in the classroom, and child social competence.

Analytic Validation of Immunohistochemical Assays: A Comparison of Laboratory Practices Before and After Introduction of an Evidence-Based Guideline.

PubMed

Fitzgibbons, Patrick L; Goldsmith, Jeffrey D; Souers, Rhona J; Fatheree, Lisa A; Volmar, Keith E; Stuart, Lauren N; Nowak, Jan A; Astles, J Rex; Nakhleh, Raouf E

2017-09-01

- Laboratories must demonstrate analytic validity before any test can be used clinically, but studies have shown inconsistent practices in immunohistochemical assay validation. - To assess changes in immunohistochemistry analytic validation practices after publication of an evidence-based laboratory practice guideline. - A survey on current immunohistochemistry assay validation practices and on the awareness and adoption of a recently published guideline was sent to subscribers enrolled in one of 3 relevant College of American Pathologists proficiency testing programs and to additional nonsubscribing laboratories that perform immunohistochemical testing. The results were compared with an earlier survey of validation practices. - Analysis was based on responses from 1085 laboratories that perform immunohistochemical staining. Of 1057 responses, 65.4% (691) were aware of the guideline recommendations before this survey was sent and 79.9% (550 of 688) of those have already adopted some or all of the recommendations. Compared with the 2010 survey, a significant number of laboratories now have written validation procedures for both predictive and nonpredictive marker assays and specifications for the minimum numbers of cases needed for validation. There was also significant improvement in compliance with validation requirements, with 99% (100 of 102) having validated their most recently introduced predictive marker assay, compared with 74.9% (326 of 435) in 2010. The difficulty in finding validation cases for rare antigens and resource limitations were cited as the biggest challenges in implementing the guideline. - Dissemination of the 2014 evidence-based guideline validation practices had a positive impact on laboratory performance; some or all of the recommendations have been adopted by nearly 80% of respondents.

Review of Diagnosis-Related Group-Based Financing of Hospital Care

PubMed Central

Kocic, Sanja; Jakovljevic, Mihajlo

2016-01-01

Since the 1990s, diagnosis-related group (DRG)-based payment systems were gradually introduced in many countries. The main design characteristics of a DRG-based payment system are an exhaustive patient case classification system (ie, the system of diagnosis-related groupings) and the payment formula, which is based on the base rate multiplied by a relative cost weight specific for each DRG. Cases within the same DRG code group are expected to undergo similar clinical evolution. Consecutively, they should incur the costs of diagnostics and treatment within a predefined scale. Such predictability was proven in a number of cost-of-illness studies conducted on major prosperity diseases alongside clinical trials on efficiency. This was the case with risky pregnancies, chronic obstructive pulmonary disease, diabetes, depression, alcohol addiction, hepatitis, and cancer. This article presents experience of introduced DRG-based payments in countries of western and eastern Europe, Scandinavia, United States, Canada, and Australia. This article presents the results of few selected reviews and systematic reviews of the following evidence: published reports on health system reforms by World Health Organization, World Bank, Organization for Economic Co-operation and Development, Canadian Institute for Health Information, Canadian Health Services Research Foundation, and Centre for Health Economics University of York. Diverse payment systems have different strengths and weaknesses in relation to the various objectives. The advantages of the DRG payment system are reflected in the increased efficiency and transparency and reduced average length of stay. The disadvantage of DRG is creating financial incentives toward earlier hospital discharges. Occasionally, such polices are not in full accordance with the clinical benefit priorities. PMID:28462278

New insights into the history of the C-14010 lactase persistence variant in Eastern and Southern Africa.

PubMed

Macholdt, Enrico; Slatkin, Montgomery; Pakendorf, Brigitte; Stoneking, Mark

2015-04-01

Lactase persistence (LP), the ability to digest lactose into adulthood, is strongly associated with the cultural traits of pastoralism and milk-drinking among human populations, and several different genetic variants are known that confer LP. Recent studies of LP variants in Southern African populations, with a focus on Khoisan-speaking groups, found high frequencies of an LP variant (the C-14010 allele) that also occurs in Eastern Africa, and concluded that the C-14010 allele was brought to Southern Africa via a migration of pastoralists from Eastern Africa. However, this conclusion was based on indirect evidence; to date no study has jointly analyzed data on the C-14010 allele from both Southern African Khoisan-speaking groups and Eastern Africa. Here, we combine and analyze published data on the C-14010 allele in Southern and Eastern African populations, consisting of haplotypes with the C-14010 allele and four closely-linked short tandem repeat loci. Our results provide direct evidence for the previously-hypothesized Eastern African origin of the C-14010 allele in Southern African Khoisan-speaking groups. In addition, we find evidence for a separate introduction of the C-14010 allele into the Bantu-speaking Xhosa. The estimated selection intensity on the C-14010 allele in Eastern Africa is lower than that in Southern Africa, which suggests that in Eastern Africa the dietary changes conferring the fitness advantage associated with LP occurred some time after the origin of the C-14010 allele. Conversely, in Southern Africa the fitness advantage was present when the allele was introduced, as would be expected if pastoralism was introduced concomitantly. © 2014 Wiley Periodicals, Inc.

Redesigning Radiotherapy Quality Assurance: Opportunities to Develop an Efficient, Evidence-Based System to Support Clinical Trials-Report of the National Cancer Institute Work Group on Radiotherapy Quality Assurance

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

Bekelman, Justin E., E-mail: bekelman@uphs.upenn.edu; Deye, James A.; Vikram, Bhadrasain

2012-07-01

Purpose: In the context of national calls for reorganizing cancer clinical trials, the National Cancer Institute sponsored a 2-day workshop to examine challenges and opportunities for optimizing radiotherapy quality assurance (QA) in clinical trial design. Methods and Materials: Participants reviewed the current processes of clinical trial QA and noted the QA challenges presented by advanced technologies. The lessons learned from the radiotherapy QA programs of recent trials were discussed in detail. Four potential opportunities for optimizing radiotherapy QA were explored, including the use of normal tissue toxicity and tumor control metrics, biomarkers of radiation toxicity, new radiotherapy modalities such asmore » proton beam therapy, and the international harmonization of clinical trial QA. Results: Four recommendations were made: (1) to develop a tiered (and more efficient) system for radiotherapy QA and tailor the intensity of QA to the clinical trial objectives (tiers include general credentialing, trial-specific credentialing, and individual case review); (2) to establish a case QA repository; (3) to develop an evidence base for clinical trial QA and introduce innovative prospective trial designs to evaluate radiotherapy QA in clinical trials; and (4) to explore the feasibility of consolidating clinical trial QA in the United States. Conclusion: Radiotherapy QA can affect clinical trial accrual, cost, outcomes, and generalizability. To achieve maximum benefit, QA programs must become more efficient and evidence-based.« less

Redesigning radiotherapy quality assurance: opportunities to develop an efficient, evidence-based system to support clinical trials--report of the National Cancer Institute Work Group on Radiotherapy Quality Assurance.

PubMed

Bekelman, Justin E; Deye, James A; Vikram, Bhadrasain; Bentzen, Soren M; Bruner, Deborah; Curran, Walter J; Dignam, James; Efstathiou, Jason A; FitzGerald, T J; Hurkmans, Coen; Ibbott, Geoffrey S; Lee, J Jack; Merchant, Thomas E; Michalski, Jeff; Palta, Jatinder R; Simon, Richard; Ten Haken, Randal K; Timmerman, Robert; Tunis, Sean; Coleman, C Norman; Purdy, James

2012-07-01

In the context of national calls for reorganizing cancer clinical trials, the National Cancer Institute sponsored a 2-day workshop to examine challenges and opportunities for optimizing radiotherapy quality assurance (QA) in clinical trial design. Participants reviewed the current processes of clinical trial QA and noted the QA challenges presented by advanced technologies. The lessons learned from the radiotherapy QA programs of recent trials were discussed in detail. Four potential opportunities for optimizing radiotherapy QA were explored, including the use of normal tissue toxicity and tumor control metrics, biomarkers of radiation toxicity, new radiotherapy modalities such as proton beam therapy, and the international harmonization of clinical trial QA. Four recommendations were made: (1) to develop a tiered (and more efficient) system for radiotherapy QA and tailor the intensity of QA to the clinical trial objectives (tiers include general credentialing, trial-specific credentialing, and individual case review); (2) to establish a case QA repository; (3) to develop an evidence base for clinical trial QA and introduce innovative prospective trial designs to evaluate radiotherapy QA in clinical trials; and (4) to explore the feasibility of consolidating clinical trial QA in the United States. Radiotherapy QA can affect clinical trial accrual, cost, outcomes, and generalizability. To achieve maximum benefit, QA programs must become more efficient and evidence-based. Copyright © 2012 Elsevier Inc. All rights reserved.

Phonemes: Lexical access and beyond.

PubMed

Kazanina, Nina; Bowers, Jeffrey S; Idsardi, William

2018-04-01

Phonemes play a central role in traditional theories as units of speech perception and access codes to lexical representations. Phonemes have two essential properties: they are 'segment-sized' (the size of a consonant or vowel) and abstract (a single phoneme may be have different acoustic realisations). Nevertheless, there is a long history of challenging the phoneme hypothesis, with some theorists arguing for differently sized phonological units (e.g. features or syllables) and others rejecting abstract codes in favour of representations that encode detailed acoustic properties of the stimulus. The phoneme hypothesis is the minority view today. We defend the phoneme hypothesis in two complementary ways. First, we show that rejection of phonemes is based on a flawed interpretation of empirical findings. For example, it is commonly argued that the failure to find acoustic invariances for phonemes rules out phonemes. However, the lack of invariance is only a problem on the assumption that speech perception is a bottom-up process. If learned sublexical codes are modified by top-down constraints (which they are), then this argument loses all force. Second, we provide strong positive evidence for phonemes on the basis of linguistic data. Almost all findings that are taken (incorrectly) as evidence against phonemes are based on psycholinguistic studies of single words. However, phonemes were first introduced in linguistics, and the best evidence for phonemes comes from linguistic analyses of complex word forms and sentences. In short, the rejection of phonemes is based on a false analysis and a too-narrow consideration of the relevant data.

Remediating Viking Origins: Genetic Code as Archival Memory of the Remote Past

PubMed Central

King, Turi; Brown, Steven D

2013-01-01

This article introduces some early data from the Leverhulme Trust-funded research programme, ‘The Impact of the Diasporas on the Making of Britain: evidence, memories, inventions’. One of the interdisciplinary foci of the programme, which incorporates insights from genetics, history, archaeology, linguistics and social psychology, is to investigate how genetic evidence of ancestry is incorporated into identity narratives. In particular, we investigate how ‘applied genetic history’ shapes individual and familial narratives, which are then situated within macro-narratives of the nation and collective memories of immigration and indigenism. It is argued that the construction of genetic evidence as a ‘gold standard’ about ‘where you really come from’ involves a remediation of cultural and archival memory, in the construction of a ‘usable past’. This article is based on initial questionnaire data from a preliminary study of those attending DNA collection sessions in northern England. It presents some early indicators of the perceived importance of being of Viking descent among participants, notes some emerging patterns and considers the implications for contemporary debates on migration, belonging and local and national identity. PMID:24179286

Remediating Viking Origins: Genetic Code as Archival Memory of the Remote Past.

PubMed

Scully, Marc; King, Turi; Brown, Steven D

2013-10-01

This article introduces some early data from the Leverhulme Trust-funded research programme, 'The Impact of the Diasporas on the Making of Britain: evidence, memories, inventions'. One of the interdisciplinary foci of the programme, which incorporates insights from genetics, history, archaeology, linguistics and social psychology, is to investigate how genetic evidence of ancestry is incorporated into identity narratives. In particular, we investigate how 'applied genetic history' shapes individual and familial narratives, which are then situated within macro-narratives of the nation and collective memories of immigration and indigenism. It is argued that the construction of genetic evidence as a 'gold standard' about 'where you really come from' involves a remediation of cultural and archival memory, in the construction of a 'usable past'. This article is based on initial questionnaire data from a preliminary study of those attending DNA collection sessions in northern England. It presents some early indicators of the perceived importance of being of Viking descent among participants, notes some emerging patterns and considers the implications for contemporary debates on migration, belonging and local and national identity.

Mild cognitive impairment and prospective memory: translating the evidence into neuropsychological practice.

PubMed

Kinsella, Glynda J; Pike, Kerryn E; Cavuoto, Marina G; Lee, Stephen D

2018-04-30

There has been a recent rapid development of research characterizing prospective memory performance in mild cognitive impairment (MCI) in older age. However, this body of literature remains largely separated from routine clinical practice in neuropsychology. Furthermore, there is emerging evidence of effective interventions to improve prospective memory performance. Therefore, our objective in this article was to offer a clinical neuropsychological perspective on the existing research in order to facilitate the translation of the evidence-base into clinical practice. By conducting a critical review of the existing research related to prospective memory and MCI, we highlight how this data can be introduced into clinical practice, either within diagnostic assessment or clinical management. Prospective memory is impaired in older adults with MCI, with a pattern of performance that helps with differential diagnosis from healthy aging. Clinical neuropsychologists are encouraged to add prospective memory assessment to their toolbox for diagnostic evaluation of clients with MCI. Preliminary findings of prospective memory interventions in MCI are promising, but more work is required to determine how different approaches translate to increasing independence in everyday life.

Thoroughfares, crossroads and cul-de-sacs: drug testing of welfare recipients.

PubMed

Wincup, Emma

2014-09-01

Over the past five years, proposals to introduce drug testing for welfare recipients have proliferated across the globe. In England, it was included in the Welfare Reform Act 2009 (yet never implemented) and in 2013, the New Zealand government introduced legislation which requires claimants to take pre-employment drug tests when requested by a prospective employer or training provider. Similarly, in over 20 US states there have been attempts to initiate drug testing of welfare recipients as a condition of eligibility for welfare, although frequently these controversial plans have either stalled or once introduced they have been halted through legal challenge. This article examines the process of introducing drug testing of welfare claimants in the UK as part of a broader strategy to address worklessness among problem drug users. Using Hudson and Lowe's (2004) multi-level analytic framework, which disputes 'top down' rational models of policy-making, it explores the mechanisms used for challenging drug testing policies. In so doing, it identifies the key policy actors involved, noting the alliances forged and strategies adopted to persuade the government to pursue alternative policies. Whilst the primary focus of the article is on the UK, consideration of the US and New Zealand facilitates comparison of the types of policy networks which emerge to oppose similar policies proposed in different socio-political contexts, and the forms of argument and/or evidence they inject into policy discussions. It is argued that a heavy reliance on rights-based arguments was a feature of opposing drug testing in the UK, US and New Zealand, and these featured more heavily than attempts to refute evidence underpinning these policies. However, there were important differences between jurisdictions in relation to the mechanisms used to challenge drug testing policies. These do not simply reflect the nature of the policies proposed but instead are reflective of different modes of governance, which influence the character of the policy networks formed and their judgements about the most effective ways of opposing what they regard as essentially flawed policies. Copyright © 2014 Elsevier B.V. All rights reserved.

Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients.

PubMed

Middelveen, Marianne J; Bandoski, Cheryl; Burke, Jennie; Sapi, Eva; Filush, Katherine R; Wang, Yean; Franco, Agustin; Mayne, Peter J; Stricker, Raphael B

2015-02-12

Morgellons disease (MD) is a complex skin disorder characterized by ulcerating lesions that have protruding or embedded filaments. Many clinicians refer to this condition as delusional parasitosis or delusional infestation and consider the filaments to be introduced textile fibers. In contrast, recent studies indicate that MD is a true somatic illness associated with tickborne infection, that the filaments are keratin and collagen in composition and that they result from proliferation and activation of keratinocytes and fibroblasts in the skin. Previously, spirochetes have been detected in the dermatological specimens from four MD patients, thus providing evidence of an infectious process. Based on culture, histology, immunohistochemistry, electron microscopy and molecular testing, we present corroborating evidence of spirochetal infection in a larger group of 25 MD patients. Irrespective of Lyme serological reactivity, all patients in our study group demonstrated histological evidence of epithelial spirochetal infection. Strength of evidence based on other testing varied among patients. Spirochetes identified as Borrelia strains by polymerase chain reaction (PCR) and/or in-situ DNA hybridization were detected in 24/25 of our study patients. Skin cultures containing Borrelia spirochetes were obtained from four patients, thus demonstrating that the organisms present in dermatological specimens were viable. Spirochetes identified by PCR as Borrelia burgdorferi were cultured from blood in seven patients and from vaginal secretions in three patients, demonstrating systemic infection. Based on these observations, a clinical classification system for MD is proposed. Our study using multiple detection methods confirms that MD is a true somatic illness associated with Borrelia spirochetes that cause Lyme disease. Further studies are needed to determine the optimal treatment for this spirochete-associated dermopathy.

Prevention in practice – a summary.

PubMed Central

2015-01-01

Background This paper is a summary document of the Prevention in Practice Conference and Special Supplement of BMC Oral Health. It represents the consensus view of the presenters and captures the questions, comments and suggestions of the assembled audience. Methods Using the prepared manuscripts for the conference, collected materials from scribes during the conference and additional resources collated in advance of the meeting, authors agreed on the summary document. Results The Prevention in Practice conference aimed to collate information about which diseases could be prevented in practice, how diseases could be identified early enough to facilitate prevention, what evidence based therapies and treatments were available and how, given the collective evidence, could these be introduced in general dental practice within different reimbursement models. Conclusions While examples of best practice were provided from both social care and insurance models it was clear that further work was required on both provider and payer side to ensure that evidence based prevention was both implemented properly but also reimbursed sufficiently. It is clear that savings can be made but these must not be overstated and that the use of effective skill mix would be key to realizing efficiencies. The evidence base for prevention of caries and periodontal disease has been available for many years, as have the tools and techniques to detect, diagnose and stage the diseases appropriately. Dentistry finds itself in a enviable position with respect to its ability to prevent, arrest and reverse much of the burden of disease, however, it is clear that the infrastructure within primary care must be changed, and practitioners and their teams appropriately supported to deliver this paradigm shift from a surgical to a medical model. PMID:26391906

[Practice guidelines in rehabilitation: infringement upon physicians' autonomy or foundation for better outcomes?].

PubMed

Brüggemann, S; Korsukéwitz, C

2004-10-01

Clinical practice guidelines - seen as an aggregation of scientific evidence - and evidence based medicine are of relevance and importance for everybody involved in health care. Nevertheless, the discussion of their pros and cons is controversial. Major criticisms concern methodological aspects, a disregard of the patients' perspective, potentially increasing costs and the limitation of doctors' autonomy possibly caused by streamlining therapy. Supporters emphasize the improvement of care that comes with using proven therapies, patients' empowerment, cost reduction and equity in the distribution of resources. Following medical practice guidelines the liability for medical malpractice may be limited, but non-adherence to guidelines does not entail liability per se. Clinical practice guidelines in the rehabilitative sector differ from those in curative medicine by being required to achieve more complex goals than maintenance, recovery and improvement of health. Activities in the rehabilitation sector address two main topics: The integration of rehabilitation into curative guidelines, e. g. by participating in the German clearing process for guidelines, and the development of guidelines specific to rehabilitation. There are a number of guideline initiatives, e. g. with the Association of the Scientific Medical Societies (AWMF), the Federation of German Pension Insurance Institutes (VDR) and the Federal Insurance Institute for Salaried Employees (BfA). The BfA project is the first to allow integration of evidence based medicine into the quality assurance programme of the German Pension Insurance complementing it with differentiated criteria for the assessment of therapeutic processes. Taking evidence based medicine increasingly into consideration and the continuous process of introducing rehabilitative clinical practice guidelines are going to improve health care for people with chronic diseases.

Three stages during the evolution of the genetic code. [Abstract only

NASA Technical Reports Server (NTRS)

Baumann, U.; Oro, J.

1994-01-01

A diversification of the genetic code based on the number of codons available for the proteinous amino acids is established. Three groups of amino acids during evolution of the code are distinguished. On the basis of their chemical complexity and a small codon number those amino acids emerging later in a translation process are derived. Both criteria indicate that His, Phe, Tyr, Cys and either Lys or Asn were introduced in the second stage, whereas the number of codons alone gives evidence that Trp and Met were introduced in the third stage. The amino acids of stage one use purines rich codons, thus purines have been retained in their third codon position. All the amino acids introduced in the second stage, in contrast, use pyrimidines in this codon position. A low abundance of pyrimidines during early translation is derived. This assumption is supported by experiments on non enzymatic replication and interactions of DNA hairpin loops with a complementary strand. A back extrapolation concludes a high purine content of the first nucleic acids which gradually decreased during their evolution. Amino acids independently available form prebiotic synthesis were thus correlated to purine rich codons. Conclusions on prebiotic replication are discussed also in the light of recent codon usage data.

Developing Evidence for Football (Soccer) Reminiscence Interventions Within Long-term Care: A Co-operative Approach Applied in Scotland and Spain.

PubMed

Coll-Planas, Laura; Watchman, Karen; Doménech, Sara; McGillivray, David; O'Donnell, Hugh; Tolson, Debbie

2017-04-01

Loneliness is a common experience within long-term care and, to promote well-being and quality of life among people with dementia, it is important to draw upon a repertoire of strategies that provide social stimulation, companionship, and enjoyment. This paper describes and reflects on a program of co-operative social participatory research that sought to introduce football-focused (ie, soccer-based) reminiscence based in 4 community settings within Spain and Scotland. Findings are reported and inform an original conceptual model that supports the introduction of sustainable approaches to the development of football-focused reminiscence with and for people with dementia. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Cultural differences in survey responding: Issues and insights in the study of response biases.

PubMed

Kemmelmeier, Markus

2016-12-01

This paper introduces the special section "Cultural differences in questionnaire responding" and discusses central topics in the research on response biases in cross-cultural survey research. Based on current conceptions of acquiescent, extreme, and socially desirable responding, the author considers current data on the correlated nature of response biases and the conditions under which different response styles they emerge. Based on evidence relating different response styles to the cultural dimension of individualism-collectivism, the paper explores how research presented as part of this special section might help resolves some tensions in this literature. The paper concludes by arguing that response styles should not be treated merely as measurement error, but as cultural behaviors in themselves. © 2016 International Union of Psychological Science.

Is there radar evidence for liquid water on Mars?

NASA Technical Reports Server (NTRS)

Roth, L. E.

1984-01-01

The hypothesis that an extraordinary radar smoothness of a lunar target suggests that ground moisture is rest on the assumption that on the penetration-depth scale, the dielectric constant be an isotropic quantity. In other words, the planet's surface should have no vertical structure. Results of modeling exercises (based on the early lunar two-layer models) conducted to simulate the behavior of radar reflectivity, at S-band, over Solis Lacus, without manipulating the dielectric constant of the base layer (i.e., without adding moisture) are summarized. More sophisticated, explicit, rather than iterative multi-layer models involving dust, duricrust, mollisol, and permafrost are under study. It is anticipated that a paradoxical situation will be reached when each improvement in the model introduces additional ambiguities into the data interpretation.

Development of an Instrument to Assess Prospective Elementary Teacher Self-Efficacy Beliefs about Equitable Science Teaching and Learning (SEBEST)

NASA Astrophysics Data System (ADS)

Ritter, Jennifer M.; Boone, William J.; Rubba, Peter A.

2001-06-01

This paper presents an overview of the procedures used to develop and validate an instrument to measure the self-efficacy beliefs of prospective elementary teachers about equitable science teaching and learning. The instrument, titled the SEBEST, was based on the work of Ashton and Webb (1986a, 1986b) and Bandura (1977, 1986). It was modeled after the Science Teaching Efficacy Belief Instrument (STEBI) (Riggs, 1988) and the Science Teaching Efficacy Belief Instrument for Prospective Teachers (STEBI-B) (Enochs & Riggs, 1990). Based on the standardized development procedures used and associated evidence, the SEBEST appears to be a content and construct valid instrument, with high internal reliability qualities. "Most probable response" plots are introduced and used to bring meaning to SEBEST raw scores.

Liquidity Dynamics in the Xetra Order Book

NASA Astrophysics Data System (ADS)

Schmidinger, Christoph

2010-09-01

In this paper we show how to reconstruct the limit order book of the 30 stocks constituting the DAX30 index based on the trading protocol of the Xetra Trading System at the Frankfurt Stock Exchange. The algorithm used is innovative as it captures all trading phases, including auctions, and delivers a reconstruction of the orderbook either from a trader's view or a supervisory view including hidden volume as well. Based on the rebuilt order book, liquidity dynamics are examined. In contrats to findings for dealer markets, past market returns play a minor role in the determination of liquidity and liquidity commonality in Xetra, a pure limit order book market. Consequently, we provide evidence that liquidity provision by multiple sources in Xetra mitigates systemic liquidity risk introduced by the interrelation of return and liquidity.

Scalable algorithms for three-field mixed finite element coupled poromechanics

NASA Astrophysics Data System (ADS)

Castelletto, Nicola; White, Joshua A.; Ferronato, Massimiliano

2016-12-01

We introduce a class of block preconditioners for accelerating the iterative solution of coupled poromechanics equations based on a three-field formulation. The use of a displacement/velocity/pressure mixed finite-element method combined with a first order backward difference formula for the approximation of time derivatives produces a sequence of linear systems with a 3 × 3 unsymmetric and indefinite block matrix. The preconditioners are obtained by approximating the two-level Schur complement with the aid of physically-based arguments that can be also generalized in a purely algebraic approach. A theoretical and experimental analysis is presented that provides evidence of the robustness, efficiency and scalability of the proposed algorithm. The performance is also assessed for a real-world challenging consolidation experiment of a shallow formation.

Identification of host fruit volatiles from domestic apple (Malus domestica), native black hawthorn (Crataegus douglasii) and introduced ornamental hawthorn (C. monogyna) attractive to R. pomonella flies from the western U.S.

USDA-ARS?s Scientific Manuscript database

The apple maggot fly, Rhagoletis pomonella, infests apple (Malus domestica) and hawthorn species (most notably the downy hawthorn, Crataegus mollis) in the eastern USA. Evidence suggests that the fly was introduced into the western USA sometime in the last 60 years. In addition to apple, R. pomonel...

Behavioral evidence for fruit odor discrimination and sympatric host races of Rhagoletis pomonella flies in the Western United States.

PubMed

Linn, Charles E; Yee, Wee L; Sim, Sheina B; Cha, Dong H; Powell, Thomas H Q; Goughnour, Robert B; Feder, Jeffrey L

2012-11-01

The recent shift of Rhagoletis pomonella (Diptera: Tephritidae) from its native host downy hawthorn, Crataegus mollis, to introduced domesticated apple, Malus domestica, in the eastern United States is a model for sympatric host race formation. However, the fly is also present in the western United States, where it may have been introduced via infested apples within the last 60 years. In addition to apple, R. pomonella also infests two hawthorns in the West, one the native black hawthorn, C. douglasii, and the other the introduced English ornamental hawthorn, C. monogyna. Here, we test for behavioral evidence of host races in the western United States. through flight tunnel assays of western R. pomonella flies to host fruit volatile blends. We report that western apple, black hawthorn, and ornamental hawthorn flies showed significantly increased levels of upwind-directed flight to their respective natal compared to nonnatal fruit volatile blends, consistent with host race status. We discuss the implications of the behavioral results for the origin(s) of western R. pomonella, including the possibility that western apple flies were not introduced, but may represent a recent shift from local hawthorn fly populations. © 2012 The Author(s). Evolution© 2012 The Society for the Study of Evolution.

Review of "The Effect of Special Education Vouchers on Public School Achievement: Evidence from Florida's McKay Scholarship Program"

ERIC Educational Resources Information Center

Yun, John T.

2008-01-01

A new report published by the Manhattan Institute for Education Policy, "The Effect of Special Education Vouchers on Public School Achievement: Evidence from Florida's McKay Scholarship Program," attempts to examine the complex issue of how competition introduced through school vouchers affects student outcomes in public schools. The…

Single-Sex School Boys' Perceptions of Coeducational Classroom Learning Environments

ERIC Educational Resources Information Center

Yates, Shirley M.

2011-01-01

Reviews in many countries have found little evidence of consistent advantages in either single-sex education or coeducation. Over the last three decades, coeducation has been introduced into many single-sex schools, but there is a dearth of evidence from the student perspective of the impact of such changes on the classroom learning environment.…

Predictors of Teacher Satisfaction with Online Professional Development: Evidence from the USA's e-Learning for Educators Initiative

ERIC Educational Resources Information Center

Reeves, Todd D.; Pedulla, Joseph J.

2011-01-01

Online professional development (OPD) is proliferating in an effort to eliminate barriers to high-quality in-service teacher training. Using the Internet as a vehicle for continuing professional development, however, introduces new concerns largely absent in its face-to-face counterpart. For example, evidence from the USA's e-Learning for…

Micronized copper wood preservatives: an efficiency and potential health risk assessment for copper-based nanoparticles.

PubMed

Civardi, Chiara; Schwarze, Francis W M R; Wick, Peter

2015-05-01

Copper (Cu) is an essential biocide for wood protection, but fails to protect wood against Cu-tolerant wood-destroying fungi. Recently Cu particles (size range: 1 nm-25 μm) were introduced to the wood preservation market. The new generation of preservatives with Cu-based nanoparticles (Cu-based NPs) is reputedly more efficient against wood-destroying fungi than conventional formulations. Therefore, it has the potential to become one of the largest end uses for wood products worldwide. However, during decomposition of treated wood Cu-based NPs and/or their derivate may accumulate in the mycelium of Cu-tolerant fungi and end up in their spores that are dispersed into the environment. Inhaled Cu-loaded spores can cause harm and could become a potential risk for human health. We collected evidence and discuss the implications of the release of Cu-based NPs by wood-destroying fungi and highlight the exposure pathways and subsequent magnitude of health impact. Copyright © 2015 Elsevier Ltd. All rights reserved.

Employing Model-Based Reasoning in Interdisciplinary Research Teams: Evidence-Based Practices for Integrating Knowledge Across Systems

NASA Astrophysics Data System (ADS)

Pennington, D. D.; Vincent, S.

2017-12-01

The NSF-funded project "Employing Model-Based Reasoning in Socio-Environmental Synthesis (EMBeRS)" has developed a generic model for exchanging knowledge across disciplines that is based on findings from the cognitive, learning, social, and organizational sciences addressing teamwork in complex problem solving situations. Two ten-day summer workshops for PhD students from large, NSF-funded interdisciplinary projects working on a variety of water issues were conducted in 2016 and 2017, testing the model by collecting a variety of data, including surveys, interviews, audio/video recordings, material artifacts and documents, and photographs. This presentation will introduce the EMBeRS model, the design of workshop activities based on the model, and results from surveys and interviews with the participating students. Findings suggest that this approach is very effective for developing a shared, integrated research vision across disciplines, compared with activities typically provided by most large research projects, and that students believe the skills developed in the EMBeRS workshops are unique and highly desireable.

Sustaining Nursing and Midwifery Grand Rounds in a Regional Australian Health Service.

PubMed

Smyth, Wendy; Abernethy, Gail

2016-07-01

This article reports the success, or otherwise, of strategies implemented to sustain nursing grand rounds in a large regional health service in North Queensland, Australia. Nursing grand rounds had been introduced in late 2010 to increase nurses' engagement with research and evidence-based practice. Although the format, topics, and purpose of grand rounds have changed, attendees continue to positively evaluate each presentation. However, after 5 years, the initiative has expanded and somewhat modified its focus. This article describes these changes and proposes options for the future progression of this professional development activity. J Contin Educ Nurs. 2016;47(7):316-320. Copyright 2016, SLACK Incorporated.

[Assessment of stress in childhood: Children's Daily Stress Inventory (Inventario Infantil de Estresores Cotidiano, IIEC)].

PubMed

Trianes Torres, María Victoria; Blanca Mena, María José; Fernández Baena, Francisco J; Escobar Espejo, Milagros; Maldonado Montero, Enrique F; Muñoz Sánchez, Angela María

2009-11-01

The present study introduces the Children's Daily Stress Inventory (Inventario Infantil de Estresores Cotidianos, IIEC) as a measure that assesses daily stress in primary school children. The inventory was applied to a sample of 1094 primary school students. The final version includes 25 dichotomic items covering the areas of health, school/peers, and family. The score is obtained by adding the total of positive answers. Analyses of items, reliability and several external pieces of evidence of validity based on relations with other variables are presented. The results show adequate psychometric properties for the assessment of daily stress in children.

Strategies for developing competency models.

PubMed

Marrelli, Anne F; Tondora, Janis; Hoge, Michael A

2005-01-01

There is an emerging trend within healthcare to introduce competency-based approaches in the training, assessment, and development of the workforce. The trend is evident in various disciplines and specialty areas within the field of behavioral health. This article is designed to inform those efforts by presenting a step-by-step process for developing a competency model. An introductory overview of competencies, competency models, and the legal implications of competency development is followed by a description of the seven steps involved in creating a competency model for a specific function, role, or position. This modeling process is drawn from advanced work on competencies in business and industry.

Selection on Moral Hazard in Health Insurance

PubMed Central

Einav, Liran; Finkelstein, Amy; Ryan, Stephen; Schrimpf, Paul

2012-01-01

We use employee-level panel data from a single firm to explore the possibility that individuals may select insurance coverage in part based on their anticipated behavioral (“moral hazard”) response to insurance, a phenomenon we label “selection on moral hazard.” Using a model of plan choice and medical utilization, we present evidence of heterogeneous moral hazard as well as selection on it, and explore some of its implications. For example, we show that, at least in our context, abstracting from selection on moral hazard could lead to over-estimates of the spending reduction associated with introducing a high-deductible health insurance option. PMID:24748682

Factors Associated with Assignment of Therapeutic Homework in a Large Public Children's Mental Health System.

PubMed

Trask, Emily Velazquez; Barounis, Kya; Carlisle, Brandon L; Garland, Ann F; Aarons, Gregory A

2018-03-24

Therapeutic homework is a fundamental skill-building component of the majority of evidence-based therapies and is associated with better treatment outcomes. However, it is rarely utilized in public mental health settings. To determine barriers to homework use and identify predictors of clinicians' assignment of homework, an online survey was administered to 267 clinicians in a large diverse public mental health system. Clinicians who were younger, licensed, whose supervisors asked about homework and whose clients completed their homework more frequently were predictors of greater homework utilization. The survey results are discussed and a novel idea to increase the use of homework is introduced.

Cochrane Rapid Reviews Methods Group to play a leading role in guiding the production of informed high-quality, timely research evidence syntheses.

PubMed

Garritty, Chantelle; Stevens, Adrienne; Gartlehner, Gerald; King, Valerie; Kamel, Chris

2016-10-28

Policymakers and healthcare stakeholders are increasingly seeking evidence to inform the policymaking process, and often use existing or commissioned systematic reviews to inform decisions. However, the methodologies that make systematic reviews authoritative take time, typically 1 to 2 years to complete. Outside the traditional SR timeline, "rapid reviews" have emerged as an efficient tool to get evidence to decision-makers more quickly. However, the use of rapid reviews does present challenges. To date, there has been limited published empirical information about this approach to compiling evidence. Thus, it remains a poorly understood and ill-defined set of diverse methodologies with various labels. In recent years, the need to further explore rapid review methods, characteristics, and their use has been recognized by a growing network of healthcare researchers, policymakers, and organizations, several with ties to Cochrane, which is recognized as representing an international gold standard for high-quality, systematic reviews. In this commentary, we introduce the newly established Cochrane Rapid Reviews Methods Group developed to play a leading role in guiding the production of rapid reviews given they are increasingly employed as a research synthesis tool to support timely evidence-informed decision-making. We discuss how the group was formed and outline the group's structure and remit. We also discuss the need to establish a more robust evidence base for rapid reviews in the published literature, and the importance of promoting registration of rapid review protocols in an effort to promote efficiency and transparency in research. As with standard systematic reviews, the core principles of evidence-based synthesis should apply to rapid reviews in order to minimize bias to the extent possible. The Cochrane Rapid Reviews Methods Group will serve to establish a network of rapid review stakeholders and provide a forum for discussion and training. By facilitating exchange, the group will strive to conduct research to advance the methods of rapid reviews.

Larvivorous fish for preventing malaria transmission

PubMed Central

Walshe, Deirdre P; Garner, Paul; Adeel, Ahmed A; Pyke, Graham H; Burkot, Thomas R

2017-01-01

Background Adult female Anopheles mosquitoes can transmit Plasmodium parasites that cause malaria. Some fish species eat mosquito larvae and pupae. In disease control policy documents, the World Health Organization (WHO) includes biological control of malaria vectors by stocking ponds, rivers, and water collections near where people live with larvivorous fish to reduce Plasmodium parasite transmission. In the past, the Global Fund has financed larvivorous fish programmes in some countries, and, with increasing efforts in eradication of malaria, policymakers may return to this option. Therefore, we assessed the evidence base for larvivorous fish programmes in malaria control. Objectives To evaluate whether introducing larvivorous fish to anopheline larval habitats impacts Plasmodium parasite transmission. We also sought to summarize studies that evaluated whether introducing larvivorous fish influences the density and presence of Anopheles larvae and pupae in water sources. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE (PubMed); Embase (Ovid); CABS Abstracts; LILACS; and the metaRegister of Controlled Trials (mRCT) up to 6 July 2017. We checked the reference lists of all studies identified by the search. We examined references listed in review articles and previously compiled bibliographies to look for eligible studies. Also we contacted researchers in the field and the authors of studies that met the inclusion criteria for additional information regarding potential studies for inclusion and ongoing studies. This is an update of a Cochrane Review published in 2013. Selection criteria Randomized controlled trials (RCTs) and non-RCTs, including controlled before-and-after studies, controlled time series, and controlled interrupted time series studies from malaria-endemic regions that introduced fish as a larvicide and reported on malaria in the community or the density of the adult anopheline population. In the absence of direct evidence of an effect on transmission, we performed a secondary analysis on studies that evaluated the effect of introducing larvivorous fish on the density or presence of immature anopheline mosquitoes (larvae and pupae forms) in water sources to determine whether this intervention has any potential that may justify further research in the control of malaria vectors. Data collection and analysis Two review authors independently screened each article by title and abstract, and examined potentially relevant studies for inclusion using an eligibility form. At least two review authors independently extracted data and assessed risk of bias of included studies. If relevant data were unclear or were not reported, we contacted the study authors for clarification. We presented data in tables, and we summarized studies that evaluated the effects of introducing fish on anopheline immature density or presence, or both. We used the GRADE approach to summarize the certainty of the evidence. We also examined whether the included studies reported any possible adverse impact of introducing larvivorous fish on non-target native species. Main results We identified no studies that reported the effects of introducing larvivorous fish on the primary outcomes of this review: malaria infection in nearby communities, entomological inoculation rate, or on adult Anopheles density. For the secondary analysis, we examined the effects of introducing larvivorous fish on the density and presence of anopheline larvae and pupae in community water sources, and found 15 small studies with a follow-up period between 22 days and five years. These studies were undertaken in Sri Lanka (two studies), India (three studies), Ethiopia (one study), Kenya (two studies), Sudan (one study), Grande Comore Island (one study), Korea (two studies), Indonesia (one study), and Tajikistan (two studies). These studies were conducted in a variety of settings, including localized water bodies (such as wells, domestic water containers, fishponds, and pools (seven studies); riverbed pools below dams (two studies)); rice field plots (five studies); and water canals (two studies). All included studies were at high risk of bias. The research was insufficient to determine whether larvivorous fish reduce the density of Anopheles larvae and pupae (12 studies, unpooled data, very low certainty evidence). Some studies with high stocking levels of fish seemed to arrest the increase in immature anopheline populations, or to reduce the number of immature anopheline mosquitoes, compared with controls. However, this finding was not consistent, and in studies that showed a decrease in immature anopheline populations, the effect was not always consistently sustained. In contrast, some studies reported larvivorous fish reduced the number of water sources withAnopheles larvae and pupae (five studies, unpooled data, low certainty evidence). None of the included studies reported effects of larvivorous fish on local native fish populations or other species. Authors' conclusions We do not know whether introducing larvivorous fish reduces malaria transmission or the density of adult anopheline mosquito populations. In research studies that examined the effects on immature anopheline stages of introducing fish to potential malaria vector larval habitats, high stocking levels of fish may reduce the density or presence of immature anopheline mosquitoes in the short term. We do not know whether this translates into impact on malaria transmission. Our interpretation of the current evidence is that countries should not invest in fish stocking as a stand alone or supplementary larval control measure in any malaria transmission areas outside the context of research using carefully controlled field studies or quasi-experimental designs. Such research should examine the effects on native fish and other non-target species. Fish that feed on mosquito larvae for preventing malaria transmission What is the aim of this review? Adult female Anopheles mosquitoes transmit the Plasmodium parasites that cause malaria. The aim of this Cochrane Review was to evaluate whether introducing fish that eat mosquito larvae and pupae (early life stages of mosquitoes) into water sources near where people live will decrease the adult Anopheles mosquito population and thus the number of people infected with Plasmodium parasites. Key messages We do not know if introducing fish that eat mosquito larvae and pupae has an impact on the number of people with malaria or on the adult Anopheles mosquito population. What was studied in the review? The review authors examined the available research that evaluated introducing fish that eat larvae ('larvivorous') to Anopheles mosquito larval habitats in areas where malaria was common. Fifteen small studies looked at the effects of larvivorous fish on Anopheles larvae and pupae in different larval habitats, including localized water bodies (such as wells, domestic water containers, fishponds, and pools; seven studies), riverbed pools below dams (two studies), rice field plots (four studies), and water canals (two studies). These studies were undertaken in Sri Lanka (two studies), India (three studies), Ethiopia (one study), Kenya (two studies), Sudan (one study), Grande Comore Island (one study), Korea (two studies), Indonesia (one study), and Tajikistan (two studies). This is an update of a 2013 Cochrane Review and includes some older unpublished studies from Tajikistan and a new trial from India. What are the main results of the review? In our main analysis, we found no studies that looked at the effects of larvivorous fish on adult Anopheles mosquito populations or on the number of people infected with Plasmodium parasites. In our analysis exploring the effect of fish introduction on the number of Anopheles larvae and pupae in water collections, these studies produced inconsistent results on immature mosquito density (12 studies, unpooled data, very low certainty evidence). Some studies that measured the number of water sources withAnopheles larvae and pupae reported a reduction in the number of sites with Anopheles larvae and pupae after introducing fish (five studies, unpooled data, low certainty evidence). None of the included studies examined the effects of introducing larvivorous fish on other native species present, but these studies were not designed to do this. All included studies were at high risk of bias. Before much is invested in this intervention, we need better research to determine the effect of introducing larvivorous fish on the number of people infected with malaria, and on adult Anopheles populations. Researchers need to use robust controlled designs with an adequate number of sites. In addition, researchers should explore the potential harms from introducing these fish on native fish and other non-Anopheles species. How up-to-date is this review? The review authors searched for studies published up to 6 July 2017. PMID:29226959

Assessing the Spread and Uptake of a Framework for Introducing and Evaluating Advanced Practice Nursing Roles.

PubMed

Boyko, Jennifer A; Carter, Nancy; Bryant-Lukosius, Denise

2016-08-01

Health system researchers must ensure that the products of their work meet the needs of various stakeholder groups (e.g., patients, practitioners, and policy makers). Evidence-based frameworks can support the uptake and spread of research evidence; however, their existence as knowledge translation tools does not ensure their uptake and it is difficult to ascertain their spread into research, practice, and policy using existing methods. The purpose of this article is to report results of a study on the spread and uptake of an evidence-based framework (i.e., the participatory, evidence-based, patient-focused process for advanced practice nursing [PEPPA] framework) into research, practice, and policies relevant to the introduction and evaluation of advanced practice nursing roles. We also reflect on the utility of using a modified citation methodology to evaluate knowledge translation efforts. We searched four databases for literature published between 2004 and 2014 citing the original paper in which the PEPPA framework was published, and carried out an Internet search for grey literature using keywords. Relevant data were extracted from sources and organized using NVivo software. We analysed results descriptively. Our search yielded 164 unique sources of which 69.5% were from published literature and the majority (83.4%) of these were published in nursing journals. Most frequently (71.5%), the framework was used by researchers and students in research studies. A smaller number of citations (11.3%) reflected use of the PEPPA framework in practice settings with a focus on role development, implementation, evaluation, or a combination of these. This study demonstrates that the PEPPA framework has been used to varying degrees as intended, and provides guidance on how to evaluate the spread and uptake of research outputs (e.g., theoretical frameworks). Further research is needed about ways to determine whether evidence-informed research tools such as frameworks have been taken up successfully into practice and policy contexts. © 2016 Sigma Theta Tau International.

Should radiology residents be taught evidence-based radiology? An experiment with "the EBR Journal Club".

PubMed

Heilbrun, Marta E

2009-12-01

Introduce radiology residents to evidence-based radiology (EBR) using a journal club format based on the Radiology Alliance for Health Services Research/American Alliance of Academic Chief Residents in Radiology (RAHSR/A3CR2) Critical Thinking Skills sessions and EBR series of articles published in Radiology in 2007. The club began with a presentation outlining the process that would occur in an alternating format, with topics and articles chosen by residents. In session A, questions were rephrased in a Patient/Population, Intervention, Comparison, Outcome format, and a literature search was performed. Articles were discussed in session B, with residents assigned by year to the tasks of article summary, technology assessment, and comparison to checklists (Standards for Reporting of Diagnostic Accuracy, Consolidated Standards of Reporting Trials, or Quality of Reporting of Meta-analysis). The residents collectively assigned a level of evidence to each article, and a scribe provided a summary. Twenty-two residents participated, with 12/22 (55%) of residents submitting any question, 6/22 (27.3%) submitting more than one question, and 4 residents submitting questions in more than one session. Topics included radiation risk, emergency radiology, screening examinations, modality comparisons, and technology assessment. Of the 31 articles submitted for review, 15 were in radiology journals and 5 were published before 2000. For 2/9 topics searched, no single article that the residents selected was available through our library's subscription service. The maximum level of evidence assigned by residents was level III, "limited evidence." In each session, the residents concluded that they became less confident in the "right answer." They proposed that future reading recommendations come from attendings rather than literature searches. A journal club format is an effective tool to teach radiology residents EBR principles. Resistance comes from the difficulty in accessing good literature for review and in constructing good review questions.

Mutual dilution of infection by an introduced parasite in native and invasive stream fishes across Hawaii.

PubMed

Gagne, Roderick B; Heins, David C; McIntyre, Peter B; Gilliam, James F; Blum, Michael J

2016-10-01

The presence of introduced hosts can increase or decrease infections of co-introduced parasites in native species of conservation concern. In this study, we compared parasite abundance, intensity, and prevalence between native Awaous stamineus and introduced poeciliid fishes by a co-introduced nematode parasite (Camallanus cotti) in 42 watersheds across the Hawaiian Islands. We found that parasite abundance, intensity and prevalence were greater in native than introduced hosts. Parasite abundance, intensity and prevalence within A. stamineus varied between years, which largely reflected a transient spike in infection in three remote watersheds on Molokai. At each site we measured host factors (length, density of native host, density of introduced host) and environmental factors (per cent agricultural and urban land use, water chemistry, watershed area and precipitation) hypothesized to influence C. cotti abundance, intensity and prevalence. Factors associated with parasitism differed between native and introduced hosts. Notably, parasitism of native hosts was higher in streams with lower water quality, whereas parasitism of introduced hosts was lower in streams with lower water quality. We also found that parasite burdens were lower in both native and introduced hosts when coincident. Evidence of a mutual dilution effect indicates that introduced hosts can ameliorate parasitism of native fishes by co-introduced parasites, which raises questions about the value of remediation actions, such as the removal of introduced hosts, in stemming the rise of infectious disease in species of conservation concern.

Bayesian evidence synthesis to estimate HIV prevalence in men who have sex with men in Poland at the end of 2009.

PubMed

Rosinska, M; Gwiazda, P; De Angelis, D; Presanis, A M

2016-04-01

HIV spread in men who have sex with men (MSM) is an increasing problem in Poland. Despite the existence of a surveillance system, there is no direct evidence to allow estimation of HIV prevalence and the proportion undiagnosed in MSM. We extracted data on HIV and the MSM population in Poland, including case-based surveillance data, diagnostic testing prevalence data and behavioural data relating to self-reported prior diagnosis, stratified by age (⩽35, >35 years) and region (Mazowieckie including the capital city of Warsaw; other regions). They were integrated into one model based on a Bayesian evidence synthesis approach. The posterior distributions for HIV prevalence and the undiagnosed fraction were estimated by Markov Chain Monte Carlo methods. To improve the model fit we repeated the analysis, introducing bias parameters to account for potential lack of representativeness in data. By placing additional constraints on bias parameters we obtained precisely identified estimates. This family of models indicates a high undiagnosed fraction [68·3%, 95% credibility interval (CrI) 53·9-76·1] and overall low prevalence (2·3%, 95% CrI 1·4-4·1) of HIV in MSM. Additional data are necessary in order to produce more robust epidemiological estimates. More effort is urgently needed to ensure timely diagnosis of HIV in Poland.

Revisiting the neurofunctional approach: Conceptualizing the core components for the rehabilitation of everyday living skills

PubMed Central

Clark-Wilson, Jo; Baxter, Doreen M.

2014-01-01

Background Background: Introduced in the 1980s, the neurofunctional approach (NFA) is one of the few interventions designed primarily for clients with severe deficits following traumatic brain injury (TBI). Specifically the NFA was intended for those individuals who were limited in their ability to solve novel problems or generalize skills from one setting to another and whose lack of insight limited their engagement in the rehabilitative process. Description of the approach Description of the approach: The NFA is a client-centred, goal-driven approach that incorporates the principles of skill learning and promotes the development of routines and competencies in practical activities required for everyday living. Programmes based on the NFA are developed specifically to meet each client’s unique needs, using a range of evidence-based interventions. Recent evidence Recent evidence: Recently the NFA has been found to be more effective than cognitive-retraining for some individuals with moderate-to-severe TBI who have deficits in activities of daily living. This paper aims to define the core features of the NFA, outline the theoretical basis on which it is founded and consider implications of the findings for rehabilitation after TBI in general. The NFA is highly relevant for clients living in the community who require a case manager to direct an integrated, rehabilitation programme or provide structured input for the long-term maintenance of skills. PMID:25153760

Semantic Modelling of Digital Forensic Evidence

NASA Astrophysics Data System (ADS)

Kahvedžić, Damir; Kechadi, Tahar

The reporting of digital investigation results are traditionally carried out in prose and in a large investigation may require successive communication of findings between different parties. Popular forensic suites aid in the reporting process by storing provenance and positional data but do not automatically encode why the evidence is considered important. In this paper we introduce an evidence management methodology to encode the semantic information of evidence. A structured vocabulary of terms, ontology, is used to model the results in a logical and predefined manner. The descriptions are application independent and automatically organised. The encoded descriptions aim to help the investigation in the task of report writing and evidence communication and can be used in addition to existing evidence management techniques.

Community-Based Recreational Football: A Novel Approach to Promote Physical Activity and Quality of Life in Prostate Cancer Survivors

PubMed Central

Bruun, Ditte Marie; Bjerre, Eik; Krustrup, Peter; Brasso, Klaus; Johansen, Christoffer; Rørth, Mikael; Midtgaard, Julie

2014-01-01

As the number of cancer survivors continues to increase, there is an increasing focus on management of the long-term consequences of cancer including health promotion and prevention of co-morbidity. Prostate cancer is the most frequent type of cancer type in men and causes increased risk of heart disease, diabetes and osteoporosis. Epidemiological evidence points to a positive effect of regular physical activity on all-cause and prostate cancer mortality and current clinical evidence supports the use of exercise in cancer rehabilitation. However, the external validity of existing exercise studies is limited and the majority of prostate cancer survivors remain sedentary. Hence, novel approaches to evaluate and promote physical activity are warranted. This paper presents the rationale behind the delivery and evaluation of community-based recreational football offered in existing football clubs under the Danish Football Association to promote quality of life and physical activity adherence in prostate cancer survivors. The RE-AIM framework will be applied to evaluate the impact of the intervention including outcomes both at the individual and organizational level. By introducing community-based sport environments, the study offers a novel approach in the strive towards sustained physical activity adherence and accessibility in prostate cancer survivors. PMID:24865394

An overview on the emerging area of identification, characterization, and assessment of health apps.

PubMed

Paglialonga, Alessia; Lugo, Alessandra; Santoro, Eugenio

2018-05-28

The need to characterize and assess health apps has inspired a significant amount of research in the past years, in search for methods able to provide potential app users with relevant, meaningful knowledge. This article presents an overview of the recent literature in this field and categorizes - by discussing some specific examples - the various methodologies introduced so far for the identification, characterization, and assessment of health apps. Specifically, this article outlines the most significant web-based resources for app identification, relevant frameworks for descriptive characterization of apps' features, and a number of methods for the assessment of quality along its various components (e.g., evidence base, trustworthiness, privacy, or user engagement). The development of methods to characterize the apps' features and to assess their quality is important to define benchmarks and minimum requirements. Similarly, such methods are important to categorize potential risks and challenges in the field so that risks can be minimized, whenever possible, by design. Understanding methods to assess apps is key to raise the standards of quality of health apps on the market, towards the final goal of delivering apps that are built on the pillars of evidence-base, reliability, long-term effectiveness, and user-oriented quality. Copyright © 2018. Published by Elsevier Inc.

Using cost-analyses to inform health professions education - The economic cost of pre-clinical failure.

PubMed

Foo, Jonathan; Ilic, Dragan; Rivers, George; Evans, Darrell J R; Walsh, Kieran; Haines, Terry P; Paynter, Sophie; Morgan, Prue; Maloney, Stephen

2017-12-07

Student failure creates additional economic costs. Knowing the cost of failure helps to frame its economic burden relative to other educational issues, providing an evidence-base to guide priority setting and allocation of resources. The Ingredients Method is a cost-analysis approach which has been previously applied to health professions education research. In this study, the Ingredients Method is introduced, and applied to a case study, investigating the cost of pre-clinical student failure. The four step Ingredients Method was introduced and applied: (1) identify and specify resource items, (2) measure volume of resources in natural units, (3) assign monetary prices to resource items, and (4) analyze and report costs. Calculations were based on a physiotherapy program at an Australian university. The cost of failure was £5991 per failing student, distributed across students (70%), the government (21%), and the university (8%). If the cost of failure and attrition is distributed among the remaining continuing cohort, the cost per continuing student educated increases from £9923 to £11,391 per semester. The economics of health professions education is complex. Researchers should consider both accuracy and feasibility in their costing approach, toward the goal of better informing cost-conscious decision-making.

Human papillomavirus vaccine policy and delivery in Latin America and the Caribbean.

PubMed

Andrus, Jon Kim; Lewis, Merle J; Goldie, Sue J; García, Patricia J; Winkler, Jennifer L; Ruiz-Matus, Cuauhtémoc; de Quadros, Ciro A

2008-08-19

Cervical cancer caused by human papillomavirus (HPV) is a major preventable public health problem. Two vaccines are now available for primary prevention of HPV infection and their introduction offers new opportunities to enhance comprehensive cervical cancer prevention and control. Currently, HPV vaccine price is a significant barrier to rapid vaccine introduction and access. Therefore, making evidence-based decisions about whether and how to introduce HPV vaccine into the immunization schedule in the countries of Latin America and the Caribbean (LAC) requires a rigorous analysis of several factors. These include: estimates of disease burden, cost-effectiveness, operational feasibility of reaching a population of adolescent females and other key analyses that have been used in recent years to support the introduction of other vaccines, such as rotavirus and pneumococcal conjugate vaccines. Given the large number of public health priorities that are competing for limited public resources, developing and using a sound evidence base is of particular importance for vaccines, like HPV, which are currently available only at prices higher than other vaccines now in use. HPV vaccination provides the opportunity to dramatically improve women's health and partnerships must also be broad-based and effectively coordinated. This can be achieved by developing programs based on the lessons learned from vaccination strategies used to eliminate rubella and neonatal tetanus and for scaling up influenza vaccination in countries of LAC.

Fossil pollen as a guide to conservation in the Galapagos.

PubMed

van Leeuwen, Jacqueline F N; Froyd, Cynthia A; van der Knaap, W O; Coffey, Emily E; Tye, Alan; Willis, Katherine J

2008-11-21

Paleoecological evidence from the past 8000 years in the Galápagos Islands shows that six presumed introduced or doubtfully native species (Ageratum conyzoides, Borreria laevis/Diodia radula-type, Brickellia diffusa, Cuphea carthagenensis, Hibiscus diversifolius, and Ranunculus flagelliformis) are in fact native to the archipelago. Fossil pollen and macrofossils from four sites in the highlands of Santa Cruz Island reveal that all were present thousands of years before the advent of human impact, refuting their classification as introduced species. These findings have substantial implications not only for conservation in Galápagos but for the management of introduced species and pantropical weeds in general.

Application of Fragment Ion Information as Further Evidence in Probabilistic Compound Screening Using Bayesian Statistics and Machine Learning: A Leap Toward Automation.

PubMed

Woldegebriel, Michael; Zomer, Paul; Mol, Hans G J; Vivó-Truyols, Gabriel

2016-08-02

In this work, we introduce an automated, efficient, and elegant model to combine all pieces of evidence (e.g., expected retention times, peak shapes, isotope distributions, fragment-to-parent ratio) obtained from liquid chromatography-tandem mass spectrometry (LC-MS/MS/MS) data for screening purposes. Combining all these pieces of evidence requires a careful assessment of the uncertainties in the analytical system as well as all possible outcomes. To-date, the majority of the existing algorithms are highly dependent on user input parameters. Additionally, the screening process is tackled as a deterministic problem. In this work we present a Bayesian framework to deal with the combination of all these pieces of evidence. Contrary to conventional algorithms, the information is treated in a probabilistic way, and a final probability assessment of the presence/absence of a compound feature is computed. Additionally, all the necessary parameters except the chromatographic band broadening for the method are learned from the data in training and learning phase of the algorithm, avoiding the introduction of a large number of user-defined parameters. The proposed method was validated with a large data set and has shown improved sensitivity and specificity in comparison to a threshold-based commercial software package.

Usage of Bone Replacement Grafts in Periodontics and Oral Implantology and Their Current Levels of Clinical Evidence - A Systematic Assessment.

PubMed

Salem, Daliah; Natto, Zuhair; Elangovan, Satheesh; Karimbux, Nadeem

2016-08-01

The aim of this review is to evaluate the levels of clinical evidence for bone replacement grafts available in the United States for periodontics and oral implantology purposes. A search was performed using PubMed, the Cochrane Library, and Google Scholar for articles relating to the use of bone replacement grafts in implant and/or periodontics by two independent reviewers. Articles unrelated to the topic, not involving patients, not including abstracts, or in languages other than English were excluded. Selected articles were graded according to "levels of evidence" based on guidelines originally introduced by Wright et al. (2003). There was limited published peer-reviewed clinical literature available regarding US commercially available bone replacement grafts in periodontics and oral implantology. Of 144 bone replacement grafts available in the United States according to Avila-Ortiz et al. (2013), only 52 met the inclusion criteria. The majority of materials used were allografts (26 of 93 available in the United States), followed by alloplasts (15 of 30) and xenografts (11 of 21). Dental providers should be aware of the limited evidence that qualified for a strong rating supporting the clinical efficacy of these materials for periodontics and oral implantology purposes using the inclusion criteria selected in this study.

Teacher's Resource Book for Animal Evidence/Tracks. Grade 4. Revised. Anchorage School District Elementary Science Program.

ERIC Educational Resources Information Center

Anchorage School District, AK.

This resource book introduces fourth-grade children to nature around them by studying animal tracks and other animal evidence. The lessons and concepts covered in this unit are designed to develop an awareness and appreciation of animals in our environment. Ten lessons are provided including: (1) identifying holes, tracks, and scratches; (2)…

School Accountability, Autonomy, Choice, and the Equity of Student Achievement: International Evidence from PISA 2003. OECD Education Working Papers, No. 14

ERIC Educational Resources Information Center

Schutz, Gabriela; West, Martin R.; Wobmann, Ludger

2007-01-01

School systems aspire to provide equal opportunity for all, irrespective of socio-economic status (SES). Much of the criticism of recent school reforms that introduce accountability, autonomy, and choice emphasizes their potentially negative consequences for equity. This report provides new evidence on how national features of accountability,…

Introduction to Evidence Centered Design and Lessons Learned from Its Application in a Global E-Learning Program

ERIC Educational Resources Information Center

Behrens, John T.; Mislevy, Robert J.; Bauer, Malcolm; Williamson, David M.; Levy, Roy

2004-01-01

This article introduces the assessment and deployment contexts of the Networking Performance Skill System (NetPASS) project and the articles in this section that report on findings from this endeavor. First, the educational context of the Cisco Networking Academy Program is described. Second, the basic outline of Evidence Centered Design is…

Clinician-led improvement in cancer care (CLICC) - testing a multifaceted implementation strategy to increase evidence-based prostate cancer care: phased randomised controlled trial - study protocol

PubMed Central

2014-01-01

Background Clinical practice guidelines have been widely developed and disseminated with the aim of improving healthcare processes and patient outcomes but the uptake of evidence-based practice remains haphazard. There is a need to develop effective implementation methods to achieve large-scale adoption of proven innovations and recommended care. Clinical networks are increasingly being viewed as a vehicle through which evidence-based care can be embedded into healthcare systems using a collegial approach to agree on and implement a range of strategies within hospitals. In Australia, the provision of evidence-based care for men with prostate cancer has been identified as a high priority. Clinical audits have shown that fewer than 10% of patients in New South Wales (NSW) Australia at high risk of recurrence after radical prostatectomy receive guideline recommended radiation treatment following surgery. This trial will test a clinical network-based intervention to improve uptake of guideline recommended care for men with high-risk prostate cancer. Methods/Design In Phase I, a phased randomised cluster trial will test a multifaceted intervention that harnesses the NSW Agency for Clinical Innovation (ACI) Urology Clinical Network to increase evidence-based care for men with high-risk prostate cancer following surgery. The intervention will be introduced in nine NSW hospitals over 10 months using a stepped wedge design. Outcome data (referral to radiation oncology for discussion of adjuvant radiotherapy in line with guideline recommended care or referral to a clinical trial of adjuvant versus salvage radiotherapy) will be collected through review of patient medical records. In Phase II, mixed methods will be used to identify mechanisms of provider and organisational change. Clinicians’ knowledge and attitudes will be assessed through surveys. Process outcome measures will be assessed through document review. Semi-structured interviews will be conducted to elucidate mechanisms of change. Discussion The study will be one of the first randomised controlled trials to test the effectiveness of clinical networks to lead changes in clinical practice in hospitals treating patients with high-risk cancer. It will additionally provide direction regarding implementation strategies that can be effectively employed to encourage widespread adoption of clinical practice guidelines. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611001251910. PMID:24884877

[Oxidative Stress Derived from Airborne Fine and Ultrafine Particles and the Effects on Brain-Nervous System: Part 2].

PubMed

Sagai, Masaru; Tin Win-Shwe, Tin

2015-01-01

Traffic-related air pollution is a major contributor to urban air pollution. Diesel exhaust (DE) is its most important component of near-road and urban air pollutions and is commonly used as a surrogate model of air pollution in health effects studies. In particular, diesel exhaust particles (DEPs) and nanoparticles in DEPs are the components considered hazardous for health. It is widely known that exposure to DEPs is associated with mortality caused by respiratory and cardiovascular diseases. Recently, evidence has been accumulating showing that DEPs and nanoparticles may cause neurodegenerative disorders. Here, we introduce evidence suggesting their association with these disorders. The chemical components and the translocation of DEPs and nanoparticles to the brain are described in part 1. In part 2, we introduce the mechanism of development of neurodegenerative diseases such as stroke, Alzheimer's disease, and Parkinson's disease via oxidative stress and inflammatory events. Furthermore, there are many lines of epidemiological evidence showing that the particulates impair cognitive function and ability of memory through oxidative and inflammatory events in the brain. These lines of evidences are supported by many animal experiments on neurological disorders.

Countering evidence denial and the promotion of pseudoscience in autism spectrum disorder.

PubMed

Smith, Isabel M; MacDonald, Noni E

2017-08-01

This commentary introduces a framework within which clinical and research experts in autism spectrum disorder (ASD) can address public instances of evidence denial and promotion of pseudoscience related to ASD. This is a generalized extension of work by a World Health Organization (WHO) group dedicated to reducing the influence of Vocal Vaccine Deniers through educating advocates in how to effectively defuse their arguments. The WHO guidelines were informed by conceptual work on the "denialism" phenomenon, and by studies in psychology, communication, vaccine science, and public health. Our goal is to introduce these ideas to, and encourage discussion within, the ASD research community. Autism Res 2017, 10: 1334-1337. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

[The introduction of gluten into the infant diet. Expert group recommendations].

PubMed

Ribes Koninckx, C; Dalmau Serra, J; Moreno Villares, J M; Diaz Martín, J J; Castillejo de Villasante, G; Polanco Allue, I

2015-11-01

At present there is a degree of uncertainty regarding when, how and in what form gluten should be introduced into the infant diet. For years the recommendations of the ESPGHAN Committee on Nutrition have prevailed, which include avoiding early introduction, before 4 months, and late, after 7 months, and gradually introducing gluten into the diet while the infant is being breastfed, with the aim of reducing the risk of celiac disease, diabetes and gluten allergy. However, 2 independent studies published in The New England Journal of Medicine in October 2014 reached the conclusion that the age of introduction of gluten does not modify the risk of developing celiac disease, and that breastfeeding at any age does not confer protection against celiac disease development. On the other hand, according to available scientific evidence, the introduction of foods other than breast milk or formula into the infants diet is generally recommended around 6 months of age, since the introduction before 4 months could be associated with an increased risk of food allergy and autoimmune diseases, and delaying it beyond 7 months would not have a protective effect. In this context, a group of experts has considered it appropriate to produce a consensus document based on the current scientific evidence and present general recommendations for daily clinical practice on the introduction of gluten into the diet. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Strategy of health information seeking among physicians, medical residents, and students after introducing digital library and information technology in teaching hospitals of Iran.

PubMed

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

2015-05-01

It is important for physicians, medical students and health care organizations of developing countries to use reliable clinical information in order to deliver the best practice. Therefore, health sector of Iran endeavored to encourage physicians and medical students to integrate research findings into practice since 2005. Several educational interventions in the areas of information technology and databases were performed. Digital library was introduced in the teaching hospitals. The purpose of this study was to investigate whether these interventions increased the use of evidence-based health information resources among physicians, medical residents and students. This descriptive study involved 315 physicians, assistants and medical students in affiliated hospitals of Semnan University of medical sciences in 2013. A total 52.9% of physicians and 79.5% of medical residents and students always used patient data. 81.3% of physicians and 67.1% of medical residents and students reported using their own experiences, 26.5% of physicians and 16.9% of medical residents and students always used databases such as PubMed and MEDLINE for patient care. Our results revealed that in spite of providing educational and technical infrastructures for accomplishment of research utilization in medical education, the study subjects often identified and used what they regarded as reliable and relevant information from sources that do not truly represent the best evidence that is available. © 2015 Chinese Cochrane Center, West China Hospital of Sichuan University and Wiley Publishing Asia Pty Ltd.

Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care

PubMed Central

Percival, Nikki; O’Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

2016-01-01

Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers. PMID:27066470

Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care.

PubMed

Percival, Nikki; O'Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

2016-01-01

Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers.

Commercial gaming devices for stroke upper limb rehabilitation: a systematic review.

PubMed

Thomson, Katie; Pollock, Alex; Bugge, Carol; Brady, Marian

2014-06-01

Rehabilitation using commercial gaming devices is a new concept for stroke care. Commercial gaming devices such as Nintendo Wii or Sony PlayStation encourage high repetition of arm movements and are being introduced into some clinical settings. The evidence base for gaming use in rehabilitation is growing rapidly and there is a need to systematically synthesise research. Our review aims to integrate evidence on how gaming is being used, explore patient/therapist experience and synthesise evidence of effectiveness. An integrative systematic review was undertaken searching Cochrane Central Register of Controlled Trials (2013), Medline (2013), Embase (2013) and twelve additional databases. Two review authors independently selected studies based on pre-defined inclusion criteria, extracted data and assessed risk of bias. Nineteen studies including 215 patients met inclusion criteria. Studies were typically small scale feasibility studies using a range of research designs, limiting the ability to reach generalised conclusions. Results have been tabulated (activities of daily living, upper limb function/ movement) and qualitative themes identified. Findings suggest that most patients enjoy using commercial gaming and can tolerate 180 mins per week without significant adverse effects. A trend towards improvement was noted for upper limb function/ movement. Few studies recorded outcomes related to activities of daily living or focused on understanding patients' experiences of this intervention. Commercial gaming can provide high intensity upper limb practice however there is insufficient high quality evidence to reach generalisable conclusions about risks or benefits on activities of daily living or upper limb function/movement. © 2014 The Authors. International Journal of Stroke © 2014 World Stroke Organization.

Calculating evidence-based renal replacement therapy - Introducing an excel-based calculator to improve prescribing and delivery in renal replacement therapy - A before and after study.

PubMed

Cottle, Daniel; Mousdale, Stephen; Waqar-Uddin, Haroon; Tully, Redmond; Taylor, Benjamin

2016-02-01

Transferring the theoretical aspect of continuous renal replacement therapy to the bedside and delivering a given "dose" can be difficult. In research, the "dose" of renal replacement therapy is given as effluent flow rate in ml kg -1  h -1 . Unfortunately, most machines require other information when they are initiating therapy, including blood flow rate, pre-blood pump flow rate, dialysate flow rate, etc. This can lead to confusion, resulting in patients receiving inappropriate doses of renal replacement therapy. Our aim was to design an excel calculator which would personalise patient's treatment, deliver an effective, evidence-based dose of renal replacement therapy without large variations in practice and prolong filter life. Our calculator prescribes a haemodialfiltration dose of 25 ml kg -1  h -1 whilst limiting the filtration fraction to 15%. We compared the episodes of renal replacement therapy received by a historical group of patients, by retrieving their data stored on the haemofiltration machines, to a group where the calculator was used. In the second group, the data were gathered prospectively. The median delivered dose reduced from 41.0 ml kg -1  h -1 to 26.8 ml kg -1  h -1 with reduced variability that was significantly closer to the aim of 25 ml kg -1 .h -1 ( p  < 0.0001). The median treatment time increased from 8.5 h to 22.2 h ( p  = 0.00001). Our calculator significantly reduces variation in prescriptions of continuous veno-venous haemodiafiltration and provides an evidence-based dose. It is easy to use and provides personal care for patients whilst optimizing continuous veno-venous haemodiafiltration delivery and treatment times.

Evolution of the evidence on the effectiveness and cost-effectiveness of acetylcholinesterase inhibitors and memantine for Alzheimer's disease: systematic review and economic model.

PubMed

Hyde, Christopher; Peters, Jaime; Bond, Mary; Rogers, Gabriel; Hoyle, Martin; Anderson, Rob; Jeffreys, Mike; Davis, Sarah; Thokala, Praveen; Moxham, Tiffany

2013-01-01

in 2007 the National Institute of Health and Clinical Excellence (NICE) restricted the use of acetylcholinesterase inhibitors and memantine. we conducted a health technology assessment (HTA) of the effectiveness and cost-effectiveness of donepezil, galantamine, rivastigmine and memantine for the treatment of AD to re-consider and up-date the evidence base used to inform the 2007 NICE decision. The systematic review of effectiveness targeted randomised controlled trials. A comprehensive search, including MEDLINE, Embase and the Cochrane Library, was conducted from January 2004 to March 2010. All key review steps were done by two reviewers. Random effects meta-analysis was conducted. The cost-effectiveness was assessed using a cohort-based model with three health states: pre-institutionalised, institutionalised and dead. The perspective was NHS and Personal Social Services and the cost year 2009. confidence about the size and statistical significance of the estimates of effect of galantamine, rivastigmine and memantine improved on function and global impact in particular. Cost-effectiveness also changed. For donepezil, galantamine and rivastigmine, the incremental cost per quality-adjusted life year (QALY) in 2004 was above £50,000; in 2010 the same drugs 'dominated' best supportive care (improved clinical outcome at reduced cost). This was primarily because of changes in the modelled costs of introducing the drugs. For memantine, the cost-effectiveness also improved from a range of £37-53,000 per QALY gained to a base-case of £32,000. there has been a change in the evidence base between 2004 and 2010 consistent with the change in NICE guidance. Further evolution in cost-effectiveness estimates is possible particularly if there are changes in drug prices.

Content-based VLE designs improve learning efficiency in constructivist statistics education.

PubMed

Wessa, Patrick; De Rycker, Antoon; Holliday, Ian Edward

2011-01-01

We introduced a series of computer-supported workshops in our undergraduate statistics courses, in the hope that it would help students to gain a deeper understanding of statistical concepts. This raised questions about the appropriate design of the Virtual Learning Environment (VLE) in which such an approach had to be implemented. Therefore, we investigated two competing software design models for VLEs. In the first system, all learning features were a function of the classical VLE. The second system was designed from the perspective that learning features should be a function of the course's core content (statistical analyses), which required us to develop a specific-purpose Statistical Learning Environment (SLE) based on Reproducible Computing and newly developed Peer Review (PR) technology. The main research question is whether the second VLE design improved learning efficiency as compared to the standard type of VLE design that is commonly used in education. As a secondary objective we provide empirical evidence about the usefulness of PR as a constructivist learning activity which supports non-rote learning. Finally, this paper illustrates that it is possible to introduce a constructivist learning approach in large student populations, based on adequately designed educational technology, without subsuming educational content to technological convenience. Both VLE systems were tested within a two-year quasi-experiment based on a Reliable Nonequivalent Group Design. This approach allowed us to draw valid conclusions about the treatment effect of the changed VLE design, even though the systems were implemented in successive years. The methodological aspects about the experiment's internal validity are explained extensively. The effect of the design change is shown to have substantially increased the efficiency of constructivist, computer-assisted learning activities for all cohorts of the student population under investigation. The findings demonstrate that a content-based design outperforms the traditional VLE-based design.

A systematic review on the impact of point-of-sale tobacco promotion on smoking.

PubMed

Robertson, Lindsay; McGee, Rob; Marsh, Louise; Hoek, Janet

2015-01-01

The tobacco retail environment is a crucial marketing medium for the industry. A 2009 review found evidence of a positive association between exposure to point-of-sale (POS) tobacco promotion and increased smoking and smoking susceptibility, though limitations in the evidence base were identified. We reviewed and critically appraised recent evidence documenting the influence of POS tobacco promotion, and POS tobacco display bans, on smoking-related behavior and cognitions. We reviewed original quantitative and qualitative research that examined the relationship between POS tobacco promotion and smoking prevalence, individual-level smoking and quitting and tobacco purchasing behavior, smoking susceptibility, and smoking-related cognitions. Twenty peer-reviewed studies (18 quantitative and 2 qualitative) met the inclusion criteria; each study reported findings consistent with a positive association between exposure to POS tobacco promotion and smoking or smoking susceptibility. Several studies met key criteria for causality: 4 indicated a dose-response association, 2 prospective studies were identified, and evidence from intervention studies supported the reversibility of the association. Findings were consistent across different study designs, settings, and measures. The existing evidence supports a positive association between exposure to POS tobacco promotion and smoking. This review provides evidence to support the continuation of POS tobacco display bans in those jurisdictions where such legislation has been introduced and strengthens the evidence encouraging similar policies in jurisdictions without a POS display ban. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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

PubMed

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

2015-05-01

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

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

PubMed Central

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

2015-01-01

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

What Goes Around Comes Around … Or Does It? Disrupting the Cycle of Traditional, Sport-Based Physical Education

PubMed Central

Ennis, Catherine D.

2015-01-01

As typically taught, sport-based, multiactivity approaches to physical education provide students with few opportunities to increase their skill, fitness, or understanding. Alternative curriculum models, such as Sport Education, Teaching Games for Understanding, and Fitness for Life, represent a second generation of models that build on strong statements of democratic, student-centered practice in physical education. In the What Goes Around section of the paper, I discuss the U.S. perspective on the origins of alternative physical education curriculum models introduced in the early and mid-20th century as a response to sport and exercise programs of the times. Today, with the help of physical educators, scholars are conducting research to test new curricular alternatives or prototypes to provide evidence-based support for these models. Yet, the multiactivity, sport-based curriculum continues to dominate in most U.S. physical education classes. I discuss reasons for this dogged persistence and propose reforms to disrupt this pervasive pattern in the future. PMID:25960937

Molecular evidence for a founder effect in invasive house finch (Carpodacus mexicanus) populations experiencing an emergent disease epidemic.

PubMed

Hawley, Dana M; Hanley, Daniel; Dhondt, André A; Lovette, Irby J

2006-01-01

The impact of founder events on levels of genetic variation in natural populations remains a topic of significant interest. Well-documented introductions provide a valuable opportunity to examine how founder events influence genetic diversity in invasive species. House finches (Carpodacus mexicanus) are passerine birds native to western North America, with the large eastern North American population derived from a small number of captive individuals released in the 1940s. Previous comparisons using amplified fragment length polymorphism (AFLP) markers found equivalent levels of diversity in eastern and western populations, suggesting that any genetic effects of the founder event were ameliorated by the rapid growth of the newly established population. We used an alternative marker system, 10 highly polymorphic microsatellites, to compare levels of genetic diversity between four native and five introduced house finch populations. In contrast to the AFLP comparisons, we found significantly lower allelic richness and heterozygosity in introduced populations across all loci. Three out of five introduced populations showed significant reductions in the ratio of the number of alleles to the allele size range, a within-population characteristic of recent bottlenecks. Finally, native and introduced populations showed significant pairwise differences in allele frequencies in every case, with stronger isolation by distance within the introduced than native range. Overall, our results provide compelling molecular evidence for a founder effect during the introduction of eastern house finches that reduced diversity levels at polymorphic microsatellite loci and may have contributed to the emergence of the Mycoplasma epidemic which recently swept the eastern range of this species.

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

PubMed

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

2011-01-01

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

The Purpose and Scope of Pedagogy in Pharmaceutical Education.

PubMed

Nakamura, Akihiro

2017-01-01

The WHO and International Pharmaceutical Federation (FIP) introduced the concept of the "seven-star pharmacist" in which a pharmacist is described as a caregiver, communicator, decision-maker, teacher, lifelong learner, leader and manager. In six-year pharmaceutical education programs, which have been provided in schools of pharmacy since 2006, 5th year students participate in on-site practice experiences in hospitals and community pharmacies. Thus, Japanese pharmacists also began to have a role in pharmaceutical education as teachers in clinical settings. Not only pharmacists in clinical settings, but also faculty members of pharmacy schools, had not previously been familiar with evidence-based education, and therefore they often teach in the way they were taught. Since research on teaching and learning has not been well developed in Japanese pharmaceutical education, both the model core curriculum for six-year programs and the subject benchmark statement for four-year programs are based on insufficient scientific evidence. We should promote the scholarship of teaching and learning, which promotes teaching as a scholarly endeavor and a worthy subject for research. In this review, I will summarize the needs and expectations for the establishment of pedagogy in pharmaceutical education.

Ventilator-associated pneumonia management in critical illness.

PubMed

Albertos, Raquel; Caralt, Berta; Rello, Jordi

2011-03-01

Ventilator-associated pneumonia (VAP) is a frequent adverse event in the intensive care unit.We review recent publications about the management and prevention of VAP. The latest care bundles introduced standard interventions to facilitate implementation of evidence-based clinical guidelines and to improve the outcome of patients. Recent studies find that prevention management of ventilated patients decreases the risk of VAP. Enteral feeding, considered a risk factor for VAP, currently has been recommended, with appropriate administration, for all critical ill patients if no contraindications exist. In view of the recently available data, it can be concluded that the implementation of care bundles on the general management of ventilated patients in daily practice has reduced the VAP rates. The main pharmacological measures to prevent VAP are proper hands hygiene, high nurse-to-patient ratio, avoid unnecessary transfer of ventilated patients, use of noninvasive mechanical ventilation, shortening weaning period, avoid the use of nasal intubation, prevent bio-film deposition in endotracheal tube, aspiration of subglottic secretions, maintenance of adequate pressure of endotracheal cuffs, avoid manipulation of ventilator circuits, semi-recumbent position and adequate enteral feeding.In addition, updated guidelines incorporate more comprehensive diagnostic protocols to the evidence-based management of VAP.

A seasonal forecast scheme for the Inner Mongolia spring drought part-II: a logical reasoning evidence-based method for spring predictions

NASA Astrophysics Data System (ADS)

Gao, Tao; Wulan, Wulan; Yu, Xiao; Yang, Zelong; Gao, Jing; Hua, Weiqi; Yang, Peng; Si, Yaobing

2018-05-01

Spring precipitation is the predominant factor that controls meteorological drought in Inner Mongolia (IM), China. This study used the anomaly percentage of spring precipitation (PAP) as a drought index to measure spring drought. A scheme for forecasting seasonal drought was designed based on evidence of spring drought occurrence and speculative reasoning methods introduced in computer artificial intelligence theory. Forecast signals with sufficient lead-time for predictions of spring drought were extracted from eight crucial areas of oceans and 500-hPa geopotential height. Using standardized values, these signals were synthesized into three examples of spring drought evidence (SDE) depending on their primary effects on three major atmospheric circulation components of spring precipitation in IM: the western Pacific subtropical high, North Polar vortex, and East Asian trough. Thresholds for the SDE were determined following numerical analyses of the influential factors. Furthermore, five logical reasoning rules for distinguishing the occurrence of SDE were designed after examining all possible combined cases. The degree of confidence in the rules was determined based on estimations of their prior probabilities. Then, an optimized logical reasoning scheme was identified for judging the possibility of spring drought. The scheme was successful in hindcast predictions of 11 of the 16 (accuracy: 68.8%) spring droughts that have occurred during 1960-2009. Moreover, the accuracy ratio for the same period was 82.0% for drought (PAP ≤ -20%) or not (PAP > -20%). Predictions for the recent 6-year period (2010-2015) demonstrated successful outcomes.

Pharmacoeconomic guidelines and their implementation in the positive list system in South Korea.

PubMed

Bae, Eun Young; Lee, Eui Kyung

2009-01-01

This article reviews the change in the reimbursement and pricing system in South Korea, which was the precursor to the eventual implementation of evidence-based decision-making. There has been pressure on Korea's National Health Insurance system to control its skyrocketing expenditures on drugs. As a result, a series of cost-containment policies have been implemented. The idea of economic evidence-based decision-making was first introduced in Korea in 2001 when the government announced cost-effectiveness as one of the criteria for reimbursement decisions. After this announcement, the Health Insurance Review and Assessment Service (HIRA) developed guidelines, which became the standard for economic evaluations. In 2006, the drug listing system for reimbursement was changed from a negative to a positive system under the drug expenditure rationalization plan. Under this new system, only drugs that are proven economically and clinically valuable can be listed, and applicants have to submit economic evaluation studies to support the cost-effectiveness of their drugs. Once new applications are submitted, HIRA reviews them, and the Drug Reimbursement Evaluation Committee (DREC) decides whether or not to recommend the submitted drugs. In its reimbursement decisions, the DREC considers not only cost-effectiveness but also the availability of therapeutic alternatives, the severity of the condition treated, and the impact on the budget, among other measures. After the introduction of the positive list system, 56% of drugs were determined to be appropriate for reimbursement by the DREC. Despite limited human resources, experience, and quality local data, Korea is continuing to make efforts to establish a system of evidence-based decision-making.

Identifying the Oscillatory Mechanism of the Glucose Oxidase-Catalase Coupled Enzyme System.

PubMed

Muzika, František; Jurašek, Radovan; Schreiberová, Lenka; Radojković, Vuk; Schreiber, Igor

2017-10-12

We provide experimental evidence of periodic and aperiodic oscillations in an enzymatic system of glucose oxidase-catalase in a continuous-flow stirred reactor coupled by a membrane with a continuous-flow reservoir supplied with hydrogen peroxide. To describe such dynamics, we formulate a detailed mechanism based on partial results in the literature. Finally, we introduce a novel method for estimation of unknown kinetic parameters. The method is based on matching experimental data at an oscillatory instability with stoichiometric constraints of the mechanism formulated by applying the stability theory of reaction networks. This approach has been used to estimate rate coefficients in the catalase part of the mechanism. Remarkably, model simulations show good agreement with the observed oscillatory dynamics, including apparently chaotic intermittent behavior. Our method can be applied to any reaction system with an experimentally observable dynamical instability.

Engineering, Life Sciences, and Health/Medicine Synergy in Aerospace Human Systems Integration: The Rosetta Stone Project

NASA Technical Reports Server (NTRS)

Williams, Richard S. (Editor); Doarn, Charles R. (Editor); Shepanek, Marc A.

2017-01-01

In the realm of aerospace engineering and the physical sciences, we have developed laws of physics based on empirical and research evidence that reliably guide design, research, and development efforts. For instance, an engineer designs a system based on data and experience that can be consistently and repeatedly verified. This reproducibility depends on the consistency and dependability of the materials on which the engineer works and is subject to physics, geometry and convention. In life sciences and medicine, these apply as well, but individuality introduces a host of variables into the mix, resulting in characteristics and outcomes that can be quite broad within a population of individuals. This individuality ranges from differences at the genetic and cellular level to differences in an individuals personality and abilities due to sex and gender, environment, education, etc.

EGFR TKI as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer

PubMed Central

Nan, Xueli; Xie, Chao; Yu, Xueyan; Liu, Jie

2017-01-01

After the discovery of activating mutations in EGFR, EGFR tyrosine kinase inhibitors (TKIs) have been introduced into the first-line treatment of non-small-cell lung cancer (NSCLC). A series of studies have shown that EGFR TKI monotherapy as first-line treatment can benefit NSCLC patients harbouring EGFR mutations. Besides, combination strategies based on EGFR TKIs in the first line treatment have also been proved to delay the occurrence of resistance. In this review, we summarize the scientific literature and evidence of EGFR TKIs as first-line therapy from the first-generation EGFR TKIs to conceptually proposed fourth-generation EGFR TKI, and also recommend the application of monotherapy and combination therapies of the EGFR-based targeted therapy with other agents such as chemotherapy, anti-angiogenic drugs and immunecheckpoint inhibitors. PMID:29088904

Direct-to-Consumer Marketing: A Complementary Approach to Traditional Dissemination and implementation Efforts for Mental Health and Substance Abuse Interventions.

PubMed

Becker, Sara J

2015-03-01

The overall chasm between those who need treatment for mental health and substance abuse (M/SU) and those who receive effective treatment consists of two, interrelated gaps: the research-to-practice gap and the treatment gap. Prior efforts to disseminate evidence-based practice (EBP) for M/SU have predominantly targeted the research-to-practice gap, by focusing efforts toward treatment providers. This article introduces direct-to-consumer (DTC) marketing that targets patients and caregivers as a complementary approach to existing dissemination efforts. Specific issues discussed include: rationale for DTC marketing based on the concept of push versus pull marketing; overview of key stakeholders involved in DTC marketing; and description of the Marketing Mix planning framework. The applicability of these issues to the dissemination of EBP for M/SU is discussed.

Phase transitions between lower and higher level management learning in times of crisis: an experimental study based on synergetics.

PubMed

Liening, Andreas; Strunk, Guido; Mittelstadt, Ewald

2013-10-01

Much has been written about the differences between single- and double-loop learning, or more general between lower level and higher level learning. Especially in times of a fundamental crisis, a transition between lower and higher level learning would be an appropriate reaction to a challenge coming entirely out of the dark. However, so far there is no quantitative method to monitor such a transition. Therefore we introduce theory and methods of synergetics and present results from an experimental study based on the simulation of a crisis within a business simulation game. Hypothesized critical fluctuations - as a marker for so-called phase transitions - have been assessed with permutation entropy. Results show evidence for a phase transition during the crisis, which can be interpreted as a transition between lower and higher level learning.

Efficient Online Learning Algorithms Based on LSTM Neural Networks.

PubMed

Ergen, Tolga; Kozat, Suleyman Serdar

2017-09-13

We investigate online nonlinear regression and introduce novel regression structures based on the long short term memory (LSTM) networks. For the introduced structures, we also provide highly efficient and effective online training methods. To train these novel LSTM-based structures, we put the underlying architecture in a state space form and introduce highly efficient and effective particle filtering (PF)-based updates. We also provide stochastic gradient descent and extended Kalman filter-based updates. Our PF-based training method guarantees convergence to the optimal parameter estimation in the mean square error sense provided that we have a sufficient number of particles and satisfy certain technical conditions. More importantly, we achieve this performance with a computational complexity in the order of the first-order gradient-based methods by controlling the number of particles. Since our approach is generic, we also introduce a gated recurrent unit (GRU)-based approach by directly replacing the LSTM architecture with the GRU architecture, where we demonstrate the superiority of our LSTM-based approach in the sequential prediction task via different real life data sets. In addition, the experimental results illustrate significant performance improvements achieved by the introduced algorithms with respect to the conventional methods over several different benchmark real life data sets.

Methods to Succeed in Effective Knowledge Translation in Clinical Practice.

PubMed

Kitson, Alison L; Harvey, Gillian

2016-05-01

To explore the evidence around facilitation as an intervention for the successful implementation of new knowledge into clinical practice. The revised version of the Promoting Action on Research Implementation in Health Services (PARIHS) framework, called the integrated or i-PARIHS framework, is used as the explanatory framework. This framework posits that evidence is a multidimensional construct embedded within innovation and operationalized by clinicians (individuals and within teams), working across multiple layers of context. Facilitation is the active ingredient that promotes successful implementation. An emerging body of evidence supports facilitation as a mechanism to getting new knowledge into clinical practice. Facilitation roles are divided into beginner, experienced, and expert facilitators. Facilitators can be internal or external to the organization they work in, and their skills and attributes complement other knowledge translation (KT) roles. Complex KT projects require facilitators who are experienced in implementation methods. Facilitation is positioned as the active ingredient to effectively introduce new knowledge into a clinical setting. Levels of facilitation experience are assessed in relation to the complexity of the KT task. Three core facilitation roles are identified, and structured interventions are established taking into account the nature and novelty of the evidence, the receptiveness of the clinicians, and the context or setting where the new evidence is to be introduced. Roles such as novice, experienced, and expert facilitators have important and complementary parts to play in enabling the successful translation of evidence into everyday practice in order to provide effective care for patients. © 2016 Sigma Theta Tau International.

Inference for High-dimensional Differential Correlation Matrices *

PubMed Central

Cai, T. Tony; Zhang, Anru

2015-01-01

Motivated by differential co-expression analysis in genomics, we consider in this paper estimation and testing of high-dimensional differential correlation matrices. An adaptive thresholding procedure is introduced and theoretical guarantees are given. Minimax rate of convergence is established and the proposed estimator is shown to be adaptively rate-optimal over collections of paired correlation matrices with approximately sparse differences. Simulation results show that the procedure significantly outperforms two other natural methods that are based on separate estimation of the individual correlation matrices. The procedure is also illustrated through an analysis of a breast cancer dataset, which provides evidence at the gene co-expression level that several genes, of which a subset has been previously verified, are associated with the breast cancer. Hypothesis testing on the differential correlation matrices is also considered. A test, which is particularly well suited for testing against sparse alternatives, is introduced. In addition, other related problems, including estimation of a single sparse correlation matrix, estimation of the differential covariance matrices, and estimation of the differential cross-correlation matrices, are also discussed. PMID:26500380

Factors that introduce intrasubject variability into ear-canal absorbance measurements.

PubMed

Voss, Susan E; Stenfelt, Stefan; Neely, Stephen T; Rosowski, John J

2013-07-01

Wideband immittance measures can be useful in analyzing acoustic sound flow through the ear and also have diagnostic potential for the identification of conductive hearing loss as well as causes of conductive hearing loss. To interpret individual measurements, the variability in test–retest data must be described and quantified. Contributors to variability in ear-canal absorbance–based measurements are described in this article. These include assumptions related to methodologies and issues related to the probe fit within the ear and potential acoustic leaks. Evidence suggests that variations in ear-canal cross-sectional area or measurement location are small relative to variability within a population. Data are shown to suggest that the determination of the Thévenin equivalent of the ER-10C probe introduces minimal variability and is independent of the foam ear tip itself. It is suggested that acoustic leaks in the coupling of the ear tip to the ear canal lead to substantial variations and that this issue needs further work in terms of potential criteria to identify an acoustic leak. In addition, test–retest data from the literature are reviewed.

The asian decapod Hemigrapsus penicillatus (de Haan, 1835) (Grapsidae, Decapoda) introduced in European waters: status quo and future perspective

NASA Astrophysics Data System (ADS)

Gollasch, S.

1998-09-01

The Asian decapod Hemigrapsus penicillatus (de Haan, 1835) was first recorded in European waters in 1994. The first specimens were collected in the estuary of Charente Maritime on the west coast of France close to La Rochelle. The current range in Europe covers Spanish shallow water habitats of the Bay of Biscay to areas north of La Rochelle (France). Densities of up to 20 specimens per square metre occur. This species has a high temperature and salinity tolerace and will expand its distribution in European waters. It is not clear whether this crab was introduced by shipping in ballast water or as a fouling organism. Based on a study of ship hull fouling in German dry docks this account provides evidence that hull fouling is a likely vector for the introduction of this crab. In August 1993, six juvenile specimens of H. penicillatus were removed from the hull of a car-carrier. After its journey from Japan into European waters this vessel docked in the port of Bremerhaven (Germany) for a routine inspection and coating with antifouling paint.

"Staying safe" - a narrative review of falls prevention in people with Parkinson's - "PDSAFE".

PubMed

Hulbert, Sophia; Rochester, Lynn; Nieuwboer, Alice; Goodwin, Vicki; Fitton, Carolyn; Chivers-Seymour, Kim; Ashburn, Ann

2018-05-18

Parkinson's disease demonstrates a spectrum of motor and non-motor symptoms. Falling is common and disabling. Current medical management shows minimal impact to reduce falls or fall-related risk factors, such as deficits in gait, strength, and postural instability. Despite evidence supporting rehabilitation in reducing fall risk factors, the most appropriate intervention to reduce overall fall rate remains inconclusive. This article aims to 1) synthesise current evidence and conceptual models of falls rehabilitation in Parkinson's in a narrative review; and based on this evidence, 2) introduce the treatment protocol used in the falls prevention and multi-centre clinical trial "PDSAFE". Search of four bibliographic databases using the terms "Parkinson*" and "Fall*" combined with each of the following; "Rehab*, Balanc*, Strength*, Strateg*and Exercis*" and a framework for narrative review was followed. A total of 3557 papers were identified, 416 were selected for review. The majority report the impact of rehabilitation on isolated fall risk factors. Twelve directly measure the impact on overall fall rate. Results were used to construct a narrative review with conceptual discussion based on the "International Classification of Functioning", leading to presentation of the "PDSAFE" intervention protocol. Evidence suggests training single, fall risk factors may not affect overall fall rate. Combining with behavioural and strategy training in a functional, personalised multi-dimensional model, addressing all components of the "International Classification of Functioning" is likely to provide a greater influence on falls reduction. "PDSAFE" is a multi-dimensional, physiotherapist delivered, individually tailored, progressive, home-based programme. It is designed with a strong evidence-based approach and illustrates a model for the clinical delivery of the conceptual theory discussed. Implications for Rehabilitation Parkinson's disease demonstrates a spectrum of motor and non-motor symptoms, where falling is common and disabling. Current medical and surgical management have minimal impact on falls, rehabilitation of falls risk factors has strong evidence but the most appropriate intervention to reduce overall fall rate remains inconclusive. Addressing all components of the International Classification of Function in a multifactorial model when designing falls rehabilitation interventions may be more effective at reducing fall rates in people with Parkinson's than treating isolated risk factors. The clinical model for falls rehabilitation in people with Parkinson's should be multi-dimensional.

[Breast cancer screening in Austria: Key figures, age limits, screening intervals and evidence].

PubMed

Jeitler, Klaus; Semlitsch, Thomas; Posch, Nicole; Siebenhofer, Andrea; Horvath, Karl

2015-01-01

In January 2014, the first nationwide quality-assured breast cancer screening program addressing women aged ≥ 40 years was introduced in Austria. As part of the process of developing a patient information leaflet, the Evidence Based Medicine (EBM) Review Center of the Medical University of Graz was charged with the task of assessing the potential benefits and harms of breast cancer screening from the available evidence. Based on these results, key figures were derived for mortality, false-positive and false-negative mammography results, and overdiagnosis, considering Austria-specific incidence rates for breast cancer and breast cancer mortality. Furthermore, the current evidence regarding age limits and screening interval, which were the subjects of controversial public discussions, was analyzed. A systematic search for primary and secondary literature was performed and additional evidence was screened, e. g., evaluation reports of European breast cancer screening programs. On the basis of the available evidence and of the Austrian breast cancer mortality and incidence rates, it can be assumed that - depending on the age group - 1 to 4 breast cancer deaths can be avoided per 1,000 women screened in a structured breast cancer screening program, while the overall mortality remains unchanged. On the other hand, 150 to 200 of these 1,000 women will be affected by false-positive results and 1 to 9 women by overdiagnosis due to the structured breast cancer screening. Therefore, the overall benefit-harm balance is uncertain. If women from 40 to 44 or above 70 years of age are considered, who can also participate in the Austrian screening program, even a negative benefit-harm balance seems possible. However, with the implementation of quality standards in breast cancer screening and the dissemination of a patient information leaflet, an improvement in the medical treatment situation, specifically in terms of informed decision-making, can be expected. Copyright © 2015. Published by Elsevier GmbH.

Hybridization and adaptation to introduced balloon vines in an Australian soapberry bug.

PubMed

Andres, J A; Thampy, P R; Mathieson, M T; Loye, J; Zalucki, M P; Dingle, H; Carroll, S P

2013-12-01

Contemporary adaptation of plant feeding insects to introduced hosts provides clear cases of ecologically based population divergence. In most cases the mechanisms permitting rapid differentiation are not well known. Here we study morphological and genetic variation associated with recent shifts by the Australian soapberry bug Leptocoris tagalicus onto two naturalized Neotropical balloon vines, Cardiospermum halicacabum and C. grandiflorum that differ in time since introduction. Our results show that these vines have much larger fruits than the native hosts (Whitewood tree -Atalaya hemiglauca- and Woolly Rambutan -Alectryon tomentosus-) and that bugs living on them have evolved significantly longer beaks and new allometries. Genetic analyses of mitochondrial haplotypes and amplified fragment length polymorphic (AFLP) markers indicate that the lineage of bugs on the annual vine C. halicacabum, the older introduction, is intermediate between the two subspecies of L. tagalicus found on native hosts. Moreover, where the annual vine and Whitewood tree co-occur, the morphology and genomic composition of the bugs are similar to those occurring in allopatry. These results show that hybridization provided the genetic elements underlying the strongly differentiated 'Halicacabum bugs'. In contrast, the bugs feeding on the recently introduced perennial balloon vine (C. grandiflorum) showed no evidence of admixture, and are genetically indistinguishable from the nearby populations on a native host. © 2013 John Wiley & Sons Ltd.

Evaluating the first introduction of rotavirus vaccine in Thailand: Moving from evidence to policy.

PubMed

Tharmaphornpilas, Piyanit; Jiamsiri, Suchada; Boonchaiya, Somchit; Rochanathimoke, Onwipa; Thinyounyong, Wiravan; Tuntiwitayapun, Sumana; Guntapong, Ratigorn; Riewpaiboon, Arthorn; Rasdjarmrearnsook, Aim-On; Glass, Roger I

2017-02-01

We assessed the effectiveness and possible impact of introducing rotavirus vaccine into the routine immunization program. Two provinces were selected for an observational study, one where vaccine was introduced and another where vaccine was not available. In these areas, two sub-studies were linked. The prospective cohort study enrolled children 2month old and followed them to the age of 18months to detect all diarrhea episodes. The hospital surveillance study enrolled all children up to age 5 hospitalized with diarrhea whose fecal samples were tested for rotavirus. Rates of rotavirus hospitalizations in older children who had not been vaccinated in both settings provided data to determine whether immunization had an indirect herd effect. The key endpoints for the study were both vaccine effectiveness (VE) based upon hospitalized rotavirus diarrhea and herd protection. From the cohort study, the overall VE for hospitalized rotavirus diarrhea was 88% (95%CI 76-94). Data from hospital surveillance indicated that for 2 consecutive years, the seasonal peak of rotavirus admissions was no longer present in the vaccinated area. Herd protection was observed among older children born before the rotavirus vaccine program was introduced, who experienced a 40-69% reduction in admission for rotavirus. Rotavirus vaccine was highly effective in preventing diarrheal hospitalizations and in conferring herd protection among older children who had not been vaccinated. Copyright © 2016 Elsevier Ltd. All rights reserved.

Genetic diversity and variation of mitochondrial DNA in native and introduced bighead carp

USGS Publications Warehouse

Li, Si-Fa; Yang, Qin-Ling; Xu, Jia-Wei; Wang, Cheng-Hui; Chapman, Duane C.; Lu, Guoping

2010-01-01

The bighead carp Hypophthalmichthys nobilis is native to China but has been introduced to over 70 countries and is established in many large river systems. Genetic diversity and variation in introduced bighead carp have not previously been evaluated, and a systematic comparison among fish from different river systems was unavailable. In this study, 190 bighead carp specimens were sampled from five river systems in three countries (Yangtze, Pearl, and Amur rivers, China; Danube River, Hungary; Mississippi River basin, USA) and their mitochondrial 16S ribosomal RNA gene and D-loop region were sequenced (around 1,345 base pairs). Moderate genetic diversity was found in bighead carp, ranging from 0.0014 to 0.0043 for nucleotide diversity and from 0.6879 to 0.9333 for haplotype diversity. Haplotype analysis provided evidence that (1) multiple haplotype groups might be present among bighead carp, (2) bighead carp probably originated from the Yangtze River, and (3) bighead carp in the Mississippi River basin may have some genetic ancestry in the Danube River. The analysis of molecular variance showed significant genetic differentiation among these five populations but also revealed limited differentiation between the Yangtze and Amur River bighead carp. This large-scale study of bighead carp genetic diversity and variation provides the first global perspective of bighead carp in the context of biodiversity conservation as well as invasive species control and management.

Gluten Introduction and the Risk of Coeliac Disease: A Position Paper by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

PubMed

Szajewska, Hania; Shamir, Raanan; Mearin, Luisa; Ribes-Koninckx, Carmen; Catassi, Carlo; Domellöf, Magnus; Fewtrell, Mary S; Husby, Steffen; Papadopoulou, Alexandra; Vandenplas, Yvan; Castillejo, Gemma; Kolacek, Sanja; Koletzko, Sibylle; Korponay-Szabó, Ilma R; Lionetti, Elena; Polanco, Isabel; Troncone, Riccardo

2016-03-01

The European Society for Paediatric Gastroenterology, Hepatology and Nutrition recommended in 2008, based on observational data, to avoid both early (<4 months) and late (≥7 months) introduction of gluten and to introduce gluten while the infant is still being breast-fed. New evidence prompted ESPGHAN to revise these recommendations. To provide updated recommendations regarding gluten introduction in infants and the risk of developing coeliac disease (CD) during childhood. The risk of inducing CD through a gluten-containing diet exclusively applies to persons carrying at least one of the CD risk alleles. Because genetic risk alleles are generally not known in an infant at the time of solid food introduction, the following recommendations apply to all infants, although they are derived from studying families with first-degree relatives with CD. Although breast-feeding should be promoted for its other well-established health benefits, neither any breast-feeding nor breast-feeding during gluten introduction has been shown to reduce the risk of CD. Gluten may be introduced into the infant's diet anytime between 4 and 12 completed months of age. In children at high risk for CD, earlier introduction of gluten (4 vs 6 months or 6 vs 12 months) is associated with earlier development of CD autoimmunity (defined as positive serology) and CD, but the cumulative incidence of each in later childhood is similar. Based on observational data pointing to the association between the amount of gluten intake and risk of CD, consumption of large quantities of gluten should be avoided during the first weeks after gluten introduction and during infancy. The optimal amounts of gluten to be introduced at weaning, however, have not been established.

Conflict of Interest Policies at French Medical Schools: Starting from the Bottom.

PubMed

Scheffer, Paul; Guy-Coichard, Christian; Outh-Gauer, David; Calet-Froissart, Zoéline; Boursier, Mathilde; Mintzes, Barbara; Borde, Jean-Sébastien

2017-01-01

Medical faculties have a role in ensuring that their students are protected from undue commercial influence during their training, and are educated about professional-industry interactions. In North America, many medical faculties have introduced more stringent conflict of interest (COI) policies during the last decade. We asked whether similar steps had been taken in France. We hypothesized that such policies may have been introduced following a 2009-2010 drug safety scandal (benfluorex, Mediator) in which COIs in medicine received prominent press attention. We searched the websites of all 37 French Faculties of Medicine in May 2015 for COI policies and curriculum, using standardized keyword searches. We also surveyed all deans of medicine on institutional COI policies and curriculum, based on criteria developed in similar US and Canadian surveys. Personal contacts were also consulted. We calculated a summary score per faculty based on 13 criteria. [range 0-26; higher scores denoting stronger policies]. In total, we found that 9/37 (24%) of French medical schools had either introduced related curriculum or implemented a COI-related policy. Of these, only 1 (2.5%) had restrictive policies for any category. No official COI policies were found at any of the schools. However, at 2 (5%), informal policies were reported. The maximum score per faculty was 5/26, with 28 (76%) scoring 0. This is the first survey in France to examine COI policies at medical faculties. We found little evidence that protection of medical students from undue commercial influence is a priority, either through institutional policies or education. This is despite national transparency legislation on industry financing of health professionals and limits on gifts. The French National Medical Students Association (ANEMF) has called for more attention to COI in medical education; our results strongly support such a call.

Fiction Out...Reality In

ERIC Educational Resources Information Center

Bailey, F. Lee

1973-01-01

Evidence indicates a tremendous void in the understanding of law by the average citizen. Participation by lawyers in the educational process is suggested to begin the task of introducing law into the classroom. (Author/KM)

Teaching letter sounds to kindergarten English language learners using incremental rehearsal.

PubMed

Peterson, Meredith; Brandes, Dana; Kunkel, Amy; Wilson, Jennifer; Rahn, Naomi L; Egan, Andrea; McComas, Jennifer

2014-02-01

Proficiency in letter-sound correspondence is important for decoding connected text. This study examined the effects of an evidence-based intervention, incremental rehearsal (IR), on the letter-sound expression of three kindergarten English language learners (ELLs) performing below the district benchmark for letter-sound fluency. Participants were native speakers of Hmong, Spanish, and Polish. A multiple-baseline design across sets of unknown letter sounds was used to evaluate the effects of IR on letter-sound expression. Visual analysis of the data showed an increase in level and trend when IR was introduced in each phase. Percentage of all non-overlapping data (PAND) ranged from 95% to 100%. All participants exceeded expected growth and reached the spring district benchmark for letter-sound fluency. Results suggest that IR is a promising intervention for increasing letter-sound expression for ELLs who evidence delays in acquiring letter sounds. Copyright © 2013 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Credit where credit is due: Pakistan's role in reducing the global burden of reproductive, maternal, newborn, and child health (RMNCH).

PubMed

Ghaffar, Abdul; Qazi, Shamim; Shah, Iqbal

2015-11-25

Factors contributing to Pakistan's poor progress in reducing reproductive, maternal, newborn, and child health (RMNCH) include its low level of female literacy, gender inequity, political challenges, and extremism along with its associated relentless violence; further, less than 1% of Pakistan's GDP is allocated to the health sector. However, despite these disadvantages, Pakistani researchers have been able to achieve positive contributions towards RMNCH-related global knowledge and evidence base, in some cases leading to the formulation of WHO guidelines, for which they should feel proud. Nevertheless, in order to improve the health of its own women and children, greater investments in human and health resources are required to facilitate the generation and use of policy-relevant knowledge. To accomplish this, fair incentives for research production need to be introduced, policy and decision-makers' capacity to demand and use evidence needs to be increased, and strong support from development partners and the global health community must be secured.

Experimental evidences for reducing Mg activation energy in high Al-content AlGaN alloy by MgGa δ doping in (AlN)m/(GaN)n superlattice

NASA Astrophysics Data System (ADS)

Wang, Xiao; Wang, Wei; Wang, Jingli; Wu, Hao; Liu, Chang

2017-03-01

P-type doping in high Al-content AlGaN alloys is a main challenge for realizing AlGaN-based deep ultraviolet optoelectronics devices. According to the first-principles calculations, Mg activation energy may be reduced so that a high hole concentration can be obtained by introducing nanoscale (AlN)5/(GaN)1 superlattice (SL) in Al0.83Ga0.17N disorder alloy. In this work, experimental evidences were achieved by analyzing Mg doped high Al-content AlGaN alloys and Mg doped AlGaN SLs as well as MgGa δ doped AlGaN SLs. Mg acceptor activation energy was significantly reduced from 0.378 to 0.331 eV by using MgGa δ doping in SLs instead of traditional doping in alloys. This new process was confirmed to be able to realize high p-type doping in high Al-content AlGaN.

Experimental evidences for reducing Mg activation energy in high Al-content AlGaN alloy by MgGa δ doping in (AlN)m/(GaN)n superlattice.

PubMed

Wang, Xiao; Wang, Wei; Wang, Jingli; Wu, Hao; Liu, Chang

2017-03-14

P-type doping in high Al-content AlGaN alloys is a main challenge for realizing AlGaN-based deep ultraviolet optoelectronics devices. According to the first-principles calculations, Mg activation energy may be reduced so that a high hole concentration can be obtained by introducing nanoscale (AlN) 5 /(GaN) 1 superlattice (SL) in Al 0.83 Ga 0.17 N disorder alloy. In this work, experimental evidences were achieved by analyzing Mg doped high Al-content AlGaN alloys and Mg doped AlGaN SLs as well as Mg Ga δ doped AlGaN SLs. Mg acceptor activation energy was significantly reduced from 0.378 to 0.331 eV by using Mg Ga δ doping in SLs instead of traditional doping in alloys. This new process was confirmed to be able to realize high p-type doping in high Al-content AlGaN.

Mechanical ventilation in patients subjected to extracorporeal membrane oxygenation (ECMO).

PubMed

López Sanchez, M

2017-11-01

Mechanical ventilation (MV) is a crucial element in the management of acute respiratory distress syndrome (ARDS), because there is high level evidence that a low tidal volume of 6ml/kg (protective ventilation) improves survival. In these patients with refractory respiratory insufficiency, venovenous extracorporeal membrane oxygenation (ECMO) can be used. This salvage technique improves oxygenation, promotes CO 2 clearance, and facilitates protective and ultraprotective MV, potentially minimizing ventilation-induced lung injury. Although numerous trials have investigated different ventilation strategies in patients with ARDS, consensus is lacking on the optimal MV settings during venovenous ECMO. Although the concept of "lung rest" was introduced years ago, there are no evidence-based guidelines on its use in application to MV in patients supported by ECMO. How MV in ECMO patients can promote lung recovery and weaning from ventilation is not clear. The purpose of this review is to describe the ventilation strategies used during venovenous ECMO in clinical practice. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Utilizing national and international registries to enhance pre-market medical device regulatory evaluation.

PubMed

Yue, Lilly Q; Campbell, Gregory; Lu, Nelson; Xu, Yunling; Zuckerman, Bram

2016-01-01

Regulatory decisions are made based on the assessment of risk and benefit of medical devices at the time of pre-market approval and subsequently, when post-market risk-benefit balance needs reevaluation. Such assessments depend on scientific evidence obtained from pre-market studies, post-approval studies, post-market surveillance studies, patient perspective information, as well as other real world data such as national and international registries. Such registries provide real world evidence and are playing a more and more important role in enhancing the safety and effectiveness evaluation of medical devices. While these registries provide large quantities of data reflecting real world practice and can potentially reduce the cost of clinical trials, challenges arise concerning (1) data quality adequate for regulatory decision-making, (2) bias introduced at every stage and aspect of study, (3) scientific validity of study designs, and (4) reliability and interpretability of study results. This article will discuss related statistical and regulatory challenges and opportunities with examples encountered in medical device regulatory reviews.

Embedding operational research into national disease control programme: lessons from 10 years of experience in Indonesia

PubMed Central

Mahendradhata, Yodi; Probandari, Ari; Widjanarko, Bagoes; Riono, Pandu; Mustikawati, Dyah; Tiemersma, Edine W.; Alisjahbana, Bachti

2014-01-01

There is growing recognition that operational research (OR) should be embedded into national disease control programmes. However, much of the current OR capacity building schemes are still predominantly driven by international agencies with limited integration into national disease control programmes. We demonstrated that it is possible to achieve a more sustainable capacity building effort across the country by establishing an OR group within the national tuberculosis (TB) control programme in Indonesia. Key challenges identified include long-term financial support, limited number of scientific publications, and difficulties in documenting impact on programmatic performance. External evaluation has expressed concerns in regard to utilisation of OR in policy making. Efforts to address this concern have been introduced recently and led to indications of increased utilisation of research evidence in policy making by the national TB control programme. Embedding OR in national disease control programmes is key in establishing an evidence-based disease control programme. PMID:25361728

What can comparative effectiveness research, propensity score and registry study bring to Chinese medicine?

PubMed

Liao, Xing; Xie, Yan-ming

2014-10-01

The impact of evidence-based medicine and clinical epidemiology on clinical research has contributed to the development of Chinese medicine in modern times over the past two decades. Many concepts and methods of modern science and technology are emerging in Chinese medicine research, resulting in constant progress. Systematic reviews, randomized controlled trials and other advanced mathematic approaches and statistical analysis methods have brought reform to Chinese medicine. In this new era, Chinese medicine researchers have many opportunities and challenges. On the one hand, Chinese medicine researchers need to dedicate themselves to providing enough evidence to the world through rigorous studies, whilst on the other hand, they also need to keep up with the speed of modern medicine research. For example, recently, real world study, comparative effectiveness research, propensity score techniques and registry study have emerged. This article aims to inspire Chinese medicine researchers to explore new areas by introducing these new ideas and new techniques.

Memory effects in stock price dynamics: evidences of technical trading

PubMed Central

Garzarelli, Federico; Cristelli, Matthieu; Pompa, Gabriele; Zaccaria, Andrea; Pietronero, Luciano

2014-01-01

Technical trading represents a class of investment strategies for Financial Markets based on the analysis of trends and recurrent patterns in price time series. According standard economical theories these strategies should not be used because they cannot be profitable. On the contrary, it is well-known that technical traders exist and operate on different time scales. In this paper we investigate if technical trading produces detectable signals in price time series and if some kind of memory effects are introduced in the price dynamics. In particular, we focus on a specific figure called supports and resistances. We first develop a criterion to detect the potential values of supports and resistances. Then we show that memory effects in the price dynamics are associated to these selected values. In fact we show that prices more likely re-bounce than cross these values. Such an effect is a quantitative evidence of the so-called self-fulfilling prophecy, that is the self-reinforcement of agents' belief and sentiment about future stock prices' behavior. PMID:24671011

Memory effects in stock price dynamics: evidences of technical trading

NASA Astrophysics Data System (ADS)

Garzarelli, Federico; Cristelli, Matthieu; Pompa, Gabriele; Zaccaria, Andrea; Pietronero, Luciano

2014-03-01

Technical trading represents a class of investment strategies for Financial Markets based on the analysis of trends and recurrent patterns in price time series. According standard economical theories these strategies should not be used because they cannot be profitable. On the contrary, it is well-known that technical traders exist and operate on different time scales. In this paper we investigate if technical trading produces detectable signals in price time series and if some kind of memory effects are introduced in the price dynamics. In particular, we focus on a specific figure called supports and resistances. We first develop a criterion to detect the potential values of supports and resistances. Then we show that memory effects in the price dynamics are associated to these selected values. In fact we show that prices more likely re-bounce than cross these values. Such an effect is a quantitative evidence of the so-called self-fulfilling prophecy, that is the self-reinforcement of agents' belief and sentiment about future stock prices' behavior.

[Financial incentives for quality improvement].

PubMed

Belicza, Eva; Evetovits, Tamás

2010-05-01

Policy makers and payers of health care services devote increasing attention to improve quality of services by incentivising health care providers. These--so called--pay for performance (P4P) programmes have so far been introduced in few countries only and evidence on their effectiveness is still scarce. Therefore we do not know yet which instruments of these programmes are most effective and efficient in improving quality. The P4P systems implemented so far in primary care and in integrated delivery systems use indicators for measurement of performance and the basis for rewards. These indicators are mostly process indicators, but there are some outcome indicators as well. The desired quality improvement effects are most likely to be achieved with programmes that provide seizable financial rewards and cover the extra cost of quality improvement efforts as well. Administration of the programme has to be fully transparent and clear to all involved. It has to be based on scientific evidence and supported with sufficient dedicated funding. Conducting pilot studies is a precondition for large scale implementation.

Evolution of semilocal string networks. II. Velocity estimators

NASA Astrophysics Data System (ADS)

Lopez-Eiguren, A.; Urrestilla, J.; Achúcarro, A.; Avgoustidis, A.; Martins, C. J. A. P.

2017-07-01

We continue a comprehensive numerical study of semilocal string networks and their cosmological evolution. These can be thought of as hybrid networks comprised of (nontopological) string segments, whose core structure is similar to that of Abelian Higgs vortices, and whose ends have long-range interactions and behavior similar to that of global monopoles. Our study provides further evidence of a linear scaling regime, already reported in previous studies, for the typical length scale and velocity of the network. We introduce a new algorithm to identify the position of the segment cores. This allows us to determine the length and velocity of each individual segment and follow their evolution in time. We study the statistical distribution of segment lengths and velocities for radiation- and matter-dominated evolution in the regime where the strings are stable. Our segment detection algorithm gives higher length values than previous studies based on indirect detection methods. The statistical distribution shows no evidence of (anti)correlation between the speed and the length of the segments.

Beyond FMEA: the structured what-if technique (SWIFT).

PubMed

Card, Alan J; Ward, James R; Clarkson, P John

2012-01-01

Although it is probably the best-known prospective hazard analysis (PHA) tool, failure mode and effects analysis (FMEA) is far from the only option available. This article introduces one of the alternatives: The structured what-if technique (SWIFT). SWIFT is a flexible, high-level risk identification technique that can be used on a stand-alone basis, or as part of a staged approach to make more efficient use of bottom-up methods like FMEA. In this article we describe the method, assess the evidence related to its use in healthcare with the use of a systematic literature review, and suggest ways in which it could be better adapted for use in the healthcare industry. Based on the limited evidence available, it appears that healthcare workers find it easy to learn, easy to use, and credible. Especially when used as part of a staged approach, SWIFT appears capable of playing a useful role as component of the PHA armamentarium. © 2012 American Society for Healthcare Risk Management of the American Hospital Association.

Individual rights over public good? The future of anthropometric monitoring of school children in the fight against obesity.

PubMed

Stubbs, Joanne M; Achat, Helen M

2009-02-02

Available evidence indicates that rates of childhood overweight and obesity have been increasing over the past two decades, but inconsistencies between study methods moderate the strength of this evidence. Concomitant health problems and associated costs make it imperative that primary prevention initiatives are introduced to combat the obesity epidemic. Fundamental to informed action is anthropometric monitoring, which if properly implemented will identify changes over time in specific populations to inform policies, practices and services aimed at prevention and treatment. Sample representativeness is essential for valid trend and prevalence data, but efforts to obtain population-based anthropometric data from school children with the required written parental consent have been thwarted by low participation rates. Notable improvements in participation rates when utilising opt-out consent, in which participation is assumed unless otherwise indicated, are evident from local as well as international studies. Opt-out consent can facilitate anthropometric monitoring, delivering a more informed, best-value-for-money response to the obesity epidemic. Health and education ethics committees need to acknowledge the benefits of opt-out consent for "low-risk" anthropometric measurement, which ultimately upholds the individual's rights.

Is sane management possible in a crazy world?

PubMed

Zitner, David

2003-01-01

Most people benefit from healthcare. However, Canadians remain dissatisfied because too often we receive faulty care and delayed care, not supported by evidence. Browman and colleagues relate successful efforts to introduce evidence-based care. They show that strong champions can be effective even in insane environments. The collaborative approach suggested is moving and thoughtful. Sharing between knowledge and financial stewards, including the use of stories, is especially valuable when financial stewardshipis not possible because we lack information about the local outcomes of care. Goodwill between stewards is especially necessary when there are few external incentives to provide excellent care. In healthcare good deeds are punished, not rewarded. Canadian governments fail to regulate healthcare because of the conflict of interest arising when the same group not only regulates care but also functions as insurer, governor, administrator and evaluator. We need radical change to eliminate the perverse incentives and bizarre management practices that bedevil our healthcare system and impede the use of evidence. Fundamental changes in organization and evaluation proposed by the Halifax Chamber of Commerce and the Kirby and Mazankowski committees will help. Separating the functions of insurer, administrator, evaluator and regulator is ethical and necessary.

Thirty years of the Paediatric Standard Treatment Book.

PubMed

Vince, John D; Mokela, David

2006-01-01

The publication of the 8th edition of the Paediatric Standard Treatment Book 30 years after the first edition was introduced in 1975 provided an opportunity to examine the changes in the book's content and composition that have occurred over time. A detailed analysis of all editions of the book was made. The 8th edition is bigger, contains more clinical and guidance topics, and is undoubtedly more complex than the first. Health workers of different levels of training undoubtedly value the book, but there is evidence that it is frequently not used appropriately. The books form an important historical record of the changes in treatment of various clinical conditions that have been driven by alterations in antimicrobial susceptibility and by the emergence of evidence for efficacy. The current book is intricately linked with the Integrated Management of Childhood Illness and the treatments it contains are based on best evidence and practicality. Whilst there are challenges in ensuring that the information in the standard treatment book is accessible, practical and up to date, the book will continue to provide the basis for treatment of the common conditions presenting in children in the future.

Phytomedicine in Otorhinolaryngology and Pulmonology: Clinical Trials with Herbal Remedies

PubMed Central

Moghadam, Koosha Ghazi; Inançlı, Hasan Mete; Bazazy, Nazanin; Plinkert, Peter K.; Efferth, Thomas; Sertel, Serkan

2012-01-01

Phytomedicine has become an important alternative treatment option for patients in the Western world, as they seek to be treated in a holistic and natural way after an unsatisfactory response to conventional drugs. Ever since herbal remedies have been introduced in the Western world, clinicians have raised concerns over their efficacy and possible side-effects. A PubMed (Medline) search was performed covering the last five years (01/07–04/12) and including 55 prospective clinical randomized control trials in the medical specialities Otorhinolaryngology and Pulmonology. In this review, we present evidence-based clinical data with herbal remedies and try to enlighten the question of efficacy and reliability of phytomedicine. PMID:24280678

Development of the Perioperative Nursing Data Set.

PubMed

Kleinbeck, S V

1999-07-01

Nursing practice is a major component of health care. Yet, it remains undervalued and essentially invisible because little data exist to substantiate the influence of nurses on patient outcomes. The research-based Perioperative Nursing Data Set (PNDS), with an easily automated nomenclature capable of describing the specialty practice of perioperative nursing, was designed to fill this gap. Four domains (i.e., safety, physiologic response to surgery, patient and family behavioral response to surgery, health system) form the foundation of the PNDS. Each domain, with accompanying desired outcomes, nursing interventions, and nursing diagnoses, has reliability, content validity, and evidence of construct validity. The purpose of this article is to introduce the conceptual framework, taxonomy, and potential clinical applications of the PNDS.

Analytically solvable chaotic oscillator based on a first-order filter.

PubMed

Corron, Ned J; Cooper, Roy M; Blakely, Jonathan N

2016-02-01

A chaotic hybrid dynamical system is introduced and its analytic solution is derived. The system is described as an unstable first order filter subject to occasional switching of a set point according to a feedback rule. The system qualitatively differs from other recently studied solvable chaotic hybrid systems in that the timing of the switching is regulated by an external clock. The chaotic analytic solution is an optimal waveform for communications in noise when a resistor-capacitor-integrate-and-dump filter is used as a receiver. As such, these results provide evidence in support of a recent conjecture that the optimal communication waveform for any stable infinite-impulse response filter is chaotic.

Analytically solvable chaotic oscillator based on a first-order filter

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

Corron, Ned J.; Cooper, Roy M.; Blakely, Jonathan N.

2016-02-15

A chaotic hybrid dynamical system is introduced and its analytic solution is derived. The system is described as an unstable first order filter subject to occasional switching of a set point according to a feedback rule. The system qualitatively differs from other recently studied solvable chaotic hybrid systems in that the timing of the switching is regulated by an external clock. The chaotic analytic solution is an optimal waveform for communications in noise when a resistor-capacitor-integrate-and-dump filter is used as a receiver. As such, these results provide evidence in support of a recent conjecture that the optimal communication waveform formore » any stable infinite-impulse response filter is chaotic.« less

Oregon's experiment in health care delivery and payment reform: coordinated care organizations replacing managed care.

PubMed

Howard, Steven W; Bernell, Stephanie L; Yoon, Jangho; Luck, Jeff; Ranit, Claire M

2015-02-01

To control Medicaid costs, improve quality, and drive community engagement, the Oregon Health Authority introduced a new system of coordinated care organizations (CCOs). While CCOs resemble traditional Medicaid managed care, they have differences that have been deliberately designed to improve care coordination, increase accountability, and incorporate greater community governance. Reforms include global budgets integrating medical, behavioral, and oral health care and public health functions; risk-adjusted payments rewarding outcomes and evidence-based practice; increased transparency; and greater community engagement. The CCO model faces several implementation challenges. If successful, it will provide improved health care delivery, better health outcomes, and overall savings. Copyright © 2015 by Duke University Press.

Can Women Have Children and a Career? IV Evidence from IVF Treatments.

PubMed

Lundborg, Petter; Plug, Erik; Rasmussen, Astrid Wurtz

2017-06-01

This paper introduces a new IV strategy based on IVF (in vitro fertilization) induced fertility variation among childless women to estimate the causal effect of having children on their career. For this purpose, we use administrative data on IVF treated women in Denmark. Because observed chances of IVF success do not depend on labor market histories, IVF treatment success provides a plausible instrument for childbearing. Our IV estimates indicate that fertility effects on earnings are: (i) negative, large, and long-lasting; (ii) driven by fertility effects on hourly earnings and not so much on labor supply; and (iii) much stronger at the extensive margin than at the intensive margin.

AHRQ series paper 1: comparing medical interventions: AHRQ and the effective health-care program.

PubMed

Slutsky, Jean; Atkins, David; Chang, Stephanie; Sharp, Beth A Collins

2010-05-01

In 2005, the Agency for Healthcare Research and Quality established the Effective Health Care (EHC) Program. The EHC Program aims to provide understandable and actionable information for patients, clinicians, and policy makers. The Evidence-based Practice Centers are one of the cornerstones of the EHC Program. Three key elements guide the EHC Program and thus, the conduct of Comparative Effectiveness Reviews by the EPC Program. Comparative Effectiveness Reviews introduce several specific challenges in addition to the familiar issues raised in a systematic review or meta-analysis of a single intervention. The articles in this series together form the current Methods Guide for Comparative Effectiveness Reviews of the EHC Program.

The YMCA/Steps Community Collaboratives, 2004-2008.

PubMed

Adamson, Katie; Shepard, Dennis; Easton, Alyssa; Jones, Ellen S

2009-07-01

Since the YMCA/Steps National Partnership began in 2004, the collaborative approach has built local synergy, linked content experts, and engaged national partners to concentrate on some of the most pressing health issues in the United States. Together, national and local partners used evidence-based public health programs to address risk factors such as poor nutrition, physical inactivity, and tobacco use. This article describes the YMCA/Steps National Partnership and focuses on the experiences and achievements of the YMCA/Steps Community Collaboratives, conducted with technical assistance from the National Association of Chronic Disease Directors between 2004 and 2008. We introduce some of the fundamental concepts underlying the partnership's success and share evaluation results.

Cardiovascular Update: Risk, Guidelines, and Recommendations.

PubMed

Pearson, Tamera

2015-09-01

This article provides an update of the current status of cardiovascular disease (CVD) in the United States, including a brief review of the underlying pathophysiology and epidemiology. This article presents a discussion of the latest American Heart Association guidelines that introduce the concept of promoting ideal cardiovascular health, defined by seven identified metrics. Specific CVD risk factors and utilization of the 10-year CVD event prediction calculator are discussed. In addition, current management recommendations of health-related conditions that increase risk for CVD, such as hypertension and hypercholesterolemia, are provided. Finally, a discussion of detailed evidence-based lifestyle recommendations to promote cardiovascular health and reduce CVD risks concludes the update. © 2015 The Author(s).

Expanding RN Scope of Knowledge-Genetics/Genomics: The New Frontier.

PubMed

Rogers, Margaret A; Lizer, Shannon; Doughty, Andrea; Hayden, Beth; Klein, Colleen J

Introducing a new competency into nursing practice requires the support of nursing leadership. A knowledge survey was used to assess nurses' knowledge following a yearlong genomics education initiative. Findings indicate that nurses benefit from repeated exposure to genetics-related content. Recommendations from this study include development and implementation of strategies that can be used to prepare nurses at all levels for the application of genetics and genomics. Clinical nurses with knowledge of genetics will be able to implement evidence-based interventions to manage acute and chronic illnesses. These nurses will then be able to engage patients more fully, thereby helping them to understand the relationship of genetics to healthy outcomes.

[The interaction between gamma-aminobutyric acid and other related neurotransmitters in depression].

PubMed

Li, Zhen; An, Shu-Cheng; Li, Jiang-Na

2014-06-01

Gamma-aminobutyric acid (GABA) is the major inhibitory neurotransmitter of the central nervous system (CNS) in mammalian, which involved in several mood disorders such as anxiety, depression and schizophrenia. Nowadays, there are growing evidences showed that the depression is concerned with a deficiency in brain GABA. However, there are numerous studies based on the monoamine hypothesis and glutamatergic dysfunction, while the study on GABA is relatively less and scattered. Our aim is to discuss the relationship between depression and GABA by introducing the role of GABA receptors and the interaction between GABA and 5-hydroxytryptamine, dopamine and glutamic acid. It provides new ideas for further study on the pathogenesis and therapy of depression.

A general method for decomposing the causes of socioeconomic inequality in health.

PubMed

Heckley, Gawain; Gerdtham, Ulf-G; Kjellsson, Gustav

2016-07-01

We introduce a general decomposition method applicable to all forms of bivariate rank dependent indices of socioeconomic inequality in health, including the concentration index. The technique is based on recentered influence function regression and requires only the application of OLS to a transformed variable with similar interpretation. Our method requires few identifying assumptions to yield valid estimates in most common empirical applications, unlike current methods favoured in the literature. Using the Swedish Twin Registry and a within twin pair fixed effects identification strategy, our new method finds no evidence of a causal effect of education on income-related health inequality. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

An innovative portfolio of research training programs for medical students.

PubMed

Zier, Karen; Wyatt, Christina; Muller, David

2012-12-01

Medical student education continues to evolve, with an increasing emphasis on evidence-based decision making in clinical settings. Many schools are introducing scholarly programs to their curriculum in order to foster the development of critical thinking and analytic skills, encourage self-directed learning, and develop more individualized learning experiences. In addition, participation in rigorous scholarly projects teaches students that clinical care and research should inform each other, with the goal of providing more benefit to patients and society. Physician-scientists, and physicians who have a better appreciation of science, have the potential to be leaders in the field who will deliver outstanding clinical care, contribute new knowledge, and educate their patients.

Thrice out of Africa: ancient and recent expansions of the honey bee, Apis mellifera.

PubMed

Whitfield, Charles W; Behura, Susanta K; Berlocher, Stewart H; Clark, Andrew G; Johnston, J Spencer; Sheppard, Walter S; Smith, Deborah R; Suarez, Andrew V; Weaver, Daniel; Tsutsui, Neil D

2006-10-27

We characterized Apis mellifera in both native and introduced ranges using 1136 single-nucleotide polymorphisms genotyped in 341 individuals. Our results indicate that A. mellifera originated in Africa and expanded into Eurasia at least twice, resulting in populations in eastern and western Europe that are geographically close but genetically distant. A third expansion in the New World has involved the near-replacement of previously introduced "European" honey bees by descendants of more recently introduced A. m. scutellata ("African" or "killer" bees). Our analyses of spatial transects and temporal series in the New World revealed differential replacement of alleles derived from eastern versus western Europe, with admixture evident in all individuals.

The Temperature of the Earth in 2020

NASA Technical Reports Server (NTRS)

Hansen, James; Einaudi, Franco (Technical Monitor)

2002-01-01

In spite of the confusion in the public discourse about global warming, there is no doubt that the Earth has been warming for the past century. The chemistry of the Earth's atmosphere is complex, and it is sometimes difficult to claim cause-and-effect with certainty. Nevertheless, the evidence seems clear that CO2 and non-CO2 forcings such as methane and air pollution are causally related to this warming trend. Our dependence on fossil fuels make it difficult to expect that massive reductions in CO2 will be feasible in the near-term, however. In this talk I will consider the evidence for global warming, the extent to which we can extrapolate current trends into the future if no changes in global policy are introduced, and those near-term policies that might be realistically introduced to significantly affect those trends.

Biological Evidence Regarding Psychopathy Does Not Affect Mock Jury Sentencing.

PubMed

Remmel, Rheanna J; Glenn, Andrea L; Cox, Jennifer

2018-02-22

Research on the biological factors influencing criminal behavior is increasingly being introduced into court, necessitating research on how such evidence is perceived and influences decision makers. Research on how this evidence influences sentencing recommendations is inconclusive. In this study, we focus on biological evidence related to psychopathy, a construct commonly associated with criminal behavior. Approximately 800 community members were presented with a case vignette detailing an individual who is described as having a high level of psychopathic traits. Participants received either psychological information about psychopathy (i.e., no biological evidence), evidence the defendant had genetic risk factors for psychopathy, or written neuroimaging evidence the defendant had brain deficits associated with psychopathy. Participants then recommended a sentence. Overall, recommended sentence lengths did not differ between evidence conditions. These findings add to a growing body of research suggesting that biological evidence may not have as much of an influence on jurors as previously thought.

Challenges of stem cell-based pulp and dentin regeneration: a clinical perspective.

PubMed

Huang, George T-J; Al-Habib, Mey; Gauthier, Philippe

2013-03-01

There are two types of approaches to regenerate tissues: cell-based and cell-free. The former approach is to introduce exogenous cells into the host to regenerate tissues, and the latter is to use materials other than cells in an attempt to regenerate tissues. There has been a significant advancement in stem cell-based pulp and dentin regeneration research in the past few years. Studies in small and large animals have demonstrated that pulp/dentin-like tissues can be regenerated partially or completely in the root canal space with apical openings of 0.7-3.0 mm using dental pulp stem cells, including stem cells from apical papilla (SCAP) and subpopulations of pulp stem cells. Bone marrow mesenchymal stem cells (BMMSCs) and adipose tissue-derived MSCs (ADMSCs) have also been shown to regenerate pulp-like tissue. In contrast, the cell-free approach has not produced convincing evidence on pulp regeneration. However, one crucial concept has not been considered nor defined in the field of pulp/dentin regeneration and that is the critical size defect of dentin and pulp. Without such consideration and definition, it is difficult to predict or anticipate the extent of cell-free pulp regeneration that would occur. By reasoning, cell-free therapy is unlikely to regenerate an organ/tissue after total loss. Similarly, after a total loss of pulp, it is unlikely to regenerate without using exogenously introduced cells. A cell homing approach may provide a limited amount of tissue regeneration. Although stem cell-based pulp/dentin regeneration has shown great promise, clinical trials are difficult to launch at present. This article will address several issues that challenge and hinder the clinical applications of pulp/dentin regeneration which need to be overcome before stem cell-based pulp/dentin regeneration can occur in the clinic.

Challenges of stem cell-based pulp and dentin regeneration: a clinical perspective

PubMed Central

HUANG, GEORGE T.-J.; AL-HABIB, MEY; GAUTHIER, PHILIPPE

2013-01-01

There are two types of approaches to regenerate tissues: cell-based and cell-free. The former approach is to introduce exogenous cells into the host to regenerate tissues, and the latter is to use materials other than cells in an attempt to regenerate tissues. There has been a significant advancement in stem cell-based pulp and dentin regeneration research in the past few years. Studies in small and large animals have demonstrated that pulp/dentin-like tissues can be regenerated partially or completely in the root canal space with apical openings of 0.7-3.0 mm using dental pulp stem cells, including stem cells from apical papilla (SCAP) and subpopulations of pulp stem cells. Bone marrow mesenchymal stem cells (BMMSCs) and adipose tissue-derived MSCs (ADMSCs) have also been shown to regenerate pulp-like tissue. In contrast, the cell-free approach has not produced convincing evidence on pulp regeneration. However, one crucial concept has not been considered nor defined in the field of pulp/dentin regeneration and that is the critical size defect of dentin and pulp. Without such consideration and definition, it is difficult to predict or anticipate the extent of cell-free pulp regeneration that would occur. By reasoning, cell-free therapy is unlikely to regenerate an organ/tissue after total loss. Similarly, after a total loss of pulp, it is unlikely to regenerate without using exogenously introduced cells. A cell homing approach may provide a limited amount of tissue regeneration. Although stem cell-based pulp/dentin regeneration has shown great promise, clinical trials are difficult to launch at present. This article will address several issues that challenge and hinder the clinical applications of pulp/dentin regeneration which need to be overcome before stem cell-based pulp/dentin regeneration can occur in the clinic. PMID:23914150

PID-based error signal modeling

NASA Astrophysics Data System (ADS)

Yohannes, Tesfay

1997-10-01

This paper introduces a PID based signal error modeling. The error modeling is based on the betterment process. The resulting iterative learning algorithm is introduced and a detailed proof is provided for both linear and nonlinear systems.

Laser and Light-based Treatment of Keloids – A Review

PubMed Central

Mamalis, A.D.; Lev-Tov, H.; Nguyen, D.H.; Jagdeo, J.R.

2015-01-01

Keloids are an overgrowth of fibrotic tissue outside the original boundaries of an injury and occur secondary to defective wound healing. Keloids often have a functional, aesthetic, or psychosocial impact on patients as highlighted by quality-of-life studies. Our goal is to provide clinicians and scientists an overview of the data available on laser and light-based therapies for treatment of keloids, and highlight emerging light-based therapeutic technologies and the evidence available to support their use. We employed the following search strategy to identify the clinical evidence reported in the biomedical literature: in November 2012, we searched PubMed.gov, Ovid MEDLINE, Embase, and Cochrane Reviews (1980-present) for published randomized clinical trials, clinical studies, case series, and case reports related to the treatment of keloids. The search terms we utilized were ‘keloid(s)’ AND ‘laser’ OR ‘light-emitting diode’ OR ‘photodynamic therapy’ OR ‘intense pulsed light’ OR ‘low level light’ OR ‘phototherapy.’ Our search yielded 347 unique articles. Of these, 33 articles met our inclusion and exclusion criteria. We qualitatively conclude that laser and light-based treatment modalities may achieve favorable patient outcomes. Clinical studies using CO2 laser are more prevalent in current literature and a combination regimen may be an adequate ablative approach. Adding light-based treatments, such as LED phototherapy or photodynamic therapy, to laser treatment regimens may enhance patient outcomes. Lasers and other light-based technology have introduced new ways to manage keloids that may result in improved aesthetic and symptomatic outcomes and decreased keloid recurrence. PMID:24033440

When is enough evidence enough? - Using systematic decision analysis and value-of-information analysis to determine the need for further evidence.

PubMed

Siebert, Uwe; Rochau, Ursula; Claxton, Karl

2013-01-01

Decision analysis (DA) and value-of-information (VOI) analysis provide a systematic, quantitative methodological framework that explicitly considers the uncertainty surrounding the currently available evidence to guide healthcare decisions. In medical decision making under uncertainty, there are two fundamental questions: 1) What decision should be made now given the best available evidence (and its uncertainty)?; 2) Subsequent to the current decision and given the magnitude of the remaining uncertainty, should we gather further evidence (i.e., perform additional studies), and if yes, which studies should be undertaken (e.g., efficacy, side effects, quality of life, costs), and what sample sizes are needed? Using the currently best available evidence, VoI analysis focuses on the likelihood of making a wrong decision if the new intervention is adopted. The value of performing further studies and gathering additional evidence is based on the extent to which the additional information will reduce this uncertainty. A quantitative framework allows for the valuation of the additional information that is generated by further research, and considers the decision maker's objectives and resource constraints. Claxton et al. summarise: "Value of information analysis can be used to inform a range of policy questions including whether a new technology should be approved based on existing evidence, whether it should be approved but additional research conducted or whether approval should be withheld until the additional evidence becomes available." [Claxton K. Value of information entry in Encyclopaedia of Health Economics, Elsevier, forthcoming 2014.] The purpose of this tutorial is to introduce the framework of systematic VoI analysis to guide further research. In our tutorial article, we explain the theoretical foundations and practical methods of decision analysis and value-of-information analysis. To illustrate, we use a simple case example of a foot ulcer (e.g., with diabetes) as well as key references from the literature, including examples for the use of the decision-analytic VoI framework by health technology assessment agencies to guide further research. These concepts may guide stakeholders involved or interested in how to determine whether or not and, if so, which additional evidence is needed to make decisions. Copyright © 2013. Published by Elsevier GmbH.

Mental health consumer participation in education: a structured literature review.

PubMed

Arblaster, Karen; Mackenzie, Lynette; Willis, Karen

2015-10-01

Consumer participation in design, delivery and evaluation of occupational therapy educational programs is a recently introduced requirement for accreditation. It aligns with the principle of recovery, which underpins Australian mental health policy. Graduates' capabilities for recovery-oriented practice are thought to be enhanced through learning from consumers' lived experience. This structured literature review evaluates the current evidence for mental health consumer participation in health professional education to inform occupational therapy educators. Searches were completed in five online databases, one journal and published reading lists on the topic. Studies were included if they addressed mental health consumer participation in health professional education programs, were published in peer reviewed journals between 2000 and 2014 and were in English. Articles were critically reviewed, and analysed for key findings related to stages of the educational process and recovery-oriented practice capabilities. An emerging body of evidence for consumer participation in mental health education was identified. Studies are characterised by a lack of quality and a low to medium level of evidence. Findings relate to design, planning, delivery and evaluation of education as well as to most aspects of recovery-oriented practice. Emphases on exploratory research and proximal outcomes, and a reliance on published outcome measurement instruments designed for other purposes are key limitations in this body of evidence. This study identifies a weak evidence base for the requirement for consumer participation in occupational therapy programs, specifically related to mental health curricula. A research agenda is proposed in response. © 2015 Occupational Therapy Australia.

Plant and root endophyte assembly history: interactive effects on native and exotic plants.

PubMed

Sikes, Benjamin A; Hawkes, Christine V; Fukami, Tadashi

2016-02-01

Differences in the arrival timing of plants and soil biota may result in different plant communities through priority effects, potentially affecting the success of native vs. exotic plants, but experimental evidence is largely lacking. We conducted a greenhouse experiment to investigate whether the assembly history of plants and fungal root endophytes could interact to influence plant emergence and biomass. We introduced a grass species and eight fungal species from one of three land-use types (undisturbed, disturbed, or pasture sites in a Florida scrubland) in factorial combinations. We then introduced all plants and fungi from the other land-use types 2 weeks later. Plant emergence was monitored for 6 months, and final plant biomass and fungal species composition assessed. The emergence and growth of the exotic Melinis repens and the native Schizacharyium niveum were affected negatively when introduced early with their "home" fungi, but early introduction of a different plant species or fungi from a different site type eliminated these negative effects, providing evidence for interactive priority effects. Interactive effects of plant and fungal arrival history may be an overlooked determinant of plant community structure and may provide an effective management tool to inhibit biological invasion and aid ecosystem restoration.

[Oxidative stress derived from airborne fine and ultrafine particles and the effects on brain-nervous system: part 1].

PubMed

Sagai, Masaru; Win-Shwe, Tin Tin

2015-01-01

Traffic-related air pollution is a major contributor to urban air pollution. Diesel exhaust (DE) is the most important component of near-road and urban air pollution and is commonly used as a surrogate model of air pollution in health effects studies. In particular, diesel exhaust particles (DEP) and the nanoparticles in DEP are considered hazardous components on health effects. It is widely known that exposure to DEP is associated with mortality due to respiratory and cardiovascular diseases. Recently, there has been accumulating evidence that DEP and the nanoparticles in DEP may be causes of neurodegenerative disorders. Here, we introduce the evidence suggesting their association with such disorders. First, we describe the chemical components and the translocation of DEP and nanoparticles to the brain, and then introduce the evidence and a mechanism by which reactive oxygen species (ROS) and any inflammatory mediators can be produced by DEP phagocytosis of macrophages, microglia and astrocyte cells in the brain. There are many lines of evidence showing that the neurodegenerative disorders are profoundly associated with enhanced oxidative and inflammatory events. Second, we describe a mechanism by which neurodegenerative diseases, such as stroke, Alzheimer's disease and Parkinson's disease, are induced via oxidative stress and inflammatory events.

Using Perplexity to Stimulate Curiosity

ERIC Educational Resources Information Center

Vidler, Derek C.; Lawlor, Francis X.

1976-01-01

Demonstrations are presented in which children can be introduced to evidence of specific concepts enabling them to participate in such a way that any conceptual conflicts that might arise in this learning situation can be gradually reduced. (EB)

Cognitive penetrability and emotion recognition in human facial expressions

PubMed Central

Marchi, Francesco

2015-01-01

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

Introducing Computers to Kindergarten Children Based on Vygotsky's Theory about Socio-Cultural Learning: The Greek Perspective.

ERIC Educational Resources Information Center

Pange, Jenny; Kontozisis, Dimitrios

2001-01-01

Greek preschoolers' level of knowledge about computers was examined as they participated in a classroom project to introduce them to new technologies. The project was based on Vygotsky's theory of socio-cultural learning. Findings suggest that this approach is a successful way to introduce new technologies to young children. (JPB)

NoGOA: predicting noisy GO annotations using evidences and sparse representation.

PubMed

Yu, Guoxian; Lu, Chang; Wang, Jun

2017-07-21

Gene Ontology (GO) is a community effort to represent functional features of gene products. GO annotations (GOA) provide functional associations between GO terms and gene products. Due to resources limitation, only a small portion of annotations are manually checked by curators, and the others are electronically inferred. Although quality control techniques have been applied to ensure the quality of annotations, the community consistently report that there are still considerable noisy (or incorrect) annotations. Given the wide application of annotations, however, how to identify noisy annotations is an important but yet seldom studied open problem. We introduce a novel approach called NoGOA to predict noisy annotations. NoGOA applies sparse representation on the gene-term association matrix to reduce the impact of noisy annotations, and takes advantage of sparse representation coefficients to measure the semantic similarity between genes. Secondly, it preliminarily predicts noisy annotations of a gene based on aggregated votes from semantic neighborhood genes of that gene. Next, NoGOA estimates the ratio of noisy annotations for each evidence code based on direct annotations in GOA files archived on different periods, and then weights entries of the association matrix via estimated ratios and propagates weights to ancestors of direct annotations using GO hierarchy. Finally, it integrates evidence-weighted association matrix and aggregated votes to predict noisy annotations. Experiments on archived GOA files of six model species (H. sapiens, A. thaliana, S. cerevisiae, G. gallus, B. Taurus and M. musculus) demonstrate that NoGOA achieves significantly better results than other related methods and removing noisy annotations improves the performance of gene function prediction. The comparative study justifies the effectiveness of integrating evidence codes with sparse representation for predicting noisy GO annotations. Codes and datasets are available at http://mlda.swu.edu.cn/codes.php?name=NoGOA .

Noble gases in SNC meteorites: Shergotty, Nakhla, Chassigny

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

Ott, U.

1988-07-01

The author reports the elemental and isotopic composition of the noble gases in various fragments of the Shergotty, Nakhla, and Chassigny meteorites. Conclusions presented earlier which were based on results for trapped Ar, Kr and Xe only, are reaffirmed by the complete set of data. Arguments are presented that Chassigny-type gases are a better choice than (fractionated) terrestrial air for the second component, that, when mixed with SPB-gases produces the Shergotty composition. The ratios {sup 40}Ar/{sup 36}Ar{sub t} and {sup 40}Ar/{sup 129}Xe* in Shergotty agree with the respective values for EETA 79001 glass. This is taken as evidence for amore » late introduction of the supposedly shock implanted atmospheric component into Shergotty; it is at odds with scenarios that introduce the atmospheric component {approximately}180 m.y. ago. Based on the variable ratio {sup 40}Ar/{sup 129}Xe* and its unshocked nature, Nakhla acquired its excess {sup 129}Xe by a different process. {sup 21}Ne-based cosmic-ray exposure ages agree well with values in the literature, but do not readily agree with the younger ages based on the abundance of cosmogenic {sup 126}Xe. Neutron capture products are present in Nakhla Kr and there is evidence for a fission-like component in Xe of both Shergotty and Nakhla. GCR interactions with the SPB are unlikely to be the reason for the low {sup 36}Ar/{sup 38}Ar ratio in SPB-Ar.« less

Evidence-based decision-making for vaccine introductions: Overview of the ProVac International Working Group’s experience

PubMed Central

Jauregui, Barbara; Garcia, Ana Gabriela Felix; Janusz, Cara Bess; Blau, Julia; Munier, Aline; Atherly, Deborah; Mvundura, Mercy; Hajjeh, Rana; Lopman, Benjamin; Clark, Andrew David; Baxter, Louise; Hutubessy, Raymond; de Quadros, Ciro; Andrus, Jon Kim

2015-01-01

Introduction Pan American Health Organization’s (PAHO) ProVac Initiative aims to strengthen countries’ technical capacity to make evidence-based immunization policy. With financial support from the Bill and Melinda Gates Foundation, PAHO established the ProVac International Working Group (IWG), a platform created for two years to transfer the ProVac Initiative’s tools and methods to support decisions in non-PAHO regions. Methods In 2011, WHO Regional Offices and partner agencies established the IWG to transfer the ProVac framework for new vaccine decision support, including tools and trainings to other regions of the world. During the two year period, PAHO served as the coordinating secretariat and partner agencies played implementing or advisory roles. Results Fifty nine national professionals from 17 countries received training on the use of economic evaluations to aid vaccine policy making through regional workshops. The IWG provided direct technical support to nine countries to develop cost-effectiveness analyses to inform decisions. All nine countries introduced the new vaccine evaluated or their NITAGs have made a recommendation to the Ministry of Health to introduce the new vaccine. Discussion Developing countries around the world are increasingly interested in weighing the potential health impact due to new vaccine introduction against the investments required. During the two years, the ProVac approach proved valuable and timely to aid the national decision making processes, even despite the different challenges and idiosyncrasies encountered in each region. The results of this work suggest that: (1) there is great need and demand for technical support and for capacity building around economic evaluations; and (2) the ProVac method of supporting country-owned analyses is as effective in other regions as it has been in the PAHO region. Conclusion Decision support for new vaccine introduction in low- and middle-income countries is critical to guiding the efficient use of resources and prioritizing high impact vaccination programs. PMID:25919170