Laparoscopic surgery for benign and malign diseases of the digestive system: indications, limitations, and evidence.

PubMed

Küper, Markus Alexander; Eisner, Friederike; Königsrainer, Alfred; Glatzle, Jörg

2014-05-07

The laparoscopic technique was introduced in gastrointestinal surgery in the mid 1980s. Since then, the development of this technique has been extraordinary. Triggered by technical innovations (stapling devices or coagulation/dissecting devices), nowadays any type of gastrointestinal resection has been successfully performed laparoscopically and can be performed laparoscopically dependent on the patient's condition. This summary gives an overview over 30 years of laparoscopic surgery with focus on today's indications and evidence. Main indications remain the more common procedures, e.g., appendectomy, cholecystectomy, bariatric procedures or colorectal resections. For all these indications, the laparoscopic approach has become the gold standard with less perioperative morbidity. Regarding oncological outcome there have been several high-quality randomized controlled trials which demonstrated equivalency between laparoscopic and open colorectal resections. Less common procedures like esophagectomy, oncological gastrectomy, liver and pancreatic resections can be performed successfully as well by an experienced surgeon. However, the evidence for these special indications is poor and a general recommendation cannot be given. In conclusion, laparoscopic surgery has revolutionized the field of gastrointestinal surgery by reducing perioperative morbidity without disregarding surgical principles especially in oncological surgery.

Levels of Evidence: Adult and Pediatric Treatment Studies (PDQ®)—Health Professional Version

Cancer.gov

Levels of evidence refers to the ranking system used by the PDQ editorial boards to indicate the strength of evidence obtained from cited studies. Get detailed information about how to weigh the strength of the evidence obtained in cancer treatment studies in this information summary.

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

PubMed

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

2017-04-01

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

Evidence-based practice: a quality indicator analysis of peer-tutoring in adapted physical education.

PubMed

Kalef, Laura; Reid, Greg; Macdonald, Cathy

2013-09-01

The purpose of the research was to conduct a quality indicator analysis of studies investigating peer-tutoring for students with a disability in adapted physical education. An electronic search was conducted among English journals published from 1960 to November 2012. Databases included ERIC, PsycINFO, and SPORTDiscus. Fifteen research studies employing group-experimental (Gersten et al., 2005) or single-subject designs (Horner et al., 2005) met inclusion criteria. Each study was assessed for the presence and clarity of quality indicators. Group designs met an average of 62.5% essential and 69% desirable indicators. An average of 80% of indicators was present for single-subject designs. Results suggest claims of peer-tutoring being an evidence-based practice are premature. Recommendations for clarifying and applying the quality indicators are offered. Copyright © 2013 Elsevier Ltd. All rights reserved.

Screen Time and Health Indicators Among Children and Youth: Current Evidence, Limitations and Future Directions.

PubMed

Saunders, Travis J; Vallance, Jeff K

2017-06-01

Despite accumulating evidence linking screen-based sedentary behaviours (i.e. screen time) with poorer health outcomes among children and youth <18 years of age, the prevalence of these behaviours continues to increase, with roughly half of children and youth exceeding the public health screen time recommendation of 2 h per day or less. The purpose of this article is to provide an overview of key research initiatives aimed at understanding the associations between screen time and health indicators including physical health, quality of life and psychosocial health. Available evidence suggests that screen time is deleteriously associated with numerous health indicators in child and youth populations, including adiposity, aerobic fitness, quality of life, self-esteem, pro-social behaviour, academic achievement, depression and anxiety. However, few longitudinal or intervention studies have been conducted, with most of these studies focusing on physical health indicators. While most studies have used self-reported assessments of screen time, the availability of more objective assessment methods presents important opportunities (e.g. more accurate and precise assessment of sedentary time and screen time) and challenges (e.g. privacy and participant burden). Novel statistical approaches such as isotemporal substitution modelling and compositional analysis, as well as studies using longitudinal and experimental methodologies, are needed to better understand the health impact of excessive screen time, and to develop strategies to minimise or reverse the negative impacts of these behaviours. The evidence to date suggests a clear need for policy aimed at minimising the hazardous health consequences associated with screen time among children and youth.

Evidence for gammacerane as an indicator of water column stratification

NASA Technical Reports Server (NTRS)

Sinninghe Damste, J. S.; Kenig, F.; Koopmans, M. P.; Koster, J.; Schouten, S.; Hayes, J. M.; de Leeuw, J. W.

1995-01-01

A new route for the formation of gammacerane from tetrahymanol is proposed; in addition to dehydration and hydrogenation, sulphurisation and early C-S cleavage are shown to be important in the pathway of formation, especially in marine sediments. Evidence is twofold. First, relatively large amounts of the gammacerane skeleton are sequestered in S-rich macromolecular aggregates formed by natural sulphurisation of functionalised lipids. Selective cleavage of polysulphide linkages with MeLi/MeI led to formation of 3-methylthiogammacerane, indicating that the gammacerane skeleton is primarily bound via sulphur at position 3, consistent with the idea that tetrahymanol (or the corresponding ketone) is the precursor for gammacerane. Second, upon mild artificial maturation of two sediments using hydrous pyrolysis, gammacerane is released from S-rich macromolecular aggregates by cleavage of the relatively weak C-S bonds. The stable carbon isotopic compositions of gammacerane and lipids derived from primary producers and green sulphur bacteria in both the Miocene Gessoso-solfifera and Upper Jurassic Allgau Formations indicate that gammacerane is derived from bacterivorous ciliates which were partially feeding on green sulphur bacteria. This demonstrates that anaerobic ciliates living at or below the chemocline are important sources for gammacerane, consistent with the fact that ciliates only biosynthesize tetrahymanol if their diet is deprived of sterols. This leads to the conclusion that gammacerane is an indicator for water column stratification, which solves two current enigmas in gammacerane geochemistry. Firstly, it explains why gammacerane is often found in sediments deposited under hypersaline conditions but is not necessarily restricted to this type of deposits. Secondly, it explains why lacustrine deposits may contain abundant gammacerane since most lakes in the temperate climatic zones are stratified during summer.

Experimental evidence for a new single-event upset (SEU) mode in a CMOS SRAM obtained from model verification

NASA Technical Reports Server (NTRS)

Zoutendyk, J. A.; Smith, L. S.; Soli, G. A.; Lo, R. Y.

1987-01-01

Modeling of SEU has been done in a CMOS static RAM containing 1-micron-channel-length transistors fabricated from a p-well epilayer process using both circuit-simulation and numerical-simulation techniques. The modeling results have been experimentally verified with the aid of heavy-ion beams obtained from a three-stage tandem van de Graaff accelerator. Experimental evidence for a novel SEU mode in an ON n-channel device is presented.

An evidence-update on the prospective relationship between childhood sedentary behaviour and biomedical health indicators: a systematic review and meta-analysis.

PubMed

van Ekris, E; Altenburg, T M; Singh, A S; Proper, K I; Heymans, M W; Chinapaw, M J M

2016-09-01

Evidence for adverse health effects of excessive sedentary behaviour in children is predominantly based on cross-sectional studies, measuring TV viewing as proxy for sedentary behaviour. This systematic review and meta-analysis summarizes the evidence on the prospective relationship between childhood sedentary behaviour and biomedical health indicators, overall and stratified by type of sedentary behaviour (TV viewing, computer use/games, screen time and objective sedentary time). PubMed, EMBASE, PsycINFO and Cochrane were systematically searched till January 2015. Methodological quality of all included studies was scored, and a best evidence synthesis was applied. We included 109 studies of which 19 were of high quality. We found moderate-to-strong evidence for a relationship of overall sedentary time with some anthropometrics (overweight/obesity, weight-for-height), one cardiometabolic biomarker (HDL-cholesterol) and some fitness indicators (fitness, being unfit). For other health indicators, we found no convincing evidence because of inconsistent or non-significant findings. The evidence varied by type of sedentary behaviour. The meta-analysis indicated that each additional baseline hour of TV viewing (β = 0.01, 95%CI = [-0.002; 0.02]) or computer use (β = 0.00, 95%CI = [-0.004; 0.01]) per day was not significantly related with BMI at follow-up. We conclude that the evidence for a prospective relationship between childhood sedentary behaviour and biomedical health is in general unconvincing. © 2016 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of International Association for the Study of Obesity (IASO).

Evidence for gammacerane as an indicator of water column stratification

NASA Astrophysics Data System (ADS)

Sinninghe Damsté, Jaap S.; Kenig, Fabien; Koopmans, Martin P.; Köster, Jürgen; Schouten, Stefan; Hayes, J. M.; de Leeuw, Jan W.

1995-05-01

A new route for the formation of gammacerane from tetrahymanol is proposed; in addition to dehydration and hydrogenation, sulphurisation and early CS cleavage are shown to be important in the pathway of formation, especially in marine sediments. Evidence is twofold. First, relatively large amounts of the gammacerane skeleton are sequestered in S-rich macromolecular aggregates formed by natural sulphurisation of functionalised lipids. Selective cleavage of polysulphide linkages with MeLi/MeI led to formation of 3-methylthiogammacerane, indicating that the gammacerane skeleton is primarily bound via sulphur at position 3, consistent with the idea that tetrahymanol (or the corresponding ketone) is the precursor for gammacerane. Second, upon mild artificial maturation of two sediments using hydrous pyrolysis, gammacerane is released from S-rich macromolecular aggregates by cleavage of the relatively weak CS bonds. The stable carbon isotopic compositions of gammacerane and lipids derived from primary producers and green sulphur bacteria in both the Miocene Gessoso-solfifera and Upper Jurassic Allgäu Formations indicate that gammacerane is derived from bacterivorous ciliates which were partially feeding on green sulphur bacteria. This demonstrates that anaerobic ciliates living at or below the chemocline are important sources for gammacerane, consistent with the fact that ciliates only biosynthesize tetrahymanol if their diet is deprived of sterols. This leads to the conclusion that gammacerane is an indicator for water column stratification, which solves two current enigmas in gammacerane geochemistry. Firstly, it explains why gammacerane is often found in sediments deposited under hypersaline conditions but is not necessarily restricted to this type of deposits. Secondly, it explains why lacustrine deposits may contain abundant gammacerane since most lakes in the temperate climatic zones are stratified during summer.

Cannabis Use in Palliative Oncology: A Review of the Evidence for Popular Indications.

PubMed

Turgeman, Ilit; Bar-Sela, Gil

2017-02-01

A flowering plant of variegated ingredients and psychoactive qualities, cannabis has long been used for medicinal and recreational purposes. Currently, cannabis is approved in several countries for indications of symptomatic alleviation. However, limited knowledge on the benefits and risks precludes inclusion of cannabis in standard treatment guidelines. This review provides a summary of the available literature on the use of cannabis and cannabinoid-based medicines in palliative oncology. Favorable outcomes are demonstrated for chemotherapy-induced nausea and vomiting and cancer-related pain, with evidence of advantageous neurological interactions. Benefit in the treatment of anorexia, insomnia and anxiety is also suggested. Short- and long-term side effects appear to be manageable and to subside after discontinuation of the drug. Finally, cannabinoids have shown anti-neoplastic effects in preclinical studies in a wide range of cancer cells and some animal models. Further research is needed before cannabis can become a part of evidence-based oncology practice.

Price discrimination in essential medicines: evidence from International Drug Price Indicator Guide data.

PubMed

Hanlon, Michael; Zhang, Raymond

2013-03-01

Few data are available on what donors, governments and other implementing organisations pay for the medicines they procure. To partly address this shortcoming, we analyse transactions of pharmaceuticals on the WHO's essential medicines list. Our objective was to identify the determinants of prices paid for these drugs. We used data from the 2008 version of the International Drug Price Indicator Guide. We normalised transactions by representing their value as a 'price per daily dose'. We used a mixed-effects regression model to quantify the impact of observable characteristics on prices paid. We present evidence of first-degree price discrimination in the market for essential medicines. We find that as a country's per capita wealth doubles, prices paid for the same pharmaceutical increase by 33%. These data indicate that purchasing agents from wealthier countries pay more for essential medicines, all factors constant. This behaviour is not a form of development assistance for health but rather is indicative of inefficient markets in which buyers' lack of information enables suppliers to charge higher prices than they could otherwise.

Numerical indicators of absorption spectra of green leaf extract obtained from plants of different life forms.

PubMed

Koldaev, Vladimir M; Manyakhin, Artem Yu

2018-06-05

The study was carried out using 58 species of terrestrial plants of different life forms at the start of their fruiting stage. Photoreceptive systems of the leaves were assessed by means of unconventional numerical indicators of absorption spectra, relative photoabsorption coefficient, photosynthetic pigments' integral absorption intensity and relative absorption intensity coefficient. As the study showed, the leaves of all trees and light-demanding grasses favoring open spaces, which were subjected to the study were featured by the lowest values of numerical indicators of absorption spectra (NIAS). Shade-demanding grasses, which grow beneath the canopy, by contrast, were featured by the highest NIAS values. These values of the shrub leaves were in between those of light-demanding plants and shade-demanding ones. The results obtained are consistent with modern visions concerning the biochemistry and the physiology of plants' photoreceptive system. It is appropriate to apply the NIAS, which were used in this study and reflect a leaf's photoreceptive properties, as spectrophotometric criteria for monitoring and environmental management of natural plant resources and agricultural plants. Copyright © 2018 Elsevier B.V. All rights reserved.

Reliability of Growth Indicators and Efficiency of Functional Treatment for Skeletal Class II Malocclusion: Current Evidence and Controversies.

PubMed

Perinetti, Giuseppe; Contardo, Luca

2017-01-01

Current evidence on the reliability of growth indicators in the identification of the pubertal growth spurt and efficiency of functional treatment for skeletal Class II malocclusion, the timing of which relies on such indicators, is highly controversial. Regarding growth indicators, the hand and wrist (including the sole middle phalanx of the third finger) maturation method and the standing height recording appear to be most reliable. Other methods are subjected to controversies or were showed to be unreliable. Main sources of controversies include use of single stages instead of ossification events and diagnostic reliability conjecturally based on correlation analyses. Regarding evidence on the efficiency of functional treatment, when treated during the pubertal growth spurt, more favorable response is seen in skeletal Class II patients even though large individual responsiveness remains. Main sources of controversies include design of clinical trials, definition of Class II malocclusion, and lack of inclusion of skeletal maturity among the prognostic factors. While no growth indicator may be considered to have a full diagnostic reliability in the identification of the pubertal growth spurt, their use may still be recommended for increasing efficiency of functional treatment for skeletal Class II malocclusion.

Reliability of Growth Indicators and Efficiency of Functional Treatment for Skeletal Class II Malocclusion: Current Evidence and Controversies

PubMed Central

2017-01-01

Current evidence on the reliability of growth indicators in the identification of the pubertal growth spurt and efficiency of functional treatment for skeletal Class II malocclusion, the timing of which relies on such indicators, is highly controversial. Regarding growth indicators, the hand and wrist (including the sole middle phalanx of the third finger) maturation method and the standing height recording appear to be most reliable. Other methods are subjected to controversies or were showed to be unreliable. Main sources of controversies include use of single stages instead of ossification events and diagnostic reliability conjecturally based on correlation analyses. Regarding evidence on the efficiency of functional treatment, when treated during the pubertal growth spurt, more favorable response is seen in skeletal Class II patients even though large individual responsiveness remains. Main sources of controversies include design of clinical trials, definition of Class II malocclusion, and lack of inclusion of skeletal maturity among the prognostic factors. While no growth indicator may be considered to have a full diagnostic reliability in the identification of the pubertal growth spurt, their use may still be recommended for increasing efficiency of functional treatment for skeletal Class II malocclusion. PMID:28168195

Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement

PubMed Central

Rabe, Eberhard; Partsch, Hugo; Hafner, Juerg; Lattimer, Christopher; Mosti, Giovanni; Neumann, Martino; Urbanek, Tomasz; Huebner, Monika; Gaillard, Sylvain; Carpentier, Patrick

2017-01-01

Objective Medical compression stockings are a standard, non-invasive treatment option for all venous and lymphatic diseases. The aim of this consensus document is to provide up-to-date recommendations and evidence grading on the indications for treatment, based on evidence accumulated during the past decade, under the auspices of the International Compression Club. Methods A systematic literature review was conducted and, using PRISMA guidelines, 51 relevant publications were selected for an evidence-based analysis of an initial 2407 unrefined results. Key search terms included: ‘acute', CEAP', ‘chronic', ‘compression stockings', ‘compression therapy', ‘lymph', ‘lymphatic disease', ‘vein' and ‘venous disease'. Evidence extracted from the publications was graded initially by the panel members individually and then refined at the consensus meeting. Results Based on the current evidence, 25 recommendations for chronic and acute venous disorders were made. Of these, 24 recommendations were graded as: Grade 1A (n = 4), 1B (n = 13), 1C (n = 2), 2B (n = 4) and 2C (n = 1). The panel members found moderately robust evidence for medical compression stockings in patients with venous symptoms and prevention and treatment of venous oedema. Robust evidence was found for prevention and treatment of venous leg ulcers. Recommendations for stocking-use after great saphenous vein interventions were limited to the first post-interventional week. No randomised clinical trials are available that document a prophylactic effect of medical compression stockings on the progression of chronic venous disease (CVD). In acute deep vein thrombosis, immediate compression is recommended to reduce pain and swelling. Despite conflicting results from a recent study to prevent post-thrombotic syndrome, medical compression stockings are still recommended. In thromboprophylaxis, the role of stockings in addition to anticoagulation is limited. For the maintenance phase

Variations in achievement of evidence-based, high-impact quality indicators in general practice: An observational study

PubMed Central

West, Robert; Rushforth, Bruno; Stokes, Tim; Glidewell, Liz; Carder, Paul; Faulkner, Simon; Foy, Robbie

2017-01-01

Background There are widely recognised variations in the delivery and outcomes of healthcare but an incomplete understanding of their causes. There is a growing interest in using routinely collected ‘big data’ in the evaluation of healthcare. We developed a set of evidence-based ‘high impact’ quality indicators (QIs) for primary care and examined variations in achievement of these indicators using routinely collected data in the United Kingdom (UK). Methods Cross-sectional analysis of routinely collected, electronic primary care data from a sample of general practices in West Yorkshire, UK (n = 89). The QIs covered aspects of care (including processes and intermediate clinical outcomes) in relation to diabetes, hypertension, atrial fibrillation, myocardial infarction, chronic kidney disease (CKD) and ‘risky’ prescribing combinations. Regression models explored the impact of practice and patient characteristics. Clustering within practice was accounted for by including a random intercept for practice. Results Median practice achievement of the QIs ranged from 43.2% (diabetes control) to 72.2% (blood pressure control in CKD). Considerable between-practice variation existed for all indicators: the difference between the highest and lowest performing practices was 26.3 percentage points for risky prescribing and 100 percentage points for anticoagulation in atrial fibrillation. Odds ratios associated with the random effects for practices emphasised this; there was a greater than ten-fold difference in the likelihood of achieving the hypertension indicator between the lowest and highest performing practices. Patient characteristics, in particular age, gender and comorbidity, were consistently but modestly associated with indicator achievement. Statistically significant practice characteristics were identified less frequently in adjusted models. Conclusions Despite various policy and improvement initiatives, there are enduring inappropriate variations in the

Cosmetics for acne: indications and recommendations for an evidence-based approach.

PubMed

Dall'oglio, F; Tedeschi, A; Fabbrocini, G; Veraldi, S; Picardo, M; Micali, G

2015-02-01

The aim of this review was to evaluate, by a thorough revision of the literature, the true efficacy of currently available topic and systemic cosmetic acne agents. The efficacy of currently available cosmetic acne agents has been retrospectively evaluated via thorough revision of the literature on matched electronic databases (PubMed). All retrieved studies, either randomized clinical trials or clinical trials, controlled or uncontrolled were considered. Scientific evidence suggests that most cosmetic products for acne may enhance the clinical outcome. Cleansers should be indicated to all acne patients; those containing benzoyl peroxide or azelaic/salicylic acid/triclosan show the best efficacy profile. Sebum-controlling agents containing nicotinamide or zinc acetate may minimize excessive sebum production. Cosmetics with antimicrobial and anti-inflammatory substances such as, respectively, ethyl lactate or phytosphingosine and nicotinamide or resveratrol, may speed acne recovery. Topical corneolytics, including retinaldehyde/glycolic acid or lactic acid, induce a comedolytic effect and may also facilitate skin absorption of topical drugs. Finally, the use of specific moisturizers should be strongly recommended in all acne patients. Cosmetics, if correctly prescribed, may improve the performance of the therapy, whereas wrong procedures and/or inadequate cosmetics may worsen acne. Cosmetological recommendations may allow clinicians to make informed decisions about the role of various cosmetics and to indentify the appropriate indications and precautions. The choice of the most effective product should take into consideration the ongoing pharmacological therapy and acne type/severity as well.

The impact of energy, agriculture, macroeconomic and human-induced indicators on environmental pollution: evidence from Ghana.

PubMed

Asumadu-Sarkodie, Samuel; Owusu, Phebe Asantewaa

2017-03-01

In this study, the impact of energy, agriculture, macroeconomic and human-induced indicators on environmental pollution from 1971 to 2011 is investigated using the statistically inspired modification of partial least squares (SIMPLS) regression model. There was evidence of a linear relationship between energy, agriculture, macroeconomic and human-induced indicators and carbon dioxide emissions. Evidence from the SIMPLS regression shows that a 1% increase in crop production index will reduce carbon dioxide emissions by 0.71%. Economic growth increased by 1% will reduce carbon dioxide emissions by 0.46%, which means that an increase in Ghana's economic growth may lead to a reduction in environmental pollution. The increase in electricity production from hydroelectric sources by 1% will reduce carbon dioxide emissions by 0.30%; thus, increasing renewable energy sources in Ghana's energy portfolio will help mitigate carbon dioxide emissions. Increasing enteric emissions by 1% will increase carbon dioxide emissions by 4.22%, and a 1% increase in the nitrogen content of manure management will increase carbon dioxide emissions by 6.69%. The SIMPLS regression forecasting exhibited a 5% MAPE from the prediction of carbon dioxide emissions.

A Health 'Kuznets' Curve'? Cross-Sectional and Longitudinal Evidence on Concentration Indices'.

PubMed

Costa-Font, Joan; Hernandez-Quevedo, Cristina; Sato, Azusa

2018-01-01

The distribution of income related health inequalities appears to exhibit changing patterns when both developing countries and developed countries are examined. This paper tests for the existence of a health Kuznets' curve; that is, an inverse U-shape pattern between economic developments (as measured by GDP per capita) and income-related health inequalities (as measured by concentration indices). We draw upon both cross sectional (the World Health Survey) and a long longitudinal (the European Community Household Panel survey) dataset. Our results suggest evidence of a health Kuznets' curve on per capita income. We find a polynomial association where inequalities decline when GDP per capita reaches a magnitude ranging between $26,000 and $38,700. That is, income-related health inequalities rise with GDP per capita, but tail off once a threshold level of economic development has been attained.

Optical spectra obtained from amorphous films of rubrene: Evidence for predominance of twisted isomer

NASA Astrophysics Data System (ADS)

Kytka, M.; Gisslen, L.; Gerlach, A.; Heinemeyer, U.; Kováč, J.; Scholz, R.; Schreiber, F.

2009-06-01

In order to investigate the optical properties of rubrene we study the vibronic progression of the first absorption band (lowest π →π∗ transition). We analyze the dielectric function ɛ2 of rubrene in solution and thin films using the displaced harmonic oscillator model and derive all relevant parameters of the vibronic progression. The findings are supplemented by density functional calculations using B3LYP hybrid functionals. Our theoretical results for the molecule in two different conformations, i.e., with a twisted or planar tetracene backbone, are in very good agreement with the experimental data obtained for rubrene in solution and thin films. Moreover, a simulation based on the monomer spectrum and the calculated transition energies of the two conformations indicates that the thin film spectrum of rubrene is dominated by the twisted isomer.

Optical spectra obtained from amorphous films of rubrene: Evidence for predominance of twisted isomer.

PubMed

Kytka, M; Gisslen, L; Gerlach, A; Heinemeyer, U; Kovác, J; Scholz, R; Schreiber, F

2009-06-07

In order to investigate the optical properties of rubrene we study the vibronic progression of the first absorption band (lowest pi-->pi( *) transition). We analyze the dielectric function epsilon(2) of rubrene in solution and thin films using the displaced harmonic oscillator model and derive all relevant parameters of the vibronic progression. The findings are supplemented by density functional calculations using B3LYP hybrid functionals. Our theoretical results for the molecule in two different conformations, i.e., with a twisted or planar tetracene backbone, are in very good agreement with the experimental data obtained for rubrene in solution and thin films. Moreover, a simulation based on the monomer spectrum and the calculated transition energies of the two conformations indicates that the thin film spectrum of rubrene is dominated by the twisted isomer.

An Evaluation of the Evidence Base for Performance Feedback to Improve Teacher Praise Using CEC's Quality Indicators

ERIC Educational Resources Information Center

Sweigart, Chris A.; Collins, Lauren W.; Evanovich, Lauren L.; Cook, Sara Cothren

2016-01-01

Despite a rich body of empirical evidence that supports the use of teacher praise to improve student outcomes, it continues to be underused in practice. One method of ameliorating this problem is the use of performance feedback. Although some studies have indicated that the use of performance feedback is an effective approach for increasing…

A multidisciplinary weight of evidence approach for environmental risk assessment at the Costa Concordia wreck: Integrative indices from Mussel Watch.

PubMed

Regoli, Francesco; Pellegrini, David; Cicero, Anna Maria; Nigro, Marco; Benedetti, Maura; Gorbi, Stefania; Fattorini, Daniele; D'Errico, Giuseppe; Di Carlo, Marta; Nardi, Alessandro; Gaion, Andrea; Scuderi, Alice; Giuliani, Silvia; Romanelli, Giulia; Berto, Daniela; Trabucco, Benedetta; Guidi, Patrizia; Bernardeschi, Margherita; Scarcelli, Vittoria; Frenzilli, Giada

2014-05-01

A complex framework of chemical, biological and oceanographic activities was immediately activated after the Costa Concordia shipwreck, to assess possible contamination events and the environmental impact during both emergency and wreck removal operations. In the present paper, we describe the results obtained with caged mussels, Mytilus galloprovincialis, chosen as bioindicator organisms to detect variations of bioavailability and the early onset of molecular and cellular effects (biomarkers). Seven translocation experiments were carried out during the first year from the incident, with organisms deployed at 2 depths in 3 different sites. After 4-6 weeks, tissue concentrations were measured for the main classes of potentially released chemicals (trace metals, polycyclic aromatic hydrocarbons, volatile and aliphatic hydrocarbons, polychlorinated biphenyls, halogenated pesticides, organotin compounds, brominated flame retardants, anionic surfactants); a wide battery of biomarkers covered responses indicative of exposure, detoxification, oxidative stress, cell damage and genotoxic effects. Results excluded serious contamination events or a consistent increase of environmental pollution although some episodic spills with reversible effects were detected. Data were elaborated within a quantitative weight of evidence (WOE) model which provided synthetic hazard indices for each typology of data, before their overall integration in an environmental risk index, which generally ranged from slight to moderate. The proposed WOE model was confirmed a useful tool to summarize large datasets of complex data in integrative indices, and to simplify the interpretation for stakeholders and decision makers, thus supporting a more comprehensive process of "site-oriented" management decisions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Using the Theoretical Domains Framework (TDF) to understand adherence to multiple evidence-based indicators in primary care: a qualitative study.

PubMed

Lawton, Rebecca; Heyhoe, Jane; Louch, Gemma; Ingleson, Emma; Glidewell, Liz; Willis, Thomas A; McEachan, Rosemary R C; Foy, Robbie

2016-08-08

There are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier screened clinical guideline recommendations to derive a set of 'high-impact' indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. Here, we explore health professionals' perceived determinants of adherence to these indicators, examining the degree to which determinants were indicator-specific or potentially generalisable across indicators. We interviewed 60 general practitioners, practice nurses and practice managers in West Yorkshire, the UK, about adherence to four indicators: avoidance of risky prescribing; treatment targets in type 2 diabetes; blood pressure targets in treated hypertension; and anticoagulation in atrial fibrillation. Interview questions drew upon the Theoretical Domains Framework (TDF). Data were analysed using framework analysis. Professional role and identity and environmental context and resources featured prominently across all indicators whilst the importance of other domains, for example, beliefs about consequences, social influences and knowledge varied across indicators. We identified five meta-themes representing more general organisational and contextual factors common to all indicators. The TDF helped elicit a wide range of reported determinants of adherence to 'high-impact' indicators in primary care. It was more difficult to pinpoint which determinants, if targeted by an implementation strategy, would maximise change. The meta-themes broadly underline the need to align the design of interventions targeting general practices with higher level supports and broader contextual considerations. However, our findings suggest that it is feasible to develop interventions to promote the uptake of different evidence-based indicators which share common features whilst also including

Towards evidence-based management: creating an informative database of nursing-sensitive indicators.

PubMed

Patrician, Patricia A; Loan, Lori; McCarthy, Mary; Brosch, Laura R; Davey, Kimberly S

2010-12-01

The purpose of this paper is to describe the creation, evolution, and implementation of a database of nursing-sensitive and potentially nursing-sensitive indicators, the Military Nursing Outcomes Database (MilNOD). It discusses data quality, utility, and lessons learned. Prospective data collected each shift include direct staff hours by levels (i.e., registered nurse, other licensed and unlicensed providers), staff categories (i.e., military, civilian, contract, and reservist), patient census, acuity, and admissions, discharges, and transfers. Retrospective adverse event data (falls, medication errors, and needle-stick injuries) were collected from existing records. Annual patient satisfaction, nurse work environment, and pressure ulcer and restraint prevalence surveys were conducted. The MilNOD contains shift level data from 56 units in 13 military hospitals and is used to target areas for managerial and clinical performance improvement. This methodology can be modified for use in other healthcare systems. As standard tools for evidence-based management, databases such as MilNOD allow nurse leaders to track the status of nursing and adverse events in their facilities. No claim to original US government works.

Are glendonites reliable indicators of cold conditions? Evidence from the Lower Cretaceous of Spitsbergen

NASA Astrophysics Data System (ADS)

Vickers, Madeleine; Price, Gregory; Watkinson, Matthew; Jerrett, Rhodri

2017-04-01

Glendonites are pseudomorphs after the mineral ikaite, and have been found in marine sediments throughout geological time. Ikaite is a metastable, hydrated form of calcium carbonate, which is only stable under specific conditions: between -2 and +5 °C, and with high alkalinity and phosphate concentrations. Glendonites are often associated with cold climates due to the strong temperature control on ikaite growth, and the coincidence in the geological record with episodes of global cooling. Glendonites are found in the Lower Cretaceous succession in Spitsbergen. During the Early Cretaceous, Spitsbergen was at a palaeolatitude of 60°N, and was part of a shallow epicontinental sea that formed during the Mesozoic as Atlantic rifting propagated northwards. Though the Early Cretaceous was generally characterised by greenhouse climate conditions, episodic cold snaps occurred during the Valanginian (the "Weissert Event") and during Aptian-Albian. Using high resolution carbon-isotope stratigraphy, we show that the first occurrences of glendonites are in the upper Lower Hauterivian and in the very upper Upper Hauterivian, stratigraphically higher than the Valanginian cooling event. Glendonites are also found in horizons in the Upper Aptian, coincident with the Aptian-Albian cold snap. Petrological analysis of the glendonite structure reveals differences between the Hauterivian and Aptian glendonites, with evidence for multiple diagenetic phases of growth in the Hauterivian glendonites, suggesting oscillating chemical conditions. This evidence suggests that local environmental conditions may have a stronger control on glendonite formation and preservation than global climate. We present a new model for ikaite growth and slow transformation to glendonite in marine sediments, which points to a more complex suite of diagenetic transformations than previously modelled. Furthermore, we critically assess whether such pseudomorphs after marine sedimentary ikaite may be indicators

Does CT evidence of a flat inferior vena cava indicate hypovolemia in blunt trauma patients with solid organ injuries?

PubMed

Liao, Yu-Ying; Lin, Hung-Jung; Lu, Yu-Hui; Foo, Ning-Ping; Guo, How-Ran; Chen, Kuo-Tai

2011-06-01

Nonoperative management for selective patients with solid organ injuries from blunt trauma has gained wide acceptance. However, for trauma surgeons, it is often difficult to estimate a patient's circulatory volume. Some authors have proposed that the presence of a collapsed inferior vena cava (IVC) on computed tomography (CT) scan correlates with inadequate circulatory volume. Our aim was to verify whether CT evidence of a flat IVC (FI) is an indicator of hypovolemia in blunt trauma patients with solid organ injuries. We conducted a retrospective chart review of all blunt trauma patients with solid organ injuries admitted to our Medical Center from July 2003 to September 2006. Of the 226 patients reviewed, 29 had CT evidence of FI. We compared Injury Severity Scores, hemodynamic parameters, fluid and blood transfusion requirements, mortality rate, and hospital course between patients with (FI group) and without FI (non-FI [NFI] group). The FI group had higher rates of intensive care unit admission and mortality, in addition to longer intensive care unit stays, when compared with the NFI group. In addition, the patients in the FI group needed larger amounts of fluid and blood transfusions and presented lower hemoglobin levels during the first week of admission; furthermore, the majority deteriorated to a state of shock in the emergency department. CT evidence of FI is a good indicator of hypovolemia and an accurate predictor for prognosis in trauma patients with blunt solid organ injuries.

An Evidence-Based Review Literature About Risk Indicators and Management of Unknown-Origin Xerostomia

PubMed Central

Agha-Hosseini, Farzaneh; Moosavi, Mahdieh-Sadat

2013-01-01

This evidence-based article reviews risk indicators and management of unknown-origin xerostomia. Xerostomia and hyposalivation refer to different aspects of dry mouth. Xerostomia is a subjective sensation of dry mouth, whilst hyposalivation is defined as an objective assessment of reduced salivary flow rate. About 30% of the elderly (65 years and older) experience xerostomia and hyposalivation. Structural and functional factors, or both may lead to salivary gland dysfunction. The EBM literature search was conducted by using the medical literature database MEDLINE via PubMed and OvidMedline search engines. Results were limited to English language articles (1965 to present) including clinical trials (CT), randomized controlled trials (RCT), systematic reviews and review articles. Case control or cohort studies were included for the etiology. Neuropathic etiology such as localized oral alteration of thermal sensations, saliva composition change (for example higher levels of K, Cl, Ca, IgA, amylase, calcium, PTH and cortisol), lower levels of estrogen and progesterone, smaller salivary gland size, and illnesses such as lichen planus, are risk indicators for unknown-origin xerostomia. The management is palliative and preventative. Management of symptoms includes drug administration (systemic secretogogues, saliva substitutes and bile secretion-stimulator), night guard, diet and habit modifications. Other managements may be indicated to treat adverse effects. Neuropathic etiology, saliva composition change, smaller salivary gland size, and illnesses such as oral lichen planus can be suggestive causes for unknown-origin xerostomia. However, longitudinal studies will be important to elucidate the causes of unknown-origin xerostomia. PMID:25512755

Linking quality indicators to clinical trials: an automated approach

PubMed Central

Coiera, Enrico; Choong, Miew Keen; Tsafnat, Guy; Hibbert, Peter; Runciman, William B.

2017-01-01

Abstract Objective Quality improvement of health care requires robust measurable indicators to track performance. However identifying which indicators are supported by strong clinical evidence, typically from clinical trials, is often laborious. This study tests a novel method for automatically linking indicators to clinical trial registrations. Design A set of 522 quality of care indicators for 22 common conditions drawn from the CareTrack study were automatically mapped to outcome measures reported in 13 971 trials from ClinicalTrials.gov. Intervention Text mining methods extracted phrases mentioning indicators and outcome phrases, and these were compared using the Levenshtein edit distance ratio to measure similarity. Main Outcome Measure Number of care indicators that mapped to outcome measures in clinical trials. Results While only 13% of the 522 CareTrack indicators were thought to have Level I or II evidence behind them, 353 (68%) could be directly linked to randomized controlled trials. Within these 522, 50 of 70 (71%) Level I and II evidence-based indicators, and 268 of 370 (72%) Level V (consensus-based) indicators could be linked to evidence. Of the indicators known to have evidence behind them, only 5.7% (4 of 70) were mentioned in the trial reports but were missed by our method. Conclusions We automatically linked indicators to clinical trial registrations with high precision. Whilst the majority of quality indicators studied could be directly linked to research evidence, a small portion could not and these require closer scrutiny. It is feasible to support the process of indicator development using automated methods to identify research evidence. PMID:28651340

Development and pilot test of a new set of good practice indicators for chronic non-malignant pain management.

PubMed

Saturno, Pedro Jesus; Angel-García, Daniel; Martínez-Nicolás, Ismael; López Soriano, Francisco; Escolar Reina, Maria Pilar; Guerrero Díaz, María Beatriz; Ros Martínez, María Encarnación; Medina Mirapeix, Francesc; Saturno Marcos, Mayo

2018-06-08

This study was designed to address the current relative void of valid measures by developing evidence-based quality indicators for pain management of chronic non-malignant pain. We performed a 10-year literature search to identify guidelines and review articles on chronic pain management to identify evidence-based recommendations for the different conditions associated to chronic pain. A complementary search of indicators and indicator-related articles was also performed. Then, we built new indicators or adapted existing ones to cover all the evidence-based recommendations we found. The resulting set was pilot-tested for feasibility, reliability (kappa) and usefulness to identify quality problems, using the Lot Quality Acceptance method, α≤0.05 y β≤0.01, for 75% (40% threshold) and 95% (70% threshold) compliance standards, and estimates with binomial exact 95% confidence intervals. The study reviews clinical records from a primary-care centre, a medium-size hospital (250 beds) and a large hospital (500 beds). Forty-six indicators were developed (six general and forty condition-specific). Thirty-three were feasible in primary care and/or hospitals. Feasible indicators were also reliable (most kappa>0.7). Regarding compliance, four quality indicators obtained compliance levels over 60%, addressing pharmacological treatment, multimodal approach and appropriate use of neuro-image tests; while sixteen obtained compliance scores under 15% (six with 0% compliance). The created set has tested to be feasible, reliable, and useful, with the capacity to serve as the baseline for developing the necessary strategies to improve the management of chronic non-malignant pain, by monitoring and evaluating quality of care. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Characteristics of efficacy evidence supporting approval of supplemental indications for prescription drugs in United States, 2005-14: systematic review.

PubMed

Wang, Bo; Kesselheim, Aaron S

2015-09-23

To characterize the types of comparators and endpoints used in efficacy trials for approvals of supplemental indications, compared with the data supporting these drugs' originally approved indications. Systematic review. Publicly accessible data on supplemental indications approved by the US Food and Drug Administration from 2005 to 2014. Types of comparators (active, placebo, historical, none) and endpoints (clinical outcomes, clinical scales, surrogate) in the efficacy trials for these drugs' supplemental and original indication approvals. The cohort included 295 supplemental indications. Thirty per cent (41/136) of supplemental approvals for new indications were supported by efficacy trials with active comparators, compared with 51% (47/93) of modified use approvals and 11% (7/65) of approvals expanding the patient population (P<0.001), almost all of which related to pediatric patients (61/65; 94%). Trials using clinical outcome endpoints led to approval for 32% (44/137) of supplemental approvals for new indications, 30% (28/93) of modified indication approvals, and 22% (14/65) of expanded population approvals (P=0.29). Orphan drugs had supplemental approvals for 40 non-orphan indications, which were supported by similar proportions of trials using active comparators (28% (11/40) for non-orphan supplemental indications versus 24% (10/42) for original orphan indications; P=0.70) and clinical outcome endpoints (25% (10/40) versus 31% (13/42); P=0.55). Wide variations were seen in the evidence supporting approval of supplemental indications, with the fewest active comparators and clinical outcome endpoints used in trials leading to supplemental approvals that expanded the patient population. © Wang et al 2015.

Corroborating evidence-based medicine.

PubMed

Mebius, Alexander

2014-12-01

Proponents of evidence-based medicine (EBM) have argued convincingly for applying this scientific method to medicine. However, the current methodological framework of the EBM movement has recently been called into question, especially in epidemiology and the philosophy of science. The debate has focused on whether the methodology of randomized controlled trials provides the best evidence available. This paper attempts to shift the focus of the debate by arguing that clinical reasoning involves a patchwork of evidential approaches and that the emphasis on evidence hierarchies of methodology fails to lend credence to the common practice of corroboration in medicine. I argue that the strength of evidence lies in the evidence itself, and not the methodology used to obtain that evidence. Ultimately, when it comes to evaluating the effectiveness of medical interventions, it is the evidence obtained from the methodology rather than the methodology that should establish the strength of the evidence. © 2014 John Wiley & Sons, Ltd.

Neural Correlates of Indicators of Sound Change in Cantonese: Evidence from Cortical and Subcortical Processes.

PubMed

Maggu, Akshay R; Liu, Fang; Antoniou, Mark; Wong, Patrick C M

2016-01-01

Across time, languages undergo changes in phonetic, syntactic, and semantic dimensions. Social, cognitive, and cultural factors contribute to sound change, a phenomenon in which the phonetics of a language undergo changes over time. Individuals who misperceive and produce speech in a slightly divergent manner (called innovators ) contribute to variability in the society, eventually leading to sound change. However, the cause of variability in these individuals is still unknown. In this study, we examined whether such misperceptions are represented in neural processes of the auditory system. We investigated behavioral, subcortical (via FFR), and cortical (via P300) manifestations of sound change processing in Cantonese, a Chinese language in which several lexical tones are merging. Across the merging categories, we observed a similar gradation of speech perception abilities in both behavior and the brain (subcortical and cortical processes). Further, we also found that behavioral evidence of tone merging correlated with subjects' encoding at the subcortical and cortical levels. These findings indicate that tone-merger categories, that are indicators of sound change in Cantonese, are represented neurophysiologically with high fidelity. Using our results, we speculate that innovators encode speech in a slightly deviant neurophysiological manner, and thus produce speech divergently that eventually spreads across the community and contributes to sound change.

Neural Correlates of Indicators of Sound Change in Cantonese: Evidence from Cortical and Subcortical Processes

PubMed Central

Maggu, Akshay R.; Liu, Fang; Antoniou, Mark; Wong, Patrick C. M.

2016-01-01

Across time, languages undergo changes in phonetic, syntactic, and semantic dimensions. Social, cognitive, and cultural factors contribute to sound change, a phenomenon in which the phonetics of a language undergo changes over time. Individuals who misperceive and produce speech in a slightly divergent manner (called innovators) contribute to variability in the society, eventually leading to sound change. However, the cause of variability in these individuals is still unknown. In this study, we examined whether such misperceptions are represented in neural processes of the auditory system. We investigated behavioral, subcortical (via FFR), and cortical (via P300) manifestations of sound change processing in Cantonese, a Chinese language in which several lexical tones are merging. Across the merging categories, we observed a similar gradation of speech perception abilities in both behavior and the brain (subcortical and cortical processes). Further, we also found that behavioral evidence of tone merging correlated with subjects' encoding at the subcortical and cortical levels. These findings indicate that tone-merger categories, that are indicators of sound change in Cantonese, are represented neurophysiologically with high fidelity. Using our results, we speculate that innovators encode speech in a slightly deviant neurophysiological manner, and thus produce speech divergently that eventually spreads across the community and contributes to sound change. PMID:28066218

The earliest fossil evidence for sexual dimorphism in primates

NASA Technical Reports Server (NTRS)

Krishtalka, Leonard; Stucky, Richard K.; Beard, K. C.

1990-01-01

Recently obtained material of the early Eocene primate Notharctus venticolus, including two partial skulls from a single stratigraphic horizon, provides the geologically earliest evidence of sexual dimorphism in canine size and shape in primates and the only unequivocal evidence for such dimorphism in strepsirhines. By analogy with living platyrrhines, these data suggest that Notharctus venticolus may have lived in polygynous social groups characterized by a relatively high level of intermale competition for mates and other limited resources. The anatomy of the upper incisors and related evidence imply that Notharctus is not as closely related to extant lemuriform primates as has been recently proposed. The early Eocene evidence for canine sexual dimorphism reported here, and its occurrence in a nonanthropoid, indicates that in the order Primates such a condition is either primitive or evolved independently more than once.

Characteristics of efficacy evidence supporting approval of supplemental indications for prescription drugs in United States, 2005-14: systematic review

PubMed Central

Wang, Bo

2015-01-01

Objective To characterize the types of comparators and endpoints used in efficacy trials for approvals of supplemental indications, compared with the data supporting these drugs’ originally approved indications. Design Systematic review. Setting Publicly accessible data on supplemental indications approved by the US Food and Drug Administration from 2005 to 2014. Main outcome measures Types of comparators (active, placebo, historical, none) and endpoints (clinical outcomes, clinical scales, surrogate) in the efficacy trials for these drugs’ supplemental and original indication approvals. Results The cohort included 295 supplemental indications. Thirty per cent (41/136) of supplemental approvals for new indications were supported by efficacy trials with active comparators, compared with 51% (47/93) of modified use approvals and 11% (7/65) of approvals expanding the patient population (P<0.001), almost all of which related to pediatric patients (61/65; 94%). Trials using clinical outcome endpoints led to approval for 32% (44/137) of supplemental approvals for new indications, 30% (28/93) of modified indication approvals, and 22% (14/65) of expanded population approvals (P=0.29). Orphan drugs had supplemental approvals for 40 non-orphan indications, which were supported by similar proportions of trials using active comparators (28% (11/40) for non-orphan supplemental indications versus 24% (10/42) for original orphan indications; P=0.70) and clinical outcome endpoints (25% (10/40) versus 31% (13/42); P=0.55). Conclusions Wide variations were seen in the evidence supporting approval of supplemental indications, with the fewest active comparators and clinical outcome endpoints used in trials leading to supplemental approvals that expanded the patient population. PMID:26400844

An environmental scan of quality indicators in critical care.

PubMed

Valiani, Sabira; Rigal, Romain; Stelfox, Henry T; Muscedere, John; Martin, Claudio M; Dodek, Peter; Lamontagne, François; Fowler, Robert; Gheshmy, Afshan; Cook, Deborah J; Forster, Alan J; Hébert, Paul C

2017-06-21

We performed a directed environmental scan to identify and categorize quality indicators unique to critical care that are reported by key stakeholder organizations. We convened a panel of experts ( n = 9) to identify key organizations that are focused on quality improvement or critical care, and reviewed their online publications and website content for quality indicators. We identified quality indicators specific to the care of critically ill adult patients and then categorized them according to the Donabedian and the Institute of Medicine frameworks. We also noted the organizations' rationale for selecting these indicators and their reported evidence base. From 28 targeted organizations, we identified 222 quality indicators, 127 of which were unique. Of the 127 indicators, 63 (32.5%) were safety indicators and 61 (31.4%) were effectiveness indicators. The rationale for selecting quality indicators was supported by consensus for 58 (26.1%) of the 222 indicators and by published research evidence for 45 (20.3%); for 119 indicators (53.6%), the rationale was not reported or the reader was referred to other organizations' reports. Of the 127 unique quality indicators, 27 (21.2%) were accompanied by a formal grading of evidence, whereas for 52 (40.9%), no reference to evidence was provided. There are many quality indicators related to critical care that are available in the public domain. However, owing to a paucity of rationale for selection, supporting evidence and results of implementation, it is not clear which indicators should be adopted for use. Copyright 2017, Joule Inc. or its licensors.

An environmental scan of quality indicators in critical care

PubMed Central

Valiani, Sabira; Rigal, Romain; Stelfox, Henry T.; Muscedere, John; Martin, Claudio M.; Dodek, Peter; Lamontagne, François; Fowler, Robert; Gheshmy, Afshan; Cook, Deborah J.; Forster, Alan J.; Hébert, Paul C.

2017-01-01

Background: We performed a directed environmental scan to identify and categorize quality indicators unique to critical care that are reported by key stakeholder organizations. Methods: We convened a panel of experts (n = 9) to identify key organizations that are focused on quality improvement or critical care, and reviewed their online publications and website content for quality indicators. We identified quality indicators specific to the care of critically ill adult patients and then categorized them according to the Donabedian and the Institute of Medicine frameworks. We also noted the organizations' rationale for selecting these indicators and their reported evidence base. Results: From 28 targeted organizations, we identified 222 quality indicators, 127 of which were unique. Of the 127 indicators, 63 (32.5%) were safety indicators and 61 (31.4%) were effectiveness indicators. The rationale for selecting quality indicators was supported by consensus for 58 (26.1%) of the 222 indicators and by published research evidence for 45 (20.3%); for 119 indicators (53.6%), the rationale was not reported or the reader was referred to other organizations' reports. Of the 127 unique quality indicators, 27 (21.2%) were accompanied by a formal grading of evidence, whereas for 52 (40.9%), no reference to evidence was provided. Interpretation: There are many quality indicators related to critical care that are available in the public domain. However, owing to a paucity of rationale for selection, supporting evidence and results of implementation, it is not clear which indicators should be adopted for use. PMID:28637683

Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector.

PubMed

Croes, R R; Krabbe-Alkemade, Y J F M; Mikkers, M C

2018-01-01

There is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be characterized as a system involving managed competition and mandatory healthcare insurance. Information about the quality of care provided by hospitals has been publicly available since 2008. In this paper, we evaluate the relationship between quality scores for three diagnosis groups and the market power indicators of hospitals. We estimate the impact of competition on quality in an environment of liberalized pricing. For this research, we used unique price and production data relating to three diagnosis groups (cataract, adenoid and tonsils, bladder tumor) produced by Dutch hospitals in the period 2008-2011. We also used the quality indicators relating to these diagnosis groups. We reveal a negative relationship between market share and quality score for two of the three diagnosis groups studied, meaning that hospitals in competitive markets have better quality scores than those in concentrated markets. We therefore conclude that more competition is associated with higher quality scores.

Do Chinese Readers Obtain Preview Benefit from Word "n" + 2? Evidence from Eye Movements

ERIC Educational Resources Information Center

Yang, Jinmian; Wang, Suiping; Xu, Yimin; Rayner, Keith

2009-01-01

The boundary paradigm (K. Rayner, 1975) was used to determine the extent to which Chinese readers obtain information from the right of fixation during reading. As characters are the basic visual unit in written Chinese, they were used as targets in Experiment 1 to examine whether readers obtain preview information from character "n" + 1 and…

Cytochemical and Cytofluorometric Evidence for Guard Cell Photosystems 1

PubMed Central

Vaughn, Kevin C.; Outlaw, William H.

1983-01-01

Evidence for photosynthetic linear electron transport in guard cells was obtained with two sensitive methods of high spacial resolution. Light-dependent diaminobenzidine oxidation (an indicator of PSI) and DCMU-sensitive, light-dependent thiocarbamyl nitroblue tetrazolium reduction (an indicator of PSII) were observed in guard cell plastids of Hordeum vulgare L. cv Himalaya using electron microscopic cytochemical procedures. DCMU-sensitive Chl a fluorescence induction (an indicator of PSII) was detected in individual guard cell pairs of Vicia faba L. cv Longpod using an ultramicrofluorometer. At least for these species, we conclude these results are proof for the presence of PSII in guard cell chloroplasts, which until now has been somewhat controversial. Images Fig. 2 Fig. 1 PMID:16662840

Treatments for somnambulism in adults: assessing the evidence.

PubMed

Harris, Melanie; Grunstein, Ronald R

2009-08-01

Somnambulism, or sleepwalking, is a parasomnia of non-rapid eye movement (NREM) sleep where movement behaviours usually confined to wakefulness are displayed during sleep. Generally, if sleepwalking is causing distress or danger in spite of safety measures, medical or psychological treatment is indicated. Clinicians will need to assess the evidence for treatment options. MEDLINE, EMBASE, PsycINFO and the Ovid Evidence-Based Medicine Reviews (EBM) multifile databases were searched. No properly powered rigorous controlled trials were found for treatment of sleepwalking in adults. Seven reports described small trials with some kind of control arm, or retrospective case series which included 30 or more patients. With no high quality evidence to underpin recommendations for treatments of somnambulism, full discussion with patients is advised. Adequately powered, well-designed clinical trials are now needed, and multi-centre collaborations may be required to obtain the sample sizes required.

New apheresis indications in hematological disorders.

PubMed

Pham, Huy P; Schwartz, Joseph

2016-11-01

Therapeutic apheresis can be used to treat many diseases. The American Society for Apheresis (ASFA) publishes Guidelines on the use of therapeutic apheresis every 3 years with the goal of providing the best available evidence for apheresis practice as well as clinical expertise. The 2016 (7th ed.) ASFA Guidelines contain 87 diseases (up from 78 in the 6th ed.) and 179 indications. This review outlines three new therapeutic apheresis indications for hematological disorders. The three new nonmalignant and nontransplant-related hematological disorders discussed are therapeutic plasma exchange procedures for hemophagocytic syndrome, hemolysis, elevated liver enzymes, and low platelets syndrome, and red blood cell exchange to prevent alloimmunization after exposure to rhesus (D)-positive red blood cells. All three indications are ASFA category III indications (i.e., optimal role of apheresis therapy is not established) with Grade 2C recommendation (weak recommendation, low-quality evidence). Although the three new therapeutic apheresis indications related to hematological disorders are ASFA category III with Grade 2C recommendations, along with other ASFA category III with Grade 2C recommendations, they may form the list of diseases for which basic, translational, and clinical research is needed to provide better evidence for clinical practice.

Edible Acid-Base Indicators.

ERIC Educational Resources Information Center

Mebane, Robert C.; Rybolt, Thomas R.

1985-01-01

Reports on the colors observed during titrations of 15 natural indicators obtained from common fruits and vegetables. These edible indicators can be used for a variety of teacher demonstrations or for simple student experiments. (JN)

Indicators of activity-friendly communities: an evidence-based consensus process.

PubMed

Brennan Ramirez, Laura K; Hoehner, Christine M; Brownson, Ross C; Cook, Rebeka; Orleans, C Tracy; Hollander, Marla; Barker, Dianne C; Bors, Philip; Ewing, Reid; Killingsworth, Richard; Petersmarck, Karen; Schmid, Thomas; Wilkinson, William

2006-12-01

Regular physical activity, even at modest intensities, is associated with many health benefits. Most Americans, however, do not engage in the recommended levels. As practitioners seek ways to increase population rates of physical activity, interventions and advocacy efforts are being targeted to the community level. Yet, advocates, community leaders, and researchers lack the tools needed to assess local barriers to and opportunities for more active, healthy lifestyles. Investigators used a systematic review process to identify key indicators of activity-friendly communities that can assess and improve opportunities for regular physical activity. Investigators conducted a comprehensive literature review of both peer-reviewed literature and fugitive information (e.g., reports and websites) to generate an initial list of indicators for review (n=230). The review included a three-tiered, modified Delphi consensus-development process that incorporated input of international, national, state, and local researchers and practitioners from academic institutions, federal and state government agencies, nonprofit organizations, and funding agencies in public health, transportation, urban planning, parks and recreation, and public policy. Ten promising indicators of activity-friendly communities were identified: land use environment, access to exercise facilities, transportation environment, aesthetics, travel patterns, social environment, land use economics, transportation economics, institutional and organizational policies, and promotion. Collaborative, multidisciplinary approaches are underway to test, refine, and expand this initial list of indicators and to develop measures that communities, community leaders, and policymakers can use to design more activity-friendly community environments.

How stable are diurnal cortisol activity indices in healthy individuals? Evidence from three multi-wave studies

PubMed Central

Ross, Kharah M.; Murphy, Michael L.M.; Adam, Emma K.; Chen, Edith; Miller, Gregory E.

2013-01-01

Summary Background Indices of cortisol activity, including the cortisol awakening response (CAR), diurnal slope, and cortisol output across the day (total daily output), are often studied as mechanistic indicators that could link stress with health. Yet there is a paucity of data speaking to their temporal features, particularly whether they behave in a more state- or trait-like manner across time. Methods To address this issue, data from 3 studies were used to assess CAR, diurnal slope and total daily output stability over different age groups and time spans: 130 healthy children and adolescents collected salivary cortisol samples 5 times/day (1, 4, 9 and 11 h after wake) over 2 days at 5 visits spaced 6 months apart (Study 1); 147 adolescent girls collected saliva 6 times/day (wake, 1, 4, 9 and 14 h after wake) for 2 days at 3 visits, each a year apart (Study 2); and 47 healthy, primarily middle age adults collected saliva 6 times/day (wake, 1, 4, 9 and 14 h after wake) for 3 days at 4 visits spaced 2–3 months apart (Study 3). Stability was estimated by multilevel model-derived intraclass correlation coefficients (ICCs). Results Across studies, approximately 50% of the variance in cortisol indices was attributable to day-to-day fluctuations, suggesting state-like properties. Of the indices, total daily output emerged as the most stable over time, followed by diurnal slope and CAR, but stability estimates were generally quite modest regardless of index and sample. Over time spans of >1 year, ICCs were ≤.13. Conclusions Most of the variance in CAR, diurnal slope and total daily output reflects day-to-day fluctuation; there was little evidence for more stable trait-like influences. These findings suggest that future research should focus on short-term fluctuations in stress, cortisol and health, as opposed to lengthy disease processes. PMID:24119668

Quality Indicators for Learning Analytics

ERIC Educational Resources Information Center

Scheffel, Maren; Drachsler, Hendrik; Stoyanov, Slavi; Specht, Marcus

2014-01-01

This article proposes a framework of quality indicators for learning analytics that aims to standardise the evaluation of learning analytics tools and to provide a mean to capture evidence for the impact of learning analytics on educational practices in a standardised manner. The criteria of the framework and its quality indicators are based on…

A Universal Trend among Proteomes Indicates an Oily Last Common Ancestor

PubMed Central

Mannige, Ranjan V.; Brooks, Charles L.; Shakhnovich, Eugene I.

2012-01-01

Despite progresses in ancestral protein sequence reconstruction, much needs to be unraveled about the nature of the putative last common ancestral proteome that served as the prototype of all extant lifeforms. Here, we present data that indicate a steady decline (oil escape) in proteome hydrophobicity over species evolvedness (node number) evident in 272 diverse proteomes, which indicates a highly hydrophobic (oily) last common ancestor (LCA). This trend, obtained from simple considerations (free from sequence reconstruction methods), was corroborated by regression studies within homologous and orthologous protein clusters as well as phylogenetic estimates of the ancestral oil content. While indicating an inherent irreversibility in molecular evolution, oil escape also serves as a rare and universal reaction-coordinate for evolution (reinforcing Darwin's principle of Common Descent), and may prove important in matters such as (i) explaining the emergence of intrinsically disordered proteins, (ii) developing composition- and speciation-based “global” molecular clocks, and (iii) improving the statistical methods for ancestral sequence reconstruction. PMID:23300421

Testing the environmental Kuznets curve hypothesis with bird populations as habitat-specific environmental indicators: evidence from Canada.

PubMed

Lantz, Van; Martínez-Espiñeira, Roberto

2008-04-01

The traditional environmental Kuznets curve (EKC) hypothesis postulates that environmental degradation follows an inverted U-shaped relationship with gross domestic product (GDP) per capita. We tested the EKC hypothesis with bird populations in 5 different habitats as environmental quality indicators. Because birds are considered environmental goods, for them the EKC hypothesis would instead be associated with a U-shaped relationship between bird populations and GDP per capita. In keeping with the literature, we included other variables in the analysis-namely, human population density and time index variables (the latter variable captured the impact of persistent and exogenous climate and/or policy changes on bird populations over time). Using data from 9 Canadian provinces gathered over 37 years, we used a generalized least-squares regression for each bird habitat type, which accounted for the panel structure of the data, the cross-sectional dependence across provinces in the residuals, heteroskedasticity, and fixed- or random-effect specifications of the models. We found evidence that supports the EKC hypothesis for 3 of the 5 bird population habitat types. In addition, the relationship between human population density and the different bird populations varied, which emphasizes the complex nature of the impact that human populations have on the environment. The relationship between the time-index variable and the different bird populations also varied, which indicates there are other persistent and significant influences on bird populations over time. Overall our EKC results were consistent with those found for threatened bird species, indicating that economic prosperity does indeed act to benefit some bird populations.

Trial Watch: Adoptive cell transfer for oncological indications

PubMed Central

Aranda, Fernando; Buqué, Aitziber; Bloy, Norma; Castoldi, Francesca; Eggermont, Alexander; Cremer, Isabelle; Fridman, Wolf Hervé; Fucikova, Jitka; Galon, Jérôme; Spisek, Radek; Tartour, Eric; Zitvogel, Laurence; Kroemer, Guido; Galluzzi, Lorenzo

2015-01-01

One particular paradigm of anticancer immunotherapy relies on the administration of (potentially) tumor-reactive immune effector cells. Generally, these cells are obtained from autologous peripheral blood lymphocytes (PBLs) ex vivo (in the context of appropriate expansion, activation and targeting protocols), and re-infused into lymphodepleted patients along with immunostimulatory agents. In spite of the consistent progress achieved throughout the past two decades in this field, no adoptive cell transfer (ACT)-based immunotherapeutic regimen is currently approved by regulatory agencies for use in cancer patients. Nonetheless, the interest of oncologists in ACT-based immunotherapy continues to increase. Accumulating clinical evidence indicates indeed that specific paradigms of ACT, such as the infusion of chimeric antigen receptor (CAR)-expressing autologous T cells, are associated with elevated rates of durable responses in patients affected by various neoplasms. In line with this notion, clinical trials investigating the safety and therapeutic activity of ACT in cancer patients are being initiated at an ever increasing pace. Here, we review recent preclinical and clinical advances in the development of ACT-based immunotherapy for oncological indications. PMID:26451319

Trial Watch: Adoptive cell transfer for oncological indications.

PubMed

Aranda, Fernando; Buqué, Aitziber; Bloy, Norma; Castoldi, Francesca; Eggermont, Alexander; Cremer, Isabelle; Fridman, Wolf Hervé; Fucikova, Jitka; Galon, Jérôme; Spisek, Radek; Tartour, Eric; Zitvogel, Laurence; Kroemer, Guido; Galluzzi, Lorenzo

2015-11-01

One particular paradigm of anticancer immunotherapy relies on the administration of (potentially) tumor-reactive immune effector cells. Generally, these cells are obtained from autologous peripheral blood lymphocytes (PBLs) ex vivo (in the context of appropriate expansion, activation and targeting protocols), and re-infused into lymphodepleted patients along with immunostimulatory agents. In spite of the consistent progress achieved throughout the past two decades in this field, no adoptive cell transfer (ACT)-based immunotherapeutic regimen is currently approved by regulatory agencies for use in cancer patients. Nonetheless, the interest of oncologists in ACT-based immunotherapy continues to increase. Accumulating clinical evidence indicates indeed that specific paradigms of ACT, such as the infusion of chimeric antigen receptor (CAR)-expressing autologous T cells, are associated with elevated rates of durable responses in patients affected by various neoplasms. In line with this notion, clinical trials investigating the safety and therapeutic activity of ACT in cancer patients are being initiated at an ever increasing pace. Here, we review recent preclinical and clinical advances in the development of ACT-based immunotherapy for oncological indications.

Non-obstetrical indications for cesarean section: a state-of-the-art review.

PubMed

Venturella, Roberta; Quaresima, Paola; Micieli, Mariella; Rania, Erika; Palumbo, Annarita; Visconti, Federica; Zullo, Fulvio; Di Carlo, Costantino

2018-07-01

To propose an evidence-based review on the most frequent indications for Cesarean section (CS) given by specialists in disciplines other than Obstetrics and Gynecology, with the aim of increasing consciousness about the available data in the literature and the guidelines recommendations about topics that are not frequently managed by obstetricians and gynecologists. We analyzed hospital discharge data regarding deliveries occurred in a 10-year study period in our department to obtain the prevalence and the list of the most recurrent non-obstetrical indications for CS. A search was performed in PubMed, the Cochrane Library, SCOPUS, Web of Science and Ovid MEDLINE and only studies published in English from 1950 to 2017 were included. For indications for which no systematic reviews existed, we included the best available evidence, including guidelines of non-obstetrics scientific societies or organizations, RCTs, non-randomized controlled clinical trials, case-control studies, cohort studies, and case series. The rising rate of CS registered in the recent years is not justified by reduction in maternal--fetal risk or perinatal outcomes and often reflects inappropriate clinical behaviour and a wrong tendency that assimilates CS as a defensive practice. In a relevant percentage of cases, the indication to CS is given by specialists in other disciplines, even when specific guidelines do not give clear recommendation about the route of delivery. To refuse non-obstetrical indications for CS, when scientific support is lacking, could be a useful and safe strategy to further reduce the rate of unnecessary CS.

Obtaining appropriate interval estimates for age when multiple indicators are used: evaluation of an ad-hoc procedure.

PubMed

Fieuws, Steffen; Willems, Guy; Larsen-Tangmose, Sara; Lynnerup, Niels; Boldsen, Jesper; Thevissen, Patrick

2016-03-01

When an estimate of age is needed, typically multiple indicators are present as found in skeletal or dental information. There exists a vast literature on approaches to estimate age from such multivariate data. Application of Bayes' rule has been proposed to overcome drawbacks of classical regression models but becomes less trivial as soon as the number of indicators increases. Each of the age indicators can lead to a different point estimate ("the most plausible value for age") and a prediction interval ("the range of possible values"). The major challenge in the combination of multiple indicators is not the calculation of a combined point estimate for age but the construction of an appropriate prediction interval. Ignoring the correlation between the age indicators results in intervals being too small. Boldsen et al. (2002) presented an ad-hoc procedure to construct an approximate confidence interval without the need to model the multivariate correlation structure between the indicators. The aim of the present paper is to bring under attention this pragmatic approach and to evaluate its performance in a practical setting. This is all the more needed since recent publications ignore the need for interval estimation. To illustrate and evaluate the method, Köhler et al. (1995) third molar scores are used to estimate the age in a dataset of 3200 male subjects in the juvenile age range.

Spectroscopic ellipsometry analysis of nanocrystalline silicon carbide obtained at low temperature

NASA Astrophysics Data System (ADS)

Kerdiles, S.; Madelon, R.; Rizk, R.

2001-12-01

Thin films of silicon carbide obtained by hydrogen-reactive magnetron sputtering with various substrate temperatures TS (100-600 °C) were analysed by transmission electron microscopy (TEM) and spectroscopic ellipsometry (SE). The TEM images show evidence of the growth of hydrogenated nanocrystalline silicon carbide (nc-SiC:H) deposited at TS as low as 300 °C, with an average grain size of 4-5 nm. The SE spectra were reproduced by using the Forouhi-Bloomer model and assuming a 7 nm thick overlayer with a void fraction of 45%. The observed increase of the refractive index with TS is assigned to the improvement of both crystallinity and compactness of the layer. The expected increase of the optical gap seems to be offset by the drop of hydrogen content, leaving the gap unchanged. The fabrication and characteristics of nc-SiC:H/c-Si diode are finally described and the data indicate a good rectifying behaviour, together with a low leakage current.

46 CFR 169.205 - Obtaining or renewing a Certificate of Inspection.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SAILING SCHOOL VESSELS Inspection and Certification Certificate of Inspection § 169.205 Obtaining or... for inspection on Form CG-3752; and (2) Evidence that the vessel has been designated as a sailing...

46 CFR 169.205 - Obtaining or renewing a Certificate of Inspection.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SAILING SCHOOL VESSELS Inspection and Certification Certificate of Inspection § 169.205 Obtaining or... for inspection on Form CG-3752; and (2) Evidence that the vessel has been designated as a sailing...

A first-approximation urban-air-quality indicator

Treesearch

David M. Paproski; Julian R. Walker

1977-01-01

Development of the first-approximation-urban-air-quality indicator was reported by the Economic Council of Canada. The indicator takes account of ambient concentrations of five pollutants: sulfur dioxide, particulate matter, oxides of nitrogen, carbon monoxide, and total oxidants. Epidemiological evidence indicating the potential impact of these pollutants on human...

Translating Evidence Into Practice via Social Media: A Mixed-Methods Study

PubMed Central

Tunnecliff, Jacqueline; Morgan, Prue; Gaida, Jamie E; Clearihan, Lyn; Sadasivan, Sivalal; Davies, David; Ganesh, Shankar; Mohanty, Patitapaban; Weiner, John; Reynolds, John; Ilic, Dragan

2015-01-01

Background Approximately 80% of research evidence relevant to clinical practice never reaches the clinicians delivering patient care. A key barrier for the translation of evidence into practice is the limited time and skills clinicians have to find and appraise emerging evidence. Social media may provide a bridge between health researchers and health service providers. Objective The aim of this study was to determine the efficacy of social media as an educational medium to effectively translate emerging research evidence into clinical practice. Methods The study used a mixed-methods approach. Evidence-based practice points were delivered via social media platforms. The primary outcomes of attitude, knowledge, and behavior change were assessed using a preintervention/postintervention evaluation, with qualitative data gathered to contextualize the findings. Results Data were obtained from 317 clinicians from multiple health disciplines, predominantly from the United Kingdom, Australia, the United States, India, and Malaysia. The participants reported an overall improvement in attitudes toward social media for professional development (P<.001). The knowledge evaluation demonstrated a significant increase in knowledge after the training (P<.001). The majority of respondents (136/194, 70.1%) indicated that the education they had received via social media had changed the way they practice, or intended to practice. Similarly, a large proportion of respondents (135/193, 69.9%) indicated that the education they had received via social media had increased their use of research evidence within their clinical practice. Conclusions Social media may be an effective educational medium for improving knowledge of health professionals, fostering their use of research evidence, and changing their clinical behaviors by translating new research evidence into clinical practice. PMID:26503129

Translating Evidence Into Practice via Social Media: A Mixed-Methods Study.

PubMed

Maloney, Stephen; Tunnecliff, Jacqueline; Morgan, Prue; Gaida, Jamie E; Clearihan, Lyn; Sadasivan, Sivalal; Davies, David; Ganesh, Shankar; Mohanty, Patitapaban; Weiner, John; Reynolds, John; Ilic, Dragan

2015-10-26

Approximately 80% of research evidence relevant to clinical practice never reaches the clinicians delivering patient care. A key barrier for the translation of evidence into practice is the limited time and skills clinicians have to find and appraise emerging evidence. Social media may provide a bridge between health researchers and health service providers. The aim of this study was to determine the efficacy of social media as an educational medium to effectively translate emerging research evidence into clinical practice. The study used a mixed-methods approach. Evidence-based practice points were delivered via social media platforms. The primary outcomes of attitude, knowledge, and behavior change were assessed using a preintervention/postintervention evaluation, with qualitative data gathered to contextualize the findings. Data were obtained from 317 clinicians from multiple health disciplines, predominantly from the United Kingdom, Australia, the United States, India, and Malaysia. The participants reported an overall improvement in attitudes toward social media for professional development (P<.001). The knowledge evaluation demonstrated a significant increase in knowledge after the training (P<.001). The majority of respondents (136/194, 70.1%) indicated that the education they had received via social media had changed the way they practice, or intended to practice. Similarly, a large proportion of respondents (135/193, 69.9%) indicated that the education they had received via social media had increased their use of research evidence within their clinical practice. Social media may be an effective educational medium for improving knowledge of health professionals, fostering their use of research evidence, and changing their clinical behaviors by translating new research evidence into clinical practice.

Evidence for involvement of gut-associated denitrifying bacteria in emission of nitrous oxide (N(2)O) by earthworms obtained from garden and forest soils.

PubMed

Matthies, C; Griesshammer, A; Schmittroth, M; Drake, H L

1999-08-01

Earthworms (Aporrectodea caliginosa, Lumbricus rubellus, and Octolasion lacteum) obtained from nitrous oxide (N(2)O)-emitting garden soils emitted 0.14 to 0.87 nmol of N(2)O h(-1) g (fresh weight)(-1) under in vivo conditions. L. rubellus obtained from N(2)O-emitting forest soil also emitted N(2)O, which confirmed previous observations (G. R. Karsten and H. L. Drake, Appl. Environ. Microbiol. 63:1878-1882, 1997). In contrast, commercially obtained Lumbricus terrestris did not emit N(2)O; however, such worms emitted N(2)O when they were fed (i.e., preincubated in) garden soils. A. caliginosa, L. rubellus, and O. lacteum substantially increased the rates of N(2)O emission of garden soil columns and microcosms. Extrapolation of the data to in situ conditions indicated that N(2)O emission by earthworms accounted for approximately 33% of the N(2)O emitted by garden soils. In vivo emission of N(2)O by earthworms obtained from both garden and forest soils was greatly stimulated when worms were moistened with sterile solutions of nitrate or nitrite; in contrast, ammonium did not stimulate in vivo emission of N(2)O. In the presence of nitrate, acetylene increased the N(2)O emission rates of earthworms; in contrast, in the presence of nitrite, acetylene had little or no effect on emission of N(2)O. In vivo emission of N(2)O decreased by 80% when earthworms were preincubated in soil supplemented with streptomycin and tetracycline. On a fresh weight basis, the rates of N(2)O emission of dissected earthworm gut sections were substantially higher than the rates of N(2)O emission of dissected worms lacking gut sections, indicating that N(2)O production occurred in the gut rather than on the worm surface. In contrast to living earthworms and gut sections that produced N(2)O under oxic conditions (i.e., in the presence of air), fresh casts (feces) from N(2)O-emitting earthworms produced N(2)O only under anoxic conditions. Collectively, these results indicate that gut

Evidence-based neurosurgery

PubMed Central

Esene, Ignatius N.; Baeesa, Saleh S.; Ammar, Ahmed

2016-01-01

Medical evidence is obtainable from approaches, which might be descriptive, analytic and integrative and ranked into levels of evidence, graded according to quality and summarized into strengths of recommendation. Sources of evidence range from expert opinions through well-randomized control trials to meta-analyses. The conscientious, explicit, and judicious use of current best evidence in making decisions related to the care of individual patients defines the concept of evidence-based neurosurgery (EBN). We reviewed reference books of clinical epidemiology, evidence-based practice and other previously related articles addressing principles of evidence-based practice in neurosurgery. Based on existing theories and models and our cumulative years of experience and expertise conducting research and promoting EBN, we have synthesized and presented a holistic overview of the concept of EBN. We have also underscored the importance of clinical research and its relationship to EBN. Useful electronic resources are provided. The concept of critical appraisal is introduced. PMID:27356649

29 CFR 1956.11 - Indices of effectiveness.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., obtaining the best available evidence through research, demonstration, experiments, and experience under... or practices in covered places of employment which could reasonably be expected to cause death or...

29 CFR 1902.4 - Indices of effectiveness.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., obtaining the best available evidence through research, demonstrations, experiments, and experience under... in covered places of employment which could reasonably be expected to cause death or serious physical...

29 CFR 1902.4 - Indices of effectiveness.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., obtaining the best available evidence through research, demonstrations, experiments, and experience under... in covered places of employment which could reasonably be expected to cause death or serious physical...

29 CFR 1956.11 - Indices of effectiveness.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., obtaining the best available evidence through research, demonstration, experiments, and experience under... or practices in covered places of employment which could reasonably be expected to cause death or...

29 CFR 1902.4 - Indices of effectiveness.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., obtaining the best available evidence through research, demonstrations, experiments, and experience under... in covered places of employment which could reasonably be expected to cause death or serious physical...

29 CFR 1902.4 - Indices of effectiveness.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., obtaining the best available evidence through research, demonstrations, experiments, and experience under... in covered places of employment which could reasonably be expected to cause death or serious physical...

29 CFR 1956.11 - Indices of effectiveness.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., obtaining the best available evidence through research, demonstration, experiments, and experience under... or practices in covered places of employment which could reasonably be expected to cause death or...

29 CFR 1902.4 - Indices of effectiveness.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., obtaining the best available evidence through research, demonstrations, experiments, and experience under... in covered places of employment which could reasonably be expected to cause death or serious physical...

29 CFR 1956.11 - Indices of effectiveness.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., obtaining the best available evidence through research, demonstration, experiments, and experience under... or practices in covered places of employment which could reasonably be expected to cause death or...

29 CFR 1956.11 - Indices of effectiveness.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., obtaining the best available evidence through research, demonstration, experiments, and experience under... or practices in covered places of employment which could reasonably be expected to cause death or...

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.

Systematic review: reliability of compendia methods for off-label oncology indications.

PubMed

Abernethy, Amy P; Raman, Gowri; Balk, Ethan M; Hammond, Julia M; Orlando, Lori A; Wheeler, Jane L; Lau, Joseph; McCrory, Douglas C

2009-03-03

The Centers for Medicare & Medicaid Services limit coverage of cancer drugs for off-label indications to indications listed in specified compendia. To assess whether compendia provide comprehensive, research-based, and timely information for off-label prescribing in oncology. 6 drug compendia, English-language literature searches of MEDLINE and the Cochrane Central Register of Controlled Trials from 2006 and 2008, and American Society of Clinical Oncology annual meeting abstracts from 2004 to 2007. Data Assessment: The compendia's stated methods, literature related to off-label indications of 14 cancer drugs in 2006, updated literature related to 1 off-label indication between 2006 and 2008, and completeness of compendia content and citations were assessed. The compendia's stated methods varied greatly from their actual practices. Compendia cited little of the available evidence, often neither the most recent nor that of highest methodological quality. Compendia differed in evidence cited, terminology, detail, presentation, and referencing. For the 14 off-label indications studied, the compendia differed in the indications included and whether and how they recommended particular agents for particular types of cancer. Update schedules varied, and documentation practices made it difficult to determine whether and when compendia content was updated. For 1 indication, compendia citations did not increase between 2006 and 2008 despite newly published articles. The 2006 analysis was limited to 14 off-label indications; the 2008 update examined 1 indication. Only off-label indications for cancer drugs were included, and results cannot be generalized to noncancer drugs or indications. Oncologists rely on compendia for up-to-date access to evidence and reimbursement information for off-label indications. Current compendia lack transparency, cite little current evidence, and lack systematic methods to review or update evidence.

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

Geomorphic evidence for former lobate debris aprons at low latitudes on Mars: Indicators of the Martian paleoclimate

USGS Publications Warehouse

Hauber, E.; Van Gasselt, S.; Chapman, M.G.; Neukum, G.

2008-01-01

Circumferential depressions enclosing mesas and plateaus in the northern Kasei Valles and in the Tartarus Colles regions of Mars are interpreted as indicators of the former extent of lobate debris aprons, thought to be mixtures of ice and elastic particles. These former lobate debris aprons existed about 1 Ga ago and were embayed by lavas or other flow deposits. After the lobate debris aprons had been removed by sublimation and deflation, topographic depressions with a depth of 50 m and a width of several kilometers were left behind between the mesa or plateau scarp and the solidified flow materials. These depressions or moats are located equatorward of ??30?? at significantly lower latitudes than generally observed for occurrences of modem, intact lobate debris aprons. This observation provides evidence that the paleoclimate at that time was different than today, probably due to a higher averaged obliquity of the planet's rotational axis. Copyright 2008 by the American Geophysical Union.

Insulin sensitivity indices: a proposal of cut-off points for simple identification of insulin-resistant subjects.

PubMed

Radikova, Z; Koska, J; Huckova, M; Ksinantova, L; Imrich, R; Vigas, M; Trnovec, T; Langer, P; Sebokova, E; Klimes, I

2006-05-01

Demanding measurement of insulin sensitivity using clamp methods does not simplify the identification of insulin resistant subjects in the general population. Other approaches such as fasting- or oral glucose tolerance test-derived insulin sensitivity indices were proposed and validated with the euglycemic clamp. Nevertheless, a lack of reference values for these indices prevents their wider use in epidemiological studies and clinical practice. The aim of our study was therefore to define the cut-off points of insulin resistance indices as well as the ranges of the most frequently obtained values for selected indices. A standard 75 g oral glucose tolerance test was carried out in 1156 subjects from a Caucasian rural population with no previous evidence of diabetes or other dysglycemias. Insulin resistance/sensitivity indices (HOMA-IR, HOMA-IR2, ISI Cederholm, and ISI Matsuda) were calculated. The 75th percentile value as the cut-off point to define IR corresponded with a HOMA-IR of 2.29, a HOMA-IR2 of 1.21, a 25th percentile for ISI Cederholm, and ISI Matsuda of 57 and 5.0, respectively. For the first time, the cut-off points for selected indices and their most frequently obtained values were established for groups of subjects as defined by glucose homeostasis and BMI. Thus, insulin-resistant subjects can be identified using this simple approach.

Gamma-Ray Burst Spectral Indices: Evidence for Deceleration of Synchrotron Shocks

NASA Technical Reports Server (NTRS)

Preece, R. D.; Briggs, M. S.; Giblin, T.; Mallozzi, R. S.; Pendleton, G. N.; Paciesas, W. S.; Band, D. L.

2000-01-01

The current scenario for gamma-ray bursts (GRBs) involves internal shocks for the prompt GRB emission phase and external shocks for the afterglow phase. Assuming synchrotron emission from energetic shocked electrons. GRB spectra observed with a low-energy power-law spectral index greater than -2/3 (for positive photon number indices E(sup alpha) indicate a problem with this model. The remaining spectra can test the synchrotron shock model prediction that the emission from a single distribution of electrons, cooling rapidly, is responsible for both the low-energy and high-energy power-low portions of the spectra. We find that the inferred relationship between the two spectral indices of observed GRB spectra is inconsistent with the constraints from the model, posing another problem for the synchrotron shock emission model. To overcome this problem, we describe a model where the average of -1, rather than the value of -3/2 predicted for cooling electrons. Situations where this might arise have been discussed in other contexts, and involve deceleration of the internal shocks during the GRB phase.

Evidence-based nursing-sensitive indicators for patients hospitalized with depression in Thailand.

PubMed

Thapinta, Darawan; Anders, Robert L; Mahatnirunkul, Suwat; Srikosai, Soontaree

2010-12-01

The aim of this study was to develop and validate nursing-sensitive indicators for patients hospitalized with depression in Thailand. The initial draft, consisting of 12 categories with 37 subcategories, was then evaluated by experts in the US and Thailand. Hospital records were then utilized to evaluate the feasibility and efficacy of the indicators. The finalized instrument consisted of 11 categories with 43 items with a validity of .98 and internal consistency of .88. This is the first set of indicators developed to evaluate nursing-sensitivity for patients hospitalized with a diagnosis of depression in Thailand. Having nursing indicators for depressed patients provides nurses with concrete tools to evaluate their work with depressed patients, allowing these staff to assess their work in a very specific, methodical, and consistent manner. When problems are discovered, both the staff and administration can work to address these issues through training, procedural changes, and departmental shifts.

Evidence-based pathology in its second decade: toward probabilistic cognitive computing.

PubMed

Marchevsky, Alberto M; Walts, Ann E; Wick, Mark R

2017-03-01

Evidence-based pathology advocates using a combination of best available data ("evidence") from the literature and personal experience for the diagnosis, estimation of prognosis, and assessment of other variables that impact individual patient care. Evidence-based pathology relies on systematic reviews of the literature, evaluation of the quality of evidence as categorized by evidence levels and statistical tools such as meta-analyses, estimates of probabilities and odds, and others. However, it is well known that previously "statistically significant" information usually does not accurately forecast the future for individual patients. There is great interest in "cognitive computing" in which "data mining" is combined with "predictive analytics" designed to forecast future events and estimate the strength of those predictions. This study demonstrates the use of IBM Watson Analytics software to evaluate and predict the prognosis of 101 patients with typical and atypical pulmonary carcinoid tumors in which Ki-67 indices have been determined. The results obtained with this system are compared with those previously reported using "routine" statistical software and the help of a professional statistician. IBM Watson Analytics interactively provides statistical results that are comparable to those obtained with routine statistical tools but much more rapidly, with considerably less effort and with interactive graphics that are intuitively easy to apply. It also enables analysis of natural language variables and yields detailed survival predictions for patient subgroups selected by the user. Potential applications of this tool and basic concepts of cognitive computing are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

Chronological evidence fails to support claim of an isochronous widespread layer of cosmic impact indicators dated to 12,800 years ago

NASA Astrophysics Data System (ADS)

Meltzer, David J.; Holliday, Vance T.; Cannon, Michael D.; Miller, D. Shane

2014-05-01

According to the Younger Dryas Impact Hypothesis (YDIH), ∼12,800 calendar years before present, North America experienced an extraterrestrial impact that triggered the Younger Dryas and devastated human populations and biotic communities on this continent and elsewhere. This supposed event is reportedly marked by multiple impact indicators, but critics have challenged this evidence, and considerable controversy now surrounds the YDIH. Proponents of the YDIH state that a key test of the hypothesis is whether those indicators are isochronous and securely dated to the Younger Dryas onset. They are not. We have examined the age basis of the supposed Younger Dryas boundary layer at the 29 sites and regions in North and South America, Europe, and the Middle East in which proponents report its occurrence. Several of the sites lack any age control, others have radiometric ages that are chronologically irrelevant, nearly a dozen have ages inferred by statistically and chronologically flawed age-depth interpolations, and in several the ages directly on the supposed impact layer are older or younger than ∼12,800 calendar years ago. Only 3 of the 29 sites fall within the temporal window of the YD onset as defined by YDIH proponents. The YDIH fails the critical chronological test of an isochronous event at the YD onset, which, coupled with the many published concerns about the extraterrestrial origin of the purported impact markers, renders the YDIH unsupported. There is no reason or compelling evidence to accept the claim that a cosmic impact occurred ∼12,800 y ago and caused the Younger Dryas.

Stable isotope evidence for increasing dietary breadth in the European mid-Upper Paleolithic

PubMed Central

Richards, Michael P.; Pettitt, Paul B.; Stiner, Mary C.; Trinkaus, Erik

2001-01-01

New carbon and nitrogen stable isotope values for human remains dating to the mid-Upper Paleolithic in Europe indicate significant amounts of aquatic (fish, mollusks, and/or birds) foods in some of their diets. Most of this evidence points to exploitation of inland freshwater aquatic resources in particular. By contrast, European Neandertal collagen carbon and nitrogen stable isotope values do not indicate significant use of inland aquatic foods but instead show that they obtained the majority of their protein from terrestrial herbivores. In agreement with recent zooarcheological analyses, the isotope results indicate shifts toward a more broad-spectrum subsistence economy in inland Europe by the mid-Upper Paleolithic period, probably associated with significant population increases. PMID:11371652

Stable isotope evidence for increasing dietary breadth in the European mid-Upper Paleolithic.

PubMed

Richards, M P; Pettitt, P B; Stiner, M C; Trinkaus, E

2001-05-22

New carbon and nitrogen stable isotope values for human remains dating to the mid-Upper Paleolithic in Europe indicate significant amounts of aquatic (fish, mollusks, and/or birds) foods in some of their diets. Most of this evidence points to exploitation of inland freshwater aquatic resources in particular. By contrast, European Neandertal collagen carbon and nitrogen stable isotope values do not indicate significant use of inland aquatic foods but instead show that they obtained the majority of their protein from terrestrial herbivores. In agreement with recent zooarcheological analyses, the isotope results indicate shifts toward a more broad-spectrum subsistence economy in inland Europe by the mid-Upper Paleolithic period, probably associated with significant population increases.

14 CFR 16.223 - Evidence.

Code of Federal Regulations, 2010 CFR

2010-01-01

... shall be submitted in written form in advance of the oral hearing pursuant to the schedule established in the hearing officer's prehearing conference report. Written direct and rebuttal fact testimony... written testimony and evidence. Except in the case of evidence obtained by subpoena, or in the case of a...

Baseline results from the Lichen Community Indicator Program in the Pacific Northwest: Air quality patterns and evidence of a nitrogen pollution problem

Treesearch

Sarah Jovan

2009-01-01

Why Are Epiphytic Lichen Communities Important? Lichens are one of the bioindicators used by the Forest Inventory and Analysis (FIA) Program to monitor forest health. To obtain data for use in its Lichen Community Indicator Program, FIA samples a regular network of permanent field plots to determine the composition of epiphytic, i.e., tree dwelling, lichen communities...

A Proposed Roadmap for Inpatient Neurology Quality Indicators

PubMed Central

Douglas, Vanja C.; Josephson, S. Andrew

2011-01-01

Background/Purpose: In recent years, there has been increasing pressure to measure and report quality in health care. However, there has been little focus on quality measurement in the field of neurology for conditions other than stroke and transient ischemic attack. As the number of evidence-based treatments for neurological conditions grows, so will the demand to measure the quality of care delivered. The purpose of this study was to review essential components of hospital performance measures for neurological disease and propose potential quality indicators for commonly encountered inpatient neurological diagnoses. Methods: We determined the most common inpatient neurological diagnoses at a major tertiary care medical center by reviewing the billing database. We then searched PubMed and the National Guidelines Clearinghouse to identify treatment guidelines for these conditions. Guideline recommendations with class I/level A evidence were evaluated as possible quality indicators. Results: We found 94 guidelines for 14 inpatient neurological conditions other than stroke and transient ischemic attack. Of these, 36 guidelines contained at least 1 recommendation with class I evidence. Based on these, potential quality indicators for intracerebral hemorrhage, subarachnoid hemorrhage, pneumococcal meningitis, coma following cardiac arrest, encephalitis, Guillain-Barre syndrome, multiple sclerosis, and benign paroxysmal positional vertigo are proposed. Conclusions: There are several inpatient neurological conditions with treatments or diagnostic test routines supported by high levels of evidence that could be used in the future as quality indicators. PMID:23983832

Is the Urban Child Health Advantage Declining in Malawi?: Evidence from Demographic and Health Surveys and Multiple Indicator Cluster Surveys.

PubMed

Lungu, Edgar Arnold; Biesma, Regien; Chirwa, Maureen; Darker, Catherine

2018-06-01

In many developing countries including Malawi, health indicators are on average better in urban than in rural areas. This phenomenon has largely prompted Governments to prioritize rural areas in programs to improve access to health services. However, considerable evidence has emerged that some population groups in urban areas may be facing worse health than rural areas and that the urban advantage may be waning in some contexts. We used a descriptive study undertaking a comparative analysis of 13 child health indicators between urban and rural areas using seven data points provided by nationally representative population based surveys-the Malawi Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Rate differences between urban and rural values for selected child health indicators were calculated to denote whether urban-rural differentials showed a trend of declining urban advantage in Malawi. The results show that all forms of child mortality have significantly declined between 1992 and 2015/2016 reflecting successes in child health interventions. Rural-urban comparisons, using rate differences, largely indicate a picture of the narrowing gap between urban and rural areas albeit the extent and pattern vary among child health indicators. Of the 13 child health indicators, eight (neonatal mortality, infant mortality, under-five mortality rates, stunting rate, proportion of children treated for diarrhea and fever, proportion of children sleeping under insecticide-treated nets, and children fully immunized at 12 months) show clear patterns of a declining urban advantage particularly up to 2014. However, U-5MR shows reversal to a significant urban advantage in 2015/2016, and slight increases in urban advantage are noted for infant mortality rate, underweight, full childhood immunization, and stunting rate in 2015/2016. Our findings suggest the need to rethink the policy viewpoint of a disadvantaged rural and much better-off urban in child health

Measuring the impact of methodological research: a framework and methods to identify evidence of impact.

PubMed

Brueton, Valerie C; Vale, Claire L; Choodari-Oskooei, Babak; Jinks, Rachel; Tierney, Jayne F

2014-11-27

Providing evidence of impact highlights the benefits of medical research to society. Such evidence is increasingly requested by research funders and commonly relies on citation analysis. However, other indicators may be more informative. Although frameworks to demonstrate the impact of clinical research have been reported, no complementary framework exists for methodological research. Therefore, we assessed the impact of methodological research projects conducted or completed between 2009 and 2012 at the UK Medical Research Council Clinical Trials Unit Hub for Trials Methodology Research Hub, with a view to developing an appropriate framework. Various approaches to the collection of data on research impact were employed. Citation rates were obtained using Web of Science (http://www.webofknowledge.com/) and analyzed descriptively. Semistructured interviews were conducted to obtain information on the rates of different types of research output that indicated impact for each project. Results were then pooled across all projects. Finally, email queries pertaining to methodology projects were collected retrospectively and their content analyzed. Simple citation analysis established the citation rates per year since publication for 74 methodological publications; however, further detailed analysis revealed more about the potential influence of these citations. Interviews that spanned 20 individual research projects demonstrated a variety of types of impact not otherwise collated, for example, applications and further developments of the research; release of software and provision of guidance materials to facilitate uptake; formation of new collaborations and broad dissemination. Finally, 194 email queries relating to 6 methodological projects were received from 170 individuals across 23 countries. They provided further evidence that the methodologies were impacting on research and research practice, both nationally and internationally. We have used the information

Challenges of Obtaining Evidence-Based Information Regarding Medications and Male Fertility.

PubMed

Drobnis, Erma Z; Nangia, Ajay K

2017-01-01

In the clinic, the existing literature is insufficient to counsel our infertile men on medication use. Most studies have flaws that limit their application to evidence-based practice. In this chapter, we discuss the limitations of the current literature and the challenges to designing more useful studies. Among the most important weaknesses of existing studies is lack of power; that is, too few men are included to draw conclusions about the existence and size of medication effects. Adequate power is particularly important when confirming an absence of medication effect. Bias is also a problem in most studies. Early studies were rarely randomized, placebo-controlled, or blinded; a common example is patients receiving different medication regimes based on the severity of their symptoms-making it impossible to attribute differences between treated and untreated men to the medications. Additional bias is introduced by failing to include other factors that influence the outcome in the experimental design. A uniform population amenable to randomization and placebo-control are experimental species, and useful information has been gained from these models. However, application to humans is limited by differences from other species in route of drug administration, absorption of the drug, concentration in the male genital tract tissues, and genital tract physiology. To a lesser degree, there is variation among individual men in their response to drugs. In addition, drugs in the same class may have different effects, limiting the applicability of data across drugs of a single class. Complicating matters further, a toxic medication may seem to improve fertility endpoints by improving a disease condition that diminishes fertility. Finally, drug interactions have not been studied, and actual fertility data (pregnancy/fecundity) in humans are rare. A healthy dose of skepticism is warranted when evaluating studies of medications and male reproductive health.

Evidence on global medical travel.

PubMed

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

2015-11-01

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

Evidence on global medical travel

PubMed Central

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

2015-01-01

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

Novel Strength Test Battery to Permit Evidence-Based Paralympic Classification

PubMed Central

Beckman, Emma M.; Newcombe, Peter; Vanlandewijck, Yves; Connick, Mark J.; Tweedy, Sean M.

2014-01-01

Abstract Ordinal-scale strength assessment methods currently used in Paralympic athletics classification prevent the development of evidence-based classification systems. This study evaluated a battery of 7, ratio-scale, isometric tests with the aim of facilitating the development of evidence-based methods of classification. This study aimed to report sex-specific normal performance ranges, evaluate test–retest reliability, and evaluate the relationship between the measures and body mass. Body mass and strength measures were obtained from 118 participants—63 males and 55 females—ages 23.2 years ± 3.7 (mean ± SD). Seventeen participants completed the battery twice to evaluate test–retest reliability. The body mass–strength relationship was evaluated using Pearson correlations and allometric exponents. Conventional patterns of force production were observed. Reliability was acceptable (mean intraclass correlation = 0.85). Eight measures had moderate significant correlations with body size (r = 0.30–61). Allometric exponents were higher in males than in females (mean 0.99 vs 0.30). Results indicate that this comprehensive and parsimonious battery is an important methodological advance because it has psychometric properties critical for the development of evidence-based classification. Measures were interrelated with body size, indicating further research is required to determine whether raw measures require normalization in order to be validly applied in classification. PMID:25068950

A sampling-based computational strategy for the representation of epistemic uncertainty in model predictions with evidence theory.

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

Johnson, J. D.; Oberkampf, William Louis; Helton, Jon Craig

2006-10-01

Evidence theory provides an alternative to probability theory for the representation of epistemic uncertainty in model predictions that derives from epistemic uncertainty in model inputs, where the descriptor epistemic is used to indicate uncertainty that derives from a lack of knowledge with respect to the appropriate values to use for various inputs to the model. The potential benefit, and hence appeal, of evidence theory is that it allows a less restrictive specification of uncertainty than is possible within the axiomatic structure on which probability theory is based. Unfortunately, the propagation of an evidence theory representation for uncertainty through a modelmore » is more computationally demanding than the propagation of a probabilistic representation for uncertainty, with this difficulty constituting a serious obstacle to the use of evidence theory in the representation of uncertainty in predictions obtained from computationally intensive models. This presentation describes and illustrates a sampling-based computational strategy for the representation of epistemic uncertainty in model predictions with evidence theory. Preliminary trials indicate that the presented strategy can be used to propagate uncertainty representations based on evidence theory in analysis situations where naive sampling-based (i.e., unsophisticated Monte Carlo) procedures are impracticable due to computational cost.« less

Interpreting magnesium status to enhance clinical care: key indicators.

PubMed

Costello, Rebecca B; Nielsen, Forrest

2017-11-01

To update advances in identifying factors affecting magnesium (Mg) status that assist in providing improved evidence-based clinical decision-making for assessing Mg status. Findings from recent cohort studies, small randomized control trials, and multiple meta-analyses reinforce earlier work that serum Mg concentrations, urinary Mg excretion, and Mg dietary intakes are inversely associated with cardiovascular disease, chronic kidney disease, and diabetes. These studies indicate that the reference range for serum Mg needs updating, and that individuals with serum Mg in the range of 0.75-0.85 mmol/l and displaying changes in other factors associated with a low Mg status may be Mg deficient. Individuals with serum Mg concentrations below this range most likely are Mg deficient and, above this range, are most likely Mg sufficient. The combined determination of serum Mg concentration, 24-h urinary Mg excretion, and dietary Mg intake is currently the most practical method to obtain a sound assessment of Mg status. The strong correlations of Mg deficiency with increased risk of several chronic diseases, some of which exist as comorbidities, indicate that Mg status should be ascertained in patients presenting such disorder.

Evaluation of current population indices for band-tailed pigeons

USGS Publications Warehouse

Casazza, Michael L.; Yee, J.L.; Miller, M.R.; Orthmeyer, D.L.; Yparraguirre, D.R.; Jarvis, R.L.; Overton, C.T.

2005-01-01

Between March, 1947, and December,1953, 359 cottontails were examined for evidence of fibromas at the Patuxent Research Refuge, Laurel, Md. No tumors were observed on the rabbits until December, 1950, when 3 of 16 shot animals had fibromas. Twelve rabbits of 70 examined in 1951, had tumors, and no tumors were found on 37 examined in 1952 and 29 examined in 1953. Neutralization tests, using Shope (OA) fibroma virus, were positive on sera from 6 of 36 rabbits trapped between July and December, 1951; one of two rabbits tested in 1952 showed evidence of antibodies; and 2 of 9 tested in 1953 were positive. Neither fibromas nor circulating antibodies were found in 70 cottontails trapped in January and February, 1953, in Rockville, Maryland and over 30 cottontails obtained from dealers in Kansas and Arkansas. No lesions developed on several species of mammals inoculated with a strain of the fibroma virus isolated from a wild cottontail captured on the Refuge. These findings were interpreted as indication of occurrence of an epizootic during the period December, 1950 through December, 1951. Although the local cottontail population showed a marked drop following this epizootic, available data were insufficient to determine whether or not fibroma virus was a contributing factor.

PACE Continuous Innovation Indicators-a novel tool to measure progress in cancer treatments.

PubMed

Paddock, Silvia; Brum, Lauren; Sorrow, Kathleen; Thomas, Samuel; Spence, Susan; Maulbecker-Armstrong, Catharina; Goodman, Clifford; Peake, Michael; McVie, Gordon; Geipel, Gary; Li, Rose

2015-01-01

Concerns about rising health care costs and the often incremental nature of improvements in health outcomes continue to fuel intense debates about 'progress' and 'value' in cancer research. In times of tightening fiscal constraints, it is increasingly important for patients and their representatives to define what constitutes 'value' to them. It is clear that diverse stakeholders have different priorities. Harmonisation of values may be neither possible nor desirable. Stakeholders lack tools to visualise or otherwise express these differences and to track progress in cancer treatments based on variable sets of values. The Patient Access to Cancer care Excellence (PACE) Continuous Innovation Indicators are novel, scientifically rigorous progress trackers that employ a three-step process to quantify progress in cancer treatments: 1) mine the literature to determine the strength of the evidence supporting each treatment; 2) allow users to weight the analysis according to their priorities and values; and 3) calculate Evidence Scores (E-Scores), a novel measure to track progress, based on the strength of the evidence weighted by the assigned value. We herein introduce a novel, flexible value model, show how the values from the model can be used to weight the evidence from the scientific literature to obtain E-Scores, and illustrate how assigning different values to new treatments influences the E-Scores. The Indicators allow users to learn how differing values lead to differing assessments of progress in cancer research and to check whether current incentives for innovation are aligned with their value model. By comparing E-Scores generated by this tool, users are able to visualise the relative pace of innovation across areas of cancer research and how stepwise innovation can contribute to substantial progress against cancer over time. Learning from experience and mapping current unmet needs will help to support a broad audience of stakeholders in their efforts to

Patient education about anticoagulant medication: is narrative evidence or statistical evidence more effective?

PubMed

Mazor, Kathleen M; Baril, Joann; Dugan, Elizabeth; Spencer, Frederick; Burgwinkle, Pamela; Gurwitz, Jerry H

2007-12-01

To determine the relative impact of incorporating narrative evidence, statistical evidence or both into patient education about warfarin, a widely used oral anticoagulant medication. 600 patients receiving anticoagulant therapy were randomly assigned to view one of three versions of a video depicting a physician-patient encounter where anticoagulation treatment was discussed, or usual care (no video). The videos differed in whether the physician used narrative evidence (patient anecdotes), statistical evidence, or both to highlight key information. 317 patients completed both the baseline and post-test questionnaires. Questions assessed knowledge, beliefs and adherence to medication and laboratory monitoring regimens. All three approaches positively effected patients' warfarin-related knowledge, and beliefs in the importance of lab testing; there was also some indication that viewing a video strengthened belief in the benefits of warfarin. There was some indication that narrative evidence had a greater impact than statistical evidence on beliefs about the importance of lab testing and on knowledge. No other evidence of the differential effectiveness of either approach was found. No statistically significant effect was found on intent to adhere, or documented adherence to lab monitoring. Videos depicting a physician-patient dialogue about warfarin were effective in educating patients about anticoagulant medication, and had a positive impact on their beliefs. The use of narrative evidence in the form of patient anecdotes may be more effective than statistical evidence for some patient outcomes. Patients on oral anticoagulant therapy may benefit from periodic educational efforts reinforcing key medication safety information, even after initial education and ongoing monitoring. Incorporating patient anecdotes into physician-patient dialogues or educational materials may increase the effectiveness of the message.

20 CFR 30.905 - How may an impairment evaluation be obtained?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false How may an impairment evaluation be obtained... UNDER THE ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000, AS AMENDED Impairment Benefits Under Part E of EEOICPA Medical Evidence of Impairment § 30.905 How may an impairment evaluation...

QSPR modeling: graph connectivity indices versus line graph connectivity indices

PubMed

Basak; Nikolic; Trinajstic; Amic; Beslo

2000-07-01

Five QSPR models of alkanes were reinvestigated. Properties considered were molecular surface-dependent properties (boiling points and gas chromatographic retention indices) and molecular volume-dependent properties (molar volumes and molar refractions). The vertex- and edge-connectivity indices were used as structural parameters. In each studied case we computed connectivity indices of alkane trees and alkane line graphs and searched for the optimum exponent. Models based on indices with an optimum exponent and on the standard value of the exponent were compared. Thus, for each property we generated six QSPR models (four for alkane trees and two for the corresponding line graphs). In all studied cases QSPR models based on connectivity indices with optimum exponents have better statistical characteristics than the models based on connectivity indices with the standard value of the exponent. The comparison between models based on vertex- and edge-connectivity indices gave in two cases (molar volumes and molar refractions) better models based on edge-connectivity indices and in three cases (boiling points for octanes and nonanes and gas chromatographic retention indices) better models based on vertex-connectivity indices. Thus, it appears that the edge-connectivity index is more appropriate to be used in the structure-molecular volume properties modeling and the vertex-connectivity index in the structure-molecular surface properties modeling. The use of line graphs did not improve the predictive power of the connectivity indices. Only in one case (boiling points of nonanes) a better model was obtained with the use of line graphs.

Indication for cataract surgery. Do we have evidence of who will benefit from surgery? A systematic review and meta-analysis.

PubMed

Kessel, Line; Andresen, Jens; Erngaard, Ditte; Flesner, Per; Tendal, Britta; Hjortdal, Jesper

2016-02-01

The need for cataract surgery is expected to rise dramatically in the future due to the increasing proportion of elderly citizens and increasing demands for optimum visual function. The aim of this study was to provide an evidence-based recommendation for the indication of cataract surgery based on which group of patients are most likely to benefit from surgery. A systematic literature search was performed in the MEDLINE, CINAHL, EMBASE and COCHRANE LIBRARY databases. Studies evaluating the outcome after cataract surgery according to preoperative visual acuity and visual complaints were included in a meta-analysis. We identified eight observational studies comparing outcome after cataract surgery in patients with poor (<20/40) and fair (>20/40) preoperative visual acuity. We could not find any studies that compared outcome after cataract surgery in patients with few or many preoperative visual complaints. A meta-analysis showed that the outcome of cataract surgery, evaluated as objective and subjective visual improvement, was independent on preoperative visual acuity. There is a lack of scientific evidence to guide the clinician in deciding which patients are most likely to benefit from surgery. To overcome this shortage of evidence, many systems have been developed internationally to prioritize patients on waiting lists for cataract surgery, but the Swedish NIKE (Nationell Indikationsmodell för Katarakt Ekstraktion) is the only system where an association to the preoperative scoring of a patient has been related to outcome of cataract surgery. We advise that clinicians are inspired by the NIKE system when they decide which patients to operate to ensure that surgery is only offered to patients who are expected to benefit from cataract surgery. © 2015 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.

Understanding An Informed Public's Views On The Role Of Evidence In Making Health Care Decisions.

PubMed

Carman, Kristin L; Maurer, Maureen; Mangrum, Rikki; Yang, Manshu; Ginsburg, Marjorie; Sofaer, Shoshanna; Gold, Marthe R; Pathak-Sen, Ela; Gilmore, Dierdre; Richmond, Jennifer; Siegel, Joanna

2016-04-01

Policy makers and practitioners increasingly believe that medical evidence plays a critical role in improving care and health outcomes and lowering costs. However, public understanding of the role of evidence-based care may be different. Public deliberation is a process that convenes diverse citizens and has them learn about and consider ethical or values-based dilemmas and weigh alternative views. The Community Forum Deliberative Methods Demonstration project, sponsored by the Agency for Healthcare Research and Quality, obtained informed public views on the role of evidence in health care decisions through seventy-six deliberative groups involving 907 people overall, in the period August-November 2012. Although participants perceived evidence as being essential to high-quality care, they also believed that personal choice or clinical judgment could trump evidence. They viewed doctors as central figures in discussing evidence with patients and key arbiters of whether to follow evidence in individual cases. They found evidence of harm to individuals or the community to be more compelling than evidence of effectiveness. These findings indicate that increased public understanding of evidence can play an important role in advancing evidence-based care by helping create policies that better reflect the needs and values of the public. Project HOPE—The People-to-People Health Foundation, Inc.

Concussion guidelines step 1: systematic review of prevalent indicators.

PubMed

Carney, Nancy; Ghajar, Jamshid; Jagoda, Andy; Bedrick, Steven; Davis-OʼReilly, Cynthia; du Coudray, Hugo; Hack, Dallas; Helfand, Nora; Huddleston, Amy; Nettleton, Tracie; Riggio, Silvana

2014-09-01

Currently, there is no evidence-based definition for concussion that is being uniformly applied in clinical and research settings. To conduct a systematic review of the highest-quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion. The goal was to establish an evidence-based foundation from which to derive, in future work, a definition, diagnostic criteria, and prognostic indicators for concussion. Key questions were developed, and an electronic literature search from 1980 to 2012 was conducted to acquire evidence about the prevalence of and associations among signs, symptoms, and neurologic and cognitive deficits in samples of individuals exposed to potential concussive events. Included studies were assessed for potential for bias and confound and rated as high, medium, or low potential for bias and confound. Those rated as high were excluded from the analysis. Studies were further triaged on the basis of whether the definition of a case of concussion was exclusive or inclusive; only those with wide, inclusive case definitions were used in the analysis. Finally, only studies reporting data collected at fixed time points were used. For a study to be included in the conclusions, it was required that the presence of any particular sign, symptom, or deficit be reported in at least 2 independent samples. From 5437 abstracts, 1362 full-text publications were reviewed, of which 231 studies were included in the final library. Twenty-six met all criteria required to be used in the analysis, and of those, 11 independent samples from 8 publications directly contributed data to conclusions. Prevalent and consistent indicators of concussion are (1) observed and documented disorientation or confusion immediately after the event, (2) impaired balance within 1 day after injury, (3) slower reaction time within 2 days after injury, and/or (4) impaired verbal learning and memory within 2 days after injury

Inefficiency in Latin-American market indices

NASA Astrophysics Data System (ADS)

Zunino, L.; Tabak, B. M.; Pérez, D. G.; Garavaglia, M.; Rosso, O. A.

2007-11-01

We explore the deviations from efficiency in the returns and volatility returns of Latin-American market indices. Two different approaches are considered. The dynamics of the Hurst exponent is obtained via a wavelet rolling sample approach, quantifying the degree of long memory exhibited by the stock market indices under analysis. On the other hand, the Tsallis q entropic index is measured in order to take into account the deviations from the Gaussian hypothesis. Different dynamic rankings of inefficieny are obtained, each of them contemplates a different source of inefficiency. Comparing with the results obtained for a developed country (US), we confirm a similar degree of long-range dependence for our emerging markets. Moreover, we show that the inefficiency in the Latin-American countries comes principally from the non-Gaussian form of the probability distributions.

[Quality indicators in the storage and dispensing process in a Hospital Pharmacy].

PubMed

Rabuñal-Álvarez, M T; Calvin-Lamas, M; Feal-Cortizas, B; Martínez-López, L M; Pedreira-Vázquez, I; Martín-Herranz, M I

2014-01-01

To establish indicators for the evaluation of the quality of the storage and dispensing processes related to semiautomatic vertical (SAVCS) and horizontal (SAHCS) carousel systems. Descriptive observational study conducted between January-December 2012. Definition of quality indicators, a target value is established and an obtained value is calculated for 2012. Five quality indicators in the process of storage and dispensing of drugs were defined and calculated: indicator 1, error filling unidose trolleys: target (<1.67%), obtained (1.03%); indicator 2, filling accuracy unidose trolleys by using an SAVCS: target (<15%), obtained (11.5%); indicator 3, reliability of drug inventory in the process of drug entries using an SAHCS: target (<15%), obtained (6.53%); indicator 4, reliability of drug inventory in the picking process of orders replacement stock of clinical units using an SAHCS: target (<10%), obtained (1.97%); indicator 5, accuracy of the picking process of drug orders using an SAHCS: target (<10%), obtained (10.41%). Establishing indicators has allowed the quality in terms of safety, precision and reliability of semiautomatic systems for storage and dispensing drugs to be assessed. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

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.

Ninety-Day Oral Toxicity Assessment of an Alternative Biopolymer for Controlled Release Drug Delivery Systems Obtained from Cassava Starch Acetate.

PubMed

Jesus, Douglas Rossi; Barbosa, Lorena Neris; Prando, Thiago Bruno Lima; Martins, Leonardo Franco; Gasparotto, Francielli; Guedes, Karla Moraes Rocha; Dragunski, Douglas Cardoso; Lourenço, Emerson Luiz Botelho; Dalsenter, Paulo Roberto; Gasparotto Junior, Arquimedes

2015-01-01

The large consumption of biodegradable films from cassava starch acetate (FCSA) as ingredients in food and pharmaceutical products requires the assessment of the possible toxicity of these products. The aim of this study was to investigate the toxicity of biodegradable film from cassava starch acetate after oral exposure of Wistar rats for 90 days. The amount of food consumed and the body weight were weekly monitored. Blood and urine samples were obtained for the assessment of serum parameters and renal function. Histopathological analyses in target organs were also performed. No evidence of clinical toxicity in hematological, biochemical, or renal parameters in the FCSA-treated animals was found. In addition, relative organ weight and histopathological evaluations did not differ between groups treated with FCSA and control. Data obtained suggest that the subchronic exposure to FCSA does not cause obvious signs of toxicity in Wistar rats, indicating possible safety of this biofilm.

An optimized procedure for obtaining DNA from fired and unfired ammunition.

PubMed

Montpetit, Shawn; O'Donnell, Patrick

2015-07-01

Gun crimes are a significant problem facing law enforcement agencies. Traditional forensic examination of firearms involves comparisons of markings imparted to bullets and cartridge casings during the firing process. DNA testing of casings and cartridges may not be routinely done in crime laboratories due a variety of factors including the typically low amounts of DNA recovered. The San Diego Police Department (SDPD) Crime Laboratory conducted a study to optimize the collection and profiling of DNA from fired and unfired ammunition. The method was optimized to where interpretable DNA results were obtained for 26.1% of the total number of forensic casework evidence samples, and provided some insights into the level of secondary transfer that might be expected from this type of evidence. Briefly detailed are the results from the experimental study and the forensic casework analysis using the optimized process. Mixtures (samples having more DNA types than the loader's known genotype detected or visible at any marker) were obtained in 39.8% of research samples and the likely source of DNA mixtures is discussed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Measuring the quality of renal care: things to keep in mind when selecting and using quality indicators.

PubMed

van der Veer, Sabine N; van Biesen, Wim; Couchoud, Cécile; Tomson, Charles R V; Jager, Kitty J

2014-08-01

This educational paper discusses a variety of indicators that can be used to measure the quality of care in renal medicine. Based on what aspect of care they reflect, indicators can be grouped into four main categories: structure, process, surrogate outcome and outcome indicators. Each category has its own advantages and disadvantages, and we give some pointers on how to balance these pros and cons while taking into account the aim of the measurement initiative. Especially within initiatives that link payment or reputation to indicator measurement, this balancing should be done with utmost care to avoid potential, unintended consequences. Furthermore, we suggest consideration of (i) a causal chain-i.e. subsequent aspects of care connected by evidence-based links-as a starting point for composing a performance indicator set and (ii) adequate case-mix adjustment, not only of (surrogate) outcomes, but also of process indicators in order to obtain fair comparisons between facilities and within facilities over time. © The Author 2013. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Reply to: Mounting evidence indicates that escalating doses of allopurinol are unnecessary for cardiovascular protection.

PubMed

Coburn, Brian W; Michaud, Kaleb; Bergman, Debra A; Mikuls, Ted R

2018-05-08

We thank Dr. Bredemeier for his comments regarding our manuscript on allopurinol dose escalation and mortality. He raises important evidence to consider in support of an interesting hypothesis that dose escalation may be unnecessary for allopurinol's cardiovascular (CV) protection and may actually be related to adverse CV outcomes. While we agree that evidence exists suggesting that low doses of allopurinol may be sufficient for CV protection, we believe that the studies cited highlight a number of areas where knowledge gaps remain which preclude any definitive conclusions about the effect of dose escalation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Health Sciences-Evidence Based Practice questionnaire (HS-EBP) for measuring transprofessional evidence-based practice: Creation, development and psychometric validation.

PubMed

Fernández-Domínguez, Juan Carlos; de Pedro-Gómez, Joan Ernest; Morales-Asencio, José Miguel; Bennasar-Veny, Miquel; Sastre-Fullana, Pedro; Sesé-Abad, Albert

2017-01-01

Most of the EBP measuring instruments available to date present limitations both in the operationalisation of the construct and also in the rigour of their psychometric development, as revealed in the literature review performed. The aim of this paper is to provide rigorous and adequate reliability and validity evidence of the scores of a new transdisciplinary psychometric tool, the Health Sciences Evidence-Based Practice (HS-EBP), for measuring the construct EBP in Health Sciences professionals. A pilot study and a subsequent two-stage validation test sample were conducted to progressively refine the instrument until a reduced 60-item version with a five-factor latent structure. Reliability was analysed through both Cronbach's alpha coefficient and intraclass correlations (ICC). Latent structure was contrasted using confirmatory factor analysis (CFA) following a model comparison aproach. Evidence of criterion validity of the scores obtained was achieved by considering attitudinal resistance to change, burnout, and quality of professional life as criterion variables; while convergent validity was assessed using the Spanish version of the Evidence-Based Practice Questionnaire (EBPQ-19). Adequate evidence of both reliability and ICC was obtained for the five dimensions of the questionnaire. According to the CFA model comparison, the best fit corresponded to the five-factor model (RMSEA = 0.049; CI 90% RMSEA = [0.047; 0.050]; CFI = 0.99). Adequate criterion and convergent validity evidence was also provided. Finally, the HS-EBP showed the capability to find differences between EBP training levels as an important evidence of decision validity. Reliability and validity evidence obtained regarding the HS-EBP confirm the adequate operationalisation of the EBP construct as a process put into practice to respond to every clinical situation arising in the daily practice of professionals in health sciences (transprofessional). The tool could be useful for EBP individual

Bowel anastomoses: The theory, the practice and the evidence base

PubMed Central

Goulder, Frances

2012-01-01

Since the introduction of stapling instruments in the 1970s various studies have compared the results of sutured and stapled bowel anastomoses. A literature search was performed from 1960 to 2010 and articles relating to small bowel, colonic and colorectal anastomotic techniques were reviewed. References from these articles were also reviewed, and relevant articles obtained. Either a stapled or sutured gastrointestinal tract anastomosis is acceptable in most situations. The available evidence suggests that in the following situations, however, particular anastomotic techniques may result in fewer complications: A stapled side-to-side ileocolic anastomosis is preferable following a right hemicolectomy for cancer. A stapled side-to-side anastomosis is likely also preferable after an ileocolic resection for Crohn’s disease. Colorectal anastomoses can be sutured or stapled with similar results, although the incidence of strictures is higher following stapled anastomoses. Following reversal of loop ileostomy there is some evidence to suggest that a stapled side-to-side anastomosis or sutured enterotomy closure (rather than spout resection and sutured anastomosis) results in fewer complications. Non-randomised data has indicated that small bowel anastomoses are best sutured in the trauma patient. This article reviews the theory, practice and evidence base behind the various gastrointestinal anastomoses to help the practising general surgeon make evidence based operative decisions. PMID:23293735

Skeletal Indicators of Shark Feeding on Human Remains: Evidence from Florida Forensic Anthropology Cases.

PubMed

Stock, Michala K; Winburn, Allysha P; Burgess, George H

2017-11-01

This research examines a series of six Florida forensic anthropology cases that exhibit taphonomic evidence of marine deposition and shark-feeding activities. In each case, we analyzed patterns of trauma/damage on the skeletal remains (e.g., sharp-force bone gouges and punctures) and possible mechanisms by which they were inflicted during shark predation/scavenging. In some cases, shark teeth were embedded in the remains; in the absence of this evidence, we measured interdental distance from defects in the bone to estimate shark body length, as well as to draw inferences about the potential species responsible. We discuss similarities and differences among the cases and make comparisons to literature documenting diagnostic shark-inflicted damage to human remains from nearby regions. We find that the majority of cases potentially involve bull or tiger sharks scavenging the remains of previously deceased, adult male individuals. This scavenging results in a distinctive taphonomic signature including incised gouges in cortical bone. © 2017 American Academy of Forensic Sciences.

[Medical indications for acupuncture: Systematic review].

PubMed

Muñoz-Ortego, Juan; Solans-Domènech, Maite; Carrion, Carme

2016-09-16

Acupuncture is a medical procedure with a very wide range of indications according to the WHO. However the indications require robust scientific evidence to support them. We have conducted a systematic review (2010-2015) in order to define in which pathologies acupuncture can be an effective strategy, STRICTA criteria that aim to set up acupuncture clinical trials standard criteria were defined in 2010. Only systematic reviews and meta-analyses of good or very good methodological quality according to SIGN criteria were selected. Its main objective was to evaluate the effectiveness of acupuncture in the management of any disease. Most of the final 31 selected reviews focus on chronic pain-related diseases, mainly in the disciplines of Neurology, Orthopaedics and Rheumatology. Current evidence supports the use of acupuncture in the treatment of headaches, migraines, back pain, cervical pain and osteoarthritis. The remaining pathologies still require further good quality studies. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Prevalence and Phylogenetic Characterization of Escherichia coli and Hygiene Indicator Bacteria Isolated from Leafy Green Produce, Beef, and Pork Obtained from Farmers' Markets in Pennsylvania.

PubMed

Scheinberg, Joshua A; Dudley, Edward G; Campbell, Jonathan; Roberts, Beth; DiMarzio, Michael; DebRoy, Chitrita; Cutter, Catherine N

2017-02-01

The popularity of farmers' markets in the United States has led to over 8,400 farmers' markets being in operation in 2015. As farmers' markets have increased in size and complexity in the kinds of foods sold at these venues, so have the potential food safety risks. Since 2008, seven major foodborne illness outbreaks and two recalls associated with food products from farmers' markets have occurred, causing 80 known reported illnesses and one death. Various researchers also have observed vendors performing high-risk food safety retail behaviors, and others have identified microbiological hazards in foods sold at farmers' markets. In this study, the presence of hygiene indicators (coliforms, fecal coliforms, Listeria spp., and Escherichia coli ) was assessed in select samples of leafy green produce and meat obtained from farmers' markets in Pennsylvania. E. coli isolates were further characterized by phylogenetic profile and virulence potential. E. coli was present in 40% (20 of 50) and 18% (9 of 50) of beef and pork samples, respectively, and in 28% (15 of 54), 29% (15 of 52), and 17% (8 of 46) of kale, lettuce, and spinach samples, respectively. Listeria spp. was found in 8% (4 of 50) of beef samples, 2% (1 of 54) of kale samples, 4% (2 of 52) of lettuce samples, and 7% (3 of 46) of spinach samples. Among the 10 Listeria spp. isolates, 3 were identified as L. monocytogenes . E. coli isolated from meat samples mainly clustered into phylogroup B1 (66%; 19 of 29), whereas produce isolates clustered into phylogroups B2 (36%; 14 of 39) and B1 (33%; 13 of 39). These E. coli isolates possessed the fimH, iroN, hlyD, and eae genes associated with extraintestinal pathogenic E. coli and Shiga toxin-producing E. coli . The high prevalence but low levels of E. coli and Listeria spp. found on both produce and meat products obtained from farmers' markets in this study strongly indicate that farmers' market vendors would benefit greatly from food safety training and increased

Estimation of an optimal chemotherapy utilisation rate for cancer: setting an evidence-based benchmark for quality cancer care.

PubMed

Jacob, S A; Ng, W L; Do, V

2015-02-01

There is wide variation in the proportion of newly diagnosed cancer patients who receive chemotherapy, indicating the need for a benchmark rate of chemotherapy utilisation. This study describes an evidence-based model that estimates the proportion of new cancer patients in whom chemotherapy is indicated at least once (defined as the optimal chemotherapy utilisation rate). The optimal chemotherapy utilisation rate can act as a benchmark for measuring and improving the quality of care. Models of optimal chemotherapy utilisation were constructed for each cancer site based on indications for chemotherapy identified from evidence-based treatment guidelines. Data on the proportion of patient- and tumour-related attributes for which chemotherapy was indicated were obtained, using population-based data where possible. Treatment indications and epidemiological data were merged to calculate the optimal chemotherapy utilisation rate. Monte Carlo simulations and sensitivity analyses were used to assess the effect of controversial chemotherapy indications and variations in epidemiological data on our model. Chemotherapy is indicated at least once in 49.1% (95% confidence interval 48.8-49.6%) of all new cancer patients in Australia. The optimal chemotherapy utilisation rates for individual tumour sites ranged from a low of 13% in thyroid cancers to a high of 94% in myeloma. The optimal chemotherapy utilisation rate can serve as a benchmark for planning chemotherapy services on a population basis. The model can be used to evaluate service delivery by comparing the benchmark rate with patterns of care data. The overall estimate for other countries can be obtained by substituting the relevant distribution of cancer types. It can also be used to predict future chemotherapy workload and can be easily modified to take into account future changes in cancer incidence, presentation stage or chemotherapy indications. Copyright © 2014 The Royal College of Radiologists. Published by

Expert opinion vs. empirical evidence

PubMed Central

Herman, Rod A; Raybould, Alan

2014-01-01

Expert opinion is often sought by government regulatory agencies when there is insufficient empirical evidence to judge the safety implications of a course of action. However, it can be reckless to continue following expert opinion when a preponderance of evidence is amassed that conflicts with this opinion. Factual evidence should always trump opinion in prioritizing the information that is used to guide regulatory policy. Evidence-based medicine has seen a dramatic upturn in recent years spurred by examples where evidence indicated that certain treatments recommended by expert opinions increased death rates. We suggest that scientific evidence should also take priority over expert opinion in the regulation of genetically modified crops (GM). Examples of regulatory data requirements that are not justified based on the mass of evidence are described, and it is suggested that expertise in risk assessment should guide evidence-based regulation of GM crops. PMID:24637724

Introducing new reactivity descriptors: "Bond reactivity indices." Comparison of the new definitions and atomic reactivity indices.

PubMed

Sánchez-Márquez, Jesús

2016-11-21

A new methodology to obtain reactivity indices has been defined. This is based on reactivity functions such as the Fukui function or the dual descriptor and makes it possible to project the information of reactivity functions over molecular orbitals instead of the atoms of the molecule (atomic reactivity indices). The methodology focuses on the molecule's natural bond orbitals (bond reactivity indices) because these orbitals (with physical meaning) have the advantage of being very localized, allowing the reaction site of an electrophile or nucleophile to be determined within a very precise molecular region. This methodology gives a reactivity index for every Natural Bond Orbital (NBO), and we have verified that they have equivalent information to the reactivity functions. A representative set of molecules has been used to test the new definitions. Also, the bond reactivity index has been related with the atomic reactivity one, and complementary information has been obtained from the comparison. Finally, a new atomic reactivity index has been defined and compared with previous definitions.

Early rehabilitation programs after laparoscopic colorectal surgery: Evidence and criticism

PubMed Central

Kim, Duck-Woo; Kang, Sung-Bum; Lee, Soo-Young; Oh, Heung-Kwon; In, Myung-Hoon

2013-01-01

During the past several decades, early rehabilitation programs for the care of patients with colorectal surgery have gained popularity. Several randomized controlled trials and meta-analyses have confirmed that the implementation of these evidence-based detailed perioperative care protocols is useful for early recovery of patients after colorectal resection. Patients cared for based on these protocols had a rapid recovery of bowel movement, shortened length of hospital stay, and fewer complications compared with traditional care programs. However, most of the previous evidence was obtained from studies of early rehabilitation programs adapted to open colonic resection. Currently, limited evidence exists on the effects of early rehabilitation after laparoscopic rectal resection, although this procedure seems to be associated with a higher morbidity than that reported with traditional care. In this article, we review previous studies and guidelines on early rehabilitation programs in patients undergoing rectal surgery. We investigated the status of early rehabilitation programs in rectal surgery and analyzed the limitations of these studies. We also summarized indications and detailed protocol components of current early rehabilitation programs after rectal surgery, focusing on laparoscopic resection. PMID:24379571

Toward evidence-based medical statistics: a Bayesian analysis of double-blind placebo-controlled antidepressant trials in the treatment of anxiety disorders.

PubMed

Monden, Rei; de Vos, Stijn; Morey, Richard; Wagenmakers, Eric-Jan; de Jonge, Peter; Roest, Annelieke M

2016-12-01

The Food and Drug Administration (FDA) uses a p < 0.05 null-hypothesis significance testing framework to evaluate "substantial evidence" for drug efficacy. This framework only allows dichotomous conclusions and does not quantify the strength of evidence supporting efficacy. The efficacy of FDA-approved antidepressants for the treatment of anxiety disorders was re-evaluated in a Bayesian framework that quantifies the strength of the evidence. Data from 58 double-blind placebo-controlled trials were retrieved from the FDA for the second-generation antidepressants for the treatment of anxiety disorders. Bayes factors (BFs) were calculated for all treatment arms compared to placebo and were compared with the corresponding p-values and the FDA conclusion categories. BFs ranged from 0.07 to 131,400, indicating a range of no support of evidence to strong evidence for the efficacy. Results also indicate a varying strength of evidence between the trials with p < 0.05. In sum, there were large differences in BFs across trials. Among trials providing "substantial evidence" according to the FDA, only 27 out of 59 dose groups obtained strong support for efficacy according to the typically used cutoff of BF ≥ 20. The Bayesian framework can provide valuable information on the strength of the evidence for drug efficacy. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

[Overview of indicators in the context of environment and health].

PubMed

Tobollik, Myriam; Kabel, Claudia; Mekel, Odile; Hornberg, Claudia; Plaß, Dietrich

2018-06-01

Evidence-based political measures need reliable information about the health status of a population and the determinants affecting health. Here, environment and health indicators can provide helpful additional insights. This article provides an overview of existing indicators in the field of environment and health. There are single indicators and indicator sets describing solely the environment or health as well as some indicators integrating both aspects. The indicator sets cover classical epidemiological indicators but also summary measures of population health, which combine mortality and morbidity as well as simple descriptions of the exposure towards environmental risks. The indicator sets mostly cover water and air quality related aspects. For some of the indicators their influence on health is also presented. Furthermore, environment related health indicators are part of sustainability indicator sets. There are indicators on the international, European, national, and municipal level. All indicator sets aim to support policy-making by advising on measures and setting priorities in the area of environment and health protection. However not all indicators reflect the effect of the environment on health adequately. Therefore, further development of the existing indicators is necessary to reflect current progress (e. g. political needs) and to include new scientific evidence in the field of environment and health. A continuous provision, review, and interpretation of meaningful indicators is required to identify trends and to react to these in order to protect the environment and health. This is necessary to adequately pursue the precautionary principle.

Health Sciences-Evidence Based Practice questionnaire (HS-EBP) for measuring transprofessional evidence-based practice: Creation, development and psychometric validation

PubMed Central

Fernández-Domínguez, Juan Carlos; de Pedro-Gómez, Joan Ernest; Morales-Asencio, José Miguel; Sastre-Fullana, Pedro; Sesé-Abad, Albert

2017-01-01

Introduction Most of the EBP measuring instruments available to date present limitations both in the operationalisation of the construct and also in the rigour of their psychometric development, as revealed in the literature review performed. The aim of this paper is to provide rigorous and adequate reliability and validity evidence of the scores of a new transdisciplinary psychometric tool, the Health Sciences Evidence-Based Practice (HS-EBP), for measuring the construct EBP in Health Sciences professionals. Methods A pilot study and a subsequent two-stage validation test sample were conducted to progressively refine the instrument until a reduced 60-item version with a five-factor latent structure. Reliability was analysed through both Cronbach’s alpha coefficient and intraclass correlations (ICC). Latent structure was contrasted using confirmatory factor analysis (CFA) following a model comparison aproach. Evidence of criterion validity of the scores obtained was achieved by considering attitudinal resistance to change, burnout, and quality of professional life as criterion variables; while convergent validity was assessed using the Spanish version of the Evidence-Based Practice Questionnaire (EBPQ-19). Results Adequate evidence of both reliability and ICC was obtained for the five dimensions of the questionnaire. According to the CFA model comparison, the best fit corresponded to the five-factor model (RMSEA = 0.049; CI 90% RMSEA = [0.047; 0.050]; CFI = 0.99). Adequate criterion and convergent validity evidence was also provided. Finally, the HS-EBP showed the capability to find differences between EBP training levels as an important evidence of decision validity. Conclusions Reliability and validity evidence obtained regarding the HS-EBP confirm the adequate operationalisation of the EBP construct as a process put into practice to respond to every clinical situation arising in the daily practice of professionals in health sciences (transprofessional). The

Animal Communication and Its Cognitive Indications.

ERIC Educational Resources Information Center

McLean, Laura L.

Various examples of communication in species ranging from bumble bees to dolphins are examined in this paper. Focus is directed to indications of the cognitive ability of each species. The signals of cognition include evidence of: adaptability to a new situation; long term memory; and the property of displacement. Most of the sources reviewed…

Does national scale economic and environmental indicators spur logistics performance? Evidence from UK.

PubMed

Khan, Syed Abdul Rehman; Qianli, Dong

2017-12-01

The aim of this study is to examine the association between national economic and environmental indicators with green logistics performance in a time series data of UK since 1981 to 2016. The research used autoregressive distributed lag method to understand the long-run and short-run relationships of national scale economic (foreign direct investment (FDI) inflows, per capita income) and environmental indicators (total greenhouse gases, fossil fuel, and renewable energy) on green logistics. In the short run, the research findings indicate that the green logistics and renewable energy have positive relationship, while fossil fuel is negatively correlated with green logistics operations. On the other hand, in the long run, the results show that FDI inflows, renewable energy sources, and per capita income have statistically significant and positive association with green logistics activities, while foreign investments attracted by environmental friendly policies and practices adopted in global logistics operations, which not only increase the environmental sustainability but also enhance economic activities with greater export opportunities in the region.

Advanced, Cost-Based Indices for Forecasting the Generation of Photovoltaic Power

NASA Astrophysics Data System (ADS)

Bracale, Antonio; Carpinelli, Guido; Di Fazio, Annarita; Khormali, Shahab

2014-01-01

Distribution systems are undergoing significant changes as they evolve toward the grids of the future, which are known as smart grids (SGs). The perspective of SGs is to facilitate large-scale penetration of distributed generation using renewable energy sources (RESs), encourage the efficient use of energy, reduce systems' losses, and improve the quality of power. Photovoltaic (PV) systems have become one of the most promising RESs due to the expected cost reduction and the increased efficiency of PV panels and interfacing converters. The ability to forecast power-production information accurately and reliably is of primary importance for the appropriate management of an SG and for making decisions relative to the energy market. Several forecasting methods have been proposed, and many indices have been used to quantify the accuracy of the forecasts of PV power production. Unfortunately, the indices that have been used have deficiencies and usually do not directly account for the economic consequences of forecasting errors in the framework of liberalized electricity markets. In this paper, advanced, more accurate indices are proposed that account directly for the economic consequences of forecasting errors. The proposed indices also were compared to the most frequently used indices in order to demonstrate their different, improved capability. The comparisons were based on the results obtained using a forecasting method based on an artificial neural network. This method was chosen because it was deemed to be one of the most promising methods available due to its capability for forecasting PV power. Numerical applications also are presented that considered an actual PV plant to provide evidence of the forecasting performances of all of the indices that were considered.

Overlap in drug-disease associations between clinical practice guidelines and drug structured product label indications.

PubMed

Leung, Tiffany I; Dumontier, Michel

2016-06-08

Clinical practice guidelines (CPGs) recommend pharmacologic treatments for clinical conditions, and drug structured product labels (SPLs) summarize approved treatment indications. Both resources are intended to promote evidence-based medical practices and guide clinicians' prescribing decisions. However, it is unclear how well CPG recommendations about pharmacologic therapies match SPL indications for recommended drugs. In this study, we perform text mining of CPG summaries to examine drug-disease associations in CPG recommendations and in SPL treatment indications for 15 common chronic conditions. We constructed an initial text corpus of guideline summaries from the National Guideline Clearinghouse (NGC) from a set of manually selected ICD-9 codes for each of the 15 conditions. We obtained 377 relevant guideline summaries and their Major Recommendations section, which excludes guidelines for pediatric patients, pregnant or breastfeeding women, or for medical diagnoses not meeting inclusion criteria. A vocabulary of drug terms was derived from five medical taxonomies. We used named entity recognition, in combination with dictionary-based and ontology-based methods, to identify drug term occurrences in the text corpus and construct drug-disease associations. The ATC (Anatomical Therapeutic Chemical Classification) was utilized to perform drug name and drug class matching to construct the drug-disease associations from CPGs. We then obtained drug-disease associations from SPLs using conditions mentioned in their Indications section in SIDER. The primary outcomes were the frequency of drug-disease associations in CPGs and SPLs, and the frequency of overlap between the two sets of drug-disease associations, with and without using taxonomic information from ATC. Without taxonomic information, we identified 1444 drug-disease associations across CPGs and SPLs for 15 common chronic conditions. Of these, 195 drug-disease associations overlapped between CPGs and SPLs, 917

Measuring quality of care: considering conceptual approaches to quality indicator development and evaluation.

PubMed

Stelfox, Henry T; Straus, Sharon E

2013-12-01

In this article, we describe one approach for developing and evaluating quality indicators. We focus on describing different conceptual approaches to quality indicator development, review one approach for developing quality indicators, outline how to evaluate quality indicators once developed, and discuss quality indicator maintenance. The key steps for developing quality indicators include specifying a clear goal for the indicators; using methodologies to incorporate evidence, expertise, and patient perspectives; and considering contextual factors and logistics of implementation. The Strategic Framework Board and the National Quality Measure Clearinghouse have developed criteria for evaluating quality indicators that complement traditional psychometric evaluations. Optimal strategies for quality indicator maintenance and dissemination have not been determined, but experiences with clinical guideline maintenance may be informative. For quality indicators to effectively guide quality improvement efforts, they must be developed, evaluated, maintained, and implemented using rigorous evidence-informed practices. Copyright © 2013 Elsevier Inc. All rights reserved.

Obtaining resources for evidence-based public health initiatives at the local level: insights from the Central Sydney Tobacco Control Plan.

PubMed

Rissel, C; McMaugh, K; O'Connor, D; Balafas, A; Ward, J

1999-02-01

In response to inquiries regarding the processes of developing a Tobacco Control Plan (TCP) for the Central Sydney Area Health Service (which in 1997 allocated dedicated funding of $ 800,000 over 2 1/2 years to implement the plan), this article describes the strengths and weaknesses of the TCP and outlines the process which contributed to its funding. Consistent with national and state priorities, the TCP recommended strategies based on best available evidence in the four action areas: reducing sales of cigarettes to minors, marketing, passive smoking and smoking cessation. Funding of this amount for a single public health issue at a local level represents a unique achievement in the application of an evidence-based approach to population health. Key elements of our advocacy methods included the involvement of all key primary health care and clinical stakeholders; comprehensive background research to identify evidence-based strategies; careful attention to budget options; strategic lobbying of senior staff and decision makers; the proposal for a multidisciplinary management structure for the TCP and specifications for funding allocation and evaluation. Early achievements and other reflections are discussed.

Quality Indicators for Safe Medication Preparation and Administration: A Systematic Review

PubMed Central

Maaskant, Jolanda M.; de Boer, Monica; Krediet, C. T. Paul; Nieveen van Dijkum, Els J. M.

2015-01-01

Background One-third of all medication errors causing harm to hospitalized patients occur in the medication preparation and administration phase, which is predominantly a nursing activity. To monitor, evaluate and improve the quality and safety of this process, evidence-based quality indicators can be used. Objectives The aim of study was to identify evidence-based quality indicators (structure, process and outcome) for safe in-hospital medication preparation and administration. Methods MEDLINE, EMBASE and CINAHL were searched for relevant studies published up to January 2015. Additionally, nine databases were searched to identify relevant grey literature. Two reviewers independently selected studies if (1) the method for quality indicator development combined a literature search with expert panel opinion, (2) the study contained quality indicators on medication safety, and (3) any of the quality indicators were applicable to hospital medication preparation and administration. A multidisciplinary team appraised the studies independently using the AIRE instrument, which contains four domains and 20 items. Quality indicators applicable to in-hospital medication preparation and administration were extracted using a structured form. Results The search identified 1683 studies, of which 64 were reviewed in detail and five met the inclusion criteria. Overall, according to the AIRE domains, all studies were clear on purpose; most of them applied stakeholder involvement and used evidence reasonably; usage of the indicator in practice was scarcely described. A total of 21 quality indicators were identified: 5 structure indicators (e.g. safety management and high alert medication), 11 process indicators (e.g. verification and protocols) and 5 outcome indicators (e.g. harm and death). These quality indicators partially cover the 7 rights. Conclusion Despite the relatively small number of included studies, the identified quality indicators can serve as an excellent starting

A multiple indicator, multiple cause method for representing social capital with an application to psychological distress

NASA Astrophysics Data System (ADS)

Congdon, Peter

2010-03-01

This paper describes a structural equation methodology for obtaining social capital scores for survey subjects from multiple indicators of social support, neighbourhood and trust perceptions, and memberships of organizations. It adjusts for variation that is likely to occur in levels of social capital according to geographic context (e.g. level of area deprivation, geographic region, level of urbanity) and demographic group. Social capital is used as an explanatory factor for psychological distress using data from the 2006 Health Survey for England. A highly significant effect of social capital in reducing the chance of psychiatric caseness is obtained after controlling for other individual and geographic risk factors. Allowing for social capital has considerable effects on the impacts on psychiatric health of other risk factors. In particular, the impact of area deprivation category is much reduced. There is also evidence of significant differentiation in social capital between population categories and geographic contexts.

Development and implementation of a nurse-led walk-in centre: evidence lost in translation?

PubMed

Desborough, Jane; Parker, Rhian; Forrest, Laura

2013-07-01

The design of the first Australian public nurse-led primary care walk-in centre was modelled on those established in the English National Health Service (NHS). An independent evaluation of the first 12 months of operation of the Australian Capital Territory (ACT) Health walk-in centre, in 2011, analysed the translation of evidence from the national evaluation of the NHS walk-in centres to the policy development and implementation of the ACT walk-in centre. Whilst in a number of ways the evidence was used well, our interest for this paper was to examine three areas identified as problematic and to identify the points at which the evidence was lost or diluted. In addition to data obtained through nurse and key stakeholder interviews for the evaluation, an analysis was undertaken of documents on the planning and establishment of the ACT walk-in centre, either provided to the evaluation team or made publicly available. Three areas were identified as problematic in the way that evidence from the NHS evaluation was translated: the use of clinical decision support software (CDSS); the marketing of the walk-in centre; and its location. Our examination indicates that despite seeking evidence to inform the development of the ACT walk-in centre, the evidence was not fully used and some clear lessons ignored, resulting in much of the evidence being lost in translation.

A Systematic Review of Socioeconomic Indicators and Dental Caries in Adults

PubMed Central

Costa, Simone M.; Martins, Carolina C.; Bonfim, Maria de Lourdes C.; Zina, Lívia G.; Paiva, Saul M.; Pordeus, Isabela A.; Abreu, Mauro H. N. G.

2012-01-01

Increasing evidence suggests that socioeconomic factors may be associated with an increased risk of dental caries. To provide better evidence of the association between dental caries in adults and socioeconomic indicators, we evaluated the relation between these two conditions in a thorough review of the literature. Seven databases were systematically searched: Pubmed, Cochrane, Web of Science, Bireme, Controlled Trials, Clinical Trials and the National Institute for Health and Clinical Excellence. No restrictions were placed on the language or year of publication. The search yielded 41 studies for systematic review. Two independent reviewers screened the studies for inclusion, extracted data and evaluated quality using the Newcastle-Ottawa scale. The following socioeconomic indicators were found: educational level, income, occupation, socio-economic status and the community index. These indicators were significantly associated with a greater occurrence of dental caries: the subject’s education, subject’s income, subject’s occupation and the Gini coefficient. A high degree of heterogeneity was found among the methods. Quality varied across studies. The criteria employed for socioeconomic indicators and dental caries should be standardized in future studies. The scientific evidence reveals that educational level, income, occupation and the Gini coefficient are associated with dental caries. PMID:23202762

Factors influencing the development of evidence-based practice among nurses: a self-report survey

PubMed Central

2012-01-01

Background Health authorities in several countries have decided that the health care services should be evidence-based. Recent research indicates that evidence-based practice may be more successfully implemented if the interventions overcome identified barriers. Aims The present study aimed to examine factors influencing the implementation of evidence-based practice among nurses in a large Norwegian university hospital. Methods Cross-sectional data was collected from 407 nurses during the period November 8 to December 3, 2010, using the Norwegian version of Developing Evidence-based Practice questionnaire (DEBP). The DEBP included data on various sources of information used for support in practice, on potential barriers for evidence-based practice, and on self-reported skills on managing research-based evidence. The DEBP was translated into Norwegian in accordance with standardized guidelines for translation and cultural adaptation. Results Nurses largely used experienced-based knowledge collected from their own observations, colleagues and other collaborators for support in practice. Evidence from research was seldom used. The greatest barriers were lack of time and lack of skills to find and manage research evidence. The nurse’s age, the number of years of nursing practice, and the number of years since obtaining the last health professional degree influenced the use of sources of knowledge and self-reported barriers. Self-reported skills in finding, reviewing and using different sources of evidence were positively associated with the use of research evidence and inversely related to barriers in use of research evidence. Conclusion Skills in evidence-based practice seem to reduce barriers to using research evidence and to increase use of research evidence in clinical practice. PMID:23092366

Proposal of indicators to evaluate complementary feeding based on World Health Organization indicators.

PubMed

Saldan, Paula Chuproski; Venancio, Sonia Isoyama; Saldiva, Silvia Regina Dias Medici; de Mello, Débora Falleiros

2016-09-01

This study compares complementary feeding World Health Organization (WHO) indicators with those built in accordance with Brazilian recommendations (Ten Steps to Healthy Feeding). A cross-sectional study was carried out during the National Immunization Campaign against Poliomyelitis in Guarapuava-Paraná, Brazil, in 2012. Feeding data from 1,355 children aged 6-23 months were obtained through the 24 h diet recall. Based on five indicators, the proportion of adequacy was evaluated: introduction of solid, semi-solid, or soft foods; minimum dietary diversity; meal frequency; acceptable diet; and consumption of iron-rich foods. Complementary feeding showed adequacy higher than 85% in most WHO indicators, while review by the Ten Steps assessment method showed a less favorable circumstance and a high intake of unhealthy foods. WHO indicators may not reflect the complementary feeding conditions of children in countries with low malnutrition rates and an increased prevalence of overweight/obesity. The use of indicators according to the Ten Steps can be useful to identify problems and redirect actions aimed at promoting complementary feeding. © 2016 John Wiley & Sons Australia, Ltd.

The incidence of un-indicated preoperative testing in a tertiary academic ambulatory center: a retrospective cohort study.

PubMed

Onuoha, Onyi C; Hatch, Michael B; Miano, Todd A; Fleisher, Lee A

2015-01-01

Despite existing evidence and guidelines advocating for appropriate risk stratification, ambulatory surgery in low-risk patients continues to be accompanied by a battery of routine tests prior to surgery. Using a single-center retrospective cohort study, we aimed to quantify the incidence of un-indicated preoperative testing in an academic ambulatory center by utilizing recommendations by the recently developed American Society of Anesthesiology (ASA) "Choosing Wisely" Top-5 list. We utilized data from the EPIC medical records of 3111 patients who had ambulatory surgery at the Hospital of the University of Pennsylvania during a 6-month period. Data were abstracted from laboratory studies- complete blood count, electrolyte panel, coagulation studies, and cardiac studies-stress test, and echocardiogram obtained within 30 days prior to surgery. Preoperative tests obtained from each patient were categorized into "indicated" (ASA ≥ 3) and "un-indicated" (ASA 1 and 2) tests, and percentages were reported. During the study period, 52.9 % (95 % confidence interval (CI) 37.6-66.4) of all patients had at least one un-indicated laboratory test performed preoperatively. Further analysis revealed variation in the incidence of preoperative ordering between tests; 73 % of all complete blood counts (CBCs), 70 % of all metabolic panels, and 49 % of all coagulation studies were considered un-indicated by "Top-5 List" criteria. Stated differently, of the patients included in the sample, 51 % of patients received an un-indicated CBC, 41 % an un-indicated metabolic panel, and 16 % un-indicated coagulation studies. Twelve percent of "any un-indicated preoperative test" were obtained from ASA 1 healthy patients. Of the 587 patients less than 36 years old, 331 (56 %) had at least one test that was deemed un-indicated. Forty-one patients had either an echocardiogram or stress test ordered and performed within 30 days of surgery. Of these, eight (19.5 %) studies were un-indicated

46 CFR 67.101 - Waiver of evidence of build.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 2 2010-10-01 2010-10-01 false Waiver of evidence of build. 67.101 Section 67.101... DOCUMENTATION OF VESSELS Build Requirements for Vessel Documentation § 67.101 Waiver of evidence of build. (a) A vessel owner applying for documentation unable to obtain the evidence of build required by § 67.99 may...

Water quality indicators obtainable from aircraft and Landsat images and their use in classifying lakes

NASA Technical Reports Server (NTRS)

Scherz, J. P.; Van Domelen, J. F.

1975-01-01

Equations describing the interaction of sunlight and skylight with the surface of a lake, particles in the water to the depth where light is extinguished, and lake bottom are presented, and the use of aircraft and Landsat images to derive water quality indicators on the basis of these interactions is discussed. A very clear, deep lake with a backscatter signal similar to that of distilled water is used as a reference standard. The degree of turbidity of other target lakes is determined by comparing their residual radiance with the clear lake standard and with the residual radiance of a lake whose turbidity has been determined from water samples. The relative and absolute strengths of residual radiance are used to determine the type and concentration of suspended material, respectively. Oil slicks are characterized by an increased specular reflectance component, decreased signal from the underlying water, and added backscatter signal from the oil volume.

Evidence regarding patient compliance with incentive spirometry interventions after cardiac, thoracic and abdominal surgeries: A systematic literature review.

PubMed

Narayanan, Aqilah Leela T; Hamid, Syed Rasul G Syed; Supriyanto, Eko

2016-01-01

Evidence regarding the effectiveness of incentive spirometry (ISy) on postoperative pulmonary outcomes after thoracic, cardiac and abdominal surgery remains inconclusive. This is attributed to various methodological issues inherent in ISy trials. Patient compliance has also been highlighted as a possible confounding factor; however, the status of evidence regarding patient compliance in these trials is unknown. To explore the status of evidence on patient compliance with ISy interventions in randomized controlled trials (RCTs) in the above contexts. A systematic search using MEDLINE, EMBASE and CINAHL databases was conducted to obtain relevant RCTs from 1972 to 2015 using the inclusion criteria. These were examined for specific ISy parameters, methods used for determining compliance and reporting on compliance. Main outcome measures were comparison of ISy parameters prescribed and assessed, and reporting on compliance. Thirty-six relevant RCTs were obtained. Six ISy parameters were identified in ISy prescriptions from these trials. Almost all (97.2%) of the trials had ISy prescriptions with specific parameters. Wilcoxon signed-rank test revealed that the ISy parameters assessed were significantly lower (Z=-5.433; P<0.001) than those prescribed; 66.7% of the trials indicated use of various methods to assess these parameters. Only six (16.7%) trials included reports on compliance; however, these were also incomprehensive. There is a scarcity and inconsistency of evidence regarding ISy compliance. Compliance data should be obtained using reliable and standardized methods to facilitate comparisons between and among trials. These should be reported comprehensively to facilitate valid inferences regarding ISy intervention effectiveness.

Evidence regarding patient compliance with incentive spirometry interventions after cardiac, thoracic and abdominal surgeries: A systematic literature review

PubMed Central

Narayanan, Aqilah Leela T; Hamid, Syed Rasul G Syed; Supriyanto, Eko

2016-01-01

BACKGROUND: Evidence regarding the effectiveness of incentive spirometry (ISy) on postoperative pulmonary outcomes after thoracic, cardiac and abdominal surgery remains inconclusive. This is attributed to various methodological issues inherent in ISy trials. Patient compliance has also been highlighted as a possible confounding factor; however, the status of evidence regarding patient compliance in these trials is unknown. OBJECTIVE: To explore the status of evidence on patient compliance with ISy interventions in randomized controlled trials (RCTs) in the above contexts. METHOD: A systematic search using MEDLINE, EMBASE and CINAHL databases was conducted to obtain relevant RCTs from 1972 to 2015 using the inclusion criteria. These were examined for specific ISy parameters, methods used for determining compliance and reporting on compliance. Main outcome measures were comparison of ISy parameters prescribed and assessed, and reporting on compliance. RESULTS: Thirty-six relevant RCTs were obtained. Six ISy parameters were identified in ISy prescriptions from these trials. Almost all (97.2%) of the trials had ISy prescriptions with specific parameters. Wilcoxon signed-rank test revealed that the ISy parameters assessed were significantly lower (Z=−5.433; P<0.001) than those prescribed; 66.7% of the trials indicated use of various methods to assess these parameters. Only six (16.7%) trials included reports on compliance; however, these were also incomprehensive. CONCLUSIONS: There is a scarcity and inconsistency of evidence regarding ISy compliance. Compliance data should be obtained using reliable and standardized methods to facilitate comparisons between and among trials. These should be reported comprehensively to facilitate valid inferences regarding ISy intervention effectiveness. PMID:26909010

Number of blastocysts biopsied as a predictive indicator to obtain at least one normal/balanced embryo following preimplantation genetic diagnosis with single nucleotide polymorphism microarray in translocation cases.

PubMed

Wang, Yi-Zi; Ding, Chen-Hui; Wang, Jing; Zeng, Yan-Hong; Zhou, Wen; Li, Rong; Zhou, Can-Quan; Deng, Ming-Fen; Xu, Yan-Wen

2017-01-01

The aim of this study is to investigate the minimum number of blastocysts for biopsy to increase the likelihood of obtaining at least one normal/balanced embryo in preimplantation genetic diagnosis (PGD) for translocation carriers. This blinded retrospective study included 55 PGD cycles for Robertsonian translocation (RT) and 181 cycles for reciprocal translocation (rcp) to indicate when only one of the couples carried a translocation. Single-nucleotide polymorphism microarray after trophectoderm biopsy was performed. Reliable results were obtained for 355/379 (93.7 %) biopsied blastocysts in RT group and 986/1053 (93.6 %) in rcp group. Mean numbers of biopsied embryos per patient, normal/balanced embryos per patient, and mean normal/balanced embryo rate per patient were 7.4, 3.1, and 40.7 % in RT group and 8.0, 2.1, and 27.3 %, respectively, in rcp group. In a regression model, three factors significantly affected the number of genetically transferrable embryos: number of biopsied embryos (P = 0.001), basal FSH level (P = 0.040), and maternal age (P = 0.027). ROC analysis with a cutoff of 1.5 was calculated for the number of biopsied embryos required to obtain at least one normal/balanced embryo for RT carriers. For rcp carriers, the cutoff was 3.5. The clinical pregnancy rate per embryo transfer was 44.2 and 42.6 % in RT and rcp groups (P = 0.836). The minimum numbers of blastocysts to obtain at least one normal/balanced embryo for RT and rcp were 2 and 4 under the conditions of female age < 37 years with a basal FSH level < 11.4 IU/L.

Evidence-informed policymaking in practice: country-level examples of use of evidence for iCCM policy

PubMed Central

Rodríguez, Daniela C; Shearer, Jessica; Mariano, Alda RE; Juma, Pamela A; Dalglish, Sarah L; Bennett, Sara

2015-01-01

Integrated Community Case Management of Childhood Illness (iCCM) is a policy for providing treatment for malaria, diarrhoea and pneumonia for children below 5 years at the community level, which is generating increasing evidence and support at the global level. As countries move to adopt iCCM, it becomes important to understand how this growing evidence base is viewed and used by national stakeholders. This article explores whether, how and why evidence influenced policy formulation for iCCM in Niger, Kenya and Mozambique, and uses Carol Weiss’ models of research utilization to further explain the use of evidence in these contexts. A documentary review and in-depth stakeholder interviews were conducted as part of retrospective case studies in each study country. Findings indicate that all three countries used national monitoring data to identify the issue of children dying in the community prior to reaching health facilities, whereas international research evidence was used to identify policy options. Nevertheless, policymakers greatly valued local evidence and pilot projects proved critical in advancing iCCM. World Health Organization and United Nations Children's Fund (UNICEF) functioned as knowledge brokers, bringing research evidence and experiences from other countries to the attention of local policymakers as well as sponsoring site visits and meetings. In terms of country-specific findings, Niger demonstrated both Interactive and Political models of research utilization by using iCCM to capitalize on the existing health infrastructure. Both Mozambique and Kenya exhibit Problem-Solving research utilization with different outcomes. Furthermore, the persistent quest for additional evidence suggests a Tactical use of research in Kenya. Results presented here indicate that while evidence from research studies and other contexts can be critical to policy development, local evidence is often needed to answer key policymaker questions. In the end, evidence may not

Developing an evidence-based practice protocol: implications for midwifery practice.

PubMed

Carr, K C

2000-01-01

Evidence-based practice is defined and its importance to midwifery practice is presented. Guidelines are provided for the development of an evidence-based practice protocol. These include: identifying the clinical question, obtaining the evidence, evaluating the validity and importance of the evidence, synthesizing the evidence and applying it to the development of a protocol or clinical algorithm, and, finally, developing an evaluation plan or measurement strategy to see if the new protocol is effective.

Assessing the Rationale and Effectiveness of Frozen Plasma Transfusions: An Evidence-based Review.

PubMed

Tinmouth, Alan

2016-06-01

Frozen plasma is a commonly used blood product. The primary indications for frozen plasma are the treatment and prevention of bleeding in patients with prolonged coagulation tests. However, there is a lack of well-conducted clinical trials to determine the appropriate indications for frozen plasma. The rationale and evidence for frozen plasma transfusions are reviewed, including the evidence or lack of evidence supporting common indications. Targeting indications in which frozen plasma transfusions are clearly not beneficial as supported by the current evidence provides an opportunity to improve the current use of frozen plasma and reduce adverse transfusion events. Copyright © 2016 Elsevier Inc. All rights reserved.

Hydrologic indices for nontidal wetlands

USGS Publications Warehouse

Lent, Robert M.; Weiskel, Peter K.; Lyford, Forest P.; Armstrong, David S.

1997-01-01

Two sets of hydrologic indices were developed to characterize the water-budget components of nontidal wetlands. The first set consisted of six water-budget indices for input and output variables, and the second set consisted of two hydrologic interaction indices derived from the water-budget indices. The indices then were applied to 19 wetlands with previously published water-budget data. Two trilinear diagrams for each wetland were constructed, one for the three input indices and another for the three output indices. These two trilinear diagrams then were combined with a central quadrangle to form a Piper-type diagram, with data points from the trilinear diagrams projected onto the quadrangle. The quadrangle then was divided into nine fields that summarized the water-budget information. Two quantitative "interaction indices" were calculated from two of the six water-budget indices (precipitation and evapotranspiration). They also were obtained graphically from the water-budget indices, which were first projected to the central quadrangle of a Piper-type diagram from the flanking trilinear plots. The first interaction index (l) defines the strength of interaction between a wetland and the surrounding ground- and surface-water system. The second interaction index (S) defines the nature of the interaction between the wetland and the surrounding ground- and surface-water system (source versus sink). Evaluation of these indices using published wetland water-budget data illustrates the usefulness of the technique.

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

PubMed

Gaeta, Rodolfo; Gentile, Nelida

2016-08-01

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

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

NASA Astrophysics Data System (ADS)

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

2016-03-01

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

Indicators of Mental Health in Various Iranian Populations

PubMed Central

Mohamadi, Khosro; Ahmadi, Khodabakhsh; Fathi Ashtiani, Ali; Azad Fallah, Parviz; Ebadi, Abbas; Yahaghi, Emad

2014-01-01

Background: Promoting mental health and preventing mental disorders are of the main concerns for every country. Achieving these goals requires effective indexes for evaluating mental health. Therefore, to develop mental health enhancement programs in Iran, there is a need to measure the state of mental health in Iran. Objectives: This study aimed to select a set of mental health indicators that can be used to monitor the status of mental health in Iran. Materials and Methods: This research work used Q-methodology which combines both quantitative and qualitative research methods for establishment of mental health indicators in Iran. In this study, 30 participants were chosen by purposive sampling from different types of professionals in the field of mental health. Results: Twenty seven mental health indicators were obtained from the Q-methodology. The most important indicators obtained in this study are as follows: annual prevalence of mental disorders, suicide rates, number of mental health professionals, mental health expenditures and suicide related deaths. Conclusions: This study provides mental health indices for measuring mental health status in Iran. These mental health indices can be used to measure progress in the reform policies and community mental health services. PMID:24719740

20 CFR 219.21 - Types of evidence to prove age.

Code of Federal Regulations, 2012 CFR

2012-04-01

...) Preferred evidence. The best type of evidence to prove a claimant's age is— (1) A birth certificate recorded before age 5; (2) A church record of birth or baptism recorded before age 5; or (3) Notification of registration of birth made before age 5. (b) Other evidence of age. If an individual cannot obtain preferred...

20 CFR 219.21 - Types of evidence to prove age.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) Preferred evidence. The best type of evidence to prove a claimant's age is— (1) A birth certificate recorded before age 5; (2) A church record of birth or baptism recorded before age 5; or (3) Notification of registration of birth made before age 5. (b) Other evidence of age. If an individual cannot obtain preferred...

20 CFR 219.21 - Types of evidence to prove age.

Code of Federal Regulations, 2013 CFR

2013-04-01

...) Preferred evidence. The best type of evidence to prove a claimant's age is— (1) A birth certificate recorded before age 5; (2) A church record of birth or baptism recorded before age 5; or (3) Notification of registration of birth made before age 5. (b) Other evidence of age. If an individual cannot obtain preferred...

20 CFR 219.21 - Types of evidence to prove age.

Code of Federal Regulations, 2014 CFR

2014-04-01

...) Preferred evidence. The best type of evidence to prove a claimant's age is— (1) A birth certificate recorded before age 5; (2) A church record of birth or baptism recorded before age 5; or (3) Notification of registration of birth made before age 5. (b) Other evidence of age. If an individual cannot obtain preferred...

20 CFR 219.21 - Types of evidence to prove age.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) Preferred evidence. The best type of evidence to prove a claimant's age is— (1) A birth certificate recorded before age 5; (2) A church record of birth or baptism recorded before age 5; or (3) Notification of registration of birth made before age 5. (b) Other evidence of age. If an individual cannot obtain preferred...

Uncertainties in obtaining high reliability from stress-strength models

NASA Technical Reports Server (NTRS)

Neal, Donald M.; Matthews, William T.; Vangel, Mark G.

1992-01-01

There has been a recent interest in determining high statistical reliability in risk assessment of aircraft components. The potential consequences are identified of incorrectly assuming a particular statistical distribution for stress or strength data used in obtaining the high reliability values. The computation of the reliability is defined as the probability of the strength being greater than the stress over the range of stress values. This method is often referred to as the stress-strength model. A sensitivity analysis was performed involving a comparison of reliability results in order to evaluate the effects of assuming specific statistical distributions. Both known population distributions, and those that differed slightly from the known, were considered. Results showed substantial differences in reliability estimates even for almost nondetectable differences in the assumed distributions. These differences represent a potential problem in using the stress-strength model for high reliability computations, since in practice it is impossible to ever know the exact (population) distribution. An alternative reliability computation procedure is examined involving determination of a lower bound on the reliability values using extreme value distributions. This procedure reduces the possibility of obtaining nonconservative reliability estimates. Results indicated the method can provide conservative bounds when computing high reliability. An alternative reliability computation procedure is examined involving determination of a lower bound on the reliability values using extreme value distributions. This procedure reduces the possibility of obtaining nonconservative reliability estimates. Results indicated the method can provide conservative bounds when computing high reliability.

[Indication: scientific and ethical basis of medical practice].

PubMed

Neitzke, G

2014-02-01

The medical indication provides a rational foundation for treatment decisions. An indication can be defined as the reasonable professional judgement that a medical procedure is suitable and useful to reach a specific therapeutic goal with a certain probability. An indication includes empirical, causal and purposive considerations and justifications, and a scrutiny of the individual case. This ensures that medical aspects of the patient, therapeutic goals and evidence-based knowledge are integrated and represented in the indication. An indication justifies a treatment proposal to the patient, which may only be carried out after a procedure of informed consent. Indications can be considered as the ethical basis of treatment decisions and as the heart of professionalism: indications should be used as a professional tool to protect against irrational therapeutic expectations, while ensuring the patient's right for reasonable treatment. In health care that is increasingly shaped by economic constraints, conscientious indications ensure the professional and ethical basis of medical treatment decisions.

Sex, Arts and Verbal Abilities: Three Further Indicators of How American Life Is Not Improving

ERIC Educational Resources Information Center

Robinson, John P.

2010-01-01

Despite clear evidence that Americans' economic standard of living has improved over the last half-century in terms of income, ownership of technology and housing among other indicators, there is scant evidence from non-economic quality-of-life (QOL) indicators of improved life quality to parallel these economic gains. The present article adds to…

Evidence for the existence of negative ions in the D and lower E regions at twilight

NASA Technical Reports Server (NTRS)

Kane, J. A.

1972-01-01

Evidence for negative ions in the lower ionosphere is based on the difference between simultaneously measured profiles of electron and positive ion density. The electron density profiles reported were obtained from ground-to-rocket radio wave absorption measurements while Gerdien ion traps were used to measure the positive ion profiles. Results from a series of three rockets launched from Thumba, India near sunset on 27 March, 1970 indicate that a significant number of negative ions are formed at altitudes as high as 95 km at twilight.

When There Is Not Enough Evidence and When Evidence Is Not Enough: An Australian Indigenous Smoking Policy Study.

PubMed

Vujcich, Daniel; Rayner, Mike; Allender, Steven; Fitzpatrick, Ray

2016-01-01

The Indigenous Tobacco Control Initiative and Tackling Indigenous Smoking Measure were both announced by the Australian Government at a time when its rhetoric around the importance of evidence-based policy making was strong. This article will (1) examine how the Rudd Government used evidence in Indigenous tobacco control policy making and (2) explore the facilitators of and barriers to the use of evidence. Data were collected through (1) a review of primary documents largely obtained under the Freedom of Information Act 1982 (Commonwealth of Australia) and (2) interviews with senior politicians, senior bureaucrats, government advisors, Indigenous health advocates, and academics. Through the Freedom of Information Act process, 24 previously undisclosed government documents relevant to the making of Indigenous tobacco control policies were identified. Interviewees ( n  = 31, response rate 62%) were identified through both purposive and snowball recruitment strategies. The Framework Analysis method was used to analyze documentary and interview data. Government policy design was heavily influenced by the recommendations presented in government authored/commissioned literature reviews. Resulting policies were led by equivocal evidence for improved tobacco control outcomes among Indigenous Australians. Many of the cited studies had methodological limitations. In the absence of high-quality evidence, some policy makers supported policy recommendations that were perceived to be popular among the Indigenous community. Other policy makers recognized that there were barriers to accumulating rigorous, generalizable evidence; in the absence of such evidence, the policy makers considered that the "need for action" could be combined with the "need for research" by introducing innovative strategies and evaluating them. Despite the absence of high-quality evidence, the formulation and adoption of Indigenous tobacco policy was neither irrational nor reckless. The decision to

Evidence-based Medicine in Pediatric Orthopaedics: Evidence-based Practice Committee Summary of Levels of Evidence, Clinical Practice Guidelines, Appropriate Use Criteria, and Best Practice Guidelines.

PubMed

Gandhi, Jigar S; Shea, Kevin G; Sponseller, Paul D; Brighton, Brian K; Ganley, Theodore J

2018-04-30

The concept of evidence-based medicine has evolved over the past 2 decades, and has become a cornerstone to clinical decision-making in virtually every aspect of medicine. With a commitment to providing its members with high-quality evidence-based guidelines, the American Academy of Orthopaedic Surgeons has instituted concerted efforts since 2006 to develop clinical practice guidelines (CPGs) and appropriate use criteria (AUCs) for certain orthopaedic conditions. Many of these CPGs and AUCs detail the management of pediatric orthopaedic conditions. By the same token, members of the Pediatric Orthopaedic Society of North America (POSNA) Evidence Based Practice Committee have been publishing succinct evaluations of randomized controlled trials in pediatric orthopaedic surgery to create an evidence-based repository for quick reference to available high-level evidence as well as resource to identify gaps in the current research and identify opportunities for future investigation. In instances where higher-level evidence needed to develop CPGs is not available to address a critically important clinical question, consensus recommendations from experts in the field have been obtained to develop best practice guidelines (BPGs). The purpose of this review is to provide readers with a deeper understanding of the key principles of evidence-based medicine and methodologies used for the development of CPGs, AUCs, and BPGs.

IgG and IgM anti-snRNP reactivity in sequentially obtained serum samples from patients with connective tissue diseases.

PubMed Central

Nyman, U; Lundberg, I; Hedfors, E; Wahren, M; Pettersson, I

1992-01-01

Sequentially obtained serum samples from 30 patients with connective tissue disease positive for antibody to ribonucleoprotein (RNP) were examined to determine the specificities of IgG and IgM antibodies to snRNP during the disease course using immunoblotting of nuclear extracts. The antibody patterns were correlated with disease activity. The patterns of antibody to snRNP of individual patients were mainly stable during the study but changes in levels of antibody to snRNP were seen corresponding to changes in clinical activity. These results indicate that increased reactivity of serum IgM antibodies against the B/B' proteins seems to precede a clinically evident exacerbation of disease whereas IgG antibody reactivity to the 70 K protein peaks at the time of a disease flare. Images PMID:1485812

Practice Parameters for the Respiratory Indications for Polysomnography in Children

PubMed Central

Aurora, R. Nisha; Zak, Rochelle S.; Karippot, Anoop; Lamm, Carin I.; Morgenthaler, Timothy I.; Auerbach, Sanford H.; Bista, Sabin R.; Casey, Kenneth R.; Chowdhuri, Susmita; Kristo, David A.; Ramar, Kannan

2011-01-01

Background: There has been marked expansion in the literature and practice of pediatric sleep medicine; however, no recent evidence-based practice parameters have been reported. These practice parameters are the first of 2 papers that assess indications for polysomnography in children. This paper addresses indications for polysomnography in children with suspected sleep related breathing disorders. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Methods: A systematic review of the literature was performed, and the American Academy of Neurology grading system was used to assess the quality of evidence. Recommendations for PSG Use: Polysomnography in children should be performed and interpreted in accordance with the recommendations of the AASM Manual for the Scoring of Sleep and Associated Events. (Standard) Polysomnography is indicated when the clinical assessment suggests the diagnosis of obstructive sleep apnea syndrome (OSAS) in children. (Standard) Children with mild OSAS preoperatively should have clinical evaluation following adenotonsillectomy to assess for residual symptoms. If there are residual symptoms of OSAS, polysomnography should be performed. (Standard) Polysomnography is indicated following adenotonsillectomy to assess for residual OSAS in children with preoperative evidence for moderate to severe OSAS, obesity, craniofacial anomalies that obstruct the upper airway, and neurologic disorders (e.g., Down syndrome, Prader-Willi syndrome, and myelomeningocele). (Standard) Polysomnography is indicated for positive airway pressure (PAP) titration in children with obstructive sleep apnea syndrome. (Standard) Polysomnography is indicated when the clinical assessment suggests the diagnosis of congenital central alveolar hypoventilation syndrome or sleep related hypoventilation due to neuromuscular disorders or chest wall deformities. It is indicated in selected cases of primary sleep

Comparing the Persuasiveness of Narrative and Statistical Evidence Using Meta-Analysis.

ERIC Educational Resources Information Center

Allen, Mike; Preiss, Raymond W.

1997-01-01

Compares the persuasiveness of using statistical versus narrative evidence (case studies or examples) across 15 investigations. Indicates that when comparing messages, statistical evidence is more persuasive than narrative evidence. (PA)

Queer challenges to evidence-based practice.

PubMed

Zeeman, Laetitia; Aranda, Kay; Grant, Alec

2014-06-01

This paper aims to queer evidence-based practice by troubling the concepts of evidence, knowledge and mental illness. The evidence-based narrative that emerged within biomedicine has dominated health care. The biomedical notion of 'evidence' has been critiqued extensively and is seen as exclusive and limiting, and even though the social constructionist paradigm attempts to challenge the authority of biomedicine to legitimate what constitutes acceptable evidence or knowledge for those experiencing mental illness, biomedical notions of evidence appear to remain relatively intact. Queer theory offers theoretical tools to disrupt biomedical norms and challenges biomedical normativity to indicate how marginalisation occurs when normative truths about mental health classify those who differ from the norm as 'ill' or 'disordered'. Queer theory's emphasis on normativity serves the political aim to subvert marginalisation and bring about radical social and material change. Reference will be made to mental health subjects within each discourse by indicating how the body acts as a vehicle for knowing. Deleuzian notions of the rhizome are used as metaphor to suggest a relational approach to knowledge that does away with either/or positions in either biomedical, or queer knowledge to arrive at a both/and position where the biomedical, constructionist and queer are interrelated and entangled in needing the other for their own evolution. However, queer does not ask for assimilation but celebrates difference by remaining outside to disrupt that which is easily overlooked, assumed to be natural or represented as the norm. The task of queer knowledge is to do justice to the lives lived in the name of evidence-based practice and demands that we consider the relations of power where knowledge is produced. This pursuit creates different knowledge spaces where we identify new intersections that allow for socially just understandings of knowing or evidence to emerge. © 2013 John Wiley

H-indices of Academic Pediatricians of Mashhad University of Medical Sciences.

PubMed

Hamidreza, Kianifar; Javad, Akhoondian; Ramin, Sadeghi; Leili, Zarifmahmoudi

2013-12-01

Web of Science, Scopus, and Google Scholar are three major sources which provide h-indices for individual researchers. In this study we aimed to compare the h-indices of the academic pediatricians of Mashhad University of Medical Sciences obtained from the above mentioned sources. Academic pediatrician who had at least 5 ISI indexed articles entered the study. Information required for evaluating the h-indices of the included researchers were retrieved from official websites Web of Science (WOS), Scopus, and Google Scholar (GS). Correlations between obtained h-indices from the mentioned databases were analyzed using Spearrman correlation coefficient. Ranks of each researcher according to each database h-index were also evaluated. In general, 16 pediatricians entered the study. Computed h-indices for individual authors were different in each database. Correlations between obtained h-indices were: 0.439 (ISI and Scopus), 0.488 (ISI and GS), and 0.810 (Scopus and GS). Despite differences between evaluated h-indices in each database for individual authors, the rankings according to these h-indices were almost similar. Although h-indices supplied by WOS, SCOPUS, and GS can be used interchangeably, their differences should be acknowledged. Setting up "ReasercherID" in WOS and "User profile" in GS, and giving regular feedback to SCOPUS can increase the validity of the calculated h-indices.

H-indices of Academic Pediatricians of Mashhad University of Medical Sciences

PubMed Central

Hamidreza, Kianifar; Javad, Akhoondian; Ramin, Sadeghi; Leili, Zarifmahmoudi

2013-01-01

Background: Web of Science, Scopus, and Google Scholar are three major sources which provide h-indices for individual researchers. In this study we aimed to compare the h-indices of the academic pediatricians of Mashhad University of Medical Sciences obtained from the above mentioned sources. Method: Academic pediatrician who had at least 5 ISI indexed articles entered the study. Information required for evaluating the h-indices of the included researchers were retrieved from official websites Web of Science (WOS), Scopus, and Google Scholar (GS). Correlations between obtained h-indices from the mentioned databases were analyzed using Spearrman correlation coefficient. Ranks of each researcher according to each database h-index were also evaluated. Results: In general, 16 pediatricians entered the study. Computed h-indices for individual authors were different in each database. Correlations between obtained h-indices were: 0.439 (ISI and Scopus), 0.488 (ISI and GS), and 0.810 (Scopus and GS). Despite differences between evaluated h-indices in each database for individual authors, the rankings according to these h-indices were almost similar. Conclusion: Although h-indices supplied by WOS, SCOPUS, and GS can be used interchangeably, their differences should be acknowledged. Setting up “ReasercherID” in WOS and “User profile” in GS, and giving regular feedback to SCOPUS can increase the validity of the calculated h-indices. PMID:24554795

Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview.

PubMed

Gademan, Maaike G J; Hofstede, Stefanie N; Vliet Vlieland, Thea P M; Nelissen, Rob G H H; Marang-van de Mheen, Perla J

2016-11-09

This systematic review gives an overview of guidelines and original publications as well as the evidence on which the currently proposed indication criteria are based. Until now such a state-of-the-science overview was lacking. Websites of orthopaedic and arthritis organizations (English/Dutch language) were independently searched by two authors for THA/TKA guidelines for OA. Furthermore, a systematic search strategy in several databases through August 2014 was performed. Quality of the guidelines was assessed with the AGREE II instrument, which consists of 6 domains (maximum summed score of 6 indicating high quality). Also, the level of evidence of all included studies was assessed. We found 6 guidelines and 18 papers, out of 3065 references. The quality of the guidelines summed across 6 domains ranged from 0.46 to 4.78. In total, 12 THA, 10 TKA and 2 THA/TKA indication sets were found. Four studies stated that no evidence-based indication criteria are available. Indication criteria concerning THA/TKA consisted of the following domains: pain (in respectively 11 and 10 sets), function (12 and 7 sets), radiological changes (10 and 9 sets), failed conservative therapy (8 and 4 sets) and other indications (6 and 7 sets). Specific cut-off values or ranges were often not stated and the level of evidence was low. The indication criteria for THA/TKA are based on limited evidence. Empirical research is needed, especially regarding domain specific cut-off values or ranges at which the best postoperative outcomes are achieved for patients, taking into account the limited lifespan of a prosthesis.

Indices of polarimetric purity for biological tissues inspection

NASA Astrophysics Data System (ADS)

Van Eeckhout, Albert; Lizana, Angel; Garcia-Caurel, Enric; Gil, José J.; Sansa, Adrià; Rodríguez, Carla; Estévez, Irene; González, Emilio; Escalera, Juan C.; Moreno, Ignacio; Campos, Juan

2018-02-01

We highlight the interest of using the Indices of Polarimetric Purity (IPPs) for the biological tissue inspection. These are three polarimetric metrics focused on the study of the depolarizing behaviour of the sample. The IPPs have been recently proposed in the literature and provide different and synthetized information than the commonly used depolarizing indices, as depolarization index (PΔ) or depolarization power (Δ). Compared with the standard polarimetric images of biological samples, IPPs enhance the contrast between different tissues of the sample and show differences between similar tissues which are not observed using the other standard techniques. Moreover, they present further physical information related to the depolarization mechanisms inherent to different tissues. In addition, the algorithm does not require advanced calculations (as in the case of polar decompositions), being the indices of polarimetric purity fast and easy to implement. We also propose a pseudo-coloured image method which encodes the sample information as a function of the different indices weights. These images allow us to customize the visualization of samples and to highlight certain of their constitutive structures. The interest and potential of the IPP approach are experimentally illustrated throughout the manuscript by comparing polarimetric images of different ex-vivo samples obtained with standard polarimetric methods with those obtained from the IPPs analysis. Enhanced contrast and retrieval of new information are experimentally obtained from the different IPP based images.

Development of a new quality fair access best value performance indicator (BVPI) for recycling services.

PubMed

Harder, M K; Stantzos, N; Woodard, R; Read, A

2008-01-01

Recycling schemes are being used worldwide to reduce the impact of municipal waste. Those using public funds are usually obliged to set performance indicators by which the standards of such schemes can be measured. In the UK, a set of statutory Best Value Performance Indicators (BVPI) must be reported annually, such as the Quality of Fair Access, which monitors the public's access to recycling facilities within 1000 m (known as BVPI 91). This work shows that BVPI 91, and performance indicators like it, quantify only very basic recycling services. A much more sensitive performance indicator is developed in this paper, labelled as the Maximum Practicable Recycling Rate Provision (MPRRP) achievable by a local authority. It indicates the percentage of local waste that could be reasonably recycled using the services provided, calculated on the basis of the average composition of the local waste, the local population coverage for collection of any materials, and nationally provided information stating how much of each material stream is generally suitable (practical) for recycling. Evidence for the usefulness of this new quantity is presented. Although this paper refers a particular performance indicator in the UK, its findings are applicable to all urban areas worldwide needing to monitor recycling service. Furthermore, the MPRRP could be used for planning purposes, and for determining the level of performance of an existing service, by comparing its predicted recycling rate to that actually obtained. Further work is now being carried out on this.

Incident CTS in a large pooled cohort study: associations obtained by a Job Exposure Matrix versus associations obtained from observed exposures.

PubMed

Dale, Ann Marie; Ekenga, Christine C; Buckner-Petty, Skye; Merlino, Linda; Thiese, Matthew S; Bao, Stephen; Meyers, Alysha Rose; Harris-Adamson, Carisa; Kapellusch, Jay; Eisen, Ellen A; Gerr, Fred; Hegmann, Kurt T; Silverstein, Barbara; Garg, Arun; Rempel, David; Zeringue, Angelique; Evanoff, Bradley A

2018-03-29

There is growing use of a job exposure matrix (JEM) to provide exposure estimates in studies of work-related musculoskeletal disorders; few studies have examined the validity of such estimates, nor did compare associations obtained with a JEM with those obtained using other exposures. This study estimated upper extremity exposures using a JEM derived from a publicly available data set (Occupational Network, O*NET), and compared exposure-disease associations for incident carpal tunnel syndrome (CTS) with those obtained using observed physical exposure measures in a large prospective study. 2393 workers from several industries were followed for up to 2.8 years (5.5 person-years). Standard Occupational Classification (SOC) codes were assigned to the job at enrolment. SOC codes linked to physical exposures for forceful hand exertion and repetitive activities were extracted from O*NET. We used multivariable Cox proportional hazards regression models to describe exposure-disease associations for incident CTS for individually observed physical exposures and JEM exposures from O*NET. Both exposure methods found associations between incident CTS and exposures of force and repetition, with evidence of dose-response. Observed associations were similar across the two methods, with somewhat wider CIs for HRs calculated using the JEM method. Exposures estimated using a JEM provided similar exposure-disease associations for CTS when compared with associations obtained using the 'gold standard' method of individual observation. While JEMs have a number of limitations, in some studies they can provide useful exposure estimates in the absence of individual-level observed exposures. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Hair and fiber transfer in an abduction case--evidence from different levels of trace evidence transfer.

PubMed

Taupin, J M

1996-07-01

Levels of trace evidence transfer were examined in a casework context. A girl was allegedly abducted in a car and rape attempted by the accused, who denied any contact with the victim. Clothing worn by the victim and the accused, and the covers from the front seats of the car, were analyzed for trace evidence. Three types of corresponding fibers and four possible pathways of transfer were identified. Synthetic fibers similar to those composing the car seat covers were located on the victim's clothing, consistent with direct transfer. Secondary transfer was indicated by dyed brown human head-type hairs (possibly originating from the accused's wife) located on the seat covers and on the victim's clothing. Secondary and possibly tertiary transfer was indicated by pink synthetic material and associated fibers (possibly originating from the victim's mother) located on the victim's clothing, a car seat cover and the accused's clothing. Light microscopy, comparison microscopy, and cross-sectioning techniques were used. The multiple fiber matches and the differing pathways and levels of transfer increased the strength of the association between the accused and the victim. After the fiber evidence was led at the trial, the accused pleaded guilty, thereby affirming the value of secondary transfer evidence.

Biological indices of soil quality: an ecosystem case study of their use

Treesearch

Jennifer D. Knoepp; David C. Coleman; D.A. Crossley; James S. Clark

2000-01-01

Soil quality indices can help ensure that site productivity and soil function are maintained. Biological indices yield evidence of how a soil functions and interacts with the plants, animals, and climate that comprise an ecosystem. Soil scientists can identify and quantify both chemical and biological soil-quality indicators for ecosystems with a single main function,...

Contact with beach sand, concentrations of fecal indicators, and enteric illness risk

EPA Science Inventory

Recent studies ofbeach sand fecal contamination have triggered interest among scientists and in the media. Although evidence shows that beach sand can harbor fecal indicator organisms as well as fecal pathogens, illness risk associated with beach sand contact and fecal indicators...

20 CFR 30.907 - Can an impairment evaluation obtained by OWCP be challenged prior to issuance of the recommended...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Can an impairment evaluation obtained by OWCP... ILLNESS COMPENSATION PROGRAM ACT OF 2000, AS AMENDED Impairment Benefits Under Part E of EEOICPA Medical Evidence of Impairment § 30.907 Can an impairment evaluation obtained by OWCP be challenged prior to...

14 CFR 29.1553 - Fuel quantity indicator.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Placards § 29.1553 Fuel quantity indicator. If the unusable fuel supply for any tank exceeds one gallon, or... extending from the calibrated zero reading to the lowest reading obtainable in level flight. ...

14 CFR 25.1553 - Fuel quantity indicator.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Placards § 25.1553 Fuel quantity indicator. If the unusable fuel supply for any tank exceeds one gallon, or... extending from the calibrated zero reading to the lowest reading obtainable in level flight. ...

The statistical evaluation of duct tape end match as physical evidence

NASA Astrophysics Data System (ADS)

Chan, Ka Lok

Duct tapes are often submitted to crime laboratories as evidence associated with abductions, homicides, or construction of explosive devices. As a result, trace evidence examiners are often asked to analyze and compare commercial duct tapes so that they can establish possible evidentiary links. Duct tape end matches are believed to be the strongest association between exemplar and question samples because they are considered as evidence with unique individual characteristics. While end match analysis and comparison have long been undertaken by trace evidence examiners, there is a significant lack of scientific research for associating two or more segments of duct tapes. This study is designed to obtain statistical inferences on the uniqueness of duct tape tears. Three experiments were devised to compile the basis for a statistical assessment of the probability of duct tape end matches along with a proposed error rate. In one experiment, we conducted the equivalent of 10,000 end match examinations with an error rate of 0%. In the second experiment, we performed 2,704 end match examinations having 0% error rate. In the third experiment, using duct tape by an Elmendorf Tear tester, we conducted 576 end match examinations with an error rate of 0% and having all samples correctly associated. The results of this study indicate that end matches are distinguishable among a single roll of duct tape and between two different rolls of duct tape having very similar surface features and weave pattern.

Developing indicators for European birds

PubMed Central

Gregory, Richard D; van Strien, Arco; Vorisek, Petr; Gmelig Meyling, Adriaan W; Noble, David G; Foppen, Ruud P.B; Gibbons, David W

2005-01-01

The global pledge to deliver ‘a significant reduction in the current rate of biodiversity loss by 2010’ is echoed in a number of regional and national level targets. There is broad consensus, however, that in the absence of conservation action, biodiversity will continue to be lost at a rate unprecedented in the recent era. Remarkably, we lack a basic system to measure progress towards these targets and, in particular, we lack standard measures of biodiversity and procedures to construct and assess summary statistics. Here, we develop a simple classification of biodiversity indicators to assist their development and clarify purpose. We use European birds, as example taxa, to show how robust indicators can be constructed and how they can be interpreted. We have developed statistical methods to calculate supranational, multi-species indices using population data from national annual breeding bird surveys in Europe. Skilled volunteers using standardized field methods undertake data collection where methods and survey designs differ slightly across countries. Survey plots tend to be widely distributed at a national level, covering many bird species and habitats with reasonable representation. National species' indices are calculated using log-linear regression, which allows for plot turnover. Supranational species' indices are constructed by combining the national species' indices weighted by national population sizes of each species. Supranational, multi-species indicators are calculated by averaging the resulting indices. We show that common farmland birds in Europe have declined steeply over the last two decades, whereas woodland birds have not. Evidence elsewhere shows that the main driver of farmland bird declines is increased agricultural intensification. We argue that the farmland bird indicator is a useful surrogate for trends in other elements of biodiversity in this habitat. PMID:15814345

Modeling Sensor Reliability in Fault Diagnosis Based on Evidence Theory

PubMed Central

Yuan, Kaijuan; Xiao, Fuyuan; Fei, Liguo; Kang, Bingyi; Deng, Yong

2016-01-01

Sensor data fusion plays an important role in fault diagnosis. Dempster–Shafer (D-R) evidence theory is widely used in fault diagnosis, since it is efficient to combine evidence from different sensors. However, under the situation where the evidence highly conflicts, it may obtain a counterintuitive result. To address the issue, a new method is proposed in this paper. Not only the statistic sensor reliability, but also the dynamic sensor reliability are taken into consideration. The evidence distance function and the belief entropy are combined to obtain the dynamic reliability of each sensor report. A weighted averaging method is adopted to modify the conflict evidence by assigning different weights to evidence according to sensor reliability. The proposed method has better performance in conflict management and fault diagnosis due to the fact that the information volume of each sensor report is taken into consideration. An application in fault diagnosis based on sensor fusion is illustrated to show the efficiency of the proposed method. The results show that the proposed method improves the accuracy of fault diagnosis from 81.19% to 89.48% compared to the existing methods. PMID:26797611

Indicators of international remote sensing activities

NASA Technical Reports Server (NTRS)

Spann, G. W.

1977-01-01

The extent of worldwide remote sensing activities, including the use of satellite and high/medium altitude aircraft data was studied. Data were obtained from numerous individuals and organizations with international remote sensing responsibilities. Indicators were selected to evaluate the nature and scope of remote sensing activities in each country. These indicators ranged from attendance at remote sensing workshops and training courses to the establishment of earth resources satellite ground stations and plans for the launch of earth resources satellites. Results indicate that this technology constitutes a rapidly increasing component of environmental, land use, and natural resources investigations in many countries, and most of these countries rely on the LANDSAT satellites for a major portion of their data.

The indications for third-molar extractions.

PubMed

Steed, Martin B

2014-06-01

Defining the indications for third-molar extraction continues to be a topic of controversy. The dentist's management of third molars commonly hinges on identifying the presence of symptoms or disease that clearly is attributable to the third molar. Use of a guide that serves as a systematic and unambiguous way to classify third molars has been advocated. Patients' symptoms are designated as present and attributable to the third molar (Sx+) or as absent (Sx-). In addition, clinical or radiographic evidence of disease is evaluated and designated as present (D+) or absent (D-). Evidence-based clinical data developed from prospective investigations have shown that an asymptomatic third molar does not necessarily reflect the absence of disease. Current data are not sufficient to refute or support prophylactic extraction versus active surveillance for the routine management of third molars that are asymptomatic and free of disease (group D). Although decisions regarding third-molar management usually are straightforward, the evidence supporting extraction versus retention of asymptomatic disease-free (group D) third molars is lacking. Active surveillance, a prescribed program of follow-up and reassessment at regular intervals are recommended for retained third molars rather than waiting for the onset of symptoms.

[Study on risk assessing indicator system after schistosomiasis transmission interruption in Wuxi City].

PubMed

Xiao-Jun, Meng; Sheng-Hua, Zong; Xuan, Zhang; Dong-Lin, Gao; Yan-Hua, Qian; Bing, Lu

2017-07-27

To establish a risk assessing indicator system after the transmission interruption of schistosomiasis in Wuxi City, so as to provide evidences for formulating strategies on schistosomiasis control and prevention. A primary risk assessing indicator system was established based on the literature review. Alternative indicators were scored and screened to establish a final indicator system through two rounds of Delphy method and the related normalized weights and combined weights were also calculated. The risk assessing indicator system was established through two rounds of expert consultation including 3 first grade indicators and 15 second grade indicators. Among the first grade indicators, the normalized weights of natural environment, key populations and social environment were 0.370 6, 0.292 9 and 0.336 5, respectively. Among the second grade indicators, the migrant population accounted for the highest combined weight of 0.125 2 compared to domestic animal of 0.037 1. The authority degree among the first grade indicators was between 0.91 and 0.93, while the authority degree among the second grade indicators was between 0.79 and 0.92. The scientific and authoritative risk assessing indicator system after the transmission interruption of schistosomiasis is established, which provides the evidences for risk assessment on schistosomiasis transmission in Wuxi City.

Observational Evidence For The Comet-Like Heliosphere

NASA Astrophysics Data System (ADS)

Bzowski, M.; Czechowski, A.; Funsten, H. O.; Grygorczuk, J.; Heerikhuisen, J.; Kubiak, M. A.; Moebius, E.; McComas, D. J.; Schwadron, N.; Sokol, J. M.; Swaczyna, P.; Zirnstein, E.

2017-12-01

The shape of the heliosphere is a subject of ongoing debate. The traditional comet-like image has recently been challenged by ideas of croissant- or bubble-like forms. Here we seek to resolve this debate by confronting available observational evidence with global modeling. Several MHD models of a comet-like heliosphere were used to simulate the radius and center of the IBEX Ribbon to fit the direction and intensity of the interstellar magnetic field (ISMF). These models assumed the secondary ENA emission mechanism, which was recently strengthened due to direct measurement of the distance to the Ribbon source most likely just beyond the heliopause. The same mechanism explains the dependence of the Ribbon center position on energy due to the latitudinal structure of solar wind. The obtained ISMF vector agrees among these models and is consistent with the draped IMF measured by Voyager. Independently, we have shown by modeling that the Warm Breeze discovered by IBEX is naturally created in the outer heliosheath due to charge-exchange between interstellar He+ ions and He atoms. Now we simulate the Warm Breeze for various directions and intensities of the local IMF and we find that the simulation results are in best agreement with IBEX observations for the IMF vector obtained from the above-mentioned Ribbon analyses and Voyager measurements. These arguments, along with the co-planarity of the inflow directions of interstellar neutral H, He, O, and the Warm Breeze, directions of the Ribbon center and ISMF, as well as measurements of the plasma flow directions in the IHS by Voyager 2 indicate the existence of a common plane of approximate mirror symmetry of the heliosphere, defined by the directions of ISMF and the Sun's motion through the local interstellar medium. This suggests that the global structure of the outer heliosphere mostly results from the conditions in the local interstellar medium and the Sun's velocity. This evidence, obtained from very different

Simple test indicates degree of cure of polyimide coatings

NASA Technical Reports Server (NTRS)

Uribe, J. R.; Wallauch, J. R.

1969-01-01

Qualitative test involves immersing a coated cable in methyl-2-pyrrolidone and removing it in one to three minutes. Evidence of any cracking, peeling, or other defects that shows under 20-power magnification indicates that the coating has not been completely cured.

Nurse staffing and system integration and change indicators in acute care hospitals: evidence from a balanced scorecard.

PubMed

McGillis Hall, Linda; Peterson, Jessica; Baker, G Ross; Brown, Adalsteinn D; Pink, George H; McKillop, Ian; Daniel, Imtiaz; Pedersen, Cheryl

2008-01-01

This study examined relationships between financial indicators for nurse staffing and organizational system integration and change indicators. These indicators, along with hospital location and type, were examined in relation to the nursing financial indicators. Results showed that different indicators predicted each of the outcome variables. Nursing care hours were predicted by the hospital type, geographic location, and the system. Both nursing and patient care hours were significantly related to dissemination and benchmarking of clinical data.

Evidence-Based Practice: Quality Indicator Analysis of Antecedent Exercise in Autism Spectrum Disorders

ERIC Educational Resources Information Center

Kasner, Melanie; Reid, Greg; MacDonald, Cathy

2012-01-01

The purpose of the research was to conduct a quality indicator analysis of studies exploring the effects of antecedent exercise on self-stimulatory behaviors of individuals with autism spectrum disorders (ASD). Educational Resources Information Center (ERIC), Google Scholar, SPORTDiscus, PsychINFO, and PubMed/MedLine databases from 1980 to October…

Obtaining real-world evidence: the Salford Lung Study

PubMed Central

New, John P; Bakerly, Nawar Diar; Leather, David; Woodcock, Ashley

2014-01-01

We need to assess clinical treatments in real-life settings outside of randomised controlled trials (RCTs). Pragmatic RCT (pRCT) data can supplement RCTs by providing effectiveness information to support healthcare decisions. Electronic health records can facilitate concurrent safety monitoring and data collection without direct patient contact for large randomised study populations in pRCTs. The Salford Lung Study is the world's first phase III pRCT in asthma and chronic obstructive pulmonary disease (COPD), which aims to randomise over 7000 patients. This paper describes the hurdles overcome and the enormous effort and resource required to establish this comparative effectiveness study of a prelicence intervention. GlaxoSmithKline protocol HZC115151 Asthma study clinicaltrials.gov registration NCT01706198 COPD study clinicaltrials.gov registration NCT01551758 PMID:24603195

Lithological indicators of loess sedimentation of SW Poland

NASA Astrophysics Data System (ADS)

Krawczyk, Marcin; Ryzner, Kamila; Skurzyński, Jacek; Jary, Zdzisław

2017-12-01

High-resolution grain-size investigations were carried out in two SW Polish loess sections: Biały Kościół (Niemcza-Strzelin Hills) and Zaprężyn (Trzebnica Hills). Each sequence was sampled by using the same methodology and samples were taken at 5 centimeters intervals. The particle size distribution was obtained with a Mastersizer 2000 laser, used for diffraction methods. From the obtained results the basic parameters and grain size indicators were calculated: Mz, Grain Size Index ratio, U-ratio and the percentage content of clay (< 4μm) and sand (> 63 μm). Both loess-soil sequences are composed of interfluve and slope loess facies and consist of five litho-pedostratigraphic units developed during the Late Pleistocene and Holocene: two loess units L1LL1, L1LL2 and three polygenetic fossil soils sets S0, S1 and L1SS1. The distance between these two profiles is about 60 km. Zaprężyn, as a section located more to the north, has almost no lower younger loess and higher level of weathering which could be related to proximity of this site to the Ice Sheet margin. The climate here was more extreme and harsh. What is more, the difference in development of soil L1SS1 can be observed: while in Biały Kościół pedogenesis process was slower and less disturbed than in Zaprężyn. The upper part of L1SS1 in Biały Kościół was deformed by gelifluction, frost heave and other periglacial processes. Mz indicator by the grain-size distribution in these sediments reflects subtle variations in the climatic system. Moreover, in Zaprężyn the content of sand fraction is higher than in Biały Kościół what can be the evidence of short episodes of strong winds during cold period of sedimentation. The aim of this paper is to compare two loess profiles by their stratigraphical and lithological similarities which are result of climate conditions and features of surrounding environment.

[Indication and Evidence of Internationally Developed Online Coaches as Intervention for Mental Illness - a Meta-Review].

PubMed

Stein, Janine; Röhr, Susanne; Luck, Tobias; Löbner, Margrit; Riedel-Heller, Steffi G

2018-01-01

The aim of the study was to investigate the current state of research concerning internationally developed Online Coaches for treatment support and prevention of mental disorders. Evidence and effectiveness of the Online Coaches ought to be explored. A systematic literature search was performed in international databases in order to provide a meta-review of existing Online Coaches for mental disorders. The assessment of the methodological quality and evidence of the studies was based on the established guidelines of the Scottish Intercollegiate Guideline Network. 52 studies (24 meta-analyses, 16 systematic reviews, 2 health-technology assessment reports, and 10 RCT studies) were identified. The efficacy was demonstrated for a variety of Online Coaches for mental disorders, especially for anxiety and depressive disorders, insomnia, and post-traumatic stress disorders, with predominantly acceptable and high quality. The present work provides an overview of internationally developed Online Coaches in the field of mental health care. Online Coaches can serve as a useful supplement to the treatment and prevention of mental disorders. © Georg Thieme Verlag KG Stuttgart · New York.

U.S. Broadcast Deregulation: A Case of Dubious Evidence.

ERIC Educational Resources Information Center

Levin, Harry J.

1986-01-01

Reviews the empirical evidence cited by the FCC in favor of increasing the allowable number of radio and TV stations owned by one group. Argues FCC was biased in favor of deregulation despite weighty evidence indicating continued need for regulation. (MS)

Suicide Prevention and Community-Level Indicators

ERIC Educational Resources Information Center

Hourani, Laurel L.; Davidson, Lucy; Clinton-Sherrod, Monique; Patel, Nita; Marshall, Maureen; Crosby, Alex E.

2006-01-01

This study sought to develop a set of easily obtainable, relevant measures of a community's condition that could be used to guide its suicide prevention efforts. Existing data were gathered across 159 Georgia counties for nine potential social indicators (rates of net migration, divorce, unemployment, violent crimes reported, driving under the…

The relation between peak response magnitudes and agreement in diagnoses obtained from two different phallometric tests for pedophilia.

PubMed

Lykins, Amy D; Cantor, James M; Kuban, Michael E; Blak, Thomas; Dickey, Robert; Klassen, Philip E; Blanchard, Ray

2010-03-01

Phallometric testing is widely considered the best psychophysiological procedure for assessing erotic preferences in men. Researchers have differed, however, on the necessity of setting some minimum criterion of penile response for ascertaining the interpretability of a phallometric test result. Proponents of a minimum criterion have generally based their view on the intuitive notion that "more is better" rather than any formal demonstration of this. The present study was conducted to investigate whether there is any empirical evidence for this intuitive notion, by examining the relation between magnitude of penile response and the agreement in diagnoses obtained in two test sessions using different laboratory stimuli. The results showed that examinees with inconsistent diagnoses responded less on both tests and that examinees with inconsistent diagnoses responded less on the second test after controlling for their response on the first test. Results also indicated that at response levels less than 1 cm(3), diagnostic consistency was no better than chance, supporting the establishment of a minimum response level criterion.

45 CFR 2400.62 - Evidence of master's degree.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 4 2014-10-01 2014-10-01 false Evidence of master's degree. 2400.62 Section 2400... FELLOWSHIP FOUNDATION FELLOWSHIP PROGRAM REQUIREMENTS Special Conditions § 2400.62 Evidence of master's... indicates that he or she has secured an approved master's degree as set forth in the Fellow's original Plan...

45 CFR 2400.62 - Evidence of master's degree.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 4 2013-10-01 2013-10-01 false Evidence of master's degree. 2400.62 Section 2400... FELLOWSHIP FOUNDATION FELLOWSHIP PROGRAM REQUIREMENTS Special Conditions § 2400.62 Evidence of master's... indicates that he or she has secured an approved master's degree as set forth in the Fellow's original Plan...

45 CFR 2400.62 - Evidence of master's degree.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 4 2012-10-01 2012-10-01 false Evidence of master's degree. 2400.62 Section 2400... FELLOWSHIP FOUNDATION FELLOWSHIP PROGRAM REQUIREMENTS Special Conditions § 2400.62 Evidence of master's... indicates that he or she has secured an approved master's degree as set forth in the Fellow's original Plan...

Promoting evidence-based practice in pharmacies.

PubMed

Toklu, Hale Zerrin

2015-01-01

Evidence-based medicine aims to optimize decision-making by using evidence from well-designed and conducted research. The concept of reliable evidence is essential, since the number of electronic information resources is increasing in parallel to the increasing number and type of drugs on the market. The decision-making process is a complex and requires an extensive evaluation as well as the interpretation of the data obtained. Different sources provide different levels of evidence for decision-making. Not all the data have the same value as the evidence. Rational use of medicine requires that the patients receive "medicines appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community." Pharmacists have a crucial role in the health system to maintain the rational use of medicine and provide pharmaceutical care to patients, because they are the drug experts who are academically trained for this purpose. The rational use of the pharmacist's workforce will improve the outcome of pharmacotherapy as well as decreasing the global health costs.

Nursing and midwifery use, perceptions and barriers to evidence-based practice: a cross-sectional survey.

PubMed

Fry, Margaret; Attawet, Jutharat

2018-03-01

The study aimed to explore how nurses and midwives obtain, use and embed evidence in everyday practice. The study design was cross-sectional survey method. The setting was one local health district in metropolitan Sydney, Australia. All nurses and midwives working within the local health district, with access to an email account, were invited to participate in the study. An online survey questionnaire was distributed to explore how evidence is obtained, used and embedded within the clinical setting. The data were analysed using descriptive statistics (frequency and percentages). Pearson's Chi-square tests were used for comparison between groups. There were 204 survey respondents. The findings identified that the majority (n = 157; 76.96%) of respondents obtained evidence primarily from clinical practice guidelines. The majority (n = 149; 73.04%) of respondents reportedly searched databases and used evidence related to general clinical practice. There was a statistical difference (χ = 17.069; df = 8; P = 0.029) when comparing leadership positions and other registered practitioner groups in the frequency of searching for evidence. Most respondents (n = 138; 67.65%) were confident in their ability to change practice on the basis of available evidence. Thematic analysis identified four barriers to sustaining evidence-based practice, which included: the need for time; the need for organizational and management support; the need for educational opportunities and challenges to accessing evidence. The study provided an understanding of how nurses and midwives obtain, use and embed evidence into everyday practice. More importantly, the role of leadership is significant to support a process of knowledge generation, research translation and the implementation of evidence into clinical settings.

Isotopic evidence indicates saprotrophy in post-fire Morchella in Oregon and Alaska.

PubMed

Hobbie, Erik A; Rice, Samuel F; Weber, Nancy S; Smith, Jane E

2016-01-01

We assessed the nutritional strategy of true morels (genus Morchella) collected in 2003 and 2004 in Oregon and Alaska, 1 or 2 y after forest fires. We hypothesized that the patterns of stable isotopes (δ(13)C and δ(15)N) in the sporocarps would match those of saprotrophic fungi and that radiocarbon (Δ(14)C) analyses would indicate that Morchella was assimilating old carbon not current-year photosynthate. We compared radiocarbon and stable isotopes in Morchella with values from concurrently collected foliage, the ectomycorrhizal Geopyxis carbonaria (Alb. & Schwein.) Sacc., the saprotrophic Plicaria endocarpoides (Berk.) Rifai, and with literature to determine isotopic values for ectomycorrhizal or saprotrophic fungi. Geopyxis, Plicaria and Morchella, respectively, were 3‰, 5‰ and 6‰ higher in 13C than foliage and 5‰, 7‰ and 7‰ higher in (15)N. High (15)N enrichment in Morchella indicated that recent litter was not the primary source for Morchella nitrogen, and similar (13)C and (15)N enrichments to Plicaria suggest that Morchella assimilates its carbon and nitrogen from the same source pool as this saprotrophic fungus. From radiocarbon analyses Morchella averaged 11 ± 6 y old (n = 19), Plicaria averaged 17 ± 5 y old (n = 3), foliage averaged 1 ± 2 y old (n = 8) and Geopyxis (n = 1) resembled foliage in Δ(14)C. We conclude that morels fruiting in post-fire environments in our study assimilated old carbon and were saprotrophic. © 2016 by The Mycological Society of America.

Evidence mapping: illustrating an emerging methodology to improve evidence-based practice in youth mental health.

PubMed

Hetrick, Sarah E; Parker, Alexandra G; Callahan, Patrick; Purcell, Rosemary

2010-12-01

Within the field of evidence-based practice, a process termed 'evidence mapping' is emerging as a less exhaustive yet systematic and replicable methodology that allows an understanding of the extent and distribution of evidence in a broad clinical area, highlighting both what is known and where gaps in evidence exist. This article describes the general principles of mapping methodology by using illustrations derived from our experience conducting an evidence map of interventions for youth mental-health disorders. Evidence maps are based on an explicit research question relating to the field of enquiry, which may vary in depth, but should be informed by end-users. The research question then drives the search for, and collection of, appropriate studies utilizing explicit and reproducible methods at each stage. This includes clear definition of components of the research question, development of a thorough and reproducible search strategy, development of explicit inclusion and exclusion criteria, and transparent decisions about the level of information to be obtained from each study. Evidence mapping is emerging as a rigorous methodology for gathering and disseminating up-to-date information to end-users. Thoughtful planning and assessment of available resources (e.g. staff, time, budget) are required by those applying this methodology to their particular field of clinical enquiry given the potential scope of the work. The needs of the end-user need to be balanced with available resources. Information derived needs to be effectively communicated, with the uptake of that evidence into clinical practice the ultimate aim. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

From randomized controlled trials to evidence grading schemes: current state of evidence-based practice in social sciences.

PubMed

Boruch, Robert; Rui, Ning

2008-11-01

With the advance of web search and navigation technology, enormous amount of information, non-information, and misinformation may be obtained in milliseconds in response to questions about 'what works' in social sciences. Today, policy makers in non-medical public service arenas are under increasing pressure to make sound decisions based on scientific evidence. Some of these decisions are a matter of legal requirement. This paper shows how such movements are closely aligned with the evolution of organizations that develop and apply evidence standards and evidence grading schemes within the social science communities. The current state of evidence-based practice in social sciences is examined by reviewing the latest development of randomized trials and evidence grading schemes in the fields of education, criminal justice, and social welfare. Studies conducted under the auspices of the Campbell Collaboration and What Works Clearinghouse are used to illustrate ingredients of evidence grading schemes, graphic display of results of systematic reviews, and discrepancies of evidence derived from randomized trials and non-experimental trials. Furthermore, it is argued that the use of evidence on 'what works' depends on the potential users' awareness, understanding of the evidence, as well as their capacity and willingness to use it. Awareness and understanding depends on the world wide web and its augmentations, while capacity and willingness depends more on incentives to use good evidence and on political and ethical values. Implications for the future development of evidence grading organizations are discussed. © 2008 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

Nanostructured Thin Films Obtained from Fischer Aminocarbene Complexes

PubMed Central

Lazo-Jiménez, Rosa E.; Ortega-Alfaro, M. Carmen; López-Cortés, José G.; Alvarez-Toledano, Cecilio; Chávez-Carvayar, José Á.; Ignés-Mullol, Jordi; González-Torres, Maykel; Carreón-Castro, Pilar

2016-01-01

The synthesis of four amphiphilic organometallic complexes with the general formula RC = M(CO)5NH(CH2)15CH3, where R is a ferrocenyl 2(a-b) or a phenyl 4(a-b) group as a donor moiety and a Fischer carbene of chromium (0) or tungsten (0) as an acceptor group, are reported. These four push-pull systems formed Langmuir (L) monolayers at the air-water interface, which were characterized by isotherms of surface pressure versus molecular area and compression/expansion cycles (hysteresis curves); Brewster angle microscopic images were also obtained. By using the Langmuir–Blodgett (LB) method, molecular monolayers were transferred onto glass substrates forming Z-type multilayers. LB films were characterized through ultraviolet-visible spectroscopy, atomic force microscopy and X-ray diffraction techniques. Results indicated that films obtained from 2b complex [(Ferrocenyl)(hexadecylamine)methylidene] pentacarbonyl tungsten (0) are the most stable and homogeneous; due to their properties, these materials may be incorporated into organic electronic devices. PMID:28773289

Evidence-based medicine Training: Kazakhstan experience.

PubMed

Kamalbekova, G; Kalieva, M

2015-01-01

understanding EBM, understanding study designs, randomization. There were no correct or complete answers to the question on study classification. Again, 35% of respondents provided correct answer to the question about the stages of decision-making process from the perspective of EBM, 65% - provided no answer. One fourth (25%) of the respondents preferred using printed literature. Only very few respondents indicated Cochrane Library, Medline (PubMed), Tripdatabasa as preferred Internet sources of information, with 40% indicating Google and 60% - other sources.The results of post-training survey showed that nearly 90% of the respondents gave correct answers to all the questions.With the aim to identify knowledge survival (the long-term training outcomes) we conducted the third survey in May 2014 in previously trained people at the seminar "Introduction to Evidence-Based Medicine". The respondents were asked to answer 4 questions, and to assess previously obtained information on the basics of Evidence-Based Medicine on a 10-point scale.We found that 100% of the respondents answered «Yes» to the question: «Have you changed your behavior after the seminar?» To the question: «Have you encountered difficulties in implementing the principles of evidence-based medicine in the educational process?» 56% of the respondents answered that they had not encountered any difficulties. The other 44% faced the difficulties associated with implementation of Evidence-Based Medicine: lack of understanding by students, low knowledge survival rate among students, too many questions from the students, difficult disputes and discussions.To the question: «Have you encountered difficulties in implementing the principles of Evidence-Based Medicine in practical health-care?» only 37.5% of the respondents answered that they had not encountered difficulties. But the remaining 62.5% of the respondents faced the problems and difficulties in implementing the principles of evidence-based medicine in their

Can health indicators help policy-makers? Experience from European system of urban health indicators (EURO-URHIS).

PubMed

Torun, Perihan; Heller, Richard F; Harrison, Annie; Verma, Arpana

2017-05-01

This paper proposes that Population Impact Measures (PIMs), the Population Impact Number of Eliminating a Risk Factor over a time period (PIN-ER-t) and the number of events prevented in your population (NEPP), can assist in policy making as they include relevant information which describes the impact or benefits to the population of risk factors and interventions. In this study, we explore the utilization of the indicators from European System of Urban Health Indicators System to produce the two PIMs. We identified from the indicators list the health determinants, health status and health interventions which can be linked, and searched Medline for evidence of association. We then investigated whether the type of frequency measure available for the indicator match with the measure used in PIMs, and explored data availability for the City of Manchester (UK) as an urban area. Of the 39 indicators relevant to socio-economic factors, health determinants and health status, it was possible to calculate the population impact of a risk factor, i.e. the PIN-ER-t, for only six associations, and the population impact of health interventions, i.e. NEPP, for only one out of the three listed indicators, as the relevant health conditions were not included. The results of this study suggest that if an indicator system is intended to play a part in the policy making process, then the method of presentation to policy-makers should be decided before setting up the system, as it is likely that some indicators which would be essential might not be available. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

20 CFR 416.802 - Type of evidence to be submitted.

Code of Federal Regulations, 2010 CFR

2010-04-01

... individual is required to submit evidence of date of birth as indicated in § 416.801, he shall submit a public record of birth or a religious record of birth or baptism established or recorded before his fifth... determination of the individual's date of birth provided such evidence is corroborated by other evidence or by...

Factors affecting evidence-based decision making in local health departments.

PubMed

Sosnowy, Collette D; Weiss, Linda J; Maylahn, Christopher M; Pirani, Sylvia J; Katagiri, Nancy J

2013-12-01

Data indicating the extent to which evidence-based decision making (EBDM) is used in local health departments (LHDs) are limited. This study aims to determine use of decision-making processes by New York State LHD leaders and upper-level staff and identify facilitators and barriers to the use of EBDM in LHDs. The New York Public Health Practice-Based Research Network implemented a mixed-methods study in 31 LHDs. There were 20 individual interviews; five small-group interviews (two or three participants each); and two focus groups (eight participants each) conducted with people who had decision-making authority. Information was obtained about each person's background and position, decision-making responsibilities, how decisions are made within their LHD, knowledge and experience with EBDM, use of each step of the EBDM process, and barriers and facilitators to EBDM implementation. Data were collected from June to November 2010 and analyzed in 2011. Overall, participants supported EBDM and expressed a desire to increase their department's use of it. Although most people understood the concept, a relatively small number had substantial expertise and experience with its practice. Many indicated that they applied EBDM unevenly. Factors associated with use of EBDM included strong leadership; workforce capacity (number and skills); resources; funding and program mandates; political support; and access to data and program models suitable to community conditions. EBDM is used inconsistently in LHDs in New York. Despite knowledge and interest among LHD leadership, the LHD capacity, resources, appropriate programming, and other issues serve as impediments to EBDM and optimal implementation of evidence-based strategies. Published by Elsevier Inc.

Engineering evidence for carbon monoxide toxicity cases.

PubMed

Galatsis, Kosmas

2016-07-01

Unintentional carbon monoxide poisonings and fatalities lead to many toxicity cases. Given the unusual physical properties of carbon monoxide-in that the gas is odorless and invisible-unorganized and erroneous methods in obtaining engineering evidence as required during the discovery process often occurs. Such evidence gathering spans domains that include building construction, appliance installation, industrial hygiene, mechanical engineering, combustion and physics. In this paper, we attempt to place a systematic framework that is relevant to key aspects in engineering evidence gathering for unintentional carbon monoxide poisoning cases. Such a framework aims to increase awareness of this process and relevant issues to help guide legal counsel and expert witnesses. © The Author(s) 2015.

Obtaining antibiotics online from within the UK: a cross-sectional study

PubMed Central

Boyd, Sara Elizabeth; Moore, Luke Stephen Prockter; Gilchrist, Mark; Costelloe, Ceire; Castro-Sánchez, Enrique; Franklin, Bryony Dean; Holmes, Alison Helen

2017-01-01

Background: Improved antibiotic stewardship (AS) and reduced prescribing in primary care, with a parallel increase in personal internet use, could lead citizens to obtain antibiotics from alternative sources online. Objectives: A cross-sectional analysis was performed to: (i) determine the quality and legality of online pharmacies selling antibiotics to the UK public; (ii) describe processes for obtaining antibiotics online from within the UK; and (iii) identify resulting AS and patient safety issues. Methods: Searches were conducted for ‘buy antibiotics online’ using Google and Yahoo. For each search engine, data from the first 10 web sites with unique URL addresses were reviewed. Analysis was conducted on evidence of appropriate pharmacy registration, prescription requirement, whether antibiotic choice was ‘prescriber-driven’ or ‘consumer-driven’, and whether specific information was required (allergies, comorbidities, pregnancy) or given (adverse effects) prior to purchase. Results: Twenty unique URL addresses were analysed in detail. Online pharmacies evidencing their location in the UK (n = 5; 25%) required a prescription before antibiotic purchase, and were appropriately registered. Online pharmacies unclear about the location they were operating from (n = 10; 50%) had variable prescription requirements, and no evidence of appropriate registration. Nine (45%) online pharmacies did not require a prescription prior to purchase. For 16 (80%) online pharmacies, decisions were initially consumer-driven for antibiotic choice, dose and quantity. Conclusions: Wide variation exists among online pharmacies in relation to antibiotic practices, highlighting considerable patient safety and AS issues. Improved education, legislation, regulation and new best practice stewardship guidelines are urgently needed for online antibiotic suppliers. PMID:28333179

Levels of Evidence: Integrative Therapies Human Studies (PDQ®)—Health Professional Version

Cancer.gov

Levels of Evidence for Integrative, Alternative, and Complementary Therapies is about how to weigh the strength of the evidence obtained in cited research studies. Get detailed information this formal ranking system in this summary for clinicians.

How food cues can enhance and inhibit motivation to obtain and consume food.

PubMed

Colagiuri, Ben; Lovibond, Peter F

2015-01-01

Learning may play an important role in over-eating. One example is Pavlovian-to-instrumental transfer (PIT), whereby reward cues facilitate responding to obtain that reward. Whilst there is increasing research indicating PIT for food in humans, these studies have exclusively tested PIT under instrumental extinction (i.e. when the food is no longer available), which may reduce their ecological validity. To address this, we conducted two experiments exploring PIT for food in humans when tested under instrumental reinforcement. Participants first underwent Pavlovian discrimination training with an auditory cue paired with a chocolate reward (CS+) and another auditory cue unpaired (CS-). In instrumental training participants learnt to press a button to receive the chocolate reward on a VR10 schedule. In the test phase, each CS was presented whilst participants maintained the opportunity to press the button to receive chocolate. In Experiment 1, the PIT test was implemented after up to 20 min of instrumental training (satiation) whereas in Experiment 2 it was implemented after only 4 min of instrumental training. In both experiments there was evidence for differential PIT, but the pattern differed according to the rate of responding at the time of the PIT test. In low baseline responders the CS+ facilitated both button press responding and consumption, whereas in high baseline responders the CS- suppressed responding. These findings suggest that both excitatory and inhibitory associations may be learnt during PIT training and that the expression of these associations depends on motivation levels at the time the cues are encountered. Particularly concerning is that a food-paired cue can elicit increased motivation to obtain and consume food even when the participant is highly satiated and no longer actively seeking food, as this may be one mechanism by which over-consumption is maintained. Copyright © 2014 Elsevier Ltd. All rights reserved.

38 CFR 3.204 - Evidence of dependents and age.

Code of Federal Regulations, 2011 CFR

2011-07-01

... seeking benefits (see § 3.216). (2) VA shall require the types of evidence indicated in §§ 3.205 through 3... reasonable indication, in the claimant's statement or otherwise, of fraud or misrepresentation of the...

Demographic and Indication-Specific Characteristics Have Limited Association With Social Network Engagement: Evidence From 24,954 Members of Four Health Care Support Groups

PubMed Central

2017-01-01

Background Digital health social networks (DHSNs) are widespread, and the consensus is that they contribute to wellness by offering social support and knowledge sharing. The success of a DHSN is based on the number of participants and their consistent creation of externalities through the generation of new content. To promote network growth, it would be helpful to identify characteristics of superusers or actors who create value by generating positive network externalities. Objective The aim of the study was to investigate the feasibility of developing predictive models that identify potential superusers in real time. This study examined associations between posting behavior, 4 demographic variables, and 20 indication-specific variables. Methods Data were extracted from the custom structured query language (SQL) databases of 4 digital health behavior change interventions with DHSNs. Of these, 2 were designed to assist in the treatment of addictions (problem drinking and smoking cessation), and 2 for mental health (depressive disorder, panic disorder). To analyze posting behavior, 10 models were developed, and negative binomial regressions were conducted to examine associations between number of posts, and demographic and indication-specific variables. Results The DHSNs varied in number of days active (3658-5210), number of registrants (5049-52,396), number of actors (1085-8452), and number of posts (16,231-521,997). In the sample, all 10 models had low R2 values (.013-.086) with limited statistically significant demographic and indication-specific variables. Conclusions Very few variables were associated with social network engagement. Although some variables were statistically significant, they did not appear to be practically significant. Based on the large number of study participants, variation in DHSN theme, and extensive time-period, we did not find strong evidence that demographic characteristics or indication severity sufficiently explain the variability in

Demographic and Indication-Specific Characteristics Have Limited Association With Social Network Engagement: Evidence From 24,954 Members of Four Health Care Support Groups.

PubMed

van Mierlo, Trevor; Li, Xinlong; Hyatt, Douglas; Ching, Andrew T

2017-02-17

Digital health social networks (DHSNs) are widespread, and the consensus is that they contribute to wellness by offering social support and knowledge sharing. The success of a DHSN is based on the number of participants and their consistent creation of externalities through the generation of new content. To promote network growth, it would be helpful to identify characteristics of superusers or actors who create value by generating positive network externalities. The aim of the study was to investigate the feasibility of developing predictive models that identify potential superusers in real time. This study examined associations between posting behavior, 4 demographic variables, and 20 indication-specific variables. Data were extracted from the custom structured query language (SQL) databases of 4 digital health behavior change interventions with DHSNs. Of these, 2 were designed to assist in the treatment of addictions (problem drinking and smoking cessation), and 2 for mental health (depressive disorder, panic disorder). To analyze posting behavior, 10 models were developed, and negative binomial regressions were conducted to examine associations between number of posts, and demographic and indication-specific variables. The DHSNs varied in number of days active (3658-5210), number of registrants (5049-52,396), number of actors (1085-8452), and number of posts (16,231-521,997). In the sample, all 10 models had low R 2 values (.013-.086) with limited statistically significant demographic and indication-specific variables. Very few variables were associated with social network engagement. Although some variables were statistically significant, they did not appear to be practically significant. Based on the large number of study participants, variation in DHSN theme, and extensive time-period, we did not find strong evidence that demographic characteristics or indication severity sufficiently explain the variability in number of posts per actor. Researchers should

Characterization of rhenium compounds obtained by electrochemical synthesis after aging process

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

Vargas-Uscategui, Alejandro, E-mail: avargasuscat@ing.uchile.cl; Mosquera, Edgar; López-Encarnación, Juan M.

2014-12-15

The proper identification of the molecular nature of the aged rhenium compound obtained by means of electrodeposition from an alkaline aqueous electrolyte was determined. Chemical, structural and vibrational experimental characterization of the aged Re compound showed agreement with quantum-computations, thereby allowing the unambiguous identification of the Re compound as H(ReO{sub 4})H{sub 2}O. - Graphical abstract: Rhenium oxides were electrodeposited on a copper surface and after environmental aging was formed the H(ReO{sub 4})H{sub 2}O compound. The characterization of the synthesized material was made through the comparison of experimental evidence with quantum mechanical computations carried out by means of density functional theorymore » (DFT). - Highlights: • Aged rhenium compound obtained by means of electrodeposition was studied. • The study was made by combining experimental and DFT-computational information. • The aged electrodeposited material is consistent with the H(ReO{sub 4})H{sub 2}O compound.« less

Evidence of Construct Validity in Published Achievement Tests.

ERIC Educational Resources Information Center

Nolet, Victor; Tindal, Gerald

Valid interpretation of test scores is the shared responsibility of the test designer and the test user. Test publishers must provide evidence of the validity of the decisions their tests are intended to support, while test users are responsible for analyzing this evidence and subsequently using the test in the manner indicated by the publisher.…

[Is "evidence-based medicine" followed by "confidence-based medicine"?].

PubMed

Porzsolt, Franz; Fangerau, Heiner

2010-08-01

In an appeal concerning accusations of defamation, the England and Wales Court of Appeal Decisions determined that evidence-based statements are to be judged as opinions and not statements of fact. Since the authors consider it probable that this legal judgment will exert influence on physicians' decisions about the provision of health care services, they have compiled the implications of the judgment and discuss its consequences. The own analyses and considerations lead to the conclusion that confidence-based medicine follows evidence-based medicine. This extension is necessary because evidence-based medicine has not been able to generate the required trust. Therefore, it will be demanded to underpin the existing concept with additional data. These data will be necessary because it is no longer sufficient to convince scientists with data which are obtained under ideal conditions, but to convince critical members of society with additional data which have been obtained under everyday conditions.

Geomagnetic and Solar Indices Data at NGDC

NASA Astrophysics Data System (ADS)

Mabie, J. J.

2012-12-01

The National Geophysical Data Center, Solar and Terrestrial Physics Indices program is a central repository for global indices derived at numerous organizations around the world. These datasets are used by customers to drive models, evaluate the solar and geomagnetic environment, and to understand space climate. Our goal is to obtain and disseminate this data in a timely and accurate manner, and to provide the short term McNish-Lincoln sunspot number prediction. NGDC is in partnership with the NOAA Space Weather Prediction Center (SWPC), University Center for Atmospheric Sciences (UCAR), the Potsdam Helmholtz Center (GFZ), the Solar Indices Data Center (SIDC), the World Data Center for Geomagnetism Kyoto and many other organizations. The large number of available indices and the complexity in how they are derived makes understanding the data one of the biggest challenges for the users of indices. Our data services include expertise in our indices and related datasets to provide feedback and analysis for our global customer base.

20 CFR 220.14 - Weighing of evidence.

Code of Federal Regulations, 2013 CFR

2013-04-01

... capacity evaluation is based upon functional objective tests with high validity and reliability; (2) The... exam findings which is indicative of exaggerated or potential malingering response; (6) The evidence...

20 CFR 220.14 - Weighing of evidence.

Code of Federal Regulations, 2011 CFR

2011-04-01

... capacity evaluation is based upon functional objective tests with high validity and reliability; (2) The... exam findings which is indicative of exaggerated or potential malingering response; (6) The evidence...

20 CFR 220.14 - Weighing of evidence.

Code of Federal Regulations, 2014 CFR

2014-04-01

... capacity evaluation is based upon functional objective tests with high validity and reliability; (2) The... exam findings which is indicative of exaggerated or potential malingering response; (6) The evidence...

20 CFR 220.14 - Weighing of evidence.

Code of Federal Regulations, 2012 CFR

2012-04-01

... capacity evaluation is based upon functional objective tests with high validity and reliability; (2) The... exam findings which is indicative of exaggerated or potential malingering response; (6) The evidence...

Short communication: effects of serum obtained from dairy cows with low or high body condition score on in vitro embryo development.

PubMed

Oba, M; Miyashita, S; Nishii, R; Koiwa, M; Koyama, H; Ambrose, D J; Dochi, O

2013-03-01

The objective of the study was to determine whether the serum obtained from animals differing in body condition score (BCS) affects in vitro embryo development. After in vitro fertilization, serum obtained from dairy cows of either low (L-BCS; 2.1 ± 0.14 on a scale of 1 to 5) or high BCS (H-BCS; 4.0 ± 0.0), or commercially available bovine serum (control) was added at 5% concentration to the in vitro culture medium. Use of serum obtained from H-BCS cows increased the cleavage rates compared with control serum at both 24 and 48 h after in vitro fertilization (78.3 vs. 71.9% and 79.9 vs. 75.1%, respectively), whereas use of serum obtained from L-BCS cows increased the blastocyst rate compared with control serum at 7d (23.8 vs. 19.1%), but this difference was not evident at 8 or 9 d after in vitro fertilization. As nonesterified fatty acid concentrations were highest in control serum, followed by serum from L-BCS and H-BCS cows (621, 559, and 272 μEq/L, respectively), a high concentration of nonesterified fatty acids might adversely affect the very early stages of embryo development, and its negative effects might be greater immediately after fertilization compared with developmental stages after morula formation. Our findings also indicate that factors promoting early stage embryo development do not necessarily promote blastocyst development. Serum obtained from animals under different physiological conditions may be used for in vitro embryo culture to study the effects of nutritional management of dairy cattle on embryo development. Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Mineralogical Indicators for Climate Change on Mars: Evidence from Landed Missions

NASA Technical Reports Server (NTRS)

Ming, D. W.; Morris, R. V.; Clark, B. C.

2015-01-01

Mineralogical and geochemical data returned by a flotilla of Mars orbiters and landers over the past 10 years has substantially enhanced our understanding on the evolution of the atmosphere and climate. Instruments onboard Mars Express and MRO discovered widespread deposits of phyllosilicates that formed during the Noachian followed by formation of sulfates into the Hesperian. The formation of extensive valley networks along with these layered deposits of phyllosilicates and sulfates during the late Noachian/ early Hesperian indicate a past martian climate that was capable of maintaining liquid water at the surface. The planet's climate changed substantially after these early 'episodes' of water and very little aqueous alteration has occurred over the past 3.5 Gyrs . A key to understanding Mars past climate is to identify, characterize, and age date secondary minerals that have formed by reaction with volatile compounds, e.g., H2O, CO2, SO2. Here, we summarize the detection of secondary minerals at the four landing sites visited over the past 10 years. We also provide potential pathways for their formation and implications for past climate change on Mars.

Evidence that Meningeal Mast Cells Can Worsen Stroke Pathology in Mice

PubMed Central

Arac, Ahmet; Grimbaldeston, Michele A.; Nepomuceno, Andrew R.B.; Olayiwola, Oluwatobi; Pereira, Marta P.; Nishiyama, Yasuhiro; Tsykin, Anna; Goodall, Gregory J.; Schlecht, Ulrich; Vogel, Hannes; Tsai, Mindy; Galli, Stephen J.; Bliss, Tonya M.; Steinberg, Gary K.

2015-01-01

Stroke is the leading cause of adult disability and the fourth most common cause of death in the United States. Inflammation is thought to play an important role in stroke pathology, but the factors that promote inflammation in this setting remain to be fully defined. An understudied but important factor is the role of meningeal-located immune cells in modulating brain pathology. Although different immune cells traffic through meningeal vessels en route to the brain, mature mast cells do not circulate but are resident in the meninges. With the use of genetic and cell transfer approaches in mice, we identified evidence that meningeal mast cells can importantly contribute to the key features of stroke pathology, including infiltration of granulocytes and activated macrophages, brain swelling, and infarct size. We also obtained evidence that two mast cell-derived products, interleukin-6 and, to a lesser extent, chemokine (C-C motif) ligand 7, can contribute to stroke pathology. These findings indicate a novel role for mast cells in the meninges, the membranes that envelop the brain, as potential gatekeepers for modulating brain inflammation and pathology after stroke. PMID:25134760

Elbow stress indices using finite element analysis

NASA Astrophysics Data System (ADS)

Yu, Lixin

Section III of the ASME Boiler and Pressure Vessel Code (the Code) specifies rules for the design of nuclear power plant components. NB-3600 of the Code presents a simplified design method using stress indices---Scalar Coefficients used the modify straight pipe stress equations so that they can be applied to elbows, tees and other piping components. The stress indices of piping components are allowed to be determined both analytically and experimentally. This study concentrates on the determination of B2 stress indices for elbow components using finite element analysis (FEA). First, the previous theoretical, numerical and experimental investigations on elbow behavior were comprehensively reviewed, as was the philosophy behind the use of stress indices. The areas of further research was defined. Then, a comprehensive investigation was carried out to determine how the finite element method should be used to correctly simulate an elbow's structural behavior. This investigation included choice of element type, convergence of mesh density, use of boundary restraint and a reconciliation study between FEA and laboratory experiments or other theoretical formulations in both elastic and elasto-plastic domain. Results from different computer programs were also compared. Reasonably good reconciliation was obtained. Appendix II of the Code describes the experimental method to determine B2 stress indices based on load-deflection curves. This procedure was used to compute the B2 stress indices for various loading modes on one particular elbow configuration. The B2 stress indices thus determined were found to be about half of the value calculated from the Code equation. Then the effect on B2 stress indices of those factors such as internal pressure and flange attachments were studied. Finally, the investigation was extended to other configurations of elbow components. A parametric study was conducted on different elbow sizes and schedules. Regression analysis was then used to

Older Americans 2016: Key Indicators of Well-Being

MedlinePlus

... Contacts FAQ Search X Home | Data Data Current Report Older Americans 2016: Key Indicators of Well-Being ... Figures PPTX How to obtain a hardcopy of Report Single copies of this report are available at ...

Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh.

PubMed

Begum, Tahmina; Rahman, Aminur; Nababan, Herfina; Hoque, Dewan Md Emdadul; Khan, Al Fazal; Ali, Taslim; Anwar, Iqbal

2017-01-01

Caesarean section (C-section) is a major obstetric intervention for saving lives of women and their newborns from pregnancy and childbirth related complications. Un-necessary C-sections may have adverse impact upon maternal and neonatal outcomes. In Bangladesh there is paucity of data on clinical indication of C-section at population level. We conducted a retrospective study in icddr,b Health and Demographic Surveillance System (HDSS) area of Matlab to look into the indications and determinants of C-sections. All resident women in HDSS service area who gave birth in 2013 with a known birth outcome, were included in the study. Women who underwent C-section were identified from birth and pregnancy files of HDSS and their indication for C-section were collected reviewing health facility records where the procedure took place, supplemented by face-to-face interview of mothers where data were missing. Indications of C-section were presented as frequency distribution and further divided into different groups following 3 distinct classification systems. Socio-demographic predictors were explored following statistical method of binary logistic regression. During 2013, facility delivery rate was 84% and population based C-section rate was 35% of all deliveries in icddr,b service area. Of all C-sections, only 1.4% was conducted for Absolute Maternal Indications (AMIs). Major indications of C-sections included: repeat C-section (24%), foetal distress (21%), prolonged labour (16%), oligohydramnios (14%) and post-maturity (13%). More than 80% C-sections were performed in for-profit private facilities. Probability of C-section delivery increased with improved socio-economic status, higher education, lower birth order, higher age, and with more number of Antenatal Care use and presence of bad obstetric history. Eight maternal deaths occurred, of which five were delivered by C-section. C-section rate in this area was much higher than national average as well as global

Atmospheric and surface properties of Mars obtained by infrared spectroscopy on Mariner 9

NASA Technical Reports Server (NTRS)

Conrath, B.; Curran, R. J.; Hanel, R.; Kunde, V. G.; Marguire, W.; Pearl, J.; Pirraglia, J. A.; Welker, J.; Burke, T.

1972-01-01

During the eleven month operational lifetime of Mariner 9, the infrared spectroscopy experiment obtained data over a large portion of Mars. Recently obtained spectra indicate that strong seasonal variations in the water vapor distribution over both polar regions occurred. The wettest atmospheric conditions observed so far contain 20 to 30 precipitable microns of water over the north polar cap during northern spring. A low resolution pressure map is presented which covers that portion of the planet between latitudes -60 deg and +25 deg. A more detailed study of the Coprates canyon indicates that at its lowest point the canyon floor must be at least 5 km below the rim. Applications of tidal theory to temperature fields derived from the spectra indicate diurnal surface pressure fluctuations of as much as 12 percent during the great dust storm of 1971-72. Qualitative arguments based on radiative transfer calculations for model dust clouds composed of spherical quartz particles suggest that particle radii during the storm were of the order of a few microns.

Searching for evidence of changes in extreme rainfall indices in the Central Rift Valley of Ethiopia

NASA Astrophysics Data System (ADS)

Muluneh, Alemayehu; Bewket, Woldeamlak; Keesstra, Saskia; Stroosnijder, Leo

2017-05-01

Extreme rainfall events have serious implications for economic sectors with a close link to climate such as agriculture and food security. This holds true in the Central Rift Valley (CRV) of Ethiopia where communities rely on highly climate-sensitive rainfed subsistence farming for livelihoods. This study investigates changes in ten extreme rainfall indices over a period of 40 years (1970-2009) using 14 meteorological stations located in the CRV. The CRV consists of three landscape units: the valley floor, the escarpments, and the highlands all of which are considered in our data analysis. The Belg (March-May) and Kiremt (June-September) seasons are also considered in the analysis. The Mann-Kendall test was used to detect trends of the rainfall indices. The results indicated that at the annual time scale, more than half (57 %) of the stations showed significant trends in total wet-day precipitation (PRCPTOT) and heavy precipitation days (R10mm). Only 7-35 % of stations showed significant trends, for the other rainfall indices. Spatially, the valley floor received increasing annual rainfall while the escarpments and the highlands received decreasing annual rainfall over the last 40 years. During Belg, 50 % of the stations showed significant increases in the maximum number of consecutive dry days (CDD) in all parts of the CRV. However, most other rainfall indices during Belg showed no significant changes. During Kiremt, considering both significant and non-significant trends, almost all rainfall indices showed an increasing trend in the valley floor and a decreasing trend in the escarpment and highlands. During Belg and Kiremt, the CDD generally showed increasing tendency in the CRV.

Epidemiologic evidence regarding vitamin C and cancer.

PubMed

Block, G

1991-12-01

Approximately 90 epidemiologic studies have examined the role of vitamin C or vitamin-C-rich foods in cancer prevention, and the vast majority have found statistically significant protective effects. Evidence is strong for cancers of the esophagus, oral cavity, stomach, and pancreas. There is also substantial evidence of a protective effect in cancers of the cervix, rectum, and breast. Even in lung cancer, for which carotenoids show a consistent protective effect, there is recent evidence of a role for vitamin C. Vitamin C is an important antioxidant and free radical scavenger in plasma and acts to regenerate active vitamin E in lipid membranes. Although several different factors in fruits and vegetables probably act jointly, the epidemiologic and biochemical evidence indicate an important role for vitamin C.

Should Non-Cognitive Skills Be Included in School Accountability Systems? Preliminary Evidence from California's CORE Districts. Evidence Speaks Reports, Vol 1, #13

ERIC Educational Resources Information Center

West, Martin R.

2016-01-01

Evidence confirms that student skills other than academic achievement and ability predict a broad range of academic and life outcomes. This evidence, along with a new federal requirement that state accountability systems include an indicator of school quality or student success not based on test scores, has sparked interest in incorporating such…

25 CFR 162.539 - Must I obtain a WEEL before obtaining a WSR lease?

Code of Federal Regulations, 2014 CFR

2014-04-01

... AND PERMITS Wind and Solar Resource Leases Wsr Leases § 162.539 Must I obtain a WEEL before obtaining... direct result of energy resource information gathered from a WEEL activity, obtaining a WEEL is not a...

25 CFR 162.539 - Must I obtain a WEEL before obtaining a WSR lease?

Code of Federal Regulations, 2013 CFR

2013-04-01

... AND PERMITS Wind and Solar Resource Leases Wsr Leases § 162.539 Must I obtain a WEEL before obtaining... direct result of energy resource information gathered from a WEEL activity, obtaining a WEEL is not a...

Probiotics in Children: What Is the Evidence?

PubMed Central

2017-01-01

The number of papers discussing probiotics increases tremendously that limits the possibility for primary care physicians and clinicians to stay updated. Therefore, the aim of this paper will be to summarize available evidence of probiotic use in well-defined clinical indications of importance for pediatricians. Based on currently available evidence certain probiotic strains (Lactobacillus rhamnosus GG [LGG] and Saccharomyces boulardii) have proven effect in the treatment of acute gastroenteritis and prevention of antibiotic associated diarrhea. Furthermore, LGG was proven to be effective in prevention of nosocomial diarrhea and respiratory tract infection in day care centers. In conclusion, not all probiotic strains have same efficacy for all clinical indications, therefore, only strains with proven efficacy and safety should be recommended. PMID:29026729

Evidence for a positron bound state on the surface of a topological insulator

NASA Astrophysics Data System (ADS)

Shastry, K.; Weiss, A. H.; Barbiellini, B.; Assaf, B. A.; Lim, Z. H.; Joglekar, P. V.; Heiman, D.

2015-06-01

We describe experiments aimed at probing the sticking of positrons to the surfaces of topological insulators using the Positron Annihilation induced Auger Electron Spectrometer (PAES). A magnetically guided beam was used to deposit positrons at the surface of Bi2Te2Se sample at energy of ∼2eV. Peaks observed in the energy spectra and intensities of electrons emitted as a result of positron annihilation showed peaks at energies corresponding to Auger peaks in Bi, Teand Se providing clear evidence of Auger emission associated with the annihilation of positrons in a surface bound state. Theoretical estimates of the binding energy of this state are compared with estimates obtained by measuring the incident beam energy threshold for secondary electron emission and the temperature dependence positronium(Ps) emission. The experiments provide strong evidence for the existence of a positron bound state at the surface of Bi2Te2Se and indicate the practicality of using positron annihilation to selectively probe the critically important top most layer of topological insulator system.

An evidence-based approach to the management of low back pain and sciatica: how the evidence is applied in clinical cases.

PubMed

Goh, L; Bawendi, A; Samanta, J; Samanta, A

2003-09-01

Low back pain and sciatica are common complaints that affect a major proportion of the population at some time in their lives. The treatment and management of this condition may vary widely. The present paper aims to provide an evidence-based approach to the management of low back pain and sciatica, and demonstrates how to search for the evidence and how to apply it practically in individual patients. The principles underlying evidence-based medicine are explained. The practice of evidence-based medicine requires initial formulation of the appropriate clinical question, followed by searching databases for relevant evidence. Finally evidence needs to be applied on a patient-specific basis. Best Evidence, the Cochrane Library, Embase and Medline were searched to obtain quality controlled information regarding the management of low back pain and sciatica. Current evidence shows that an active exercise programme promotes early recovery. This may allow patients to resume an active and sportive lifestyle. Epidural corticosteroid injections may help to resolve additional troublesome symptoms of sciatica. Two clinical cases are used to show how evidence-based medicine can be individualized to specific patients. A patient-focused strategy combining best evidence and clinical expertise is suggested as the mainstay for the management of low back pain.

40 CFR 262.21 - Manifest tracking numbers, manifest printing, and obtaining manifests.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 26 2014-07-01 2014-07-01 false Manifest tracking numbers, manifest printing, and obtaining manifests. 262.21 Section 262.21 Protection of Environment ENVIRONMENTAL PROTECTION..., scanned, or faxed, except that the marginal words indicating copy distribution must be printed with a...

40 CFR 262.21 - Manifest tracking numbers, manifest printing, and obtaining manifests.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Manifest tracking numbers, manifest printing, and obtaining manifests. 262.21 Section 262.21 Protection of Environment ENVIRONMENTAL PROTECTION..., scanned, and faxed, except that the marginal words indicating copy distribution must be in red ink. (5...

40 CFR 262.21 - Manifest tracking numbers, manifest printing, and obtaining manifests.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 27 2012-07-01 2012-07-01 false Manifest tracking numbers, manifest printing, and obtaining manifests. 262.21 Section 262.21 Protection of Environment ENVIRONMENTAL PROTECTION..., scanned, or faxed, except that the marginal words indicating copy distribution must be printed with a...

40 CFR 262.21 - Manifest tracking numbers, manifest printing, and obtaining manifests.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 27 2013-07-01 2013-07-01 false Manifest tracking numbers, manifest printing, and obtaining manifests. 262.21 Section 262.21 Protection of Environment ENVIRONMENTAL PROTECTION..., scanned, or faxed, except that the marginal words indicating copy distribution must be printed with a...

Renal impairment as a surgical indication in primary hyperparathyroidism: do the data support this recommendation?

PubMed

Hendrickson, Chase D; Castro Pereira, Daniel J; Comi, Richard J

2014-08-01

Management of primary hyperparathyroidism has evolved over the past two decades, yet impaired renal function has consistently been a surgical indication. This recommendation has been based upon the historical association between primary hyperparathyroidism and renal impairment, and a review of the literature is needed to determine whether such a recommendation is warranted. PubMed was utilized to identify English-language articles published between January 1990 and February 2014 using keywords related to hyperparathyroidism and renal function. The keywords were "primary hyperparathyroidism," "surgery," "parathyroidectomy," "kidney," "renal," "glomerular filtration rate," and "creatinine." Of the 1926 articles obtained with this search, all articles germane to the topic that quantified the relationship between primary hyperparathyroidism and renal function were included. All references within these articles were investigated for inclusion. When helpful, data tables were constructed to summarize the results succinctly. A secondary elevation of PTH levels has not been consistently shown to occur at the threshold currently indicated for surgical intervention. While renal impairment is seen with more significant disease, mild asymptomatic primary hyperparathyroidism has not been conclusively associated with renal impairment. Furthermore, there is no evidence to suggest that surgically curing primary hyperparathyroidism via a parathyroidectomy has any impact upon renal function.

Eyeblink Conditioning Deficits Indicate Timing and Cerebellar Abnormalities in Schizophrenia

ERIC Educational Resources Information Center

Brown, S.M.; Kieffaber, P.D.; Carroll, C.A.; Vohs, J.L.; Tracy, J.A.; Shekhar, A.; O'Donnell, B.F.; Steinmetz, J.E.; Hetrick, W.P.

2005-01-01

Accumulating evidence indicates that individuals with schizophrenia manifest abnormalities in structures (cerebellum and basal ganglia) and neurotransmitter systems (dopamine) linked to internal-timing processes. A single-cue tone delay eyeblink conditioning paradigm comprised of 100 learning and 50 extinction trials was used to examine cerebellar…

Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh

PubMed Central

Begum, Tahmina; Nababan, Herfina; Hoque, Dewan Md. Emdadul; Khan, Al Fazal; Ali, Taslim; Anwar, Iqbal

2017-01-01

Background and methods Caesarean section (C-section) is a major obstetric intervention for saving lives of women and their newborns from pregnancy and childbirth related complications. Un-necessary C-sections may have adverse impact upon maternal and neonatal outcomes. In Bangladesh there is paucity of data on clinical indication of C-section at population level. We conducted a retrospective study in icddr,b Health and Demographic Surveillance System (HDSS) area of Matlab to look into the indications and determinants of C-sections. All resident women in HDSS service area who gave birth in 2013 with a known birth outcome, were included in the study. Women who underwent C-section were identified from birth and pregnancy files of HDSS and their indication for C-section were collected reviewing health facility records where the procedure took place, supplemented by face-to-face interview of mothers where data were missing. Indications of C-section were presented as frequency distribution and further divided into different groups following 3 distinct classification systems. Socio-demographic predictors were explored following statistical method of binary logistic regression. Findings During 2013, facility delivery rate was 84% and population based C-section rate was 35% of all deliveries in icddr,b service area. Of all C-sections, only 1.4% was conducted for Absolute Maternal Indications (AMIs). Major indications of C-sections included: repeat C-section (24%), foetal distress (21%), prolonged labour (16%), oligohydramnios (14%) and post-maturity (13%). More than 80% C-sections were performed in for-profit private facilities. Probability of C-section delivery increased with improved socio-economic status, higher education, lower birth order, higher age, and with more number of Antenatal Care use and presence of bad obstetric history. Eight maternal deaths occurred, of which five were delivered by C-section. Conclusions C-section rate in this area was much higher than

38 CFR 3.201 - Exchange of evidence; Social Security and Department of Veterans Affairs.

Code of Federal Regulations, 2011 CFR

2011-07-01

...; Social Security and Department of Veterans Affairs. 3.201 Section 3.201 Pensions, Bonuses, and Veterans... Compensation Evidence Requirements § 3.201 Exchange of evidence; Social Security and Department of Veterans... Social Security Administration or to have the Department of Veterans Affairs obtain such evidence from...

38 CFR 3.201 - Exchange of evidence; Social Security and Department of Veterans Affairs.

Code of Federal Regulations, 2013 CFR

2013-07-01

...; Social Security and Department of Veterans Affairs. 3.201 Section 3.201 Pensions, Bonuses, and Veterans... Compensation Evidence Requirements § 3.201 Exchange of evidence; Social Security and Department of Veterans... Social Security Administration or to have the Department of Veterans Affairs obtain such evidence from...

38 CFR 3.201 - Exchange of evidence; Social Security and Department of Veterans Affairs.

Code of Federal Regulations, 2012 CFR

2012-07-01

...; Social Security and Department of Veterans Affairs. 3.201 Section 3.201 Pensions, Bonuses, and Veterans... Compensation Evidence Requirements § 3.201 Exchange of evidence; Social Security and Department of Veterans... Social Security Administration or to have the Department of Veterans Affairs obtain such evidence from...

38 CFR 3.201 - Exchange of evidence; Social Security and Department of Veterans Affairs.

Code of Federal Regulations, 2014 CFR

2014-07-01

...; Social Security and Department of Veterans Affairs. 3.201 Section 3.201 Pensions, Bonuses, and Veterans... Compensation Evidence Requirements § 3.201 Exchange of evidence; Social Security and Department of Veterans... Social Security Administration or to have the Department of Veterans Affairs obtain such evidence from...

38 CFR 3.201 - Exchange of evidence; Social Security and Department of Veterans Affairs.

Code of Federal Regulations, 2010 CFR

2010-07-01

...; Social Security and Department of Veterans Affairs. 3.201 Section 3.201 Pensions, Bonuses, and Veterans... Compensation Evidence Requirements § 3.201 Exchange of evidence; Social Security and Department of Veterans... Social Security Administration or to have the Department of Veterans Affairs obtain such evidence from...

Blackcurrant Leaf Chlorosis Associated Virus: Evidence of the Presence of Circular RNA during Infections.

PubMed

James, Delano; Phelan, James; Sanderson, Daniel

2018-05-15

Blackcurrant leaf chlorosis associated virus (BCLCaV) was detected recently by next-generation sequencing (NGS) and a new and distinct species in the genus Idaeovirus was proposed. Analysis of NGS-derived paired-end reads revealed the existence of bridge reads encompassing the 3'-terminus and 5'-terminus of RNA-2 or RNA-3 of BCLCaV. The full RNA-2 or RNA-3 could be amplified using outward facing or abutting primers; also, RNA-2/RNA-3 could be detected even after three consecutive RNase R enzyme treatments, with denaturation at 95 °C preceding each digestion. Evidence was obtained indicating that there are circular forms of BCLCaV RNA-2 and RNA-3.

Technological advances and changing indications for lumbar puncture in neurological disorders.

PubMed

Costerus, Joost M; Brouwer, Matthijs C; van de Beek, Diederik

2018-03-01

Technological advances have changed the indications for and the way in which lumbar puncture is done. Suspected CNS infection remains the most common indication for lumbar puncture, but new molecular techniques have broadened CSF analysis indications, such as the determination of neuronal autoantibodies in autoimmune encephalitis. New screening techniques have increased sensitvity for pathogen detection and can be used to identify pathogens that were previously unknown to cause CNS infections. Evidence suggests that potential treatments for neurodegenerative diseases, such as Alzheimer's disease, will rely on early detection of the disease with the use of CSF biomarkers. In addition to being used as a diagnostic tool, lumbar puncture can also be used to administer intrathecal treatments as shown by studies of antisense oligonucleotides in patients with spinal muscular atrophy. Lumbar puncture is generally a safe procedure but complications can occur, ranging from minor (eg, back pain) to potentially devastating (eg, cerebral herniation). Evidence that an atraumatic needle tip design reduces complications of lumbar puncture is compelling, and reinforces the need to change clinical practice. Copyright © 2018 Elsevier Ltd. All rights reserved.

Summer Nights: A Review of the Evidence of Seasonal Variations in Sexual Health Indicators among Young People

ERIC Educational Resources Information Center

Macdowall, Wendy; Wellings, Kaye; Stephenson, Judith; Glasier, Anna

2008-01-01

Purpose: This paper aims to examine whether greater consideration should be given to the timing of sexual health interventions within the calendar year. Design/methodology/approach: The paper uses a review of the literature. Findings: The evidence points to seasonality in a number of areas of sexual health among young people, including: the timing…

Levels of Evidence: Cancer Screening and Prevention Studies (PDQ®)—Health Professional Version

Cancer.gov

Levels of Evidence for Cancer Screening and Prevention Studies explains how to weigh the strength of the evidence obtained in cited research studies. Get detailed information on this formal ranking system in this summary for clinicians.

Library residencies and internships as indicators of success: evidence from three programs.

PubMed Central

Lanier, D; Henderson, C L

1999-01-01

This paper discusses post-master's degree internships in three very different organizations; the University of Illinois at Chicago, the National Library of Medicine, and the Library of Congress. It discusses the internships using several questions. Do the programs serve as a recruitment strategy? Do the programs develop key competencies needed by the participant or organization? Do the programs develop leaders and managers? Is acceptance into a program an indicator of future career success? A survey was mailed to 520 persons who had completed internships in one of the three programs. There was a 49.8% response rate. Responses to fifty-four questions were tabulated and analyzed for each program and for the total group. The results confirm the value of internships to the career of participants. PMID:10219479

Multi-level significance of vulnerability indicators. Case study: Eastern Romania

NASA Astrophysics Data System (ADS)

Stanga, I. C.; Grozavu, A.

2012-04-01

Vulnerability assessment aims, most frequently, to emphasize internal fragility of a system comparing to a reference standard, to similar systems or in relation to a given hazard. Internal fragility, either biophysical or structural, may affect the capacity to predict, to prepare for, to cope with or to recover from a disaster. Thus, vulnerability is linked to resilience and adaptive capacity. From local level to global one, vulnerability factors and corresponding indicators are different and their significance must be tested and validated in a well-structured conceptual and methodological framework. In this paper, the authors aim to show the real vulnerability of rural settlements in Eastern Romania in a multi-level approach. The research area, Tutova Hills, counts about 3421 sq.km and more than 200.000 inhabitants in 421 villages characterized by deficient accessibility, lack of endowments, subsistential agriculture, high pressure on natural environment (especially on forest and soil resources), poverty and aging process of population. Factors that could influence the vulnerability of these rural settlements have been inventoried and assigned into groups through a cluster analysis: habitat and technical urban facilities, infrastructure, economical, social and demographical indicators, environment quality, management of emergency situations etc. Firstly, the main difficulty was to convert qualitative variable in quantitative indicators and to standardize all values to make possible mathematical and statistical processing of data. Secondly, the great variability of vulnerability factors, their different measuring units and their high amplitude of variation require different method of standardization in order to obtain values between zero (minimum vulnerability) and one (maximum vulnerability). Final vulnerability indicators were selected and integrated in a general scheme, according to their significance resulted from an appropriate factor analysis: linear and

Obtaining Parts

Science.gov Websites

The Cosmic Connection Parts for the Berkeley Detector Suppliers: Scintillator Eljen Technology 1 obtain the components needed to build the Berkeley Detector. These companies have helped previous the last update. He estimates that the cost to build a detector varies from $1500 to $2700 depending

Council for Exceptional Children: Standards for Evidence-Based Practices in Special Education

ERIC Educational Resources Information Center

TEACHING Exceptional Children, 2014

2014-01-01

In this article, the "Council for Exceptional Children (CEC)" presents Standards for Evidence-Based Practices in Special Education. The statement presents an approach for categorizing the evidence base of practices in special education. The quality indicators and the criteria for categorizing the evidence base of special education…

Legal and psychological considerations for obtaining informed consent for reverse total shoulder arthroplasty.

PubMed

Blackwood, Craig; Dixon, Jen; Reilly, Peter; Emery, Roger J

2017-01-01

This paper seeks to outline recent legal developments and requirements pertinent to obtaining informed consent. We argue that this is of particular relevance to patients considering a reverse total shoulder arthroplasty, due to the high complication rate associated with this procedure. By examining the cognitive processes involved in decision-making, and other clinician-related factors such as delivery of information, gender bias and conflict of interest, we explore some of the barriers that can undermine the processes of shared decision-making and obtaining genuine informed consent. We argue that these issues highlight the importance for surgeons in understanding the cognitive processes and other influential factors involved in patients' comprehension and decision-making. We recommend, based on strong evidence, that decision aids could prove useful in overcoming such challenges and could provide one way of mitigating the ethical, professional and legal consequences of failing to obtain proper informed consent. They are not widely used in orthopaedics at present, although it would be in the interests of both the surgeon and patient for such measures to be explored.

Legal and psychological considerations for obtaining informed consent for reverse total shoulder arthroplasty

PubMed Central

Blackwood, Craig; Reilly, Peter; Emery, Roger J

2016-01-01

This paper seeks to outline recent legal developments and requirements pertinent to obtaining informed consent. We argue that this is of particular relevance to patients considering a reverse total shoulder arthroplasty, due to the high complication rate associated with this procedure. By examining the cognitive processes involved in decision-making, and other clinician-related factors such as delivery of information, gender bias and conflict of interest, we explore some of the barriers that can undermine the processes of shared decision-making and obtaining genuine informed consent. We argue that these issues highlight the importance for surgeons in understanding the cognitive processes and other influential factors involved in patients’ comprehension and decision-making. We recommend, based on strong evidence, that decision aids could prove useful in overcoming such challenges and could provide one way of mitigating the ethical, professional and legal consequences of failing to obtain proper informed consent. They are not widely used in orthopaedics at present, although it would be in the interests of both the surgeon and patient for such measures to be explored. PMID:28572846

The ultrasound-enhanced bioscouring performance of four polygalacturonase enzymes obtained from rhizopus oryzae

USDA-ARS?s Scientific Manuscript database

An analytical and statistical method has been developed to measure the ultrasound-enhanced bioscouring performance of milligram quantities of endo- and exo-polygalacturonase enzymes obtained from Rhizopus oryzae fungi. UV-Vis spectrophotometric data and a general linear mixed models procedure indic...

Domestic water service delivery indicators and frameworks for monitoring, evaluation, policy and planning: a review.

PubMed

Kayser, Georgia L; Moriarty, Patrick; Fonseca, Catarina; Bartram, Jamie

2013-10-11

Monitoring of water services informs policy and planning for national governments and the international community. Currently, the international monitoring system measures the type of drinking water source that households use. There have been calls for improved monitoring systems over several decades, some advocating use of multiple indicators. We review the literature on water service indicators and frameworks with a view to informing debate on their relevance to national and international monitoring. We describe the evidence concerning the relevance of each identified indicator to public health, economic development and human rights. We analyze the benefits and challenges of using these indicators separately and combined in an index as tools for planning, monitoring, and evaluating water services. We find substantial evidence on the importance of each commonly recommended indicator--service type, safety, quantity, accessibility, reliability or continuity of service, equity, and affordability. Several frameworks have been proposed that give structure to the relationships among individual indicators and some combine multiple indicator scores into a single index but few have been rigorously tested. More research is needed to understand if employing a composite metric of indicators is advantageous and how each indicator might be scored and scaled.

WE-AB-207B-04: A Preliminary Investigation of Indicators for Treatment Outcomes of CT Guided Cervical Cancer Brachytherapy

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

Meerschaert, R; Paul, A; Chen, W

Purpose: To identify indicators for recurrence in cervical cancer patients treated with high-dose-rate brachytherapy (HDR-BT). Methods: A total of 37 biopsy proven uterine cervical cancer patients of stage IB-IVA treated between 2011 and 2015 were included in this study. All patients were treated with 37.8–52.2Gy of external beam radiotherapy (EBRT) plus 5 × 5.0–6.5Gy of HDR-BT. Patient age, standard deviation of high-risk clinical tumor volume (HR-CTVSD) collected throughout HDR-BT, and D90 (EQD2, α/β=10Gy) of the HR-CTV were investigated as potential indicators for local/distant recurrence using ROC analysis. The optimal cutoff value was identified through the Youden index and was subsequentlymore » used to obtain a group assignment for all patients. Another two comparing groups were defined per evidence of post-EBRT tumor shrinkage based on the pre-HDR MR scan. Kaplan-Meier curves were generated for recurrence-free proportions for comparing groups where time was measured from the final HDR treatment date to the date of the final follow-up exam and compared through Cox regression. Results: Patients had a median follow-up of 12 months, where 16% had local pelvic recurrence and 16% had distant recurrence. HR-CTVSD was identified as a statistically significant indicator for recurrence (AUC=0.802, p=0.007) compared to D90 (AUC=0.655, p=0.167) and patient age (AUC=0.683, p=0.103). HR-CTVSD of 6.26cc was chosen as the optimal cutoff value, which was used as the basis for patient group assignment. Patients with HR-CTVSD>6.26cc had a hazard ratio of 3.92 (95% CI-1.37, 11.24; p=0.011) for recurrence compared to HRCTVSD≤ 6.26cc. Patients without evidence of post-EBRT tumor shrinkage compared to those with had a hazard ratio of 4.28 (95% CI-1.14, 16.15; p=0.032) for recurrence. Conclusion: HR-CTVSD was identified as an indicator for recurrence and an optimal value of 6.26cc was established in our study. In addition, patients without evidence of post-EBRT tumor

The Effect of Online College Attendance on Job Obtainment through Social Connections

ERIC Educational Resources Information Center

Taggart, Gabel

2017-01-01

Attending college online has implications for students' ability to make social connections and eventually obtain jobs by means of social capital. Previous academic work has tested employer callback rates to fictitious resumes treated by indications of either online or face-to-face college attendance but such methods overlook the networking aspect…

Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery.

PubMed

Gockel, Ines; Ahlbrand, Constantin Johannes; Arras, Michael; Schreiber, Elke Maria; Lang, Hauke

2015-12-01

Ranking systems and comparisons of quality and performance indicators will be of increasing relevance for complex "high-risk" procedures such as esophageal cancer surgery. The identification of evidence-based standards relevant for key performance indicators in esophageal surgery is essential for establishing monitoring systems and furthermore a requirement to enhance treatment quality. In the course of this review, we analyze the key performance indicators case volume, radicality of resection, and postoperative morbidity and mortality, leading to continuous quality improvement. Ranking systems established on this basis will gain increased relevance in highly complex procedures within the national and international comparison and furthermore improve the treatment of patients with esophageal carcinoma.

Quality indicators for hip fracture care, a systematic review.

PubMed

Voeten, S C; Krijnen, P; Voeten, D M; Hegeman, J H; Wouters, M W J M; Schipper, I B

2018-05-17

Quality indicators are used to measure quality of care and enable benchmarking. An overview of all existing hip fracture quality indicators is lacking. The primary aim was to identify quality indicators for hip fracture care reported in literature, hip fracture audits, and guidelines. The secondary aim was to compose a set of methodologically sound quality indicators for the evaluation of hip fracture care in clinical practice. A literature search according to the PRISMA guidelines and an internet search were performed to identify hip fracture quality indicators. The indicators were subdivided into process, structure, and outcome indicators. The methodological quality of the indicators was judged using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. For structure and process indicators, the construct validity was assessed. Sixteen publications, nine audits and five guidelines were included. In total, 97 unique quality indicators were found: 9 structure, 63 process, and 25 outcome indicators. Since detailed methodological information about the indicators was lacking, the AIRE instrument could not be applied. Seven indicators correlated with an outcome measure. A set of nine quality indicators was extracted from the literature, audits, and guidelines. Many quality indicators are described and used. Not all of them correlate with outcomes of care and have been assessed methodologically. As methodological evidence is lacking, we recommend the extracted set of nine indicators to be used as the starting point for further clinical research. Future research should focus on assessing the clinimetric properties of the existing quality indicators.

Clopidogrel: A Case for Indication-Specific Pharmacogenetics

PubMed Central

Johnson, JA; Roden, DM; Lesko, LJ; Ashley, E; Klein, TE; Shuldiner, AR

2012-01-01

The CYP2C19*2 loss-of-function allele is associated with reduced generation of active metabolites of clopidogrel. However, meta-analyses have supported or discounted the impact of genotype on adverse cardiovascular outcomes during clopidogrel therapy, depending on studies included in the analysis. Here we review these data and conclude that evidence supports a differential effect of genotype on protection from major adverse cardiovascular outcomes following percutaneous coronary intervention (PCI), but not for other clopidogrel indications. PMID:22513313

Developing quality indicators for general practice care for vulnerable elders; transfer from US to The Netherlands.

PubMed

van der Ploeg, E; Depla, M F I A; Shekelle, P; Rigter, H; Mackenbach, J P

2008-08-01

Measurement of the quality of healthcare is a first step for quality improvement. To measure quality of healthcare, a set of quality indicators is needed. We describe the adaptation of a set of systematically developed US quality indicators for healthcare for vulnerable elders in The Netherlands. We also compare the US and the Dutch set to see if quality indicators can be transferred between countries, as has been done in two studies in the UK, with mixed results. 108 US quality indicators on GP care for vulnerable elders, covering eight conditions, were assessed by a panel of nine clinical experts in The Netherlands. A modified version of the RAND/UCLA appropriateness method was used. The panel members received US literature reviews, extended with more recent and Dutch literature, summarising the evidence for each quality indicator. 72 indicators (67% of US set) were (nearly) identical in the Dutch and US sets. For some conditions, this percentage was much lower. For undernutrition, only half of the US indicators were included in the Dutch set. For depression, many indicators were discarded or changed in a significant way, with the result that only five of the original 17 indicators (29%) are the same in the Dutch and the US set. Quality indicators can be transferred between countries, but with caution, because in two of the three studies on transferring indicators between the US and Europe, 33-44% of the indicators were discarded. For some conditions in the current study, this percentage is much higher. For undernutrition, there is hardly any evidence, and differences between the indicator sets can be attributed to differences in expert opinion between the countries. For depression, it seems that different evidence is considered important in the US and in The Netherlands, of which the Dutch body of knowledge is not known in the US.

Extraordinary Claims Require Extraordinary Evidence: The Case of Non-Local Perception, a Classical and Bayesian Review of Evidences

PubMed Central

Tressoldi, Patrizio E.

2011-01-01

Starting from the famous phrase “extraordinary claims require extraordinary evidence,” we will present the evidence supporting the concept that human visual perception may have non-local properties, in other words, that it may operate beyond the space and time constraints of sensory organs, in order to discuss which criteria can be used to define evidence as extraordinary. This evidence has been obtained from seven databases which are related to six different protocols used to test the reality and the functioning of non-local perception, analyzed using both a frequentist and a new Bayesian meta-analysis statistical procedure. According to a frequentist meta-analysis, the null hypothesis can be rejected for all six protocols even if the effect sizes range from 0.007 to 0.28. According to Bayesian meta-analysis, the Bayes factors provides strong evidence to support the alternative hypothesis (H1) over the null hypothesis (H0), but only for three out of the six protocols. We will discuss whether quantitative psychology can contribute to defining the criteria for the acceptance of new scientific ideas in order to avoid the inconclusive controversies between supporters and opponents. PMID:21713069

Health benefits of tai chi: What is the evidence?

PubMed

Huston, Patricia; McFarlane, Bruce

2016-11-01

To summarize the evidence on the health benefits of tai chi. A literature review was conducted on the benefits of tai chi for 25 specific conditions, as well as for general health and fitness, to update a 2014 review of systematic reviews. Systematic reviews and recent clinical trials were assessed and organized into 5 different groups: evidence of benefit as excellent, good, fair, or preliminary, or evidence of no direct benefit. During the past 45 years more than 500 trials and 120 systematic reviews have been published on the health benefits of tai chi. Systematic reviews of tai chi for specific conditions indicate excellent evidence of benefit for preventing falls, osteoarthritis, Parkinson disease, rehabilitation for chronic obstructive pulmonary disease, and improving cognitive capacity in older adults. There is good evidence of benefit for depression, cardiac and stroke rehabilitation, and dementia. There is fair evidence of benefit for improving quality of life for cancer patients, fibromyalgia, hypertension, and osteoporosis. Current evidence indicates no direct benefit for diabetes, rheumatoid arthritis, or chronic heart failure. Systematic reviews of general health and fitness benefits show excellent evidence of benefit for improving balance and aerobic capacity in those with poor fitness. There is good evidence for increased strength in the lower limbs. There is fair evidence for increased well-being and improved sleep. There were no studies that found tai chi worsened a condition. A recent systematic review on the safety of tai chi found adverse events were typically minor and primarily musculoskeletal; no intervention-related serious adverse events have been reported. There is abundant evidence on the health and fitness effects of tai chi. Based on this, physicians can now offer evidence-based recommendations to their patients, noting that tai chi is still an area of active research, and patients should continue to receive medical follow-up for any

Using the Retrospective Pretest to Get Usable, Indirect Evidence of Student Learning

ERIC Educational Resources Information Center

Coulter, Shannon E.

2012-01-01

Minimal evidence exists regarding the retrospective pretest's effectiveness as a tool to obtain usable, indirect evidence of student learning in open admissions institutions. The researcher conducted this study to determine if a retrospective pretest more accurately detected a change in students' knowledge compared to a conventional…

Hospital successes and failures indicate change in hospital marketing.

PubMed

Krampf, R F; Miller, D W

1993-01-01

Marketing has become an essential management function for hospitals during the past decade. A number of changes have occurred in hospital marketing as they have progressed through the marketing adoption process. A survey of Hospital CEOs reporting hospital successes and failures in the area of marketing have recently placed emphasis on sales and advertising based upon marketing research programs thus indicating entrance into the "Integrated Tactical Marketing" phase. This study also indicates that a few hospitals have entered the "Strategic Marketing Orientation" phase while future plans reported by the CEOs provide evidence that this trend is likely to continue.

Quantitative Indicators for Behaviour Drift Detection from Home Automation Data.

PubMed

Veronese, Fabio; Masciadri, Andrea; Comai, Sara; Matteucci, Matteo; Salice, Fabio

2017-01-01

Smart Homes diffusion provides an opportunity to implement elderly monitoring, extending seniors' independence and avoiding unnecessary assistance costs. Information concerning the inhabitant behaviour is contained in home automation data, and can be extracted by means of quantitative indicators. The application of such approach proves it can evidence behaviour changes.

[Blood cultures in the paediatric emergency department. Guidelines and recommendations on their indications, collection, processing and interpretation].

PubMed

Hernández-Bou, S; Álvarez Álvarez, C; Campo Fernández, M N; García Herrero, M A; Gené Giralt, A; Giménez Pérez, M; Piñeiro Pérez, R; Gómez Cortés, B; Velasco, R; Menasalvas Ruiz, A I; García García, J J; Rodrigo Gonzalo de Liria, C

2016-05-01

Blood culture (BC) is the gold standard when a bacteraemia is suspected, and is one of the most requested microbiological tests in paediatrics. Some changes have occurred in recent years: the introduction of new vaccines, the increasing number of patients with central vascular catheters, as well as the introduction of continuous monitoring BC systems. These changes have led to the review and update of different factors related to this technique in order to optimise its use. A practice guideline is presented with recommendations on BC, established by the Spanish Society of Paediatric Emergency Care and the Spanish Society for Paediatric Infectious Diseases. After reviewing the available scientific evidence, several recommendations for each of the following aspects are presented: BC indications in the Emergency Department, how to obtain, transport and process cultures, special situations (indications and interpretation of results in immunosuppressed patients and/or central vascular catheter carriers, indications for anaerobic BC), differentiation between bacteraemia and contamination when a BC shows bacterial growth and actions to take with a positive BC in patients with fever of unknown origin. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

A coloured oil level indicator detection method based on simple linear iterative clustering

NASA Astrophysics Data System (ADS)

Liu, Tianli; Li, Dongsong; Jiao, Zhiming; Liang, Tao; Zhou, Hao; Yang, Guoqing

2017-12-01

A detection method of coloured oil level indicator is put forward. The method is applied to inspection robot in substation, which realized the automatic inspection and recognition of oil level indicator. Firstly, the detected image of the oil level indicator is collected, and the detected image is clustered and segmented to obtain the label matrix of the image. Secondly, the detection image is processed by colour space transformation, and the feature matrix of the image is obtained. Finally, the label matrix and feature matrix are used to locate and segment the detected image, and the upper edge of the recognized region is obtained. If the upper limb line exceeds the preset oil level threshold, the alarm will alert the station staff. Through the above-mentioned image processing, the inspection robot can independently recognize the oil level of the oil level indicator, and instead of manual inspection. It embodies the automatic and intelligent level of unattended operation.

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.

Domestic Water Service Delivery Indicators and Frameworks for Monitoring, Evaluation, Policy and Planning: A Review

PubMed Central

Kayser, Georgia L.; Moriarty, Patrick; Fonseca, Catarina; Bartram, Jamie

2013-01-01

Monitoring of water services informs policy and planning for national governments and the international community. Currently, the international monitoring system measures the type of drinking water source that households use. There have been calls for improved monitoring systems over several decades, some advocating use of multiple indicators. We review the literature on water service indicators and frameworks with a view to informing debate on their relevance to national and international monitoring. We describe the evidence concerning the relevance of each identified indicator to public health, economic development and human rights. We analyze the benefits and challenges of using these indicators separately and combined in an index as tools for planning, monitoring, and evaluating water services. We find substantial evidence on the importance of each commonly recommended indicator—service type, safety, quantity, accessibility, reliability or continuity of service, equity, and affordability. Several frameworks have been proposed that give structure to the relationships among individual indicators and some combine multiple indicator scores into a single index but few have been rigorously tested. More research is needed to understand if employing a composite metric of indicators is advantageous and how each indicator might be scored and scaled. PMID:24157507

Two new frameworks of potassium saccharate obtained from acidic and alkaline solution

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

Lv, Yao-Kang; Feng, Yun-Long, E-mail: sky37@zjnu.edu.c; Liu, Ji-Wei

2011-05-15

Two chiral K(I) complexes based on D-saccharic acid (H{sub 2}sac), [K(Hsac)]{sub n} (1) and [K{sub 2}(sac)]{sub n} (2) were obtained from acidic and alkaline solution. The 3D framework of 1 includes K(I) polyhedral rods and typical pairwise coaxial right- and left-handed helical chains, and displays binodal 6-connected pcu topology. 2 contains 2D polyhedral sheets consisting of left-handed helical chains, and generates 3D network with an unprecedented (7,11)-connected net. Cyclic voltammetry tests and charge-discharge tests indicate that the addition of complex 2 to the electrolyte could improve the electrochemical properties of the nickel hydroxide electrode. -- Graphical abstract: Two K(I) complexesmore » based on D-saccharic acid (H{sub 2}sac), [K(Hsac)]{sub n} (1) and [K{sub 2}(sac)]{sub n} (2) were obtained and characterized. Electrochemical studies indicate the potential use of 2 in Ni-MH battery. Display Omitted highlights: > Two novel chiral K(I) frameworks based on D-saccharic acid were obtained. > The structure of 1 includes K(I) polyhedral rods and typical helical chains. > 2 contains 2D polyhedral sheets and generates an unprecedented (7,11)-connected net. > Addition of 2 to electrolyte could improve the nickel hydroxide electrode's property.« less

Calibration of a universal indicated turbulence system

NASA Technical Reports Server (NTRS)

Chapin, W. G.

1977-01-01

Theoretical and experimental work on a Universal Indicated Turbulence Meter is described. A mathematical transfer function from turbulence input to output indication was developed. A random ergodic process and a Gaussian turbulence distribution were assumed. A calibration technique based on this transfer function was developed. The computer contains a variable gain amplifier to make the system output independent of average velocity. The range over which this independence holds was determined. An optimum dynamic response was obtained for the tubulation between the system pitot tube and pressure transducer by making dynamic response measurements for orifices of various lengths and diameters at the source end.

Factors influencing evidence-based practice in prosthetics and orthotics.

PubMed

Andrysek, Jan; Christensen, James; Dupuis, Annie

2011-03-01

The importance of evidence-based practice is being recognized across a broad range of healthcare disciplines as a means for improving patient outcomes and also efficiently managing healthcare resources. The objective of this work was to obtain information from clinicians about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics. Cross sectional survey. An internet survey was developed and distributed to 300 prosthetists and orthotists currently practicing in Canada. A principal component factor analysis of the survey results revealed ten primary factors affecting evidence-based practice. These include time constraints, workload and system demands, limited relevant evidence from research, and gaps in skills and knowledge required to perform evidence-based practice. Clinicians value research as a means of improving clinical practice, but they are faced with a number of practical barriers in performing evidence-based practice. This study provides empirical data about the underlying barriers and facilitators relating to evidence-based practice in prosthetics and orthotics. Such data are essential in order to inform those involved in improving existing clinical practices, including educators, professional organizations, and governing bodies.

Obtaining antibiotics online from within the UK: a cross-sectional study.

PubMed

Boyd, Sara Elizabeth; Moore, Luke Stephen Prockter; Gilchrist, Mark; Costelloe, Ceire; Castro-Sánchez, Enrique; Franklin, Bryony Dean; Holmes, Alison Helen

2017-05-01

Improved antibiotic stewardship (AS) and reduced prescribing in primary care, with a parallel increase in personal internet use, could lead citizens to obtain antibiotics from alternative sources online. A cross-sectional analysis was performed to: (i) determine the quality and legality of online pharmacies selling antibiotics to the UK public; (ii) describe processes for obtaining antibiotics online from within the UK; and (iii) identify resulting AS and patient safety issues. Searches were conducted for 'buy antibiotics online' using Google and Yahoo. For each search engine, data from the first 10 web sites with unique URL addresses were reviewed. Analysis was conducted on evidence of appropriate pharmacy registration, prescription requirement, whether antibiotic choice was 'prescriber-driven' or 'consumer-driven', and whether specific information was required (allergies, comorbidities, pregnancy) or given (adverse effects) prior to purchase. Twenty unique URL addresses were analysed in detail. Online pharmacies evidencing their location in the UK ( n  = 5; 25%) required a prescription before antibiotic purchase, and were appropriately registered. Online pharmacies unclear about the location they were operating from ( n  = 10; 50%) had variable prescription requirements, and no evidence of appropriate registration. Nine (45%) online pharmacies did not require a prescription prior to purchase. For 16 (80%) online pharmacies, decisions were initially consumer-driven for antibiotic choice, dose and quantity. Wide variation exists among online pharmacies in relation to antibiotic practices, highlighting considerable patient safety and AS issues. Improved education, legislation, regulation and new best practice stewardship guidelines are urgently needed for online antibiotic suppliers. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email

Evidence-based dentistry.

PubMed

Chambers, David W

2010-01-01

choose to wait for collective professional standards to reveal acceptable practice or follow a strategy of punctuated equilibrium, only switching out established practice habits when very conspicuous advantages are identified. Integration in medicine appears to follow the statistically sophisticated practice of updating estimates of clinical parameters (probabilities) for diagnoses, treatments, prognoses, and side-effects. This approach is likely beyond the skill or interest of clinical dentists and it fails to incorporate values in the integration. The use of decision trees to integrate both research and experiential parameters and values is illustrated and it is shown that such a technique identifies why there are very few cases in dentistry where evidence needs to be consulted and indicates what such cases are.

Deep-sea biostratigraphy of prograding platform margins (Neogene, Bahamas): key evidence linked to depositional rhythm

USGS Publications Warehouse

Lidz, B.H.; McNeill, D.F.

1995-01-01

New foraminiferal evidence from two boreholes on the paleoshelf and slope of western Great Bahama Bank has wide-ranging implications for understanding formation and evolution of carbonate-platform margins. The new data, abundant well-preserved planktic foraminifera, were obtained by disaggregating samples from intercalated pelagic layers and selected parts of thick hemipelagic limestone. The new data define six units in one hole and seven in the other, bracket the biozones present and their ages, indicate different sedimentation rates, and show that within the limits of biostratigraphic resolution the biozones are correlative between the holes. Most importantly, the revised ages show that the paleoshelf borehole probably penetrated the late Miocene rather than middle Miocene. -from Authors

Obtaining active parental consent for school-based research: a guide for researchers.

PubMed

Wolfenden, Luke; Kypri, Kypros; Freund, Megan; Hodder, Rebecca

2009-06-01

Schools increasingly require researchers to obtain active parental consent for students to participate in health research. We sought to identify effective strategies for the recruitment of child research participants through schools. A search of Medline, PsycINFO, Educational Resources Information Center, ProQuest 5000 and the Cochrane Library electronic databases was conducted for the period 1988 to 2008. The review found evidence that the following strategies may be effective in enhancing participation rates: 1) promotion of the research to school principals, teachers, parents and students; 2) dissemination of study information using methods allowing direct contact with parents (i.e. telephone or face-to-face); 3) provision of incentives to teachers, students and at a class level; 4) making reminder contacts; and 5) having a member of the research team co-ordinate and closely monitor the recruitment process. Application of these strategies should reduce the risk of non-response and other biases that result from selective non-participation. Further randomised controlled trials of these and other strategies are required to strengthen the evidence base.

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

Cancer.gov

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

Does Training Pay? Evidence from Australian Enterprises.

ERIC Educational Resources Information Center

Blandy, Richard; Dockery, Michael; Hawke, Anne; Webster, Elizabeth

A study was conducted to obtain pilot evidence that could serve as a basis for developing convincing methods for individual Australian companies to use in determining their returns from investment in training. The study attempted to replicate survey results from significant overseas surveys by using information collected on more than 90 Australian…

Evaluating Response Cards as Evidence Based

ERIC Educational Resources Information Center

Owiny, Ruby L.; Spriggs, Amy D.; Sartini, Emily C.; Mills, Jeremy R.

2018-01-01

Increased accountability for quality instruction leading to higher achievement for all students has made it essential for identification and implementation of evidence-based practices. The Council for Exceptional Children's development of quality indicators (QI) has provided measures for researchers to apply to a body of literature to determine if…

Sedimentary Rocks and Evidence for Aqueous Environment on the Surface of Mars

NASA Astrophysics Data System (ADS)

Grotzinger, J. P.; Athena Science Team

2004-12-01

On January 24, 2004 the Mars Exploration Rover Opportunity landed at Meridiani Planum. The landing region lies on a broad, flat plain near the martian equator. The landing site itself is within an impact crater about 20 meters in diameter which exposes small rock outcrops along its northwestern rim. As of September 1, 2004, the Opportunity rover has explored the outcrops exposed within Eagle crater, along with much larger outcrops exposed almost continuously along the rim of Endurance crater, about 175 m in diameter and approximately 750 m away from Eagle crater. The intervening plains exposed additional outcrop within a regionally-pervasive fracture system, and within a smaller impact crater of just a few meters diameter. All outcrops studied to date from these differing localities indicate the presence of regionally extensive, lithified sedimentary materials consisting of fine-grained siliciclastic sediments derived from basaltic source rocks, admixed and cemented by abundant sulfate minerals and hematite. These include the hydrated sulphate mineral jarosite, in addition to Mg-sulphate. Cross-stratification provides evidence for both eolian and aqueous transport. Subsequent alteration of these rocks produced hematite-rich concretions and vuggy porosity that is pseudomorphic after probable sulphate evaporite minerals. These combined observations indicate episodic inundation by surface water to shallow depths, followed by evaporation, exposure and desiccation. Festoon cross-lamination provides evidence for inundation by water, the mineralogy and geochemistry indicate evaporation of water and precipitation of dissolved salts, and the planar to low-angle lamination and larger scale cross-bedding are consistent with sediment transport across a dry surface. Terrestrial analogs for such a suite of facies and surface processes include interdune depressions, playa lakes, and sabkhas adjacent to marginal seaways. The primary objective of the Mars Exploration Rover mission

British Military surgical key performance indicators: time for an update?

PubMed

Marsden, Max Er; Sharrock, A E; Hansen, C L; Newton, N J; Bowley, D M; Midwinter, M

2016-10-01

Key performance indicators (KPIs) are metrics that compare actual care against an ideal structure, process or outcome standard. KPIs designed to assess performance in deployed military surgical facilities have previously been published. This study aimed to review the overall performance of surgical trauma care for casualties treated at Role 3 Camp Bastion, Medical Treatment Facility, Afghanistan, in light of the existing Defence Medical Services (DMS) KPIs. The secondary aims were to assess the utility of the surgical KPIs and make recommendations for future surgical trauma care review. Data on 22 surgical parameters were prospectively collected for 150 injured patients who had primary surgery at Camp Bastion between 1 May 2013 and 20 August 2013. Additional information for these patients was obtained using the Joint Theatre Trauma Register. The authors assessed data recording, applicability and compliance with the KPIs. Median data recording was 100% (IQR 98%-100%), median applicability was 56% (IQR 10%-99%) and median compliance was 78% (IQR 58%-93%). One KPI was not applicable to any patient in our population. Eleven KPIs achieved >80% compliance, five KPIs had 80%-60% compliance and five KPIs had <60% compliance. Recommendations are made for minor modifications to the current KPIs. 78% compliance with the DMS KPIs provides a snapshot of the performance of the surgical aspect of military trauma care in 2013. The KPIs highlight areas for improvement in service delivery. Individual KPI development should be driven by evidence and reflect advances in practice and knowledge. A method of stakeholder consultation, and sequential refinement following evidence review, may be the right process to develop the future set of DMS KPIs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Differences of Perceived Image Generated through the Web Site: Empirical Evidence Obtained in Spanish Destinations

PubMed Central

Blazquez-Resino, Juan J.; Muro-Rodriguez, Ana I.; Perez-Jimenez, Israel R.

2016-01-01

In this paper, a study of the perceived destination image created by promotional Web Pages is expounded in an attempt to identify their differences as generators of destination image in the consumers' mind. Specifically, it seeks to analyse whether the web sites of different Spanish regions improve the image that consumers have of the destination, identifying their main dimensions and analysing its effect on satisfaction and intentions of the future behavior of potential visitors. To achieve these objectives and verify the hypotheses, a laboratory experiment was performed, where it was determined what changes are produced in the tourist's previous image after browsing the tourist webs of three different regions. Moreover, it analyses the differences in the effect of the perceived image on satisfaction and potential visitors' future behavioral intentions. The results obtained enable us to identify differences in the composition of the perceived image according to the destination, while confirming the significant effect of different perceived image dimensions regarding satisfaction. The results allow managers to gain a better understanding of the effectiveness of their sites from a consumer perspective as well as suggestions to follow in order to achieve greater efficiency in their communication actions in order to improve the motivation of visitors to go to the destination. PMID:27933027

Differences of Perceived Image Generated through the Web Site: Empirical Evidence Obtained in Spanish Destinations.

PubMed

Blazquez-Resino, Juan J; Muro-Rodriguez, Ana I; Perez-Jimenez, Israel R

2016-01-01

In this paper, a study of the perceived destination image created by promotional Web Pages is expounded in an attempt to identify their differences as generators of destination image in the consumers' mind. Specifically, it seeks to analyse whether the web sites of different Spanish regions improve the image that consumers have of the destination, identifying their main dimensions and analysing its effect on satisfaction and intentions of the future behavior of potential visitors. To achieve these objectives and verify the hypotheses, a laboratory experiment was performed, where it was determined what changes are produced in the tourist's previous image after browsing the tourist webs of three different regions. Moreover, it analyses the differences in the effect of the perceived image on satisfaction and potential visitors' future behavioral intentions. The results obtained enable us to identify differences in the composition of the perceived image according to the destination, while confirming the significant effect of different perceived image dimensions regarding satisfaction. The results allow managers to gain a better understanding of the effectiveness of their sites from a consumer perspective as well as suggestions to follow in order to achieve greater efficiency in their communication actions in order to improve the motivation of visitors to go to the destination.

Indicator-based water sustainability assessment - a review.

PubMed

Juwana, I; Muttil, N; Perera, B J C

2012-11-01

In the past few decades, there have been extensive efforts on measuring sustainability. One example is the development of assessment tools based on sustainability indicators. Several individuals and organisations have suggested various indices for assessing sustainability. This paper focuses on the review of water sustainability assessment using the indicator-based approach. It discusses major definitions of sustainable development that have been proposed and more specific concepts of sustainability based on sustainability principles and criteria. It then proceeds with the review of existing definitions, principles and guidelines on sustainable water resource management. The paper then explores elements of indicator-based water sustainability assessment. These elements include the selection of components and indicators, obtaining sub-index values, weighting schemes for components and indicators, aggregation of components and indicators, robustness analysis of the index, and interpretation of the final index value. These six elements are explored considering four existing water sustainability indices and two other sustainability indices that are thought to be useful for the development and use of water sustainability indices. The review presented in this paper on indicator-based water sustainability assessment can provide significant inputs to water stakeholders worldwide for using existing indices, for customising existing indices for their applications, and for developing new water sustainability indices. These indices can provide information on current conditions of water resources, including identifying all factors contributing to the improvement of water resources. This information can be used to communicate the current status of existing water resources to the wider community. Also, the water sustainability indices can be used to assist decision makers to prioritise issues, challenges and programmes related to water resource management. Copyright © 2012

European Society of Gynaecologic Oncology Quality Indicators for Advanced Ovarian Cancer Surgery.

PubMed

Querleu, Denis; Planchamp, François; Chiva, Luis; Fotopoulou, Christina; Barton, Desmond; Cibula, David; Aletti, Giovanni; Carinelli, Silvestro; Creutzberg, Carien; Davidson, Ben; Harter, Philip; Lundvall, Lene; Marth, Christian; Morice, Philippe; Rafii, Arash; Ray-Coquard, Isabelle; Rockall, Andrea; Sessa, Cristiana; van der Zee, Ate; Vergote, Ignace; du Bois, Andreas

2016-09-01

The surgical management of advanced ovarian cancer involves complex surgery. Implementation of a quality management program has a major impact on survival. The goal of this work was to develop a list of quality indicators (QIs) for advanced ovarian cancer surgery that can be used to audit and improve the clinical practice. This task has been carried out under the auspices of the European Society of Gynaecologic Oncology (ESGO). Quality indicators were based on scientific evidence and/or expert consensus. A 4-step evaluation process included a systematic literature search for the identification of potential QIs and the documentation of scientific evidence, physical meetings of an ad hoc multidisciplinarity International Development Group, an internal validation of the targets and scoring system, and an external review process involving physicians and patients. Ten structural, process, or outcome indicators were selected. Quality indicators 1 to 3 are related to achievement of complete cytoreduction, caseload in the center, training, and experience of the surgeon. Quality indicators 4 to 6 are related to the overall management, including active participation to clinical research, decision-making process within a structured multidisciplinary team, and preoperative workup. Quality indicator 7 addresses the high value of adequate perioperative management. Quality indicators 8 to 10 highlight the need of recording pertinent information relevant to improvement of quality. An ESGO-approved template for the operative report has been designed. Quality indicators were described using a structured format specifying what the indicator is measuring, measurability specifications, and targets. Each QI was associated with a score, and an assessment form was built. The ESGO quality criteria can be used for self-assessment, for institutional or governmental quality assurance programs, and for the certification of centers. Quality indicators and corresponding targets give

[Revision of Quality Indicators for the Endoscopy Quality Improvement Program of the National Cancer Screening Program in Korea].

PubMed

Min, Jun Ki; Cha, Jae Myung; Cho, Yu Kyung; Kim, Jie Hyun; Yoon, Soon Man; Im, Jong Pil; Jung, Yunho; Moon, Jeong Seop; Kim, Jin Oh; Jeen, Yoon Tae

2018-05-25

Gastroscopy and colonoscopy are widely used for the early diagnosis of stomach and colorectal cancer. The present revision integrates recent data regarding previous quality indicators and novel indicators suggested for gastroscopy and colonoscopy procedures for the National Cancer Screening Program in Korea. The new indicators, developed by the Quality Improvement Committee of the Korean Society for Gastrointestinal Endoscopy, vary in the level of supporting evidence, and most are based solely on expert opinion. Updated indicators validated by clinical research were prioritized, but were chosen by expert consensus when such studies were absent. The resultant quality indicators were graded according to the levels of consensus and recommendations. The updated indicators will provide a relevant guideline for high-quality endoscopy. The future direction of quality indicator development should include relevant outcome measures and an evidence-based approach to support proposed performance targets.

Five years after the Hawai'i smoke-free law: tourism and hospitality economic indicators appear unharmed.

PubMed

Dobson Amato, Katharine A; Rivard, Cheryl; Lipsher, Julian; Hyland, Andrew

2013-10-01

Opponents of Hawai'i's smoke-free law argued that such a law would lead to a decrease in tourism. The purpose of this study is to determine if there is evidence of an adverse impact of Hawai'i's smoke-free law on tourism utilizing data obtained from Hawai'i's Department of Business, Economic Development & Tourism website for tourists from the United States. Descriptive statistics were reported before and after the law and linear regression was used to assess the relationship between the implementation of the law and changes in indicators of tourism while adjusting for underlying economic factors. The most pronounced fluctuations observed with all tourism indicators occurred around the time the US entered the recession (December 2007), with steady increases following the end of the US recession. While controlling for economic and seasonal trends, the presence of the smoke-free law was associated with an increase in arrivals (β= 42847.9; 95% CI: 16303.3, 69392.5), accommodation employees (β= 969.0; 95% CI: 351.1, 1586.8) and food services & beverage places employees (β=3390.8; 95% CI: 2326.9, 4454.7). Fluctuations in tourism indicators are likely to be associated with greater economic forces, such as decreasing GDP and consumer confidence in the United States and greater global economic trends, rather than the smoke-free law.

Transboundary secondary organic aerosol in western Japan: An observed limitation of the f44 oxidation indicator

NASA Astrophysics Data System (ADS)

Irei, Satoshi; Takami, Akinori; Sadanaga, Yasuhiro; Miyoshi, Takao; Arakaki, Takemitsu; Sato, Kei; Kaneyasu, Naoki; Bandow, Hiroshi; Hatakeyama, Shiro

2015-11-01

To obtain evidence for secondary organic aerosol formation during the long-range transport of air masses over the East China Sea, we conducted field measurements in March 2012 at the Fukue atmospheric monitoring station, Nagasaki, in western Japan. The relative abundance of m/z 44 in fine organic aerosol (f44) was measured by an Aerodyne aerosol chemical speciation monitor. The stable carbon isotope ratio (δ13C) of low-volatile water-soluble organic carbon (LV-WSOC) in the daily filter samples of total suspended particulate matter was also analyzed using an elemental-analyzer coupled with an isotope ratio mass spectrometer. Additionally, in situ measurements of NOx and NOy were performed using NOx and NOy analyzers. The measurements showed that, unlike the systematic trends observed in a previous field study, a scatter plot for δ13C of LV-WSOC versus f44 indicated a random variation. Comparison of f44 with the estimated photochemical age by the NOx/NOy ratio revealed that the random distribution of f44 values near 0.2 is likely an indication of saturation already. Such f44 values were significantly lower than the observed f44 (∼0.3) at Hedo in the previous study. These findings imply that the saturation point of f44, and the use of f44 as an oxidation indicator, is case dependent.

Five Years After the Hawai‘i Smoke-free Law: Tourism and Hospitality Economic Indicators Appear Unharmed

PubMed Central

Rivard, Cheryl; Lipsher, Julian; Hyland, Andrew

2013-01-01

Opponents of Hawai‘i's smoke-free law argued that such a law would lead to a decrease in tourism. The purpose of this study is to determine if there is evidence of an adverse impact of Hawai‘i's smoke-free law on tourism utilizing data obtained from Hawai‘i's Department of Business, Economic Development & Tourism website for tourists from the United States. Descriptive statistics were reported before and after the law and linear regression was used to assess the relationship between the implementation of the law and changes in indicators of tourism while adjusting for underlying economic factors. The most pronounced fluctuations observed with all tourism indicators occurred around the time the US entered the recession (December 2007), with steady increases following the end of the US recession. While controlling for economic and seasonal trends, the presence of the smoke-free law was associated with an increase in arrivals (β= 42847.9; 95% CI: 16303.3, 69392.5), accommodation employees (β= 969.0; 95% CI: 351.1, 1586.8) and food services & beverage places employees (β=3390.8; 95% CI: 2326.9, 4454.7). Fluctuations in tourism indicators are likely to be associated with greater economic forces, such as decreasing GDP and consumer confidence in the United States and greater global economic trends, rather than the smoke-free law. PMID:24167770

Correlation studies of Pioneer Venus imagery obtained from PV experiments with near IR imagery obtained from ground-based observations during Venus inferior conjunction

NASA Technical Reports Server (NTRS)

Ragent, Boris

1993-01-01

The purpose of this study is to attempt to find correlations between data taken by experiments aboard the Pioneer-Venus Orbiter (PVO) and those obtained from Earth-based near-infrared (NIR) measurements of Venus during periods near inferior conjunction. Since the NIR measurements have been found to provide data on the middle atmosphere cloud morphology and motion, it is assumed that any correlations will also indicate that the PVO experiments are also documenting cloud behavior. If such correlations are found, then a further task is to attempt to study the long term behavior of the cloud features implied by the correlations. Many PVO data have been obtained over an extended period extending from 1978 until the PV demise in 1992. There exists a long, somewhat ill-conditioned time series of data that may contain valuable information on the long time, as well as short term behavior of the clouds, and, derivatively from cloud motion, atmospheric dynamics and wave activity in the Venus atmosphere. For example, determination of the zonal velocities of any OCPP (Cloud Photopolarimeter) 0.935 micron features could then be used for comparisons with data from other sources to attempt to fix the altitude region in which such features existed. A further task of this study is to attempt to correlate any features found in simultaneously obtained data, for example, the OCPP 0.365 and 0.935 micron data. The existence of such correlations may imply that data was obtained in overlapping altitude regions of the atmosphere.

Use of microbiological indicators for assessing hygiene controls for the manufacture of powdered infant formula.

PubMed

Buchanan, Robert L; Oni, Ruth

2012-05-01

Microbiological testing for various indicator microorganisms is used extensively as a means of verifying the effectiveness of efforts to ensure the microbiological quality and safety of a wide variety of foods. However, for each use of an indicator organism the underlying scientific assumptions related to the behavior of the target microorganism, the characteristics of the food matrix, the details of the food manufacturing processes, environment, and distribution system, and the methodological basis for the assay must be evaluated to determine the validity, utility, and efficacy of potential microbiological indicator tests. The recent adoption by the Codex Alimentarius Commission of microbiological criteria for powdered infant formulae and related products provides an excellent example of an evidence-based approach for the establishment of consensus microbiological criteria. The present article reviews these criteria and those of various national governments in relation to emerging principles for the evidence-based establishment of effective indicator organisms.

Evidence Combination From an Evolutionary Game Theory Perspective

PubMed Central

Deng, Xinyang; Han, Deqiang; Dezert, Jean; Deng, Yong; Shyr, Yu

2017-01-01

Dempster-Shafer evidence theory is a primary methodology for multi-source information fusion because it is good at dealing with uncertain information. This theory provides a Dempster’s rule of combination to synthesize multiple evidences from various information sources. However, in some cases, counter-intuitive results may be obtained based on that combination rule. Numerous new or improved methods have been proposed to suppress these counter-intuitive results based on perspectives, such as minimizing the information loss or deviation. Inspired by evolutionary game theory, this paper considers a biological and evolutionary perspective to study the combination of evidences. An evolutionary combination rule (ECR) is proposed to help find the most biologically supported proposition in a multi-evidence system. Within the proposed ECR, we develop a Jaccard matrix game (JMG) to formalize the interaction between propositions in evidences, and utilize the replicator dynamics to mimick the evolution of propositions. Experimental results show that the proposed ECR can effectively suppress the counter-intuitive behaviors appeared in typical paradoxes of evidence theory, compared with many existing methods. Properties of the ECR, such as solution’s stability and convergence, have been mathematically proved as well. PMID:26285231

Evidence of Formation of Superdense Nonmagnetic Cobalt.

PubMed

Banu, Nasrin; Singh, Surendra; Satpati, B; Roy, A; Basu, S; Chakraborty, P; Movva, Hema C P; Lauter, V; Dev, B N

2017-02-03

Because of the presence of 3d transition metals in the Earth's core, magnetism of these materials in their dense phases has been a topic of great interest. Theory predicts a dense face-centred-cubic phase of cobalt, which would be nonmagnetic. However, this dense nonmagnetic cobalt has not yet been observed. Recent investigations in thin film polycrystalline materials have shown the formation of compressive stress, which can increase the density of materials. We have discovered the existence of ultrathin superdense nonmagnetic cobalt layers in a polycrystalline cobalt thin film. The densities of these layers are about 1.2-1.4 times the normal density of Co. This has been revealed by X-ray reflectometry experiments, and corroborated by polarized neutron reflectometry (PNR) experiments. Transmission electron microscopy provides further evidence. The magnetic depth profile, obtained by PNR, shows that the superdense Co layers near the top of the film and at the film-substrate interface are nonmagnetic. The major part of the Co film has the usual density and magnetic moment. These results indicate the possibility of existence of nonmagnetic Co in the earth's core under high pressure.

Seismicity in Pennsylvania: Evidence for Anthropogenic Events?

NASA Astrophysics Data System (ADS)

Homman, K.; Nyblade, A.

2015-12-01

The deployment and operation of the USArray Transportable Array (TA) and the PASEIS (XY) seismic networks in Pennsylvania during 2013 and 2014 provide a unique opportunity for investigating the seismicity of Pennsylvania. These networks, along with several permanent stations in Pennsylvania, resulted in a total of 104 seismometers in and around Pennsylvania that have been used in this study. Event locations were first obtained with Antelope Environmental Monitoring Software using P-wave arrival times. Arrival times were hand picked using a 1-5 Hz bandpass filter to within 0.1 seconds. Events were then relocated using a velocity model developed for Pennsylvania and the HYPOELLIPSE location code. In this study, 1593 seismic events occurred between February 2013 and December 2014 in Pennsylvania. These events ranged between magnitude (ML) 1.04 and 2.89 with an average MLof 1.90. Locations of the events occur across the state in many areas where no seismicity has been previously reported. Preliminary results indicate that most of these events are related to mining activity. Additional work using cross-correlation techniques is underway to examine a number of event clusters for evidence of hydraulic fracturing or wastewater injection sources.

Effects of an Evidence-Based Text on Scepticism, Methodological Reasoning, Values and Juror Decision-Making

ERIC Educational Resources Information Center

Leshowitz, Barry; Okun, Morris

2011-01-01

Research in social cognition laboratories and in simulated legal settings demonstrates that people often do not understand the statistical properties of evidence and are unable to detect scientifically flawed studies. In a mock jury study, we examined the effects of an evidence-based transcript on scepticism towards evidence obtained in flawed…

[The balanced scorecard used as a management tool in a clinical laboratory: internal business processes indicators].

PubMed

Salinas La Casta, Maria; Flores Pardo, Emilio; Uris Selles, Joaquín

2009-01-01

to propose a set of indicators as a management tool for a clinical laboratory, by using the balanced scorecard internal business processes perspective. indicators proposed are obtained from different sources; external proficiency testing of the Valencia Community Government, by means of internal surveys and laboratory information system registers. One year testing process proportion indicators results are showed. internal management indicators are proposed (process, appropriateness and proficiency testing). The process indicators results show gradual improvement since its establishment. after one years of using a conceptually solid Balanced Scorecard Internal business processes perspective indicators, the obtained results validate the usefulness as a laboratory management tool.

Analysis of the Digital Evidence Presented in the Yahoo! Case

NASA Astrophysics Data System (ADS)

Kwan, Michael; Chow, Kam-Pui; Lai, Pierre; Law, Frank; Tse, Hayson

The “Yahoo! Case” led to considerable debate about whether or not an IP address is personal data as defined by the Personal Data (Privacy) Ordinance (Chapter 486) of the Laws of Hong Kong. This paper discusses the digital evidence presented in the Yahoo! Case and evaluates the impact of the IP address on the verdict in the case. A Bayesian network is used to quantify the evidentiary strengths of hypotheses in the case and to reason about the evidence. The results demonstrate that the evidence about the IP address was significant to obtaining a conviction in the case.

Fusion of Optimized Indicators from Advanced Driver Assistance Systems (ADAS) for Driver Drowsiness Detection

PubMed Central

Daza, Iván G.; Bergasa, Luis M.; Bronte, Sebastián; Yebes, J. Javier; Almazán, Javier; Arroyo, Roberto

2014-01-01

This paper presents a non-intrusive approach for monitoring driver drowsiness using the fusion of several optimized indicators based on driver physical and driving performance measures, obtained from ADAS (Advanced Driver Assistant Systems) in simulated conditions. The paper is focused on real-time drowsiness detection technology rather than on long-term sleep/awake regulation prediction technology. We have developed our own vision system in order to obtain robust and optimized driver indicators able to be used in simulators and future real environments. These indicators are principally based on driver physical and driving performance skills. The fusion of several indicators, proposed in the literature, is evaluated using a neural network and a stochastic optimization method to obtain the best combination. We propose a new method for ground-truth generation based on a supervised Karolinska Sleepiness Scale (KSS). An extensive evaluation of indicators, derived from trials over a third generation simulator with several test subjects during different driving sessions, was performed. The main conclusions about the performance of single indicators and the best combinations of them are included, as well as the future works derived from this study. PMID:24412904

The Triangle Technique: a new evidence-based educational tool for pediatric medication calculations.

PubMed

Sredl, Darlene

2006-01-01

Many nursing student verbalize an aversion to mathematical concepts and experience math anxiety whenever a mathematical problem is confronted. Since nurses confront mathematical problems on a daily basis, they must learn to feel comfortable with their ability to perform these calculations correctly. The Triangle Technique, a new educational tool available to nurse educators, incorporates evidence-based concepts within a graphic model using visual, auditory, and kinesthetic learning styles to demonstrate pediatric medication calculations of normal therapeutic ranges. The theoretical framework for the technique is presented, as is a pilot study examining the efficacy of the educational tool. Statistically significant results obtained by Pearson's product-moment correlation indicate that students are better able to calculate accurate pediatric therapeutic dosage ranges after participation in the educational intervention of learning the Triangle Technique.

Oxidative degradation of biorefinery lignin obtained after pretreatment of forest residues of Douglas Fir.

PubMed

Srinivas, Keerthi; de Carvalho Oliveira, Fernanda; Teller, Philip Johan; Gonҫalves, Adilson Roberto; Helms, Gregory L; Ahring, Birgitte Kaer

2016-12-01

Harvested forest residues are usually considered a fire hazards and used as "hog-fuel" which results in air pollution. In this study, the biorefinery lignin stream obtained after wet explosion pretreatment and enzymatic hydrolysis of forestry residues of Douglas Fir (FS-10) was characterized and further wet oxidized under alkaline conditions. The studies indicated that at 10% solids, 11.7wt% alkali and 15min residence time, maximum yields were obtained for glucose (12.9wt%), vanillin (0.4wt%) at 230°C; formic acid (11.6wt%) at 250°C; acetic acid (10.7wt%), hydroxybenzaldehyde (0.2wt%), syringaldehyde (0.13wt%) at 280°C; and lactic acid (12.4wt%) at 300°C. FTIR analysis of the solid residue after wet oxidation showed that the aromatic skeletal vibrations relating to lignin compounds increased with temperature indicating that higher severity could result in increased lignin oxidation products. The results obtained, as part of the study, is significant for understanding and optimizing processes for producing high-value bioproducts from forestry residues. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assessing efficacy and therapeutic claims in emerging indications for recombinant factor VIIa: regulatory perspectives.

PubMed

Farrugia, Albert

2006-01-01

When compared with the evidence-based, cost-effectiveness criteria underpinning most government reimbursement schemes in the social market economies, the three regulatory hurdles of safety, quality and efficacy are probably of modest impact in influencing increased usage of recombinant activated factor VII (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark). Nevertheless, efficacy claims must be supported if regulatory approval is to be granted for the wider range of indications that have been proposed for rFVIIa. With the refinement of clinical trial designs over the past 40 years, the randomized controlled trial (RCT) has assumed the role of gold standard, providing the highest level of evidence for therapeutic efficacy. However, it is incorrect to assume that regulatory authorities give sole credence to RCTs in assessing claims. It is noteworthy that the indications already accepted for rFVIIa by international regulatory authorities--including the treatment of inhibitors to factor VIII and factor IX, substitution for FVII deficiency, and treatment of Glanzmann's thrombasthenia--were supported not by RCTs but by studies conventionally considered to provide modest evidence levels. Therefore, the use of studies other than RCTs for the more recently proposed indications for rFVIIa in a range of conditions requiring hemostatic correction is perfectly feasible. What regulators expect are well-conducted and well-described studies adhering to principles of good clinical practice, which can be scrutinized for evidence of clinical efficacy and which are based on the initially proven principle for the drug. This paper discusses the regulatory history of rFVIIa in the major regulatory authorities and assesses the route needed to support claims being made in the mainstream literature. Recent episodes where post-market events have forced regulators to be more than usually cautious will be used as examples to suggest possible pitfalls to the extension of approved claims for

Observation, Sherlock Holmes, and Evidence Based Medicine.

PubMed

Osborn, John

2002-01-01

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

Defining quality indicators for best-practice management of inflammatory bowel disease in Canada

PubMed Central

Nguyen, Geoffrey C; Devlin, Shane M; Afif, Waqqas; Bressler, Brian; Gruchy, Steven E; Kaplan, Gilaad G; Oliveira, Liliana; Plamondon, Sophie; Seow, Cynthia H; Williams, Chadwick; Wong, Karen; Yan, Brian M; Jones, Jennifer

2014-01-01

BACKGROUND: There is a paucity of published data regarding the quality of care of inflammatory bowel disease (IBD) in Canada. Clinical quality indicators are quantitative end points used to guide, monitor and improve the quality of patient care. In Canada, where universal health care can vary significantly among provinces, quality indicators can be used to identify potential gaps in the delivery of IBD care and standardize the approach to interprovincial management. METHODS: The Emerging Practice in IBD Collaborative (EPIC) group generated a shortlist of IBD quality indicators based on a comprehensive literature review. An iterative voting process was used to select quality indicators to take forward. In a face-to-face meeting with the EPIC group, available evidence to support each quality indicator was presented by the EPIC member aligned to it, followed by group discussion to agree on the wording of the statements. The selected quality indicators were then ratified in a final vote by all EPIC members. RESULTS: Eleven quality indicators for the management of IBD within the single-payer health care system of Canada were developed. These focus on accurate diagnosis, appropriate and timely management, disease monitoring, and prevention or treatment of complications of IBD or its therapy. CONCLUSIONS: These quality indicators are measurable, reflective of the evidence base and expert opinion, and define a standard of care that is at least a minimum that should be expected for IBD management in Canada. The next steps for the EPIC group involve conducting research to assess current practice across Canada as it pertains to these quality indicators and to measure the impact of each of these indicators on patient outcomes. PMID:24839622

A search for the evidence supporting community paediatric practice

PubMed Central

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

1999-01-01

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

 PMID:10325707

New classification system for indications for endoscopic retrograde cholangiopancreatography predicts diagnoses and adverse events.

PubMed

Yuen, Nicholas; O'Shaughnessy, Pauline; Thomson, Andrew

2017-12-01

Indications for endoscopic retrograde cholangiopancreatography (ERCP) have received little attention, especially in scientific or objective terms. To review the prevailing ERCP indications in the literature, and to propose and evaluate a new ERCP indication system, which relies on more objective pre-procedure parameters. An analysis was conducted on 1758 consecutive ERCP procedures, in which contemporaneous use was made of an a-priori indication system. Indications were based on the objective pre-procedure parameters and divided into primary [cholangitis, clinical evidence of biliary leak, acute (biliary) pancreatitis, abnormal intraoperative cholangiogram (IOC), or change/removal of stent for benign/malignant disease] and secondary [combination of two or three of: pain attributable to biliary disease ('P'), imaging evidence of biliary disease ('I'), and abnormal liver function tests (LFTs) ('L')]. A secondary indication was only used if a primary indication was not present. The relationship between this newly developed classification system and ERCP findings and adverse events was examined. The indications of cholangitis and positive IOC were predictive of choledocholithiasis at ERCP (101/154 and 74/141 procedures, respectively). With respect to secondary indications, only if all three of 'P', 'I', and 'L' were present there was a statistically significant association with choledocholithiasis (χ 2 (1) = 35.3, p < .001). Adverse events were associated with an unusual indication leading to greater risk of unplanned hospitalization (χ 2 (1) = 17.0, p < .001). An a-priori-based indication system for ERCP, which relies on pre-ERCP objective parameters, provides a more useful and scientific classification system than is available currently.

In defense of causal-formative indicators: A minority report.

PubMed

Bollen, Kenneth A; Diamantopoulos, Adamantios

2017-09-01

Causal-formative indicators directly affect their corresponding latent variable. They run counter to the predominant view that indicators depend on latent variables and are thus often controversial. If present, such indicators have serious implications for factor analysis, reliability theory, item response theory, structural equation models, and most measurement approaches that are based on reflective or effect indicators. Psychological Methods has published a number of influential articles on causal and formative indicators as well as launching the first major backlash against them. This article examines 7 common criticisms of these indicators distilled from the literature: (a) A construct measured with "formative" indicators does not exist independently of its indicators; (b) Such indicators are causes rather than measures; (c) They imply multiple dimensions to a construct and this is a liability; (d) They are assumed to be error-free, which is unrealistic; (e) They are inherently subject to interpretational confounding; (f) They fail proportionality constraints; and (g) Their coefficients should be set in advance and not estimated. We summarize each of these criticisms and point out the flaws in the logic and evidence marshaled in their support. The most common problems are not distinguishing between what we call causal-formative and composite-formative indicators, tautological fallacies, and highlighting issues that are common to all indicators, but presenting them as special problems of causal-formative indicators. We conclude that measurement theory needs (a) to incorporate these types of indicators, and (b) to better understand their similarities to and differences from traditional indicators. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Lenalidomide in multiple myeloma: an evidence-based review of its role in therapy

PubMed Central

Richardson, Paul; Mitsiades, Constantine; Laubach, Jacob; Schlossman, Robert; Ghobrial, Irene; Hideshima, Teru; Munshi, Nikhil; Anderson, Kenneth

2010-01-01

Introduction: Multiple myeloma (MM) is a relatively common and incurable hematological malignancy. Currently, there is no single standard therapy, with choice of treatment dependent on individual patient factors. Lenalidomide is an immunomodulatory drug with potent antitumor, antiangiogenic, immunomodulatory, and proapoptotic activity in MM. Aims: To evaluate the evidence for the use of lenalidomide in its current indication in relapsed or refractory MM, and additionally its investigational use for the treatment of newly diagnosed MM. Evidence review: In patients with relapsed and refractory MM, adding lenalidomide to high-dose dexamethasone significantly improves response rates and time-to-progression, relative to high-dose dexamethasone alone. This translates into a significant extension of overall survival (with a median extension of 9.1 months in a pivotal phase III study). Outcome is independent of patient age, number of previous therapies, type of previous therapy (including thalidomide or autologous stem cell transplantation), renal impairment, and β2-microglobulin level. Evidence suggests that combining lenalidomide with low-dose dexamethasone improves outcomes in patients with newly diagnosed disease and is superior to lenalidomide combined with high-dose dexamethasone. Myelosuppression is the predominant toxicity observed, although some studies have shown high incidences of venous thromboembolism in the absence of prophylactic antithrombotic anticoagulation therapy. There is currently only limited evidence regarding the health economics of lenalidomide. Role in therapy: The encouraging results obtained with lenalidomide alone and in combination with dexamethasone in patients with relapsed or refractory MM have led to its adoption as a recommended therapy in patients who have received at least one prior treatment. Emerging evidence supports the ongoing investigation of lenalidomide in combination with low-dose dexamethasone, and in other combinations

CHOICE OF INDICATOR DETERMINES THE SIGNIFICANCE AND RISK OBTAINED FROM THE STATISTICAL ASSOCIATION BETWEN FINE PARTICULATE MATTER MASS AND CARDIOVASCULAR MORTALITY

EPA Science Inventory

Minor changes in the indicator used to measure fine PM, which cause only modest changes in Mass concentrations, can lead to dramatic changes in the statistical relationship of fine PM mass with cardiovascular mortality. An epidemiologic study in Phoenix (Mar et al., 2000), augme...

Home Care Quality Indicators (HCQIS) Based on the MDS-HC

ERIC Educational Resources Information Center

Hirdes, John P.; Fries, Brant E.; Morris, John N.; Ikegami, Naoki; Zimmerman, David; Dalby, Dawn M.; Aliaga, Pablo; Hammer, Suzanne; Jones, Richard

2004-01-01

Purpose: This study aimed to develop home care quality indicators (HCQIs) to be used by a variety of audiences including consumers, agencies, regulators, and policy makers to support evidence-based decision making related to the quality of home care services. Design and Methods: Data from 3,041 Canadian and 11,252 U.S. home care clients assessed…

Detailed analysis of metagenome datasets obtained from biogas-producing microbial communities residing in biogas reactors does not indicate the presence of putative pathogenic microorganisms

PubMed Central

2013-01-01

Background In recent years biogas plants in Germany have been supposed to be involved in amplification and dissemination of pathogenic bacteria causing severe infections in humans and animals. In particular, biogas plants are discussed to contribute to the spreading of Escherichia coli infections in humans or chronic botulism in cattle caused by Clostridium botulinum. Metagenome datasets of microbial communities from an agricultural biogas plant as well as from anaerobic lab-scale digesters operating at different temperatures and conditions were analyzed for the presence of putative pathogenic bacteria and virulence determinants by various bioinformatic approaches. Results All datasets featured a low abundance of reads that were taxonomically assigned to the genus Escherichia or further selected genera comprising pathogenic species. Higher numbers of reads were taxonomically assigned to the genus Clostridium. However, only very few sequences were predicted to originate from pathogenic clostridial species. Moreover, mapping of metagenome reads to complete genome sequences of selected pathogenic bacteria revealed that not the pathogenic species itself, but only species that are more or less related to pathogenic ones are present in the fermentation samples analyzed. Likewise, known virulence determinants could hardly be detected. Only a marginal number of reads showed similarity to sequences described in the Microbial Virulence Database MvirDB such as those encoding protein toxins, virulence proteins or antibiotic resistance determinants. Conclusions Findings of this first study of metagenomic sequence reads of biogas producing microbial communities suggest that the risk of dissemination of pathogenic bacteria by application of digestates from biogas fermentations as fertilizers is low, because obtained results do not indicate the presence of putative pathogenic microorganisms in the samples analyzed. PMID:23557021

Evaluating Comprehensive State Tobacco Prevention and Control Programs Using an Outcome Indicator Framework.

PubMed

Fulmer, Erika; Rogers, Todd; Glasgow, LaShawn; Brown, Susan; Kuiper, Nicole

2018-03-01

The outcome indicator framework helps tobacco prevention and control programs (TCPs) plan and implement theory-driven evaluations of their efforts to reduce and prevent tobacco use. Tobacco use is the single-most preventable cause of morbidity and mortality in the United States. The implementation of public health best practices by comprehensive state TCPs has been shown to prevent the initiation of tobacco use, reduce tobacco use prevalence, and decrease tobacco-related health care expenditures. Achieving and sustaining program goals require TCPs to evaluate the effectiveness and impact of their programs. To guide evaluation efforts by TCPs, the Centers for Disease Control and Prevention's Office on Smoking and Health developed an outcome indicator framework that includes a high-level logic model and evidence-based outcome indicators for each tobacco prevention and control goal area. In this article, we describe how TCPs and other community organizations can use the outcome indicator framework in their evaluation efforts. We also discuss how the framework is used at the national level to unify tobacco prevention and control efforts across varying state contexts, identify promising practices, and expand the public health evidence base.

Coliform Bacteria as Indicators of Diarrheal Risk in Household Drinking Water: Systematic Review and Meta-Analysis

PubMed Central

Gruber, Joshua S.; Ercumen, Ayse; Colford, John M.

2014-01-01

Background Current guidelines recommend the use of Escherichia coli (EC) or thermotolerant (“fecal”) coliforms (FC) as indicators of fecal contamination in drinking water. Despite their broad use as measures of water quality, there remains limited evidence for an association between EC or FC and diarrheal illness: a previous review found no evidence for a link between diarrhea and these indicators in household drinking water. Objectives We conducted a systematic review and meta-analysis to update the results of the previous review with newly available evidence, to explore differences between EC and FC indicators, and to assess the quality of available evidence. Methods We searched major databases using broad terms for household water quality and diarrhea. We extracted study characteristics and relative risks (RR) from relevant studies. We pooled RRs using random effects models with inverse variance weighting, and used standard methods to evaluate heterogeneity and publication bias. Results We identified 20 relevant studies; 14 studies provided extractable results for meta-analysis. When combining all studies, we found no association between EC or FC and diarrhea (RR 1.26 [95% CI: 0.98, 1.63]). When analyzing EC and FC separately, we found evidence for an association between diarrhea and EC (RR: 1.54 [95% CI: 1.37, 1.74]) but not FC (RR: 1.07 [95% CI: 0.79, 1.45]). Across all studies, we identified several elements of study design and reporting (e.g., timing of outcome and exposure measurement, accounting for correlated outcomes) that could be improved upon in future studies that evaluate the association between drinking water contamination and health. Conclusions Our findings, based on a review of the published literature, suggest that these two coliform groups have different associations with diarrhea in household drinking water. Our results support the use of EC as a fecal indicator in household drinking water. PMID:25250662

Coliform bacteria as indicators of diarrheal risk in household drinking water: systematic review and meta-analysis.

PubMed

Gruber, Joshua S; Ercumen, Ayse; Colford, John M

2014-01-01

Current guidelines recommend the use of Escherichia coli (EC) or thermotolerant ("fecal") coliforms (FC) as indicators of fecal contamination in drinking water. Despite their broad use as measures of water quality, there remains limited evidence for an association between EC or FC and diarrheal illness: a previous review found no evidence for a link between diarrhea and these indicators in household drinking water. We conducted a systematic review and meta-analysis to update the results of the previous review with newly available evidence, to explore differences between EC and FC indicators, and to assess the quality of available evidence. We searched major databases using broad terms for household water quality and diarrhea. We extracted study characteristics and relative risks (RR) from relevant studies. We pooled RRs using random effects models with inverse variance weighting, and used standard methods to evaluate heterogeneity and publication bias. We identified 20 relevant studies; 14 studies provided extractable results for meta-analysis. When combining all studies, we found no association between EC or FC and diarrhea (RR 1.26 [95% CI: 0.98, 1.63]). When analyzing EC and FC separately, we found evidence for an association between diarrhea and EC (RR: 1.54 [95% CI: 1.37, 1.74]) but not FC (RR: 1.07 [95% CI: 0.79, 1.45]). Across all studies, we identified several elements of study design and reporting (e.g., timing of outcome and exposure measurement, accounting for correlated outcomes) that could be improved upon in future studies that evaluate the association between drinking water contamination and health. Our findings, based on a review of the published literature, suggest that these two coliform groups have different associations with diarrhea in household drinking water. Our results support the use of EC as a fecal indicator in household drinking water.

What are the indications for using probiotics in children?

PubMed

Szajewska, Hania

2016-04-01

The health benefits of probiotics have been the subject of extensive research. Still, some questions are being repeatedly asked: should one use or not use probiotics? If yes, how and when should probiotics be used? The purpose of this review is to summarise current evidence on specific probiotics' efficacy and safety to help healthcare professionals make evidence-based decisions on the indications for using specific probiotic strains or combinations in children. To identify relevant data, searches of MEDLINE and the Cochrane Library databases were performed in July 2015 to locate randomised controlled trials or their meta-analyses published in the last five years. The MEDLINE database also was searched for evidence-based clinical practice guidelines, developed by scientific societies. Considering that probiotics have strain-specific effects, the main focus was on data on individual probiotic strains, not on probiotics in general. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Evaluation of Evidence-Based Nursing Pain Management Practice

PubMed Central

Song, Wenjia; Eaton, Linda H.; Gordon, Debra B.; Hoyle, Christine; Doorenbos, Ardith Z.

2014-01-01

Background It is important to ensure that cancer pain management is based on the best evidence. Nursing evidence-based pain management can be examined through an evaluation of pain documentation. Aims This study aimed to (a) modify and test an evaluation tool for nursing cancer pain documentation, and (b) describe the frequency and quality of nursing pain documentation in one oncology unit via electronic medical system. Design and Setting A descriptive cross-sectional design was used for this study at an oncology unit of an academic medical center in the Pacific Northwest. Methods Medical records were examined for 37 adults hospitalized during April and May of 2013. Nursing pain documentations (N = 230) were reviewed using an evaluation tool modified from the Cancer Pain Practice Index to consist of 13 evidence-based pain management indicators, including pain assessment, care plan, pharmacologic and nonpharmacologic interventions, monitoring and treatment of analgesic side effects, communication with physicians, and patient education. Individual nursing documentation was assigned a score from 0 (worst possible) to 13 (best possible), to reflect the delivery of evidence-based pain management. Results The participating nurses documented 90% of the recommended evidence-based pain management indicators. Documentation was suboptimal for pain reassessment, pharmacologic interventions, and bowel regimen. Conclusions The study results provide implications for enhancing electronic medical record design and highlight a need for future research to understand the reasons for suboptimal nursing documentation of cancer pain management. For the future use of the data evaluation tool, we recommend additional modifications according to study settings. PMID:26256215

Evaluation of Evidence-based Nursing Pain Management Practice.

PubMed

Song, Wenjia; Eaton, Linda H; Gordon, Debra B; Hoyle, Christine; Doorenbos, Ardith Z

2015-08-01

It is important to ensure that cancer pain management is based on the best evidence. Nursing evidence-based pain management can be examined through an evaluation of pain documentation. The aim of this study was to modify and test an evaluation tool for nursing cancer pain documentation, and describe the frequency and quality of nursing pain documentation in one oncology unit via the electronic medical system. A descriptive cross-sectional design was used for this study at an oncology unit of an academic medical center in the Pacific Northwest. Medical records were examined for 37 adults hospitalized during April and May 2013. Nursing pain documentations (N = 230) were reviewed using an evaluation tool modified from the Cancer Pain Practice Index to consist of 13 evidence-based pain management indicators, including pain assessment, care plan, pharmacologic and nonpharmacologic interventions, monitoring and treatment of analgesic side effects, communication with physicians, and patient education. Individual nursing documentation was assigned a score ranging from 0 (worst possible) to 13 (best possible), to reflect the delivery of evidence-based pain management. The participating nurses documented 90% of the recommended evidence-based pain management indicators. Documentation was suboptimal for pain reassessment, pharmacologic interventions, and bowel regimen. The study results provide implications for enhancing electronic medical record design and highlight a need for future research to understand the reasons for suboptimal nursing documentation of cancer pain management. For the future use of the data evaluation tool, we recommend additional modifications according to study settings. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Identifying key performance indicators for nursing and midwifery care using a consensus approach.

PubMed

McCance, Tanya; Telford, Lorna; Wilson, Julie; Macleod, Olive; Dowd, Audrey

2012-04-01

The aim of this study was to gain consensus on key performance indicators that are appropriate and relevant for nursing and midwifery practice in the current policy context. There is continuing demand to demonstrate effectiveness and efficiency in health and social care and to communicate this at boardroom level. Whilst there is substantial literature on the use of clinical indicators and nursing metrics, there is less evidence relating to indicators that reflect the patient experience. A consensus approach was used to identify relevant key performance indicators. A nominal group technique was used comprising two stages: a workshop involving all grades of nursing and midwifery staff in two HSC trusts in Northern Ireland (n = 50); followed by a regional Consensus Conference (n = 80). During the workshop, potential key performance indicators were identified. This was used as the basis for the Consensus Conference, which involved two rounds of consensus. Analysis was based on aggregated scores that were then ranked. Stage one identified 38 potential indicators and stage two prioritised the eight top-ranked indicators as a core set for nursing and midwifery. The relevance and appropriateness of these indicators were confirmed with nurses and midwives working in a range of settings and from the perspective of service users. The eight indicators identified do not conform to the majority of other nursing metrics generally reported in the literature. Furthermore, they are strategically aligned to work on the patient experience and are reflective of the fundamentals of nursing and midwifery practice, with the focus on person-centred care. Nurses and midwives have a significant contribution to make in determining the extent to which these indicators are achieved in practice. Furthermore, measurement of such indicators provides an opportunity to evidence of the unique impact of nursing/midwifery care on the patient experience. © 2011 Blackwell Publishing Ltd.

Comparative morphometry of facial surface models obtained from a stereo vision system in a healthy population

NASA Astrophysics Data System (ADS)

López, Leticia; Gastélum, Alfonso; Chan, Yuk Hin; Delmas, Patrice; Escorcia, Lilia; Márquez, Jorge

2014-11-01

Our goal is to obtain three-dimensional measurements of craniofacial morphology in a healthy population, using standard landmarks established by a physical-anthropology specialist and picked from computer reconstructions of the face of each subject. To do this, we designed a multi-stereo vision system that will be used to create a data base of human faces surfaces from a healthy population, for eventual applications in medicine, forensic sciences and anthropology. The acquisition process consists of obtaining the depth map information from three points of views, each depth map is obtained from a calibrated pair of cameras. The depth maps are used to build a complete, frontal, triangular-surface representation of the subject face. The triangular surface is used to locate the landmarks and the measurements are analyzed with a MATLAB script. The classification of the subjects was done with the aid of a specialist anthropologist that defines specific subject indices, according to the lengths, areas, ratios, etc., of the different structures and the relationships among facial features. We studied a healthy population and the indices from this population will be used to obtain representative averages that later help with the study and classification of possible pathologies.

Physical characteristics of polymer complexes in suspension obtained from cellulosic latexes with ondansetron.

PubMed

Ruiz, A; Llácer, J M; Morales, E; Gallardo, V

2004-06-01

Ondansetron is a carbazol with antiemetic properties. It is used primarily to control nausea and vomiting caused by cytotoxic chemotherapy and radiotherapy, as well as in postoperative vomiting in gynecological surgery. Ondansetron has a half-life of approximately 4 h, hence it is a matter of great interest to determine the ideal conditions for the formation of a drug-polymer complex in order to prolong the duration of the therapeutic action. A stability study of the active drug was first carried out on each of the polymers (Aquateric and Aquacoat). The adsorption of ondansetron on the lattices was determined with respect to time, pH and concentration. The results obtained suggest that both polymers are suitable as drug carriers for the controlled-release formulations obtained. We conclude that an acid pH is evidently fundamental in the adsorption process of this drug in the latexes. Moreover, the Aquateric latex would seem to be the best-suited polymer to use as a vehicle for drug delivery.

Level Indicator On A Tubular Inside Micrometer

NASA Technical Reports Server (NTRS)

Malinzak, R. Michael; Booth, Gary N.

1995-01-01

Leveling helps to ensure accurate measurements. Attachment helpful because in some situations that involve measurement of large, tight-tolerance inside dimensions, inside micrometers not held level between contact point give inaccurate readings. User adjusts position and orientation of micrometer and verifies level by observing bubble in level indicator. Upon feeling correct drag between micrometer tips and workpiece, user confident that tool used correctly and accurate measurement obtained.

Water on Mars: Evidence from MER Mission Results

NASA Technical Reports Server (NTRS)

Landis, Geoffrey A.

2004-01-01

The Viking and the Mars Exploration Rover missions observed that the surface of Mars is encrusted by a thinly cemented layer, or "duricrust". Elemental analyzes at five sites on Mars show that these soils have sulfur content and chlorine content consistent with the presence of sulfates and halides as mineral cements. The soil is highly enriched in the salt-forming elements compared with rock. Analysis of the soil cementation indicates some features which may be evidence of liquid water. At both MER sites, duricrust textures revealed by the Microscopic Imager show features including the presence of fine sand-sized grains, some of which may be aggregates of fine silt and clay, surrounded by a pervasive light colored material that is associated with microtubular structures and networks of microfractures. Stereo views of undisturbed duricrust surfaces reveal rugged microrelief between 2-3 mm and minimal loose material. Comparisons of microscopic images of duricrust soils obtain before and after placement of the Mossbauer spectrometer indicate differing degrees of compaction and cementation. Two models of a transient water hypothesis are offered, a "top down" hypothesis that emphasizes the surface deposition of frost, melting and downward migration of liquid water and a "bottom up" alternative that proposes the presence of interstitial ice/brine, with the upward capillary migration of liquid water. The viability of both of these models ultimately hinges on the availability of seasonally transient liquid water for brief periods.

What Does the Evidence Say Is Best for Your Student? CLUE #3: Appraise.

PubMed

Maughan, Erin D; Yonkaitis, Catherine F

2018-03-01

School nurses are often faced with various requests from parents, teachers, and even healthcare providers. How do you know what requests should be honored? What does the current evidence indicate? This article is the third in a series of articles outlining the steps of evidence-based practice. The article explains and provides tips for accomplishing the third step: Appraise the evidence. Appraising the evidence means better understanding what the literature says and how strong the evidence is. This is an important step in evidence-based school nursing practice.

Quality Indicators in Radiation Oncology

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

Albert, Jeffrey M.; Das, Prajnan, E-mail: prajdas@mdanderson.org

Oncologic specialty societies and multidisciplinary collaborative groups have dedicated considerable effort to developing evidence-based quality indicators (QIs) to facilitate quality improvement, accreditation, benchmarking, reimbursement, maintenance of certification, and regulatory reporting. In particular, the field of radiation oncology has a long history of organized quality assessment efforts and continues to work toward developing consensus quality standards in the face of continually evolving technologies and standards of care. This report provides a comprehensive review of the current state of quality assessment in radiation oncology. Specifically, this report highlights implications of the healthcare quality movement for radiation oncology and reviews existing efforts tomore » define and measure quality in the field, with focus on dimensions of quality specific to radiation oncology within the “big picture” of oncologic quality assessment efforts.« less

Eight indicators of unilateral pregnancy.

PubMed

Melchionne, Kevin

2010-12-01

Unintended pregnancy often leads to undesirable outcomes for both mothers and children. However, the definition of unintended pregnancy in the sociology of family formation has been restricted to the intentions of mothers. The intentions of fathers--and, with them, the possible role of disagreement about pregnancy intention--remain outside most conceptual frameworks and research programs. This article draws together a number of indicators of unilateral pregnancy in research on contemporary family formation in the United States. Studies of pregnancy intendedness and contraceptive use consistently provide evidence suggesting a significant role for unilateral pregnancy in family formation. Working on the assumption that unilateral pregnancy presents great potential for social dislocation, this article argues for the integration of the concept of unilateral pregnancy into the theoretical framework informing research on family formation.

Measuring performance to drive improvement: development of a clinical indicator set for general medicine.

PubMed

Brand, C; Lam, S K L; Roberts, C; Gorelik, A; Amatya, B; Smallwood, D; Russell, D

2009-06-01

There are delays in implementing evidence about effective therapy into clinical practice. Clinical indicators may support implementation of guideline recommendations. To develop and evaluate the short-term impact of a clinical indicator set for general medicine. A set of clinical process indicators was developed using a structured process. The indicator set was implemented between January 2006 and December 2006, using strategies based on evidence about effectiveness and local contextual factors. Evaluation included a structured survey of general medical staff to assess awareness and attitudes towards the programme and qualitative assessment of barriers to implementation. Impact on documentation of adherence to clinical indicators was assessed by auditing a random sample of medical records before (2003-2005) and after (2006) implementation. Clinical indicators were developed for the following areas: venous thromboembolism, cognition, chronic heart failure, chronic obstructive pulmonary disease, diabetes, low trauma fracture, patient written care plans. The programme was well supported and incurred little burden to staff. Implementation occurred largely as planned; however, documentation of adherence to clinical indicators was variable. There was a generally positive trend over time, but for most indicators this was independent of the implementation process and may have been influenced by other system improvement activities. Failure to demonstrate a significant impact during the pilot phase is likely to have been influenced by administrative factors, especially lack of an integrative data documentation and collection process. Successful implementation in phase two is likely to depend upon an effective data collection system integrated into usual care.

The Riso-Hudson Enneagram Type Indicator: Estimates of Reliability and Validity

ERIC Educational Resources Information Center

Newgent, Rebecca A.; Parr, Patricia E.; Newman, Isadore; Higgins, Kristin K.

2004-01-01

This investigation was conducted to estimate the reliability and validity of scores on the Riso-Hudson Enneagram Type Indicator (D. R. Riso & R. Hudson, 1999a). Results of 287 participants were analyzed. Alpha suggests an adequate degree of internal consistency. Evidence provides mixed support for construct validity using correlational and…

Physical evidence of predatory behavior in Tyrannosaurus rex.

PubMed

DePalma, Robert A; Burnham, David A; Martin, Larry D; Rothschild, Bruce M; Larson, Peter L

2013-07-30

Feeding strategies of the large theropod, Tyrannosaurus rex, either as a predator or a scavenger, have been a topic of debate previously compromised by lack of definitive physical evidence. Tooth drag and bone puncture marks have been documented on suggested prey items, but are often difficult to attribute to a specific theropod. Further, postmortem damage cannot be distinguished from intravital occurrences, unless evidence of healing is present. Here we report definitive evidence of predation by T. rex: a tooth crown embedded in a hadrosaurid caudal centrum, surrounded by healed bone growth. This indicates that the prey escaped and lived for some time after the injury, providing direct evidence of predatory behavior by T. rex. The two traumatically fused hadrosaur vertebrae partially enclosing a T. rex tooth were discovered in the Hell Creek Formation of South Dakota.

Physical evidence of predatory behavior in Tyrannosaurus rex

NASA Astrophysics Data System (ADS)

DePalma, Robert A., II; Burnham, David A.; Martin, Larry D.; Rothschild, Bruce M.; Larson, Peter L.

2013-07-01

Feeding strategies of the large theropod, Tyrannosaurus rex, either as a predator or a scavenger, have been a topic of debate previously compromised by lack of definitive physical evidence. Tooth drag and bone puncture marks have been documented on suggested prey items, but are often difficult to attribute to a specific theropod. Further, postmortem damage cannot be distinguished from intravital occurrences, unless evidence of healing is present. Here we report definitive evidence of predation by T. rex: a tooth crown embedded in a hadrosaurid caudal centrum, surrounded by healed bone growth. This indicates that the prey escaped and lived for some time after the injury, providing direct evidence of predatory behavior by T. rex. The two traumatically fused hadrosaur vertebrae partially enclosing a T. rex tooth were discovered in the Hell Creek Formation of South Dakota.

Physical evidence of predatory behavior in Tyrannosaurus rex

PubMed Central

DePalma, Robert A.; Burnham, David A.; Martin, Larry D.; Rothschild, Bruce M.; Larson, Peter L.

2013-01-01

Feeding strategies of the large theropod, Tyrannosaurus rex, either as a predator or a scavenger, have been a topic of debate previously compromised by lack of definitive physical evidence. Tooth drag and bone puncture marks have been documented on suggested prey items, but are often difficult to attribute to a specific theropod. Further, postmortem damage cannot be distinguished from intravital occurrences, unless evidence of healing is present. Here we report definitive evidence of predation by T. rex: a tooth crown embedded in a hadrosaurid caudal centrum, surrounded by healed bone growth. This indicates that the prey escaped and lived for some time after the injury, providing direct evidence of predatory behavior by T. rex. The two traumatically fused hadrosaur vertebrae partially enclosing a T. rex tooth were discovered in the Hell Creek Formation of South Dakota. PMID:23858435

Are biodiversity indices of spontaneous grass covers in olive orchards good indicators of soil degradation?

NASA Astrophysics Data System (ADS)

Taguas, E. V.; Arroyo, C.; Lora, A.; Guzmán, G.; Vanderlinden, K.; Gómez, J. A.

2015-03-01

Spontaneous grass covers are an inexpensive soil erosion control measure in olive orchards. Olive farmers allow grass to grow on sloping terrain to comply with the basic environmental standards derived from the Common Agricultural Policy (CAP). However, to date there are very few studies assessing the environmental quality and extent of such covers. In this study, we described and compared the biodiversity indicators associated to herbaceous vegetation in two contrasting olive orchards in order to evaluate its relevance and quality. In addition, biodiversity patterns and their relationships with environmental factors such as soil type and properties, precipitation, topography and soil management were analyzed. Different grass cover biodiversity indices were evaluated in two olive orchard catchments under conventional tillage and no tillage with grass cover, during 3 hydrological years (2011-2013). Seasonal samples of vegetal material and pictures in a permanent grid (4 samples ha-1) were taken to characterize the temporal variations of the number of species, frequency, diversity and transformed Shannon's and Pielou's indices. Sorensen's index obtained in the two olive orchard catchments showed notable differences in composition, probably linked with the different site conditions. The catchment with the best site conditions (deeper soil and higher precipitation), with average annual soil losses over 10 t ha-1 and a more intense management, presented the highest biodiversity indices. In absolute terms, the diversity indices were reasonably high in both catchments, despite the fact that agricultural activity usually severely limits the landscape and the variety of species. Finally, a significantly higher content of organic matter in the first 10 cm of soil was found in the catchment with the worst site conditions, average annual soil losses of 2 t ha-1 and the least intense management. Therefore, the biodiversity indicators associated to weeds were not found to be

Synthesis of systematic review evidence of interprofessional education.

PubMed

Reeves, Scott; Goldman, Joanne; Burton, Andrea; Sawatzky-Girling, Brenda

2010-01-01

Interprofessional education (IPE) continues to be a central focus within health care and research spheres. As a result, there is a sustained interest in understanding its overall effects on learners, professions, organizations, and patients. Systematic reviews are instrumental in assessing evidence and informing disciplinary fields about the effects of interventions and providing direction for future activity and research. This paper provides a synthesis and critical appraisal of the evidence for IPE contained in the small, but growing, systematic review literature. Six IPE reviews were located. In general, the reviews shared similar definitions of IPE and similar methodological approaches to their inclusion of studies. Findings from the synthesis indicated that IPE varied in terms of content, duration, and professional participation. The synthesis also indicated that studies that evaluated this form of education were of variable quality and captured a range of different outcomes-from reports of learner satisfaction to changes in the delivery of care. While a number of methodological problems were found, in general the synthesis indicated that IPE delivered in a variety of settings was generally well received by learners and enabled the acquisition of knowledge and skills necessary for collaborative working. Some evidence was also found that IPE can improve the delivery of services and make a positive impact on care. The paper goes on to discuss the synthesis findings in relation to the most recent IPE literature and also offers a series of suggestions for future directions.

A European Sustainable Tourism Labels proposal using a composite indicator

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

Blancas, Francisco Javier, E-mail: fjblaper@upo.es; Lozano-Oyola, Macarena, E-mail: mlozoyo@upo.es; González, Mercedes, E-mail: m_gonzalez@uma.es

The tourism sector in Europe faces important challenges which it must deal with to promote its future development. In this context, the European Commission considers that two key issues must be addressed. On the one hand, a better base of socio-economic knowledge about tourism and its relationship with the environment is needed, and, on the other hand, it is necessary to improve the image of European areas as quality sustainable tourism destinations. In this paper we present analytical tools that cover these needs. Specifically, we define a system of sustainable tourism indicators and we obtain a composite indicator incorporating weightsmore » quantified using a panel of experts. Employing the values of this global indicator as a basis, we define a Sustainable Tourism Country-Brand Ranking which assesses the perception of each country-brand depending on its degree of sustainability, and a system of sustainable tourism labels which reward the management carried out. - Highlights: • We define a system of indicators to improve the knowledge about sustainable tourism. • We obtain composite indicators based on expert knowledge. • The Sustainable Tourism Country-Brand Ranking would improve the image of destinations. • We define a Sustainable Tourism Labels System to assess country-brands. • The conclusions of the empirical analysis can be extrapolated to other tourist areas.« less

Plain packaging of cigarettes: do we have sufficient evidence?

PubMed Central

Smith, Collin N; Kraemer, John D; Johnson, Andrea C; Mays, Darren

2015-01-01

Tobacco industry marketing is a primary factor influencing cigarette smoking behavior and the cigarette pack has become an important marketing vehicle for tobacco companies. Standardized “plain” cigarette packaging is advocated as a public health policy to prevent and reduce morbidity and mortality caused by smoking by reducing youth smoking initiation and promoting cessation among smokers. Plain packaging was implemented in Australia in December 2012, and several other countries are considering doing so, but each faces foreseeable legal resistance from opponents to such measures. Tobacco companies have challenged these public health policies, citing international trade agreements and intellectual property laws. Decision-making in these court cases will hinge in part on whether the evidence indicates the public health benefits of plain packaging outweigh any potential harm to tobacco manufacturers’ interests. We reviewed the available evidence in support of plain packaging, finding evidence from observational, experimental, and population-based studies. Results indicate that plain packaging can reduce positive perceptions of smoking and dissuade tobacco use. Governments deciding to implement plain cigarette packaging measures can rely on this evidence to help make a strong case that plain packaging plays an important role in the context of comprehensive smoking prevention efforts. PMID:25897269

[Indicators of water microbial pollution: problems and perspectives].

PubMed

Nusca, A; D'Alessandro, D; Funari, E

2008-01-01

Conventional indicators of fecal contamination provide a precious contribution in evaluating water microbiological quality. In recent years some important issues have sprung up which have risen doubts about their reliability and have suggested a revision of their function. In developed countries, where the law regarding water quality is very strict, there have been several outbreaks, even though conventional indicators of fecal pollution pointed an appropriate microbiological quality. These outbreaks have been imputed to new pathogenic microorganisms which are often characterized by a great resistance to disinfection treatments than conventional indicators. In order to obtain an appropriate microbiological quality of waters, various approaches have been started such as the Water Safety Plans by World Health Organization the revision of the functions of suitable indicators (of the water quality), the setting up of specific methods either for pathogen microorganisms and for a quick surveying of an inadequate microbiological water quality.

Applying Quality Indicators to Single-Case Research Designs Used in Special Education: A Systematic Review

ERIC Educational Resources Information Center

Moeller, Jeremy D.; Dattilo, John; Rusch, Frank

2015-01-01

This study examined how specific guidelines and heuristics have been used to identify methodological rigor associated with single-case research designs based on quality indicators developed by Horner et al. Specifically, this article describes how literature reviews have applied Horner et al.'s quality indicators and evidence-based criteria.…

Prognostic Indicators: Predicting Degree of Change from Interventions for Adolescents at Risk for Language Weakness

ERIC Educational Resources Information Center

Poll, Gerard H.; Burke, Lisa; Miller, Carol A.; Fiene, Judy

2017-01-01

Prognostic statements are a standard component of assessments for adolescents at risk for language-learning disabilities, but there is limited evidence on the validity of prognostic indicators. In two studies, we collected measures of language ability and candidate prognostic indicators from adolescents age 12 to 13. We conducted an expository…

Impact of Postapproval Evidence Generation on the Biopharmaceutical Industry.

PubMed

Milne, Christopher-Paul; Cohen, Joshua P; Felix, Abigail; Chakravarthy, Ranjana

2015-08-01

Meeting marketplace demands for proving the value of new products requires more data than the industry has routinely produced. These data include evidence from comparative effectiveness research (CER), including randomized, controlled trials; pragmatic clinical trials; observational studies; and meta-analyses. We designed and conducted a survey to examine the industry's perceptions on new data requirements regarding CER evidence, the acceptability of postapproval study types, payer-specific issues related to CER, communication of data being generated postapproval, and methods used for facilitating postapproval evidence generation. CER is being used by payers for most types of postapproval decisions. Randomized, controlled trials were indicated as the most acceptable form of evidence. At the same time, there was support for the utility of other types of studies, such as pragmatic clinical trials and observational studies. Respondents indicated the use of multiple formats for communicating postapproval data with many different stakeholders including regulators, payers, providers, and patients. Risk-sharing agreements with payers were unanimously supported by respondents with regard to certain products with unclear clinical and economic outcomes at launch. In these instances, conditional reimbursement through coverage with evidence development was considered a constructive option. The Food and Drug Administration's initiative called Regulatory Science was considered by the respondents as having the most impact on streamlining the generation of postapproval research-related evidence. The biopharmaceutical industry is faced with a broad and complex set of challenges related to evidence generation for postapproval decisions by a variety of health care system stakeholders. Uncertainty remains as to how the industry and payers use postapproval studies to guide decision making with regard to pricing and reimbursement status. Correspondingly, there is uncertainty regarding

20 CFR 416.916 - If you fail to submit medical and other evidence.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false If you fail to submit medical and other... fail to submit medical and other evidence. You (and if you are a child, your parent, guardian, relative... obtain or identify, available medical or other evidence about your impairment(s). When you fail to...

20 CFR 416.916 - If you fail to submit medical and other evidence.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false If you fail to submit medical and other... fail to submit medical and other evidence. You (and if you are a child, your parent, guardian, relative... obtain or identify, available medical or other evidence about your impairment(s). When you fail to...

20 CFR 416.916 - If you fail to submit medical and other evidence.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false If you fail to submit medical and other... fail to submit medical and other evidence. You (and if you are a child, your parent, guardian, relative... obtain or identify, available medical or other evidence about your impairment(s). When you fail to...

20 CFR 416.916 - If you fail to submit medical and other evidence.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false If you fail to submit medical and other... fail to submit medical and other evidence. You (and if you are a child, your parent, guardian, relative... obtain or identify, available medical or other evidence about your impairment(s). When you fail to...

20 CFR 416.916 - If you fail to submit medical and other evidence.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false If you fail to submit medical and other... fail to submit medical and other evidence. You (and if you are a child, your parent, guardian, relative... obtain or identify, available medical or other evidence about your impairment(s). When you fail to...

Evidence Combination From an Evolutionary Game Theory Perspective.

PubMed

Deng, Xinyang; Han, Deqiang; Dezert, Jean; Deng, Yong; Shyr, Yu

2016-09-01

Dempster-Shafer evidence theory is a primary methodology for multisource information fusion because it is good at dealing with uncertain information. This theory provides a Dempster's rule of combination to synthesize multiple evidences from various information sources. However, in some cases, counter-intuitive results may be obtained based on that combination rule. Numerous new or improved methods have been proposed to suppress these counter-intuitive results based on perspectives, such as minimizing the information loss or deviation. Inspired by evolutionary game theory, this paper considers a biological and evolutionary perspective to study the combination of evidences. An evolutionary combination rule (ECR) is proposed to help find the most biologically supported proposition in a multievidence system. Within the proposed ECR, we develop a Jaccard matrix game to formalize the interaction between propositions in evidences, and utilize the replicator dynamics to mimick the evolution of propositions. Experimental results show that the proposed ECR can effectively suppress the counter-intuitive behaviors appeared in typical paradoxes of evidence theory, compared with many existing methods. Properties of the ECR, such as solution's stability and convergence, have been mathematically proved as well.

Clinical evidence for orphan medicinal products-a cause for concern?

PubMed

Picavet, Eline; Cassiman, David; Hollak, Carla E; Maertens, Johan A; Simoens, Steven

2013-10-16

The difficulties associated with organising clinical studies for orphan medicinal products (OMPs) are plentiful. Recent debate on the long-term effectiveness of some OMPs, led us to question whether the initial standards for clinical evidence for OMPs, set by the European Medicines Agency (EMA) at the time of marketing authorization, are too low. Therefore, the aim of this study was to quantitatively evaluate the characteristics and quality of clinical evidence that is presented for OMPs to obtain marketing authorization in Europe, using the new and validated COMPASS tool. We quantitatively assessed the characteristics and quality of clinical evidence of the pivotal studies of 64 OMPs as described in the European Public Assessment Report and/or the Scientific Discussion document prepared by the Committee for Human Medicinal Products of the EMA. The 64 OMPs were altogether authorized for 78 orphan indications, for which 117 studies were identified as 'pivotal' or 'main' studies. In approximately two thirds of the studies, the allocation was randomized (64.8%) and a control arm was used (68.5%). Half of the studies applied some type of blinding. Only a minority (26.9%) of the studies included a Quality-of-Life (QoL) related endpoint, of which a third claim an improvement in QoL. Upon analyzing the quality of reporting, we found that some aspects (i.e. the endpoints, the sampling criteria, and the interventions) are well described, whereas other items (i.e. a description of the patients and of potential biases) are not reported for all studies. In conclusion, the pivotal studies that are the basis for marketing authorization of OMPs are a cause for concern, as they exhibit methodological flaws i.e. the lack of QoL-related endpoints as outcome, lack of blinding in the study design and the use of surrogate endpoints. Additionally, there are shortcomings in the reporting of those studies that complicate the interpretation. A more demanding regulatory process for OMPs is

Evidence-Based Assessment of Depression in Adults

ERIC Educational Resources Information Center

Joiner, Thomas E.; Walker, Rheeda L.; Pettit, Jeremy W.; Perez, Marisol; Cukrowicz, Kelly C.

2005-01-01

From diverse perspectives, there is little doubt that depressive symptoms cohere to form a valid and distinct syndrome. Research indicates that an evidence-based assessment of depression would include (a) measures with adequate psychometric properties; (b) adequate coverage of symptoms; (c) adequate coverage of depressed mood, anhedonia, and…

Evidences of Multiple Magma Injections in Quaternary Balerang and Rajabasa Volcanoes, Indonesia

NASA Astrophysics Data System (ADS)

Hasibuan, R. F.; Ohba, T.; Abdurrachman, M.

2016-12-01

Quaternary Balerang and Rajabasa volcanoes are situated along the nearly north-south lineament with a most explosive Krakatau volcanic complex in the south and effusive Sukadana basalt plateau in the north. Some studies have elucidated that Krakatau volcano has multiple magma storage regions beneath together with evidences of magma mixing process. By considering these circumstances, it is necessary to know lateral variations of magmas and to characterize volcanic rocks from Rajabasa volcanic complex which is located between these distinct magmatic systems, in terms of magmatic processes and evolution. Methodologies we used are X-ray fluorescence to determine the whole rock chemistry, K-Ar isotope dating to determine the lifespan of the volcano, as well as EPMA analysis to obtain the chemical composition of minerals. The rock chemistry or TAS plot shows a linear trend, ranging from basaltic (51 wt.%) to rhyolitic (75 wt.%), indicating a chemical heterogeneity of magma. When SiO2 contents are correlated with the relative ages, we found a broad tendency that SiO2 contents progressively decrease with age. The Rajabasa volcano lifespan is known formed at 0.31 Ma while one of the youngest lava is identified erupted at 0.12 Ma. Some plagioclase crystals exhibit disequilibrium textures, like highly sieved core and clear rim regions, also overgrowth rim on the plagioclase and pyroxene crystals whose composition more primitive than the core's composition, indicating magmatic recharge events. Reverse zoning and resorption textures associated with compositional step zoning or progressive zoning are quite common as well in clinopyroxene and plagioclase crystals. By considering these evidences, we conclude that injection of a hotter basaltic magma into colder and more felsic magma occurred beneath the volcanoes.

Field evidence for the potential of Rhodobacter capsulatus as Biofertilizer for flooded rice.

PubMed

Gamal-Eldin, Hosny; Elbanna, Khaled

2011-02-01

In a previous study, we evaluated the effects of inoculating rice plants with the phototrophic purple nonsulfur bacterium Rhodobacter capsulatus (Rc) on growth and yield of rice in pots and lysimeter experiments and the results obtained have been highly encouraging. In this study, we carried out two field experiments: one in the experimental farm of the Faculty of Agriculture, Fayoum University, and the second in a farmer's field in Kafr El-sheikh, to assess the effects of Rc on growth and yield of rice in comparison and in combination with chemical nitrogen fertilizer (CNF) and farmyard manure. The results indicated that both biological and grain yields in all the Rc inoculated treatments were significantly higher than those in the uninoculated corresponding treatments in both fields. With regard to grain yield, the major factor for determining the effectiveness of any agricultural treatment, inoculation with Rc in combination with 50% of the recommended CNF rate gave a grain yield that was statistically equivalent to that obtained with 100% of the recommended CNF rate. These results provide a clear evidence for the potential of Rc as biofertilizer for flooded rice under field conditions.

New evidence for global tectonic zones on Venus

NASA Technical Reports Server (NTRS)

Kozak, Richard C.; Schaber, Gerald G.

1989-01-01

Venera 15 and 16 spacecraft images show clear evidence of major crustal disruptions on Venus which have been interpreted to indicate crustal divergence. Complementary to the divergent zones are mountain belts that border the continent-like high terrains. The requisite transcurrent motions appear to be manifested as diffuse shear zones. The rift zones form an interconnected transpolar system which ties in with previously recognized equatorial disruption zones, suggesting a global tectonic network. Several independent lines of evidence suggest that the tectonism may be geologically young.

Integrating Hyperthermia into Modern Radiation Oncology: What Evidence Is Necessary?

PubMed Central

Peeken, Jan C.; Vaupel, Peter; Combs, Stephanie E.

2017-01-01

Hyperthermia (HT) is one of the hot topics that have been discussed over decades. However, it never made its way into primetime. The basic biological rationale of heat to enhance the effect of radiation, chemotherapeutic agents, and immunotherapy is evident. Preclinical work has confirmed this effect. HT may trigger changes in perfusion and oxygenation as well as inhibition of DNA repair mechanisms. Moreover, there is evidence for immune stimulation and the induction of systemic immune responses. Despite the increasing number of solid clinical studies, only few centers have included this adjuvant treatment into their repertoire. Over the years, abundant prospective and randomized clinical data have emerged demonstrating a clear benefit of combined HT and radiotherapy for multiple entities such as superficial breast cancer recurrences, cervix carcinoma, or cancers of the head and neck. Regarding less investigated indications, the existing data are promising and more clinical trials are currently recruiting patients. How do we proceed from here? Preclinical evidence is present. Multiple indications benefit from additional HT in the clinical setting. This article summarizes the present evidence and develops ideas for future research. PMID:28713771

Interannual variations in feeding frequencies and food quality of greater flamingo chicks (Phoenicopterus roseus): evidence from plasma chemistry and effects on body condition.

PubMed

Amat, Juan A; Hortas, Francisco; Arroyo, Gonzalo M; Rendón, Miguel A; Ramírez, José M; Rendón-Martos, Manuel; Pérez-Hurtado, Alejandro; Garrido, Araceli

2007-06-01

Greater flamingos in southern Spain foraged in areas distant from a breeding site, spending 4-6 days in foraging areas between successive visits to the colony to feed their chicks. During four years, we took blood samples from chicks to ascertain whether there were interannual variations in several blood parameters, indicative of food quality and feeding frequencies. When the chicks were captured, 20-31% of them had their crops empty, indicating that not all chicks were fed daily. Additional evidence of variations in feeding frequencies was obtained from a principal component analysis (PCA) on plasma chemistry values, which also indicated that there were annual variations in the quality of food received by chicks. The association of cholesterol and glucose with some PC axes indicated that some chicks were experiencing fasting periods. Of all plasma metabolites considered, cholesterol was the best one to predict body condition. Greater flamingo chicks experiencing longer fasting intervals, as suggested by higher plasma levels of cholesterol, were in lower body condition.

Indications and interpretation of esophageal function testing.

PubMed

Gyawali, C Prakash; de Bortoli, Nicola; Clarke, John; Marinelli, Carla; Tolone, Salvatore; Roman, Sabine; Savarino, Edoardo

2018-05-12

Esophageal symptoms are common, and can arise from mucosal, motor, functional, and neoplastic processes, among others. Judicious use of diagnostic testing can help define the etiology of symptoms and can direct management. Endoscopy, esophageal high-resolution manometry (HRM), ambulatory pH or pH-impedance manometry, and barium radiography are commonly used for esophageal function testing; functional lumen imaging probe is an emerging option. Recent consensus guidelines have provided direction in using test findings toward defining mechanisms of esophageal symptoms. The Chicago Classification describes hierarchical steps in diagnosing esophageal motility disorders. The Lyon Consensus characterizes conclusive evidence on esophageal testing for a diagnosis of gastroesophageal reflux disease (GERD), and establishes a motor classification of GERD. Taking these recent advances into consideration, our discussion focuses primarily on the indications, technique, equipment, and interpretation of esophageal HRM and ambulatory reflux monitoring in the evaluation of esophageal symptoms, and describes indications for alternative esophageal tests. © 2018 New York Academy of Sciences.

Indicators of safety compromise in gastrointestinal endoscopy.

PubMed

Borgaonkar, Mark Ram; Hookey, Lawrence; Hollingworth, Roger; Kuipers, Ernst J; Forster, Alan; Armstrong, David; Barkun, Alan; Bridges, Ron; Carter, Rose; de Gara, Chris; Dube, Catherine; Enns, Robert; Macintosh, Donald; Forget, Sylviane; Leontiadis, Grigorios; Meddings, Jonathan; Cotton, Peter; Valori, Roland

2012-02-01

, gastrointestinal bleeding within 14 days of procedure, infection or symptomatic metabolic complications. The 19 indicators of safety compromise in endoscopy, identified by a rigorous, evidence-based consensus process, provide clear outcomes to be recorded by all facilities as part of their continuing quality improvement programs.

Perinatal Complications and Aging Indicators by Midlife

PubMed Central

Caspi, Avshalom; Ambler, Antony; Belsky, Daniel W.; Chapple, Simon; Cohen, Harvey Jay; Israel, Salomon; Poulton, Richie; Ramrakha, Sandhya; Rivera, Christine D.; Sugden, Karen; Williams, Benjamin; Wolke, Dieter; Moffitt, Terrie E.

2014-01-01

BACKGROUND: Perinatal complications predict increased risk for morbidity and early mortality. Evidence of perinatal programming of adult mortality raises the question of what mechanisms embed this long-term effect. We tested a hypothesis related to the theory of developmental origins of health and disease: that perinatal complications assessed at birth predict indicators of accelerated aging by midlife. METHODS: Perinatal complications, including both maternal and neonatal complications, were assessed in the Dunedin Multidisciplinary Health and Development Study cohort (N = 1037), a 38-year, prospective longitudinal study of a representative birth cohort. Two aging indicators were assessed at age 38 years, objectively by leukocyte telomere length (TL) and subjectively by perceived facial age. RESULTS: Perinatal complications predicted both leukocyte TL (β = −0.101; 95% confidence interval, −0.169 to −0.033; P = .004) and perceived age (β = 0.097; 95% confidence interval, 0.029 to 0.165; P = .005) by midlife. We repeated analyses with controls for measures of family history and social risk that could predispose to perinatal complications and accelerated aging, and for measures of poor health taken in between birth and the age-38 follow-up. These covariates attenuated, but did not fully explain the associations observed between perinatal complications and aging indicators. CONCLUSIONS: Our findings provide support for early-life developmental programming by linking newborns’ perinatal complications to accelerated aging at midlife. We observed indications of accelerated aging “inside,” as measured by leukocyte TL, an indicator of cellular aging, and “outside,” as measured by perceived age, an indicator of declining tissue integrity. A better understanding of mechanisms underlying perinatal programming of adult aging is needed. PMID:25349321

Research on the Fusion of Dependent Evidence Based on Rank Correlation Coefficient.

PubMed

Shi, Fengjian; Su, Xiaoyan; Qian, Hong; Yang, Ning; Han, Wenhua

2017-10-16

In order to meet the higher accuracy and system reliability requirements, the information fusion for multi-sensor systems is an increasing concern. Dempster-Shafer evidence theory (D-S theory) has been investigated for many applications in multi-sensor information fusion due to its flexibility in uncertainty modeling. However, classical evidence theory assumes that the evidence is independent of each other, which is often unrealistic. Ignoring the relationship between the evidence may lead to unreasonable fusion results, and even lead to wrong decisions. This assumption severely prevents D-S evidence theory from practical application and further development. In this paper, an innovative evidence fusion model to deal with dependent evidence based on rank correlation coefficient is proposed. The model first uses rank correlation coefficient to measure the dependence degree between different evidence. Then, total discount coefficient is obtained based on the dependence degree, which also considers the impact of the reliability of evidence. Finally, the discount evidence fusion model is presented. An example is illustrated to show the use and effectiveness of the proposed method.

Research on the Fusion of Dependent Evidence Based on Rank Correlation Coefficient

PubMed Central

Su, Xiaoyan; Qian, Hong; Yang, Ning; Han, Wenhua

2017-01-01

In order to meet the higher accuracy and system reliability requirements, the information fusion for multi-sensor systems is an increasing concern. Dempster–Shafer evidence theory (D–S theory) has been investigated for many applications in multi-sensor information fusion due to its flexibility in uncertainty modeling. However, classical evidence theory assumes that the evidence is independent of each other, which is often unrealistic. Ignoring the relationship between the evidence may lead to unreasonable fusion results, and even lead to wrong decisions. This assumption severely prevents D–S evidence theory from practical application and further development. In this paper, an innovative evidence fusion model to deal with dependent evidence based on rank correlation coefficient is proposed. The model first uses rank correlation coefficient to measure the dependence degree between different evidence. Then, total discount coefficient is obtained based on the dependence degree, which also considers the impact of the reliability of evidence. Finally, the discount evidence fusion model is presented. An example is illustrated to show the use and effectiveness of the proposed method. PMID:29035341

An indicator gene to demonstrate intracellular transposition of defective retroviruses.

PubMed Central

Heidmann, T; Heidmann, O; Nicolas, J F

1988-01-01

An indicator gene for detection and quantitation of RNA-mediated transposition was constructed (neoRT). It was inserted into a Moloney murine leukemia provirus (Mo-MLV) deleted for the envelope gene to test for intracellular transposition of defective retroviruses [Mo-MLV(neo)RT]. NeoRT contains the selectable neo gene (which confers resistance to the drug G418), inactivated by a polyadenylylation sequence inserted between the neo promotor and coding sequence. The polyadenylylation sequence is flanked (on the antisense strand of the DNA) by a donor and an acceptor splice site so as to be removed upon passage of the provirus through an RNA intermediate. 3T3 cells transfected with the defective Mo-MLV(neo)RT provirus are sensitive to G418. After trans-complementation with Mo-MLV, viral transcripts confer resistance to G418 upon infection of test cells. In the resistant cells, the polyadenylylation sequence has been removed, as a result in most cases of precise splicing of the intronic domain. Retrotransposition of the defective Mo-MLV(neo)RT provirus was demonstrated by submitting transfected G418-sensitive clones to selection. Between 1 and 10 G418-resistant clones were obtained per 10(7) cells. Several possess additional copies, with evidence for precise removal of the intronic domain. By using target test cells in coculture experiments, extracellular intermediates of retrotransposition could not be detected. Images PMID:2832848

Exploratory Evidence of Accounting Majors' Motivation to Learn

ERIC Educational Resources Information Center

Gabbin, Alexander L.

2009-01-01

A common theme among faculty at many universities is that student motivation to learn is lacking in the classroom. The primary concern of today's students is to obtain A and B grades regardless of demonstrated proficiency in the subject matter. Concern about students' motivation to learn is evident at the accounting educator's conference known as…

Short-term ozone exposure and asthma severity: Weight-of-evidence analysis.

PubMed

Goodman, Julie E; Zu, Ke; Loftus, Christine T; Lynch, Heather N; Prueitt, Robyn L; Mohar, Isaac; Shubin, Sara Pacheco; Sax, Sonja N

2018-01-01

To determine whether evidence indicates that short-term exposure to ambient concentrations of ozone in the United States can affect asthma severity, we systematically reviewed published controlled human exposure, epidemiology, and animal toxicity studies. The strongest evidence for a potential causal relationship came from epidemiology studies reporting increased emergency department visits and hospital admissions for asthma following elevated ambient ozone concentrations. However, while controlled exposure studies reported lung function decrements and increased asthma symptoms following high ozone exposures 160-400 parts per billion [ppb]), epidemiology studies evaluating similar outcomes reported less consistent results. Animal studies showed changes in pulmonary function at high ozone concentrations (> 500ppb), although there is substantial uncertainty regarding the relevance of these animal models to human asthma. Taken together, the weight of evidence indicates that there is at least an equal likelihood that either explanation is true, i.e., the strength of the evidence for a causal relationship between short-term exposure to ambient ozone concentrations and asthma severity is "equipoise and above." Copyright © 2017 Elsevier Inc. All rights reserved.

Analysis of Meteorological Data Obtained During Flight in a Supercooled Stratiform Cloud of High Liquid-Water Content

NASA Technical Reports Server (NTRS)

Perkins, Porter J.; Kline, Dwight B.

1951-01-01

Flight icing-rate data obtained in a dense and. abnormally deep supercooled stratiform cloud system indicated the existence of liquid-water contents generally exceeding values in amount and extent previously reported over the midwestern sections of the United States. Additional information obtained during descent through a part of the cloud system indicated liquid-water contents that significantly exceeded theoretical values, especially near the middle of the cloud layer.. The growth of cloud droplets to sizes that resulted in sedimentation from the upper portions of the cloud is considered to be a possible cause of the high water contents near the center of the cloud layer. Flight measurements of the vertical temperature distribution in the cloud layer indicated a rate of change of temperature with altitude exceeding that of the moist adiabatic lapse rate. This excessive rate of change is considered to have contributed to the severity of the condition.

Identifying models of delivery, care domains and quality indicators relevant to palliative day services: a scoping review protocol.

PubMed

O'Connor, Seán R; Dempster, Martin; McCorry, Noleen K

2017-05-16

With an ageing population and increasing numbers of people with life-limiting illness, there is a growing demand for palliative day services. There is a need to measure and demonstrate the quality of these services, but there is currently little agreement on which aspects of care should be used to do this. The aim of the scoping review will be to map the extent, range and nature of the evidence around models of delivery, care domains and existing quality indicators used to evaluate palliative day services. Electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials) will be searched for evidence using consensus development methods; randomised or quasi-randomised controlled trials; mixed methods; and prospective, longitudinal or retrospective case-control studies to develop or test quality indicators for evaluating palliative care within non-residential settings, including day hospices and community or primary care settings. At least two researchers will independently conduct all searches, study selection and data abstraction procedures. Meta-analyses and statistical methods of synthesis are not planned as part of the review. Results will be reported using numerical counts, including number of indicators in each care domain and by using qualitative approach to describe important indicator characteristics. A conceptual model will also be developed to summarise the impact of different aspects of quality in a palliative day service context. Methodological quality relating to indicator development will be assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) tool. Overall strength of evidence will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Final decisions on quality assessment will be made via consensus between review authors. Identifying, developing and implementing evidence-based quality indicators is critical to the evaluation and

Enzyme/indicator optrodes for detection of heavy metal ions and pesticides

NASA Astrophysics Data System (ADS)

Nabok, Alexei V.; Ray, Asim K.; Starodub, Nickolaj F.; Dowker, Kenneth P.

2000-12-01

Composite films containing enzyme and indicator molecules were produced by means of polyelectrolyte self-assembly. These membranes provide two functions: (i) molecular recognition of the substratum by respective enzyme, and (ii) optrode transducing, when the products o the substratum decomposition affect optical spectra of indicator molecules. Apart from direct registration of enzyme reactions, inhibition reactions can also be monitored with this method. Particularly, heavy metal salts and phosphor organic pesticides acting as inhibitors for Urease and Cholinesterase, respectively, were registered. Composite PESA films were deposited onto glass slides and consisted of several layers of poly(alylamine) hydrochloride (PAA) alternated with indicator molecules, either Cyclo-tetra- chromotropylene or Thymol Blue, both containing SO3- Na+ groups. Then a few layers of PAA/enzyme were deposited on top. A typical structure of the samples was (PAA/Indicator)n/(PAA/Enzyme)m/PAA with n equals 1-5. The obtained films were characterized with UV-visible absorption spectroscopy. The effect of the substrate decomposition on the UV-vis spectra of respective indicator molecules was studied. The inhibition of enzymes Urease and Cholinesterase by heavy metal ions and phosphor organic pesticide, respectively was found. The results obtained show the prospects towards development of optical enzyme sensor arrays.

Surgical Management of the Giant Pannus: Indications, Strategies, and Outcomes.

PubMed

Michaels, Joseph; Coon, Devin; Calotta, Nicholas A; Peter Rubin, J

2018-04-01

The obesity pandemic continues to produce an inexorable increase in the number of patients requiring surgical treatment of obesity and obesity-related complications. Along with this growing number of patients, there is a concomitant increase in the complexity of management. One particular example is the treatment of patients with an exceptionally large and morbid pannus. In this report, we detail the management of seven patients suffering from a giant pannus. Medical and surgical variables were assessed. A quality of life questionnaire was administered pre- and postoperatively. All seven patients suffered some obesity-related medical morbidity and six of seven (86%) had local complications of the giant pannus. Each patient underwent giant panniculectomy [resection weight > 13. 6 kg (30 lb)]. The mean resection weight was 20.0 kg. Four of seven (57%) patients experienced postoperative complications, with two (29%) requiring re-operation and blood transfusion. Six patients were available for long-term follow-up; 100% of participants indicated an increased quality of life while five (83%) reported additional postoperative weight loss, increase in exercise frequency and walking ability, and improved ability to work. Our results indicate that giant panniculectomy is a challenging and risky procedure, but careful patient selection and intraoperative scrutiny can ameliorate these risks and afford patients a dramatically improved quality of life. 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

TNF inhibitors - Mechanisms of action, approved and off-label indications.

PubMed

Cessak, Grzegorz; Kuzawińska, Olga; Burda, Agnieszka; Lis, Krzysztof; Wojnar, Marcin; Mirowska-Guzel, Dagmara; Bałkowiec-Iskra, Ewa

2014-10-01

Tumor necrosis factor inhibitors (TNFi) belong to the group of biologic drugs, holding presently top positions on lists of most profitable products for pharmaceutical companies. Although current indications for TNFi include only selected diseases with an established role of immune dysfunction in their pathogenesis, studies on new indications are being carried out all over the world. The most important aspect of TNFi therapy is a targeted therapeutic approach, allowing to avoid a wide range of side effects associated with treatment with nonspecific immunosuppressive agents. Results of the trials on TNFi in the approved indications are widely accessible and analyzed elsewhere, both in primary publications as well as in systematic reviews and meta-analyses. Here we aim to discuss their mechanisms of action, and approved, as well as off-label indications of TNFi. In addition, we present comprehensive evidence on TNFi in treatment of rheumatoid arthritis (RA); the first authorized and probably most extensively developed indication for the majority of TNFi. Copyright © 2014 Institute of Pharmacology, Polish Academy of Sciences. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Development of Mental Health Indicators in Korea

PubMed Central

Han, Hyeree; Ahn, Dong Hyun; Song, Jinhee; Hwang, Tae Yeon

2012-01-01

Objective Promoting mental health and preventing mental health problems are important tasks for international organizations and nations. Such goals entail the establishment of active information networks and effective systems and indicators to assess the mental health of populations. This being said, there is a need in Korea develop ways to measure the state of mental health in Korea. Methods This paper reviews the mental health indicator development policies and practices of seven organizations, countries, and regions: WHO, OECD, EU, United States, Australia, UK, and Scotland. Using Delphi method, we conducted two surveys of mental health indicators for experts in the field of mental health. The survey questionnaire included 5 domains: mental health status, mental health factor, mental health system, mental health service, and quality of mental health services. We considered 124 potential mental health indicators out of more than 600 from indicators of international organizations and foreign countries. Results We obtained the top 30 mental health indicators from the surveys. Among them, 10 indicators belong to the mental health system. The most important five mental health indicators are suicide rate, rate of increase in mental disorder treatment, burden caused by mental disorders, adequacy of identifying problems of mental health projects and deriving solutions, and annual prevalence of mental disorders. Conclusion Our study provides information about the process for indicator development and the use of survey results to measure the mental health status of the Korean population. The aim of mental health indicator development is to improve the mental health system by better grasping the current situation. We suggest these mental health indicators can monitor progress in efforts to implement reform policies, provide community services, and involve users, families and other stakeholders in mental health promotion, prevention, care and rehabilitation. PMID:23251193

Evidence based practice in clinical physiotherapy education: a qualitative interpretive description.

PubMed

Olsen, Nina R; Bradley, Peter; Lomborg, Kirsten; Nortvedt, Monica W

2013-04-11

Health care undergraduate students are expected to practice evidence-based after they graduate. Previous research indicates that students face several problems with transferring evidence-based practice to real patient situations. Few studies have explored reasons for this. The aim of this study was to explore beliefs, experiences and attitudes related to third year students' use of evidence-based practice in clinical physiotherapy education among students, clinical instructors and visiting teachers. In total, six focus group interviews were conducted: three with 16 students, two with nine clinical instructors and one with four visiting teachers. In addition, one individual interview and one interview in a pair were conducted with clinical instructors. Interviewing three different participant-categories ensured comparative analysis and enabled us to exploit differences in perspectives and interactions. Interpretive description guided this process. Four integrative themes emerged from the analysis: "attempt to apply evidence-based practice", "novices in clinical practice", "prioritize practice experience over evidence-based practice" and "lack role models in evidence-based practice". Students tried to search for research evidence and to apply this knowledge during clinical placements; a behaviour that indicated a positive attitude towards evidence-based practice. At the same time, students were novices and required basic background information more than research information. As novices they tended to lean on their clinical instructors, and were more eager to gain practical experience than practicing evidence-based; a behaviour that clinical instructors and visiting teachers often supported. Students noticed a lack of an EBP culture. Both students and clinical instructors perceived a need for role models in evidence-based practice. Clinical instructors are in a position to influence students during clinical education, and thus, important potential role models in

Evidence based practice in clinical physiotherapy education: a qualitative interpretive description

PubMed Central

2013-01-01

Background Health care undergraduate students are expected to practice evidence-based after they graduate. Previous research indicates that students face several problems with transferring evidence-based practice to real patient situations. Few studies have explored reasons for this. The aim of this study was to explore beliefs, experiences and attitudes related to third year students’ use of evidence-based practice in clinical physiotherapy education among students, clinical instructors and visiting teachers. Methods In total, six focus group interviews were conducted: three with 16 students, two with nine clinical instructors and one with four visiting teachers. In addition, one individual interview and one interview in a pair were conducted with clinical instructors. Interviewing three different participant-categories ensured comparative analysis and enabled us to exploit differences in perspectives and interactions. Interpretive description guided this process. Results Four integrative themes emerged from the analysis: “attempt to apply evidence-based practice”, “novices in clinical practice”, “prioritize practice experience over evidence-based practice” and “lack role models in evidence-based practice”. Students tried to search for research evidence and to apply this knowledge during clinical placements; a behaviour that indicated a positive attitude towards evidence-based practice. At the same time, students were novices and required basic background information more than research information. As novices they tended to lean on their clinical instructors, and were more eager to gain practical experience than practicing evidence-based; a behaviour that clinical instructors and visiting teachers often supported. Students noticed a lack of an EBP culture. Both students and clinical instructors perceived a need for role models in evidence-based practice. Conclusions Clinical instructors are in a position to influence students during clinical

[Development of Audio Indicator System for Respiratory Dynamic CT Imaging].

PubMed

Muramatsu, Shun; Moriya, Hiroshi; Tsukagoshi, Shinsuke; Yamada, Norikazu

We created the device, which can conduct a radiological technologist's voice to a subject during CT scanning. For 149 lung cancer, dynamic respiratory CT were performed. 92 cases were performed using this device, the others were without this device. The respiratory cycle and respiratory amplitude were analyzed from the lung density. A stable respirating cycle was obtained by using the audio indicator system. The audio indicator system is useful for respiratory dynamic CT.

Evidence-Based and Personalized Medicine. It's [AND] not [OR].

PubMed

Mokhles, Sahar; Takkenberg, Johanna Jm; Treasure, Tom

2017-01-01

Good clinical practice is an amalgamation of personalized medicine with evidence-based medicine in the best interests of patient. Hence, our title uses Boolean operators to indicate that it is [AND] not [OR]. This is the syntax of formal searching for systematic reviews, ensuring that all the evidence is found. Comprehensive evidence-based guidance can thus be formulated. Many residents and fellows around the world, and their chiefs, are now exposed to consensus documents, white papers, levels of appropriateness, and guidelines and are in many jurisdictions expected to comply with them. However, they are the summation of many forms of evidence, each of which has its place, and we consider them in turn in this article. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Historical photometric evidence for volatile migration on Triton

NASA Technical Reports Server (NTRS)

Buratti, Bonnie J.; Goguen, Jay D.; Gibson, James; Mosher, Joel

1994-01-01

Analysis of CCD images of Triton obtained with the 1.5-m telescope on Palomar Mountain shows that in the time period surrounding the Voyager 2 encounter with the satellite (1985-1990), no changes in the satellite's visual albedo or color occurred. The published observations of Triton in the 0.35- to 0.60-micrometer spectral region obtained between 1950 and 1990 were reanalyzed to detect historical variability in both its albedo and visual color. Analysis of the photometry indicates that there is little, if any, change in Triton's visual geometric albedo. This result is consistent with the albedo pattern observed by Voyager and the change in sub-Earth latitude. Two distinct types of color changes are evident: a significant secular increase in the blue region of the visual spectrum since at least the 1950s, and the reported dramatic reddening of Triton's spectrum in the late 1970s. The latter change can be explained only by a short-lived geological phenomenon. Triton's changing pole orientation with respect to a terrestrial observer cannot explain the secular color changes. These changes imply volatile transport on a global scale on Triton's surface during the past 4 decades. We present two models which show that either removal of a red volatile from Triton's polar cap or deposition of a blue volatile in the equatorial regions can explain the secular color changes. A third possibility is that the changes are the result of the alpha-beta phase transition of nitrogen and subsequent fracturing of the polar cap region (N. S. Duxbury and R. H. Brown (1993).

Optical properties of hydroxyapatite obtained by mechanical alloying

NASA Astrophysics Data System (ADS)

Silva, C. C.; Thomazini, D.; Pinheiro, A. G.; Lanciotti, F.; Sasaki, J. M.; Góes, J. C.; Sombra, A. S. B.

2002-09-01

Calcium phosphate based bioceramics, mainly in the form of hydroxyapatite (HA), have been in use in medicine and dentistry for the last 20 years. Applications include coatings of orthopaedic and dental implants, alveolar ridge augmentation, maxillofacial surgery, otolaryngology, and scaffolds for bone growth and as powders in total hip and knee surgery. These materials exhibit several problems of handling and fabrication, which can be overcome by mixing with a suitable binder. In this paper, mechanical alloying has been used successfully to produce nanocrystalline powders of HA using five different experimental procedures. The milled HA were studied by X-ray powder diffraction, infrared and Raman scattering spectroscopy. For four different procedures, HA was obtained after a couple of hours of milling (on an average, 20 h of milling depending on the reaction procedure). The XRD patterns indicate that the grain size is within the range of 29-103 nm. This milling process, used to produce HA, presents the advantage that melting is not necessary and the powder obtained is nanocrystalline with extraordinary mechanical properties. The material can be compacted and transformed in solid ceramic samples. The high efficiency of the process opens a way to produce commercial amount of nanocrystalline HA. Due to the nanocrystalline character of this powder, their mechanical properties have changed and for this reason a pressure of 1 GPa is enough to shape the sample into any geometry.

48 CFR 53.107 - Obtaining forms.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 2 2012-10-01 2012-10-01 false Obtaining forms. 53.107 Section 53.107 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION (CONTINUED) CLAUSES AND FORMS FORMS General 53.107 Obtaining forms. (a) Executive agencies shall obtain standard and...

48 CFR 53.107 - Obtaining forms.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 2 2013-10-01 2013-10-01 false Obtaining forms. 53.107 Section 53.107 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION (CONTINUED) CLAUSES AND FORMS FORMS General 53.107 Obtaining forms. (a) Executive agencies shall obtain standard and...

48 CFR 53.107 - Obtaining forms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 2 2010-10-01 2010-10-01 false Obtaining forms. 53.107 Section 53.107 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION (CONTINUED) CLAUSES AND FORMS FORMS General 53.107 Obtaining forms. (a) Executive agencies shall obtain standard and...

48 CFR 53.107 - Obtaining forms.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 2 2011-10-01 2011-10-01 false Obtaining forms. 53.107 Section 53.107 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION (CONTINUED) CLAUSES AND FORMS FORMS General 53.107 Obtaining forms. (a) Executive agencies shall obtain standard and...

48 CFR 53.107 - Obtaining forms.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 2 2014-10-01 2014-10-01 false Obtaining forms. 53.107 Section 53.107 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION (CONTINUED) CLAUSES AND FORMS FORMS General 53.107 Obtaining forms. (a) Executive agencies shall obtain standard and...

Providing reviews of evidence to COPD patients: controlled prospective 12-month trial.

PubMed

Harris, M; Smith, B J; Veale, A J; Esterman, A; Frith, P A; Selim, P

2009-01-01

The aim of this study was to evaluate a novel patient-held manual designed to reduce the evidence-practice gap in chronic obstructive pulmonary disease (COPD). The intervention manual contained summaries of research evidence. It was developed using current best practice for patient information materials and designed to cause discussion of evidence between patient and doctor. A controlled before-and-after study was employed in two similar but geographically separate regions of metropolitan Adelaide, South Australia. Participants had moderate to severe COPD, with 249 included at baseline and 201 completing the study. Evidence-based COPD management was measured using an indicator with three components: rates of influenza vaccination, bone density testing, and pulmonary rehabilitation. A survey of behavioral steps leading to practice change was conducted with the trial. Analysis, by median split of socioeconomic disadvantage, showed significant difference between study arms for only one component of the indicator of evidence-based practice, enrollment in pulmonary rehabilitation and only for the most socioeconomically disadvantaged stratum. For both socioeconomic strata, more intervention participants than control participants reported remembering being given the information material, reading part or all, and finding it very or quite helpful. Other significant differences were restricted to the stratum of greatest socioeconomic disadvantage: reading all of the material, learning from it, referring back, and talking to a doctor about a topic from the material. Above 90% of all participants who received the manual reported reading from it, 42% reported discussing topics with a doctor, but only 10% reported treatment change attributable to the manual. We have found that people with COPD will read an evidence manual developed using current best practice. However, the study demonstrated improvement for only one of the three components of an indicator of evidence

Evidence for a subsurface ocean on Europa.

PubMed

Carr, M H; Belton, M J; Chapman, C R; Davies, M E; Geissler, P; Greenberg, R; McEwen, A S; Tufts, B R; Greeley, R; Sullivan, R; Head, J W; Pappalardo, R T; Klaasen, K P; Johnson, T V; Kaufman, J; Senske, D; Moore, J; Neukum, G; Schubert, G; Burns, J A; Thomas, P; Veverka, J

1998-01-22

Ground-based spectroscopy of Jupiter's moon Europa, combined with gravity data, suggests that the satellite has an icy crust roughly 150 km thick and a rocky interior. In addition, images obtained by the Voyager spacecraft revealed that Europa's surface is crossed by numerous intersecting ridges and dark bands (called lineae) and is sparsely cratered, indicating that the terrain is probably significantly younger than that of Ganymede and Callisto. It has been suggested that Europa's thin outer ice shell might be separated from the moon's silicate interior by a liquid water layer, delayed or prevented from freezing by tidal heating; in this model, the lineae could be explained by repetitive tidal deformation of the outer ice shell. However, observational confirmation of a subsurface ocean was largely frustrated by the low resolution (>2 km per pixel) of the Voyager images. Here we present high-resolution (54 m per pixel) Galileo spacecraft images of Europa, in which we find evidence for mobile 'icebergs'. The detailed morphology of the terrain strongly supports the presence of liquid water at shallow depths below the surface, either today or at some time in the past. Moreover, lower-resolution observations of much larger regions suggest that the phenomena reported here are widespread.

Evidence for a subsurface ocean on Europa

USGS Publications Warehouse

Carr, M.H.; Belton, M.J.S.; Chapman, C.R.; Davies, M.E.; Geissler, P.; Greenberg, R.; McEwen, A.S.; Tufts, B.R.; Greeley, R.; Sullivan, R.; Head, J.W.; Pappalardo, R.T.; Klaasen, K.P.; Johnson, T.V.; Kaufman, J.; Senske, D.; Moore, J.; Neukum, G.; Schubert, G.; Burns, J.A.; Thomas, P.; Veverka, J.

1998-01-01

Ground-based spectroscopy of Jupiter's moon Europa, combined with gravity data, suggests that the satellite has an icy crust roughly 150 km thick and a rocky interior. In addition, images obtained by the Voyager spacecraft revealed that Europa's surface is crossed by numerous intersecting ridges and dark bands (called lineae) and is sparsely cratered, indicating that the terrain is probably significantly younger than that of Ganymede and Callisto. It has been suggested that Europa's thin outer ice shell might be separated from the moon's silicate interior by a liquid water layer, delayed or prevented from freezing by tidal heating; in this model, the lineae could be explained by repetitive tidal deformation of the outer ice shell. However, observational confirmation of a subsurface ocean was largely frustrated by the low resolution (>2 km per pixel) of the Voyager images. Here we present high-resolution (54 m per pixel) Galileo spacecraft images of Europa, in which we find evidence for mobile 'icebergs'. The detailed morphology of the terrain strongly supports the presence of liquid water at shallow depths below the surface, either today or at some time in the past. Moreover, lower- resolution observations of much larger regions suggest that the phenomena reported here are widespread.

Taking Evidence-Based Practices to School: Using Expert Opinion to Develop a Brief, Evidence-Informed School-Based Mental Health Intervention

ERIC Educational Resources Information Center

Lyon, Aaron R.; Bruns, Eric J.; Weathers, Ericka S.; Canavas, Nick; Ludwig, Kristy; Vander Stoep, Ann; Cheney, Douglas; McCauley, Elizabeth

2014-01-01

School-based mental health services offer unparalleled opportunities for providing accessible care to children and adolescents. Research indicates that services available in schools are rarely based on evidence of effectiveness and are typically disconnected from the larger school context. To address these issues, the current paper presents…

Prediction of the intensity and diversity of day-to-day activities among people with schizophrenia using parameters obtained during acute hospitalization.

PubMed

Lipskaya-Velikovsky, Lena; Jarus, Tal; Kotler, Moshe

2017-06-01

Participation in day-to-day activities of people with schizophrenia is restricted, causing concern to them, their families, service providers and the communities at large. Participation is a significant component of health and recovery; however, factors predicting participation are still not well established. This study examines whether the parameters obtained during acute hospitalization can predict the intensity and diversity of participation in day-to-day activities six months after discharge. In-patients with chronic schizophrenia (N = 104) were enrolled into the study and assessed for cognitive functioning, functional capacity in instrumental activities of daily living (IADL), and symptoms. Six months after discharge, the intensity and diversity of participation in day-to-day activities were evaluated (N = 70). Multiple correlations were found between parameters obtained during hospitalization and participation diversity, but not participation intensity. The model that is better suited to the prediction of participation diversity contains cognitive ability of construction, negative symptoms and number of previous hospitalizations. The total explained variance is 37.8% (F 3,66  =   14.99, p < 0.001). This study provides evidence for ecological validity of the in-patient evaluation process for the prediction of participation diversity in day-to-day activities six months after discharge. Participation diversity is best predicted through a set of factors reflecting personal and environmental indicators. Implications for rehabilitation Results of in-patient evaluations can predict the diversity of participation in day-to-day activities six months after discharge. Higher prediction of participation diversity is obtained using a holistic evaluation model that includes assessments for cognitive abilities, negative symptoms severity and number of hospitalizations.

Innovative Formulation Combining Al, Zr and Si Precursors to Obtain Anticorrosion Hybrid Sol-Gel Coating.

PubMed

Genet, Clément; Menu, Marie-Joëlle; Gavard, Olivier; Ansart, Florence; Gressier, Marie; Montpellaz, Robin

2018-05-10

The aim of our study is to improve the aluminium alloy corrosion resistance with Organic-Inorganic Hybrid (OIH) sol-gel coating. Coatings are obtained from unusual formulation with precursors mixing: glycidoxypropyltrimethoxysilane (GPTMS), zirconium (IV) propoxide (TPOZ) and aluminium tri-sec-butoxide (ASB). This formulation was characterized and compared with sol formulations GPTMS/TPOZ and GPTMS/ASB. In each formulation, a corrosion inhibitor, cerium (III) nitrate hexahydrate, is employed to improve the corrosion performance. Coatings obtained from sol based on GPTMS/TPOZ/ASB have good anti-corrosion performances with Natural Salt Spray (NSS) resistance of 500 h for a thickness lower than 4 µm. Contact angle measurement showed a coating hydrophobic behaviour. To understand these performances, nuclear magnetic resonance (NMR) analyses were performed, results make sol-gel coating condensation evident and are in very good agreement with previous results.

Evidence acquisition and evaluation for evidence summit on enhancing provision and use of maternal health services through financial incentives.

PubMed

Higgs, Elizabeth S; Stammer, Emily; Roth, Rebecca; Balster, Robert L

2013-12-01

Recognizing the need for evidence to inform US Government and governments of the low- and middle-income countries on efficient, effective maternal health policies, strategies, and programmes, the US Government convened the Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives in April 2012 in Washington, DC, USA. This paper summarizes the background and methods for the acquisition and evaluation of the evidence used for achieving the goals of the Summit. The goal of the Summit was to obtain multidisciplinary expert review of literature to inform both US Government and governments of the low- and middle-income countries on evidence-informed practice, policies, and strategies for financial incentives. Several steps were undertaken to define the tasks for the Summit and identify the appropriate evidence for review. The process began by identifying focal questions intended to inform governments of the low-and middle-income countries and the US Government about the efficacy of supply- and demand-side financial incentives for enhanced provision and use of quality maternal health services. Experts were selected representing the research and programme communities, academia, relevant non-governmental organizations, and government agencies and were assembled into Evidence Review Teams. This was followed by a systematic process to gather relevant peer-reviewed literature that would inform the focal questions. Members of the Evidence Review Teams were invited to add relevant papers not identified in the initial literature review to complete the bibliography. The Evidence Review Teams were asked to comply with a specific evaluation framework for recommendations on practice and policy based on both expert opinion and the quality of the data. Details of the search processes and methods used for screening and quality reviews are described.

The influence of FMRI lie detection evidence on juror decision-making.

PubMed

McCabe, David P; Castel, Alan D; Rhodes, Matthew G

2011-01-01

In the current study, we report on an experiment examining whether functional magnetic resonance imaging (fMRI) lie detection evidence would influence potential jurors' assessment of guilt in a criminal trial. Potential jurors (N = 330) read a vignette summarizing a trial, with some versions of the vignette including lie detection evidence indicating that the defendant was lying about having committed the crime. Lie detector evidence was based on evidence from the polygraph, fMRI (functional brain imaging), or thermal facial imaging. Results showed that fMRI lie detection evidence led to more guilty verdicts than lie detection evidence based on polygraph evidence, thermal facial imaging, or a control condition that did not include lie detection evidence. However, when the validity of the fMRI lie detection evidence was called into question on cross-examination, guilty verdicts were reduced to the level of the control condition. These results provide important information about the influence of lie detection evidence in legal settings. Copyright © 2011 John Wiley & Sons, Ltd.

Cognitive Profile of Students Who Enter Higher Education with an Indication of Dyslexia

PubMed Central

Brysbaert, Marc

2012-01-01

For languages other than English there is a lack of empirical evidence about the cognitive profile of students entering higher education with a diagnosis of dyslexia. To obtain such evidence, we compared a group of 100 Dutch-speaking students diagnosed with dyslexia with a control group of 100 students without learning disabilities. Our study showed selective deficits in reading and writing (effect sizes for accuracy between d = 1 and d = 2), arithmetic (d≈1), and phonological processing (d>0.7). Except for spelling, these deficits were larger for speed related measures than for accuracy related measures. Students with dyslexia also performed slightly inferior on the KAIT tests of crystallized intelligence, due to the retrieval of verbal information from long-term memory. No significant differences were observed in the KAIT tests of fluid intelligence. The profile we obtained agrees with a recent meta-analysis of English findings suggesting that it generalizes to all alphabetic languages. Implications for special arrangements for students with dyslexia in higher education are outlined. PMID:22719864

Flight evidence of spacecraft surface contamination rate enhancement by spacecraft charging obtained with a quartz crystal microbalance

NASA Technical Reports Server (NTRS)

Clark, D. M.; Hall, D. F.

1980-01-01

The significance of the fraction of the mass outgassed by a negatively charged space vehicle which is ionized within the vehicle plasma sheath and electrostatically reattracted to the space vehicle was determined. The ML-12 retarding potential analyzer/temperature controlled quartz crystal microbalances (RPA/TQCMs) distinguishes between charged and neutral molecules and investigates contamination mass transport mechanism. Two long term, quick look flight data sets indicate that on the average a significant fraction of mass arriving at one RPA/TQCM is ionized. It is assumed that vehicle frame charging during these periods was approximately uniformly distributed in degree and frequency. It is shown that electrostatic reattraction of ionized molecules is an important contamination mechanism at and near geosynchronous altitudes.

Public-Interest and Level-of-Evidence Considerations in Cold Fusion Public Policy

NASA Astrophysics Data System (ADS)

Grinshaw, Thomas

2008-03-01

Cold fusion (CF) protagonists and antagonists would no doubt agree that scientific processes have been challenged in the CF case. The public interest in CF turns on two questions: What are the potential benefits? What is the probability that CF is ``real''? Potential benefits have been agreed on since CF announcement in 1989. The probability of CF reality may be assessed based on level of evidence (LoE): preponderance of evidence (PoE); clear and convincing evidence (CCE); and beyond a reasonable doubt (BRD). PoE, from civil law, indicates a probability of 50% or higher. BRD, from criminal law, has a probability approaching 90%. CCE, in between, thus has a 70-75% probability. CF experimental evidence, based on: 1) initial affirmations, 2) the large number of corroborations since marginalization, and 3) particularly demonstrative experiments, reasonably indicates at least a PoE level of evidence for excess heat. A case can also be made for a CCE (but probably not for a BRD) LoE. In either the PoE or CCE scenario a clear need is demonstrated for change in policy toward CR, given its potential benefits to humanity.

The Role of Noncomparative Evidence in Health Technology Assessment Decisions.

PubMed

Griffiths, Elizabeth A; Macaulay, Richard; Vadlamudi, Nirma K; Uddin, Jasim; Samuels, Ebony R

2017-12-01

Many health technology assessment (HTA) agencies express a preference for randomized controlled trial evidence when appraising health technologies; nevertheless, it is not always feasible or ethical to conduct such comparative trials. To assess the role of noncomparative evidence in HTA decision making. The Web sites of the National Institute for Health and Care Excellence (NICE) in the United Kingdom, the Canadian Agency for Drugs and Technologies in Health (CADTH) in Canada, and the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen [IQWiG]) in Germany were searched for single HTA reports (published between January 2010 and December 2015). The product, indication, outcome, and clinical evidence presented (comparative/noncomparative) were double-extracted, with any discrepancies reconciled. A noncomparative study was defined as any study not presenting results against another treatment (including placebo or best supportive care), regardless of phase or setting, including dose-ranging studies. A total of 549 appraisals were extracted. Noncomparative evidence was considered in 38% (45 of 118) of NICE submissions, 13% (34 of 262) of CADTH submissions, and 12% (20 of 169) of IQWiG submissions. Evidence submissions based exclusively on noncomparative evidence were presented in only 4% (5 of 118) of NICE appraisals, 6% (16 of 262) of CADTH appraisals, and 4% (6 of 169) of IQWiG appraisals. Most drugs appraised solely on the basis of noncomparative evidence were indicated for cancer or hepatitis C. Positive outcome rates (encompassing recommended/restricted/added-benefit decisions) for submissions presenting only noncomparative evidence were similar to overall recommendation rates for CADTH (69% vs. 68%, respectively), but were numerically lower for NICE (60% vs. 84%, respectively) and IQWiG (17% vs. 38%, respectively) (P > 0.05 for all). Noncomparative studies can be viewed as acceptable clinical

Evolutionary synthesis of simple stellar populations. Colours and indices

NASA Astrophysics Data System (ADS)

Kurth, O. M.; Fritze-v. Alvensleben, U.; Fricke, K. J.

1999-07-01

We construct evolutionary synthesis models for simple stellar populations using the evolutionary tracks from the Padova group (1993, 1994), theoretical colour calibrations from \\cite[Lejeune et al. (1997, 1998)]{lejeune} and fit functions for stellar atmospheric indices from \\cite[Worthey et al. (1994)]{worthey}. A Monte-Carlo technique allows us to obtain a smooth time evolution of both broad band colours in UBVRIK and a series of stellar absorption features for Single Burst Stellar Populations (SSPs). We present colours and indices for SSPs with ages from 1 \\ 10(9) yrs to 1.6 \\ 10(10) yrs and metallicities [M/H]=-2.3, -1.7, -0.7, -0.4, 0.0 and 0.4. Model colours and indices at an age of about a Hubble time are in good agreement with observed colours and indices of the Galactic and M 31 GCs.

Novel indicators of recreational water quality and swimming-associated illness

EPA Science Inventory

In the United States and elsewhere, recreational water quality is monitored for fecal indicator bacteria to help prevent swimming-associated illnesses. Standard methods to measure these bacteria take at least 24 hours to obtain results. Molecular approaches such as quantitative p...

27 CFR 44.229 - Collateral evidence as to landing.

Code of Federal Regulations, 2010 CFR

2010-04-01

... failure to furnish such proofs; that such failure was not occasioned by any lack of diligence on the part... prescribed evidence of landing as may be obtained from the consignee or other persons having knowledge... translations thereof in English, and, when the letters fail to identify sufficiently the tobacco products, and...

Report of results obtained in 2,934 women using donor sperm: donor insemination versus in vitro fertilization according to indication.

PubMed

Viloria, Thamara; Garrido, Nicolas; Minaya, Francisco; Remohí, José; Muñoz, Manuel; Meseguer, Marcos

2011-11-01

To demonstrate that the use of donor sperm leads to varying outcome rates and that its use has evolved. Retrospective observational cohort study. University-affiliated private IVF setting. Women (2,934) undergoing donor insemination (DI) or IVF with donor sperm (IVF-D). None. We evaluated the distribution of the clinical indications for the use of donated sperm, studying the reproductive outcome. A total of 1,663 DI (57%) and 1,271 IVF-D (43%) were performed. There were significant differences in the indications for the use of donated sperm (DI vs. IVF-D). Regarding pregnancy rates (PR), cases of nonobstructive azoospermia presented the highest rate (29.1%), whereas cases of intracytoplasmic sperm injection (ICSI) failures and single women showed rates of 27.6% and 22.6%, respectively. Meanwhile, patients with ICSI failures achieved the highest PRs in IVF cycles (48.7%), whereas nonobstructive azoospermia and single women showed rates of 42.0% and 38.2%, respectively. There have been significant increases in the use of donated sperm in single women. Single women, which also represented the oldest group, show a lower probability of achieving pregnancy, and thus represent a subfertile population. Associated factors could include advanced maternal age. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Selecting clinical quality indicators for laboratory medicine.

PubMed

Barth, Julian H

2012-05-01

Quality in laboratory medicine is often described as doing the right test at the right time for the right person. Laboratory processes currently operate under the oversight of an accreditation body which gives confidence that the process is good. However, there are aspects of quality that are not measured by these processes. These are largely focused on ensuring that the most clinically appropriate test is performed and interpreted correctly. Clinical quality indicators were selected through a two-phase process. Firstly, a series of focus groups of clinical scientists were held with the aim of developing a list of quality indicators. These were subsequently ranked in order by an expert panel of primary and secondary care physicians. The 10 top indicators included the communication of critical results, comprehensive education to all users and adequate quality assurance for point-of-care testing. Laboratories should ensure their tests are used to national standards, that they have clinical utility, are calibrated to national standards and have long-term stability for chronic disease management. Laboratories should have error logs and demonstrate evidence of measures introduced to reduce chances of similar future errors. Laboratories should make a formal scientific evaluation of analytical quality. This paper describes the process of selection of quality indicators for laboratory medicine that have been validated sequentially by deliverers and users of the service. They now need to be converted into measureable variables related to outcome and validated in practice.

Constructing a new theory from old ideas and new evidence

PubMed Central

Rhodes, Marjorie; Wellman, Henry

2014-01-01

A central tenet of constructivist models of conceptual development is that children’s initial conceptual level constrains how they make sense of new evidence and thus whether exposure to evidence will prompt conceptual change. Yet, little experimental evidence directly examines this claim for the case of sustained, fundamental conceptual achievements. The present study combined scaling and experimental microgenetic methods to examine the processes underlying conceptual change in the context of an important conceptual achievement of early childhood—the development of a representational theory of mind. Results from 47 children (M age = 3.7 years) indicate that only children who were conceptually close to understanding false belief at the beginning of the study, and who were experimentally exposed to evidence of people acting on false beliefs, reliably developed representational theories of minds. Combined scaling and microgenetic data revealed how prior conceptual level interacts with experience, thereby providing critical experimental evidence for how conceptual change results from the interplay between conceptions and evidence. PMID:23489194

The Use of a Digital Badge as an Indicator and a Motivator

ERIC Educational Resources Information Center

Iwata, Jun; Telloyan, John; Murphy, Lynne; Wang, Shudong; Clayton, John

2017-01-01

Digital portfolios can provide a space where evidence of a learner's competency is stored and digital badges can be used in their portfolios as valid indicators of accomplishment, skill, knowledge, or interest. The authors issued "digital badges" to our students who successfully completed the modules of a Medical English Terminology…

Rapid evidence assessment: increasing the transparency of an emerging methodology.

PubMed

Varker, Tracey; Forbes, David; Dell, Lisa; Weston, Adele; Merlin, Tracy; Hodson, Stephanie; O'Donnell, Meaghan

2015-12-01

Within the field of evidence-based practice, policy makers, health care professionals and consumers require timely reviews to inform decisions on efficacious health care and treatments. Rapid evidence assessment (REA), also known as rapid review, has emerged in recent years as a literature review methodology that fulfils this need. It highlights what is known in a clinical area to the target audience in a relatively short time frame. This article discusses the lack of transparency and limited critical appraisal that can occur in REA, and goes on to propose general principles for conducting a REA. The approach that we describe is consistent with the principles underlying systematic review methodology, but also makes allowances for the rapid delivery of information as required while utilizing explicit and reproducible methods at each stage. Our method for conducting REA includes: developing an explicit research question in consultation with the end-users; clear definition of the components of the research question; development of a thorough and reproducible search strategy; development of explicit evidence selection criteria; and quality assessments and transparent decisions about the level of information to be obtained from each study. In addition, the REA may also include an assessment of the quality of the total body of evidence. Transparent reporting of REA methodologies will provide greater clarity to end-users about how the information is obtained and about the trade-offs that are made between speed and rigour. © 2015 John Wiley & Sons, Ltd.

Products obtained after in vitro reaction of 7,12-dimethylbenz[alpha]anthracene 5,6-oxide with nucleic acids.

PubMed

Blobstein, S H; Weinstein, I B; Grunberger, D; Weisgras, J; Harvey, R G

1975-07-29

Several lines of evidence suggest that oxide derivatives of carcinogenic polycyclic hydrocarbons are the reactive intermediates for in vivo binding to cellular nucleic acids. In the present study the covalent binding of 7,12-dimethylbenz[alpha]anthracene 5,6-oxide to synthetic homopolymers and nucleic acids in aqueous-acetone solutions has been investigated. Poly(G) was found to be the most reactive nucleic acid and underwent approximately 7-10% modification. Alkaline hydrolysis of the poly(G)-dimethylbenzathracene conjugate yielded chromatographically distinct polycyclic hydrocarbon-modified nucleotides which were further characterized by spectral analyses and enzymatic and chemical degradation. When the oxide was allowed to react with GMP or dGMP, at least two products were obtained in about 1% yield. Acid hydrolysis of the dGMP-dimethylbenzanthracene conjugates liberated the corresponding guanine-dimethylbenzathracene products. Mass spectral analysis of the modified bases provided direct evidence that we had obtained covalent binding of the poly-cyclic hydrocarbon to guanine. The mass spectral cleavage pattern suggest that one of these products is a hydroxydihydro derivative of dimethylbenzanthracene bound to guanine and the other is a dimethylbenzanthracene-guanine conjugate. Additional structural aspects of these guanine derivatives are discussed.

EditorialEvidence based library and information practice.

PubMed

Grant, Maria J

2011-06-01

Whilst many of us engage in supporting clinicians in identifying, appraising and using evidence, how many of us adopt the same approach to our own work? A recent survey by the UK LIS Research Coalition indicated that 60% of respondents use research reports as a source of information whilst a similar proportion of health library respondents use professional events such as conferences as a source of information. This summer sees the 6(th) International Evidence Based Library and Information Practice (EBLIP6) being held at the University of Salford, UK between 27(th) -30(th) June which will go some way to satisfying this latter information need whilst the Health Information and Libraries Journal can help satisfy the need for research reports. Whatever you're doing this summer, let's make it evidence based. © 2011 The authors. Health Information and Libraries Journal © 2011 Health Libraries Group.

HON label and DISCERN as content quality indicators of health-related websites.

PubMed

Khazaal, Yasser; Chatton, Anne; Zullino, Daniele; Khan, Riaz

2012-03-01

Content quality indicators are warranted in order to help patients and consumers to judge the content quality of health-related on-line information. The aim of the present study is to evaluate web-based information on health topics and to assess particular content quality indicators like HON (Health on the Net) and DISCERN. The present study is based on the analysis of data issued from six previous studies which assessed with a standardized tool the general and content quality (evidence-based health information) of health-related websites. Keywords related to Social phobia, bipolar disorders, pathological gambling as well as cannabis, alcohol and cocaine addiction were entered into popular World Wide Web search engines. Websites were assessed with a standardized proforma designed to rate sites on the basis of accountability, presentation, interactivity, readability and content quality (evidence-based information). "Health on the Net" (HON) quality label, and DISCERN scale scores were used to verify their efficiency as quality indicators. Of 874 websites identified, 388 were included. Despite an observed association with higher content quality scores, the HON label fails to predict good content quality websites when used in a multiple regression. Sensibility and specificity of a DISCERN score >40 in the detection of good content quality websites were, respectively, 0.45 and 0.96. The DISCERN is a potential quality indicator with a relatively high specificity. Further developments in this domain are warranted in order to facilitate the identification of high-quality information on the web by patients.

Key performance indicators in intensive care medicine. A retrospective matched cohort study.

PubMed

Kastrup, M; von Dossow, V; Seeling, M; Ahlborn, R; Tamarkin, A; Conroy, P; Boemke, W; Wernecke, K-D; Spies, Claudia

2009-01-01

Expert panel consensus was used to develop evidence-based process indicators that were independent risk factors for the main clinical outcome parameters of length of stay in the intensive care unit (ICU) and mortality. In a retrospective, matched data analysis of patients from five ICUs at a tertiary university hospital, agreed process indicators (sedation monitoring, pain monitoring, mean arterial pressure [MAP] >or= 60 mmHg, tidal volume [TV] or= 80 and or= 60 mmHg and BG >or= 80 mg/dl were relevant for survival. Linear regression of the 634 patients showed that analgesia monitoring, PIP or= 60 mmHg, BG >or= 80 mg/dl and indicating that adherence to evidence-based key process indicators may reduce mortality and length of ICU stay.

EPR: Evidence and fallacy.

PubMed

Nichols, Joseph W; Bae, You Han

2014-09-28

The enhanced permeability and retention (EPR) of nanoparticles in tumors has long stood as one of the fundamental principles of cancer drug delivery, holding the promise of safe, simple and effective therapy. By allowing particles preferential access to tumors by virtue of size and longevity in circulation, EPR provided a neat rationale for the trend toward nano-sized drug carriers. Following the discovery of the phenomenon by Maeda in the mid-1980s, this rationale appeared to be well justified by the flood of evidence from preclinical studies and by the clinical success of Doxil. Clinical outcomes from nano-sized drug delivery systems, however, have indicated that EPR is not as reliable as previously thought. Drug carriers generally fail to provide superior efficacy to free drug systems when tested in clinical trials. A closer look reveals that EPR-dependent drug delivery is complicated by high tumor interstitial fluid pressure (IFP), irregular vascular distribution, and poor blood flow inside tumors. Furthermore, the animal tumor models used to study EPR differ from clinical tumors in several key aspects that seem to make EPR more pronounced than in human patients. On the basis of this evidence, we believe that EPR should only be invoked on a case-by-case basis, when clinical evidence suggests the tumor type is susceptible. Copyright © 2014 Elsevier B.V. All rights reserved.

Obtaining Reimbursement in France and Italy for New Diabetes Products

PubMed Central

Schaefer, Elmar; Sonsalla, Jessica

2015-01-01

Manufacturers launching next-generation or innovative medical devices in Europe face a very heterogeneous reimbursement landscape, with each country having its own pathways, timing, requirements and success factors. We selected 2 markets for a deeper look into the reimbursement landscape: France, representing a country with central decision making with defined processes, and Italy, which delegates reimbursement decisions to the regional level, resulting in a less transparent approach to reimbursement. Based on our experience in working on various new product launches and analyzing recent reimbursement decisions, we found that payers in both countries do not reward improved next-generation products with incremental reimbursement. Looking at innovations, we observe that manufacturers face a challenging and lengthy process to obtain reimbursement. In addition, requirements and key success factors differ by country: In France, comparative clinical evidence and budget impact very much drive reimbursement decisions in terms of pricing and restrictions, whereas in Italy, regional key opinion leader (KOL) support and additional local observational data are key. PMID:25550411

Scanning electron microscopy of heat treated TiO2 nanotubes arrays obtained by anodic oxidation

NASA Astrophysics Data System (ADS)

Naranjo, D. I.; García-Vergara, S. J.; Blanco, S.

2017-12-01

Scanning electron microscopy was used to investigate the anatase-rutile transformation of self-organized TiO2 nanotubes obtained on titanium foil by anodizing and subsequent heat treatment. The anodizing was carried out at 20V in an 1% v/v HF acid and ethylene glycol:water (50:50) electrolyte at room temperature. The anodized samples were initially pre-heat treated at 450°C for 4 hours to modify the amorphous structure of TiO2 nanotubes into anatase structure. Then, the samples were heated between 600 to 800°C for different times, in order to promote the transformation to rutile structure. The formation of TiO2 nanotubes is evident by SEM images. Notably, when the samples are treated at high temperature, the formation of rutile crystals starts to become evident at the nanotubes located on the originally grain boundaries of the titanium. Thus, the anatase - rutile transformation has a close relationship with the microstructure of the titanium, more exactly with grain boundaries.

Transition from in-hospital ventilation to home ventilation: process description and quality indicators

PubMed Central

Kastrup, Marc; Tittmann, Benjamin; Sawatzki, Tanja; Gersch, Martin; Vogt, Charlotte; Rosenthal, Max; Rosseau, Simone; Spies, Claudia

2017-01-01

The current demographic development of our society results in an increasing number of elderly patients with chronic diseases being treated in the intensive care unit. A possible long-term consequence of such a treatment is that patients remain dependent on certain invasive organ support systems, such as long-term ventilator dependency. The main goal of this project is to define the transition process between in-hospital and out of hospital (ambulatory) ventilator support. A further goal is to identify evidence-based quality indicators to help define and describe this process. This project describes an ideal sequence of processes (process chain), based on the current evidence from the literature. Besides the process chain, key data and quality indicators were described in detail. Due to the limited project timeline, these indicators were not extensively tested in the clinical environment. The results of this project may serve as a solid basis for proof of feasibility and proof of concept investigations, optimize the transition process of ventilator-dependent patients from a clinical to an ambulatory setting, as well as reduce the rate of emergency re-admissions. PMID:29308061

Mechanism of Action for Obtaining Job Offers With Virtual Reality Job Interview Training.

PubMed

Smith, Matthew J; Smith, Justin D; Fleming, Michael F; Jordan, Neil; Brown, C Hendricks; Humm, Laura; Olsen, Dale; Bell, Morris D

2017-07-01

Four randomized controlled trials revealed that virtual-reality job interview training (VR-JIT) improved interviewing skills and the odds of obtaining a job offer among trainees with severe mental illness or autism spectrum disorder. This study assessed whether postintervention interviewing skills mediated the relationship between completion of virtual interviews and receiving job offers by six-month follow-up. VR-JIT trainees (N=79) completed pre- and posttest mock interviews and a brief survey approximately six months later to assess whether they received a job offer. As hypothesized, analyses indicated that the number of completed virtual interviews predicted greater posttest interviewing skills (β=.20, 95% posterior credible interval [PCI]=.08-.33), which in turn predicted trainees' obtaining a job offer (β=.28, 95% PCI=.01-.53). VR-JIT may provide a mechanism of action that helps trainees with various psychiatric diagnoses obtain job offers in the community. Future research can evaluate the community-based effectiveness of this novel intervention.

Time trends and sex differences in associations between socioeconomic status indicators and overweight-obesity in Mexico (2006-2012).

PubMed

Quezada, Amado D; Lozada-Tequeanes, Ana L

2015-12-16

Although the associations between specific socioeconomic status (SES) indicators and overweight or obesity (OWOB) have been studied in different countries, fewer evidence exists for these associations when multiple SES indicators are considered simultaneously. Furthermore, there are few studies investigating time trends in OWOB and their relation with SES in upper-middle income countries, especially for men. The present study contributes to a better understanding of the nature and evolution of the associations between SES indicators and OWOB in the Mexican adult population. We pooled data from the 2006 and 2012 National Health and Nutrition Surveys in Mexico and obtained covariate-adjusted prevalence from a design-based logistic multiple regression model. Covariates included a wealth index, education, occupational status, marital status, and all interactions for each covariate with sex (male/female) and survey year. For men, the association between wealth and OWOB remained positive in general but curvature was more evident in 2012. The wealth-OWOB association in women showed an inverted-U pattern at both years with a positive slope that turned into a negative one as wealth increased. Among women, OWOB prevalence at the college/university education level was approximately 12.0 ± 2.4 (percentage points ± standard error) lower compared with the elementary education level. We did not find differences between educational categories for men in 2006, but in 2012 OWOB tended to be higher among the more educated. The prevalence of obesity in women increased at wealth levels from the middle and upper-middle section of the wealth distributions. Overall OWOB prevalence was near 70 % in 2012 for both sexes. Among Mexican women, the associations between SES indicators and excess body weight were consistent to those found in developed countries. Among Mexican men, higher education was not associated with a lower prevalence of OWOB but the positive association between

[Development of quality of care indicators to support chronic disease management].

PubMed

Beaulieu, Marie-dominique; Pomey, Marie-pascale; Del Grande, Claudio; Côté, Brigitte; Tremblay, Éric; Ghorbel, Monia; Hua, Phuong

2015-01-01

This article presents the results of a project conducted by the Institut national d'excellence en santé et en services sociaux of Québec to develop quality of care indicators for the management of six chronic illnesses. Indicators were identified through literature searches and analysis of clinical practice guidelines (CPGs). Interdisciplinary expert panels assessed their validity and the strength of the evidence on which they were based. Representatives of patients (N = 19) and professionals (N = 29) were consulted on their relevance and acceptability. Indicators were categorized according to the Chronic Care Model (CCM). A total of 164 indicators were developed, 126 specific to the illnesses under study and 38 on processes and outcomes generic to the CCM. There was convergence between patients and professionals on the relevance of a majority of indicators. Professionals expressed concerns on the indicators measured by means of patient surveys that they considered to be too subjective. The importance given to CPGs as the main source of indicators resulted in a great number of indicators of the technical quality ofcare. Using the CCM contributed to a broader perspective of quality. The consultation process identified some of the concerns of professionals about indicator measurement, thusguidingfuture implementation initiatives.

Seismically active volume not a good indicator of the stimulated reservoir: evidence from Paralana

NASA Astrophysics Data System (ADS)

Riffault, J.; Dempsey, D. E.; Karra, S.; Archer, R.

2017-12-01

Hydraulic stimulation is routinely carried out in EGS projects in order to engineer the geothermal reservoir, triggering large amounts of seismicity. There is broad consensus that hydroshearing, the shear failure of existing fractures caused by pore pressure increasing above a critical value, is the mechanism primarily responsible for the seismicity. It is also often assumed to be the primary mechanism behind permeability enhancement and thus reservoir creation, although several other physical processes, such as thermal and chemical effects, and tensile failure, can also contribute. An extension of this assumption is that the seismically active volume reflects the extent of the stimulated reservoir. This may not always be the case. Hydraulic stimulation aims to improve injectivity, which we define as the ratio of injection rate to wellhead pressure. During the Paralana-2 EGS stimulation, undertaken in South Australia in 2011, injectivity increased linearly over time, implying permeability enhancement. Concurrently, 4754 micro-earthquakes were detected and located. We have spatially averaged hypocentre positions in order to image the spatio-temporally evolving seismicity cloud and its main features. Using an established correlation from a previous EGS experiment, we use hypocentre density as a proxy measure of pore pressure increase. Knowing then how pressure and injectivity evolve over time, we develop an inversion procedure based on reservoir simulation to infer how permeability has evolved around the well. Our results indicate that, although there is significant permeability enhancement close to the wellbore, this is largely uncoupled from the seismically active volume that extends much further away. In other words, for the Paralana stimulation, the seismicity cloud is a poor indicator of the stimulated reservoir volume. It further implies that hydroshearing itself is not the main cause of permeability enhancement at Paralana. Our study suggests that past

Comparing clinical quality indicators for asthma management in children with outcome measures used in randomised controlled trials: a protocol.

PubMed

Choong, Miew Keen; Tsafnat, Guy; Hibbert, Peter; Runciman, William B; Coiera, Enrico

2015-09-08

Clinical quality indicators are necessary to monitor the performance of healthcare services. The development of indicators should, wherever possible, be based on research evidence to minimise the risk of bias which may be introduced during their development, because of logistic, ethical or financial constraints alone. The development of automated methods to identify the evidence base for candidate indicators should improve the process of indicator development. The objective of this study is to explore the relationship between clinical quality indicators for asthma management in children with outcome and process measurements extracted from randomised controlled clinical trial reports. National-level indicators for asthma management in children will be extracted from the National Quality Measures Clearinghouse (NQMC) database and the National Institute for Health and Care Excellence (NICE) quality standards. Outcome measures will be extracted from published English language randomised controlled trial (RCT) reports for asthma management in children aged below 12 years. The two sets of measures will be compared to assess any overlap. The study will provide insights into the relationship between clinical quality indicators and measurements in RCTs. This study will also yield a list of measurements used in RCTs for asthma management in children, and will find RCT evidence for indicators used in practice. Ethical approval is not necessary because this study will not include patient data. Findings will be disseminated through peer-reviewed publications. 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.

Protocol for obtaining platelet-rich plasma (PRP), platelet-poor plasma (PPP), and thrombin for autologous use.

PubMed

Franco, Diogo; Franco, Talita; Schettino, Angélica Maria; Filho, João Medeiros Tavares; Vendramin, Fabiel Spani

2012-10-01

Plasma has been widely studied and used in many different situations to speed up healing with better tissue adherence and hemostasis. Research projects are now attempting to isolate platelet-rich plasma (PRP) and platelet-poor plasma (PPP), making better use of their properties, particularly during operations and for wounds that are slow to heal. In view of the wide diversity of industrial machines and extraction protocols, together with the variety of industrially produced biologic glues, this article suggests an option for obtaining PRP, PPP, and human thrombin for autologous use. A way of obtaining PRP, PPP, and thrombin is reproduced through a protocol defined and established by the authors. Autologous thrombin and plasma were obtained through the collection and successive centrifugation of ten whole blood samples, until the desired hemocomponents were isolated, followed by quantitative and qualitative analyses of the elements obtained. The mean platelet concentration obtained was 6.03 × 10(8) platelets/ml, with a mean thrombin concentration of 33.54 nM, both values compatible with reports in the literature when different protocols are applied. The protocol described is a good option for the preparation and application of PRP, PPP, and autologous thrombin, particularly as they can be obtained simultaneously, eliminating the possibilities of viral contamination and allergic reactions. Moreover, the cost of this procedure is low, it is easy to perform, and replicable. This journal requires that authors assign a level of evidence to each article.

The INVEST project: investigating the use of evidence synthesis in the design and analysis of clinical trials.

PubMed

Clayton, Gemma L; Smith, Isabelle L; Higgins, Julian P T; Mihaylova, Borislava; Thorpe, Benjamin; Cicero, Robert; Lokuge, Kusal; Forman, Julia R; Tierney, Jayne F; White, Ian R; Sharples, Linda D; Jones, Hayley E

2017-05-15

When designing and analysing clinical trials, using previous relevant information, perhaps in the form of evidence syntheses, can reduce research waste. We conducted the INVEST (INVestigating the use of Evidence Synthesis in the design and analysis of clinical Trials) survey to summarise the current use of evidence synthesis in trial design and analysis, to capture opinions of trialists and methodologists on such use, and to understand any barriers. Our sampling frame was all delegates attending the International Clinical Trials Methodology Conference in November 2015. Respondents were asked to indicate (1) their views on the use of evidence synthesis in trial design and analysis, (2) their own use during the past 10 years and (3) the three greatest barriers to use in practice. Of approximately 638 attendees of the conference, 106 (17%) completed the survey, half of whom were statisticians. Support was generally high for using a description of previous evidence, a systematic review or a meta-analysis in trial design. Generally, respondents did not seem to be using evidence syntheses as often as they felt they should. For example, only 50% (42/84 relevant respondents) had used a meta-analysis to inform whether a trial is needed compared with 74% (62/84) indicating that this is desirable. Only 6% (5/81 relevant respondents) had used a value of information analysis to inform sample size calculations versus 22% (18/81) indicating support for this. Surprisingly large numbers of participants indicated support for, and previous use of, evidence syntheses in trial analysis. For example, 79% (79/100) of respondents indicated that external information about the treatment effect should be used to inform aspects of the analysis. The greatest perceived barrier to using evidence synthesis methods in trial design or analysis was time constraints, followed by a belief that the new trial was the first in the area. Evidence syntheses can be resource-intensive, but their use in

Refractive indices of CaF2 single crystals under elastic shock loading

NASA Astrophysics Data System (ADS)

Li, Y.; Zhou, X. M.; Liu, C. L.; Luo, S. N.

2017-07-01

Refractive indices and Hugoniots of CaF2 single crystals are investigated by laser displacement interferometry under shock loading below 5 GPa. Birefringence is observed for the [110] loading. We obtain the Hugoniot equation of states for [100], [110] and [111], and refractive indices for these orientations with consideration of their polarization. The measured refractive indices are in reasonable agreement with predictions based on the piezo-optic theory, and are used to refine the elasto-optic coefficients.

Return migration and the health of older aged parents: evidence from rural Thailand.

PubMed

Zimmer, Zachary; Knodel, John

2010-10-01

To examine the extent to which an association exists between health of older parents and return migration of children in rural Thailand. Data come from the 2006 Migration Impact Survey specifically designed to obtain information on the impact of migration on older adults in rural areas. Associations are examined from both the perspectives of parents (N = 883) and migrating children (N = 2,150) using equations that adjust for demographic characteristics of parents and children and factors that may indicate unmet support needs. A robust association with poor health promoting migration returns from both parent and child perspective exists and remains even with controls that might attenuate the relationship. Although media discussions have pointed out dangers of out-migration for older adults, little systematic evidence exists. This study supports the viewpoint that accommodations for older adults can be made despite social changes promoting out-migration and demographic aging of the population.

Aircraft and ground vehicle friction measurements obtained under winter runway conditions

NASA Technical Reports Server (NTRS)

Yager, Thomas J.

1989-01-01

Tests with specially instrumented NASA B-737 and B-727 aircraft together with several different ground friction measuring devices have been conducted for a variety of runway surface types and wetness conditions. This effort is part of the Joint FAA/NASA Aircraft/Ground Vehicle Runway Friction Program aimed at obtaining a better understanding of aircraft ground handling performance under adverse weather conditions, and defining relationships between aircraft and ground vehicle tire friction measurements. Aircraft braking performance on dry, wet, snow-, and ice-covered runway conditions is discussed together with ground vehicle friction data obtained under similar runway conditions. For the wet, compacted snow- and ice-covered runway conditions, the relationship between ground vehicles and aircraft friction data is identified. The influence of major test parameters on friction measurements such as speed, test tire characteristics, and surface contaminant-type are discussed. The test results indicate that use of properly maintained and calibrated ground vehicles for monitoring runway friction conditions should be encouraged particularly under adverse weather conditions.

Strategy to obtain axenic cultures from field-collected samples of the cyanobacterium Phormidium animalis.

PubMed

Vázquez-Martínez, Guadalupe; Rodriguez, Mario H; Hernández-Hernández, Fidel; Ibarra, Jorge E

2004-04-01

An efficient strategy, based on a combination of procedures, was developed to obtain axenic cultures from field-collected samples of the cyanobacterium Phormidium animalis. Samples were initially cultured in solid ASN-10 medium, and a crude separation of major contaminants from P. animalis filaments was achieved by washing in a series of centrifugations and resuspensions in liquid medium. Then, manageable filament fragments were obtained by probe sonication. Fragmentation was followed by forceful washing, using vacuum-driven filtration through an 8-microm pore size membrane and an excess of water. Washed fragments were cultured and treated with a sequential exposure to four different antibiotics. Finally, axenic cultures were obtained from serial dilutions of treated fragments. Monitoring under microscope examination and by inoculation in Luria-Bertani (LB) agar plates indicated either axenicity or the degree of contamination throughout the strategy.

Classification of permafrost active layer depth from remotely sensed and topographic evidence

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

Peddle, D.R.; Franklin, S.E.

1993-04-01

The remote detection of permafrost (perennially frozen ground) has important implications to environmental resource development, engineering studies, natural hazard prediction, and climate change research. In this study, the authors present results from two experiments into the classification of permafrost active layer depth within the zone of discontinuous permafrost in northern Canada. A new software system based on evidential reasoning was implemented to permit the integrated classification of multisource data consisting of landcover, terrain aspect, and equivalent latitude, each of which possessed different formats, data types, or statistical properties that could not be handled by conventional classification algorithms available to thismore » study. In the first experiment, four active layer depth classes were classified using ground based measurements of the three variables with an accuracy of 83% compared to in situ soil probe determination of permafrost active layer depth at over 500 field sites. This confirmed the environmental significance of the variables selected, and provided a baseline result to which a remote sensing classification could be compared. In the second experiment, evidence for each input variable was obtained from image processing of digital SPOT imagery and a photogrammetric digital elevation model, and used to classify active layer depth with an accuracy of 79%. These results suggest the classification of evidence from remotely sensed measures of spectral response and topography may provide suitable indicators of permafrost active layer depth.« less

Expert opinion vs. empirical evidence: the precautionary principle applied to GM crops.

PubMed

Herman, Rod A; Raybould, Alan

2014-01-01

Expert opinion is often sought by government regulatory agencies when there is insufficient empirical evidence to judge the safety implications of a course of action. However, it can be reckless to continue following expert opinion when a preponderance of evidence is amassed that conflicts with this opinion. Factual evidence should always trump opinion in prioritizing the information that is used to guide regulatory policy. Evidence-based medicine has seen a dramatic upturn in recent years spurred by examples where evidence indicated that certain treatments recommended by expert opinions increased death rates. We suggest that scientific evidence should also take priority over expert opinion in the regulation of genetically modified crops (GM). Examples of regulatory data requirements that are not justified based on the mass of evidence are described, and it is suggested that expertise in risk assessment should guide evidence-based regulation of GM crops.

Assessing Spectral Evidence of Aqueous Activity in Two Putative Martian Paleolakes

NASA Technical Reports Server (NTRS)

Roush, Ted L.; Marzo, Giuseppe A.; Fonti, Sergio; Orofino, Vicenzo; Blanco, Armando; Gross, Christoph; Wendt, Lorenz

2011-01-01

We evaluate the evidence for the presence of mineral spectral signatures indicative of the past presence of water at two putative paleolakes on Mars using observations by the Mars Reconnaissance Orbiter (MRO) Compact Reconnaissance Image Spectrometer for Mars (CRISM). CRISM spectra of both sites are consistent with laboratory spectra of Mg-rich phyllosilicates. Our analysis represents the first detailed evaluation of these locations. The spatial occurrence and association with topographic features within the craters is distinctly different for the two sites. The occurrence of these minerals supports the conclusion that water was once active in the areas sampled by these craters. The distribution of the phyllosilicates in Luqa does not provide distinctive evidence for the presence of a previous standing body of water and is consistent with either impact emplacement or post-impact alteration. For Cankuzo, the phyllosilicate distribution provides evidence of a layer in the crater wall indicative of aqueous activity, but does not require a paleolake.

Comparing Drug-Disease Associations in Clinical Practice Guideline Recommendations and Drug Product Label Indications.

PubMed

Leung, Tiffany I; Dumontier, Michel

2015-01-01

Clinical practice guidelines (CPGs) and structured product labels (SPLs) are both intended to promote evidence-based medical practices and guide clinicians' prescribing decisions. However, it is unclear how well CPG recommendations about pharmacologic therapies for certain diseases match SPL indications for recommended drugs. In this study, we use publicly available data and text mining methods to examine drug-disease associations in CPG recommendations and SPL treatment indications for 15 common chronic conditions. Preliminary results suggest that there is a mismatch between guideline-recommended pharmacologic therapies and SPL indications. Conflicting or inconsistent recommendations and indications may complicate clinical decision making and implementation or measurement of best practices.

[Evidence and Evidence Gaps - an Introduction].

PubMed

Dreier, G; Löhler, J

2016-04-01

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

Female Pelvic Vein Embolization: Indications, Techniques, and Outcomes

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

Lopez, Anthony James, E-mail: consultant@radiologist.co.uk

Until recently, the main indication for pelvic vein embolization (PVE) in women was to treat pelvic venous congestion syndrome (PVC) but increasingly, patients with refluxing pelvic veins associated with leg varicosities are also being treated. A more unusual reason for PVE is to treat pelvic venous malformations, although such lesions may be treated with sclerotherapy alone. Embolotherapy for treating PVC has been performed for many years with several published studies included in this review, whilst an emerging indication for PVE is to treat lower limb varicosities associated with pelvic vein reflux. Neither group, however, has been subjected to an adequatemore » randomized, controlled trial. Consequently, some of the information presented in this review should be considered anecdotal (level III evidence) at this stage, and a satisfactory ‘proof’ of clinical efficacy remains deficient until higher-level evidence is presented. Furthermore, a wide range of techniques not accepted by all are used, and some standardization will be required based on future mandatory prospective studies. Large studies have also clearly shown an unacceptably high recurrence rate of leg varicose veins following venous surgery. Furthermore, minimally or non-invasive imaging is now revealing that there is a refluxing pelvic venous source in a significant percentage of women with de novo leg varicose veins, and many more with recurrent varicosities. Considering that just over half the world’s population is female and a significant number of women not only have pelvic venous reflux, but also have associated leg varicosities, minimally invasive treatment of pelvic venous incompetence will become a common procedure.« less

Vulnerable land ecosystems classification using spatial context and spectral indices

NASA Astrophysics Data System (ADS)

Ibarrola-Ulzurrun, Edurne; Gonzalo-Martín, Consuelo; Marcello, Javier

2017-10-01

Natural habitats are exposed to growing pressure due to intensification of land use and tourism development. Thus, obtaining information on the vegetation is necessary for conservation and management projects. In this context, remote sensing is an important tool for monitoring and managing habitats, being classification a crucial stage. The majority of image classifications techniques are based upon the pixel-based approach. An alternative is the object-based (OBIA) approach, in which a previous segmentation step merges image pixels to create objects that are then classified. Besides, improved results may be gained by incorporating additional spatial information and specific spectral indices into the classification process. The main goal of this work was to implement and assess object-based classification techniques on very-high resolution imagery incorporating spectral indices and contextual spatial information in the classification models. The study area was Teide National Park in Canary Islands (Spain) using Worldview-2 orthoready imagery. In the classification model, two common indices were selected Normalized Difference Vegetation Index (NDVI) and Optimized Soil Adjusted Vegetation Index (OSAVI), as well as two specific Worldview-2 sensor indices, Worldview Vegetation Index and Worldview Soil Index. To include the contextual information, Grey Level Co-occurrence Matrices (GLCM) were used. The classification was performed training a Support Vector Machine with sufficient and representative number of vegetation samples (Spartocytisus supranubius, Pterocephalus lasiospermus, Descurainia bourgaeana and Pinus canariensis) as well as urban, road and bare soil classes. Confusion Matrices were computed to evaluate the results from each classification model obtaining the highest overall accuracy (90.07%) combining both Worldview indices with the GLCM-dissimilarity.

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

PubMed Central

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

2014-01-01

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

Relationship between indices of obesity obtained by anthropometry and dual-energy X-ray absorptiometry: The Fourth and Fifth Korea National Health and Nutrition Examination Survey (KNHANES IV and V, 2008-2011).

PubMed

Kim, Seul Gi; Ko, Ki dong; Hwang, In Cheol; Suh, Heuy Sun; Kay, Shelley; Caterson, Ian; Kim, Kyoung Kon

2015-01-01

Body mass index (BMI), waist circumference (WC), and even dual-energy X-ray absorptiometry (DXA) are used for obesity diagnosis. However, it is not known which DXA-derived index of obesity correlates best with BMI and/or WC and it is not clear whether such an index is accurate or not. The aim of this study is to show the relationship between anthropometric measurements (BMI, WC) and body fat indices from DXA and to determine which DXA indices are strongly related to BMI and WC. This study was based on data obtained from the Fourth and Fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-V). DXA measurements were performed on survey subjects over 10 years old from July 2008 through to May 2011. Of these, 18 198 individuals, aged 19 years and older for whom DXA data were available, were included. Weighted Pearson's correlated coefficients (r) were calculated among indices, according to sex, age group and menopause, and the coefficients were compared with each other. BMI correlates most with trunk body fat mass in kg (r=0.831) and then with total body fat in kg (r=0.774, P<0.00043 for difference of r). In the older age group, BMI correlates with total body fat mass (r=0.822) better than with trunk fat mass (r=0.817, P<0.00043). WC correlates with trunk body fat mass most in both genders and all age groups (0.804≤r≤0.906). Correlations of BMI (r=0.645 for men, 0.689 for women) and WC (r=0.678 for men, 0.634 for women) to body fat percentages (%) were less robust than those to body fat mass. BMI and WC reflect trunk and total body fat in kg more than body fat percentage derived by DXA. Copyright © 2014 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Definitions and validation criteria for biomarkers and surrogate endpoints: development and testing of a quantitative hierarchical levels of evidence schema.

PubMed

Lassere, Marissa N; Johnson, Kent R; Boers, Maarten; Tugwell, Peter; Brooks, Peter; Simon, Lee; Strand, Vibeke; Conaghan, Philip G; Ostergaard, Mikkel; Maksymowych, Walter P; Landewe, Robert; Bresnihan, Barry; Tak, Paul-Peter; Wakefield, Richard; Mease, Philip; Bingham, Clifton O; Hughes, Michael; Altman, Doug; Buyse, Marc; Galbraith, Sally; Wells, George

2007-03-01

There are clear advantages to using biomarkers and surrogate endpoints, but concerns about clinical and statistical validity and systematic methods to evaluate these aspects hinder their efficient application. Our objective was to review the literature on biomarkers and surrogates to develop a hierarchical schema that systematically evaluates and ranks the surrogacy status of biomarkers and surrogates; and to obtain feedback from stakeholders. After a systematic search of Medline and Embase on biomarkers, surrogate (outcomes, endpoints, markers, indicators), intermediate endpoints, and leading indicators, a quantitative surrogate validation schema was developed and subsequently evaluated at a stakeholder workshop. The search identified several classification schema and definitions. Components of these were incorporated into a new quantitative surrogate validation level of evidence schema that evaluates biomarkers along 4 domains: Target, Study Design, Statistical Strength, and Penalties. Scores derived from 3 domains the Target that the marker is being substituted for, the Design of the (best) evidence, and the Statistical strength are additive. Penalties are then applied if there is serious counterevidence. A total score (0 to 15) determines the level of evidence, with Level 1 the strongest and Level 5 the weakest. It was proposed that the term "surrogate" be restricted to markers attaining Levels 1 or 2 only. Most stakeholders agreed that this operationalization of the National Institutes of Health definitions of biomarker, surrogate endpoint, and clinical endpoint was useful. Further development and application of this schema provides incentives and guidance for effective biomarker and surrogate endpoint research, and more efficient drug discovery, development, and approval.

Receptor binding sites for substance P in surgical specimens obtained from patients with ulcerative colitis and Crohn disease

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

Mantyh, C.R.; Gates, T.S.; Zimmerman, R.P.

1988-05-01

Several lines of evidence indicate that tachykinin neuropeptides (substance P (SP), substance K (SK), and neuromedin K (NK)) play a role in regulating the inflammatory and immune responses. To test this hypothesis in a human inflammatory disease, quantitative receptor autoradiography was used to examine possible abnormalities in tachykinin binding sites in surgical specimens from patients with inflammatory bowel disease. In all cases, specimens were processed for quantitative receptor autoradiography by using /sup 125/I-labeled Bolton-Hunter conjugates of NK, SK, and SP. In colon tissue obtained from ulcerative colitis and Crohn disease patients, very high concentrations of SP receptor binding sites aremore » expressed by arterioles and venules located in the submucosa, muscalairs mucosa, external circular muscle, external longitudinal muscle, and serosa, in contrast to control patients. These results demonstrate that receptor binding sites for SP, but not SK or NK, are ectopically expressed in high concentrations by cells involved in mediating inflammatory and immune responses. These data suggest that SP may be involved in the pathophysiology of inflammatory bowel disease and might provide some insight into the interaction between the nervous system and the regulation of inflammation and the immune response in human inflammatory disease.« less

Geochemical Evidence Against Pyroxenites in the Sources of Hawaiian Volcanoes

NASA Astrophysics Data System (ADS)

Humayun, M.; Yang, S.; Clague, D. A.

2017-12-01

Hawaiian lavas exhibit high Fe/Mn ratios, and other elemental and isotopic characteristics, that have been argued to be evidence for chemical interactions at the core-mantle boundary. Alternatively, the enrichment in silica relative to 3 GPa melts of garnet peridotite, and the high Fe/Mn, has been argued to represent the contributions of garnet pyroxenite melts generated beneath a thick lithosphere. Here, we present a set of new elemental ratios designed to effectively discriminate partial melts of peridotite from pyroxenite in mantle sources. A set of 200 Hawaiian volcanic glasses from 7 volcanoes were analyzed by LA-ICP-MS for the abundances of 63 elements, with an emphasis on obtaining precise Ge/Si ratios. From experimental partitioning, silica-rich partial melts of MORB-like garnet pyroxenite are expected to have low Ge/Si ratios relative to their sources due to the retention of Ge in the residue by both garnet and pyroxene. In contrast, partial melts of peridotite are expected to have high Ge/Si ratios relative to mantle peridotites due to the incompatibility of Ge in olivine. We observed that Ge abundances in subaerial Hawaiian volcanoes are correlated with indicators of volcanic degassing, including S, Re and As. Subaerial and submarine lavas exhibit a correlation between Ge/Si ratio and S content that indicates that all Hawaiian lavas share the same pre-eruptive Ge/Si ratio. Submarine glasses with the least evidence of degassing exhibit a constant Ge/Si ratio over the range of SiO2 (44-52 %) observed in Hawaiian volcanics. Surprisingly, MORB glasses exhibit more variation in Ge/Si ratio than the pre-eruptive Ge/Si of Hawaiian glasses, implying the presence of 0-12% recycled crust in the MORB source. The constant Ge/Si ratio of Hawaiian glasses implies that pyroxenite melting did not enrich Hawaiian lavas in silica. Processes that could yield Si-rich melts without changing the Ge/Si ratio may involve melt-lithosphere interaction or bridgmanite

Lack of Serologic Evidence of Neospora caninum in Humans, England