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Sample records for reflective capacity clinical

  1. Enhancing the clinical reflective capacities of nursing students.

    PubMed

    Andersen, Elizabeth

    2016-07-01

    The purpose of clinical practicums is to help nursing students learn from real clinical experiences. In clinical settings, nursing instructors set-aside time at the end of each clinical day for reflective, debriefing discussions that are designed to draw the students' attention to relevant information and help them understand their beliefs and experiences. The students' competence and decision-making skills are enhanced when they are able to reflect on critical incidents or everyday practice events. It is sometimes difficult, however, for instructors to engage students meaningfully in discussions and promote reflection when students are fatigued. In this article, I argue that it is possible to refresh, support, and inspire undergraduate nursing students by engaging them in an activity designed to distract them and occupy their conscious attention, so that their more divergent and less accessible ideas are allowed to surface. Less accessible ideas are associated with the default network; regions in the brain that are most active when the brain is allowed to rest and wander. Congruent with the middle range theory of comfort, a distracting activity will provide comfort to students who are fatigued and/or distressed, and at the same time, will enhance their reflective capacities. A distracting activity that is enjoyable, not too demanding, and can be sustained for more than just a few minutes works best for idea generation and reflection.

  2. Beyond the margins: reflective writing and development of reflective capacity in medical education.

    PubMed

    Wald, Hedy S; Reis, Shmuel P

    2010-07-01

    Reflective capacity has been described as an essential characteristic of professionally competent clinical practice, core to ACGME competencies. Reflection has been recently linked to promoting effective use of feedback in medical education and associated with improved diagnostic accuracy, suggesting promising outcomes. There has been a proliferation of reflective writing pedagogy within medical education to foster development of reflective capacity, extend empathy with deepened understanding of patients' experience of illness, and promote practitioner well-being. At Alpert Med, "interactive" reflective writing with guided individualized feedback from interdisciplinary faculty to students' reflective writing has been implemented in a Doctoring course and Family Medicine clerkship as an educational method to achieve these aims. Such initiatives, however, raise fundamental questions of reflection definition, program design, efficacy of methods, and outcomes assessment. Within this article, we consider opportunities and challenges associated with implementation of reflective writing curricula for promotion of reflective capacity within medical education. We reflect upon reflection.

  3. Clinical Linguistics: Conversational Reflections

    ERIC Educational Resources Information Center

    Crystal, David

    2013-01-01

    This is a report of the main points I made in an informal "conversation" with Paul Fletcher and the audience at the 14th ICPLA conference in Cork. The observations arose randomly, as part of an unstructured 1-h Q&A, so they do not provide a systematic account of the subject, but simply reflect the issues which were raised by the conference…

  4. Clinical linguistics: conversational reflections.

    PubMed

    Crystal, David

    2013-04-01

    This is a report of the main points I made in an informal "conversation" with Paul Fletcher and the audience at the 14th ICPLA conference in Cork. The observations arose randomly, as part of an unstructured 1-h Q&A, so they do not provide a systematic account of the subject, but simply reflect the issues which were raised by the conference participants during that time.

  5. Strengthening Reflective Capacity in Skilled Home Visitors

    ERIC Educational Resources Information Center

    Gilkerson, Linda; Imberger, Jaci

    2016-01-01

    This article describes the FAN (Facilitating Attuned Interactions) approach to attunement in relationships and how it serves as a framework for reflective practice in an exemplary home visiting program. The authors highlight the role of the FAN as a tool for "reflection-in-action" and as a guide for "reflection-on-action." The…

  6. Building the Reflective Capacity of Practicing Principals

    ERIC Educational Resources Information Center

    Rich, Robert A.; Jackson, Sherion H.

    2006-01-01

    Reflection is often used as a professional development tool in coaching and mentoring leaders. Outside of education, research is underway to learn how managers can develop as learning facilitators in the workplace. However, the current focus on learning communities and learning organizations within education makes reflective thinking particularly…

  7. Reflections in the clinical practice.

    PubMed

    Borrell-Carrió, F; Hernández-Clemente, J C

    2014-03-01

    The purpose of this article is to analyze some models of expert decision and their impact on the clinical practice. We have analyzed decision-making considering the cognitive aspects (explanatory models, perceptual skills, analysis of the variability of a phenomenon, creating habits and inertia of reasoning and declarative models based on criteria). We have added the importance of emotions in decision making within highly complex situations, such as those occurring within the clinical practice. The quality of the reflective act depends, among other factors, on the ability of metacognition (thinking about what we think). Finally, we propose an educational strategy based on having a task supervisor and rectification scenarios to improve the quality of medical decision making.

  8. Reflections on the clinical implications of symbolism.

    PubMed

    da Rocha Barros, Elias M; da Rocha Barros, Elizabeth L

    2011-08-01

    We start by stressing the idea that the process itself of constructing the symbol in its different components and its vicissitudes is centrally important to contemporary psychoanalysis as symbols are essential for thinking and for storing emotional experiences in our memory and for conveying our affects to others and to ourselves. Our implicit idea is that internal attacks are not directed only at the internal objects, but also include attacks on the structure or forms of the mental representations before and while they become constituted in symbols. It is by this means that destructive impulses invade the processes of symbolic construction. Symbols can lose their plasticity and thus silence the emotions and therefore cut off the patient from their meanings. Our clinical material allows us to increase our understanding of how the formal qualities of symbols operate in mental life, and how they can interfere in the capacity to work through emotional experiences. Finally, our reflections based on the analysis of a patient with difficulty in relating with the meanings of the symbols he produced will highlight the importance of the analyst's reverie along the process of formulating an interpretation. This paper is also part of a development in the study of the process of reverie.

  9. Conceptual Models and Guidelines for Clinical Assessment of Financial Capacity.

    PubMed

    Marson, Daniel

    2016-09-01

    The ability to manage financial affairs is a life skill of critical importance, and neuropsychologists are increasingly asked to assess financial capacity across a variety of settings. Sound clinical assessment of financial capacity requires knowledge and appreciation of applicable clinical conceptual models and principles. However, the literature has presented relatively little conceptual guidance for clinicians concerning financial capacity and its assessment. This article seeks to address this gap. The article presents six clinical models of financial capacity : (1) the early gerontological IADL model of Lawton, (2) the clinical skills model and (3) related cognitive psychological model developed by Marson and colleagues, (4) a financial decision-making model adapting earlier decisional capacity work of Appelbaum and Grisso, (5) a person-centered model of financial decision-making developed by Lichtenberg and colleagues, and (6) a recent model of financial capacity in the real world developed through the Institute of Medicine. Accompanying presentation of the models is discussion of conceptual and practical perspectives they represent for clinician assessment. Based on the models, the article concludes by presenting a series of conceptually oriented guidelines for clinical assessment of financial capacity. In summary, sound assessment of financial capacity requires knowledge and appreciation of clinical conceptual models and principles. Awareness of such models, principles and guidelines will strengthen and advance clinical assessment of financial capacity.

  10. Subitizing Reflects Visuo-Spatial Object Individuation Capacity

    ERIC Educational Resources Information Center

    Piazza, Manuela; Fumarola, Antonia; Chinello, Alessandro; Melcher, David

    2011-01-01

    Subitizing is the immediate apprehension of the exact number of items in small sets. Despite more than a 100 years of research around this phenomenon, its nature and origin are still unknown. One view posits that it reflects a number estimation process common for small and large sets, which precision decreases as the number of items increases,…

  11. Reflective strategies in the neonatal clinical area.

    PubMed

    Vittner, Dorothy

    2009-02-01

    By nature and history, the newborn intensive care unit (NICU) is technology focused and crisis driven. Working there demands technical competence as well as the emotional aptitude to ensure that infants are cared for in an environment that values their basic humanness. Reflective strategies augment professional caregivers' perception of the emotional experience of working with others. Reflection is an essential skill that enhances the nursing profession. Reflection is a process of creating meaning from interpreting experiences through purposeful thought that guides decision making for taking the next step of action. In an effort to make a major change in our NICU, we incorporated reflective process to prepare us for implementing change. We used reflective practices to enhance the implementation efforts of individualized developmentally supportive care.

  12. Compartmentalized immune response reflects clinical severity of beryllium disease.

    PubMed

    Newman, L S; Bobka, C; Schumacher, B; Daniloff, E; Zhen, B; Mroz, M M; King, T E

    1994-07-01

    Although beryllium disease has been associated with a bronchoalveolar lavage (BAL) lymphocytosis and T cell-mediated immune response, we do not know if either the BAL cellular profile or the compartmentalized pulmonary response to the antigen reflect the severity of the disease. We studied 110 subjects divided into three groups of subjects: beryllium disease patients (n = 55), beryllium-sensitized patients without disease (n = 8), and control subjects (n = 47). Evaluation included completion of a respiratory symptom questionnaire, clinical examination, chest radiograph, spirometry, body plethysmographic lung volumes, and diffusing capacity (DLCO). In the patient groups, we performed maximal exercise testing with an indwelling arterial line. In addition, we examined BAL and performed blood and BAL beryllium lymphocyte transformation tests (BeLT) as measures of the beryllium-specific T cell-mediated response in these two compartments. In beryllium disease patients we correlated the BAL cellular constituents with clinical parameters indicative of disease severity. Beryllium disease patients exhibited elevated numbers of white cells and lymphocytes in BAL compared with both other groups; however, this lymphocytic alveolitis was significantly obscured in smokers. The BAL cellular constituents correlated with BAL BeLT but not with the blood BeLT. BAL cellular constituents also correlated with the radiographic profusion of small opacities, FEV1/FVC, DLCO, maximal achievable work load, VO2max, and measures of gas exchange at rest and at maximum exercise. We conclude that the lymphocyte-predominant pulmonary inflammatory response in beryllium disease is related to the magnitude of the localized response to antigen and that BAL cellularity, differential cell count, and BeLT reflect beryllium disease clinical severity.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Building capacity for the clinical placement of nursing students.

    PubMed

    Barnett, Tony; Cross, Merylin; Jacob, Elisabeth; Shahwan-Akl, Lina; Welch, Anthony; Caldwell, Alison; Berry, Robyn

    2008-01-01

    The current workforce crisis mandates that education providers increase the number of graduates from nursing courses. In a practice-based profession however, any growth in student numbers is constrained by the ability of clinical venues to accept students for clinical experience. Factors within the operating environment such as bed capacity, staffing mix and shortage of experienced clinicians to act as preceptors, clinical teachers, mentors or role models; limit the number of students that can be accommodated and both the quality and level of educational support provided. These factors are compounded in rural hospitals, where opportunities for placements can be also overlooked or ineffectively utilised. This paper reports on a project undertaken by a rural health service, two universities and a TAFE institute. It demonstrates that a greater number of students can be accommodated when all major stakeholders accept responsibility and agree to work together to create a learning community and find ways to overcome barriers and impediments that constrain capacity. It is concluded that the capacity of a rural hospital to accept students for placement can be increased when cancellation rates are reduced, the clinical timetable rationalised and more collaborative approaches to clinical education are implemented.

  14. Primary Care Collaborative Memory Clinics: Building Capacity for Optimized Dementia Care.

    PubMed

    Lee, Linda; Hillier, Loretta M; Molnar, Frank; Borrie, Michael J

    2017-01-01

    Increasingly, primary care collaborative memory clinics (PCCMCs) are being established to build capacity for person-centred dementia care. This paper reflects on the significance of PCCMCs within the system of care for older adults, supported with data from ongoing evaluation studies. Results highlight timelier access to assessment with a high proportion of patients being managed in primary care within a person-centred approach to care. Enhancing primary care capacity for dementia care with interprofessional and collaborative care will strengthen the system's ability to respond to increasing demands for service and mitigate the growth of wait times to access geriatric specialist assessment.

  15. Design of reflectance confocal microscopes for clinical applications

    NASA Astrophysics Data System (ADS)

    Zavislan, James M.

    2009-02-01

    Reflectance confocal microscopy provides real time, cellular resolution images of in-vivo and ex-vivo tissues and has been cleared by the FDA and international regulatory agencies for medical applications. Clinical applications of reflectance confocal microscopy are being tested in single- and multi-center clinical trials. In this paper I will review the design challenges of sub-surface imaging with confocal microscopy and techniques to compare the instruments performance between different sites.

  16. Reflective thinking in clinical nursing education: a concept analysis.

    PubMed

    Chabeli, M; Muller, M

    2004-11-01

    Over decades nursing had an interest in clarifying and developing its knowledge base and its conceptual foundation. Reflective thinking has become a popular word in nursing education world wide, but its meaning and effective use remains debatable because of lack of clarity in its meaning (Mackintosh, 1998:553). The researcher engaged in the concept analysis of reflective thinking so as to fully understand its meaning and interpretation, hence the research question to be addressed by this article is: "What is the meaning of reflective thinking in clinical nursing education?" This article seeks to explore and describe the conceptual meaning of reflective thinking in clinical nursing education using the method of concept analysis as outlined by Wilson (1963:23-39) and Gift (1997:75,76). Concept analysis of reflective thinking constitutes the first phase of a study to develop a model to facilitate reflective thinking in clinical nursing education, thus ensuring theoretical validity of the model. An extensive examination of domain specific and various disciplines' literature was explored as part of the concept analysis. A selection of information regarding variations and similarities in the use and interpretation of reflective thinking across clinical nursing education was drawn from computerised data bases. This increased the rigor and the findings of the analysis. Through deductive reasoning and drawing of inferences, attributes were clustered in an attempt to identify the apparent essence of the concept. Three categories and the related connotations emerged as follows: Antecedents (Cognitive and affective thinking skills). Process (The three phases of reflective thinking). Outcome ( New insight and changed perspective). Reflective thinking was considered from the result of concept analysis as a cyclic, interactive constructing mental process to improve practice in a specific context. It is recommended that a model to facilitate reflective thinking in clinical nursing

  17. Clinical and symptomatological reflections: the fascial system

    PubMed Central

    Bordoni, Bruno; Zanier, Emiliano

    2014-01-01

    Every body structure is wrapped in connective tissue, or fascia, creating a structural continuity that gives form and function to every tissue and organ. Currently, there is still little information on the functions and interactions between the fascial continuum and the body system; unfortunately, in medical literature there are few texts explaining how fascial stasis or altered movement of the various connective layers can generate a clinical problem. Certainly, the fascia plays a significant role in conveying mechanical tension, in order to control an inflammatory environment. The fascial continuum is essential for transmitting muscle force, for correct motor coordination, and for preserving the organs in their site; the fascia is a vital instrument that enables the individual to communicate and live independently. This article considers what the literature offers on symptoms related to the fascial system, trying to connect the existing information on the continuity of the connective tissue and symptoms that are not always clearly defined. In our opinion, knowing and understanding this complex system of fascial layers is essential for the clinician and other health practitioners in finding the best treatment strategy for the patient. PMID:25258540

  18. Reflection-in-Action: Case Study of a Clinical Supervisor.

    ERIC Educational Resources Information Center

    Turner-Muecke, Lee A.

    1986-01-01

    Applies Donald Schon's concept of the "reflective practitioner" to Robert Goldhammer's clinical supervision cycle (pre-observation conference, observation, analysis and strategy, supervision conference, and postconference analysis), stressing personal growth purposes for teacher and supervisor alike. Explores a clinical supervisor's…

  19. Reflective journal writing: how it promotes reflective thinking in clinical nursing education: a students' perspective.

    PubMed

    Kok, J; Chabeli, M M

    2002-08-01

    According to the outcomes-based education and training system of education (OBET) in the country and the South African Nursing Council, education should focus on "creating" reflective learners and practitioners. This article seeks to determine the effectiveness of reflective journal writing in promoting the reflective thinking of learners in clinical nursing education and to validate the guidelines described in a bigger study on how to facilitate reflective thinking using reflective journal writing. A qualitative, contextual, explorative, descriptive research design was used to determine the learners' perceptions on whether reflective journal writing did promote their higher-level thinking skills during the six-month placement in a psychiatric clinical practice using the reflective diaries. From a population of seventeen fourth-year students, six volunteered to participate in a focus group interview. The data was analysed by means of the descriptive method of open coding of Tesch (in Creswell, 1994:154-156). Positive and negative results from the perceptions of the participants and a literature review served as a basis for deducing and describing guidelines for the effective use of reflective journal writing in promoting reflective thinking in clinical nursing education. The positive perception was the development of problem-solving skills attained through reflection by using analytical critical thinking, synthesis and the evaluation of situations. Self-evaluation leading to intellectual growth and self-awareness indicated a positive perception. Negative perceptions were that reflective journal writing is time consuming, content based with a lack of clear expectations from the teacher, and distrust of students about the information written. Guba's model of ensuring trustworthiness in qualitative research as described in Krefting (1991:215-222) was employed. It is concluded that reflective journal writing in clinical nursing education does promote reflective

  20. A model for reflection for good clinical practice.

    PubMed

    Balla, John I; Heneghan, Carl; Glasziou, Paul; Thompson, Matthew; Balla, Margaret E

    2009-12-01

    Rationale and aim The rapidly changing knowledge base of clinical practice highlights the need to keep abreast of knowledge changes that are most relevant for the practitioner. We aimed to develop a model for reflection on clinical practice that identified the key elements of medical knowledge needed for good medical practice. Method The dual theory of cognition, an integration of intuitive and analytic processes, provided the framework for the study. The design looked at the congruence between the clinical thinking process and the dual theory. A one-year study was conducted in general practice clinics in Oxfordshire, UK. Thirty-five general practitioners participated in 20-minute interviews to discuss how they worked through recently seen clinical cases. Over a one-year period 72 cases were recorded from 35 interviews. These were categorized according to emerging themes, which were manually coded and substantiated with verbatim quotations. Results There was a close fit between the dual theory and participants' clinical thinking processes. This included instant problem framing, consistent with automatic intuitive thinking, focusing on the risk and urgency of the case. Salient features accounting for these choices were recognizable. There was a second reflective phase, leading to the review of initial judgements. Conclusions The proposed model highlights the critical steps in decision making. This allows regular recalibration of knowledge that is most critical at each of these steps. In line with good practice, the model also links the crucial knowledge used in decision making, to value judgments made in relation to the patient.

  1. A model to facilitate reflective thinking in clinical nursing education.

    PubMed

    Chabeli, M; Muller, M

    2004-11-01

    A qualitative, contextual, exploratory and descriptive design for theory generation was used to develop a model to facilitate reflective thinking in clinical nursing education (Mouton & Marais, 1990:43; Mouton, 1996: 103-109; Chinn & Kramer 1991:79-120). A model was developed within the existing frameworks of theory generation. Wilson (1963:23-39) and Gift (1997:75,76) provided a theoretical framework for a concept analysis of reflective thinking in phase one of the study. Further conceptual meaning was attained through a perceptual survey where twelve nurse educators participated in a focus group interview with regard to how reflective thinking can be facilitated in clinical nursing education. Classification of the main concepts and sub-concepts was made through a conceptualisation process within Dickoff, James and Wiedenbach's (1968:415-435) theoretical framework using the six elements of practice theory. Concluding relation statements were inferred through deductive analysis and synthesis after conceptualisation of each main concept. The relation statements provided the basis for model description (Chinn & Kramer, 1991:107-125). Definitions of the main concepts and sub-concepts were described using the basic rules by (Rossouw, 2001:10-11; Cohen & Copi, 1994:192-195). The adapted educational process from five learning theories provided a framework through which the procedure to facilitate reflective thinking in clinical nursing education was described. Lastly, the model was evaluated using the pre-determined criteria by Chinn and Kramer (1991:128-137) and refined by experts in qualitative research and theory generation. Guidelines were developed which do not form part of this article. Theoretical validity was ensured. Recommendations, limitations, challenging hypothesis and a conclusion were made.

  2. The Provider Reflective Process Assessment Scales (PRPAS): Taking a Deep Look into Growing Reflective Capacity in Early Childhood Providers

    ERIC Educational Resources Information Center

    Heller, Sherryl Scott; Ash, Jordana

    2016-01-01

    The need to build an evidence base for reflective supervision (RS) is threefold: (1) to determine the elements of a supervision session that make it reflective, (2) to demonstrate that change occurs within the supervisee, and (3) to demonstrate that having staff members participate in RS enhances positive program (or client) outcomes. This article…

  3. Reflections on Speech-Language Therapists' Talk: Implications for Clinical Practice and Education. Clinical Forum

    ERIC Educational Resources Information Center

    Ferguson, Alison; Armstrong, Elizabeth

    2004-01-01

    Background: Research into the practices of speech-language therapists in clinical sessions is beginning to identify the way communication in clinical interactions both facilitates and potentially impedes the achievement of therapy goals. Aims: This target article aims to raise the issues that arise from critical reflections on the communication of…

  4. The use of abstract paintings and narratives to foster reflective capacity in medical educators: a multinational faculty development workshop

    PubMed Central

    Karkabi, Khaled; Wald, Hedy S; Cohen Castel, Orit

    2014-01-01

    Reflective capacity is integral to core healthcare professional practice competencies. Reflection plays a central role in teacher education as reflecting on teaching behaviours with critical analysis can potentially improve teaching practice. The humanities including narrative and the visual arts can serve as a valuable tool for fostering reflection. We conducted a multinational faculty development workshop aiming to enhance reflective capacity in medical educators by using a combination of abstract paintings and narratives. Twenty-three family physicians or physicians-in-training from 10 countries participated in the workshop. Qualitative assessment of the workshop showed that the combined use of art and narrative was well received and perceived as contributing to the reflective exercise. Participants generally felt that viewing abstract paintings had facilitated a valuable mood transformation and prepared them emotionally for the reflective writing. Our analysis found that the following themes emerged from participants’ responses: (1) narratives from different countries are similar; (2) the use of art helped access feelings; (3) viewing abstract paintings facilitated next steps; (4) writing reflective narratives promoted examination of educational challenges, compassion for self and other, and building an action plan; and (5) sharing of narrative was helpful for fostering active listening and appreciating multiple perspectives. Future research might include comparing outcomes for a group participating in arts–narrative-based workshops with those of a control group using only reflective narrative or in combination with figurative art, and implementing a combination of qualitative and quantitative methods of assessment. PMID:24273319

  5. The use of abstract paintings and narratives to foster reflective capacity in medical educators: a multinational faculty development workshop.

    PubMed

    Karkabi, Khaled; Wald, Hedy S; Cohen Castel, Orit

    2014-06-01

    Reflective capacity is integral to core healthcare professional practice competencies. Reflection plays a central role in teacher education as reflecting on teaching behaviours with critical analysis can potentially improve teaching practice. The humanities including narrative and the visual arts can serve as a valuable tool for fostering reflection. We conducted a multinational faculty development workshop aiming to enhance reflective capacity in medical educators by using a combination of abstract paintings and narratives. Twenty-three family physicians or physicians-in-training from 10 countries participated in the workshop. Qualitative assessment of the workshop showed that the combined use of art and narrative was well received and perceived as contributing to the reflective exercise. Participants generally felt that viewing abstract paintings had facilitated a valuable mood transformation and prepared them emotionally for the reflective writing. Our analysis found that the following themes emerged from participants' responses: (1) narratives from different countries are similar; (2) the use of art helped access feelings; (3) viewing abstract paintings facilitated next steps; (4) writing reflective narratives promoted examination of educational challenges, compassion for self and other, and building an action plan; and (5) sharing of narrative was helpful for fostering active listening and appreciating multiple perspectives. Future research might include comparing outcomes for a group participating in arts-narrative-based workshops with those of a control group using only reflective narrative or in combination with figurative art, and implementing a combination of qualitative and quantitative methods of assessment.

  6. Preservice Teachers' Reflection on Clinical Experiences: A Comparison of Blog and Final Paper Assignments

    ERIC Educational Resources Information Center

    Harland, Darci J.; Wondra, Joshua D.

    2011-01-01

    This study focused on the depth of reflection in the writing of preservice teachers who completed end-of-the-semester reflective papers or reflective blogs for undergraduate education courses associated with clinical experiences. Coders rated the depth of reflection as one of four categories: non-reflection, understanding, reflection, or critical…

  7. Does Objective Structured Clinical Examinations Score Reflect the Clinical Reasoning Ability of Medical Students?

    PubMed Central

    Park, Wan Beom; Kang, Seok Hoon; Lee, Yoon-Seong

    2015-01-01

    Abstract: Background: Clinical reasoning ability is an important factor in a physician's competence and thus should be taught and tested in medical schools. Medical schools generally use objective structured clinical examinations (OSCE) to measure the clinical competency of medical students. However, it is unknown whether OSCE can also evaluate clinical reasoning ability. In this study, the authors investigated whether OSCE scores reflected students' clinical reasoning abilities. Methods: Sixty-five fourth-year medical students participated in this study. Medical students completed the OSCE with 4 cases using standardized patients. For assessment of clinical reasoning, students were asked to list differential diagnoses and the findings that were compatible or not compatible with each diagnosis. The OSCE score (score of patient encounter), diagnostic accuracy score, clinical reasoning score, clinical knowledge score and grade point average (GPA) were obtained for each student, and correlation analysis was performed. Results: Clinical reasoning score was significantly correlated with diagnostic accuracy and GPA (correlation coefficient = 0.258 and 0.380; P = 0.038 and 0.002, respectively) but not with OSCE score or clinical knowledge score (correlation coefficient = 0.137 and 0.242; P = 0.276 and 0.052, respectively). Total OSCE score was not significantly correlated with clinical knowledge test score, clinical reasoning score, diagnostic accuracy score or GPA. Conclusions: OSCE score from patient encounters did not reflect the clinical reasoning abilities of the medical students in this study. The evaluation of medical students' clinical reasoning abilities through OSCE should be strengthened. PMID:25647834

  8. Clinical and Ethical Aspects of Financial Capacity in Dementia: A Commentary

    PubMed Central

    Marson, Daniel C.

    2013-01-01

    In contrast to issues like treatment and research consent capacity, financial capacity has received relatively little clinical and ethical attention in the dementia literature. Yet issues of financial capacity emerge frequently in patients with Alzheimer's disease (AD), Parkinson's disease (PD) and related dementias, and commonly present ethical and clinical challenges for clinicians treating these patients. These issues include whether a patient with possible dementia has sufficient capacity independently to manage their financial affairs, needs referral for financial capacity assessment, and/or is being financially exploited or abused by others. The accurate identification, assessment and successful handling of such financial capacity issues can have a substantial impact on the financial and psychological well-being of patients and their family members. The present commentary presents an overview of financial capacity and associated clinical and ethical issues in dementia, and describes a set of possible clinician roles regarding these issues as they arise in clinical practice. The commentary concludes with a section describing educational resources available to clinicians and bioethicists seeking additional guidance in handling financial capacity issues. The ultimate goal of the paper is to focus clinical and ethical attention on a neglected capacity that is of fundamental importance for patients, families, and health care and legal professionals. PMID:24078779

  9. Capacity for Clinical Research on Herbal Medicines in Africa

    PubMed Central

    Siegfried, Nandi; Johnson, Quinton

    2012-01-01

    Abstract An electronic survey was used to assess the training needs of clinical and public health researchers who have been involved, and/or plan to become involved, in clinical trials of herbal medicines in Africa. Over 90 researchers were contacted through pre-existing networks, of whom 58 (64%) responded, from 35 institutions in 14 African countries. Over half (57%) had already been involved in a clinical trial of an herbal medicine, and gave information about a total of 23 trials that have already been completed. Of these, only five had been published, and only one had resulted in a licensed product. Fifty-four (54) of the researchers were planning to conduct a clinical trial of an herbal medicine in the future, and gave information about 54 possible trials. Respondents outlined the following most commonly encountered difficulties when conducting clinical trials: resource constraints (including lack of funding, equipment, staff, and infrastructure); social acceptance of the clinical trial (including difficulty recruiting enough patients, poor rapport with traditional healers, and willingness of biomedical staff to be involved); herbal medicine supply (including insufficient cultivation, production, and quality control); lack of trained staff; and logistical issues in conducting trials. The topics in which researchers were least confident were Intellectual Property Rights issues, statistical issues, and issues related to Good Clinical Practice guidelines. PMID:22784350

  10. A shared, flexible neural map architecture reflects capacity limits in both visual short-term memory and enumeration.

    PubMed

    Knops, André; Piazza, Manuela; Sengupta, Rakesh; Eger, Evelyn; Melcher, David

    2014-07-23

    Human cognition is characterized by severe capacity limits: we can accurately track, enumerate, or hold in mind only a small number of items at a time. It remains debated whether capacity limitations across tasks are determined by a common system. Here we measure brain activation of adult subjects performing either a visual short-term memory (vSTM) task consisting of holding in mind precise information about the orientation and position of a variable number of items, or an enumeration task consisting of assessing the number of items in those sets. We show that task-specific capacity limits (three to four items in enumeration and two to three in vSTM) are neurally reflected in the activity of the posterior parietal cortex (PPC): an identical set of voxels in this region, commonly activated during the two tasks, changed its overall response profile reflecting task-specific capacity limitations. These results, replicated in a second experiment, were further supported by multivariate pattern analysis in which we could decode the number of items presented over a larger range during enumeration than during vSTM. Finally, we simulated our results with a computational model of PPC using a saliency map architecture in which the level of mutual inhibition between nodes gives rise to capacity limitations and reflects the task-dependent precision with which objects need to be encoded (high precision for vSTM, lower precision for enumeration). Together, our work supports the existence of a common, flexible system underlying capacity limits across tasks in PPC that may take the form of a saliency map.

  11. Excess digestive capacity in predators reflects a life of feast and famine.

    PubMed

    Armstrong, Jonathan B; Schindler, Daniel E

    2011-07-06

    A central challenge for predators is achieving positive energy balance when prey are spatially and temporally heterogeneous. Ecological heterogeneity produces evolutionary trade-offs in the physiological design of predators; this is because the ability to capitalize on pulses of food abundance requires high capacity for food-processing, yet maintaining such capacity imposes energetic costs that are taxing during periods of food scarcity. Recent advances in physiology show that when variation in foraging opportunities is predictable, animals may adjust energetic trade-offs by rapidly modulating their digestive system to track variation in foraging opportunities. However, it is increasingly recognized that foraging opportunities for animals are unpredictable, which should favour animals that maintain a capacity for food-processing that exceeds average levels of consumption (loads). Despite this basic principle of quantitative evolutionary design, estimates of digestive load:capacity ratios in wild animals are virtually non-existent. Here we provide an extensive assessment of load:capacity ratios for the digestive systems of predators in the wild, compiling 639 estimates across 38 species of fish. We found that piscine predators typically maintain the physiological capacity to feed at daily rates 2-3 times higher than what they experience on average. A numerical simulation of the trade-off between food-processing capacity and metabolic cost suggests that the observed level of physiological opportunism is profitable only if predator-prey encounters, and thus predator energy budgets, are far more variable in nature than currently assumed.

  12. Functional capacity of Brazilian patients with Parkinson's disease (PD): relationship between clinical characteristics and disease severity.

    PubMed

    Barbieri, Fabio A; Rinaldi, Natalia M; Santos, Paulo Cezar R; Lirani-Silva, Ellen; Vitório, Rodrigo; Teixeira-Arroyo, Cláudia; Stella, Florindo; Gobbi, Lilian Teresa B

    2012-01-01

    The present study had three objectives: (a) to characterize the functional capacity of patients with PD, (b) to assess the relationship between the physical fitness components of functional capacity with clinical characteristics and disease severity, and (c) to compare the physical fitness components of functional capacity with clinical characteristics according to disease severity. The study included 54 patients with idiopathic PD who were distributed into two groups according to PD severity: unilateral group (n=35); and bilateral group (n=19). All patients underwent psychiatric assessment by means of the Hoehn and Yahr (HY) staging of PD, the Unified Parkinson's Disease Rating Scale (UPDRS), the Hospital Anxiety and Depression Scale (HADS-A and HADS-D, respectively), and The Mini-Mental State Examination (MMSE). The physical fitness components of functional capacity were evaluated over a 2-day period, using recommendations by the American Alliance for Health, Physical Education, Recreation and Dance, and the Berg Balance Scale (BBS). Pearson correlation coefficients and multiple regressions were calculated to test the correlation between functional capacity and clinical characteristics, and to predict clinical scores from physical performance, respectively. Clinical variables and physical component data were compared between groups using analysis of variance to determine the effects of disease severity. Patients with advanced disease showed low levels of functional capacity. Interestingly, patients with good functional capacity in one of the physical fitness components also showed good capacities in the other components. Disease severity is a major factor affecting functional capacity and clinical characteristics. Medical providers should take disease severity into consideration when prescribing physical activity for PD patients, since the relationship between functional capacity and clinical characteristics is dependent on disease severity.

  13. Research on the fiber reflecting sensor for detecting the residual capacity of the lead-acid battery

    NASA Astrophysics Data System (ADS)

    Zhao, Mingfu; Zhong, Nianbing; Chen, Yan; Luo, Yuwei

    2006-11-01

    According to the Lambert-Bee law, we can see that the photic absorption coefficient is related to the matter's concentration, the distance of the light through the absorption medium and the transmitted light intensity. The paper just according to the physical phenomena and the theory make the reflex energy relate to the concentration testing of the electrolyte, at the same time the electrolyte's concentration is related to the capacity of lead-acid battery on a corresponding function relation, so we can know the capacity state of the lead-acid battery according to the measurement on the electrolyte's concentration. According to the experiment and research the author deeply discussed how the temperature change affects the capacity of lead-acid battery and the concentration's changing relation, according to the analyses of the thermo-optic effect, we made a new reflecting fiber sensor based on the comparative temperature testing theory and absorption which can eliminate the temperature effect on the tested signal namely the output signal just related to the concentration, so really reflects the change of the capacity of the lead-acid battery when it is in the charge and discharge process. The results of the experiment and theory analyses show that this method is easy to realize the online testing of the capacity of lead-acid battery. This sensor has many merits such as precise measurement, sensitive reaction, long-life use etc. It can be widely used in the electric capacity testing of the automobile lead-acid battery, the electric capacity testing of the industry lead-acid battery, liquor's concentration testing and salinity testing of the sea and have a bright future.

  14. A New Model of Clinical Education to Increase Student Placement Availability: The Capacity Development Facilitator Model

    ERIC Educational Resources Information Center

    Fairbrother, Michele; Nicole, Madelyn; Blackford, Julia; Nagarajan, Srivalli Vilapakkam; McAllister, Lindy

    2016-01-01

    This paper reports on a trial of a new model of clinical education designed to increase student clinical placement availability and address workforce constraints on supervision. The University of Sydney deployed the Capacity Development Facilitators (CDF) in selected Sydney hospitals to work with staff to expand student clinical placement…

  15. Reflections on Clinical Learning in Novice Speech-Language Therapy Students

    ERIC Educational Resources Information Center

    Hill, Anne E.; Davidson, Bronwyn J.; Theodoros, Deborah G.

    2012-01-01

    Background: Reflective practice is reported to enhance clinical reasoning and therefore to maximize client outcomes. The inclusion of targeted reflective practice in academic programmes in speech-language therapy has not been consistent, although providing opportunities for speech-language therapy students to reflect during their clinical practice…

  16. Financial capacity in persons with schizophrenia and serious mental illness: clinical and research ethics aspects.

    PubMed

    Marson, Daniel C; Savage, Robert; Phillips, Jacqueline

    2006-01-01

    In contrast with issues of consent capacity, financial capacity has received surprisingly little clinical or ethical attention in the psychiatric literature. Issues of financial capacity emerge frequently regarding clients with serious mental illness (SMI), and their resolution has practical and ethical significance for clients, their families, and mental health professionals. These issues include whether a client has sufficient financial skills and judgment to live independently, whether a client requires a representative payee, and what goals for community reintegration should be established with a client. Similar to informed consent, issues of financial capacity raise ethical challenges for clinicians, caseworkers, and agencies. The present article addresses clinical and research ethics questions related to financial capacity in clients with schizophrenia and SMI. Clinical questions concern evaluation of financial capacity in clients with SMI, whether to seek assignment of a mandatory representative payee, whether to leverage treatment compliance through a representative payee arrangement, and whether a mental health professional should also serve as a client's representative payee. The research ethics question addresses implications of providing financial compensation for research participation to individuals with SMI and limited financial capacity and means. The ultimate goal of this article is to focus clinical and ethical attention on a neglected decisional capacity in SMI that is of fundamental importance for clients, families, clinicians, and researchers.

  17. Building health systems capacity in global health graduate programs: reflections from Australian educators.

    PubMed

    Negin, Joel; Martiniuk, Alexandra; Morgan, Chris; Davies, Philip; Zwi, Anthony

    2012-08-24

    There has been increasing focus on the role of health systems in low and middle-income countries. Despite this, very little evidence exists on how best to build health systems program and research capacity in educational programs. The current experiences in building capacity in health systems in five of the most prominent global health programs at Australian universities are outlined. The strengths and weaknesses of various approaches and techniques are provided along with examples of global practice in order to provide a foundation for future discussion and thus improvements in global health systems education.

  18. 21 CFR 862.2400 - Densitometer/scanner (integrating, reflectance, TLC, or radiochromatogram) for clinical use.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Densitometer/scanner (integrating, reflectance... CLINICAL TOXICOLOGY DEVICES Clinical Laboratory Instruments § 862.2400 Densitometer/scanner (integrating... (integrating, reflectance, thin-layer chromatography, or radiochromatogram) for clinical use is device...

  19. 21 CFR 862.2400 - Densitometer/scanner (integrating, reflectance, TLC, or radiochromatogram) for clinical use.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Densitometer/scanner (integrating, reflectance... CLINICAL TOXICOLOGY DEVICES Clinical Laboratory Instruments § 862.2400 Densitometer/scanner (integrating... (integrating, reflectance, thin-layer chromatography, or radiochromatogram) for clinical use is device...

  20. 21 CFR 862.2400 - Densitometer/scanner (integrating, reflectance, TLC, or radiochromatogram) for clinical use.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Densitometer/scanner (integrating, reflectance... CLINICAL TOXICOLOGY DEVICES Clinical Laboratory Instruments § 862.2400 Densitometer/scanner (integrating... (integrating, reflectance, thin-layer chromatography, or radiochromatogram) for clinical use is device...

  1. The capacity to tell a joke: Reflections from work with Asperger children.

    PubMed

    Brown, Lawrence J

    2016-12-01

    The capacity to tell a joke is a highly complex interpersonal event that depends upon the maturation of certain developmental achievements which are absent or stunted in children with Asperger's Syndrome. These include the ability to know another's mind, a sense of interpersonal timing and, most notably, a capacity for abstract thinking. The author discusses Freud's () notion of joke-work, which is akin to dream-work, both of which are pathways to forming mental representations. Freud considered joke-work as a mental activity that operated on the verbal level and the author examines the preverbal dimensions that are rooted in the earliest mother/infant interactions. An extended case discussion of the psychoanalytic treatment of an Asperger boy is offered to illustrate these points and to demonstrate the activity of joke-work as a means of building mental representations.

  2. Multidimensional Collaboration: Reflections on Action Research in a Clinical Context

    ERIC Educational Resources Information Center

    Gregory, Sheila; Poland, Fiona; Spalding, Nicola J.; Sargen, Kevin; McCulloch, Jane; Vicary, Penny

    2011-01-01

    This paper reflects on the challenges and benefits of multidimensional collaboration in an action research study to evaluate and improve preoperative education for patients awaiting colorectal surgery. Three cycles of planning, acting, observing and reflecting were designed to evaluate practice and implement change in this interactive setting,…

  3. Determination of antioxidant capacity and phenolic content of chocolate by attenuated total reflectance-Fourier transformed-infrared spectroscopy.

    PubMed

    Hu, Yaxi; Pan, Zhi Jie; Liao, Wen; Li, Jiaqi; Gruget, Pierre; Kitts, David D; Lu, Xiaonan

    2016-07-01

    Antioxidant capacity and phenolic content of chocolate, containing different amounts of cacao (35-100%), were determined using attenuated total reflectance (ATR)-Fourier transformed-infrared (FT-IR) spectroscopy (4000-550cm(-1)). Antioxidant capacities were first characterized using DPPH (2,2-diphenyl-1-picrylhydrazyl) and ORAC (oxygen radical absorbance capacity) assays. Phenolic contents, including total phenol and procyanidins monomers, were quantified using the Folin-Ciocalteu assay and high performance liquid chromatography coupled with photodiode array detector (HPLC-DAD), respectively. Five partial least-squares regression (PLSR) models were constructed and cross-validated using FT-IR spectra from 18 types of chocolate and corresponding reference values determined using DPPH, ORAC, Folin-Ciocalteu, and HPLC assays. The models were validated using seven unknown samples of chocolate. PLSR models showed good prediction capability for DPPH [R(2)-P (prediction)=0.88, RMSEP (root mean squares error of prediction)=12.62μmol Trolox/g DFW], ORAC (R(2)-P=0.90, RMSEP=37.92), Folin-Ciocalteu (R(2)-P=0.88, RMSEP=5.08), and (+)-catechin (R(2)-P=0.86, RMSEP=0.10), but lacked accuracy in the prediction of (-)-epicatechin (R(2)-P=0.72, RMSEP=0.57). ATR-FT-IR spectroscopy can be used for rapid prediction of antioxidant capacity, total phenolic content, and (+)-catechin in chocolate.

  4. Primary Care-Based Memory Clinics: Expanding Capacity for Dementia Care.

    PubMed

    Lee, Linda; Hillier, Loretta M; Heckman, George; Gagnon, Micheline; Borrie, Michael J; Stolee, Paul; Harvey, David

    2014-09-01

    The implementation in Ontario of 15 primary-care-based interprofessional memory clinics represented a unique model of team-based case management aimed at increasing capacity for dementia care at the primary-care level. Each clinic tracked referrals; in a subset of clinics, charts were audited by geriatricians, clinic members were interviewed, and patients, caregivers, and referring physicians completed satisfaction surveys. Across all clinics, 582 patients were assessed, and 8.9 per cent were referred to a specialist. Patients and caregivers were very satisfied with the care received, as were referring family physicians, who reported increased capacity to manage dementia. Geriatricians' chart audits revealed a high level of agreement with diagnosis and management. This study demonstrated acceptability, feasibility, and preliminary effectiveness of the primary-care memory clinic model. Led by specially trained family physicians, it provided timely access to high-quality collaborative dementia care, impacting health service utilization by more-efficient use of scarce geriatric specialist resources.

  5. Predictive capacity of risk assessment scales and clinical judgment for pressure ulcers: a meta-analysis.

    PubMed

    García-Fernández, Francisco Pedro; Pancorbo-Hidalgo, Pedro L; Agreda, J Javier Soldevilla

    2014-01-01

    A systematic review with meta-analysis was completed to determine the capacity of risk assessment scales and nurses' clinical judgment to predict pressure ulcer (PU) development. Electronic databases were searched for prospective studies on the validity and predictive capacity of PUs risk assessment scales published between 1962 and 2010 in English, Spanish, Portuguese, Korean, German, and Greek. We excluded gray literature sources, integrative review articles, and retrospective or cross-sectional studies. The methodological quality of the studies was assessed according to the guidelines of the Critical Appraisal Skills Program. Predictive capacity was measured as relative risk (RR) with 95% confidence intervals. When 2 or more valid original studies were found, a meta-analysis was conducted using a random-effect model and sensitivity analysis. We identified 57 studies, including 31 that included a validation study. We also retrieved 4 studies that tested clinical judgment as a risk prediction factor. Meta-analysis produced the following pooled predictive capacity indicators: Braden (RR = 4.26); Norton (RR = 3.69); Waterlow (RR = 2.66); Cubbin-Jackson (RR = 8.63); EMINA (RR = 6.17); Pressure Sore Predictor Scale (RR = 21.4); and clinical judgment (RR = 1.89). Pooled analysis of 11 studies found adequate risk prediction capacity in various clinical settings; the Braden, Norton, EMINA (mEntal state, Mobility, Incontinence, Nutrition, Activity), Waterlow, and Cubbin-Jackson scales showed the highest predictive capacity. The clinical judgment of nurses was found to achieve inadequate predictive capacity when used alone, and should be used in combination with a validated scale.

  6. Enhancing Learning in Clinical Placements: Reflective Practice, Self-Assessment, Rubrics and Scaffolding

    ERIC Educational Resources Information Center

    Stupans, Ieva; March, Geoff; Owen, Susanne M.

    2013-01-01

    Professional preparatory health programmes generally involve clinical placements with a focus on integration of theory into real life practice. Reflective writing is often included in the assessment requirements for clinical placement courses. However enabling students to engage in deeper levels of reflective writing in action, on action and for…

  7. Cortical potentials in an auditory oddball task reflect individual differences in working memory capacity

    PubMed Central

    Yurgil, Kate A.; Golob, Edward J.

    2014-01-01

    This study determined whether auditory cortical responses associated with mechanisms of attention vary with individual differences in working memory capacity (WMC) and perceptual load. The operation span test defined subjects with low vs. high WMC, who then discriminated target/nontarget tones while EEG was recorded. Infrequent white noise distracters were presented at midline or ±90° locations, and perceptual load was manipulated by varying nontarget frequency. Amplitude of the N100 to distracters was negatively correlated with WMC. Relative to targets, only high WMC subjects showed attenuated N100 amplitudes to nontargets. In the higher WMC group, increased perceptual load was associated with decreased P3a amplitudes to distracters and longer-lasting negative slow wave to nontargets. Results show that auditory cortical processing is associated with multiple facets of attention control related to WMC and possibly higher-level cognition. PMID:24016201

  8. Reflective writing in the competency-based curriculum at the cleveland clinic lerner college of medicine.

    PubMed

    Isaacson, J Harry; Salas, Renee; Koch, Carl; McKenzie, Margaret

    2008-01-01

    The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University is a five-year medical school where the major emphasis is to train physician investigators. In this article we describe our experience with reflective writing in our competency-based medical school, which has reflective practice as one of the nine core competencies. We outline how we use reflective writing as a way to help students develop their reflective practice skills. Reflective writing opportunities, excerpts of student pieces, and faculty and student perspectives are included. We have experienced the value of reflective writing in medical school education and believe elements of our program can be adapted to other training environments.

  9. Supporting youth and community capacity through photovoice: Reflections on participatory research on maternal health in Wakiso district, Uganda.

    PubMed

    Musoke, David; Ndejjo, Rawlance; Ekirapa-Kiracho, Elizabeth; George, Asha S

    2016-01-01

    This paper reflects on the experiences of using photovoice to examine maternal health in Wakiso district, Uganda. The project involved 10 youth aged 18-29 years old, who were diverse in education, occupation, and marital status and identified by community leaders with researchers. By taking photos and sharing images and experiences in monthly meetings over five months, youth reported becoming more knowledgeable. They realised that they had common experiences but also reflected on and reinterpreted their circumstances. While they acquired self-confidence and enhanced their communication skills, they also initially faced community resistance regarding consent and lack of trust in their motives. Ethical practice in photovoice goes beyond institutional approval and individual consent. It includes extensively discussing the project with community members and building relationships with them. In certain instances, photos needed not to identify community members, or not be taken at all. Through these relationships and with improved capacity, youth engaged in individual instances of health education and advocacy, as well as spurred further local action through community dialogues. Researchers supporting photovoice must be open to learning alongside participants, flexible regarding study focus and processes, sustain interest and manage logistics, all while being reflective about the balance of power in such partnerships.

  10. Clinical judgment development using structured classroom reflective practice: a qualitative study.

    PubMed

    Glynn, Donna M

    2012-03-01

    This qualitative study examined the incorporation of "reflection-on-action" in a structured reflective classroom format as defined by Tanner's Clinical Judgment Model on the development of perceived clinical judgment and clinical confidence in Bachelor of Science nursing students. The qualitative results described the students' perceptions of the benefit of the intervention on their development of clinical judgment and clinical confidence. This research was an important contribution to the debate regarding the benefit of structured reflection in a classroom setting. By using reflection in the classroom, nurse educators may influence the education-practice gap and incorporate new pedagogies to strengthen the educational preparedness of nursing students to provide high-quality, competent, compassionate care to patients and their families.

  11. Clinical applications of lightguide diffuse reflectance spectrophotometry in vascular disease

    NASA Astrophysics Data System (ADS)

    Harrison, David K.; Delaney, Colin; Brown, Linda; Newton, David J.; McCollum, Peter T.

    1994-02-01

    There is enormous potential for application of lightguide tissue reflectance spectrophotometry in the diagnosis and treatment of peripheral vascular disease. In the present study, measurements were carried out in 10 such pre-amputation patients to compare the use of micro-lightguide spectrophotometry with the macro-lightguide technique. These preliminary results show excellent agreement between the new, non-invasive micro-lightguide technique and the `gold standard' skin blood flow measurements. This technique could thus provide a more functional, non-invasive assessment of healing potential than skin blood flow measurement.

  12. Clinical features of drug abuse that reflect genetic risk

    PubMed Central

    Kendler, K. S.; Ohlsson, H.; Sundquist, K.; Sundquist, J.

    2014-01-01

    Background Drug abuse (DA) is a clinically heterogeneous syndrome. Can we, in a large epidemiological sample, identify clinical features of DA cases that index genetic risk? Method Using registration in medical, legal or pharmacy records, we identified four kinds of relative pairs (n =935854) starting with a proband with DA: monozygotic co-twins; full siblings; half-siblings; and cousins. Using linear hazard regression, we examined the interaction between three clinical features of DA in the proband and risk for DA in these four relative pairs, ordered by degree of genetic relationship. Results Increased risk for DA in relatives was robustly predicted by early age at first registration, total number of registrations, and ascertainment in the criminal versus the medical or pharmacy registry. In multivariate models, all three of these variables remained significant and in aggregate strongly predicted DA risk in relatives. The risk for DA in siblings of DA probands in the highest decile of genetic risk predicted by our three indices was more than twice as great as that predicted in siblings of probands in the lowest decile of risk. Conclusions In an epidemiological sample, genetic risk for DA can be substantially indexed by simple clinical and historical variables. PMID:24461082

  13. Reflective blogs in clinical education to promote critical thinking in dental hygiene students.

    PubMed

    Wetmore, Ann O'Kelley; Boyd, Linda D; Bowen, Denise M; Pattillo, Robin E

    2010-12-01

    One challenge facing dental hygiene, as well as dental, education is to identify clinical teaching strategies promoting critical thinking and clinical reasoning. These skills are crucial elements in the practice of dental hygiene. A two-group design (intervention, n=28, and control, n=30) assessed first-year dental hygiene students using pre-and post-Health Science Reasoning Test (HSRT) scores to evaluate the effect of reflective blogging on critical thinking skills. A reflective blog rubric, based on Mezirow's levels of reflection, determined if reflective blogging increased the level of reflection for dental hygiene students. The results suggest within this nonprobability sample that reflective blogging did not produce a significant change in students' HSRT scores (p>0.05). However, analyses of reflective blog rubric scores demonstrated statistically significant improvements (p<0.05) in students' levels of reflection. Furthermore, data analysis revealed a correlation (p<0.05) between HSRT subscale scores and the element of reflection scores for the intervention group. This study addressed needs of the dental and dental hygiene education community by examining the use of blogs, an emerging technology, as a tool for reflecting on clinical experiences and, in turn, for promoting critical thinking.

  14. Research Capacity at Traditional Chinese Medicine (TCM) Centers in China: A Survey of Clinical Investigators

    PubMed Central

    Han, Mei; Lai, Lily; Wang, Si-cheng

    2017-01-01

    Background. The development of an evidence-based approach to traditional Chinese medicine (TCM), which depends on the generation of good quality evidence, requires an adequate workforce. However, the research capacity of TCM investigators is not known. Study Design. This cross-sectional study was conducted to describe the research capacity of TCM clinical investigators in China. Participants. A total of 584 participants from TCM hospitals and research centers were included. They were asked about the academic and research characteristics, needs for research capacity building, and barriers to clinical research. Results. The majority (80.82%) were qualified to at least a Master's degree, whilst a smaller proportion (40.24%) held a senior professional title. We found that academic outputs were low with the majority (62.16%) authoring less than five publications in total. The most pressing needs for building research capacity identified were training in research methodology (97.43%) and identification of research questions (86.81%), whilst the highest ranking barriers to conducting research were limited motivation, funding (40.72%), and time (37.15%). Conclusion. The methodology training, along with investment in the research workforce, needs to be urgently addressed to improve investigators' research capacity and the development of an evidence-based approach of TCM. PMID:28373888

  15. Clinical exome sequencing: results from 2819 samples reflecting 1000 families

    PubMed Central

    Trujillano, Daniel; Bertoli-Avella, Aida M; Kumar Kandaswamy, Krishna; Weiss, Maximilian ER; Köster, Julia; Marais, Anett; Paknia, Omid; Schröder, Rolf; Garcia-Aznar, Jose Maria; Werber, Martin; Brandau, Oliver; Calvo del Castillo, Maria; Baldi, Caterina; Wessel, Karen; Kishore, Shivendra; Nahavandi, Nahid; Eyaid, Wafaa; Al Rifai, Muhammad Talal; Al-Rumayyan, Ahmed; Al-Twaijri, Waleed; Alothaim, Ali; Alhashem, Amal; Al-Sannaa, Nouriya; Al-Balwi, Mohammed; Alfadhel, Majid; Rolfs, Arndt; Abou Jamra, Rami

    2017-01-01

    We report our results of 1000 diagnostic WES cases based on 2819 sequenced samples from 54 countries with a wide phenotypic spectrum. Clinical information given by the requesting physicians was translated to HPO terms. WES processes were performed according to standardized settings. We identified the underlying pathogenic or likely pathogenic variants in 307 families (30.7%). In further 253 families (25.3%) a variant of unknown significance, possibly explaining the clinical symptoms of the index patient was identified. WES enabled timely diagnosing of genetic diseases, validation of causality of specific genetic disorders of PTPN23, KCTD3, SCN3A, PPOX, FRMPD4, and SCN1B, and setting dual diagnoses by detecting two causative variants in distinct genes in the same patient. We observed a better diagnostic yield in consanguineous families, in severe and in syndromic phenotypes. Our results suggest that WES has a better yield in patients that present with several symptoms, rather than an isolated abnormality. We also validate the clinical benefit of WES as an effective diagnostic tool, particularly in nonspecific or heterogeneous phenotypes. We recommend WES as a first-line diagnostic in all cases without a clear differential diagnosis, to facilitate personal medical care. PMID:27848944

  16. 21 CFR 862.2400 - Densitometer/scanner (integrating, reflectance, TLC, or radiochromatogram) for clinical use.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... (integrating, reflectance, thin-layer chromatography, or radiochromatogram) for clinical use is device intended to measure the concentration of a substance on the surface of a film or other support media by...

  17. 21 CFR 862.2400 - Densitometer/scanner (integrating, reflectance, TLC, or radiochromatogram) for clinical use.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... (integrating, reflectance, thin-layer chromatography, or radiochromatogram) for clinical use is device intended to measure the concentration of a substance on the surface of a film or other support media by...

  18. Mentalizing Makes Parenting Work: A Review about Parental Reflective Functioning and Clinical Interventions to Improve It.

    PubMed

    Camoirano, Andrea

    2017-01-01

    In the last decade several studies have investigated the role of parental reflective functioning (RF), defined as the parental ability to understand his/her child's mental states, on the child's development. Herein, a narrative review on parental RF is presented aimed at (1) presenting an overview of the existing empirical studies, (2) pinpointing unrequited questions, and (3) identifying future research directions. Specifically, the current review focused on (a) the impact of parental RF on the quality of caregiving and the child's attachment security, (b) the effect of parental RF on the child's emotion regulation and the child's RF, (c) maternal RF in women with a history of neglect and abuse, (d) the efficacy of mentalization-based clinical interventions, and (e) the recently developed Parental Reflective Questionnaire. The following terms "maternal RF," "paternal RF," "parental RF," "parental mentalization," "maternal mentalization," and "paternal mentalization" were searched in titles, abstracts, and main texts using Medline, Web of Science, and Scopus databases. Next, a search in Mendeley was also conducted. Inclusion criteria comprised original articles if they refer to the RF Scale (Fonagy et al., 1998) and were published in an English language, peer-reviewed journal before July, 2016. According to exclusion criteria, dissertations, qualitative or theoretical papers, and chapters in books were not taken into account. The review includes 47 studies that, taken together, supported the notion that higher parental RF was associated with adequate caregiving and the child's attachment security, whereas low maternal RF was found in mothers whose children suffered from anxiety disorders, impairment in emotion regulation, and externalizing behaviors. In addition, higher parental RF was associated with better mentalizing abilities in children. However, unexpected findings have emerged from the most recent randomized controlled trials that tested the efficacy of

  19. Generic Reflective Feedback: An Effective Approach to Developing Clinical Reasoning Skills

    ERIC Educational Resources Information Center

    Wojcikowski, K.; Brownie, S.

    2013-01-01

    Problem-based learning can be an effective tool to develop clinical reasoning skills. However, it traditionally takes place in tutorial groups, giving students little flexibility in how and when they learn. This pilot study compared the effectiveness of generic reflective feedback (GRF) with tutorial-based reflective feedback on the development of…

  20. They Went, They Saw, They Learned: Medical Students' Reflections on Community Clinic Visits

    ERIC Educational Resources Information Center

    Beylefeld, Adriana A.

    2014-01-01

    Medicine has become a profession with increasing accountability to the needs of society. To meet this need, real-world, community-located experiences and reflection are frequently used to promote students' learning and personal growth. This article reports first-year medical students' reflective writing after visiting a primary healthcare clinic.…

  1. Diffuse reflectance spectroscopy: towards clinical application in breast cancer.

    PubMed

    Evers, Daniel J; Nachabe, Rami; Vranken Peeters, Marie-Jeanne; van der Hage, Jos A; Oldenburg, Hester S; Rutgers, Emiel J; Lucassen, Gerald W; Hendriks, Benno H W; Wesseling, Jelle; Ruers, Theo J M

    2013-01-01

    Diffuse reflectance spectroscopy (DRS) is a promising new technique for breast cancer diagnosis. However, inter-patient variation due to breast tissue heterogeneity may interfere with the accuracy of this technique. To tackle this issue, we aim to determine the diagnostic accuracy of DRS in individual patients. With this approach, DRS measurements of normal breast tissue in every individual patient are directly compared with measurements of the suspected malignant tissue. Breast tissue from 47 female patients was analysed ex vivo by DRS. A total of 1,073 optical spectra were collected. These spectra were analyzed for each patient individually as well as for all patients collectively and results were compared to the pathology analyses. Collective patient data analysis for discrimination between normal and malignant breast tissue resulted in a sensitivity of 90 %, a specificity of 88 %, and an overall accuracy of 89 %. In the individual analyses all measurements per patient were categorized as either benign or malignant. The discriminative accuracy of these individual analyses was nearly 100 %. The diagnosis was classified as uncertain in only one patient. Based on the results presented in this study, we conclude that the analysis of optical characteristics of different tissue classes within the breast of a single patient is superior to an analysis using the results of a cohort data analysis. When integrated into a biopsy device, our results demonstrate that DRS may have the potential to improve the diagnostic workflow in breast cancer.

  2. Development of reflective judgement in the pre-doctoral dental clinical curriculum.

    PubMed

    Boyd, L D

    2008-08-01

    When dental students begin patient care in the clinical curriculum, they are required to move from the well-defined problems of the classroom to the more ambiguous and real life problems encountered in the context of patient care in the clinical setting. This change in learning environment requires development of reflective thinking. Reflective thinking refers to the process of thinking about uncertainty or ill-defined problems. King and Kitchener refer to the outcome of the reflective thinking process as reflective judgement. The purpose of this study was to explore the development of reflective judgement in the initial phase of the clinical curriculum. This exploratory study used a case study approach with qualitative methods. A convenience sample of third year predoctoral dental students (n = 16) volunteered to participate in writing a clinic journal and semi-structured interviews at three time points over a time period of one year. Student compliance in writing clinical journals was poor; therefore the qualitative data was primarily gathered from interview transcripts. The qualitative interview data were analysed using a coding scheme based on King and Kitchener's Reflective Judgement Model of Intellectual Development. The Cronbach alpha was 0.76 for reliability of the coding scheme. Based on the analysis of interview data, the there was an average growth in reflective judgement over the year from Stage 4.89 to 5.59 for an overall change of +0.70. Additional research is needed to explore the growth in reflective judgement over the final year of the clinical curriculum as well as to identify the most effective educational strategies to facilitate growth in reflective judgment.

  3. Journaling and dialogue pairs to promote reflection in clinical nursing education.

    PubMed

    Van Horn, Rita; Freed, Shirley

    2008-01-01

    This research focused on the use of writing to increase reflection and problem solving in the clinical setting. Two groups of associate degree students provided clinical care and maintained journals, answering a series of focused questions. One group of students worked as individuals in the clinical setting; the other consisted of students working in pairs. There were significant differences between levels of reflection of students who worked in pairs and those who were not paired. Three major themes were found in students' journals: emotions, connections between theory and practice, and learning.

  4. Surge capacity for response to bioterrorism in hospital clinical microbiology laboratories.

    PubMed

    Shapiro, Daniel S

    2003-12-01

    Surge capacity is the ability to rapidly mobilize to meet an increased demand. While large amounts of federal funding have been allocated to public health laboratories, little federal funding has been allocated to hospital microbiology laboratories. There are concerns that hospital laboratories may have inadequate surge capacities to deal with a significant bioterrorism incident. A workflow analysis of a clinical microbiology laboratory that serves an urban medical center was performed to identify barriers to surge capacity in the setting of a bioterrorism event and to identify solutions to these problems. Barriers include a national shortage of trained medical technologists, the inability of clinical laboratories to deal with a dramatic increase in the number of blood cultures, a delay while manufacturers increase production of critical products and then transport and deliver these products to clinical laboratories, and a shortage of class II biological safety cabinets. Federal funding could remedy staffing shortages by making the salaries of medical technologists comparable to those of similarly educated health care professionals and by providing financial incentives for students to enroll in clinical laboratory science programs. Blood culture bottles, and possibly continuous-monitoring blood culture instruments, should be added to the national antibiotic stockpile. Federal support must ensure that companies that manufacture essential laboratory supplies are capable of rapidly scaling up production. Hospitals must provide increased numbers of biological safety cabinets and amounts of space dedicated to clinical microbiology laboratories. Laboratories should undertake limited cross-training of technologists, ensure that adequate packaging supplies are available, and be able to move to a 4-day blood culture protocol.

  5. Building capacity for clinical research in developing countries: the INDOX Cancer Research Network experience.

    PubMed

    Ali, Raghib; Finlayson, Alexander; Indox Cancer Research Network

    2012-01-01

    Transnational Organisations increasingly prioritise the need to support local research capacity in low and middle income countries in order that local priorities are addressed with due consideration of contextual issues. There remains limited evidence on the best way in which this should be done or the ways in which external agencies can support this process.We present an analysis of the learning from the INDOX Research Network, established in 2005 as a partnership between the Institute of Cancer Medicine at the University of Oxford and India's top nine comprehensive cancer centres. INDOX aims to enable Indian centres to conduct clinical research to the highest international standards; to ensure that trials are developed to address the specific needs of Indian patients by involving Indian investigators from the outset; and to provide the training to enable them to design and conduct their own studies. We report on the implementation, outputs and challenges of simultaneously trying to build capacity and deliver meaningful research output.

  6. Mentalizing Makes Parenting Work: A Review about Parental Reflective Functioning and Clinical Interventions to Improve It

    PubMed Central

    Camoirano, Andrea

    2017-01-01

    In the last decade several studies have investigated the role of parental reflective functioning (RF), defined as the parental ability to understand his/her child’s mental states, on the child’s development. Herein, a narrative review on parental RF is presented aimed at (1) presenting an overview of the existing empirical studies, (2) pinpointing unrequited questions, and (3) identifying future research directions. Specifically, the current review focused on (a) the impact of parental RF on the quality of caregiving and the child’s attachment security, (b) the effect of parental RF on the child’s emotion regulation and the child’s RF, (c) maternal RF in women with a history of neglect and abuse, (d) the efficacy of mentalization-based clinical interventions, and (e) the recently developed Parental Reflective Questionnaire. The following terms “maternal RF,” “paternal RF,” “parental RF,” “parental mentalization,” “maternal mentalization,” and “paternal mentalization” were searched in titles, abstracts, and main texts using Medline, Web of Science, and Scopus databases. Next, a search in Mendeley was also conducted. Inclusion criteria comprised original articles if they refer to the RF Scale (Fonagy et al., 1998) and were published in an English language, peer-reviewed journal before July, 2016. According to exclusion criteria, dissertations, qualitative or theoretical papers, and chapters in books were not taken into account. The review includes 47 studies that, taken together, supported the notion that higher parental RF was associated with adequate caregiving and the child’s attachment security, whereas low maternal RF was found in mothers whose children suffered from anxiety disorders, impairment in emotion regulation, and externalizing behaviors. In addition, higher parental RF was associated with better mentalizing abilities in children. However, unexpected findings have emerged from the most recent randomized controlled

  7. Evaluation of a Clinical Cancer Trial Research Training Workshop: Helping Nurses Build Capacity in Southwest Virginia.

    PubMed

    Burnett, Camille; Bullock, Linda; Collins, Cathleen A; Hauser, Lindsay

    2016-11-01

    Residents of Southwest Virginia (SWVA) face significant barriers in accessing the most advanced forms of cancer care, cancer risk reduction, and clinical trials involvement. A collaboration between the University of Virginia (UVA) Cancer Center and UVA School of Nursing was forged with oncology caregivers in this region to build community capacity to support Cancer Clinical trials (CCT) by strengthening the workforce, and thus improving health outcomes for this underserved region of Appalachia. The UVA School of Nursing designed an educational workshop focusing on the basics of CCT to facilitate the development of a skilled nursing workforce in the SWVA region that could provide care to patients on protocol and/or to encourage residents to participate in trials. The goal of the workshop was to offer a CCT training session for oncology nurses that fostered the knowledge and skills necessary to facilitate and support CCT infrastructure across this high-risk region. This evaluation reports the learning outcomes of the CCT training on 32 nurse participants from SWVA. Evaluations of the training program showed high rates of satisfaction, increased comfort level with CCTs, and increased knowledge and attitude toward CCTs. These findings provide information about a curriculum that could be useful in educating other oncology nurses and student nurses how to care for patients who may be enrolled in a clinical trial. Nurses can also be advocates for participation in clinical trials once they have the knowledge and are comfortable in their own understanding of a trial's usefulness. Educating the nursing workforce is an essential component of building capacity and infrastructure to support clinical trials research.

  8. The Use of Reflection and Inquiry in an Online Clinical Post-Conference

    ERIC Educational Resources Information Center

    Zapko, Karen A.

    2013-01-01

    An important goal of nursing education is to produce graduates who are problem solvers and competent clinical practitioners able to practice in a very complicated health care environment; reflection and inquiry are two ways to accomplish this goal. This qualitative study explored how eight senior baccalaureate nursing students developed in their…

  9. Reflections of physiotherapy students in the United Arab Emirates during their clinical placements: A qualitative study

    PubMed Central

    Larin, Hélène; Wessel, Jean; Al-Shamlan, Amal

    2005-01-01

    Background Although Western models of education are being used to establish health professional programs in non-Western countries, little is known about how students in these countries perceive their learning experiences. The purpose of this qualitative study was to describe the reflections of physiotherapy students from a Middle East culture during their clinical placements and to compare them to reflections of physiotherapy students from a Western culture. Methods Subjects were six senior students (3 females, 3 males, mean age 22.6 years) and 15 junior, female students (mean age 20.1 years) in the baccalaureate physiotherapy program at a university in the United Arab Emirates (UAE). They wrote weekly entries in a journal while in their clinical placements. They described an event, their reaction to it, and how it might affect their future behavior. Two evaluators independently read and coded the content of all the journals, and then worked together to categorize the data and develop themes. A third evaluator, an UAE national, independently read the journals to validate the content analysis. A feedback session with students was used to further validate the data interpretation. The themes were compared to those derived from a similar study of Canadian physiotherapy students. Results The content of the students' reflections were grouped into 4 themes: professional behavior, awareness of learning, self-development and shift to a patient orientation, and identification and analysis of ethical issues. Although the events were different, students from the UAE considered many of the same issues reflected on by Canadian students. Conclusion Physiotherapy students from a Middle East culture consider many of the same issues as students from a Western culture when asked to reflect on their clinical experience. They reflect on their personal growth, on how they learn in a clinical setting, and on the ethical and professional behaviors of themselves and others. PMID:15661079

  10. A Data-Driven Approach For Better Assignment Of Clinical And Surgical Capacity In An Elective Surgical Practice

    PubMed Central

    Martinez, Gabriela; Bernard, Brian J.; Larson, David W.; Pasupathy, Kalyan S.; Sir, Mustafa Y.

    2016-01-01

    This work analyzes strategies for better allocation of surgeon resources in an elective surgical practice. Among the metrics considered to evaluate the assignment of tasks are OR-to-Clinic ratio per provider, OR-to-Clinic ratio per day, patient access to clinic, and patient access to surgery. In addition, a simulation model is used to evaluate the clinical and surgical capacity of the calendar to identify potential inefficiencies and propose strategic changes to the calendar. PMID:28269884

  11. Self-regulated learning during a clinical preceptorship: the reflections of senior baccalaureate nursing students.

    PubMed

    Kuiper, RuthAnne

    2005-01-01

    This research was conducted to test the efficacy of audiotapes as a method of recording reflections of senior baccalaureate nursing students in a clinical preceptorship. The over-all aim of the research was to promote cognitive and metacognitive thinking processes with self-regulated learning strategies for problem solving in clinical situations. Verbal protocol technique revealed a consistent use of self-regulated learning strategies with a focus on environmental structuring for metacognitive activities. Common themes of thought were found in both clinical experiences and the use of critical thinking skills.

  12. Narrative thematic analysis of baccalaureate nursing students' reflections: critical thinking in the clinical education context.

    PubMed

    Naber, Jessica L; Hall, Joanne; Schadler, Craig Matthew

    2014-09-01

    This study sought to identify characteristics of clinically situated critical thinking in nursing students' reflections, originally part of a study guided by Richard Paul's model of critical thinking. Nurses are expected to apply critical thinking in all practice situations to improve health outcomes, including patient safety and satisfaction. In a previous study, Paul's model of critical thinking was used to develop questions for reflective writing assignments. Within that study, 30 nursing students completed six open-ended narratives of nurse-patient clinical encounters during an 8-week period. Improvements were seen in critical thinking scores after the intervention. This article reports the qualitative analysis of the content of six open-ended narratives. Six overarching themes were identified and combined into a tentative conceptual model. Faculty's understanding of the characteristics of critical thinking in the context of clinical education will help them to teach and evaluate students' progress and competencies for future practice.

  13. Learning from clinical placement experience: Analysing nursing students' final reflections in a digital storytelling activity.

    PubMed

    Paliadelis, Penny; Wood, Pamela

    2016-09-01

    This paper reports on the learning potential of a reflective activity undertaken by final year nursing students, in which they were asked to recount two meaningful events that occurred during their clinical placements over the duration of their 3-year nursing degree program and reflect on how these events contributed to their learning to become beginning level Registered Nurses (RNs). This descriptive qualitative study gathered narratives from 92 students as individual postings in an online forum created within the University's learning management system. An analysis of the students' reflections are the focus of this paper particularly in relation to the value of reflecting on the identified events. Four themes emerged that clearly highlight the way in which these students interpreted and learned from both positive and negative clinical experiences, their strong desire to fit into their new role and their ability to re-imagine how they might respond to clinical events when they become Registered Nurses. The findings of this study may contribute to developing nursing curricula that better prepares final year students for the realities of practice.

  14. The clinical utility of functional capacity evaluations: the opinion of health professionals working within occupational rehabilitation.

    PubMed

    James, Carole; MacKenzie, Lynette

    2009-01-01

    Functional Capacity Evaluations (FCE's) are used within the occupational rehabilitation arena with the aim of assessing an individual's functional abilities in relation to work tasks. Therapists use a variety of different FCE's, both standardized and non standardized. This study aimed to investigate therapists' views on the clinical utility of FCE's in general and to identify if these differed between professional groups. A cross sectional study design was used. Health professionals who conduct FCE's and who worked for WorkCover accredited rehabilitation providers in NSW were surveyed. Surveys were returned from 79 participants working for 65 different rehabilitation providers. Of those who replied, 82\\% (n=63) were occupational therapists, 13% (n=10) physiotherapists and 5% (n=5) exercise physiologists. The mean years of professional experience was 10.9 years and the mean years of FCE experience was 5.3 years. Data were analyzed using STATA [v8.0] and the clinical utility of FCE's was considered relating to: usefulness & relevance; adaptability and flexibility; therapist perceived requirements and issues in practice. No differences were found related to the clinical utility of FCE's between professional groups or years of professional experience. The results suggest consistency and similarities in how FCE's are currently used in practice across NSW (Australia). Limitations of this study and areas for further research are suggested.

  15. Does Reflective Learning with Feedback Improve Dental Students' Self-Perceived Competence in Clinical Preparedness?

    PubMed

    Ihm, Jung-Joon; Seo, Deog-Gyu

    2016-02-01

    The value of dental students' self-assessment is often debated. The aim of this study was to explore whether reflective learning with feedback enabled dental students to more accurately assess their self-perceived levels of preparedness on dental competencies. Over 16 weeks, all third- and fourth-year students at a dental school in the Republic of Korea took part in clinical rotations that incorporated reflective learning and feedback. Following this educational intervention, they were asked to assess their perceptions of their clinical competence. The results showed that the students reported feeling most confident about performing periodontal treatment (mean 7.1 on a ten-point scale) and least confident about providing orthodontic care (mean 5.6). The fourth-year students reported feeling more confident on all the competencies than the third-year students. Their self-perceived competence in periodontal treatment and oral medicine significantly predicted the instructors' clinical evaluations. This study offered insights into determining if structured reflective learning with effective feedback helps to increase dental students' self-perceived level of clinical preparedness.

  16. An Integrative Professional Theory and Practice Paper: Personal Reflections from the Journey through Clinical Pastoral Education.

    PubMed

    McLean, Gillian

    2015-12-01

    CPE is an experience-based approach to learning spiritual care which combines clinical care with qualified supervision, in-class education and group reflection (CASC--http://www.spiritualcare.ca/). Through didactic seminars, group presentations and personal reading there is opportunity for the student to acquire, apply and integrate relevant theoretical information into their practice. Written for my CPE Specialist application, this paper describes how, through the course of advanced CPE education, I learn to utilize and integrate theory into my clinical work. Beginning with three strands--authenticity, listening and storytelling--I then discuss how the behavioural sciences and theology inform my practice. Focusing on empathy, I speak of the application of disclosure, the use of counter-transference as a diagnostic tool, and the place of therapeutic termination. Group theory, family systems theory, theological reflection, liturgical ministry, and multi-faith practices are considered.

  17. STRENGTHENING THE REFLECTIVE FUNCTIONING CAPACITIES OF PARENTS WHO HAVE A CHILD WITH A NEURODEVELOPMENTAL DISABILITY THROUGH A BRIEF, RELATIONSHIP-FOCUSED INTERVENTION.

    PubMed

    Sealy, Julie; Glovinsky, Ira P

    2016-01-01

    This randomized controlled trial examined the reflective functioning capacities of caregivers who have a child with a neurodevelopmental disorder between the ages of 2 years 0 months and 6 years 11 months. Children with a neurodevelopmental disorder receive a range of diagnoses, including sutism; however, they all exhibit social communication challenges that can derail social relationships. Forty parent-child dyads in Barbados were randomly assigned to either a developmental individual-difference, relationship-based/floortime(DIR/FT) group (n = 20), or a psychoeducational (wait-list) group (n = 20) with parental reflective functioning measured before and after a 12-week DIR/FT treatment intervention. Results revealed significant gains in parental reflective functioning in the treatment group, as compared to the psychoeducational (wait-list) group, after the 12-week relationship-focused intervention.

  18. Does reflective web-based discussion strengthen nursing students' learning experiences during clinical training?

    PubMed

    Mettiäinen, Sari; Vähämaa, Kristiina

    2013-09-01

    The aim of this research was to study how a web-based discussion forum can be used as a supervision tool during nursing students' clinical training. The study emphasises peer support and its importance for the students. The empirical research was carried out at a Finnish university of applied sciences. 25 nursing students took part in web-based discussion during their eight-week clinical training period. All in all, 395 comments were submitted. The material was analysed by using categorisation and a thematic analysis process. Finally, the results were reported using a modified Salmon's (2002) 5-stage model of Teaching and Learning On-line and Mezirow's (1981) levels of reflection. The students motivated each other by sharing their feelings and experiences. They noticed the value of peer support and started to learn from each other as well. By reflecting on their experiences, the students progressed in their learning process and at the same time advanced their reflective thinking process. This combination of theoretical knowledge and practice, based on the students' needs and interests, could lead to a deeper understanding which could also result in better clinical skills. This method offers the lecturers the possibility to support and follow the professional growth process in a new evidence-based manner.

  19. Virtual Patients in Primary Care: Developing a Reusable Model That Fosters Reflective Practice and Clinical Reasoning

    PubMed Central

    Zary, Nabil; Björklund, Karin; Toth-Pal, Eva; Leanderson, Charlotte

    2014-01-01

    Background Primary care is an integral part of the medical curriculum at Karolinska Institutet, Sweden. It is present at every stage of the students’ education. Virtual patients (VPs) may support learning processes and be a valuable complement in teaching communication skills, patient-centeredness, clinical reasoning, and reflective thinking. Current literature on virtual patients lacks reports on how to design and use virtual patients with a primary care perspective. Objective The objective of this study was to create a model for a virtual patient in primary care that facilitates medical students’ reflective practice and clinical reasoning. The main research question was how to design a virtual patient model with embedded process skills suitable for primary care education. Methods The VP model was developed using the Open Tufts University Sciences Knowledgebase (OpenTUSK) virtual patient system as a prototyping tool. Both the VP model and the case created using the developed model were validated by a group of 10 experienced primary care physicians and then further improved by a work group of faculty involved in the medical program. The students’ opinions on the VP were investigated through focus group interviews with 14 students and the results analyzed using content analysis. Results The VP primary care model was based on a patient-centered model of consultation modified according to the Calgary-Cambridge Guides, and the learning outcomes of the study program in medicine were taken into account. The VP primary care model is based on Kolb’s learning theories and consists of several learning cycles. Each learning cycle includes a didactic inventory and then provides the student with a concrete experience (video, pictures, and other material) and preformulated feedback. The students’ learning process was visualized by requiring the students to expose their clinical reasoning and reflections in-action in every learning cycle. Content analysis of the focus

  20. A preclinical rodent model of acute radiation-induced lung injury after ablative focal irradiation reflecting clinical stereotactic body radiotherapy.

    PubMed

    Hong, Zhen-Yu; Lee, Hae-June; Choi, Won Hoon; Lee, Yoon-Jin; Eun, Sung Ho; Lee, Jung Il; Park, Kwangwoo; Lee, Ji Min; Cho, Jaeho

    2014-07-01

    In a previous study, we established an image-guided small-animal micro-irradiation system mimicking clinical stereotactic body radiotherapy (SBRT). The goal of this study was to develop a rodent model of acute phase lung injury after ablative irradiation. A radiation dose of 90 Gy was focally delivered to the left lung of C57BL/6 mice using a small animal stereotactic irradiator. At days 1, 3, 5, 7, 9, 11 and 14 after irradiation, the lungs were perfused with formalin for fixation and paraffin sections were stained with hematoxylin and eosin (H&E) and Masson's trichrome. At days 7 and 14 after irradiation, micro-computed tomography (CT) images of the lung were taken and lung functional measurements were performed with a flexiVent™ system. Gross morphological injury was evident 9 days after irradiation of normal lung tissues and dynamic sequential events occurring during the acute phase were validated by histopathological analysis. CT images of the mouse lungs indicated partial obstruction located in the peripheral area of the left lung. Significant alteration in inspiratory capacity and tissue damping were detected on day 14 after irradiation. An animal model of radiation-induced lung injury (RILI) in the acute phase reflecting clinical stereotactic body radiotherapy was established and validated with histopathological and functional analysis. This model enhances our understanding of the dynamic sequential events occurring in the acute phase of radiation-induced lung injury induced by ablative dose focal volume irradiation.

  1. A Difficult Journey: Reflections on Driving and Driving Cessation From a Team of Clinical Researchers.

    PubMed

    Liddle, Jacki; Gustafsson, Louise; Mitchell, Geoffrey; Pachana, Nancy A

    2017-02-01

    Recognizing the clinical importance and safety and well-being implications for the population, a multidisciplinary team has been researching older drivers and driving cessation issues for more than 15 years. Using empirical approaches, the team has explored quality of life and participation outcomes related to driving and nondriving for older people and has developed interventions to improve outcomes after driving cessation. The team members represent occupational therapists, medical practitioners, and clinical and neuropsychologists. While building the evidence base for driving- and driving cessation-related clinical practice, the researchers have also had first-hand experiences of interruptions to their own or parents' driving; involvement of older family members in road crashes; and provision of support during family members' driving assessment and cessation. This has led to reflection on their understandings and re-evaluation and refocusing of their perspectives in driving cessation research. This work will share the narratives of the authors and note their developing perspectives and foci within research as well as their clinical practice. Personal reflections have indicated the far-reaching implications for older drivers and family members of involvement in road crashes: the potential for interruptions to driving as a time for support and future planning and the conflicting and difficult roles of family members within the driving cessation process. Overall the lived, personal experience of the authors has reinforced the complex nature of driving and changes to driving status for the driver and their support team and the need for further research and support.

  2. Enhancing Capacity for Success in the Creative Industries: Undergraduate Student Reflections on the Implementation of Work-Integrated Learning Strategies

    ERIC Educational Resources Information Center

    Daniel, Ryan; Daniel, Leah

    2015-01-01

    This article reflects on ongoing research-led teaching in the area of creative industries in higher education. Specifically it reports on key work-integrated learning strategies designed to better prepare graduates for the employment sector. The creative industries sector is complex and competitive, characterized by non-linear career paths driven…

  3. Meeting local complex health needs by building the capacity of general practice: the University of Queensland GP super clinic model.

    PubMed

    Dart, Jared M; Jackson, Claire L; Chenery, Helen J; Shaw, Paul N; Wilkinson, David

    2010-07-19

    The GP Super Clinics Program is a highly topical and controversial initiative with varying levels of support within the policy, consumer and health care communities. Here, we describe the GP super clinic initiative of the University of Queensland (UQ), and how it aims to enhance primary-care capacity in the regions where clinics are based. The UQ GP super clinic model has considered the concerns of general practitioners, patients and other stakeholders, and addresses the needs of these groups while providing an excellent opportunity for the university to be involved in innovative service delivery, community-based education, primary-care service design and evaluation.

  4. Hiding clinical information in medical images: A new high capacity and reversible data hiding technique.

    PubMed

    Parah, Shabir A; Ahad, Farhana; Sheikh, Javaid A; Bhat, G M

    2017-02-01

    A new high capacity and reversible data hiding scheme for e-healthcare applications has been presented in this paper. Pixel to Block (PTB) conversion technique has been used as an effective and computationally efficient alternative to interpolation for the cover image generation to ensure reversibility of medical images. A fragile watermark and Block Checksum (computed for each 4×4 block) have been embedded in the cover image for facilitating tamper detection and tamper localization, and hence content authentication at receiver. The EPR, watermark data and checksum data has been embedded using Intermediate Significant Bit Substitution (ISBS) to avoid commonly used LSB removal/replacement attack. Non-linear dynamics of chaos have been put to use for encrypting the Electronic Patient Record (EPR)/clinical data and watermark data for improving the security of data embedded. The scheme has been evaluated for perceptual imperceptibility and tamper detection capability by subjecting it to various image processing and geometric attacks. Experimental results reveal that the proposed system besides being completely reversible is capable of providing high quality watermarked images for fairly high payload. Further, it has been observed that the proposed technique is able to detect and localise the tamper. A comparison of the observed results with that of some state-of-art schemes show that our scheme performs better.

  5. Clinical assessment of decision-making capacity in acquired brain injury with personality change

    PubMed Central

    Owen, Gareth S.; Freyenhagen, Fabian; Martin, Wayne; David, Anthony S.

    2017-01-01

    Assessment of decision-making capacity (DMC) can be difficult in acquired brain injury (ABI) particularly with the syndrome of organic personality disorder (OPD) (the “frontal lobe syndrome”). Clinical neuroscience may help but there are challenges translating its constructs to the decision-making abilities considered relevant by law and ethics. An in-depth interview study of DMC in OPD was undertaken. Six patients were purposefully sampled and rich interview data were acquired for scrutiny using interpretative phenomenological analysis. Interview data revealed that awareness of deficit and thinking about psychological states can be present. However, the awareness of deficit may not be “online” and effectively integrated into decision-making. Without this online awareness of deficit the ability to appreciate or use and weigh information in the process of deciding some matters appeared absent. We argue that the decision-making abilities discussed are: (1) necessary for DMC, (2) threatened by ABI , and (3) assessable at interview. Some advice for practically incorporating these abilities within assessments of DMC in patients with OPD is outlined. PMID:26088818

  6. Building a Long Distance Training Program to Enhance Clinical Cancer Research Capacity in Puerto Rico

    PubMed Central

    Appleyard, Caroline B.; Antonia, Scott J.; Sullivan, Daniel M.; Santiago-Cardona, Pedro G.; Cáceres, William; Velez, Hector; Torres-Ruiz, Jose A.; Wright, Kenneth L.

    2015-01-01

    Barriers persist in the development and delivery of effective cancer therapies to under-represented minority populations. In Puerto Rico, cancer is the second leading cause of death, yet cancer research awareness and training opportunities remain somewhat limited on the island. These limitations hinder progress toward decreasing the cancer health disparities that exist within the Puerto Rican population. The predominantly Hispanic population of Puerto Rico is the focus of a partnership between the Ponce Health Sciences University-Medical School and Ponce Research Institute (PHSU) in Ponce, Puerto Rico and the H. Lee Moffitt Cancer Center in Tampa, Florida. The Partnership goals are to reduce these barriers through an integrated, multipronged approach of training and education alongside outreach and research components. This report describes the approaches, successes and challenges of enhancing clinical cancer research capacity on the island and the unique challenges of a partnership between two institutes physically separated by long distances. Once fully developed this model may be exportable to other Latin American countries where the need is even greater. PMID:25626061

  7. [Recipient capacity of clinical strains of staphylococci belonging to different phage groups].

    PubMed

    Ponomareva, T R; Smolianskaia, A Z

    1976-11-01

    The recipient capacity of the strains of Staph. epidermidis and Staph. areus belonging to different phage groups, as well as the possibility of epidemic distribution of the erythromycin resistance marker among the clinical staphyloccal strains on using the defective phage obtained from strain 8325 P IIde was studied. The defective phage P IIde may be the source of epidemic distribution of the drug resistance among the competent strains of Staph. aureus. All erythromycin sensitive strains of Staph. aureus lysed by the phages of groups I and III proved to be competent recipients of the erythromycin resistance marker. The strains of Staph. aureus of phage group II and phage type 80/81, as well as the strains of Staph. epidermidis were not competent recipients under our experimental conditions. It was not possible to transfer the high level of erythromycin resistance (1000 gamma/ml) on transduction to the strains of phage group I with a relatively low level of resistance to this antibiotic (20-50 gamma/ml.

  8. A Retrospective Study on Students’ and Teachers’ Perceptions of the Reflective Ability Clinical Assessment

    PubMed Central

    Bosnic-Anticevich, Sinthia; Smith, Lorraine

    2016-01-01

    Objective. To evaluate student and teacher perceptions of the utility of the Reflective Ability Clinical Assessment (RACA) in an undergraduate pharmacy curriculum at an Australian university. Methods. A mixed-method study comprising the administration of a 7-item student survey on a 6-point Likert-type scale and a 45-minute focus group/phone interview with teachers. Results. Student (n=199) and teaching staff respondents (n=3) provided their perceptions of the implementation of the new educational tool. Student responses showed significant positive correlations between self-directed learning, counseling skills, relevance to future practice, and performance in an oral examination. Seven key themes emerged from the teacher interviews. Conclusion. The study revealed both students and teachers perceive the RACA as an effective educational tool that may enhance skill development for future clinical practice. PMID:27667838

  9. A Model for Strengthening Collaborative Research Capacity: Illustrations from the Atlanta Clinical Translational Science Institute

    ERIC Educational Resources Information Center

    Rodgers, Kirsten C.; Akintobi, Tabia; Thompson, Winifred Wilkins; Evans, Donoria; Escoffery, Cam; Kegler, Michelle C.

    2014-01-01

    Introduction: Community-engaged research is effective in addressing health disparities but may present challenges for both academic institutions and community partners. Therefore, the need to build capacity for conducting collaborative research exists. The purpose of this study is to present a model for building research capacity in…

  10. A clinical evaluation of the ability of the Dentobuff method to estimate buffer capacity of saliva.

    PubMed

    Wikner, S; Nedlich, U

    1985-01-01

    The power of a colourimetric method to estimate buffer capacity of saliva (Dentobuff) was compared with an electrometric method in 220 adults. The methods correlated well but Dentobuff frequently underestimated high buffer values which was considered to be of minor practical importance. Dentobuff identified groups with low, intermediate and high buffer capacity as good as the electrometric method.

  11. Decision-making capacity and competency in the elderly: a clinical and neuropsychological perspective.

    PubMed

    Moberg, Paul J; Rick, Jacqueline H

    2008-01-01

    With our ageing population, the number of older adults with cognitive impairment has also increased. There is both an acute and growing need for evidence-based assessments to identify their decision making capacity and competence. In the present article we (1) present definitions of decision-making capacity and competence, (2) review cognitive functions that are central to decision-making capacity as well as the methods and procedures commonly used to assess these domains, and (3) address the communication of assessment findings to patients and their loved ones. The importance of assessing decision-making capacity in the context of specific functions and of respecting the values and interests of older adults are emphasized.

  12. Non-invasive detection of periodontal disease using diffuse reflectance spectroscopy: a clinical study

    NASA Astrophysics Data System (ADS)

    Prasanth, Chandra Sekhar; Betsy, Joseph; Subhash, Narayanan; Jayanthi, Jayaraj L.; Prasanthila, Janam

    2012-03-01

    In clinical diagnostic procedures, gingival inflammation is considered as the initial stage of periodontal breakdown. This is often detected clinically by bleeding on probing as it is an objective measure of inflammation. Since conventional diagnostic procedures have several inherent drawbacks, development of novel non-invasive diagnostic techniques assumes significance. This clinical study was carried out in 15 healthy volunteers and 25 patients to demonstrate the applicability of diffuse reflectance (DR) spectroscopy for quantification and discrimination of various stages of inflammatory conditions in periodontal disease. The DR spectra of diseased lesions recorded using a point monitoring system consisting of a tungsten halogen lamp and a fiber-optic spectrometer showed oxygenated hemoglobin absorption dips at 545 and 575 nm. Mean DR spectra on normalization shows marked differences between healthy and different stages of gingival inflammation. Among the various DR intensity ratios investigated, involving oxy Hb absorption peaks, the R620/R575 ratio was found to be a good parameter of gingival inflammation. In order to screen the entire diseased area and its surroundings instantaneously, DR images were recorded with an EMCCD camera at 620 and 575 nm. We have observed that using the DR image intensity ratio R620/R575 mild inflammatory tissues could be discriminated from healthy with a sensitivity of 92% and specificity of 93%, and from moderate with a sensitivity of 83% and specificity of 96%. The sensitivity and specificity obtained between moderate and severe inflammation are 82% and 76% respectively.

  13. Reflective THz and MR imaging of burn wounds: a potential clinical validation of THz contrast mechanisms

    NASA Astrophysics Data System (ADS)

    Bajwa, Neha; Nowroozi, Bryan; Sung, Shijun; Garritano, James; Maccabi, Ashkan; Tewari, Priyamvada; Culjat, Martin; Singh, Rahul; Alger, Jeffry; Grundfest, Warren; Taylor, Zachary

    2012-10-01

    Terahertz (THz) imaging is an expanding area of research in the field of medical imaging due to its high sensitivity to changes in tissue water content. Previously reported in vivo rat studies demonstrate that spatially resolved hydration mapping with THz illumination can be used to rapidly and accurately detect fluid shifts following induction of burns and provide highly resolved spatial and temporal characterization of edematous tissue. THz imagery of partial and full thickness burn wounds acquired by our group correlate well with burn severity and suggest that hydration gradients are responsible for the observed contrast. This research aims to confirm the dominant contrast mechanism of THz burn imaging using a clinically accepted diagnostic method that relies on tissue water content for contrast generation to support the translation of this technology to clinical application. The hydration contrast sensing capabilities of magnetic resonance imaging (MRI), specifically T2 relaxation times and proton density values N(H), are well established and provide measures of mobile water content, lending MRI as a suitable method to validate hydration states of skin burns. This paper presents correlational studies performed with MR imaging of ex vivo porcine skin that confirm tissue hydration as the principal sensing mechanism in THz burn imaging. Insights from this preliminary research will be used to lay the groundwork for future, parallel MRI and THz imaging of in vivo rat models to further substantiate the clinical efficacy of reflective THz imaging in burn wound care.

  14. Experimental and clinical evaluation of a noninvasive reflectance pulse oximeter sensor.

    PubMed

    Takatani, S; Davies, C; Sakakibara, N; Zurick, A; Kraenzler, E; Golding, L R; Noon, G P; Nose, Y; DeBakey, M E

    1992-10-01

    The objective of this study was to evaluate a new reflectance pulse oximeter sensor. The prototype sensor consists of 8 light-emitting diode (LED) chips (4 at 665 nm and 4 at 820 nm) and a photodiode chip mounted on a single substrate. The 4 LED chips for each wavelength are spaced at 90-degree intervals around the substrate and at an equal radial distance from the photodiode chip. An optical barrier between the photodiode and LED chips prevents a direct coupling effect between them. Near-infrared LEDs (940 nm) in the sensor warm the tissue. The microthermocouple mounted on the sensor surface measures the temperature of the skin-sensor interface and maintains it at a present level by servoregulating the current in the 940-nm LEDs. An animal study and a clinical study were performed. In the animal study, 5 mongrel dogs (weight, 10-20 kg) were anesthetized, mechanically ventilated, and cannulated. In each animal, arterial oxygen saturation (SaO2) was measured continuously by a standard transmission oximeter probe placed on the dog's earlobe and a reflectance oximeter sensor placed on the dog's tongue. In the first phase of the experiment, signals from the reflectance sensor were recorded while the dog was immersed in ice water until its body temperature decreased to 30 degrees C. In the second phase, the animal's body temperature was normal, and the oxygen content of the ventilator was varied to alter the SaO2. In the clinical study, 18 critically ill patients were monitored perioperatively with the prototype reflectance sensor. The first phase of the study investigated the relationship between local skin temperature and the accuracy of oximeter readings with the reflectance sensor. Each measurement was taken at a high saturation level as a function of local skin temperature. The second phase of the study compared measurements of oxygen saturation by a reflectance oximeter (SpO2[r]) with those made by a co-oximeter (SaO2[IL]) and a standard transmission oximeter (Sp

  15. In vivo reflectance-mode confocal microscopy in clinical dermatology and cosmetology.

    PubMed

    González, S; Gilaberte-Calzada, Y

    2008-02-01

    In vivo reflectance confocal microscopy (RCM) is a non-invasive imaging tool that allows real-time visualization of cells and structures in living skin with near histological resolution. RCM has been used for the assessment of benign and malignant lesions, showing great potential for applications in basic skin research and clinical dermatology. RCM also reveals dynamic changes in the skin over time and in response to specific stimuli, like ultraviolet exposure, which makes it a promising tool in cosmetology, as it allows repetitive sampling without biopsy collection, causing no further damage to the areas under investigation. This review summarizes the latest advances in RCM, and its applications in the characterization of both normal and pathological skin.

  16. Light-induced autofluorescence and diffuse reflectance spectroscopy in clinical diagnosis of skin cancer

    NASA Astrophysics Data System (ADS)

    Borisova, E.; Pavlova, E.; Kundurjiev, T.; Troyanova, P.; Genova, Ts.; Avramov, L.

    2014-05-01

    We investigated more than 500 clinical cases to receive the spectral properties of basal cell (136 patients) and squamous cell carcinoma (28), malignant melanoma (41) and different cutaneous dysplastic and benign cutaneous lesions. Excitation at 365, 385 and 405 nm using LEDs sources is applied to obtain autofluorescence spectra, and broad-band illumination in the region of 400-900 nm is used to detect diffuse reflectance spectra of all pathologies investigated. USB4000 microspectrometer (Ocean Optics Inc, USA) is applied as a detector and fiber-optic probe is used for delivery of the light. In the case of in vivo tumor measurements spectral shape and intensity changes are observed that are specific for a given type of lesion. Autofluorescence origins of the signals coming from skin tissues are mainly due to proteins, such as collagen, elastin, keratin, their cross-links, co-enzimes - NADH and flavins and endogenous porphyrins. Spectral features significant into diffuse spectroscopy diagnosis are related to the effects of re-absorption of hemoglobin and its forms, as well as melanin and its concentration in different pathologies. We developed significant database and revealed specific features for a large class of cutaneous neoplasia, using about 30 different spectral peculiarities to differentiate cutaneous tumors. Sensitivity and specificity obtained exceed 90%, which make optical biopsy very useful tool for clinical practice. These results are obtained in the frames of clinical investigations for development of significant "spectral features" database for the most common cutaneous malignant, dysplastic and benign lesions. In the forthcoming plans, our group tries to optimize the existing experimental system for optical biopsy of skin, and to introduce it and the diagnostic algorithms developed into clinical practice, based on the high diagnostic accuracy achieved.

  17. The Effect of Reflective Activities on Reflective Thinking Ability in an Undergraduate Pharmacy Curriculum

    PubMed Central

    Bosnic-Anticevich, Sinthia; Schneider, Carl R.; Smith, Lorraine

    2016-01-01

    Objective. To determine the effectiveness of integrating reflective practice activities into a second-year undergraduate pharmacy curriculum and their impact on reflective thinking ability. Design. A cross-over design with repeated measures was employed. Newly developed reflective modules based on real hospital and community pharmacy cases were integrated into the second-year pharmacy practice curriculum. A novel strategy, the Reflective Ability Clinical Assessment (RACA), was introduced to enhance self- and peer reflection. Assessment. Student responses (n=214) to the adapted Kember et al1 Reflective Thinking Questionnaire (RTQ) were compared before and after reflective activities were undertaken. Significant improvement in three indicators of reflective thinking was shown after students engaged in reflective activities. Conclusion. Integration of reflective activities into a pharmacy curriculum increased the reflective thinking capacity of students. Enhancing reflective thinking ability may help students make better informed decisions and clinical judgments, thus improving future practice. PMID:27293232

  18. The Effect of Reflective Activities on Reflective Thinking Ability in an Undergraduate Pharmacy Curriculum.

    PubMed

    Tsingos-Lucas, Cherie; Bosnic-Anticevich, Sinthia; Schneider, Carl R; Smith, Lorraine

    2016-05-25

    Objective. To determine the effectiveness of integrating reflective practice activities into a second-year undergraduate pharmacy curriculum and their impact on reflective thinking ability. Design. A cross-over design with repeated measures was employed. Newly developed reflective modules based on real hospital and community pharmacy cases were integrated into the second-year pharmacy practice curriculum. A novel strategy, the Reflective Ability Clinical Assessment (RACA), was introduced to enhance self- and peer reflection. Assessment. Student responses (n=214) to the adapted Kember et al(1) Reflective Thinking Questionnaire (RTQ) were compared before and after reflective activities were undertaken. Significant improvement in three indicators of reflective thinking was shown after students engaged in reflective activities. Conclusion. Integration of reflective activities into a pharmacy curriculum increased the reflective thinking capacity of students. Enhancing reflective thinking ability may help students make better informed decisions and clinical judgments, thus improving future practice.

  19. The Development of a Scale to Assess Practitioner Capacity to Engage in Clinical Education

    ERIC Educational Resources Information Center

    Abey, Sally; Lea, Susan; Callaghan, Lynne; Cotton, Debby; Shaw, Steve

    2015-01-01

    Clinical educators play an important role in the development of clinical skills during health care undergraduates' practice placements. The supportiveness of the learning environment and the attitude of the clinical educator towards student development are considered to be important factors that impact upon practice placement experience, although…

  20. Analysis of midwifery students' written reflections to evaluate progression in learning during clinical practice at birthing units.

    PubMed

    Persson, Eva K; Kvist, Linda J; Ekelin, Maria

    2015-03-01

    Written daily reflections during clinical practice on birthing units have been used during several years in midwifery education at Lund University, Sweden. However, the usefulness of these reflections for evaluation of progression in learning and professional development of students has to date not been evaluated. In order to analyse written reflections, two taxonomies developed by Bloom and Pettersen have been applied to the texts. Progression in the professional development of midwifery students can be seen through levels of complexity in cognitive and psycho-motor learning areas and also in the description of learning situations. Progression can be seen from a basic description of facts in simple situations at the beginning of the students' practice to a complex description of complicated situations towards the end of the practice. Written daily reflections appear to be a suitable method to help students to reflect in a structured way, thereby helping their professional development. Reflections can help clinical supervisors to understand the needs of the individual student and to support their knowledge accruement. Daily written reflections on clinical practice can be of use in other health education programs.

  1. Evaluating the Use of Reflective Practice in a Nonprofessional, Undergraduate Clinical Communication Skills Course

    ERIC Educational Resources Information Center

    Beveridge, Tyler S.; Fruchter, Lauren L.; Sanmartin, Cleo V.; deLottinville, Carl B.

    2014-01-01

    Recent studies suggest that the quality of reflective practice being achieved in educational settings is inadequate. Our study aims to determine the level of reflection present in written student reflections in a nonprofessional undergraduate course. We also seek to explore student and instructor perspectives on the value of reflective practices.…

  2. Reproductive options for prospective parents in families with Huntington's disease: clinical, psychological and ethical reflections.

    PubMed

    de Die-Smulders, C E M; de Wert, G M W R; Liebaers, I; Tibben, A; Evers-Kiebooms, G

    2013-01-01

    BACKGROUND Huntington's disease (HD) is an autosomal dominant neurodegenerative late onset disorder. This review of reproductive options aims to increase reproductive confidence and to prevent suffering in relation to family planning around HD and possibly other late onset neurodegenerative disorders. METHODS Selected relevant literature and own views and experiences as clinical geneticists, psychologists and ethicists have been used. RESULTS Possible options, with emphasis on prenatal diagnosis (PD) and preimplantation genetic diagnosis (PGD) to prevent the transmission of HD to the next generation, are described and discussed. They are formally presented in a decision tree, taking into account the presence or absence of a fully penetrant allele (FPA), a reduced penetrant allele (RPA) or an intermediate allele (IA). A table compares invasive and non-invasive PD and PGD. From a psychological perspective, the complex process of counselling and decision-making regarding reproductive options is discussed. Special attention is paid to the decision to avoid the transmission of the mutation and to the confrontation and coping of a mutation-free child growing up with a parent developing disease symptoms. From an ethical point of view, reflections on both PD and PGD are brought forward taking into account the difference between FPA, RPA and IA, direct testing or exclusion testing and taking into account the welfare of the child in the context of medically assisted reproduction. CONCLUSION Recommendations and suggestions for good clinical practice in the reproductive care for HD families are formulated.

  3. Biased Recognition of Facial Affect in Patients with Major Depressive Disorder Reflects Clinical State

    PubMed Central

    Münkler, Paula; Rothkirch, Marcus; Dalati, Yasmin; Schmack, Katharina; Sterzer, Philipp

    2015-01-01

    Cognitive theories of depression posit that perception is negatively biased in depressive disorder. Previous studies have provided empirical evidence for this notion, but left open the question whether the negative perceptual bias reflects a stable trait or the current depressive state. Here we investigated the stability of negatively biased perception over time. Emotion perception was examined in patients with major depressive disorder (MDD) and healthy control participants in two experiments. In the first experiment subjective biases in the recognition of facial emotional expressions were assessed. Participants were presented with faces that were morphed between sad and neutral and happy expressions and had to decide whether the face was sad or happy. The second experiment assessed automatic emotion processing by measuring the potency of emotional faces to gain access to awareness using interocular suppression. A follow-up investigation using the same tests was performed three months later. In the emotion recognition task, patients with major depression showed a shift in the criterion for the differentiation between sad and happy faces: In comparison to healthy controls, patients with MDD required a greater intensity of the happy expression to recognize a face as happy. After three months, this negative perceptual bias was reduced in comparison to the control group. The reduction in negative perceptual bias correlated with the reduction of depressive symptoms. In contrast to previous work, we found no evidence for preferential access to awareness of sad vs. happy faces. Taken together, our results indicate that MDD-related perceptual biases in emotion recognition reflect the current clinical state rather than a stable depressive trait. PMID:26039710

  4. Detection of cervical lesions by multivariate analysis of diffuse reflectance spectra: a clinical study.

    PubMed

    Prabitha, Vasumathi Gopala; Suchetha, Sambasivan; Jayanthi, Jayaraj Lalitha; Baiju, Kamalasanan Vijayakumary; Rema, Prabhakaran; Anuraj, Koyippurath; Mathews, Anita; Sebastian, Paul; Subhash, Narayanan

    2016-01-01

    Diffuse reflectance (DR) spectroscopy is a non-invasive, real-time, and cost-effective tool for early detection of malignant changes in squamous epithelial tissues. The present study aims to evaluate the diagnostic power of diffuse reflectance spectroscopy for non-invasive discrimination of cervical lesions in vivo. A clinical trial was carried out on 48 sites in 34 patients by recording DR spectra using a point-monitoring device with white light illumination. The acquired data were analyzed and classified using multivariate statistical analysis based on principal component analysis (PCA) and linear discriminant analysis (LDA). Diagnostic accuracies were validated using random number generators. The receiver operating characteristic (ROC) curves were plotted for evaluating the discriminating power of the proposed statistical technique. An algorithm was developed and used to classify non-diseased (normal) from diseased sites (abnormal) with a sensitivity of 72 % and specificity of 87 %. While low-grade squamous intraepithelial lesion (LSIL) could be discriminated from normal with a sensitivity of 56 % and specificity of 80 %, and high-grade squamous intraepithelial lesion (HSIL) from normal with a sensitivity of 89 % and specificity of 97 %, LSIL could be discriminated from HSIL with 100 % sensitivity and specificity. The areas under the ROC curves were 0.993 (95 % confidence interval (CI) 0.0 to 1) and 1 (95 % CI 1) for the discrimination of HSIL from normal and HSIL from LSIL, respectively. The results of the study show that DR spectroscopy could be used along with multivariate analytical techniques as a non-invasive technique to monitor cervical disease status in real time.

  5. Rheumatoid arthritis associated pulmonary hypertension: Clinical challenges reflecting the diversity of pathophysiology.

    PubMed

    Panagiotidou, Evangelia; Sourla, Evdokia; Kotoulas, Serafim Xrisovalantis; Akritidou, Sofia; Bikos, Vasileios; Bagalas, Vasileios; Stanopoulos, Ioannis; Pitsiou, Georgia

    2017-01-01

    The present article reports three clinical cases in order to elucidate the diversity of the pathophysiological mechanisms that underlie rheumatoid arthritis associated pulmonary hypertension. The condition's three major causes are: interstitial lung disease, vasculitis, and chronic thromboembolic disease, but it should be noted that the multiple pulmonary manifestations of rheumatoid arthritis, can all contribute to chronic lung disease or hypoxia. The first patient in this report suffered from moderate restriction due to fibrosis and was diagnosed with pulmonary hypertension during an episode of life threatening hypoxia. Early upfront combination therapy prevented intubation and reversed hypoxia to adequate levels. The second presented patient was a case of isolated pulmonary hypertension attributable to vasculopathy. The patient maintained normal lung volumes but low diffusion capacity and echocardiography dictated the need for right heart catheterization. Finally, the third patient presented severe functional limitation due to several manifestations of rheumatoid arthritis, but a past episode of acute pulmonary embolism was also reported although it had never been evaluated. Chronic thromboembolic disease was eventually proved to be one major cause of the patient's pulmonary hypertension. The importance of early identification of pulmonary hypertension in patients with rheumatoid arthritis is therefore emphasized, especially since multiple treatment options are available, symptoms can be treated, and right heart failure can be avoided.

  6. Clinical effects of closed root planing compared to papilla reflection and fiber optic augmentation.

    PubMed

    Reinhardt, R A; Johnson, G K; DuBois, L M

    1991-05-01

    Mini-surgical approaches in 4 to 7 mm probing depths have been shown to facilitate improved deposit removal as compared to closed instrumentation. At the same time this treatment is less traumatic than more extensive flap reflection for root planing. The purpose of this study was to compare the clinical effects of closed root planing (C/SCRP) to those of root planing augmented by papilla reflection and fiber optic illumination (PR/SCRP) over a 6-month period. Fourteen patients with moderate/advanced adult periodontitis received each therapy in 2 experimental periodontitis sites (PS = greater than or equal to 5 mm probing depth and greater than 5 mm attachment loss) and one non-periodontitis site (NPS = less than or equal to 3 mm probing depth and no recession). Presence of supragingival plaque, bleeding on probing, probing depths, and clinical attachment levels were measured before treatment and 6, 12, and 24 weeks posttreatment. Mean supragingival plaque levels were high and did not vary significantly over the course of the study, but bleeding on probing was significantly reduced in PS following both C/SCRP and PR/SCRP (P less than or equal to 0.0001). Mean probing depths were significantly reduced after 6 months (P less than or equal to 0.01) in NPS-PR/SCRP from 2.8 +/- 0.1 to 2.0 +/- 0.2 mm, in PS-C/SCRP from 5.5 +/- 0.2 to 4.5 +/- 0.4 mm, and in PS-PR/SCRP from 5.8 +/- 0.2 to 3.2 +/- 0.1 mm. In periodontitis sites, PR/SCRP demonstrated greater probing depth reductions than C/SCRP at all time periods (P less than or equal to 0.004). PS attachment levels also improved following C/SCRP and PR/SCRP at all postoperative times (P less than or equal to 0.01). PR/SCRP appears to provide better short-term mean probing depth reduction (2.6 mm) than C/SCRP (1.0 mm), presumably due to apical positioning of the papillae and periodontal repair following improved access for root planing.

  7. Does the MUNIX Method Reflect Clinical Dysfunction in Amyotrophic Lateral Sclerosis: A Practical Experience.

    PubMed

    Gawel, Malgorzata; Kuzma-Kozakiewicz, Magdalena

    2016-05-01

    The aim of our study was to assess the usefulness of the MUNIX method in reflecting the clinical dysfunction in patients with amyotrophic lateral sclerosis (ALS), as well as to assess an intra-rater reproducibility of MUNIX. The study group consisted of a total of 15 ALS patients. The mean age of symptoms onset was 55 years, and the mean disease duration was 10 months. The muscle strength and patients' functional status were assessed according to the Medical Research Council (MRC) and by ALS functional rating scale revised (ALSFRS-R), respectively. The MUNIX was performed in 6 muscles: abductor pollicis brevis (APB), abductor digiti minimi (ADM), biceps brachii (BB), tibial anterior (TA), extensor digitorum brevis (EDB), and abductor hallucis (AH), unilaterally, at a less affected side. Both muscle-specific and global MRC and MUNIX scores were calculated. In 11 patients, the study protocol was repeated at least twice every 3 months. An additional testing of the intra-rater reliability was performed at the first visit.There were no significant differences between MUNIX test and re-test values in the APB, ADM, BB, TA, EDB, and AH muscles (P >0.05). The highest variability of the test-retest values was found in the BB muscle (7.53%). Although there was a significant test-retest difference in the global MUNIX score (P = 0.02), the variability of the results was as low as 1.26%. The MUNIX value correlated with the muscle-specific MRC score in ABP, ADM, TA, EDB and AH (P <0.05), and the global MUNIX values correlated with global MRC scores (P <0.05). There was also a significant correlation between the global MUNIX score and the clinical dysfunction measured by the ALSFRS-R scale (P <0.05). The global MUNIX showed a higher monthly decline (4.3%) as compared with ALFRS-R (0.7%) and the MRC global score (0.5%).This study confirms that the MUNIX method is a sensitive, reliable, and accurate tool reflecting both motor dysfunction and disease progression in ALS

  8. Clinical and translational research capacity building needs in minority medical and health science Hispanic institutions.

    PubMed

    Estapé-Garrastazu, Estela S; Noboa-Ramos, Carlamarie; De Jesús-Ojeda, Lizbelle; De Pedro-Serbiá, Zulmarie; Acosta-Pérez, Edna; Camacho-Feliciano, Delia M

    2014-10-01

    A preliminary needs assessment was conducted among faculty and students of three minority medical and health science institutions comprising the Puerto Rico Clinical and Translational Research Consortium (PRCTRC). The Web-based survey was focused on evaluating the training interests in the clinical and translational research core areas and competencies developed by the National Institutes of Health-Clinical and Translational Sciences Award. The survey was the result of a team effort of three PRCTRC key function's leaderships: Multidisciplinary Training and Career Development, Tracking and Evaluation and Community Research and Engagement. The questionnaire included 45 items distributed across five content areas including demographics, research training needs, training activities coordination and knowledge about the services offered by the PRCTRC. Analysis of research needs includes a sample distribution according to professor, assistant/associate professor and graduate students. The thematic area with highest response rate among the three groups was: "Identify major clinical/public health problems and relevant translational research questions," with the competency "Identify basic and preclinical studies that are potential testable clinical research hypothesis." These preliminary results will guide the training and professional development of the new generation of clinical and translational researchers needed to eliminate health disparities.

  9. Endoscopic reflectance spectrophotometry and visible light spectroscopy in clinical gastrointestinal studies.

    PubMed

    Leung, Felix W

    2008-06-01

    The use of reflectance spectrophotometry (RS) for mucosal hemodynamic measurement relies on the recognition of changes in indexes of mucosal hemoglobin concentration and oxygen saturation. Endoscopic application in clinical studies has confirmed important observations demonstrated in animal experiments. The vasoconstriction induced by propranolol, vasopressin, glypressin, or somatostatin in the portal hypertensive gastric mucosa and the reduction of gastroduodenal mucosal perfusion by nonsteroidal anti-inflammatory drugs (NSAIDs) or smoking, mesenteric venoconstriction associated with systemic hypoxia, and acid-induced duodenal hyperemia are important examples. Prognostic predictions include the development of stress-induced gastric ulcerations in patients with significant reductions in gastric perfusion after thermal or head injury, or the demonstration of delayed gastric or duodenal ulcer healing when the hyperemia at the ulcer margin fails to materialize. In mechanical-ventilator-dependent patients with sepsis, a significantly reduced gastric mucosal RS measurement portends a grave prognosis (mortality >80%). Recent advances in technology resulted in the construction and validation of instruments for visible light spectroscopy. Measurements focused on tissue oxygen saturation demonstrated epinephrine and vessel-ligation-induced vasoconstriction, the absence of ischemia in radiation-induced rectal telangiectasias, and gut ischemia responsive to revascularization treatment. Endoscopic RS and visible light spectroscopy are suitable for assessing the role of blood flow in conditions with a lesser degree of ischemia and for testing the hypothesis that functional dyspepsia and dysmotility syndromes may be due to gut ischemia.

  10. In vivo inflammation mapping of periodontal disease based on diffuse reflectance spectral imaging: a clinical study

    NASA Astrophysics Data System (ADS)

    Prasanth, Chandra Sekhar; Betsy, Joseph; Jayanthi, Jayaraj L.; Nisha, Unni G.; Prasantila, Janam; Subhash, Narayanan

    2013-02-01

    Since conventional techniques using periodontal probes have inherent drawbacks in the diagnosis of different grades of gingival inflammation, development of noninvasive screening devices becomes significant. Diffuse reflectance (DR) spectra recorded with white light illumination is utilized to detect periodontal inflammation from the oxygenated hemoglobin absorption ratio R620/R575. A multispectral imaging system is utilized to record narrow-band DR images at 575 and 620 nm from the anterior sextant of the gingivia of 15 healthy volunteers and 25 patients (N=40). An experienced periodontist assesses the level of gingival inflammation at each site through periodontal probing and assigns diagnosis as healthy, mild, moderate, or severe inflammation. The DR image ratio R620/R575 computed for each pixel (8-μm resolution) from the monochrome images is pseudo-color-mapped to identify gingival inflammation sites. The DR image ratio values at each site are compared with clinical diagnosis to estimate the specificity and sensitivity of the DR imaging technique in inflammation mapping. The high diagnostic accuracy is utilized to detect underlying inflammation in six patients with a previous history of periodontitis.

  11. Chromophore based analyses of steady-state diffuse reflectance spectroscopy: current status and perspectives for clinical adoption.

    PubMed

    Bydlon, Torre M; Nachabé, Rami; Ramanujam, Nimmi; Sterenborg, Henricus J C M; Hendriks, Benno H W

    2015-01-01

    Diffuse reflectance spectroscopy is a rapidly growing technology in the biophotonics community where it has shown promise in its ability to classify different tissues. In the steady-state domain a wide spectrum of clinical applications is supported with this technology ranging from diagnostic to guided interventions. Diffuse reflectance spectra provide a wealth of information about tissue composition; however, extracting biologically relevant information from the spectra in terms of chromophores may be more useful to gain acceptance into the clinical community. The chromophores that absorb light in the visible and near infrared wavelengths can provide information about tissue composition. The key characteristics of these chromophores and their relevance in different organs and clinical applications is the focus of this review, along with translating their use to the clinic.

  12. Differences in Hypnotic Capacity: Patients Referred to a Psychiatric Consultation Liaison Clinic vs. Patients Referred to a Psychiatric Outpatient Clinic

    DTIC Science & Technology

    1994-01-04

    Weitzenhoffer and Hilgard, 1962), were able to complete denta l work with hypnosis alone, compared to 38% of low susceptible patients who needed...researchers ( weitzenhoffer , 1959), and it has also been suggested that the clinical entity is ahead of basic research. An understanding of the nature of...Eysenck and Furneaux (1945), LaCrone and Bordeaux (1947) and Watkins (1949) . In 1959, The Stanford Scales were developed by Weitzenhoffer and Hilgard

  13. The Pitfalls of Collegial Coaching: An Analysis of Collegial Coaching in Medical Education and Its Influence on Stimulating Reflection and Performance of Novice Clinical Teachers

    ERIC Educational Resources Information Center

    Truijen, Karin J. P.; van Woerkom, Marianne

    2008-01-01

    Purpose: Competent clinical teachers are essential for clinical teaching. According to the literature, coaching can contribute to improved levels of reflection and better performance of clinical teachers. By engaging in a dialogue about coachee's teaching behaviour, coaches can stimulate reflection of novice teachers. This study aims to gain…

  14. Preparing to care for an aging population: medical student reflections on their clinical mentors within a new geriatrics curriculum.

    PubMed

    Farrell, Timothy W; Shield, Renée R; Wetle, Terrie; Nanda, Aman; Campbell, Susan

    2013-01-01

    Reflective writing techniques such as journaling help provide insights into the process by which medical students are mentored and develop into practicing physicians. The authors sought to analyze medical students' journals regarding their mentored experiences within a new geriatrics curriculum at a U.S. medical school. Thirty preclinical and clinical medical student journalers participated in this project. The authors employed qualitative analytic techniques using an interdisciplinary team process. Three major themes emerged: (a) exposure to clinical mentors challenged medical students' preconceptions regarding older adults and geriatric medicine; (b) students learned new medical knowledge and techniques from observing their mentors; and (c) students provided positive and negative assessments of their mentors. Reflective journaling provides important insights into the process by which medical students draw upon mentored clinical experiences during their training. Such mentorship may be particularly relevant to promoting their interest in geriatrics.

  15. Teaching Reflective Practice in Practice Settings: Students' Perceptions of Their Clinical Educators

    ERIC Educational Resources Information Center

    Trede, Franziska; Smith, Megan

    2012-01-01

    Reflective practice in practice settings can enhance practice knowledge, self-assessment and lifelong learning, develop future practice capability and professional identity, and critically appraise practice traditions rather than reproduce them. The inherent power imbalance between student and educator runs the risk for the reflective practice…

  16. Teaching Softly in Hard Environments: Meanings of Small-Group Reflective Teaching to Clinical Faculty

    ERIC Educational Resources Information Center

    Whiting, Ellen; Wear, Delese; Aultman, Julie M.; Zupp, Laurie

    2012-01-01

    A vast literature exists on teaching reflection and reflective practice to trainees in small groups, yet with few exceptions the literature does not address the benefits of these interactions to faculty. Like multiculturalism or cultural competency, the literature assumes that faculty have themselves "achieved" these propensities and…

  17. A Learner-Centered Technique and Clinical Reasoning, Reflection, and Case Presentation Attributes in Athletic Training Students

    PubMed Central

    Heinerichs, Scott; Vela, Luzita I.; Drouin, Joshua M.

    2013-01-01

    Context: Providing opportunities to develop clinical decision-making skills, including clinical reasoning, is an important aspect of clinical education. The learner-centered technique of summarizing the history and findings, narrowing the differential, analyzing the differential, probing the instructor about uncertainties, plan management, and selecting an issue for self-directed study (SNAPPS) is used in medicine to express clinical reasoning. Objective: To investigate the effects of SNAPPS on the clinical reasoning, reflection, and 4 case presentation attributes (length, conciseness, case summary, and expression of clinical reasoning) in athletic training students. Design: Randomized controlled clinical trial. Setting: Three undergraduate programs accredited by the Commission on Accreditation of Athletic Training Education. Patients or Other Participants: We randomly assigned 38 athletic training students (17 men, 21 women; age = 21.53 ± 1.18 years, grade point average = 3.25 ± 0.31) who had completed at least 1 year of clinical education and all orthopaedic evaluation coursework to the SNAPPS group or the usual and customary group using a stratification scheme. Intervention(s): The SNAPPS group completed four 45-minute clinical reasoning and case presentation learning modules led by an investigator to learn the SNAPPS technique, whereas the usual and customary group received no formal instruction. Both groups audio recorded all injury evaluations performed over a 2-week period. Main Outcome Measures: Participants completed the Diagnostic Thinking Inventory and Reflection in Learning Scale twice. Case presentations were analyzed for 4 attributes: length, conciseness, case summary, and expression of clinical reasoning. Results: Case presentations were longer (t18.806 = −5.862, P < .001) but were more concise (t32 = 11.297, P < .001) for the SNAPPS group than for the usual and customary group. The SNAPPS group performed better on both the case summary subscale

  18. Assessing the Impact of Airborne Outreach to Build Clinical Capacity in Rural Botswana

    PubMed Central

    Kirk, Brianna L.

    2013-01-01

    There is a paucity of research demonstrating how best to address inequalities in health and access to specialist care faced by rural disadvantaged populations in high HIV-prevalent settings in Sub Saharan Africa. Delivering equitable and cost-effective specialist clinical services in many parts of Africa is challenging, given human resource shortages, poor transport infrastructure and competing health priorities. In this report we describe how an airborne outreach program to provide HIV services to high HIV burden health facilities in rural Botswana has been an important catalyst for improving specialist service delivery across the spectrum of clinical care. The success of Botswana’s airborne program is a consequence of many country-specific determinants as well as external funding support. We argue that lessons learned from the experience in Botswana are normative for other African settings. Specialist medical airborne outreach to rural hospitals can improve access to and quality of care, when part of a multifaceted, multidisciplinary intervention. Furthermore, we demonstrate how an HIV funded program can be a vehicle for enhanced access to essential sub-specialist clinicians in rural Botswana. PMID:28299100

  19. Routine clinical evaluation of cerebrovascular reserve capacity using carbogen in patients with intracranial stenosis

    PubMed Central

    Donahue, Manus J.; Dethrage, Lindsey; Faraco, Carlos C.; Jordan, Lori C.; Clemmons, Paul; Singer, Robert; Mocco, J; Shyr, Yu; Desai, Aditi; O’Duffy, Anne; Riebau, Derek; Hermann, Lisa; Connors, John; Kirshner, Howard; Strother, Megan K.

    2014-01-01

    Background and Purpose A promising method for identifying hemodynamic impairment that may serve as a biomarker for stroke risk in patients with intracranial (IC) stenosis is cerebrovascular reactivity (CVR) mapping using non-invasive MRI. Here, abilities to measure CVR safely in the clinic using hypercarbic hyperoxic (carbogen) gas challenges, which increase oxygen delivery to tissue, are investigated. Methods In sequence with structural and angiographic imaging, blood-oxygenation-level-dependent (BOLD) carbogen-induced CVR scans were performed in patients with symptomatic IC stenosis (n=92) and control (n=10) volunteers, with a subgroup of patients (n=57) undergoing cerebral blood flow-weighted (CBFw) pseudo-continuous arterial spin labeling (pCASL) CVR. Subjects were stratified for four sub-studies: to evaluate relationships between (i) carbogen and hyercarbic normoxic (HN) CVR in healthy tissue (n=10), (ii) carbogen CBF CVR and BOLD CVR in IC stenosis patients (n=57), (iii) carbogen CVR and clinical measures of disease in patients with asymmetric IC atherosclerotic (n=31) and moyamoya (n=29) disease, and (iv) the CVR scan and immediate and longer-term complications (n=92). Results Non-invasive BOLD carbogen-induced CVR values correlate with (i) lobar HN gas stimuli in healthy tissue (R=0.92; P<0.001), (ii) carbogen-induced CBF CVR in IC stenosis patients (R=0.30–0.33; P<0.012), and (iii) angiographic measures of disease severity both in atherosclerotic and moyamoya patients after appropriate processing. No immediate stroke-related complications were reported in response to carbogen administration; longer-term neurological events fell within the range for expected events in this patient population. Conclusions Carbogen-induced CVR elicited no added adverse events and provided a surrogate marker of cerebrovascular reserve consistent with IC vasculopathy. PMID:24938845

  20. The use of structured reflective journal questions to promote fundamental development of clinical decision-making abilities of the first-semester nursing student.

    PubMed

    Croke, Eileen

    2004-01-01

    The ability to reflect is becoming a core competency in many nursing educational programs. A clinical journal assignment was developed for first-semester (novice) nursing students. The aim was to see if the process of reflection-on-action through the medium of journal writing promoted fundamental clinical decision-making abilities of the first semester nursing student. This author discusses components of the clinical decision-making process used to structure six clinical journal questions for use by the first semester nursing students during their clinical rotation. Exemplars of students' self-reported reflections are included.

  1. Rural mental health: implications for telepsychiatry in clinical service, workforce development, and organizational capacity.

    PubMed

    Chung-Do, Jane; Helm, Susana; Fukuda, Michael; Alicata, Dan; Nishimura, Stephanie; Else, Iwalani

    2012-04-01

    In Hawai'i, rural residents suffer disproportionately from poor health and mental health outcomes. Hawai'i's island geography makes rural health service disparities especially compelling. Physician workforce shortages are projected to increase, despite 30 years of programs aimed at recruiting physicians to rural areas. Telepsychiatry has been shown to be a feasible way to provide a variety of health services to individuals living in rural areas with limited access to healthcare. The University of Hawai'i Rural Health Collaboration (UHRHC) was established by the Department of Psychiatry to address the need for workforce development and rural access to mental health services across the State of Hawai'i by using telepsychiatry. Partnerships with community health clinics have been formed to provide patient care and consultation-liaison services through telepsychiatry technology. In addition, UHRHC focuses on workforce development in its residency training curriculum by utilizing a service-learning approach to rural mental health. Evaluation of these efforts is currently underway, with preliminary evidence suggesting that UHRHC is a promising strategy to increase access to critical mental health services and reduce health disparities in rural Hawai'i.

  2. The Vital Capacity Is Vital: Epidemiology and Clinical Significance of the Restrictive Spirometry Pattern.

    PubMed

    Godfrey, Mark S; Jankowich, Matthew D

    2016-01-01

    Epidemiologic research has revealed a substantial portion of the general population with abnormal spirometry results that are characterized by decreased FEV1 and FVC but a preserved FEV1/FVC ratio. This restrictive spirometry pattern (RSP) is inconsistently defined in the literature and not well addressed by current guidelines; there is an accumulating body of evidence, however, that RSP is prevalent to a similar degree as airflow obstruction. Genetic and other risk factors for RSP, such as inhalational injuries and early life exposures, continue to be actively described. Although it seems that RSP is closely associated with the metabolic syndrome, diabetes, and systemic inflammation, it is not a simple marker of obesity. RSP is associated with adverse cardiovascular outcomes, as well as mortality, and it may be an underappreciated cause of functional impairments and respiratory symptoms. Improvement in outcomes in this population will require that clinicians have an appreciation for the significance of this spirometry pattern; additional research into the clinical and radiologic phenotype of these subjects is also needed. This article provides an overview of the recent developments in our understanding of this prevalent and highly morbid spirometry pattern.

  3. Fostering Dental Students' Academic Achievements and Reflection Skills Through Clinical Peer Assessment and Feedback.

    PubMed

    Tricio, Jorge A; Woolford, Mark J; Escudier, Michael P

    2016-08-01

    Peer assessment is increasingly being encouraged to enhance dental students' learning. The aim of this study was to evaluate the educational impact in terms of academic achievements and reflective thinking of a formative prospective peer assessment and feedback protocol. Volunteer final-year dental students at King's College London Dental Institute, UK, received training on peer assessment, peer feedback, and self-reflection. At the beginning (baseline) and end (resultant) of the 2012-13 academic year, 86 students (55% of the year group) completed a reflection questionnaire (RQ). Sixty-eight of those students used a modified Direct Observation of Procedural Skills (DOPS) as a framework for peer assessment and peer feedback during a complete academic year. End-of-year, high-stakes examination grades and RQ scores from the participants and nonparticipants were statistically compared. The participants completed 576 peer DOPS. Those 22 students who peer assessed each other ≥10 times exhibited highly statistically significant differences and powerful positive effect sizes in their high-stakes exam grades (p=0.0001, d=0.74) and critical reflection skills (p=0.005, d=1.41) when compared to those who did not assess one another. Furthermore, only the same 22 students showed a statistically significant increase and positive effect size in their critical reflection skills from baseline to resultant (p=0.003, d=1.04). The results of this study suggest that the protocol used has the potential to impact dental students' academic and reflection skills, provided it is practiced in ten or more peer encounters and ensuring peer feedback is provided followed by self-reflection.

  4. Assessment of Capacity in an Aging Society

    ERIC Educational Resources Information Center

    Moye, Jennifer; Marson, Daniel C.; Edelstein, Barry

    2013-01-01

    Over the past 40 years, the assessment and scientific study of capacity in older adults has emerged as a distinct field of clinical and research activity for psychologists. This new field reflects the convergence of several trends: the aging of American society, the growing incidence and prevalence of dementia, and the patient rights,…

  5. Effect of Phosphodiesterase-5 Inhibition on Exercise Capacity and Clinical Status in Heart Failure with Preserved Ejection Fraction: A Randomized Clinical Trial

    PubMed Central

    Redfield, Margaret M; Chen, Horng H; Borlaug, Barry A; Semigran, Marc J.; Lee, Kerry L.; Lewis, Gregory; LeWinter, Martin M.; Rouleau, Jean L.; Bull, David A.; Mann, Douglas L.; Deswal, Anita; Stevenson, Lynne W.; Givertz, Michael M.; Ofili, Elizabeth O.; O’Connor, Christopher M.; Felker, G. Michael; Goldsmith, Steven R.; Bart, Bradley A.; McNulty, Steven E; Ibarra, Jenny C.; Lin, Grace; Oh, Jae K.; Patel, Manesh R.; Kim, Raymond J.; Tracy, Russell P.; Velazquez, Eric J.; Anstrom, Kevin J.; Hernandez, Adrian F.; Mascette, Alice M.; Braunwald, Eugene

    2013-01-01

    Importance Studies in experimental and human heart failure suggest that phosphodiesterase type-5 inhibitors may enhance cardiovascular function, and thus, exercise capacity in heart failure with preserved ejection fraction. Objective To determine the effect of the phosphodiesterase type-5 inhibitor, sildenafil, in comparison to placebo on exercise capacity and clinical status in heart failure with preserved ejection fraction. Design, setting, and patients Multicenter, double-blind, placebo-controlled, parallel design, randomized clinical trial of 216 stable outpatients with heart failure, ejection fraction ≥ 50%, elevated N-terminal pro-brain natriuretic peptide or elevated invasively-measured filling pressures, and reduced exercise capacity. Participants were randomized from October 2008 through February 2012 at 26 centers in the United States and Canada. Intervention Sildenafil (n=113) or placebo (n=103) administered orally at 20 mg three times daily for 12 weeks followed by 60 mg three times daily for 12 weeks. Main outcome measures Primary endpoint was change in peak oxygen consumption after 24 weeks of therapy. Secondary endpoints included change in six-minute walk distance and a three tier hierarchical composite clinical status score where patients were ranked (range 1-N) based on time to death, time to cardiovascular or cardiorenal hospitalization and change in quality of life for participants alive without cardiovascular or cardiorenal hospitalization at 24 weeks. Results Median age was 69 years and 48% of patients were female. At baseline, median peak oxygen consumption (11.7 ml/kg/min) and six-minute walk distance (308 meters) were reduced and median E/e′ (16), left atrial volume index (44 ml/m2) and pulmonary artery systolic pressure (41 mmHg) were consistent with chronically-elevated left ventricular filling pressures. At 24 weeks, median (interquartile range) changes in peak oxygen consumption (ml/kg/min) in patients who received placebo [−0

  6. Wave reflection quantification based on pressure waveforms alone--methods, comparison, and clinical covariates.

    PubMed

    Hametner, Bernhard; Wassertheurer, Siegfried; Kropf, Johannes; Mayer, Christopher; Holzinger, Andreas; Eber, Bernd; Weber, Thomas

    2013-03-01

    Within the last decade the quantification of pulse wave reflections mainly focused on measures of central aortic systolic pressure and its augmentation through reflections based on pulse wave analysis (PWA). A complementary approach is the wave separation analysis (WSA), which quantifies the total amount of arterial wave reflection considering both aortic pulse and flow waves. The aim of this work is the introduction and comparison of aortic blood flow models for WSA assessment. To evaluate the performance of the proposed modeling approaches (Windkessel, triangular and averaged flow), comparisons against Doppler measurements are made for 148 patients with preserved ejection fraction. Stepwise regression analysis between WSA and PWA parameters are performed to provide determinants of methodological differences. Against Doppler measurement mean difference and standard deviation of the amplitudes of the decomposed forward and backward pressure waves are comparable for Windkessel and averaged flow models. Stepwise regression analysis shows similar determinants between Doppler and Windkessel model only. The results indicate that the Windkessel method provides accurate estimates of wave reflection in subjects with preserved ejection fraction. The comparison with waveforms derived from Doppler ultrasound as well as recently proposed simple triangular and averaged flow waves showed that this approach may reduce variability and provide realistic results.

  7. Peer Assisted Learning and Blogging: A Strategy to Promote Reflective Practice during Clinical Fieldwork

    ERIC Educational Resources Information Center

    Ladyshewsky, Richard K.; Gardner, Peter

    2008-01-01

    The use of peer assisted learning in clinical education is explored in this case study. Groups of undergraduate physiotherapy students were structured into communities of practice during the second half of their clinical fieldwork program. They collaborated online in an asynchronous manner, using information communications technology (blogs) and…

  8. Clinical Teacher Education: Reflections from an Urban Professional Development School Network. Readings in Educational Thought

    ERIC Educational Resources Information Center

    Bohan, Chara Haeussler, Ed.; Many, Joyce E., Ed.

    2011-01-01

    Clinical Teacher Education focuses on how to build a school-university partnership network for clinical teacher education in urban school systems serving culturally and linguistically diverse populations. The labor intensive nature of professional development school work has resulted in research institutions being slow to fully adopt a clinical…

  9. Theory before practice: implicit assumptions about clinical nursing education in Australia as revealed through a shared critical reflection.

    PubMed

    Grealish, Laurie; Smale, Lacey Anne

    2011-08-01

    The transfer of nursing education into the higher education sector occurred over a 10-year period in Australia (1985-1994). Australian nurse leaders settled on a single outcome measure to be applied for all nursing graduates in the form of national competency standards. While this move enabled diversity, the lack of consistency in curriculum design has subsequently led to increasing confusion for clinicians who support students' learning in clinical placements. Using a shared critical reflection method, the authors reviewed (1) the evaluation comments from nurses in one nursing unit of a hospital in one Australian jurisdiction and (2) an historical review of nursing literature at the time of the transfer of nursing education into the higher education sector. The reflection suggests that the aim of the transfer, to create critical thinking graduates, has been undermined by the implicit clinical education practices that have since emerged. In order to address the contemporary challenges for clinical staff working with students from multiple universities, as well as increased student numbers to address the nursing shortage, we recommend a new approach to curriculum design: a national clinical curriculum drawn from social, as well as cognitive, learning theory that at once informs clinicians of students' potential abilities and provides the scope to accommodate the increasingly difficult and critical learning requirements of tertiary-based nursing students.

  10. An infant with pulmonary interstitial glycogenosis: clinical improvement is associated with improvement in the pulmonary diffusion capacity.

    PubMed

    Ehsan, Zarmina; Montgomery, Gregory S; Tiller, Christina; Kisling, Jeffrey; Chang, Daniel V; Tepper, Robert S

    2014-03-01

    Pulmonary interstitial glycogenosis (PIG) is an idiopathic interstitial lung disease of infants. The underlying pulmonary pathophysiology of PIG has not been well characterized. Herein we report a term-gestation infant who presented with persistent tachypnea and hypoxia. A chest CT scan demonstrated a diffuse ground glass appearance and lung biopsy demonstrated increased alveolar septae cellularity with glycogen-containing cells, consistent with a diagnosis of PIG. At 3 months of age, pulmonary function testing included: pre- and post-bronchodilator forced expiratory flows using the raised-volume technique and the ratio of pulmonary diffusing capacity for carbon monoxide to alveolar volume (DLCO /VA ). He was prescribed 5 days of oral prednisolone (2mg/kg/day) and pulmonary function testing (PFT) was repeated at 5, 13, and 20 months of age. Initial PFTs demonstrated reduced forced vital capacity (FVC: Z-score = -2.36) and an increased ratio of forced expiratory volume in 0.5 sec to FVC (FEV0.5/FVC: Z-score = 1.15) with no significant change following an inhaled bronchodilator. There was also a marked reduction in DLCO /VA (Z-score = -4.74) compared to age-matched controls. Follow-up demonstrated progressive clinical improvement as well as an increase in Z-FVC and normalization of DLCO /VA . Our in vivo physiological findings are consistent with previous reports that symptom resolution correlated with histological thinning of the alveolar septae upon repeat lung biopsy. The restrictive lung disease we observed is consistent with expected reduced compliance of an alveolar interstitial lung process like PIG, whereas the absence of a reduction in FEV0.5/FVC confirms the absence of obstructive airway disease.

  11. Helen Flanders Dunbar, John Dewey, and clinical pragmatism: reflections on method in psychosomatic medicine and bioethics.

    PubMed

    Hart, Curtis W

    2002-01-01

    This article outlines the method utilized by physicians and major figures in the founding of Clinical Pastoral Education, Helen Flanders Dunbar, in her work of 1943, Psychosomatic Diagnosis, and relates it to the currently evolving approach in bioethics known as clinical pragmatism. It assesses Dewey's influence on both Dunbar in psychosomatic medicine and clinical pragmatism in bioethics, and illustrates the breadth of influence of the school of philosophical thought known as pragmatism with which Dewey's name and those of William James and Charles Sanders Pierce are most often identified.

  12. Clinical Thanatology and Psychotherapy: Some Reflections on Caring for the Dying Person.

    ERIC Educational Resources Information Center

    Feigenberg, Loma; Shneidman, Edwin S.

    1979-01-01

    Explores the relationship between psychotherapy and clinical thanatology relative to working with dying patients and their survivors. Eight special characteristics of thanatological exchanges are explained including comments on time, transference, aspirations, and empathy. Conversation, heirarchical exchange, psychotherapy, and thanatological…

  13. Reflections on clinical expertise and silent know-how in voice therapy.

    PubMed

    Iwarsson, Jenny

    2015-07-01

    The concept of 'clinical expertise' is described as a part of evidence-based practice (EBP) together with 'external scientific evidence' and 'patient values and perspectives'. However, clinical expertise in the management of voice disorders has not been described or discussed in much detail. The expertise seems to consist partly of silent know-how that, from the outside, may seem improperly related to the personality of the speech-language pathologist or exclusively dependent on the number of years in the field. In this paper, it is suggested that clinical expertise in voice therapy consists of specific skills that can be explicitly described and trained. These skills are discussed together with educational aspects that contribute to the development of clinical expertise. The skills are also discussed from the perspectives of the past, present, and future.

  14. Harnessing the hidden curriculum: a four-step approach to developing and reinforcing reflective competencies in medical clinical clerkship.

    PubMed

    Holmes, Cheryl L; Harris, Ilene B; Schwartz, Alan J; Regehr, Glenn

    2015-12-01

    Changing the culture of medicine through the education of medical students has been proposed as a solution to the intractable problems of our profession. Yet few have explored the issues associated with making students partners in this change. There is a powerful hidden curriculum that perpetuates not only desired attitudes and behaviors but also those that are less than desirable. So, how do we educate medical students to resist adopting unprofessional practices they see modeled by supervisors and mentors in the clinical environment? This paper explores these issues and, informed by the literature, we propose a specific set of reflective competencies for medical students as they transition from classroom curricula to clinical practice in a four-step approach: (1) Priming-students about hidden curriculum in their clinical environment and their motivations to conform or comply with external pressures; (2) Noticing-educating students to be aware of their motivations and actions in situations where they experience pressures to conform to practices that they may view as unprofessional; (3) Processing-guiding students to analyze their experiences in collaborative reflective exercises and finally; (4) Choosing-supporting students in selecting behaviors that validate and reinforce their aspirations to develop their best professional identity.

  15. Electronic Medical Records (EMRs), Epidemiology, and Epistemology: Reflections on EMRs and Future Pediatric Clinical Research

    PubMed Central

    Wasserman, Richard C.

    2011-01-01

    Electronic medical records (EMRs) are increasingly common in pediatric patient care. EMR data represent a relatively novel and rich resource for clinical research. The fact, however, that pediatric EMR data are collected for the purposes of clinical documentation and billing rather than research creates obstacles to their use in scientific investigation. Particular issues include accuracy, completeness, comparability between settings, ease of extraction, and context of recording. Although these problems can be addressed through standard strategies for dealing with partially accurate and incomplete data, a longer term solution will involve work with pediatric clinicians to improve data quality. As research becomes one of the explicit purposes for which pediatricians collect EMR data, the pediatric clinician will play a central role in future pediatric clinical research. PMID:21622040

  16. Clinical usefulness of reflectance confocal microscopy in the management of facial lentigo maligna melanoma.

    PubMed

    Alarcón, I; Carrera, C; Puig, S; Malvehy, J

    2014-04-01

    Facial lentigo maligna melanoma can be a diagnostic challenge in daily clinical practice as it has similar clinical and morphological features to other lesions such as solar lentigines and pigmented actinic keratoses. Confocal microscopy is a noninvasive technique that provides real-time images of the epidermis and superficial dermis with cellular-level resolution. We describe 3 cases of suspected facial lentigo maligna that were assessed using dermoscopy and confocal microscopy before histopathology study. In the first case, diagnosed as lentigo maligna melanoma, presurgical mapping by confocal microscopy was performed to define the margins more accurately. In the second and third cases, with a clinical and dermoscopic suspicion of lentigo maligna melanoma, confocal microscopy was used to identify the optimal site for biopsy.

  17. Electronic medical records (EMRs), epidemiology, and epistemology: reflections on EMRs and future pediatric clinical research.

    PubMed

    Wasserman, Richard C

    2011-01-01

    Electronic medical records (EMRs) are increasingly common in pediatric patient care. EMR data represent a relatively novel and rich resource for clinical research. The fact, however, that pediatric EMR data are collected for the purposes of clinical documentation and billing rather than research creates obstacles to their use in scientific investigation. Particular issues include accuracy, completeness, comparability between settings, ease of extraction, and context of recording. Although these problems can be addressed through standard strategies for dealing with partially accurate and incomplete data, a longer-term solution will involve work with pediatric clinicians to improve data quality. As research becomes one of the explicit purposes for which pediatricians collect EMR data, the pediatric clinician will play a central role in future pediatric clinical research.

  18. An Instructional Design Course for Clinical Educators: First Iteration Design Research Reflections

    ERIC Educational Resources Information Center

    Blake, Adam; Doherty, Iain

    2007-01-01

    This paper describes the theoretical foundations of an online course to teach clinical educators how to convert a traditional face-to-face course for either flexible or distance delivery. We describe the design research approach to the creation of the course and the pedagogical theory behind the course development. We also present the details of…

  19. Drug administration in animal studies of cardiac arrest does not reflect human clinical experience

    PubMed Central

    Reynolds, Joshua C.; Rittenberger, Jon C.; Menegazzi, James J.

    2007-01-01

    Introduction To date, there is no evidence showing a benefit from any advanced cardiac life support (ACLS) medication in out-of-hospital cardiac arrest (OOHCA), despite animal data to the contrary. One explanation may be a difference in the time to first drug administration. Our previous work has shown the mean time to first drug administration in clinical trials is 19.4 minutes. We hypothesized that the average time to drug administration in large animal experiments occurs earlier than in OOHCA clinical trials. Methods We conducted a literature review between 1990 and 2006 in MEDLINE using the following MeSH headings: swine, dogs, resuscitation, heart arrest, EMS, EMT, ambulance, ventricular fibrillation, drug therapy, epinephrine, vasopressin, amiodarone, lidocaine, magnesium, and sodium bicarbonate. We reviewed the abstracts of 331 studies and 197 full manuscripts. Exclusion criteria included: non-peer reviewed, all without primary animal data, and traumatic models. From these, we identified 119 papers that contained unique information on time to medication administration. The data are reported as mean, ranges, and 95% confidence intervals. Mean time to first drug administration in animal laboratory studies and clinical trials was compared with a t-test. Regression analysis was performed to determine if time to drug predicted ROSC. Results Mean time to first drug administration in 2378 animals was 9.5 minutes (range 3.0–28.0; 95% CI around mean 2.78, 16.22). This is less than the time reported in clinical trials (19.4 min, p<0.001). Time to drug predicted ROSC (Odds Ratio 0.844; 95% CI 0.738, 0.966). Conclusion Shorter drug delivery time in animal models of cardiac arrest may be one reason for the failure of animal studies to translate successfully into the clinical arena. PMID:17360097

  20. Parental reflective functioning in fathers who use intimate partner violence: Findings from a Norwegian clinical sample

    PubMed Central

    Mohaupt, Henning; Duckert, Fanny

    2016-01-01

    Abstract Few studies have examined fathering in an intimate partner violence (IPV) context outside the US. The present study included 36 Norwegian men who were voluntarily participating in therapy after perpetrating acts of IPV. They were interviewed with the revised Parent Development Interview, which is designed to assess parental reflective functioning (parental RF), and screened for alcohol- and substance-use habits and trauma history. At the group level, participants exhibited poor parental RF, high relational trauma scores, and elevated alcohol intake. Parental RF did not correlate with education level, alcohol or substance use, or compound measures of trauma history. There was a moderate negative relationship between having experienced physical abuse in childhood and parental RF. PMID:28163804

  1. Reflective Prompts to Guide Termination of the Psychiatric Clinical Student Nursing Experience.

    PubMed

    Hubbard, Grace B

    2016-04-01

    The average length of stay on psychiatric inpatient units has decreased in the past 40 years from 24.9 to 7.2 days. Inpatient psychiatric nurses are challenged to meet the standards and scope of practice despite the changing circumstances of their work environment. The amount of time student nurses spend with a given patient has been affected by changes in acute psychiatric inpatient care and decreased length of stay; however, opportunities exist for effective termination of the nurse-client relationship. Facilitation of students' awareness and understanding of the dynamics inherent in the termination process is an important teaching task for psychiatric nursing clinical instructors. In the current article, a clinically focused learning activity using structured prompts to guide and promote psychiatric nursing students' experiences with the process of termination is described and teaching strategies are discussed.

  2. Quality management: patients reflections on health care at outpatient clinic of internal medicine department.

    PubMed

    Ljubičić, Neven; Boban, Marko; Gaćina, Petar; Adzija, Jasminka; Benceković, Zeljka; Rajković, Ana

    2009-06-01

    Middle and older age group relative share in the community permanently grows. Those are commonly burdened with several chronic health conditions or elevated incidence of acute ones and in more frequent need for consulting health services. In the era of modern technical medicine, it is important to increase quality of services particularly patients orientated. Department of Internal Medicine developed questionnaire to assess reflections on medical care from the receiver of medical services point of view. Sample was formed from individuals that visited outpatient triage Unit (OTU) and voluntary enrolled, during period April 1-August 31, 2008 for any medical reason. Study population structure had similarly equally of both genders, socio-economical background, and was in age range 18-87. Questionnaire was developed by team of experienced personnel covering satisfaction on received medical care. There were 279 returned formulary in a sample of 6700 patients (4.18%). Patients visited OTU chiefly on behalf medical condition secondary to address of residency, followed by personal choice, on advice given by general practitioner, by emergency transportation services, or just due to earlier experiences. Regarding provided medical care extent, 4/5 of patients were examined in lesser than 2 hours, while total workup lasted mostly for 2-4, followed by over four. Over half of patients were moderate toward highly satisfied with provided medical information, personnel communication style and general reflection on all services while being in the Department premises. Astonishing proportion of patients (93%) was satisfied with positive personnel communication. Integration of patients' self-perceived reports about medical services in organizing process is inevitable for augmenting content and at the same time valuable for developing overall quality of treatment. Communication excellence is of premier importance and unavoidable for giving additional positive effect to remain health

  3. Child Rights and Clinical Bioethics: Historical Reflections on Modern Medicine and Ethics.

    PubMed

    Brosco, Jeffrey P

    2016-01-01

    Why might pediatric bioethicists in the United States reject the U.N. Convention on the Rights of the Child (CRC) as a framework for resolving ethical issues? The essays in this issue present arguments and counterarguments regarding the usefulness of the CRC in various clinical and research cases. But underlying this debate are two historical factors that help explain the seeming paradox of pediatric bioethicists' arguing against child's rights. First, the profession of clinical bioethics emerged in the 1970s as one component of modern medicine's focus on improving health through the application of technologically sophisticated treatments. The everyday work of U.S. bioethicists thus usually involves emerging technologies or practices in clinical or laboratory settings; the articles of the CRC, in contrast, seem better suited to addressing broad policy issues that affect the social determinants of health. Second, U.S. child health policy veered away from a more communitarian approach in the early 20th century for reasons of demography that were reinforced by ideology and concerns about immigration. The divide between clinical medicine and public health in the United States, as well as the relatively meager social safety net, are not based on a failure to recognize the rights of children. Indeed, there is some historical evidence to suggest that "rights language" has hindered progress on child health and well-being in the United States. In today's political climate, efforts to ensure that governments pledge to treat children in accordance with their status as human beings (a child right's perspective) are less likely to improve child health than robust advocacy on behalf of children's unique needs, especially as novel models of health-care financing emerge.

  4. Bridging the reductive and the synthetic: some reflections on the clinical implications of synchronicity.

    PubMed

    Connolly, Angela

    2015-04-01

    When Jung introduced the concepts of synchronicity and the psychoid unconscious, he expanded analytical psychology into decidedly uncanny territory. Despite the early interest shown by Freud, anomalous phenomena such as telepathy have become a taboo subject in psychoanalysis. Today, however, there is an increasing interest in thought transference and synchronicity, thus opening the way for a fruitful exchange between different psychoanalytical schools on their clinical implications. I propose to examine some of the ambiguities of Jung's thinking, to clarify how we define synchronicity, the relationship between synchronicities and parapsychological events, and their clinical significance. At the present moment, we are still unsure if such events should be considered as normal and a way of facilitating individuation, or as an indication of psychopathology in the patient or in the analyst, just as we are uncertain about the particular characteristics of the intersubjective field that can lead to synchronicities. Making use of the typology of mind-matter correlations presented by Atmanspacher and Fach, and the distinction they draw between acategorial and non-categorial states of mind, I will use two clinical vignettes to illustrate the different states of mind in analyst and analysand that can lead to synchronicities. In particular I will focus on the relationship between analytical reverie and synchronicity.

  5. A clinical education program for speech-language pathologists applying reflective practice, evidence-based practice and case-based learning.

    PubMed

    Meilijson, Sara; Katzenberger, Irit

    2014-01-01

    This paper presents a comprehensive clinical education program for speech-language pathology students while considering the learning process and gradual acquisition of knowledge and skills for becoming a practicing speech-language pathologist. It describes the clinical speech and language education program for speech-language pathology students at Hadassah Academic College Jerusalem (HAC) based on three facets of learning: reflective practice, evidence-based practice and case-based learning. Also described are the choice of the model of learning and its implementation. The clinical education program presented reflects the professional development of the faculty at HAC as well as recent trends in clinical education methods.

  6. The invisible basal cell carcinoma: how reflectance confocal microscopy improves the diagnostic accuracy of clinically unclear facial macules and papules.

    PubMed

    Ruini, C; Hartmann, D; Saral, S; Krammer, S; Ruzicka, T; von Braunmühl, T

    2016-11-01

    Difficult to diagnose and early non-melanoma skin cancer lesions are frequently seen in daily clinical practice. Besides precancerous lesions such as actinic keratosis, basal cell carcinomas (BCCs) score the highest frequency in skin tumors. While infiltrative and nodular BCCs require a surgical treatment with a significant impact on the patients' quality of life, early and superficial BCCs might benefit from numerous conservative treatments, such as topical immune-modulators or photodynamic therapy. Dermoscopy has shown a high sensitivity and specificity in the diagnosis of early BCCs, and non-invasive imaging techniques like reflectance confocal microscopy (RCM) have proven to be helpful. The aim of our study was to investigate the importance of RCM in the diagnosis of BCCs with indistinct clinical and dermoscopic features. We retrospectively examined 27 histologically proven BCCs in which diagnosis was not possible based on naked eye examination; we separately reviewed clinical, dermoscopic, and confocal microscopy features and evaluated the lesions meeting the common diagnostic criteria for BCCs, and our diagnostic confidence. All lesions were clinically unclear, with no characteristic features suggestive for BCC; dermoscopy showed in most cases unspecific teleangiectasias (74 %) and micro-erosions (52 %). Confocal microscopy revealed in most of the cases the presence of specific criteria: peripheral palisading of the nuclei (89 %), clefting (70 %), stromal reaction (70 %), dark silhouettes (70 %), inflammatory particles (70 %), and tumor islands (67 %). In the absence of significant diagnostic clinical signs and with unclear dermoscopic features, specific confocal patterns were present in most of the lesions and enabled a correct diagnosis. In the absence of significant clinical features of BCC and in the case of uncertain dermoscopy, striking confocal features are detectable and easy to recognize in most cases. Confocal microscopy can therefore be

  7. [Mobbing, coping and narcisism: reflections in the light of a clinical experience].

    PubMed

    Ziliotto, G

    2008-01-01

    The term "mobbing" has today erroneously come to be a huge general recepticle for all the conflicts and interpersonal problems breaking out in the work environment. The author, who collaborates as clinical psychologist in an anti-mobbing network, shows that frequently events at work and personality structures are closely connected. In particular, attention to the modes of coping becomes a fundamental aspect for the diagnosis of mobbing. If psychic distress has gradually moved from a neurotic basis to a more preponderantly narcissistic pathology, the author underlines that precisely narcissistic pathologies may be correlated to the vast container of mobbing.

  8. Research Capacity-Building with New Technologies within New Communities of Practice: Reflections on the First Year of the Teacher Education Research Network

    ERIC Educational Resources Information Center

    Fowler, Zoe; Stanley, Grant; Murray, Jean; Jones, Marion; McNamara, Olwen

    2013-01-01

    This article focuses on a virtual research environment (VRE) and how it facilitated the networking of teacher educators participating in an Economic and Social Research Council-funded research capacity-building project. Using the theoretical lenses of situated learning and socio-cultural approaches to literacy, participants' ways of engaging with…

  9. Do leaf total antioxidant capacities (TAC) reflect specific antioxidant potentials? - A comparison of TAC and reactive oxygen scavenging in tobacco leaf extracts.

    PubMed

    Majer, Petra; Stoyanova, Silviya; Hideg, Eva

    2010-07-02

    Two traditional methods of total antioxidant capacity (TAC) assessment, Trolox equivalent antioxidant capacity (TEAC) and ferric reducing antioxidant power (FRAP) were applied to water extracts from tobacco leaves at various stages of senescence. Physiological status of the leaves was characterized by the effective photochemical quantum yield of photosynthesis (Y(II)). TAC values were compared to amounts of total phenolics, carotenoid contents and also to reactive oxygen scavenging capacities of the leaf extracts. To this end a new, simple fluorimetric assay was introduced for testing hydroxyl radical neutralizing capacity in leaf extracts. We found that while both TAC values increased with declining photosynthesis and decreasing pigment content, they were not characteristic to specific superoxide or hydroxyl radical scavenging and had limited connection to leaf antioxidant content. Good linear correlations were only found between the following pairs of parameters: Y(II) - total carotenoid, TEAC - total carotenoid, FRAP - total phenolics. Our data show that TEAC and FRAP are not interchangeable in leaf studies and do not represent antioxidant action on ROS.

  10. Perspectives in medical education: 6 reflections on the state of clinical training for residents in Japan.

    PubMed

    Rao, R Harsha

    2007-12-01

    The Muribushi Project in Okinawa, Japan, is breaking new ground for residency training in Japan by explicitly emphasizing clinical skills training and primary care. The core philosophy of the Project is defined by seven "concepts" that commit to (i) establishing cooperation between several hospitals to educate good clinicians; (ii) providing the best learning environment at multiple training sites; (iii) following global standards of practice; (iv) focusing on primary and emergency care of common diseases; (v) emphasizing faculty development through international exchange; (vi) providing residents with opportunities to obtain training abroad; and (vii) improving the quality of medical care through residents. Observations by the author during two week-long visits, one year apart, reveal that the Muribushi Project is fulfilling conceptual goals (iv), (v) and (vi) by emphasizing primary care and encouraging international exchange for faculty and students. The opportunity exists to fulfill goals (i) and (ii), but it is not being exploited because programs at member hospitals are not integrated, so that residents spend the duration of their residency at one location, and there is no formal system of rotations that would broaden their clinical experience. The Project is failing to meet a sixth goal of following global standards of care (goal #iii) and it is too early to say if it's pioneering approach to residency training is having an impact on healthcare in Japan (goal #vii). On balance, the Project's success in implementing elements of its core philosophy for residency training in the tradition-bound environment of Japan is particularly laudable.

  11. [Reflections on the clinical reports «minimum data set»].

    PubMed

    Prieto de Paula, J M; Franco Hidalgo, S

    2012-02-01

    Royal Decree 1093/2010 (3 September 2010) establishes the minimum data set that the clinical reports of discharges and outpatient visits elaborated in the facilities of the National Health System should contain, among others. Until then, the Ministerial Order 221/1984, that only required the drawing up of a discharge report for patients seen in a hospital-regime health care establishment, was in force. In spite of the importance of these documents, their quality is far from that desired, especially that of the reports on visits, which, among other things, are not performed in a high percentage of the cases. Recently the Sociedad Española de Medicina Interna (SEMI) (Spanish Society of Internal Medicine), in collaboration with other scientific societies, issued some recommendations for the drawing up of the discharge reports. In this present work, a series of thoughts are made on the implications of the new decree, especially in the case of the reports of the outpatient clinics.

  12. Pentosidine, an Advanced Glycation End-Product, May Reflect Clinical and Morphological Features of Hand Osteoarthritis

    PubMed Central

    Braun, Martin; Hulejová, Hana; Gatterová, Jindřiška; Filková, Mária; Pavelková, Andrea; Šléglová, Olga; Kaspříková, Nikola; Vencovský, Jiří; Pavelka, Karel; Šenolt, Ladislav

    2012-01-01

    The study investigates pentosidine levels, an advanced glycation end-product, in patients with erosive and non-erosive hand osteoarthritis (HOA) and determine its potential association with clinical findings and imaging-defined joint damage. Pentosidine was measured by HPLC in serum and urine of 53 females with HOA (31 erosive and 22 non-erosive HOA) and normalised to the total serum protein or urinary creatinine, respectively. Pain, joint stiffness and disability were assessed by the Australian/Canadian OA hand index (AUSCAN). The hand radiographs scored according to the Kallman grading scale were assessed to determine a baseline value and reassessed after two years. The levels of urine pentosidine, but not of serum pentosidine, were higher in patients with erosive HOA than in non-erosive HOA (p=0.039). Urinary pentosidine correlated with CRP (r=0.302, p=0.031), ESR (r=0.288, p=0.041) and AUSCAN (r=0.408, p=0.003). Serum pentosidine, but not in urine, significantly correlated with the Kallman radiographic score in erosive HOA at the baseline (r=0.409, p=0.022) and after 2 years (r=0.385, p=0.032). However, when corrected for age and disease duration, only correlation between urine pentosidine and AUSCAN remained significant (r=0.397, p=0.004). Our data suggest that serum and urine pentosidine levels may relate to the distinctive clinical and morphological features of HOA. PMID:22715350

  13. Reflections on clinical applications of yoga in voice therapy with MTD.

    PubMed

    Moore, Carmelle

    2012-12-01

    This paper explores the application of modified yoga techniques, as an adjunct to voice therapy, by a speech pathologist who is also a yoga teacher. Yoga practices, with effects that may be short-term, are not considered a substitute for comprehensive and integrated somatic retraining systems (such as the Alexander Technique or Feldenkrais ATM). However, when yoga is conducted emphasizing kinaesthetic and proprioceptive awareness, the client may achieve an 'awareness state' that facilitates the learning of vocal remediation techniques (for example, by more easily 'tuning in' to the subtle sensations of supralaryngeal deconstriction). Core yoga elements and clinical applications are identified. The potential benefits and considerations when using yoga as an adjunct to the treatment of muscle tension dysphonia (MTD) are explored.

  14. Clinical neurological examination vs electrophysiological studies: Reflections from experiences in occupational medicine.

    PubMed

    Jepsen, Jørgen Riis

    2015-06-26

    Seventy-five percent of upper limb disorders that are related to work are regarded as diagnostically unclassifiable and therefore challenging to the clinician. Therefore it has been generally less successfully to prevent and treat these common and frequently disabling disorders. To reach a diagnosis requires the identification of the responsible pathology and the involved tissues and structures. Consequently, improved diagnostic approaches are needed. This editorial discusses the potentials of using the clinical neurologic examination in patients with upper limb complaints related to work. It is argued that a simple but systematic physical approach permits the examiner to frequently identify patterns of neurological findings that suggest nerve afflictions and their locations, and that electrophysiological studies are less likely to identify pathology. A diagnostic algorithm for the physical assessment is provided to assist the clinician. Failure to include representative neurological items in the physical examination may result in patients being misinterpreted, misdiagnosed and mistreated.

  15. Assessment of capacity in an aging society.

    PubMed

    Moye, Jennifer; Marson, Daniel C; Edelstein, Barry

    2013-04-01

    Over the past 40 years, the assessment and scientific study of capacity in older adults has emerged as a distinct field of clinical and research activity for psychologists. This new field reflects the convergence of several trends: the aging of American society, the growing incidence and prevalence of dementia, and the patient rights, deinstitutionalization, and disability rights movements. Because of these forces, capacity issues now permeate the fabric of everyday life, whether in the form of guardianship petitions, questions of capacity to consent to treatment, the ability to make a new will, or participation in human research. In seeking to resolve these issues, families, clinicians, and legal professionals increasingly turn to psychologists to assess a capacity and to provide empirically supported judgments that properly balance autonomy and protection for the individual. Psychologists have taken a leading role in the development of functional assessment instruments that measure important aspects of the capacity construct. In addition, psychology has been a major contributor to the scientific study of capacity. In collaboration with colleagues from medicine and law, psychologists have articulated crucial theoretical frameworks that integrate legal, clinical, and ethical dimensions of the capacity problem. This article focuses on the evolution of theory, law, science, and practice in the evaluation of capacity in older adults and its recent culmination in a series of interdisciplinary handbooks sponsored by the American Psychological Association and the American Bar Association.

  16. Assessment of Capacity in an Aging Society

    PubMed Central

    Moye, Jennifer; Marson, Daniel C.; Edelstein, Barry

    2014-01-01

    Over the past 40 years, the assessment and scientific study of capacity in older adults has emerged as a distinct field of clinical and research activity for psychologists. This new field reflects the convergence of several trends: the aging of American society, the growing incidence and prevalence of dementia, and the patient rights, deinstitutionalization, and disability rights movements. Because of these forces, capacity issues now permeate the fabric of everyday life, whether in the form of guardianship petitions, questions of capacity to consent to treatment, the ability to make a new will, or participation in human research. In seeking to resolve these issues, families, clinicians, and legal professionals increasingly turn to psychologists to assess a capacity and to provide empirically supported judgments that properly balance autonomy and protection for the individual. Psychologists have taken a leading role in the development of functional assessment instruments that measure important aspects of the capacity construct. In addition, psychology has been a major contributor to the scientific study of capacity. In collaboration with colleagues from medicine and law, psychologists have articulated crucial theoretical frameworks that integrate legal, clinical, and ethical dimensions of the capacity problem. This article focuses on the evolution of theory, law, science, and practice in the evaluation of capacity in older adults and its recent culmination in a series of interdisciplinary handbooks sponsored by the American Psychological Association and the American Bar Association. PMID:23586491

  17. Effects of overnight captivity on antioxidant capacity and clinical chemistry of wild southern hairy-nosed wombats (Lasiorhinus latifrons).

    PubMed

    Debrincat, Steven; Taggart, David; Rich, Brian; Beveridge, Ian; Boardman, Wayne; Dibben, Ron

    2014-09-01

    An animal's antioxidant capacity is measured by its ability to quench reactive oxygen species (ROS). During everyday metabolism, antioxidants and ROS are in equilibrium with one another. In times of stress, an animal produces more ROS and therefore uses its antioxidant capacity more readily in order to maintain this equilibrium. When the production of ROS exceeds the antioxidant capacity, an animal will experience extensive oxidative stress, which can ultimately affect that animal's health. During experimental study of wild animals, it is often necessary to capture them for a short period of time. In order to obtain a measurement of the effects of short-term captivity on oxidative capacity in wild animals, a population of southern hairy-nosed wombats (Lasiorhinus latifrons) in Swan Reach, South Australia (34.57 degrees S, 139.60 degrees E), was studied. To assess the variation in antioxidant capacity, two assays, the ferric reducing ability of plasma and the trolox equivalent antioxidant capacity, were performed. A third assay, thiobarbituric acid reactive substances, was used to measure the effects of ROS. Measurements of the specific antioxidants uric acid, ascorbic acid, retinol, alpha-tocopherol, and superoxide dismutase were also performed. The biochemical parameters albumin, total protein, cholinesterase, creatinine, and urea were measured as indicators for health. Results showed a significant reduction in antioxidant capacity during the overnight period of captivity.

  18. Making clinical case-based learning in veterinary medicine visible: analysis of collaborative concept-mapping processes and reflections.

    PubMed

    Khosa, Deep K; Volet, Simone E; Bolton, John R

    2014-01-01

    The value of collaborative concept mapping in assisting students to develop an understanding of complex concepts across a broad range of basic and applied science subjects is well documented. Less is known about students' learning processes that occur during the construction of a concept map, especially in the context of clinical cases in veterinary medicine. This study investigated the unfolding collaborative learning processes that took place in real-time concept mapping of a clinical case by veterinary medical students and explored students' and their teacher's reflections on the value of this activity. This study had two parts. The first part investigated the cognitive and metacognitive learning processes of two groups of students who displayed divergent learning outcomes in a concept mapping task. Meaningful group differences were found in their level of learning engagement in terms of the extent to which they spent time understanding and co-constructing knowledge along with completing the task at hand. The second part explored students' and their teacher's views on the value of concept mapping as a learning and teaching tool. The students' and their teacher's perceptions revealed congruent and contrasting notions about the usefulness of concept mapping. The relevance of concept mapping to clinical case-based learning in veterinary medicine is discussed, along with directions for future research.

  19. Portable handheld diffuse reflectance spectroscopy system for clinical evaluation of skin: a pilot study in psoriasis patients.

    PubMed

    Tzeng, Shih-Yu; Guo, Jean-Yan; Yang, Chao-Chun; Hsu, Chao-Kai; Huang, Hung Ji; Chou, Shih-Jie; Hwang, Chi-Hung; Tseng, Sheng-Hao

    2016-02-01

    Diffuse reflectance spectroscopy (DRS) has been utilized to study biological tissues for a variety of applications. However, many DRS systems are not designed for handheld use and/or relatively expensive which limit the extensive clinical use of this technique. In this paper, we report a handheld, low-cost DRS system consisting of a light source, optical switch, and a spectrometer, that can precisely quantify the optical properties of tissue samples in the clinical setting. The handheld DRS system was employed to determine the skin chromophore concentrations, absorption and scattering properties of 11 patients with psoriasis. The measurement results were compared to the clinical severity of psoriasis as evaluated by dermatologist using PASI (Psoriasis Area and Severity Index) scores. Our statistical analyses indicated that the handheld DRS system could be a useful non-invasive tool for objective evaluation of the severity of psoriasis. It is expected that the handheld system can be used for the objective evaluation and monitoring of various skin diseases such as keloid and psoriasis.

  20. Portable handheld diffuse reflectance spectroscopy system for clinical evaluation of skin: a pilot study in psoriasis patients

    PubMed Central

    Tzeng, Shih-Yu; Guo, Jean-Yan; Yang, Chao-Chun; Hsu, Chao-Kai; Huang, Hung Ji; Chou, Shih-Jie; Hwang, Chi-Hung; Tseng, Sheng-Hao

    2016-01-01

    Diffuse reflectance spectroscopy (DRS) has been utilized to study biological tissues for a variety of applications. However, many DRS systems are not designed for handheld use and/or relatively expensive which limit the extensive clinical use of this technique. In this paper, we report a handheld, low-cost DRS system consisting of a light source, optical switch, and a spectrometer, that can precisely quantify the optical properties of tissue samples in the clinical setting. The handheld DRS system was employed to determine the skin chromophore concentrations, absorption and scattering properties of 11 patients with psoriasis. The measurement results were compared to the clinical severity of psoriasis as evaluated by dermatologist using PASI (Psoriasis Area and Severity Index) scores. Our statistical analyses indicated that the handheld DRS system could be a useful non-invasive tool for objective evaluation of the severity of psoriasis. It is expected that the handheld system can be used for the objective evaluation and monitoring of various skin diseases such as keloid and psoriasis. PMID:26977366

  1. [Ethical reflections and recommendations for making clinical decisions in the care of the healthy newborn].

    PubMed

    Sánchez Escartín, M C; López de Heredia Goya, J; Aguayo Maldonado, M J; Blanco Bravo, D; Molina Morales, V

    2012-12-01

    The care of healthy newborn during their stay in health centres is not usually a problem and there are few conflicts in the relationship with the family. Conflicts may arise because the parents do not accept the care or care routines that health professionals provide. They believe that the newborn does not require testing or prophylactic measures, such as administration of vitamin K, or puncture to obtain a blood sample for newborn screening. This is because the information they have is not adequate, or because they reject some measures as they are invasive and that from their point of view, do not correspond to the care of a healthy newborn. This document seeks to reconcile the values of family and participation in the care of their child, the rights of the newborn, and the values of health professionals. It is based on adequate information, a good clinical relationship, and discussion in case of discrepancies that can lead to changes in some procedures that are not essential in the care of the newborn.

  2. Using videoed simulated clinical interaction to promote communication skills and reflective practice for overseas-born medical students.

    PubMed

    Hill, Kathryn; Hamilton, Jan

    2013-01-01

    This paper describes a teaching intervention designed to promote the clinical communications skills of overseas-born medical students through critical reflection on the practice of others. Using a staged process and a video recording of a simulated medical interaction it investigated the extent to which the participants were able to anticipate, identify and resolve the targeted communication issues, and demonstrate selected skills in a simulated interaction. Data comprised worksheet notes, transcriptions (group discussions) and completed questionnaires (ratings and comments). Analysis was thematic (worksheet notes, transcription, questionnaire feedback) and quantitative (questionnaire ratings). The results suggest the notion of reflective practice could be productively extended to take account of current developments in pedagogy and learning. This includes providing opportunities for students to share ideas, resolve differences and ambiguities, and address gaps in their communication skills as well as to apply learned concepts and receive targeted feedback. While the intervention specifically targeted overseas-born medical students, the approach described in the paper has potential for developing the communication skills of 'local' medical students and healthcare professionals more generally.

  3. The Leishmaniasis East Africa Platform (LEAP): strengthening clinical trial capacity in resource-limited countries to deliver new treatments for visceral leishmaniasis

    PubMed Central

    Wasunna, Monique; Musa, Ahmed; Hailu, Asrat; Khalil, Eltahir A. G.; Olobo, Joseph; Juma, Rashid; Wells, Susan; Alvar, Jorge; Balasegaram, Manica

    2016-01-01

    Visceral leishmaniasis is a neglected tropical disease endemic in East Africa where improved patient-adapted treatments are needed. The Leishmaniasis East Africa Platform (LEAP) was created in 2003 to strengthen clinical research capacity, serve as a base for training, and evaluate and facilitate implementation of new treatments. Major infrastructure upgrades and personnel training have been carried out. A short course of Sodium Stibogluconate and Paramomycin (SSG&PM) was evaluated and is now first-line treatment in the region; alternative treatments have also been assessed. LEAP can serve as a successful model of collaboration between different partners and countries when conducting clinical research in endemic countries to international standards. PMID:27268714

  4. Application of Attenuated Total Reflectance-Fourier Transformed Infrared (ATR-FTIR) Spectroscopy To Determine the Chlorogenic Acid Isomer Profile and Antioxidant Capacity of Coffee Beans.

    PubMed

    Liang, Ningjian; Lu, Xiaonan; Hu, Yaxi; Kitts, David D

    2016-01-27

    The chlorogenic acid isomer profile and antioxidant activity of both green and roasted coffee beans are reported herein using ATR-FTIR spectroscopy combined with chemometric analyses. High-performance liquid chromatography (HPLC) quantified different chlorogenic acid isomer contents for reference, whereas ORAC, ABTS, and DPPH were used to determine the antioxidant activity of the same coffee bean extracts. FTIR spectral data and reference data of 42 coffee bean samples were processed to build optimized PLSR models, and 18 samples were used for external validation of constructed PLSR models. In total, six PLSR models were constructed for six chlorogenic acid isomers to predict content, with three PLSR models constructed to forecast the free radical scavenging activities, obtained using different chemical assays. In conclusion, FTIR spectroscopy, coupled with PLSR, serves as a reliable, nondestructive, and rapid analytical method to quantify chlorogenic acids and to assess different free radical-scavenging capacities in coffee beans.

  5. Context Impact of Clinical Scenario on Knowledge Transfer and Reasoning Capacity in a Medical Problem-Based Learning Curriculum

    ERIC Educational Resources Information Center

    Collard, A.; Brédart, S.; Bourguignon, J.-P.

    2016-01-01

    Since 2000, the faculty of Medicine at the University of Liège has integrated problem-based learning (PBL) seminars from year two to seven in its seven-year curriculum. The PBL approach has been developed to facilitate students' acquisition of reasoning capacity. This contextualized learning raises the question of the de- and re-contextualization…

  6. From cases to capacity? A critical reflection on the role of 'ethical dilemmas' in the development of dual-use governance.

    PubMed

    Edwards, Brett; Revill, James; Bezuidenhout, Louise

    2014-06-01

    The dual-use issue is often framed as a series of paralyzing 'dilemmas' facing the scientific community as well as institutions which support innovation. While this conceptualization of the dual-use issue can be useful in certain contexts (such as in awareness-raising and as part of educational activities directed at the scientific community) its usefulness is more limited when reflecting on the governance and politics of the dual-use issue. Within this paper, key shortcomings of the dilemma framing are outlined. It is argued that many of the issues raised in the most recent debates about 'dual-use' bird flu research remain unresolved. This includes questions about the trajectories of certain lines of research, as well as broader trends in the practice and governance of science. This leads to difficult questions about current approaches to the dual-use issue within the US, as well as internationally.

  7. From Cases to Capacity? A Critical Reflection on the Role of ‘Ethical Dilemmas’ in the Development of Dual-Use Governance

    PubMed Central

    Edwards, Brett; Revill, James; Bezuidenhout, Louise

    2016-01-01

    The dual-use issue is often framed as a series of paralyzing ‘dilemmas’ facing the scientific community as well as institutions which support innovation. While this conceptualization of the dual-use issue can be useful in certain contexts (such as in awareness-raising and as part of educational activities directed at the scientific community) its usefulness is more limited when reflecting on the governance and politics of the dual-use issue. Within this paper, key shortcomings of the dilemma framing are outlined. It is argued that many of the issues raised in the most recent debates about ‘dual-use’ bird flu research remain unresolved. This includes questions about the trajectories of certain lines of research, as well as broader trends in the practice and governance of science. This leads to difficult questions about current approaches to the dual-use issue within the US, as well as internationally. PMID:23703451

  8. 1987 Volvo award in clinical sciences. The perception of back pain and the role of psychophysical tests of lifting capacity.

    PubMed

    Troup, J D; Foreman, T K; Baxter, C E; Brown, D

    1987-09-01

    In order to study the predictive value of pre-employment screening tests, a volunteer population of 1,741 men and 1,150 women was questioned about their experience of low-back pain (LBP) and their perception of physical exertion at work. They undertook a battery of tests, including psychophysical assessments of lifting capacity, and they were followed up by postal questionnaire after 1 year. The response rate was 88.7%. The psychophysical tests have proved to be simple and inexpensive to administer; in good hands, they are repeatable. Although psychophysical lifting capacity was less in those with previous LBP, the psychophysical strength tests were poor predictors of future LBP. But when the previous history of LBP was known, then the test results significantly enhanced the prediction.

  9. Reflecting Reflective Practice

    ERIC Educational Resources Information Center

    Galea, Simone

    2012-01-01

    This paper demystifies reflective practice on teaching by focusing on the idea of reflection itself and how it has been conceived by two philosophers, Plato and Irigaray. It argues that reflective practice has become a standardized method of defining the teacher in teacher education and teacher accreditation systems. It explores how practices of…

  10. Serum sPD-L1, Upregulated in Sepsis, May Reflect Disease Severity and Clinical Outcomes in Septic Patients.

    PubMed

    Liu, M; Zhang, X; Chen, H; Wang, G; Zhang, J; Dong, P; Liu, Y; An, S; Wang, L

    2017-01-01

    We aimed to find the correlation between serum sPD-L1 (soluble programmed cell death L-1 ligand) and sepsis. Totally 91 consecutive patients with sepsis were performed in a 15-bed medical intensive care unit (ICU) of the second affiliated hospital, Xi'an Jiaotong University in Xi'an, China, between February 2015 and May 2016. Healthy controls (HC) consisted of 29 healthy volunteer. Baseline demographic data were recorded. Blood samples were collected through an indwelling central venous or by peripheral venipuncture. Serum sPD-L1 and sPD-1 levels were determined with enzyme-linked immunosorbent assay kits (Elabscience Biotechnology Co. Ltd, Wuhan, China). SPSS19.0 software (SPSS Inc., Chicago, Illinois, USA) was used for statistical analysis. Kaplan-Meier survival analysis and Cox regression analysis were also performed. Serum sPD-L1 levels and sPD-1 levels were significantly increased in septic patients compared with HC (P = 0.000). Serum sPD-L1 levels were significantly increased in non-survivors compared with survivors (P < 0.05), but there was no statistically difference on serum sPD-1 levels between non-survivors and survivors (P > 0.05). Serum sPD-L1 levels were correlated with absolute lymphocyte (ALC), platelets and SOFA scores. Serum sPD-L1/sPD-1 levels were negatively correlated with ALC and platelets, and SOFA scores. The prognostic accuracy of the sPD-L1 level to predict 28-day mortality was similar to that of the APACHE-II scores and SOFA scores. Cox regression analysis showed that sPD-L1 was an independent prognostic factor. Serum sPD-L1 is upregulated in sepsis and may reflect disease severity and clinical outcomes in patients. Serum sPD-L1 may be an independent prognostic factor for sepsis.

  11. The Therapeutic Relationship in the Brief Treatment of Depression: Contributions to Clinical Improvement and Enhanced Adaptive Capacities

    ERIC Educational Resources Information Center

    Zuroff, David C.; Blatt, Sidney J.

    2006-01-01

    Using data from the National Institute of Mental Health Treatment for Depression Collaborative Research Program, the authors examined the impact on treatment outcome of the patient's perception of the quality of the therapeutic relationship and contribution to the therapeutic alliance. Shared variance with early clinical improvement was removed…

  12. How Current Clinical Practice Guidelines for Low Back Pain Reflect Traditional Medicine in East Asian Countries: A Systematic Review of Clinical Practice Guidelines and Systematic Reviews

    PubMed Central

    Cho, Hyun-Woo; Hwang, Eui-Hyoung; Lim, Byungmook; Heo, Kwang-Ho; Liu, Jian-Ping; Tsutani, Kiichiro; Lee, Myeong Soo; Shin, Byung-Cheul

    2014-01-01

    Objectives The aims of this study were to investigate whether there is a gap between evidence of traditional medicine (TM) interventions in East-Asian countries from the current Clinical Practice Guidelines (CPGs) and evidence from current systematic reviews and meta-analyses (SR-MAs) and to analyze the impact of this gap on present CPGs. Methods We examined 5 representative TM interventions in the health care systems of East-Asian countries. We searched seven relevant databases for CPGs to identify whether core CPGs included evidence of TM interventions, and we searched 11 databases for SR-MAs to re-evaluate current evidence on TM interventions. We then compared the gap between the evidence from CPGs and SR-MAs. Results Thirteen CPGs and 22 SR-MAs met our inclusion criteria. Of the 13 CPGs, 7 CPGs (54%) mentioned TM interventions, and all were for acupuncture (only one was for both acupuncture and acupressure). However, the CPGs did not recommend acupuncture (or acupressure). Of 22 SR-MAs, 16 were for acupuncture, 5 for manual therapy, 1 for cupping, and none for moxibustion and herbal medicine. Comparing the evidence from CPGs and SR-MAs, an underestimation or omission of evidence for acupuncture, cupping, and manual therapy in current CPGs was detected. Thus, applying the results from the SR-MAs, we moderately recommend acupuncture for chronic LBP, but we inconclusively recommend acupuncture for (sub)acute LBP due to the limited current evidence. Furthermore, we weakly recommend cupping and manual therapy for both (sub)acute and chronic LBP. We cannot provide recommendations for moxibustion and herbal medicine due to a lack of evidence. Conclusions The current CPGs did not fully reflect the evidence for TM interventions. As relevant studies such as SR-MAs are conducted and evidence increases, the current evidence on acupuncture, cupping, and manual therapy should be rigorously considered in the process of developing or updating the CPG system. PMID:24505363

  13. Adaptive capacity of the Adjusted Clinical Groups Case-Mix System to the cost of primary healthcare in Catalonia (Spain): a observational study

    PubMed Central

    Velasco-Velasco, Soledad; Navarro-Artieda, Ruth; Prados-Torres, Alexandra; Bolibar-Ribas, Buenaventura; Violan-Fors, Concepción

    2012-01-01

    Objectives To describe the adaptive capacity of the Adjusted Clinical Groups (ACG) system to the cost of care in primary healthcare centres in Catalonia (Spain). Design Retrospective study (multicentres) conducted using computerised medical records. Setting 13 primary care teams in 2008 were included. Participants All patients registered in the study centres who required care between 1 January and 31 December 2008 were finally studied. Patients not registered in the study centres during the study period were excluded. Outcome measures Demographic (age and sex), dependent (cost of care) and case-mix variables were studied. The cost model for each patient was established by differentiating the fixed and variable costs. To evaluate the adaptive capacity of the ACG system, Pearson's coefficient of variation and the percentage of outliers were calculated. To evaluate the explanatory power of the ACG system, the authors used the coefficient of determination (R2). Results The number of patients studied was 227 235 (frequency: 5.9 visits per person per year), with a mean of 4.5 (3.2) episodes and 8.1 (8.2) visits per patient per year. The mean total cost was €654.2. The explanatory power of the ACG system was 36.9% for costs (56.5% without outliers). 10 ACG categories accounted for 60.1% of all cases and 19 for 80.9%. 5 categories represented 71% of poor performance (N=78 887, 34.7%), particularly category 0300-Acute Minor, Age 6+ (N=26 909, 11.8%), which had a coefficient of variation =139% and 6.6% of outliers. Conclusions The ACG system is an appropriate manner of classifying patients in routine clinical practice in primary healthcare centres in Catalonia, although improvements to the adaptive capacity through disaggregation of some categories according to age groups and, especially, the number of acute episodes in paediatric patients would be necessary to reduce intra-group variation. PMID:22734115

  14. Benefits of maltodextrin intake 2 hours before cholecystectomy by laparotomy in respiratory function and functional capacity: a prospective randomized clinical trial

    PubMed Central

    Zani, Fabiana Vieira Breijão; Aguilar-Nascimento, José Eduardo; Nascimento, Diana Borges Dock; da Silva, Ageo Mário Cândido; Caporossi, Fernanda Stephan; Caporossi, Cervantes

    2015-01-01

    ABSTRACT Objective: To evaluate the change in respiratory function and functional capacity according to the type of preoperative fasting. Methods: Randomized prospective clinical trial, with 92 female patients undergoing cholecystectomy by laparotomy with conventional or 2 hours shortened fasting. The variables measured were the peak expiratory flow, forced expiratory volume in the first second, forced vital capacity, dominant handgrip strength, and non-dominant handgrip strength. Evaluations were performed 2 hours before induction of anesthesia and 24 hours after the operation. Results: The two groups were similar in preoperative evaluations regarding demographic and clinical characteristics, as well as for all variables. However, postoperatively the group with shortened fasting had higher values than the group with conventional fasting for lung function tests peak expiratory flow (128.7±62.5 versus 115.7±59.9; p=0.040), forced expiratory volume in the first second (1.5±0.6 versus 1.2±0.5; p=0.040), forced vital capacity (2.3±1.1 versus 1.8±0.9; p=0.021), and for muscle function tests dominant handgrip strength (24.9±6.8 versus 18.4±7.7; p=0.001) and non-dominant handgrip strength (22.9±6.3 versus 17.0±7.8; p=0.0002). In the intragroup evaluation, there was a decrease in preoperative compared with postoperative values, except for dominant handgrip strength (25.2±6.7 versus 24.9±6.8; p=0.692), in the shortened fasting group. Conclusion: Abbreviation of preoperative fasting time with ingestion of maltodextrin solution is beneficial to pulmonary function and preserves dominant handgrip strength. PMID:26154547

  15. Does living and working in a hot environment induce clinically relevant changes in immune function and voluntary force production capacity?

    PubMed

    Knez, Wade; Girard, Olivier; Racinais, Sebastien; Walsh, Andrew; Gaoua, Nadia; Grantham, Justin

    2014-01-01

    This study investigated the effect of living (summer vs. winter) and working (morning vs. afternoon) in a hot environment on markers of immune function and forearm strength. Thirty-one healthy male gas field employees were screened before (between 05:30 and 07:00) and after their working day (between 15:30 and 17:00) during both seasons. Body core temperature and physical activity were recorded throughout the working days. The hot condition (i.e. summer) led a higher (p≤0.05) average body core temperature (~37.2 vs. ~37.4 °C) but reduced physical activity (-14.8%) during the work-shift. Our data showed an increase (p≤0.05) in lymphocyte and monocyte counts in the summer. Additionally, work-shift resulted in significant (p≤0.001) changes in leukocytes, lymphocytes and monocytes independently of the environment. Handgrip (p=0.069) and pinch (p=0.077) forces tended to be reduced from pre-to post-work, while only force produced during handgrip manoeuvres was significantly reduced (p≤0.05) during the hot compared to the temperate season. No interactions were observed between the environment and work-shift for any marker of immune function or forearm strength. In summary, working and living in hot conditions impact on markers of immune function and work capacity; however by self-regulating energy expenditure, immune markers remained in a healthy reference range.

  16. How legislation on decisional capacity can negatively affect the feasibility of clinical trials in patients with dementia.

    PubMed

    Galeotti, Francesca; Vanacore, Nicola; Gainotti, Sabina; Izzicupo, Fabio; Menniti-Ippolito, Francesca; Petrini, Carlo; Chiarotti, Flavia; Chattat, Rabih; Raschetti, Roberto

    2012-08-01

    Antipsychotic drugs are widely used to treat behavioural and psychological disturbances associated with Alzheimer's disease (AD), although only modest evidence from randomized controlled trials supports their efficacy, and increasing evidence from post-marketing surveillance shows serious adverse events associated with their use, including increased mortality. The AdCare study, a non-profit, randomized, placebo-controlled, double-blind, multicentre, pragmatic trial coordinated by the Italian National Institute of Health, aimed to evaluate the long-term safety and efficacy profiles of three atypical antipsychotic drugs (risperidone, olanzapine and quetiapine) and one conventional antipsychotic drug (haloperidol) in treating psychosis, aggression and agitation in outpatients with AD. The study was planned to be carried out in 19 clinical centres and to enrol 1000 outpatients. According to Italian law, in the case where a patient is considered unable to give informed consent, a legal representative designated by the court has to provide it. Because of difficulties in the informed consent procedure, the study had to be prematurely interrupted. From February 2009 to April 2010, 83 patients gave informed consent to participate in the trial. Fifty-six patients (68%) were included with consent given by a legal representative, while 27 patients (32%) were considered to provide personal informed consent on the basis of the results from a specifically built procedure. Patients and caregivers were offered the opportunity to participate in the trial before the occurrence of behavioural disturbances, in order to provide them with enough time to consider their participation in the study. Twenty-three patients experienced behavioural, clinically relevant symptoms and were randomized to the study drug; all randomized patients except one had consent for inclusion in the study given by legal representatives. After trial interruption, all patients taking an active drug continued

  17. Effects of an Exercise Programme on Functional Capacity, Body Composition and Risk of Falls in Patients with Cirrhosis: A Randomized Clinical Trial

    PubMed Central

    Román, Eva; García-Galcerán, Cristina; Torrades, Teresa; Herrera, Silvia; Marín, Ana; Doñate, Maite; Alvarado-Tapias, Edilmar; Malouf, Jorge; Nácher, Laura; Serra-Grima, Ricard; Guarner, Carlos; Soriano, German

    2016-01-01

    Patients with cirrhosis often have functional limitations, decreased muscle mass, and a high risk of falls. These variables could improve with exercise. The aim was to study the effects of moderate exercise on functional capacity, body composition and risk of falls in patients with cirrhosis. Twenty-three cirrhotic patients were randomized to an exercise programme (n = 14) or to a relaxation programme (n = 9). Both programmes consisted of a one-hour session 3 days a week for 12 weeks. At the beginning and end of the study, we measured functional capacity using the cardiopulmonary exercise test, evaluated body composition using anthropometry and dual energy X-ray absorptiometry, and estimated risk of falls using the Timed Up&Go test. In the exercise group, cardiopulmonary exercise test showed an increase in total effort time (p<0.001) and ventilatory anaerobic threshold time (p = 0.009). Upper thigh circumference increased and mid-arm and mid-thigh skinfold thickness decreased. Dual energy X-ray absorptiometry showed a decrease in fat body mass (-0.94 kg, 95%CI -0.48 to -1.41, p = 0.003) and an increase in lean body mass (1.05 kg, 95%CI 0.27 to 1.82, p = 0.01), lean appendicular mass (0.38 kg, 95%CI 0.06 to 0.69, p = 0.03) and lean leg mass (0.34 kg, 95%CI 0.10 to 0.57, p = 0.02). The Timed Up&Go test decreased at the end of the study compared to baseline (p = 0.02). No changes were observed in the relaxation group. We conclude that a moderate exercise programme in patients with cirrhosis improves functional capacity, increases muscle mass, and decreases body fat and the Timed Up&Go time. Trial Registration: ClinicalTrials.gov NCT01447537 PMID:27011355

  18. Logistic regression analyses for predicting clinically important differences in motor capacity, motor performance, and functional independence after constraint-induced therapy in children with cerebral palsy.

    PubMed

    Wang, Tien-ni; Wu, Ching-yi; Chen, Chia-ling; Shieh, Jeng-yi; Lu, Lu; Lin, Keh-chung

    2013-03-01

    Given the growing evidence for the effects of constraint-induced therapy (CIT) in children with cerebral palsy (CP), there is a need for investigating the characteristics of potential participants who may benefit most from this intervention. This study aimed to establish predictive models for the effects of pediatric CIT on motor and functional outcomes. Therapists administered CIT to 49 children (aged 3-11 years) with CP. Sessions were 1-3.5h a day, twice a week, for 3-4 weeks. Parents were asked to document the number of restraint hours outside of the therapy sessions. Domains of treatment outcomes included motor capacity (measured by the Peabody Developmental Motor Scales II), motor performance (measured by the Pediatric Motor Activity Log), and functional independence (measured by the Pediatric Functional Independence Measure). Potential predictors included age, affected side, compliance (measured by time of restraint), and the initial level of motor impairment severity. Tests were administered before, immediately after, and 3 months after the intervention. Logistic regression analyses showed that total amount of restraint time was the only significant predictor for improved motor capacity immediately after CIT. Younger children who restrained the less affected arm for a longer time had a greater chance to achieve clinically significant improvements in motor performance. For outcomes of functional independence in daily life, younger age was associated with clinically meaningful improvement in the self-care domain. Baseline motor abilities were significantly predictive of better improvement in mobility and cognition. Significant predictors varied according to the aspects of motor outcomes after 3 months of follow-up. The potential predictors identified in this study allow clinicians to target those children who may benefit most from CIT.

  19. Clinical system model for monitoring the physiological status of jaundice by extracting bilirubin components from skin diffuse reflectance spectra

    NASA Astrophysics Data System (ADS)

    Kumar, Alla S.; Clark, Joseph; Beyette, Fred R., Jr.

    2009-02-01

    Neonatal jaundice is a medical condition which occurs in newborns as a result of an imbalance between the production and elimination of bilirubin. The excess bilirubin in the blood stream diffuses into the surrounding tissue leading to a yellowing of the skin. As the bilirubin levels rise in the blood stream, there is a continuous exchange between the extra vascular bilirubin and bilirubin in the blood stream. Exposure to phototherapy alters the concentration of bilirubin in the vascular and extra vascular regions by causing bilirubin in the skin layers to be broken down. Thus, the relative concentration of extra vascular bilirubin is reduced leading to a diffusion of bilirubin out of the vascular region. Diffuse reflectance spectra from human skin contains physiological and structural information of the skin and nearby tissue. A diffuse reflectance spectrum must be captured before and after blanching in order to isolate the intravascular and extra vascular bilirubin. A new mathematical model is proposed with extra vascular bilirubin concentration taken into consideration along with other optical parameters in defining the diffuse reflectance spectrum from human skin. A nonlinear optimization algorithm has been adopted to extract the optical properties (including bilirubin concentration) from the skin reflectance spectrum. The new system model and nonlinear algorithm have been combined to enable extraction of Bilirubin concentrations within an average error of 10%.

  20. The Practicum Script Concordance Test: An Online Continuing Professional Development Format to Foster Reflection on Clinical Practice

    ERIC Educational Resources Information Center

    Hornos, Eduardo H.; Pleguezuelos, Eduardo M.; Brailovsky, Carlos A.; Harillo, Leandro D.; Dory, Valerie; Charlin, Bernard

    2013-01-01

    Introduction: Judgment in the face of uncertainty is an important dimension of expertise and clinical competence. However, it is challenging to conceive continuing professional development (CPD) initiatives aimed at helping physicians enhance their clinical judgment skills in ill-defined situations. We present an online script concordance-based…

  1. Reflecting on reflections: enhancement of medical education curriculum with structured field notes and guided feedback.

    PubMed

    Wald, Hedy S; Davis, Stephen W; Reis, Shmuel P; Monroe, Alicia D; Borkan, Jeffrey M

    2009-07-01

    The promotion of reflective capacity within the teaching of clinical skills and professionalism is posited as fostering the development of competent health practitioners. An innovative approach combines structured reflective writing by medical students and individualized faculty feedback to those students to augment instruction on reflective practice. A course for preclinical students at the Warren Alpert Medical School of Brown University, entitled "Doctoring," combined reflective writing assignments (field notes) with instruction in clinical skills and professionalism and early clinical exposure in a small-group format. Students generated multiple e-mail field notes in response to structured questions on course topics. Individualized feedback from a physician-behavioral scientist dyad supported the students' reflective process by fostering critical-thinking skills, highlighting appreciation of the affective domain, and providing concrete recommendations. The development and implementation of this innovation are presented, as is an analysis of the written evaluative comments of students taking the Doctoring course. Theoretical and clinical rationales for features of the innovation and supporting evidence of their effectiveness are presented. Qualitative analyses of students' evaluations yielded four themes of beneficial contributions to their learning experience: promoting deeper and more purposeful reflection, the value of (interdisciplinary) feedback, the enhancement of group process, and personal and professional development. Evaluation of the innovation was the fifth theme; some limitations are described, and suggestions for improvement are provided. Issues of the quality of the educational paradigm, generalizability, and sustainability are addressed.

  2. The American Thoracic Society methods in epidemiologic, clinical, and operations research program. A research capacity-building program in low- and middle-income countries.

    PubMed

    Buist, A Sonia; Parry, Vivienne

    2013-08-01

    Respiratory diseases are a major cause of morbidity and mortality worldwide. The greatest impact of many of these diseases is felt in low- and middle-income countries, but their control and management is hampered by lack of accurate estimates of their prevalence, risk factors, and distribution, and knowledge of the social and cultural setting in which they occur. Providing enough information for cost-effective response to respiratory diseases requires research by trained investigators and public health personnel. The American Thoracic Society (ATS) Methods in Epidemiologic, Clinical, and Operations Research (MECOR) Program was launched in 1994 to provide a sustainable means of increasing local and national research capacity aimed at addressing this need. As of March 2013, approximately 1,015 students have completed at least one level of the training program. Post-MECOR, 64% of participants have published a medical paper, 79% have presented at a scientific or academic meeting, 51% have submitted a research protocol for funding, and 42% have had one funded. One-quarter have been awarded an academic or clinical fellowship, and 78% reported that MECOR had made a significant or extremely important contribution to their professional life and accomplishments. Future challenges include funding, recruitment of local faculty, helping to build the research infrastructure in MECOR countries, and providing ongoing mentoring for research.

  3. Bone-Forming Capacity and Biodistribution of Bone Marrow-Derived Stromal Cells Directly Loaded Into Scaffolds: A Novel and Easy Approach for Clinical Application of Bone Regeneration.

    PubMed

    Léotot, Julie; Lebouvier, Angélique; Hernigou, Philippe; Bierling, Philippe; Rouard, Hélène; Chevallier, Nathalie

    2015-01-01

    In the context of clinical applications of bone regeneration, cell seeding into scaffolds needs to be safe and easy. Moreover, cell density also plays a crucial role in the development of efficient bone tissue engineering constructs. The aim of this study was to develop and evaluate a simple and rapid cell seeding procedure on hydroxyapatite/β-tricalcium phosphate (HA/βTCP), as well as define optimal cell density and control the biodistribution of grafted cells. To this end, human bone marrow-derived stromal cells (hBMSCs) were seeded on HA/βTCP scaffolds, and we have compared bone formation using an ectopic model. Our results demonstrated a significantly higher bone-forming capacity of hBMSCs directly loaded on HA/βTCP during surgery compared to hBMSCs preseeded for 7 days in vitro on HA/βTCP before ectopic implantation. The extent of new bone formation increases with increasing hBMSC densities quantitatively, qualitatively, and in frequency. Also, this study showed that grafted hBMSCs remained confined to the implantation site and did not spread toward other tissues, such as liver, spleen, lungs, heart, and kidneys. In conclusion, direct cell loading into a scaffold during surgery is more efficient for bone regeneration, as well as quick and safe. Therefore direct cell loading is suitable for clinical requirements and cell production control, making it a promising approach for orthopedic applications. Moreover, our results have provided evidence that the formation of a mature bone organ containing hematopoietic islets needs a sufficiently high local density of grafted hBMSCs, which should guide the optimal dose of cells for clinical use.

  4. The heterogeneity of clinical ethics: the state of the field as reflected in the Encyclopedia of Bioethics.

    PubMed

    Koczwara, B; Madigan, T J

    1997-02-01

    The 1995 Encyclopedia of Bioethics is an almost complete reworking of the original 1978 edition, due to the expanding nature of the field. The following article focuses on how the second edition of the Encyclopedia deals with the topic of "clinical ethics" and three related topics: "nursing ethics", "trust", and "conflict of interest". We assess their relevance to the current developments in these fields and the Encyclopedia's usefulness as a resource to ethics consultants, researchers and clinicians. We emphasize the heterogeneity of clinical ethics as a still new and evolving field.

  5. Host Immune Transcriptional Profiles Reflect the Variability in Clinical Disease Manifestations in Patients with Staphylococcus aureus Infections

    PubMed Central

    Banchereau, Romain; Jordan-Villegas, Alejandro; Ardura, Monica; Mejias, Asuncion; Baldwin, Nicole; Xu, Hui; Saye, Elizabeth; Rossello-Urgell, Jose; Nguyen, Phuong; Blankenship, Derek; Creech, Clarence B.; Pascual, Virginia; Banchereau, Jacques; Chaussabel, Damien; Ramilo, Octavio

    2012-01-01

    Staphylococcus aureus infections are associated with diverse clinical manifestations leading to significant morbidity and mortality. To define the role of the host response in the clinical manifestations of the disease, we characterized whole blood transcriptional profiles of children hospitalized with community-acquired S. aureus infection and phenotyped the bacterial strains isolated. The overall transcriptional response to S. aureus infection was characterized by over-expression of innate immunity and hematopoiesis related genes and under-expression of genes related to adaptive immunity. We assessed individual profiles using modular fingerprints combined with the molecular distance to health (MDTH), a numerical score of transcriptional perturbation as compared to healthy controls. We observed significant heterogeneity in the host signatures and MDTH, as they were influenced by the type of clinical presentation, the extent of bacterial dissemination, and time of blood sampling in the course of the infection, but not by the bacterial isolate. System analysis approaches provide a new understanding of disease pathogenesis and the relation/interaction between host response and clinical disease manifestations. PMID:22496797

  6. The effects of electrical stimulation combined with continuous passive motion versus isometric exercise on symptoms, functional capacity, quality of life and balance in knee osteoarthritis: randomized clinical trial.

    PubMed

    Tok, Fatih; Aydemir, Koray; Peker, Fatma; Safaz, Ismail; Taşkaynatan, Mehmet Ali; Ozgül, Ahmet

    2011-02-01

    The aim of this study was to evaluate effects of electrical stimulation combined with continuous passive motion (CPM-ES) versus isometric exercise on symptoms, functional capacity, quality of life, muscle strength, knee and thigh circle measurements, and balance in knee osteoarthritis (OA). This is a randomized clinical trial. The study was done in Gulhane Military Medical Academy (GMMA) Rehabilitation Center. Forty patients with knee OA were included in this study. Participants were randomly assigned to two groups: 20 patients placed in Group 1 were treated with conventional physical therapy and CPM-ES combination; 20 patients in Group 2 were treated with conventional physical therapy and isometric exercise. Therapies were applied 3 weeks, 5 days per week. The following main outcome measures were done: values of pain (VAS was used), WOMAC, SF-36, knee and thigh circle measurements, isokinetic tests, dynamic and static balance tests were determined at baseline and after the treatment. There were no statistically significant differences in the tested variables between the groups for post-treatment values. Dynamic and static balance test improved statistically strongly significantly in both groups. The findings of this study demonstrate that knee OA patients could improve their balance function in both static and dynamic conditions after CPM-ES combination or isometric exercise therapy. The improvement might prevent knee OA patients from falling down and increase their sense of security during physical activities.

  7. The Ulcerative Colitis Endoscopic Index of Severity More Accurately Reflects Clinical Outcomes and Long-term Prognosis than the Mayo Endoscopic Score

    PubMed Central

    Ikeya, Kentaro; Sugimoto, Ken; Osawa, Satoshi; Kawasaki, Shinsuke; Iida, Takayuki; Maruyama, Yasuhiko; Watanabe, Fumitoshi

    2016-01-01

    Background and Aims: The Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and the Mayo endoscopic score (Mayo ES) are used to evaluate ulcerative colitis (UC) severity. This study compared UCEIS and the Mayo ES for evaluating UC severity and outcomes in patients undergoing remission induction during routine clinical practice with the aim of predicting medium- to long-term prognosis. Methods: Forty-one UC patients who received colonoscopy before and after tacrolimus remission induction therapy were included. An index of clinical activity and endoscopic findings scored by both the UCEIS and the Mayo ES were determined. Changes in UCEIS and Mayo ES before and after induction therapy were compared. Results: The mean UCEIS improved from 6.2±0.9 to 3.4±2.1 (p < 0.001). Based on the UCEIS, a significant reduction was reached in both the response and the remission groups. In contrast, the Mayo ES did not reflect a significant change in the response group. The discrepancy appeared to be due to ulcers becoming smaller and shallower during the early stages of mucosal healing; the Mayo ES seems to miss these early changes. In other words, whereas the UCEIS indicates improvements when ulcers shrink, the Mayo ES does not distinguish deep ulcers from shallow ulcers and is 3 (severe UC) for both deep and shallow ulcers. Additionally, better UCEIS strata after induction therapy were associated with lower incidences of colectomy (p = 0.0001) or relapse (p = 0.0008). Conclusions: The UCEIS accurately reflects clinical outcomes and predicts the medium- to long-term prognosis in UC patients undergoing induction therapy. These findings should support decision-making in clinical practice settings. PMID:26581895

  8. “Twin lesions”: Which one is the bad one? Improvement of clinical diagnosis with reflectance confocal microscopy

    PubMed Central

    Saral, Secil; Hartmann, Daniela; Letulè, Valerie; Ruzicka, Thomas; Ruini, Cristel; von Braunmühl, Tanja

    2017-01-01

    Background In vivo reflectance confocal microscopy (RCM) is a novel non-invasive diagnostic tool, which is used to differentiate skin lesions. Even in lesions with similar dermatoscopic images, RCM may improve diagnostic accuracy. Methods Three sets of false “twin lesions” with similar macroscopic and dermatoscopic images are matched. All lesions are evaluated with RCM and lesions are excised for further evaluation. Corresponding features in confocal images, dermatoscopy and histopathology are discussed. Results In all matched pairs, one of the lesions was diagnosed as melanoma with the observation of melanoma findings such as: epidermal disarray, pagetoid cells in epidermis and cellular atypia at the junction. Benign lesions were differentiated easily with RCM imaging. Conclusion Examining dermatoscopically difficult and/or similar lesions with RCM facilitates diagnostic and therapeutic decision making. Using RCM in daily practice may contribute to a decrease in unnecessary excisions. PMID:28243488

  9. A "safe space" for learning and reflection: one school's design for continuity with a peer group across clinical clerkships.

    PubMed

    Chou, Calvin L; Johnston, C Bree; Singh, Bobby; Garber, Jonathan D; Kaplan, Elizabeth; Lee, Kewchang; Teherani, Arianne

    2011-12-01

    The value of continuity in medical education, particularly during clerkships, is increasingly recognized. Previous clerkship-based models have described changes that emphasize continuity in patient care, learner supervision, and curriculum. The creation of continuous student peer groups can foster interactions that enhance mutual support through uncomfortable professional transitions during the clerkship years. Here, the authors describe a third-year clerkship model based at the San Francisco Veterans Affairs (VA) Medical Center called VA Longitudinal Rotations (VALOR), designed explicitly to establish a supportive learning environment for small peer groups.Seven groups of medical students (42 total) completed VALOR across three academic years between 2007 and 2009. On clerkships during VALOR, one hour per week was designated for faculty-facilitated sessions amongst peer groups. Students' perceptions of peer group support and overall program satisfaction were determined with immediate post surveys and focus groups at the end of VALOR, and with follow-up surveys 5 to 27 months after completing VALOR. Students strongly valued several elements of VALOR peer groups, including support through clerkship challenges, meeting for facilitated reflection, and appreciating patient experiences across the continuum of care. Students' appreciation for their peer group experiences persisted well after the conclusion of VALOR. VALOR students performed the same as or better than traditional clerkship students on knowledge and skill-based outcomes. The authors demonstrate that their third-year clerkship program using peer groups has built supportive learning networks and facilitated reflection, allowing students to develop critical professional skills. Student communication around patient care was also feasible and highly valued.

  10. Diet-induced mouse model of fatty liver disease and nonalcoholic steatohepatitis reflecting clinical disease progression and methods of assessment.

    PubMed

    Clapper, Jason R; Hendricks, Michelle D; Gu, Guibao; Wittmer, Carrie; Dolman, Carrie S; Herich, John; Athanacio, Jennifer; Villescaz, Christiane; Ghosh, Soumitra S; Heilig, Joseph S; Lowe, Carolyn; Roth, Jonathan D

    2013-10-01

    Shortcomings of previously reported preclinical models of nonalcoholic steatohepatitis (NASH) include inadequate methods used to induce disease and assess liver pathology. We have developed a dietary model of NASH displaying features observed clinically and methods for objectively assessing disease progression. Mice fed a diet containing 40% fat (of which ∼18% was trans fat), 22% fructose, and 2% cholesterol developed three stages of nonalcoholic fatty liver disease (steatosis, steatohepatitis with fibrosis, and cirrhosis) as assessed by histological and biochemical methods. Using digital pathology to reconstruct the left lateral and right medial lobes of the liver, we made comparisons between and within lobes to determine the uniformity of collagen deposition, which in turn informed experimental sampling methods for histological, biochemical, and gene expression analyses. Gene expression analyses conducted with animals stratified by disease severity led to the identification of several genes for which expression highly correlated with the histological assessment of fibrosis. Importantly, we have established a biopsy method allowing assessment of disease progression. Mice subjected to liver biopsy recovered well from the procedure compared with sham-operated controls with no apparent effect on liver function. Tissue obtained by biopsy was sufficient for gene and protein expression analyses, providing the opportunity to establish an objective method of assessing liver pathology before subjecting animals to treatment. The improved assessment techniques and the observation that mice fed the high-fat diet exhibit many clinically relevant characteristics of NASH establish a preclinical model for identifying pharmacological interventions with greater likelihood of translating to the clinic.

  11. Clinical practice placements in the community: a survey to determine if they reflect the shift in healthcare delivery from secondary to primary care settings.

    PubMed

    Betony, Karen

    2012-01-01

    With the worldwide strategic shift of health care delivery from secondary to primary care settings, more newly qualified nurses are working in primary care, making exposure to the variety of roles available to nurses essential for future workforce development. The aim of this small research project was to explore whether English universities' programmes are providing clinical practice placement experiences which reflect the breadth and complexity of nursing roles available in primary care. A survey of academic staff highlighted that universities designed curricula based on local placement and mentor availability and while a variety of primary care teams are being used, district nursing teams continue to be used the most, particularly for substantive placements. The need for specified staff to work across university and placement settings was deemed essential for identifying and supporting community based clinical placements. Recommendations from the project include: an increasingly collaborative approach amongst clinical, academic and managerial staff to create a learning culture for all health professional students' practice experience; robust strategic systems to ensure clinical placements are offered by services on the periphery of a national health service; and focussing of resources on students with a desire to pursue a primary care career.

  12. The use of rituximab in newly diagnosed patients with systemic lupus erythematosus: long-term steroid saving capacity and clinical effectiveness

    PubMed Central

    Gracia-Tello, Borja; Ezeonyeji, Amara; Isenberg, David

    2017-01-01

    Background Previous reports indicate that treating patients with lupus (SLE) at or close to the time of diagnosis successfully without using any, or minimal, corticosteroids by using B-cell depletion (BCD) is possible in the short-term. It is not however known whether using BCD is as effective or reduces corticosteroid use in the long-term. We report the long-term (up to 7 years) use of BCD with respect to its steroid-saving capacity and clinical effectiveness in newly diagnosed SLE. Methods Sixteen female patients with SLE were treated at, or shortly after diagnosis, with BCD therapy (BCDT) minimising the routine use of oral steroids. Post-treatment, most patients were given hydroxychloroquine (n=14) and azathioprine (n=10). The British Isles Lupus Assessment Group (BILAG) disease activity index was used for clinical assessment. Serum antidouble-stranded DNA (dsDNA) antibodies, complement (C3), erythrocyte sedimentation rate (ESR), circulating B lymphocytes (CD19+) and total inmmunoglobulins were tested every 2–6 months (average of 4.5 years) (SD 2) post-treatment. Disease activity and steroid requirement were compared with three patients with SLE treated conventionally, each matched for ethnicity, sex, age, clinical features, disease duration at diagnosis and follow-up period. Results All patients given rituximab achieved BCD. The mean number of flares during follow-up (new BILAG A or B) was 2.63 (SD 3) in the BCDT group and 4 (SD 3.6) in the controls (NS, p=0.14). Post-BCDT, mean anti-dsDNA antibody level fell from 1114 U/mL (SD 1699.3) to 194 (SD 346.7) at 18 months (p=0.043), mean serum ESR fell by >70% at 6 months maintained during follow-up and serum C3 level normalised in 8 patients. The mean cumulative prednisolone dose at 60 months for the patients who underwent BCDT (n=11) was 4745.67 mg (SD 6090 mg) vs 12 553.92 mg (SD 12 672 mg) for the controls (p=0.01). Conclusions Early treatment of patients with SLE with BCDT is safe

  13. Reflections on the role of a traveling wave along the basilar membrane in view of clinical and experimental findings.

    PubMed

    Sohmer, Haim

    2015-03-01

    Air conduction (AC) is accompanied by displacements of the two cochlear windows, bulk fluid flow between them, a pressure difference across the basilar membrane, leading to a passive traveling wave along the membrane, which activates the cochlear amplifier and enhances the displacements. AC interacts with bone conduction (BC) stimulation, so that it has been assumed that BC stimulation also involves a passive traveling wave. However, several clinical conditions and experimental manipulations provide evidence that a passive traveling wave may not be involved in BC stimulation at low intensities. Soft tissue conduction (STC) (also called non-osseous bone conduction) involves applying the bone vibrator to soft tissues on the head, neck and thorax, eliciting auditory sensation. STC stimulation probably does not involve a passive traveling wave. This review presents clinical conditions and experimental manipulations which assess the contributions of AC, BC and STC stimulation to the passive traveling wave. Evidence from the clinic (otosclerosis, round window atresia) and from the laboratory (holes in the wall of the inner ear, immobilization of the ossicular chain and the windows, discontinuity of the chain, measurement of basilar membrane displacements in the absence of the cochlear amplifier) lead to the conclusion that a passive basilar membrane traveling wave may not be involved in stimulation at low sound intensities. It is suggested that at low sound levels, the outer hair cell cochlear amplifier may not be activated by a passive traveling wave, but may be directly activated by the fast cochlear fluid pressures induced by AC, BC and STC stimulation. On the other hand, at high intensities, the cochlea is activated by the slow passive traveling wave.

  14. Reflection Coefficients.

    ERIC Educational Resources Information Center

    Greenslade, Thomas B., Jr.

    1994-01-01

    Discusses and provides an example of reflectivity approximation to determine whether reflection will occur. Provides a method to show thin-film interference on a projection screen. Also applies the reflectivity concepts to electromagnetic wave systems. (MVL)

  15. Network Modules of the Cross-Species Genotype-Phenotype Map Reflect the Clinical Severity of Human Diseases

    PubMed Central

    Han, Seong Kyu; Kim, Inhae; Hwang, Jihye; Kim, Sanguk

    2015-01-01

    Recent advances in genome sequencing techniques have improved our understanding of the genotype-phenotype relationship between genetic variants and human diseases. However, genetic variations uncovered from patient populations do not provide enough information to understand the mechanisms underlying the progression and clinical severity of human diseases. Moreover, building a high-resolution genotype-phenotype map is difficult due to the diverse genetic backgrounds of the human population. We built a cross-species genotype-phenotype map to explain the clinical severity of human genetic diseases. We developed a data-integrative framework to investigate network modules composed of human diseases mapped with gene essentiality measured from a model organism. Essential and nonessential genes connect diseases of different types which form clusters in the human disease network. In a large patient population study, we found that disease classes enriched with essential genes tended to show a higher mortality rate than disease classes enriched with nonessential genes. Moreover, high disease mortality rates are explained by the multiple comorbid relationships and the high pleiotropy of disease genes found in the essential gene-enriched diseases. Our results reveal that the genotype-phenotype map of a model organism can facilitate the identification of human disease-gene associations and predict human disease progression. PMID:26301634

  16. Tumor DNA in cerebral spinal fluid reflects clinical course in a patient with melanoma leptomeningeal brain metastases.

    PubMed

    Li, Yingmei; Pan, Wenying; Connolly, Ian D; Reddy, Sunil; Nagpal, Seema; Quake, Stephen; Gephart, Melanie Hayden

    2016-05-01

    Cerebral spinal fluid (CSF) from brain tumor patients contains tumor cellular and cell-free DNA (cfDNA), which provides a less-invasive and routinely accessible method to obtain tumor genomic information. In this report, we used droplet digital PCR to test mutant tumor DNA in CSF of a patient to monitor the treatment response of metastatic melanoma leptomeningeal disease (LMD). The primary melanoma was known to have a BRAF (V600E) mutation, and the patient was treated with whole brain radiotherapy and BRAF inhibitors. We collected 9 CSF samples over 6 months. The mutant cfDNA fraction gradually decreased from 53 % (time of diagnosis) to 0 (time of symptom alleviation) over the first 6 time points. Three months after clinical improvement, the patient returned with severe symptoms and the mutant cfDNA was again detected in CSF at high levels. The mutant DNA fraction corresponded well with the patient's clinical response. We used whole exome sequencing to examine the mutation profiles of the LMD tumor DNA in CSF before therapeutic response and after disease relapse, and discovered a canonical cancer mutation PTEN (R130*) at both time points. The cellular and cfDNA revealed similar mutation profiles, suggesting cfDNA is representative of LMD cells. This study demonstrates the potential of using cellular or cfDNA in CSF to monitor treatment response for LMD.

  17. Novel Biomarkers of Human GM1 Gangliosidosis Reflect the Clinical Efficacy of Gene Therapy in a Feline Model.

    PubMed

    Gray-Edwards, Heather L; Regier, Debra S; Shirley, Jamie L; Randle, Ashley N; Salibi, Nouha; Thomas, Sarah E; Latour, Yvonne L; Johnston, Jean; Golas, Gretchen; Maguire, Annie S; Taylor, Amanda R; Sorjonen, Donald C; McCurdy, Victoria J; Christopherson, Peter W; Bradbury, Allison M; Beyers, Ronald J; Johnson, Aime K; Brunson, Brandon L; Cox, Nancy R; Baker, Henry J; Denney, Thomas S; Sena-Esteves, Miguel; Tifft, Cynthia J; Martin, Douglas R

    2017-02-21

    GM1 gangliosidosis is a fatal neurodegenerative disease that affects individuals of all ages. Favorable outcomes using adeno-associated viral (AAV) gene therapy in GM1 mice and cats have prompted consideration of human clinical trials, yet there remains a paucity of objective biomarkers to track disease status. We developed a panel of biomarkers using blood, urine, cerebrospinal fluid (CSF), electrodiagnostics, 7 T MRI, and magnetic resonance spectroscopy in GM1 cats-either untreated or AAV treated for more than 5 years-and compared them to markers in human GM1 patients where possible. Significant alterations were noted in CSF and blood of GM1 humans and cats, with partial or full normalization after gene therapy in cats. Gene therapy improved the rhythmic slowing of electroencephalograms (EEGs) in GM1 cats, a phenomenon present also in GM1 patients, but nonetheless the epileptiform activity persisted. After gene therapy, MR-based analyses revealed remarkable preservation of brain architecture and correction of brain metabolites associated with microgliosis, neuroaxonal loss, and demyelination. Therapeutic benefit of AAV gene therapy in GM1 cats, many of which maintain near-normal function >5 years post-treatment, supports the strong consideration of human clinical trials, for which the biomarkers described herein will be essential for outcome assessment.

  18. Globalisation as we enter the 21st century: reflections and directions for nursing education, science, research and clinical practice.

    PubMed

    Davidson, Patricia M; Meleis, Afaf; Daly, John; Douglas, Marilyn Marty

    2003-10-01

    The events of September 11th, 2001 in the United States and the Bali bombings of October 2002 are chastening examples of the entangled web of the religious, political, health, cultural and economic forces we experience living in a global community. To view these forces as independent, singular, linearly deterministic entities of globalisation is irrational and illogical. Understanding the concept of globalisation has significant implications not only for world health and international politics, but also the health of individuals. Depending on an individual's political stance and world-view, globalisation may be perceived as an emancipatory force, having the potential to bridge the chasm between rich and poor or, in stark contrast, the very essence of the divide. It is important that nurses appreciate that globalisation does not pertain solely to the realms of economic theory and world politics, but also that it impacts on our daily nursing practice and the welfare of our patients. Globalisation and the closer interactions of human activity that result, have implications for international governance, policy and theory development as well as nursing education, research and clinical practice. Nurses, individually and collectively, have the political power and social consciousness to influence the forces of globalisation to improve health for all. This paper defines and discusses globalisation in today's world and its implications for contemporary nursing education, science, research and clinical practice.

  19. Effect of reflective practice education on self-reflection, insight, and reflective thinking among experienced nurses: a pilot study.

    PubMed

    Asselin, Marilyn E; Fain, James A

    2013-01-01

    A mixed-method study was conducted to determine whether nurses' participation in a reflective practice continuing education program using a structured reflection model makes a difference in nurses' self-reflection, insight, and reflective thinking about clinical practice situations. Findings suggested that use of structured reflection using question cues, written narratives, and peer-facilitated reflection increased nurses' engagement in self-reflection and enhanced reflective thinking in practice. Including reflective practice education in novice orientation and preceptor training may be beneficial.

  20. Students' reflections on the relationships between safe learning environments, learning challenge and positive experiences of learning in a simulated GP clinic.

    PubMed

    Young, J E; Williamson, M I; Egan, T G

    2016-03-01

    Learning environments are a significant determinant of student behaviour, achievement and satisfaction. In this article we use students' reflective essays to identify key features of the learning environment that contributed to positive and transformative learning experiences. We explore the relationships between these features, the students' sense of safety in the learning environment (LE), the resulting learning challenge with which they could cope and their positive reports of the experience itself. Our students worked in a unique simulation of General Practice, the Safe and Effective Clinical Outcomes clinic, where they consistently reported positive experiences of learning. We analysed 77 essays from 2011 and 2012 using an immersion/crystallisation framework. Half of the students referred to the safety of the learning environment spontaneously. Students described deep learning experiences in their simulated consultations. Students valued features of the LE which contributed to a psychologically safe environment. Together with the provision of constructive support and immediate, individualised feedback this feeling of safety assisted students to find their own way through clinical dilemmas. These factors combine to make students feel relaxed and able to take on challenges that otherwise would have been overwhelming. Errors became learning opportunities and students could practice purposefully. We draw on literature from medical education, educational psychology and sociology to interpret our findings. Our results demonstrate relationships between safe learning environments, learning challenge and powerful learning experiences, justifying close attention to the construction of learning environments to promote student learning, confidence and motivation.

  1. The reported clinical utility of taurine in ischemic disorders may reflect a down-regulation of neutrophil activation and adhesion.

    PubMed

    McCarty, M F

    1999-10-01

    The first publications regarding clinical use of taurine were Italian reports claiming therapeutic efficacy in angina, intermittent claudication and symptomatic cerebral arteriosclerosis. A down-regulation of neutrophil activation and endothelial adhesion might plausibly account for these observations. Endothelial platelet-activating factor (PAF) is a crucial stimulus to neutrophil adhesion and activation, whereas endothelial nitric oxide (NO) suppresses PAF production and acts in various other ways to antagonize binding and activation of neutrophils. Hypochlorous acid (HOCl), a neutrophil product which avidly oxidizes many sulfhydryl-dependent proteins, can be expected to inhibit NO synthase while up-regulating PAF generation; thus, a vicious circle can be postulated whereby HOCl released by marginating neutrophils acts on capillary or venular endothelium to promote further neutrophil adhesion and activation. Taurine is the natural detoxicant of HOCl, and thus has the potential to intervene in this vicious circle, promoting a less adhesive endothelium and restraining excessive neutrophil activation. Agents which inhibit the action of PAF on neutrophils, such as ginkgolides and pentoxifylline, have documented utility in ischemic disorders and presumably would complement the efficacy of taurine in this regard. Fish oil, which inhibits endothelial expression of various adhesion factors and probably PAF as well, and which suppresses neutrophil leukotriene production, may likewise be useful in ischemia. These agents may additionally constitute a non-toxic strategy for treating inflammatory disorders in which activated neutrophils play a prominent pathogenic role. Double-blind studies to confirm the efficacy of taurine in symptomatic chronic ischemia are needed.

  2. Reflections One Year into the 22 Center NIH-funded WRIST Study. A Primer on Conducting a Multicenter Clinical Trial

    PubMed Central

    2013-01-01

    The Wrist and Radius Surgery Trial (WRIST) study group is a collaboration of 22 hand surgery centers in the US, Canada, and Singapore to showcase the interest and capability of hand surgeons to conduct a multicenter clinical trial. The WRIST study group was formed in response to the seminal systematic review by Margaliot et al. and the Cochrane report that indicated marked deficiency in the quality of evidence in the distal radius fracture literature. Since the initial description of this fracture by Colles in 1814, over 2,000 studies have been published on this subject, yet high level studies based on the principles of evidence-based medicine are lacking. As we continue to embrace evidence-based medicine to raise the quality of research, the lessons learned during the organization and conduct of WRIST can serve as a template for others contemplating similar efforts. This paper will trace the course of WRIST by sharing the triumphs, and more importantly the struggles, faced in the first year of this study. PMID:23608306

  3. Clinical features reflect exon sites of EGFR mutations in patients with resected non-small-cell lung cancer.

    PubMed

    Na, Im Il; Rho, Jin Kyung; Choi, Yun Jung; Kim, Cheol Hyeon; Koh, Jae Soo; Ryoo, Baek-Yeol; Yang, Sung Hyun; Lee, Jae Cheol

    2007-06-01

    The aim of the current study was to determine the clinical significance according to the subtypes of epidermal growth factor receptor (EGFR) mutations and presence of KRAS mutations in operable non-small-cell lung cancer (NSCLC). We sequenced exons 18-21 of the EGFR tyrosine kinase domain and examined mutations in codons 12 and 13 of KRAS in tissues of patients with NSCLC who had undergone surgical resection. EGFR mutations were more frequent in never-smokers than smokers (33% vs. 14%, respectively; p=0.009) and in females than in males (31% vs. 16%, respectively; p=0.036). Mutations in exon 18-19 and 20-21 were found in 10 and 22 patients, respectively. Never-smokers and broncho-alveolar cell carcinoma features were positively associated with a mutation in exon 18-19 (p=0.027 and 0.016, respectively). The five-year survival rate in patients with a mutation in exons 18-19 (100%) was higher than that in patients without such mutation (47%; p=0.021). KRAS mutations were found in 16 patients (12%) and were not related to the overall survival (p=0.742). Patients with an EGFR mutation in exons 18-19 had better survival than patients without such mutation. Subtypes of EGFR mutations may be prognostic factors in patients undergoing curative resection.

  4. Working with chronic and relentless self-hatred, self-harm and existential shame: a clinical study and reflections.

    PubMed

    Austin, Sue

    2016-02-01

    This paper is the first of a two-part series which explores some of the theoretical and experiential reference points that have emerged in my work with people whose relationship to their body and/or sense of self is dominated by self-hatred and (what Hultberg describes as) existential shame. The first paper focuses on self-hatred and the second paper focuses on shame. This first paper is structured around vignettes taken from a 14-year analysis with a woman who was bulimic, self-harmed and repeatedly described herself as 'feeling like a piece of shit'. It draws together elements of Jung's concepts of the complex and symbol, and Laplanche's enigmatic signifier to focus on experiences of 'inner otherness' around which we are unconsciously organized. It also brings Jung's understanding that emotion is the chief source of consciousness into conversation with Laplanche's approach to the transference which is that by being aware that they do not 'know', the analyst provides a 'hollow' in which the patient's analytic process can evolve. These combinations of ideas are linked speculatively to emerging understandings of the neuroscience of perception and throughout the paper clinical material is used to illustrate these discussions.

  5. Objective evaluation by reflectance spectrophotometry can be of clinical value for the verification of blanching/non blanching erythema in the sacral area.

    PubMed

    Sterner, Eila; Fossum, Bjöörn; Berg, Elisabeth; Lindholm, Christina; Stark, André

    2014-08-01

    Early detection of non blanching erythema (pressure ulcer category I) is necessary to prevent any further skin damage. An objective method to discriminate between blanching/non blanching erythema is presently not available. The purpose of this investigation was to explore if a non invasive objective method could differentiate between blanching/non blanching erythema in the sacral area of patients undergoing hip fracture surgery. Seventy-eight patients were included. The sacral area of all patients was assessed using (i) conventional finger-press test and (ii) digital reading of the erythema index assessed with reflectance spectrophotometry. The patients were examined at admission and during 5 days postsurgery. Reflectance spectrophotometry measurements proved able to discriminate between blanching/non blanching erythema. The reliability, quantified by the intra-class correlation coefficient, was excellent between repeated measurements over the measurement period, varying between 0·82 and 0·96, and a significant change was recorded in the areas from day 1 to day 5 (P < 0·0001). The value from the reference point did not show any significant changes over the same period (P = 0·32). An objective method proven to identify early pressure damage to tissue can be a valuable tool in clinical practice.

  6. EFFICACY OF THE 20-WEEK CIRCLE OF SECURITY INTERVENTION: CHANGES IN CAREGIVER REFLECTIVE FUNCTIONING, REPRESENTATIONS, AND CHILD ATTACHMENT IN AN AUSTRALIAN CLINICAL SAMPLE.

    PubMed

    Huber, Anna; McMahon, Catherine A; Sweller, Naomi

    2015-01-01

    Circle of Security is an attachment theory based intervention that aims to promote secure parent-child attachment relationships. Despite extensive uptake of the approach, there is limited empirical evidence regarding efficacy. The current study examined whether participation in the 20-week Circle of Security intervention resulted in positive caregiver-child relationship change in four domains: caregiver reflective functioning; caregiver representations of the child and the relationship with the child; child attachment security, and attachment disorganization. Archived pre- and postintervention data were analyzed from 83 clinically referred caregiver-child dyads (child age: 13-88 months) who completed the Circle of Security intervention in sequential cohorts and gave permission for their data to be included in the study. Caregivers completed the Circle of Security Interview, and dyads were filmed in the Strange Situation Procedure before and after the intervention. Results supported all four hypotheses: Caregiver reflective functioning, caregiving representations, and level of child attachment security increased after the intervention, and level of attachment disorganization decreased for those with high baseline levels. Those whose scores were least optimal prior to intervention showed the greatest change in all domains. This study adds to the evidence suggesting that the 20-week Circle of Security intervention results in significant relationship improvements for caregivers and their children.

  7. Mental capacity.

    PubMed

    Williams, Ruth

    2010-02-03

    Three short videos exploring some of the different principles in the Mental Capacity Act 2009 are available on Social Care TV, an online channel intended mainly for the social care sector, although the films are relevant to any professionals whose work is affected by the act. The dramas, which are set in a residential home, a person's own home and a residential school for young people with learning difficulties, concern thedecision-making process and can be viewed at www.scie.org.uk/socialcaretv/topic.asp?guid=377dbe1b-de0c-4d66-bb87-22a243542db2.

  8. The Reflective Learning Continuum: Reflecting on Reflection

    ERIC Educational Resources Information Center

    Peltier, James W.; Hay, Amanda; Drago, William

    2005-01-01

    The importance of reflection to marketing educators is increasingly recognized. However, there is a lack of empirical research that considers reflection within the context of both the marketing and general business education literature. This article describes the use of an instrument that can be used to measure four identified levels of a…

  9. Caring for demented people in their homes or in sheltered accommodation as reflected on by home-care staff during clinical supervision sessions.

    PubMed

    Olsson, A; Hallberg, I R

    1998-02-01

    This study aimed to illuminate both the content of and the care given to demented people and the reflections of home care staff about it as revealed in two clinical group supervision sessions (n = 36). Verbatim transcriptions were analysed using a phenomenological hermeneutic approach and the following were found to be reflected on: the pensioners' personal situation--disease-related behaviour, ADL-functions, social network and self-esteem; the pensioners' environment--their relationships to significant others, adequate level of housing/care, access to activities, and satisfactory personal space; pensioner/staff interaction--their relations to each other, the staffs' relation to the pensioners' family, and the balance between reality-orientation vs. validation; the staff's situation--co-operation with other professionals, in primary health care, hospital, and within the social services; job satisfaction, lack of knowledge and sharing of knowledge, and lack of resources, especially time. The reasoning of the participants under supervision was found to be based on medical, historical, psychological, and environmental explanations, or personal beliefs. Feelings explored during supervision were directed towards the pensioners or the pensioners' families, towards themselves or towards the management. The findings were interpreted within a nursing model based on the four central concepts of nursing; person, environment, nursing intervention and health. The reasoning about nursing care revealed in the supervision sessions reflected a holistic approach and the relationship between the staff and the demented person stood out as central for care quality. Thus focusing on what promotes or, respectively, obstructs this relationship is likely to be one important focus in clinical supervision not only to achieve improvement and high quality in home care but also to develop and enhance the quality of the working life of the staff. Since the results could be understood within a

  10. Attachment and Reflective Functioning in Women With Borderline Personality Disorder.

    PubMed

    Badoud, Deborah; Prada, Paco; Nicastro, Rosetta; Germond, Charlotte; Luyten, Patrick; Perroud, Nader; Debbané, Martin

    2017-03-06

    Insecure attachment and impairments in reflective functioning (RF) are thought to play a critical role in borderline personality disorder (BPD). In particular, the mentalization-based model argues that insecure attachment indirectly accounts for increased BPD features, notably via disruption of RF capacities. Although the mediation relationship between attachment, RF, and BPD is supported by previous evidence, it remains to be directly tested in adults with BPD. In the current study, a sample of 55 female adult BPD patients and 105 female healthy controls completed a battery of self-report measures to investigate the interplay between attachment, RF capacities, and BPD clinical status. Overall, the results showed that BPD patients predominantly reported insecure attachment, characterized by negative internal working models of the self as unlovable and unimportant to others, and decreased RF abilities. Our findings further indicated that actual RF capacities mediated the relationships between adult insecure attachment and BPD clinical status.

  11. Submerged Reflectance

    DTIC Science & Technology

    1976-08-01

    at 450 and viewed at 0* (i.e., viewed nor1al to the surface). Instruments for performing this particular bi-directional reflectance measurement are...are described below. 3.1 THEORY OF ABSOLUTE SUBMERGED REFLECTANCE MEASUREMENT An absolute measurement of the reflectance of a surface can be obtained by...relative reflectance measurement is shown in Figure 2. The irradiance across the target will vary within the field of view of the photometer because

  12. Commentary: "I hope i'll continue to grow": rubrics and reflective writing in medical education.

    PubMed

    Coulehan, Jack; Granek, Iris A

    2012-01-01

    One respected tradition in medical education holds that physicians should struggle to maintain sensibility, openness, and compassion in the face of strong contravening tendencies. However, today's medical education is structured around a more recent tradition, which maintains that physicians should struggle to develop emotional detachment as a prerequisite for objectivity. In this model, sensibility and reflective capacity are potentially subversive. Reflective writing is one component of a revisionist approach to medical education that explicitly addresses reflective "habits of the mind" as core competencies and builds on existential concerns voiced by medical students. In response to Wald and colleagues' study, the authors reflect on the role of repeated formative feedback in developing reflective capacity. Formative feedback is as critical in this process as it is in traditional clinical learning. The authors emphasize that well-designed rubrics can assist learners in delineating desired outcomes and teachers in providing appropriate guidance.

  13. Bioethics for clinicians: 3. Capacity.

    PubMed Central

    Etchells, E; Sharpe, G; Elliott, C; Singer, P A

    1996-01-01

    In the context of patient consent, "capacity" refers to the patient's ability to understand information relevant to a treatment decision and to appreciate the reasonably foreseeable consequences of a decision or lack of decision. A person may be "capable" with respect to one decision but not with respect to another. Clinicians can usually identify patients who are clearly capable or incapable, but in some cases a clinical capacity assessment is required. Such assessment may consist of cognitive status testing, general impressions of capacity or specific capacity assessment. Specific capacity assessment, in which the clinician evaluates the patient's ability to understand pertinent information and appreciate its implications, is probably the optimal method. When conducting a specific capacity assessment, the clinician must ensure that the disclosure of information is effective and must evaluate the patient's reason for his or her decision. If the assessment suggests that the patient is incapable, further assessment is generally recommended. PMID:8823211

  14. The measurement of reflective function in adolescents with and without borderline traits.

    PubMed

    Ha, Carolyn; Sharp, Carla; Ensink, Karin; Fonagy, Peter; Cirino, Paul

    2013-12-01

    Reflective function refers to the capacity to reflect on the mind of self and others in the context of the attachment relationship. Reflective function (and its conceptual neighbor, mentalizing) has been shown to be an important correlate of a variety of disorders, including borderline personality disorder (BPD). The current study examined the construct validity of the Reflective Function Questionnaire for Youths (RFQY) in an inpatient sample of adolescents. Adequate internal consistency was established for the RFQY. Significant positive associations with an interview-based measure of reflective function and an experimental-based assessment of mentalization were found for the RFQY. Strong negative relations with BPD features were found and adolescent patients who scored above clinical cut-off for BPD symptoms demonstrated significantly poorer reflective function compared to patients without the disorder. These findings provide preliminary support for the notion that reflective function can be validly and reliably assessed in adolescent populations.

  15. Clinical Measures Are Feasible and Sensitive to Assess Balance and Gait Capacities in Older Persons with Mild to Moderate Intellectual Disabilities

    ERIC Educational Resources Information Center

    Enkelaar, Lotte; Smulders, Ellen; Lantman-de Valk, Henny van Schrojenstein; Weerdesteyn, Vivian; Geurts, Alexander C. H.

    2013-01-01

    Mobility limitations are common in persons with Intellectual Disabilities (ID). Differences in balance and gait capacities between persons with ID and controls have mainly been demonstrated by instrumented assessments (e.g. posturography and gait analysis), which require sophisticated and expensive equipment such as force plates or a 3D motion…

  16. Reflections From the Intersection of Health Professions Education and Clinical Practice: The State of the Science of Interprofessional Education and Collaborative Practice.

    PubMed

    Lutfiyya, M Nawal; Brandt, Barbara F; Cerra, Frank

    2016-06-01

    This informed reflection, from the intersection of health professions education and clinical practice, takes stock of the state of the field of interprofessional education (IPE) and collaborative practice (CP) (together IPECP) by answering the following three questions: (1) As a field of study, where is IPECP? (2) As a research enterprise, what are the current analytical gaps? (3) Scientifically, what needs to be done going forward? While IPE and CP, as well as IPECP, have been areas of scholarly inquiry for nearly 50 years, they have collectively and individually had a limited sphere of influence. Analytical gaps identified include little research dealing with big picture health-related outcomes; mixed results on the effectiveness of health care teams; increasing recognition that additional IPECP competencies might be needed; a gap between the identification and application of educational best practices; and the need for sound, reliable, and validated tools for measuring IPECP. The authors outline the work of the National Center for Interprofessional Practice and Education at the University of Minnesota, which is focused on filling the identified analytical gaps by way of strategic actions organized around three domains-(1) developing an IPECP research agenda, (2) nurturing IPECP intervention research grounded in comparative effectiveness research study designs and the assumptions of critical realism, and (3) the creation of a sound informatics platform. The authors argue that filling these gaps is important because if the effectiveness of IPE on CP and of CP on health outcomes is ever to be ascertained, generalizable findings are paramount.

  17. The Value of Reflective: Functioning within an Academic Therapeutic Nursery.

    PubMed

    LaLonde, Mary M; Dreier, Mona; Aaronson, Gayle; O'Brien, John

    2015-01-01

    The self begins as a social self and is dependent on the other and the self-other relationship. Furthermore, shortly after birth, the intersubjective self is nurtured and sustained by the reciprocal interactions with the significant other. Recent research suggests that the significant other's reciprocity depends on his or her capacity for mentalization, and this reflective functioning capacity influences not only the child's developing sense of I, other, and we, but also his or her developing attachment pattern. Several studies have demonstrated that parental reflective functioning can be improved with intervention, and enhancing parental reflective functioning can lead to a more secure attachment pattern and better outcomes for the child and parent. Therefore, intervention with toddlers and their families requires us to consider this dynamic two-person psychology. In this paper, we describe an academic parent-child nursery program aimed at enhancing parental reflective functioning. A clinical example from the collaborative treatment of a mother and her two-year-old will demonstrate how reflective functioning can be enhanced in the parent-child dyad and lead to a more secure parent-child relationship. We will also discuss the value of reflective functioning to the interdisciplinary team and how we dealt with countertransference issues that arose during the treatment.

  18. Reflecting on Reflecting on Practice

    ERIC Educational Resources Information Center

    Wilson, Arthur L.

    2009-01-01

    This article discusses three broad themes--reflection, power, and negotiation--that are evidenced in all of the articles in this issue. In this article, the author tries to transgress the articles at some middling altitude to seek some broader thematics. His observations about reflection, power, and negotiation do transcend individual efforts,…

  19. Are American College of Rheumatology 50% response criteria superior to 20% criteria in distinguishing active aggressive treatment in rheumatoid arthritis clinical trials reported since 1997? A meta‐analysis of discriminant capacities

    PubMed Central

    Chung, C P; Thompson, J L; Koch, G G; Amara, I; Strand, V; Pincus, T

    2006-01-01

    Objective To carry out a meta‐analysis designed to compare the discriminant capacities of American College of Rheumatology 50% (ACR50) with 20% (ACR20) responses in clinical trials on rheumatoid arthritis reported after 1997 and to analyse whether ACR50 can be as informative as ACR20 in distinguishing active from control treatments in more recent trials. Methods Clinical trials on rheumatoid arthritis reported since 1997 were identified, which included aggressive combinations of disease‐modifying antirheumatic drugs and glucocorticoids, as well as powerful new agents—leflunomide, etanercept, infliximab, anakinra, adalimumab, abatacept, tacrolimus and rituximab. A meta‐analysis of ACR20 compared with ACR50 responses for 21 clinical trials was carried out on differences in proportions of responders for active and control treatments and corresponding odds ratios (ORs). Results In all but one clinical trial on rheumatoid arthritis published since 1997 with data available on ACR20 and ACR50, more than 50% of patients who were ACR20 responders among those randomised to active treatment were also ACR50 responders. This phenomenon was seen for control groups in 38% of trials, many of which included treatment with methotrexate. A meta‐analysis of the clinical trials indicated a slight advantage to ACR50 for quantifying treatment comparisons, not significant for differences in proportions but significant for ORs. Conclusion ACR20 and ACR50 seem to be similar in distinguishing active from control treatments in clinical trials on rheumatoid arthritis reported since 1997. As ACR50 represents a considerably stronger clinical response, ACR50 may be a preferred end point for contemporary clinical trials on rheumatoid arthritis. PMID:16504992

  20. Reflection and Learning: Characteristics, Obstacles, and Implications

    ERIC Educational Resources Information Center

    Denton, David

    2011-01-01

    Reflection represents an important form of human thought; from ancient to modern times, the human capacity for reflective thinking has held the imagination of various philosophers and educational theorists. Despite this interest, researchers define reflection in different ways. One of the purposes of this article is to explore the activity of…

  1. Psychological effects of patient surge in large-scale emergencies: a quality improvement tool for hospital and clinic capacity planning and response.

    PubMed

    Meredith, Lisa S; Zazzali, James L; Shields, Sandra; Eisenman, David P; Alsabagh, Halla

    2010-01-01

    Although information is available to guide hospitals and clinics on the medical aspects of disaster surge, there is little guidance on how to manage the expected surge of persons needing psychological assessment and response after a catastrophic event. This neglected area of disaster medicine is addressed by presenting a novel and practical quality improvement tool for hospitals and clinics to use in planning for and responding to the psychological consequences of catastrophic events that create a surge of psychological casualties presenting for health care. Industrial quality improvement processes, already widely adopted in the healthcare sector, translate well when applied to disaster medicine and public health preparedness. This paper describes the development of the tool, presents data on facility preparedness from 31 hospitals and clinics in Los Angeles County, and discusses how the tool can be used as a benchmark for targeting improvement. The tool can serve to increase facility awareness of which components of disaster preparedness and response must be addressed through hospitals' and clinics' existing quality improvement programs. It also can provide information for periodic assessment and evaluation of progress over time.

  2. Comparison of Biofilm Formation Capacities of Two Clinical Isolates of Staphylococcus Epidermidis with and without icaA and icaD Genes on Intraocular Lenses

    PubMed Central

    Kıvanç, Sertaç Argun; Kıvanç, Merih; Kılıç, Volkan; Güllülü, Gülay; Özmen, Ahmet Tuncer

    2017-01-01

    Objectives: To compare biofilm formations of two Staphylococcus epidermidis (S. epidermidis) isolates with known biofilm formation capacities on four different intraocular lenses (IOL) that have not been studied before. Materials and Methods: Two isolates obtained from ocular surfaces and identified in previous studies and stored at -86 °C in 15% glycerol in the microbiology laboratory of the Anadolu University Department of Biology were purified and used in the study. The isolates were S. epidermidis KA 15.8 (ICA+), a known biofilm producer isolate positive for icaA, icaD and bap genes, and S. epidermidis KA 14.5 (ICA-), known as a non-biofilm producer isolate negative for icaA, icaD and bap genes. The biofilm formation capacities of the 2 isolates on 4 different IOLs were compared. Two of the IOLs were acrylic (UD613 [IOL A], Turkey; SA60AT [IOL B], USA), and the other two were polymethyl methacrylate (PMMA) (B60130C [IOL C], India; B55125C [IOL D], India). Bacterial enumeration and optical density measurements were done from biofilms that formed on the IOLs. Biofilms were imaged using scanning electron microscopy. Results: Mean bacterial counts on the IOLs were 7.1±0.4 log10 CFU/mL with the ICA+ isolate, and 6.7±0.8 log10 CFU/mL with the ICA- isolate; there were no statistically significant differences. Biofilm formation was lower with acrylic lenses than PMMA lenses with both isolates (p=0.009 and p=0.013). The highest biofilm production was obtained on IOL C (PMMA) (p<0.001) and the lowest was obtained on IOL A (hydrophilic acrylic) (p<0.001). Conclusion: Bacterial counts after biofilm formation were lower on acrylic lenses, especially hydrophilic acrylic with hydrophobic properties. Further animal and in vivo studies are required to support the findings of this study.

  3. Reflectance Modeling

    NASA Technical Reports Server (NTRS)

    Smith, J. A. (Principal Investigator)

    1985-01-01

    The overall goal of this work has been to develop a set of computational tools and media abstractions for the terrain bidirectional reflectance problem. The modeling of soil and vegetation surfaces has been emphasized with a gradual increase in the complexity of the media geometries treated. Pragmatic problems involved in the combined modeling of soil, vegetation, and atmospheric effects have been of interest and one of the objectives has been to describe the canopy reflectance problem in a classical radiative transfer sense permitting easier inclusion of our work by other workers in the radiative transfer field.

  4. Neutron reflectivity

    NASA Astrophysics Data System (ADS)

    Cousin, Fabrice; Menelle, Alain

    2015-10-01

    The specular neutron reflectivity is a technique enabling the measurement of neutron scattering length density profile perpendicular to the plane of a surface or an interface, and thereby the profile of chemical composition. The characteristic sizes that are probed range from around 5 Å up 5000 Å. It is a scattering technique that averages information on the entire surface and it is therefore not possible to obtain information within the plane of the interface. The specific properties of neutrons (possibility of tuning the contrast by isotopic substitution, sensitivity to magnetism, negligible absorption, low energy of the incident neutrons) makes it particularly interesting in the fields of soft matter, biophysics and magnetic thin films. This course is a basic introduction to the technique and does not address the magnetic reflectivity. It is composed of three parts describing respectively its principle and its formalism, the experimental aspects of the method (spectrometers, samples) and two examples related to the materials for energy.

  5. [Creating a good relationship between hospital and clinic for the support of end-of-life home care patients-usefulness of questionnaires to indicate the capacity of home care-supporting clinics for palliative care].

    PubMed

    Takahashi, Osamu; Kato, Toshihiko; Shimizu, Kazuko; Chiba, Yasuko; Ishiguro, Motoko; Iwadare, Midori

    2012-12-01

    We have been practicing palliative care for terminal cancer patients at outpatient sections, patient wards, by home care, and by visiting nursing stations for the last 4 years. After the establishment of our palliative care unit in June 2011, it became difficult for us to provide sufficient home care support by ourselves, because of the increasing number of the patients and their widespread locations. It is therefore necessary to cooperate with regional medical clinics in order to support the patients who need home care even after their condition deteriorates. To determine the extent to which the home care-supporting clinics perform palliative care, we used an original questionnaire. Twenty-five clinics agreed to the publication of their names as our cooperating clinics. The number of patients who received palliative care at home from home care clinics after visiting our hospital increased from 8% to 14%, and the rate of patients who died at home also increased from 10% to 13%. Information about cooperating with home care clinics is very important and the improvement of palliative care skills necessary for home care doctors to continue their support for End-Of-Life cancer patients. Furthermore, the hospital should offer a strict and timely backup when the condition of patients treated at home suddenly deteriorates.

  6. Students' Reflections on the Relationships between Safe Learning Environments, Learning Challenge and Positive Experiences of Learning in a Simulated GP Clinic

    ERIC Educational Resources Information Center

    Young, J. E.; Williamson, M. I.; Egan, T. G.

    2016-01-01

    Learning environments are a significant determinant of student behaviour, achievement and satisfaction. In this article we use students' reflective essays to identify key features of the learning environment that contributed to positive and transformative learning experiences. We explore the relationships between these features, the students'…

  7. Multicultural Training Applied in Clinical Practice: Reflections from a Euro-American Female Counselor-in-Training Working with Mexican Immigrants

    ERIC Educational Resources Information Center

    Paynter, Clara K.; Estrada, Diane

    2009-01-01

    The clinical experience of a Euro-American female counselor-in-training providing bilingual family therapy services to Mexican immigrants is described. Cultural themes encountered when applying academic discourse to clinical work are raised in the context of case studies in which the student therapist works from a postmodern client-as-expert…

  8. Safety profile, efficacy, and biodistribution of a bicistronic high-capacity adenovirus vector encoding a combined immunostimulation and cytotoxic gene therapy as a prelude to a phase I clinical trial for glioblastoma

    SciTech Connect

    Puntel, Mariana; Ghulam, Muhammad A.K.M.; Farrokhi, Catherine; VanderVeen, Nathan; Paran, Christopher; Appelhans, Ashley; Kroeger, Kurt M.; Salem, Alireza; Lacayo, Liliana; Pechnick, Robert N.; Kelson, Kyle R.; Kaur, Sukhpreet; Kennedy, Sean; Palmer, Donna; Ng, Philip; and others

    2013-05-01

    Adenoviral vectors (Ads) are promising gene delivery vehicles due to their high transduction efficiency; however, their clinical usefulness has been hampered by their immunogenicity and the presence of anti-Ad immunity in humans. We reported the efficacy of a gene therapy approach for glioma consisting of intratumoral injection of Ads encoding conditionally cytotoxic herpes simplex type 1 thymidine kinase (Ad-TK) and the immunostimulatory cytokine fms-like tyrosine kinase ligand 3 (Ad-Flt3L). Herein, we report the biodistribution, efficacy, and neurological and systemic effects of a bicistronic high-capacity Ad, i.e., HC-Ad-TK/TetOn-Flt3L. HC-Ads elicit sustained transgene expression, even in the presence of anti-Ad immunity, and can encode large therapeutic cassettes, including regulatory elements to enable turning gene expression “on” or “off” according to clinical need. The inclusion of two therapeutic transgenes within a single vector enables a reduction of the total vector load without adversely impacting efficacy. Because clinically the vectors will be delivered into the surgical cavity, normal regions of the brain parenchyma are likely to be transduced. Thus, we assessed any potential toxicities elicited by escalating doses of HC-Ad-TK/TetOn-Flt3L (1 × 10{sup 8}, 1 × 10{sup 9}, or 1 × 10{sup 10} viral particles [vp]) delivered into the rat brain parenchyma. We assessed neuropathology, biodistribution, transgene expression, systemic toxicity, and behavioral impact at acute and chronic time points. The results indicate that doses up to 1 × 10{sup 9} vp of HC-Ad-TK/TetOn-Flt3L can be safely delivered into the normal rat brain and underpin further developments for its implementation in a phase I clinical trial for glioma. - Highlights: ► High capacity Ad vectors elicit sustained therapeutic gene expression in the brain. ► HC-Ad-TK/TetOn-Flt3L encodes two therapeutic genes and a transcriptional switch. ► We performed a dose escalation study at

  9. Reflective Packaging

    NASA Technical Reports Server (NTRS)

    1994-01-01

    The aluminized polymer film used in spacecraft as a radiation barrier to protect both astronauts and delicate instruments has led to a number of spinoff applications. Among them are aluminized shipping bags, food cart covers and medical bags. Radiant Technologies purchases component materials and assembles a barrier made of layers of aluminized foil. The packaging reflects outside heat away from the product inside the container. The company is developing new aluminized lines, express mailers, large shipping bags, gel packs and insulated panels for the building industry.

  10. Teaching Critical Reflection to Graduate Students

    ERIC Educational Resources Information Center

    Watson, Gavan Peter Longley; Kenny, Natasha

    2014-01-01

    Critical reflection is a highly valued and widely applied learning approach in higher education. There are many benefits associated with engaging in critical reflection, and it is often integrated into the design of graduate level courses on university teaching as a life-long learning strategy to help ensure that learners build their capacity as…

  11. Theatre fleet's vital additional capacity.

    PubMed

    2012-11-01

    Vanguard Healthcare's fleet of mobile surgical facilities has been deployed to healthcare sites throughout Europe and beyond for over a decade, providing vital additional clinical capacity when existing buildings are refurbished or upgraded, in the event of flood or fire, or simply to help hospitals cater for rising demand. It is a combination of careful planning, teamwork, and the specialist expertise of Vanguard's personnel--many with a clinical background--that ensures not only each unit's successful installation, but equally its subsequent running, servicing, and maintenance, the company explains.

  12. Reflected Glory

    NASA Astrophysics Data System (ADS)

    2011-02-01

    The nebula Messier 78 takes centre stage in this image taken with the Wide Field Imager on the MPG/ESO 2.2-metre telescope at the La Silla Observatory in Chile, while the stars powering the bright display take a backseat. The brilliant starlight ricochets off dust particles in the nebula, illuminating it with scattered blue light. Igor Chekalin was the overall winner of ESO's Hidden Treasures 2010 astrophotography competition with his image of this stunning object. Messier 78 is a fine example of a reflection nebula. The ultraviolet radiation from the stars that illuminate it is not intense enough to ionise the gas to make it glow - its dust particles simply reflect the starlight that falls on them. Despite this, Messier 78 can easily be observed with a small telescope, being one of the brightest reflection nebulae in the sky. It lies about 1350 light-years away in the constellation of Orion (The Hunter) and can be found northeast of the easternmost star of Orion's belt. This new image of Messier 78 from the MPG/ESO 2.2-metre telescope at the La Silla Observatory is based on data selected by Igor Chekalin in his winning entry to the Hidden Treasures competition [1]. The pale blue tint seen in the nebula in this picture is an accurate representation of its dominant colour. Blue hues are commonly seen in reflection nebulae because of the way the starlight is scattered by the tiny dust particles that they contain: the shorter wavelength of blue light is scattered more efficiently than the longer wavelength red light. This image contains many other striking features apart from the glowing nebula. A thick band of obscuring dust stretches across the image from the upper left to the lower right, blocking the light from background stars. In the bottom right corner, many curious pink structures are also visible, which are created by jets of material being ejected from stars that have recently formed and are still buried deep in dust clouds. Two bright stars, HD 38563A and

  13. Pathways to Reflection: Exploring the Reflective Analytical Practices of Novice Teachers

    ERIC Educational Resources Information Center

    Hayden, H. Emily

    2010-01-01

    This mixed methods study explores reflective analytical practices of novice teachers who taught in a University Reading Clinic just prior to student teaching. Novices' reflective practices are compared to reflective practices of experienced teachers in a pilot study in the same setting. A theoretical model of novices' reflective analytical…

  14. Event-related brain potentials reflect increased concentration ability after mindfulness-based cognitive therapy for depression: a randomized clinical trial.

    PubMed

    Bostanov, Vladimir; Keune, Philipp M; Kotchoubey, Boris; Hautzinger, Martin

    2012-10-30

    Mindfulness-based cognitive therapy (MBCT) effectively prevents relapse/recurrence in major depression. The ability to deploy and maintain attention on a particular focus is considered as a prerequisite for 'mindful', 'metacognitive' awareness, and hence crucial for therapy success. Accordingly, sustained concentration is the skill most extensively taught in MBCT. The goal of the present study was to test whether this ability increases after MBCT, as assumed. The late component of the contingent negative variation (CNV), an event-related brain potential (ERP), known to reflect the allocation of attentional resources, was used as the measure of concentration ability. In the main phase of the study, 91 recurrently depressed patients in remission were randomly assigned to eight-week treatment by either MBCT or waiting (WAIT for delayed MBCT). The CNV response to an auditory test stimulus was measured pre- and post-treatment in a 'mindfulness task', in which patients were instructed to focus on their breath, as taught in MBCT. The late CNV (LCNV) was increased only after MBCT (and not after WAIT). This result reflects patients' improved ability to shift their attention toward current moment experience and away from potentially depressogenic thinking or rumination during mild dysphoric states-a known risk factor for depressive relapse/recurrence.

  15. Reflecting on imagery: a clinical perspective and overview of the special issue of memory on mental imagery and memory in psychopathology.

    PubMed

    Hackmann, Ann; Holmes, Emily A

    2004-07-01

    The authors provide an overview of the papers in the special issue of Memory on mental imagery and memory in psychopathology. The papers address emotional, intrusive mental imagery across a range of psychological disorders including post-traumatic stress disorder (PTSD), agoraphobia, body dysmorphic disorder, mood disorders, and psychosis. They include work on information processing issues including modelling cravings, conditioning, and aversions, as well as imagery qualities such as vividness and emotionality. The overview aims to place the articles in a broader context and draw out some exciting implications of this novel work. It provides a clinical context to the recent growth in this area from a cognitive behavioural therapy (CBT) perspective. We begin with PTSD, and consider links to imagery in other disorders. The clinical implications stemming from this empirical work and from autobiographical memory theory are discussed. These include consideration of a variety of techniques for eliminating troublesome imagery, and creating healthy, realistic alternatives.

  16. From Whining to Wondering: Reflective Journaling with Preservice Educators

    ERIC Educational Resources Information Center

    Applebaum, Lauren

    2014-01-01

    Reflective journaling is frequently employed to help preservice educators make sense of fieldwork experiences. Analyzing the weekly journals of eight preservice educators, I offer conceptual language to describe how journal writing provides a window into students' capacity for reflection. This capacity is described in terms of three continua:…

  17. On Gaussian feedback capacity

    NASA Technical Reports Server (NTRS)

    Dembo, Amir

    1989-01-01

    Pinsker and Ebert (1970) proved that in channels with additive Gaussian noise, feedback at most doubles the capacity. Cover and Pombra (1989) proved that feedback at most adds half a bit per transmission. Following their approach, the author proves that in the limit as signal power approaches either zero (very low SNR) or infinity (very high SNR), feedback does not increase the finite block-length capacity (which for nonstationary Gaussian channels replaces the standard notion of capacity that may not exist). Tighter upper bounds on the capacity are obtained in the process. Specializing these results to stationary channels, the author recovers some of the bounds recently obtained by Ozarow.

  18. A Reflective Look at Reflecting Teams

    ERIC Educational Resources Information Center

    Pender, Rebecca L.; Stinchfield, Tracy

    2012-01-01

    This article reviewed existing literature and research on the reflecting team process. There is a dearth of empirical research that explores the reflecting team process and the outcome of counseling that uses reflecting teams. Implications of using reflecting teams for counselors, counselor educators, and clients will be discussed. A call for…

  19. Reflected Ceiling Plan/Reflected Deck Plan 2009; Reflected Ceiling Plan/Reflected Deck ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Reflected Ceiling Plan/Reflected Deck Plan 2009; Reflected Ceiling Plan/Reflected Deck Plan 2010 - Gilpin's Falls Covered Bridge, Spanning North East Creek at Former (Bypassed) Section of North East Road (SR 272), North East, Cecil County, MD

  20. Heat Capacity Analysis Report

    SciTech Connect

    A. Findikakis

    2004-11-01

    The purpose of this report is to provide heat capacity values for the host and surrounding rock layers for the waste repository at Yucca Mountain. The heat capacity representations provided by this analysis are used in unsaturated zone (UZ) flow, transport, and coupled processes numerical modeling activities, and in thermal analyses as part of the design of the repository to support the license application. Among the reports that use the heat capacity values estimated in this report are the ''Multiscale Thermohydrologic Model'' report, the ''Drift Degradation Analysis'' report, the ''Ventilation Model and Analysis Report, the Igneous Intrusion Impacts on Waste Packages and Waste Forms'' report, the ''Dike/Drift Interactions report, the Drift-Scale Coupled Processes (DST and TH Seepage) Models'' report, and the ''In-Drift Natural Convection and Condensation'' report. The specific objective of this study is to determine the rock-grain and rock-mass heat capacities for the geologic stratigraphy identified in the ''Mineralogic Model (MM3.0) Report'' (BSC 2004 [DIRS 170031], Table 1-1). This report provides estimates of the heat capacity for all stratigraphic layers except the Paleozoic, for which the mineralogic abundance data required to estimate the heat capacity are not available. The temperature range of interest in this analysis is 25 C to 325 C. This interval is broken into three separate temperature sub-intervals: 25 C to 95 C, 95 C to 114 C, and 114 C to 325 C, which correspond to the preboiling, trans-boiling, and postboiling regimes. Heat capacity is defined as the amount of energy required to raise the temperature of a unit mass of material by one degree (Nimick and Connolly 1991 [DIRS 100690], p. 5). The rock-grain heat capacity is defined as the heat capacity of the rock solids (minerals), and does not include the effect of water that exists in the rock pores. By comparison, the rock-mass heat capacity considers the heat capacity of both solids and pore

  1. Hydrophilic carbon clusters as therapeutic, high capacity antioxidants

    PubMed Central

    Samuel, Errol L. G.; Duong, MyLinh T.; Bitner, Brittany R.; Marcano, Daniela C.; Tour, James M.; Kent, Thomas A.

    2014-01-01

    Oxidative stress reflects an excessive accumulation of reactive oxygen species (ROS) and is a hallmark of several acute and chronic human pathologies. While many antioxidants have been investigated, the majority have demonstrated poor efficacy in clinical trials. Here, we discuss limitations of current antioxidants and describe a new class of nanoparticle antioxidants, poly(ethylene glycol)-functionalized hydrophilic carbon clusters (PEG-HCCs). PEG-HCCs show high capacity to annihilate ROS such as superoxide and hydroxyl radicals, show no reactivity toward nitric oxide, and can be functionalized with targeting moieties without loss of activity. Given these properties, we propose that PEG-HCCs offer an exciting new area of study for treatment of numerous ROS-induced human pathologies. PMID:25175886

  2. Problems of Excess Capacity

    NASA Technical Reports Server (NTRS)

    Douglas, G.

    1972-01-01

    The problems of excess capacity in the airline industry are discussed with focus on the following topics: load factors; fair rate of return on investment; service-quality rivalry among airlines; pricing (fare) policies; aircraft production; and the impacts of excess capacity on operating costs. Also included is a discussion of the interrelationships among these topics.

  3. Liquid heat capacity lasers

    DOEpatents

    Comaskey, Brian J.; Scheibner, Karl F.; Ault, Earl R.

    2007-05-01

    The heat capacity laser concept is extended to systems in which the heat capacity lasing media is a liquid. The laser active liquid is circulated from a reservoir (where the bulk of the media and hence waste heat resides) through a channel so configured for both optical pumping of the media for gain and for light amplification from the resulting gain.

  4. Forced vital capacity, slow vital capacity, or inspiratory vital capacity: which is the best measure of vital capacity?

    PubMed

    Chhabra, S K

    1998-01-01

    Vital capacity can be measured as forced vital capacity (FVC), slow vital capacity (SVC), and inspiratory vital capacity (IVC). Although it is well known that the latter two are generally greater, a systematic comparison of the three in subjects with different degrees of airways obstruction has not been made. Sixty asthmatics and 20 normal subjects performed maneuvers for measurement of FVC, SVC, and IVC on a dry, rolling-seal spirometer. The severity of airways obstruction in asthmatics was classified as mild, moderate, and severe. There was no significant difference between FVC, SVC, and IVC in normal subjects. However, the three measurements of vital capacity were significantly different in all subgroups of asthmatics. FVC was smaller than both SVC and IVC. The differences were more marked in patients with moderate and severe degrees of airways obstruction. The differences between SVC and IVC were small and clinically not important. Forced expiratory volume in 1 sec (FEV1) expressed as percent of FVC, SVC, and IVC, was not different in normals and asthmatics with mild airways obstruction. The ratios were significantly different in asthmatics with moderate and severe airways obstruction. FEV1/IVC ratio was the lowest in both the groups followed by FEV1/SVC and FEV1/FVC. IVC and SVC are greater than FVC in patients with airways obstruction. This difference increases as the degree of obstruction increases. The difference between SVC or IVC and FVC serves as an indicator of air trapping. Both FVC and IVC could be measured and the largest VC used to calculate the FEV1/VC ratio because this increases the sensitivity of spirometry in detecting airways obstruction.

  5. Nanofluid heat capacities

    NASA Astrophysics Data System (ADS)

    Starace, Anne K.; Gomez, Judith C.; Wang, Jun; Pradhan, Sulolit; Glatzmaier, Greg C.

    2011-12-01

    Significant increases in the heat capacity of heat transfer fluids are needed not only to reduce the costs of liquid heating and cooling processes, but also to bring clean energy producing technologies like concentrating solar power (CSP) to price parity with conventional energy generation. It has been postulated that nanofluids could have higher heat capacities than conventional fluids. In this work, nano- and micron-sized particles were added to five base fluids (poly-α olefin, mineral oil, ethylene glycol, a mixture of water and ethylene glycol, and calcium nitrate tetrahydrate), and the resulting heat capacities were measured and compared with those of the neat base fluids and the weighted average of the heat capacities of the components. The particles used were inert metals and metal oxides that did not undergo any phase transitions over the temperature range studied. In the nanofluids studied here, we found no increase in heat capacity upon the addition of the particles larger than the experimental error.

  6. Who needs capacity?

    PubMed

    Buchanan, Alec

    2015-01-01

    The UK Law Commission's Discussion Paper, Criminal Liability: Insanity and Automatism, recommends introducing the concept of capacity to the insanity defence. The concept of capacity has an established role in those parts of the law that concern the validity of the decisions that people make, for instance in composing a will or entering into a contract. Making mental capacity a criterion for criminal responsibility in a mentally disordered defendant, however, is potentially problematic. First, the term capacity already has several different meanings in the literature on the jurisprudence of mental abnormality. Second, using the concept of capacity in the way that the Law Commission proposes poses difficulties that relate to the provision of testimony by expert witnesses.

  7. Working with chronic and relentless self-hatred, self-harm, and existential shame: a clinical study and reflections (Paper 2 of 2).

    PubMed

    Austin, Sue

    2016-09-01

    This second of two papers focuses on the shame which emerged in the first 14 years of analysis of a woman who was bulimic, self-harmed, and repeatedly described herself as 'feeling like a piece of shit'. To explore this intense and pervasive shame I draw on Jung's and Laplanche's emphasis on experiences of unresolvable, non-pathological 'foreignness' or 'otherness' at the heart of the psyche. Images, metaphors, elements of clinical experience, and working hypotheses from a number of analytic traditions are used to flesh out this exploration. These include Kilborne's use of Pirandello's image of shame as like a 'hole in the paper sky' which, I suggest, points to a crack in subjectivity, and reveals our belief in the efficacy of the self to be illusory. Hultberg's observations on shame as having an existential mode (function) are also explored, as is the nature of analytic truth. Using these ideas I describe my patient's process of finding some small but freeing space in relation to her shame and self-hatred. Through enduring and learning from her shame in analysis she realized that it was part of a desperate unconscious attempt to draw close to her troubled father and so to 'love him better'.

  8. Reflections 1 year into the 21-Center National Institutes of Health--funded WRIST study: a primer on conducting a multicenter clinical trial.

    PubMed

    2013-06-01

    The Wrist and Radius Injury Surgery Trial (WRIST) study group is a collaboration of 21 hand surgery centers in the United States, Canada, and Singapore, to showcase the interest and capability of hand surgeons to conduct a multicenter clinical trial. The WRIST study group was formed in response to the seminal systematic review by Margaliot et al and the Cochrane report that indicated marked deficiency in the quality of evidence in the distal radius fracture literature. Since the initial description of this fracture by Colles in 1814, over 2,000 studies have been published on this subject; yet, high-level studies based on the principles of evidence-based medicine are lacking. As we continue to embrace evidence-based medicine to raise the quality of research, the lessons learned during the organization and conduct of WRIST can serve as a template for others contemplating similar efforts. This article traces the course of WRIST by sharing the triumphs and, more important, the struggles faced in the first year of this study.

  9. Capacity Assurance - A Twenty Year Planning Tool for the Future Management of Hazardous Waste

    EPA Pesticide Factsheets

    This page contains information about the assessment of national capacity is intended to reflect the reality of waste flows and needs for future management capacity along with the 2015 report, previous reports, and supporting documents

  10. Impaired self-reflection in psychiatric disorders among adults: a proposal for the existence of a network of semi independent functions.

    PubMed

    Dimaggio, Giancarlo; Vanheule, Stijn; Lysaker, Paul H; Carcione, Antonino; Nicolò, Giuseppe

    2009-09-01

    Self-reflection plays a key role in healthy human adaptation. Self-reflection might involve different capacities which may be impaired to different degrees relatively independently of one another. Variation in abilities for different forms of self-reflection are commonly seen as key aspects of many adult mental disorders. Yet little has been written about whether there are different kinds of deficits in self-reflection found in mental illness, how those deficits should be distinguished from one another and how to characterize the extent to which they are interrelated. We review clinical and experimental literature and suggest four different forms of deficits in self-reflection: (a) sense of ownership of one's own thoughts and actions, (b) emotional awareness, (c) distinction between fantasy and reality and (d) the integration of a range of different views of oneself and others. We propose how these different impairments in self-reflection are linked with one another.

  11. A subpopulation that may correspond to granulocytic myeloid-derived suppressor cells reflects the clinical stage and progression of cutaneous melanoma

    PubMed Central

    Miller, Karolina; Kandolf-Sekulovic, Lidija; Mijuskovic, Zeljko; Zolotarevski, Lidija; Jovic, Milena; Gacevic, Milomir; Djukic, Mirjana; Arsenijevic, Nebojsa; Vojvodic, Danilo

    2016-01-01

    Seventy-eight melanoma patients and 10 healthy individuals were examined. Follow-up examinations of all melanoma patients were performed regularly every three months. Myeloid-derived suppressor cells (MDSC) were defined as lineage negative (CD3−, CD19−, CD56−), HLA-DR−/low, CD11b+ and CD33+. Classification of granulocytic (GrMDSC) and monocytic (MoMDSC) subsets was based on the CD15 and CD14 expression, respectively. Unlike the MoMDSC, that were present in 60% of healthy controls and 15% of melanoma patients, the GrMDSC were present in all examined participants, and the melanoma patients were found to have statistically higher frequencies compared with healthy controls. Accordingly, we kept focused on GrMDSC frequencies in relation to the melanoma stages and course of the disease. The GrMDSC values are highest in stage IV melanoma patients, with statistical significance compared with stages IA, IB, IIA and IIB. Patients with progression had statistically higher GrMDSC counts comparing with those with stable disease (P = 0.0079). Patients who had progression-free interval (PFI) < 12 months showed significantly higher GrMDSC values compared with those with PFI > 12 months (P = 0.0333). GrMDSC showed significant negative correlation with PFI intervals (P = 0.0095). The GrMDSC subset was predominant in all our patients. We confirmed that GrMDSC do accumulate early in the peripheral blood of melanoma patients and their frequencies correlate narrowly with the clinical stage and the spread of the disease. The increase in GrMDSC frequencies correlates well with a progressive disease and could be considered a potential predictive biomarker of high-risk melanoma cases that are more likely to have a shorter PFI. PMID:26391013

  12. Capacity Development for Education Systems in Fragile Contexts. Working Paper

    ERIC Educational Resources Information Center

    Davies, Lynn

    2009-01-01

    This paper examines fragility, capacity development and education and the links between these by analysing relevant research and policy literature. It proposes ways forward for action and reflection at national, regional and international levels. An important element of capacity development in education systems is the establishment of education…

  13. Reflective Practice in Dance: A Review of the Literature

    ERIC Educational Resources Information Center

    Tembrioti, Lara; Tsangaridou, Niki

    2014-01-01

    The importance of reflective practice is frequently noted in the literature; indeed, reflective capacity is regarded as an essential characteristic for professional competence. The ability to think about why and what one does is critical to intelligent practice, practice that is reflective rather than routine. In recent years, higher education…

  14. Emergent Biosynthetic Capacity in Simple Microbial Communities

    PubMed Central

    Chiu, Hsuan-Chao; Levy, Roie; Borenstein, Elhanan

    2014-01-01

    Microbes have an astonishing capacity to transform their environments. Yet, the metabolic capacity of a single species is limited and the vast majority of microorganisms form complex communities and join forces to exhibit capabilities far exceeding those achieved by any single species. Such enhanced metabolic capacities represent a promising route to many medical, environmental, and industrial applications and call for the development of a predictive, systems-level understanding of synergistic microbial capacity. Here we present a comprehensive computational framework, integrating high-quality metabolic models of multiple species, temporal dynamics, and flux variability analysis, to study the metabolic capacity and dynamics of simple two-species microbial ecosystems. We specifically focus on detecting emergent biosynthetic capacity – instances in which a community growing on some medium produces and secretes metabolites that are not secreted by any member species when growing in isolation on that same medium. Using this framework to model a large collection of two-species communities on multiple media, we demonstrate that emergent biosynthetic capacity is highly prevalent. We identify commonly observed emergent metabolites and metabolic reprogramming patterns, characterizing typical mechanisms of emergent capacity. We further find that emergent secretion tends to occur in two waves, the first as soon as the two organisms are introduced, and the second when the medium is depleted and nutrients become limited. Finally, aiming to identify global community determinants of emergent capacity, we find a marked association between the level of emergent biosynthetic capacity and the functional/phylogenetic distance between community members. Specifically, we demonstrate a “Goldilocks” principle, where high levels of emergent capacity are observed when the species comprising the community are functionally neither too close, nor too distant. Taken together, our results

  15. Emergent biosynthetic capacity in simple microbial communities.

    PubMed

    Chiu, Hsuan-Chao; Levy, Roie; Borenstein, Elhanan

    2014-07-01

    Microbes have an astonishing capacity to transform their environments. Yet, the metabolic capacity of a single species is limited and the vast majority of microorganisms form complex communities and join forces to exhibit capabilities far exceeding those achieved by any single species. Such enhanced metabolic capacities represent a promising route to many medical, environmental, and industrial applications and call for the development of a predictive, systems-level understanding of synergistic microbial capacity. Here we present a comprehensive computational framework, integrating high-quality metabolic models of multiple species, temporal dynamics, and flux variability analysis, to study the metabolic capacity and dynamics of simple two-species microbial ecosystems. We specifically focus on detecting emergent biosynthetic capacity--instances in which a community growing on some medium produces and secretes metabolites that are not secreted by any member species when growing in isolation on that same medium. Using this framework to model a large collection of two-species communities on multiple media, we demonstrate that emergent biosynthetic capacity is highly prevalent. We identify commonly observed emergent metabolites and metabolic reprogramming patterns, characterizing typical mechanisms of emergent capacity. We further find that emergent secretion tends to occur in two waves, the first as soon as the two organisms are introduced, and the second when the medium is depleted and nutrients become limited. Finally, aiming to identify global community determinants of emergent capacity, we find a marked association between the level of emergent biosynthetic capacity and the functional/phylogenetic distance between community members. Specifically, we demonstrate a "Goldilocks" principle, where high levels of emergent capacity are observed when the species comprising the community are functionally neither too close, nor too distant. Taken together, our results

  16. Refinery Capacity Report

    EIA Publications

    2016-01-01

    Data series include fuel, electricity, and steam purchased for consumption at the refinery; refinery receipts of crude oil by method of transportation; and current and projected atmospheric crude oil distillation, downstream charge, and production capacities. Respondents are operators of all operating and idle petroleum refineries (including new refineries under construction) and refineries shut down during the previous year, located in the 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, and other U.S. possessions. The Refinery Capacity Report does not contain working and shell storage capacity data. This data is now being collected twice a year as of March 31 and September 30 on the Form EIA-810, "Monthly Refinery Report", and is now released as a separate report Working and Net Available Shell Storage Capacity.

  17. Emotion and Value in the Evaluation of Medical Decision-Making Capacity: A Narrative Review of Arguments

    PubMed Central

    Hermann, Helena; Trachsel, Manuel; Elger, Bernice S.; Biller-Andorno, Nikola

    2016-01-01

    Ever since the traditional criteria for medical decision-making capacity (understanding, appreciation, reasoning, evidencing a choice) were formulated, they have been criticized for not taking sufficient account of emotions or values that seem, according to the critics and in line with clinical experiences, essential to decision-making capacity. The aim of this paper is to provide a nuanced and structured overview of the arguments provided in the literature emphasizing the importance of these factors and arguing for their inclusion in competence evaluations. Moreover, a broader reflection on the findings of the literature is provided. Specific difficulties of formulating and measuring emotional and valuational factors are discussed inviting reflection on the possibility of handling relevant factors in a more flexible, case-specific, and context-specific way rather than adhering to a rigid set of operationalized criteria. PMID:27303329

  18. Panama Canal capacity analysis

    SciTech Connect

    Bronzini, M.S.

    1995-04-27

    Predicting the transit capacities of the various Panama Canal alternatives required analyzing data on present Canal operations, adapting and extending an existing computer simulation model, performing simulation runs for each of the alternatives, and using the simulation model outputs to develop capacity estimates. These activities are summarized in this paper. A more complete account may be found in the project final report (TAMS 1993). Some of the material in this paper also appeared in a previously published paper (Rosselli, Bronzini, and Weekly 1994).

  19. Photovoltaics effective capacity: Interim final report 2

    SciTech Connect

    Perez, R.; Seals, R.

    1997-11-01

    The authors provide solid evidence, based on more than 8 million data points, that regional photovoltaic (PV) effective capacity is largely unrelated to the region`s solar resource. They confirm, however, that effective capacity is strongly related to load-shape characteristics. The load-shape effective-capacity relationship appears to be valid for end-use loads as small as 100 kW, except possibly in the case of electrically heated buildings. This relationship was used as a tool to produce a US map of PV`s effective capacity. The regions of highest effective capacities include (1) the central US from the northern Great Plains to the metropolitan areas of Chicago and Detroit, down to the lower Mississippi Valley, (2) California and western Arizona, and (3) the northeast metropolitan corridor. The features of this map are considerably different from the traditional solar resource maps. They tend to reflect the socio-economic and climatic factors that indirectly drive PV`s effective capacity: e.g., commercial air-conditioning, little use of electric heat, and strong summer heat waves. The map provides a new and significant insight to a comprehensive valuation of the PV resource. The authors assembled preliminary evidence showing that end-use load type may be related to PV`s effective capacity. Highest effective capacities were found for (nonelectrically heated) office buildings, followed by hospitals. Lowest capacities were found for airports and residences. Many more data points are needed, however, to ascertain and characterize these preliminary findings.

  20. Orientations to Reflective Practice.

    ERIC Educational Resources Information Center

    Wellington, Bud; Austin, Patricia

    1996-01-01

    Delineates five orientations to reflective practice: immediate, technical, deliberative, dialectic, and transpersonal, each reflecting different social science bases and beliefs and values about education. Views them as interactive, interdependent, noncompeting, aspects of reflective practice. (SK)

  1. Financial capacity in older adults: a growing concern for clinicians.

    PubMed

    Gardiner, Paul A; Byrne, Gerard J; Mitchell, Leander K; Pachana, Nancy A

    2015-02-02

    Older people with cognitive impairment and/or dementia may be particularly vulnerable to diminished financial decision-making capacity. Financial capacity refers to the ability to satisfactorily manage one's financial affairs in a manner consistent with personal self-interest and values. Impairment of financial capacity makes the older individual vulnerable to financial exploitation, may negatively affect their family's financial situation and places strain on relationships within the family. Clinicians are often on the front line of responding to queries regarding decision-making capacity, and clinical evaluation options are often not well understood. Assessment of financial capacity should include formal objective assessment in addition to a clinical interview and gathering contextual data. Development of a flexible, empirically supported and clinically relevant assessment approach that spans all dimensions of financial capacity yet is simple enough to be used by non-specialist clinicians is needed.

  2. Uncertainty in adaptive capacity

    NASA Astrophysics Data System (ADS)

    Adger, W. Neil; Vincent, Katharine

    2005-03-01

    The capacity to adapt is a critical element of the process of adaptation: it is the vector of resources that represent the asset base from which adaptation actions can be made. Adaptive capacity can in theory be identified and measured at various scales, from the individual to the nation. The assessment of uncertainty within such measures comes from the contested knowledge domain and theories surrounding the nature of the determinants of adaptive capacity and the human action of adaptation. While generic adaptive capacity at the national level, for example, is often postulated as being dependent on health, governance and political rights, and literacy, and economic well-being, the determinants of these variables at national levels are not widely understood. We outline the nature of this uncertainty for the major elements of adaptive capacity and illustrate these issues with the example of a social vulnerability index for countries in Africa. To cite this article: W.N. Adger, K. Vincent, C. R. Geoscience 337 (2005).

  3. Instrument independent diffuse reflectance spectroscopy.

    PubMed

    Yu, Bing; Fu, Henry L; Ramanujam, Nirmala

    2011-01-01

    Diffuse reflectance spectroscopy with a fiber optic probe is a powerful tool for quantitative tissue characterization and disease diagnosis. Significant systematic errors can arise in the measured reflectance spectra and thus in the derived tissue physiological and morphological parameters due to real-time instrument fluctuations. We demonstrate a novel fiber optic probe with real-time, self-calibration capability that can be used for UV-visible diffuse reflectance spectroscopy in biological tissue in clinical settings. The probe is tested in a number of synthetic liquid phantoms over a wide range of tissue optical properties for significant variations in source intensity fluctuations caused by instrument warm up and day-to-day drift. While the accuracy for extraction of absorber concentrations is comparable to that achieved with the traditional calibration (with a reflectance standard), the accuracy for extraction of reduced scattering coefficients is significantly improved with the self-calibration probe compared to traditional calibration. This technology could be used to achieve instrument-independent diffuse reflectance spectroscopy in vivo and obviate the need for instrument warm up and post∕premeasurement calibration, thus saving up to an hour of precious clinical time.

  4. Panel on Capacity Building

    NASA Astrophysics Data System (ADS)

    Elhadani, D.

    The demonstration was made that space technologies are an important tool for developing countries. But the fundamental question is how those countries could integrate such technologies, in an effective an operational way, in the process of resources management and administration. Capacity building is a cornerstone in any strategy to set up a national programme or infrastructure for the use of space technologies. The proposed presentation attempts to bring the first elements on the actual uses of space technology in developing countries compared to their needs, the role of training activities and programs in the capacity building process as well as the role of international cooperation and what are the required conditions to ensure sustainability of the established capacities.

  5. Dual capacity reciprocating compressor

    DOEpatents

    Wolfe, R.W.

    1984-10-30

    A multi-cylinder compressor particularly useful in connection with northern climate heat pumps and in which different capacities are available in accordance with reversing motor rotation is provided with an eccentric cam on a crank pin under a fraction of the connecting rods, and arranged for rotation upon the crank pin between opposite positions 180[degree] apart so that with cam rotation on the crank pin such that the crank throw is at its normal maximum value all pistons pump at full capacity, and with rotation of the crank shaft in the opposite direction the cam moves to a circumferential position on the crank pin such that the overall crank throw is zero. Pistons whose connecting rods ride on a crank pin without a cam pump their normal rate with either crank rotational direction. Thus a small clearance volume is provided for any piston that moves when in either capacity mode of operation. 6 figs.

  6. Dual capacity reciprocating compressor

    DOEpatents

    Wolfe, Robert W.

    1984-01-01

    A multi-cylinder compressor 10 particularly useful in connection with northern climate heat pumps and in which different capacities are available in accordance with reversing motor 16 rotation is provided with an eccentric cam 38 on a crank pin 34 under a fraction of the connecting rods, and arranged for rotation upon the crank pin between opposite positions 180.degree. apart so that with cam rotation on the crank pin such that the crank throw is at its normal maximum value all pistons pump at full capacity, and with rotation of the crank shaft in the opposite direction the cam moves to a circumferential position on the crank pin such that the overall crank throw is zero. Pistons 24 whose connecting rods 30 ride on a crank pin 36 without a cam pump their normal rate with either crank rotational direction. Thus a small clearance volume is provided for any piston that moves when in either capacity mode of operation.

  7. Capacity Maximizing Constellations

    NASA Technical Reports Server (NTRS)

    Barsoum, Maged; Jones, Christopher

    2010-01-01

    Some non-traditional signal constellations have been proposed for transmission of data over the Additive White Gaussian Noise (AWGN) channel using such channel-capacity-approaching codes as low-density parity-check (LDPC) or turbo codes. Computational simulations have shown performance gains of more than 1 dB over traditional constellations. These gains could be translated to bandwidth- efficient communications, variously, over longer distances, using less power, or using smaller antennas. The proposed constellations have been used in a bit-interleaved coded modulation system employing state-ofthe-art LDPC codes. In computational simulations, these constellations were shown to afford performance gains over traditional constellations as predicted by the gap between the parallel decoding capacity of the constellations and the Gaussian capacity

  8. Geothermal Plant Capacity Factors

    SciTech Connect

    Greg Mines; Jay Nathwani; Christopher Richard; Hillary Hanson; Rachel Wood

    2015-01-01

    The capacity factors recently provided by the Energy Information Administration (EIA) indicated this plant performance metric had declined for geothermal power plants since 2008. Though capacity factor is a term commonly used by geothermal stakeholders to express the ability of a plant to produce power, it is a term frequently misunderstood and in some instances incorrectly used. In this paper we discuss how this capacity factor is defined and utilized by the EIA, including discussion on the information that the EIA requests from operations in their 923 and 860 forms that are submitted both monthly and annually by geothermal operators. A discussion is also provided regarding the entities utilizing the information in the EIA reports, and how those entities can misinterpret the data being supplied by the operators. The intent of the paper is to inform the facility operators as the importance of the accuracy of the data that they provide, and the implications of not providing the correct information.

  9. Autonomous decision making and moral capacities.

    PubMed

    Moser, Albine; Houtepen, Rob; van der Bruggen, Harry; Spreeuwenberg, Cor; Widdershoven, Guy

    2009-03-01

    This article examines how people with type 2 diabetes perceive autonomous decision making and which moral capacities they consider important in diabetes nurses' support of autonomous decision making. Fifteen older adults with type 2 diabetes were interviewed in a nurse-led unit. First, the data were analysed using the grounded theory method. The participants described a variety of decision-making processes in the nurse and family care-giver context. Later, descriptions of the decision-making processes were analysed using hermeneutic text interpretation. We suggest first- and second-order moral capacities that nurses specializing in diabetes need to promote the autonomous decision making of their patients. We recommend nurses to engage in ongoing, interactive reflective practice to further develop these moral capacities.

  10. Father regression. Clinical narratives and theoretical reflections.

    PubMed

    Stein, Ruth

    2006-08-01

    The author deals with love-hate enthrallment and submission to a primitive paternal object. This is a father-son relationship that extends through increasing degrees of 'primitiveness' or extremeness, and is illustrated through three different constellations that constitute a continuum. One pole of the continuum encompasses certain male patients who show a loving, de-individuated connection to a father experienced as trustworthy, soft, and in need of protection. Further along the continuum is the case of a transsexual patient whose analysis revealed an intense 'God-transference', a bondage to an idealized, feared, and ostensibly protective father-God introject. A great part of this patient's analysis consisted in a fierce struggle to liberate himself from this figure. The other end of the continuum is occupied by religious terrorists, who exemplify the most radical thralldom to a persecutory, godly object, a regressive submission that banishes woman and enthrones a cruel superego, and that ends in destruction and self-destruction. Psychoanalytic thinking has traditionally dealt with the oedipal father and recently with the nurturing father, but there is a gap in thinking about the phallic, archaic father, and his relations with his son(s). The author aims at filling this gap, at the same time as she also raises the very question of 'What is a father?' linking it with literary and religious themes.

  11. Reflective practice for personal and professional transformation.

    PubMed

    Kofoed, Nancy A

    2011-01-01

    Reflection is the mindful (and prayerful) consideration of professional or personal actions in such a way as to transform present and future experience. Nurses will find ways to create transformation in patient care through reflection in practice, clinical supervision, leadership, education, and evidence-based practice. This article discusses models and processes for reflective practice for professional, personal, and Christian spiritual transformation, making application to case studies in nursing practice.

  12. Scintillator reflective layer coextrusion

    DOEpatents

    Yun, Jae-Chul; Para, Adam

    2001-01-01

    A polymeric scintillator has a reflective layer adhered to the exterior surface thereof. The reflective layer comprises a reflective pigment and an adhesive binder. The adhesive binder includes polymeric material from which the scintillator is formed. A method of forming the polymeric scintillator having a reflective layer adhered to the exterior surface thereof is also provided. The method includes the steps of (a) extruding an inner core member from a first amount of polymeric scintillator material, and (b) coextruding an outer reflective layer on the exterior surface of the inner core member. The outer reflective layer comprises a reflective pigment and a second amount of the polymeric scintillator material.

  13. Ethical reflections of gender equality and equity in adolescence medicine.

    PubMed

    Tozzo, P; Caenazzo, L

    2015-01-01

    Gender differences, in both clinical and research environment, exist also in a particular category of patients, adolescents, who constitute a vulnerable group with respect to healthcare decisions. In clinical context, the main ethical issues that may be identified within gender medicine for adolescent patients are related to the information given to the patient and its parents, the adolescent's capacity of understanding considering his/her maturity, vulnerability and autonomy, the consent to medical treatment in relation to the different possible approaches to their different efficacy and possible side effects. Also, with regard to the research context, ethical issues may arise from the participation of female minors in clinical trials. Ethical concerns may also arise in the field of resource allocation in health policies, such as the equitable distribution and access to resources, considering the young age of the subjects involved. A bioethical reflection, which takes into account not only the differences biologically and epidemiologically relevant, but also the main determinants of health in adolescence, might find a role in structured education for diversity and gender equity. Given the magnitude of the problem, to encourage the pursuit of gender equity in health and, in some situations, also to promote the full recognition of the right to health of women are some of the most effective and direct ways to reduce inequalities and to ensure a rational and efficient use of available resources, including through a bioethical reflection on the topic. The Authors show the necessity to differentiate the various aspects of gender differences in adolescence medicine, providing arguments in support of the fact that interventions for health prevention and promotion should be modulated in relation to the gender of the recipients, emphasizing the most important aspects for each group of individuals. This approach could implement personalized medicine, even and especially

  14. Heart Valve Replacements with Regenerative Capacity

    PubMed Central

    Dijkman, Petra E.; Fioretta, Emanuela S.; Frese, Laura; Pasqualini, Francesco S.; Hoerstrup, Simon P.

    2016-01-01

    The incidence of severe valvular dysfunctions (e.g., stenosis and insufficiency) is increasing, leading to over 300,000 valves implanted worldwide yearly. Clinically used heart valve replacements lack the capacity to grow, inherently requiring repetitive and high-risk surgical interventions during childhood. The aim of this review is to present how different tissue engineering strategies can overcome these limitations, providing innovative valve replacements that proved to be able to integrate and remodel in pre-clinical experiments and to have promising results in clinical studies. Upon description of the different types of heart valve tissue engineering (e.g., in vitro, in situ, in vivo, and the pre-seeding approach) we focus on the clinical translation of this technology. In particular, we will deepen the many technical, clinical, and regulatory aspects that need to be solved to endure the clinical adaptation and the commercialization of these promising regenerative valves. PMID:27721704

  15. Person-centred reflective practice.

    PubMed

    Devenny, Bob; Duffy, Kathleen

    Person-centred health and person-centred care have gained prominence across the UK following the publication of reports on public inquiries exploring failings in care. Self-awareness and participation in reflective practice are recognised as vital to supporting the person-centred agenda. This article presents an education framework for reflective practice, developed and used in one NHS board in Scotland, and based on the tenets of the clinical pastoral education movement. Providing an insight into the usefulness of a spiritual component in the reflective process, the framework provides an opportunity for nurses and other healthcare professionals to examine the spiritual dimensions of patient encounters, their own values and beliefs, and the effect these may have on their practice.

  16. International Clinical Trial Day and clinical trials in Ethiopia and Africa.

    PubMed

    Fekadu, Abebaw; Teferra, Solomon; Hailu, Asrat; Gebre-Mariam, Tsige; Addissie, Adamu; Deressa, Wakgari; Yimer, Getnet; Reja, Ahmed

    2014-12-19

    Low income countries like Ethiopia are underrepresented in clinical research. As a major public commitment to clinical research, Ethiopia celebrated the International Clinical Trial Day (ICTD) for the first time on 20 May 2014 under the auspices of Addis Ababa University. The motto for the day was 'Clinical Trials for Excellence in Patient Care'. The celebration offered an opportunity to inform academic staff, researchers, students and the leadership about clinical trials being conducted and to discuss the future of clinical trials in the country. Although clear challenges to the conduct of trials abound, clinical trials registered from Ethiopia in trial registration databases is increasing. Cross-country collaborations, international funding support, motivation of academic staff to conduct clinical trials and the commitment and engagement of the leadership in research are all improving. The overall impact of clinical trials is also encouraging. For example, some of the trials conducted in Ethiopia have informed treatment guidelines. However, administrative capacity, research infrastructure as well as financial support remain weak. There is a need for enhanced university-industry linkage and translation of research findings into locally relevant evidence. Ethiopia, as well as the whole of Africa, has an unparalleled opportunity to lead the way in clinical trials, given its prospect of development and the need to have locally relevant evidence for its growing population. In this commentary we reflect on the celebration of ICTD, the status and opportunities for conducting clinical trials and the way forward for facilitating clinical trials in Ethiopia and Africa.

  17. Selection History Modulates Working Memory Capacity

    PubMed Central

    Kuo, Bo-Cheng

    2016-01-01

    Recent studies have shown that past selection history affects the allocation of attention on target selection. However, it is unclear whether context-driven selection history can modulate the efficacy of attention allocation on working memory (WM) representations. This study tests the influences of selection history on WM capacity. A display of one item (low load) or three/four items (high load) was shown for the participants to hold in WM in a delayed response task. Participants then judged whether a probe item was in the memory display or not. Selection history was defined as the number of items attended across trials in the task context within a block, manipulated by the stimulus set-size in the contexts with fewer possible stimuli (4-item or 5-item context) or more possible stimuli (8-item or 9-item context) from which the memorized content was selected. The capacity measure (i.e., the K measure) was estimated to reflect the number of items that can be held in WM. Across four behavioral experiments, the results revealed that the capacity was significantly reduced in the context with more possible stimuli relative to the context with fewer possible stimuli. Moreover, the reduction in capacity was significant for high WM load and not observed when the focus was on only a single item. Together, these findings indicate that context-driven selection history and focused attention influence WM capacity. PMID:27774082

  18. Understanding reflective practice.

    PubMed

    Nicol, Jacqueline Sian; Dosser, Isabel

    2016-05-04

    The Nursing and Midwifery Council (NMC) requires that nurses and midwives use feedback as an opportunity for reflection and learning, to improve practice. The NMC revalidation process stipulates that practitioners provide examples of how they have achieved this. To reflect in a meaningful way, it is important to understand what is meant by reflection, the skills required, and how reflection can be undertaken successfully. Traditionally, reflection occurs after an event encountered in practice. The authors challenge this perception, suggesting that reflection should be undertaken before, during and after an event. This article provides practical guidance to help practitioners use reflective models to write reflective accounts. It also outlines how the reflective process can be used as a valuable learning tool in preparation for revalidation.

  19. Reflecting on reflection: a personal encounter.

    PubMed

    Glen, S; Clark, A; Nicol, M

    1995-02-01

    This paper reports a retrospective study of a Senior Lecturer in Nursing Studies experience of supervising a student teacher who, as part of her teaching placement experience, utilised 'Critically Reflective Analysis of an Educational Event' as a means to assess her teaching in the practice setting. The Senior Lecturer and student nurse teacher used an external 'advisor' to facilitate their meta-reflection on the theoretical perspectives that informed the process in which they were engaged. The paper raises the following questions for consideration--What is the link between ability to reflect and quality of practice? Is it possible to utilise reflective tutorials as a means of assessing professional competence whilst at the same time encouraging personal and professional development? Is the ability to reflect on practice dependent on the context? Should we assume that all practitioners have the necessary skills to supervise students in practice and what preparation and support is needed? The paper demonstrates that by introducing 'Critically Reflective Analysis of an Education Event' into the student teachers' curriculum the role of both supervisor and student teacher was challenged and changed. The paper also demonstrates that reflective tutorials are not wholly a retrospective business. They are creative, or recreative of a teaching experience, as well as to some extent representing it. Finally, even if one cannot speak in Kuhnian parlance, of a conceptual revolution, it would seem legitimate to say, in Schon's terms, that the contextual frame in which professional problems are addressed has undergone significant change.

  20. A three-step method of self-reflection using reflective journal writing.

    PubMed

    Riley-Doucet, C; Wilson, S

    1997-05-01

    Fiscal and financial constraints present a challenge for nurse educators to broaden the diversity and scope of teaching/learning methodologies. One method designed to promote autonomy and self-direction of nursing students is self-reflection combined with reflective journal writing. This paper describes a three-step process of self-reflection encompassing critical appraisal, peer group discussion and self-awareness. This process of self-reflection was initiated with one group of clinical nursing students. Using student and teacher feedback, implications for employing this teaching/learning strategy in clinical practice are suggested.

  1. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure

    PubMed Central

    Guyatt, Gordon H.; Sullivan, Michael J.; Thompson, Penelope J.; Fallen, Ernest L.; Pugsley, Stewart O.; Taylor, D. Wayne; Berman, Leslie B.

    1985-01-01

    Cycle and treadmill exercise tests are unsuitable for elderly, frail and severely limited patients with heart failure and may not reflect capacity to undertake day-to-day activities. Walking tests have proved useful as measures of outcome for patients with chronic lung disease. To investigate the potential value of the 6-minute walk as an objective measure of exercise capacity in patients with chronic heart failure, the test was administered six times over 12 weeks to 18 patients with chronic heart failure and 25 with chronic lung disease. The subjects also underwent cycle ergometer testing, and their functional status was evaluated by means of conventional measures. The walking test proved highly acceptable to the patients, and stable, reproducible results were achieved after the first two walks. The results correlated with the conventional measures of functional status and exercise capacity. The authors conclude that the 6-minute walk is a useful measure of functional exercise capacity and a suitable measure of outcome for clinical trials in patients with chronic heart failure. PMID:3978515

  2. Heat Capacity Mapping Mission

    NASA Technical Reports Server (NTRS)

    Nilsson, C. S.; Andrews, J. C.; Scully-Power, P.; Ball, S.; Speechley, G.; Latham, A. R. (Principal Investigator)

    1980-01-01

    The Tasman Front was delineated by airborne expendable bathythermograph survey; and an Heat Capacity Mapping Mission (HCMM) IR image on the same day shows the same principal features as determined from ground-truth. It is clear that digital enhancement of HCMM images is necessary to map ocean surface temperatures and when done, the Tasman Front and other oceanographic features can be mapped by this method, even through considerable scattered cloud cover.

  3. Community Capacity Building

    PubMed Central

    Goytia, Crispin N.; Todaro-Rivera, Lea; Brenner, Barbara; Shepard, Peggy; Piedras, Veronica; Horowitz, Carol

    2013-01-01

    Background: Successful community–academic research partnerships require building the capacity of both community-based organizations (CBOs) and academics to conduct collaborative research of mutual interest and benefit. Yet, information about the needs and goals of research-interested CBOs is lacking. Our partnership aimed to conduct a community research needs assessment and to use results to develop future capacity-building programs for CBOs. Methods: Based on our review of the literature, informal interviews with research-interested CBOs and community-engaged research groups locally and nationally, we developed a needs assessment survey. Key domains of this survey included history and experience with research collaboration, interest in specific research topics, and preference for learning format and structure. We trained community health workers (CHWs) to recruit senior leaders from CBOs in New York City (NYC) and encourage them to complete an on-line survey. Results: Fully 54% (33/61) of CBOs completed the needs assessment. Most (69%) reported involvement with research or evaluation in the last 2 years and 33% had some funding for research. Although 75% had collaborated with academic institutions in the past, 58% did not rate this experience well. The four areas respondents prioritized for skills building were program evaluation, developing needs assessments, building surveys, and understanding statistical analyses. They were less interested in learning to build collaborations with academics. Conclusions: A formal needs assessment of research training and educational needs of CBOs revealed that most had experience, albeit negative, with academic collaborations. CBO leaders wanted to build skills to conduct and analyze assessments and program evaluations. Our community–academic partnership is using these findings to develop a research capacity-building course. Other partnerships should consider conducting such assessments to transform the capacity of CBOs to

  4. Enhancing capacity management.

    PubMed

    Rees, Susan; Houlahan, Beth; Lavrenz, Dennise

    2014-03-01

    It is essential for organizations to be able to accept patients requiring care. Capacity planning and management are necessary to ensure an organization has an accepting physician/service, an available bed, and staff to care for the patient and family. This organization implemented strategies including communication plans, staffing guidelines, morning rounds, proactive planning, and an escalation process to reverse the trend of not being able to accept all patients.

  5. Enabling Partner Capacity Building

    DTIC Science & Technology

    2013-03-01

    Market Street, Philadelphia, PA 19104, (215) 662-5606. The Commission on Higher Education is an institutional accrediting agency recognized by the U.S...valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE (DD-MM-YYYY) xx-03-2013 2. REPORT TYPE STRATEGY ...National Security Strategy emphasizes building the capacity of our allies and partner countries to share the burden of global leadership. The Army is

  6. Reflections in art

    PubMed Central

    CAVANAGH, PATRICK; CHAO, JESSICA; WANG, DINA

    2009-01-01

    When artists depict a mirror in a painting, it necessarily lacks the most obvious property of a mirror: as we move around the painting of the mirror, the reflections we see in it do not change. And yet representations of mirrors and other reflecting surfaces can be quite convincing in paintings. Here, we will examine the rules of reflection, the many ways that painters can break those rules without losing the impression of reflection and the rules that cannot be broken. The rules that govern the perception of reflection are a small subset of the physical rules of reflection. PMID:18534102

  7. CSTI high capacity power

    SciTech Connect

    Winter, J.M.

    1994-09-01

    The SP-100 program was established in 1983 by DOD, DOE, and NASA as a joint program to develop the technology necessary for space nuclear power systems for military and civil application. During FY86 and 87, the NASA SP-100 Advanced Technology Program was devised to maintain the momentum of promising technology advancement efforts started during Phase I of SP-100 and to strengthen, in key areas, the chances for successful development and growth capability of space nuclear reactor power systems for future space applications. In FY88, the Advanced Technology Program was incorporated into NASA`s new Civil Space Technology Initiative (CSTI). The CSTI Program was established to provide the foundation for technology development in automation and robotics, information, propulsion, and power. The CSTI High Capacity Power Program builds on the technology efforts of the SP-100 program, incorporates the previous NASA SP-100 Advanced Technology project, and provides a bridge to NASA Project Pathfinder. The elements of CSTI High Capacity Power development include Conversion Systems, Thermal Management, Power Management, System Diagnostics, and Environmental Interactions. Technology advancement in all areas, including materials, is required to assure the high reliability and 7 to 10 year lifetime demanded for future space nuclear power systems. The overall program will develop and demonstrate the technology base required to provide a wide range of modular power systems as well as allowing mission independence from solar and orbital attitude requirements. Several recent advancements in CSTI High Capacity power development will be discussed.

  8. CSTI High Capacity Power

    NASA Technical Reports Server (NTRS)

    Winter, Jerry M.

    1989-01-01

    The SP-100 program was established in 1983 by DOD, DOE, and NASA as a joint program to develop the technology necessary for space nuclear power systems for military and civil application. During FY-86 and 87, the NASA SP-100 Advanced Technology Program was devised to maintain the momentum of promising technology advancement efforts started during Phase 1 of SP-100 and to strengthen, in key areas, the chances for successful development and growth capability of space nuclear reactor power systems for future space applications. In FY-88, the Advanced Technology Program was incorporated into NASA's new Civil Space Technology Initiative (CSTI). The CSTI Program was established to provide the foundation for technology development in automation and robotics, information, propulsion, and power. The CSTI High Capacity Power Program builds on the technology efforts of the SP-100 program, incorporates the previous NASA SP-100 Advanced Technology project, and provides a bridge to NASA Project Pathfinder. The elements of CSTI High Capacity Power development include Conversion Systems, Thermal Management, Power Management, System Diagnostics, and Environmental Interactions. Technology advancement in all areas, including materials, is required to assure the high reliability and 7 to 10 year lifetime demanded for future space nuclear power systems. The overall program will develop and demonstrate the technology base required to provide a wide range of modular power systems as well as allowing mission independence from solar and orbital attitude requirements. Several recent advancements in CSTI High Capacity power development will be discussed.

  9. Mental capacity and borderline personality disorder

    PubMed Central

    Ayre, Karyn; Owen, Gareth S.; Moran, Paul

    2017-01-01

    The use of the Mental Capacity Act 2005 in assessing decision-making capacity in patients with borderline personality disorder (BPD) is inconsistent. We believe this may stem from persisting confusion regarding the nosological status of personality disorder and also a failure to recognise the fact that emotional dysregulation and characteristic psychodynamic abnormalities may cause substantial difficulties in using and weighing information. Clearer consensus on these issues is required in order to provide consistent patient care and reduce uncertainty for clinicians in what are often emergency and high-stakes clinical scenarios. PMID:28184315

  10. Implementing reflection: insights from pre-registration mental health students.

    PubMed

    Donovan, Moira O

    2007-08-01

    Reflection and reflective practice continues to be contentious issues in nursing. The focus of this article is the use of reflection by pre-registration mental health students. The broad aim of this preliminary study was to discover student mental health nurses' perceptions of reflection as a learning strategy during clinical placement. Using a constructivist grounded theory methodology [Charmaz, K., 2000. Grounded theory: Objectivist and Constructivist Methods. In: Denzin, N., Lincoln, Y. (Eds.), Handbook of Qualitative Research, second ed. Sage, Thousand Oaks, California], five students were interviewed individually in their clinical placements. Data analysis revealed three major categories: understanding the process of reflection, using reflection in clinical practice, and needing support and guidance. Findings indicated that students were primarily using reflection-on-action, but to varying extents. Overall, students felt that reflection facilitated their learning. Factors were discovered that both helped and hindered students' use of reflection. These included level of preparation to reflect, a limited culture of reflection and the level of support from preceptors, clinical staff, clinical placement co-ordinators, and lecturers. In conclusion, it appears that a collaborative approach between students, Health Service Providers and institutes of nursing is vital for the successful development and implementation of reflective learning strategies in clinical placement. Suggestions are made as to how a collaborative approach may be developed to enhance this process.

  11. Reflectance measurement validation using acoustic horns

    PubMed Central

    Rasetshwane, Daniel M.; Neely, Stephen T.

    2015-01-01

    Variability in wideband acoustic reflectance (and absorbance) measurements adversely affects the clinical utility of reflectance for diagnosis of middle-ear disorders. A reflectance standard would encourage consistency across different measurement systems and help identify calibration related issues. Theoretical equations exist for the reflectance of finite-length exponential, conical, and parabolic acoustic horns. Reflectance measurements were repeatedly made in each of these three horn shapes and the results were compared to the corresponding theoretical reflectance. A method is described of adjusting acoustic impedance measurements to compensate for spreading of the wave front that propagates from the small diameter sound port of the probe to the larger diameter of the acoustic cavity. Agreement between measured and theoretical reflectance was less than 1 dB at most frequencies in the range from 0.2 to 10 kHz. Pearson correlation coefficients were greater than 0.95 between measured and theoretical time-domain reflectance within the flare region of the horns. The agreement suggests that the distributed reflectance of acoustic horns may be useful for validating reflectance measurements made in human ear canals; however, refinements to reflectance measurement methods may still be needed. PMID:26520306

  12. Reflectance measurement validation using acoustic horns.

    PubMed

    Rasetshwane, Daniel M; Neely, Stephen T

    2015-10-01

    Variability in wideband acoustic reflectance (and absorbance) measurements adversely affects the clinical utility of reflectance for diagnosis of middle-ear disorders. A reflectance standard would encourage consistency across different measurement systems and help identify calibration related issues. Theoretical equations exist for the reflectance of finite-length exponential, conical, and parabolic acoustic horns. Reflectance measurements were repeatedly made in each of these three horn shapes and the results were compared to the corresponding theoretical reflectance. A method is described of adjusting acoustic impedance measurements to compensate for spreading of the wave front that propagates from the small diameter sound port of the probe to the larger diameter of the acoustic cavity. Agreement between measured and theoretical reflectance was less than 1 dB at most frequencies in the range from 0.2 to 10 kHz. Pearson correlation coefficients were greater than 0.95 between measured and theoretical time-domain reflectance within the flare region of the horns. The agreement suggests that the distributed reflectance of acoustic horns may be useful for validating reflectance measurements made in human ear canals; however, refinements to reflectance measurement methods may still be needed.

  13. Neutron reflecting supermirror structure

    DOEpatents

    Wood, James L.

    1992-01-01

    An improved neutron reflecting supermirror structure comprising a plurality of stacked sets of bilayers of neutron reflecting materials. The improved neutron reflecting supermirror structure is adapted to provide extremely good performance at high incidence angles, i.e. up to four time the critical angle of standard neutron mirror structures. The reflection of neutrons striking the supermirror structure at a high critical angle provides enhanced neutron throughput, and hence more efficient and economical use of neutron sources.

  14. Neutron reflecting supermirror structure

    DOEpatents

    Wood, J.L.

    1992-12-01

    An improved neutron reflecting supermirror structure comprising a plurality of stacked sets of bilayers of neutron reflecting materials. The improved neutron reflecting supermirror structure is adapted to provide extremely good performance at high incidence angles, i.e. up to four time the critical angle of standard neutron mirror structures. The reflection of neutrons striking the supermirror structure at a high critical angle provides enhanced neutron throughput, and hence more efficient and economical use of neutron sources. 2 figs.

  15. Liberating Moral Reflection

    ERIC Educational Resources Information Center

    Horell, Harold D.

    2013-01-01

    The author argues that if we are to foster life-giving and liberating moral reflection, we must first liberate moral reflection from distortions; specifically, from the distorting effects of moral insensitivity, destructive moral relativism, and confusions resulting from a failure to understand the dynamics of moral reflection. The author proposes…

  16. Teaching Critical Reflection

    ERIC Educational Resources Information Center

    Smith, Elizabeth

    2011-01-01

    Despite long-standing commitment to the notion of critical reflection across the healthcare professions it is unusual for critical theory and practice to be taught as explicit subjects in healthcare higher education. There is evidence to show that reflective techniques such as critical portfolios and reflective diaries can help students to…

  17. A method for assessing reflective journal writing.

    PubMed

    Plack, Margaret M; Driscoll, Maryanne; Blissett, Sylvene; McKenna, Raymond; Plack, Thomas P

    2005-01-01

    Reflection is widely accepted as a learning tool and is considered integral to professional practice. Journal writing is advocated in facilitating reflection, yet little is written about how to assess reflection in journals. The purpose of this study was to develop and test a method of assessing the elements of reflection in journals and to determine whether, and to what level, reflection occurs in journals. Twenty-seven physical therapy students maintained written reflective journals throughout three of their four eight-week clinical affiliations. The students were introduced to concepts of reflective practice with definitions of terms and reflective questions before their second affiliation. A coding schema was developed to assess the journals. Three raters assessed forty-three journals. The text of each journal was analyzed for evidence of nine elements of reflection, and each journal was categorized as showing no evidence of reflection, evidence of reflection, or evidence of critical reflection. Descriptive statistics were used to demonstrate evidence of reflection. Reliability between each pair of raters was assessed using percent agreement, phi coefficients, and gamma statistics. Interrater reliability of all raters was assessed using intraclass correlation coefficients (ICC[2,1]). Results showed that the raters assessed 95.3%-100% of the journals as showing at least one element of reflection. The percent agreement between rater pairs for the nine elements of reflection ranged from 65.1% to 93.0%, the phi coefficient ranged from 0.08 to 0.81, and the ICC(2,1) values used to assess reliability among the three raters on each element ranged from 0.03 to 0.72. Averaging the assessment of the three raters for the overall journal, 14.7% of the journals were assessed as showing no evidence of reflection, 43.4% as showing evidence of reflection, and 41.9% as showing evidence of critical reflection. The percent agreement between rater pairs for the overall assessment

  18. Quantum reading capacity

    NASA Astrophysics Data System (ADS)

    Pirandola, Stefano; Lupo, Cosmo; Giovannetti, Vittorio; Mancini, Stefano; Braunstein, Samuel L.

    2011-11-01

    The readout of a classical memory can be modelled as a problem of quantum channel discrimination, where a decoder retrieves information by distinguishing the different quantum channels encoded in each cell of the memory (Pirandola 2011 Phys. Rev. Lett. 106 090504). In the case of optical memories, such as CDs and DVDs, this discrimination involves lossy bosonic channels and can be remarkably boosted by the use of nonclassical light (quantum reading). Here we generalize these concepts by extending the model of memory from single-cell to multi-cell encoding. In general, information is stored in a block of cells by using a channel-codeword, i.e. a sequence of channels chosen according to a classical code. Correspondingly, the readout of data is realized by a process of ‘parallel’ channel discrimination, where the entire block of cells is probed simultaneously and decoded via an optimal collective measurement. In the limit of a large block we define the quantum reading capacity of the memory, quantifying the maximum number of readable bits per cell. This notion of capacity is nontrivial when we suitably constrain the physical resources of the decoder. For optical memories (encoding bosonic channels), such a constraint is energetic and corresponds to fixing the mean total number of photons per cell. In this case, we are able to prove a separation between the quantum reading capacity and the maximum information rate achievable by classical transmitters, i.e. arbitrary classical mixtures of coherent states. In fact, we can easily construct nonclassical transmitters that are able to outperform any classical transmitter, thus showing that the advantages of quantum reading persist in the optimal multi-cell scenario.

  19. Scaffolding Collaborative Reflective Writing in a VET Curriculum

    ERIC Educational Resources Information Center

    Boldrini, Elena; Cattaneo, Alberto

    2014-01-01

    Learning journal writing is an effective tool to foster the development of reflective capacity in the context of Vocational Education and Training (VET) if conceived as a collection of descriptions and reflections on real professional experiences. Reporting professional situations in a learning journal outside the workplace in turn fosters the…

  20. Parenting and Adolescent Adjustment: The Role of Parental Reflective Function

    ERIC Educational Resources Information Center

    Benbassat, Naomi; Priel, Beatriz

    2012-01-01

    Reflective function (RF) is the capacity to reflect on one's own mental experiences and those of others. This study examined the relationship between parental RF and adolescent adjustment. One hundred and five adolescents, aged 14-18, and their mothers and fathers were interviewed and completed questionnaires during home visits. We measured…

  1. Developing reflective writing as effective pedagogy.

    PubMed

    Kennison, Monica

    2012-01-01

    While reflective writing about practice experiences is frequently used in nursing curricula to foster critical thinking, faculty members may be unaware of how to help students reflect, what kinds of feedback are helpful, and how to deal with students' concerns. This article describes faculty best practices in mentoring the student to effectively think critically through structured reflective writing. Models of structured reflection, Baker's four-step model and John's revision of Carper's patterns of knowing, are discussed as effective guides at graduate and undergraduate levels. The article addresses potentially problematic issues with the implementation and evaluation of reflective writing assignments in clinical courses. With foresight and planning, reflective writing may be an empowering strategy for facilitating students' thinking skills.

  2. Heat Capacity in Proteins

    NASA Astrophysics Data System (ADS)

    Prabhu, Ninad V.; Sharp, Kim A.

    2005-05-01

    Heat capacity (Cp) is one of several major thermodynamic quantities commonly measured in proteins. With more than half a dozen definitions, it is the hardest of these quantities to understand in physical terms, but the richest in insight. There are many ramifications of observed Cp changes: The sign distinguishes apolar from polar solvation. It imparts a temperature (T) dependence to entropy and enthalpy that may change their signs and which of them dominate. Protein unfolding usually has a positive ΔCp, producing a maximum in stability and sometimes cold denaturation. There are two heat capacity contributions, from hydration and protein-protein interactions; which dominates in folding and binding is an open question. Theoretical work to date has dealt mostly with the hydration term and can account, at least semiquantitatively, for the major Cp-related features: the positive and negative Cp of hydration for apolar and polar groups, respectively; the convergence of apolar group hydration entropy at T ≈ 112°C; the decrease in apolar hydration Cp with increasing T; and the T-maximum in protein stability and cold denaturation.

  3. Early hominin auditory capacities

    PubMed Central

    Quam, Rolf; Martínez, Ignacio; Rosa, Manuel; Bonmatí, Alejandro; Lorenzo, Carlos; de Ruiter, Darryl J.; Moggi-Cecchi, Jacopo; Conde Valverde, Mercedes; Jarabo, Pilar; Menter, Colin G.; Thackeray, J. Francis; Arsuaga, Juan Luis

    2015-01-01

    Studies of sensory capacities in past life forms have offered new insights into their adaptations and lifeways. Audition is particularly amenable to study in fossils because it is strongly related to physical properties that can be approached through their skeletal structures. We have studied the anatomy of the outer and middle ear in the early hominin taxa Australopithecus africanus and Paranthropus robustus and estimated their auditory capacities. Compared with chimpanzees, the early hominin taxa are derived toward modern humans in their slightly shorter and wider external auditory canal, smaller tympanic membrane, and lower malleus/incus lever ratio, but they remain primitive in the small size of their stapes footplate. Compared with chimpanzees, both early hominin taxa show a heightened sensitivity to frequencies between 1.5 and 3.5 kHz and an occupied band of maximum sensitivity that is shifted toward slightly higher frequencies. The results have implications for sensory ecology and communication, and suggest that the early hominin auditory pattern may have facilitated an increased emphasis on short-range vocal communication in open habitats. PMID:26601261

  4. Early hominin auditory capacities.

    PubMed

    Quam, Rolf; Martínez, Ignacio; Rosa, Manuel; Bonmatí, Alejandro; Lorenzo, Carlos; de Ruiter, Darryl J; Moggi-Cecchi, Jacopo; Conde Valverde, Mercedes; Jarabo, Pilar; Menter, Colin G; Thackeray, J Francis; Arsuaga, Juan Luis

    2015-09-01

    Studies of sensory capacities in past life forms have offered new insights into their adaptations and lifeways. Audition is particularly amenable to study in fossils because it is strongly related to physical properties that can be approached through their skeletal structures. We have studied the anatomy of the outer and middle ear in the early hominin taxa Australopithecus africanus and Paranthropus robustus and estimated their auditory capacities. Compared with chimpanzees, the early hominin taxa are derived toward modern humans in their slightly shorter and wider external auditory canal, smaller tympanic membrane, and lower malleus/incus lever ratio, but they remain primitive in the small size of their stapes footplate. Compared with chimpanzees, both early hominin taxa show a heightened sensitivity to frequencies between 1.5 and 3.5 kHz and an occupied band of maximum sensitivity that is shifted toward slightly higher frequencies. The results have implications for sensory ecology and communication, and suggest that the early hominin auditory pattern may have facilitated an increased emphasis on short-range vocal communication in open habitats.

  5. Reflectance imaging by fiber bundle endoscope: Vertical reconstruction by multipositional illumination

    NASA Astrophysics Data System (ADS)

    Ando, Yoriko; Koida, Kowa; Sawahata, Hirohito; Sakurai, Takashi; Natsume, Mitsuo; Kawano, Takeshi; Numano, Rika

    2016-02-01

    Fiber bundles for imaging internal organs with minimum physical damage have been increasingly developed for both basic life sciences and clinical applications. Reflectance imaging is possible using fiber bundles for detecting the intrinsic optical contrast of blood vessels and tissue structure. The placement of an illumination source adjacent to imaging optics causes scattered light from deeper tissue layers to illuminate superficial tissues and results in a reflectance image. However, it does not have focal capacity and lacks depth resolution. In this study, we performed spatial analysis for the vertical reconstruction of in vivo tissues using a multipositional illumination scheme. The observed image corresponded to the "shadow" of a target object. When we manipulated the location of illumination, the shadow moved horizontally depending on the depth of the target. We used this horizontal displacement as a cue and successfully performed the vertical reconstruction of mouse brain blood vessels.

  6. Preschoolers' use of reflective properties: identification of reflections on partially transparent surfaces.

    PubMed

    Costanzo, E S; Wittgenstein, K M; Benson, K

    2001-12-01

    This exploratory study extended past studies of children's ability to reference the mirror as a tool in locating the source of reflected images to preschoolers' ability to use the affordances of a transparency. Thirty-six children (3.5 to 5 years old) were shown nonreflected lights and lights reflected on a partially transparent, glassy surface. Children did not spontaneously locate the source of the reflected image. However, they were able to verbally discriminate reflected from nonreflected images following training. These findings indicate that, although preschoolers may not spontaneously use transparencies as a perceptual tool, the ability to distinguish visual differences of reflected from nonreflected images on transparencies is likely within preschool children's developmental capacity.

  7. Reflective diffraction grating

    DOEpatents

    Lamartine, Bruce C.

    2003-06-24

    Reflective diffraction grating. A focused ion beam (FIB) micromilling apparatus is used to store color images in a durable medium by milling away portions of the surface of the medium to produce a reflective diffraction grating with blazed pits. The images are retrieved by exposing the surface of the grating to polychromatic light from a particular incident bearing and observing the light reflected by the surface from specified reception bearing.

  8. Tandem resonator reflectance modulator

    DOEpatents

    Fritz, I.J.; Wendt, J.R.

    1994-09-06

    A wide band optical modulator is grown on a substrate as tandem Fabry-Perot resonators including three mirrors spaced by two cavities. The absorption of one cavity is changed relative to the absorption of the other cavity by an applied electric field, to cause a change in total reflected light, as light reflecting from the outer mirrors is in phase and light reflecting from the inner mirror is out of phase with light from the outer mirrors. 8 figs.

  9. Tandem resonator reflectance modulator

    DOEpatents

    Fritz, Ian J.; Wendt, Joel R.

    1994-01-01

    A wide band optical modulator is grown on a substrate as tandem Fabry-Perot resonators including three mirrors spaced by two cavities. The absorption of one cavity is changed relative to the absorption of the other cavity by an applied electric field, to cause a change in total reflected light, as light reflecting from the outer mirrors is in phase and light reflecting from the inner mirror is out of phase with light from the outer mirrors.

  10. Honesty in Critically Reflective Essays: An Analysis of Student Practice

    ERIC Educational Resources Information Center

    Maloney, Stephen; Tai, Joanna Hong-Meng; Lo, Kristin; Molloy, Elizabeth; Ilic, Dragan

    2013-01-01

    In health professional education, reflective practice is seen as a potential means for self-improvement from everyday clinical encounters. This study aims to examine the level of student honesty in critical reflection, and barriers and facilitators for students engaging in honest reflection. Third year physiotherapy students, completing summative…

  11. Neutron reflecting supermirror structure

    DOEpatents

    Wood, James L.

    1992-01-01

    An improved neutron reflecting supermirror structure comprising a plurality of stacked sets of bilayers of neutron reflecting materials. The improved neutron reflecting supermirror structure is adapted to provide extremely good performance at high incidence angles, i.e. up to four time the critical angle of standard neutron mirror structures. The reflection of neutrons striking the supermirror structure at a high critical angle provides enhanced neutron throughput, and hence more efficient and economical use of neutron sources. One layer of each set of bilayers consist of titanium, and the second layer of each set of bilayers consist of an alloy of nickel with carbon interstitially present in the nickel alloy.

  12. Continuity of Quantum Channel Capacities

    NASA Astrophysics Data System (ADS)

    Leung, Debbie; Smith, Graeme

    2009-11-01

    We prove that a broad array of capacities of a quantum channel are continuous. That is, two channels that are close with respect to the diamond norm have correspondingly similar communication capabilities. We first show that the classical capacity, quantum capacity, and private classical capacity are continuous, with the variation on arguments {\\varepsilon} apart bounded by a simple function of {\\varepsilon} and the channel’s output dimension. Our main tool is an upper bound of the variation of output entropies of many copies of two nearby channels given the same initial state; the bound is linear in the number of copies. Our second proof is concerned with the quantum capacities in the presence of free backward or two-way public classical communication. These capacities are proved continuous on the interior of the set of non-zero capacity channels by considering mutual simulation between similar channels.

  13. Changes in Strain Pattern and Exercise Capacity after Transcatheter Closure of Atrial Septal Defects

    PubMed Central

    Kim, Jung Yoon; Yun, Bong-Sic; Lee, Sunho; Jung, Se Yong; Choi, Jae Young

    2017-01-01

    Background and Objectives Assessment of left ventricle (LV) function by using strain and strain rate is popular in the clinical setting. However, the use of these echocardiographic tools in assessing right ventricle (RV) failure, and the manner in which they both reflect the functional capacity of the patient, remains poorly understood. This study aimed to investigate the change in exercise capacity and strain between before and (1 month) after the transcatheter closure of atrial septal defects (ASDs). Subjects and Methods Thirty patients who underwent transcatheter closure of ASD between May 2014 and June 2015 at the Division of Pediatric Cardiology, Severance Cardiovascular Hospital, were enrolled. We compared and analyzed the results of the following examinations, before and (1 month) after the procedure: echocardiography, cardiopulmonary exercise test (CPET), and N-terminal pro-brain natriuretic peptide level. Results There were no mortalities, and the male-to-female ratio was 1:2. The mean defect size was 22.3±4.9 mm; the mean Qp/Qs ratio, 2.1±0.5; and the mean device size, 22.3±4.9 mm. Changes in global RV longitudinal (GRVL) strain and LV torsion were measured echocardiographically. Exercise capacity improved from 7.7±1.2 to 8.7±1.8 metabolic equivalents (p=0.001). These findings correlated to the change in GRVL strain (p=0.03). Conclusion The average exercise capacity increased after device closure of ASD. The change in strain was evident on echocardiography, especially for GRVL strain and LV torsion. Further studies comparing CPET and strain in various patients may show increased exercise capacity in patients with improved RV function. PMID:28382081

  14. Renewable liquid reflection grating

    DOEpatents

    Ryutov, Dmitri D.; Toor, Arthur

    2003-10-07

    A renewable liquid reflection grating. Electrodes are operatively connected to a conducting liquid in an arrangement that produces a reflection grating and driven by a current with a resonance frequency. In another embodiment, the electrodes create the grating by a resonant electrostatic force acting on a dielectric liquid.

  15. Ultraviolet reflective coating

    NASA Technical Reports Server (NTRS)

    Schutt, J. B.

    1974-01-01

    Composition consists of dispersion of barium sulphate in aqueous solution of water-soluble inorganic binder. Binder is selected from group consisting of alkali metal sulphates. Coating exhibits high reflectance of ultraviolet light to wavelengths of approximately 200.0 nm, which compares favorably with high reflectance of virgin barium sulphate power.

  16. Reflective Learning in Practice.

    ERIC Educational Resources Information Center

    Brockbank, Anne, Ed.; McGill, Ian, Ed.; Beech, Nic, Ed.

    This book contains 22 papers on reflective learning in practice. The following papers are included: "Our Purpose" (Ann Brockbank, Ian McGill, Nic Beech); "The Nature and Context of Learning" (Ann Brockbank, Ian McGill, Nic Beech); "Reflective Learning and Organizations" (Ann Brockbank, Ian McGill, Nic Beech);…

  17. Reflection in Medical Education

    ERIC Educational Resources Information Center

    Hargreaves, Ken

    2016-01-01

    This paper offers a medical-education perspective that I will hope complement other disciplinary perspectives in examining the value of reflection for learning in tertiary education. The paper outlines some of the theoretical strands of reflective practice facilitated in a unique course subject for professionalism and patient safety, within the…

  18. Transparencies and Reflections.

    ERIC Educational Resources Information Center

    Hubbard, Guy

    1999-01-01

    Discusses the use of perspective, or showing things as the human eye sees them, when creating reflections and transparencies in works of art. Provides examples of artwork using transparency, reflection, and refraction by M. C. Escher, Richard Estes, and Janet Fish to give students an opportunity to learn about these three art techniques. (CMK)

  19. Earth's Reflection: Albedo

    ERIC Educational Resources Information Center

    Gillette, Brandon; Hamilton, Cheri

    2011-01-01

    When viewing objects of different colors, you might notice that some appear brighter than others. This is because light is reflected differently from various surfaces, depending on their physical properties. The word "albedo" is used to describe how reflective a surface is. The Earth-atmosphere has a combined albedo of about 30%, a number that is…

  20. Rethinking Reflection: Teachers' Critiques

    ERIC Educational Resources Information Center

    Atkinson, Becky M.

    2012-01-01

    This article presents findings from a study conducted with a teacher focus group asked to read and discuss their responses to selected published teacher narratives of reflective practice. The teachers challenged features of practitioner reflection presented in several of the reading selections as not representative of how they experienced…

  1. [Ecotourism carrying capacity of Hangzhou Xixi National Wetland Park in China].

    PubMed

    Li, Rui; Rong, Liang

    2007-10-01

    In this paper, an integrated estimation on the ecotourism carrying capacity of Hangzhou Xixi National Wetland Park in China was made from the aspects of ecological carrying capacity, spatial carrying capacity, facility carrying capacity, management carrying capacity, and psychological carrying capacity. The results indicated that the tourism carrying capacity of the Park was 4 145 - 6 450 persons per day. The rational distance between man and bird was first adopted to determine the ecotourism carrying capacity of wetland, which provided an effective solution both to fully ensure bird safety and to appropriately develop wetland tourism. The estimation of psychological carrying capacity based on tourist satisfaction degree reflected more objectively the extent the tourist demands satisfied at the planning, construction and management of tour places. Such an integrated estimation method based on the distance between man and bird and the tourist satisfaction degree could be of practical and instructive significances in the planning and management of wetland parks.

  2. The making of expert clinicians: reflective practice.

    PubMed

    Maestre, J M; Szyld, D; Del Moral, I; Ortiz, G; Rudolph, J W

    2014-05-01

    Debriefing is a rigorous reflection process which helps trainees recognize and resolve clinical and behavioral dilemmas raised by a clinical case. This approach emphasizes eliciting trainees'assumptions about the situation and their reasons for performing as they did (mental models). It analyses their impact on actions, to understand if it is necessary to maintain them or construct new ones that may lead to better performance in the future. It blends evidence and theory from education research, the social and cognitive sciences, and experience drawn from conducting and teaching debriefing to clinicians worldwide, on how to improve professional effectiveness through "reflective practice".

  3. Exploring problems encountered among experienced nurses using critical reflective inquiry: implications for nursing professional development.

    PubMed

    Asselin, Marilyn E; Schwartz-Barcott, Donna

    2015-01-01

    This study explored problems encountered by nurses using critical reflective inquiry to examine clinical situations and the impact of group discussion on the reflective process. Secondary qualitative analysis of 19 reflective situations, rom a reflection continuing education program, revealed that nurses had problematic pauses in reflection and were stuck in cyclical self-questioning. Peer group discussion prompted deeper reflection. Experienced nurses may need assistance to enhance the comprehensiveness, depth, and scope of reflection on practice situations.

  4. Preeclampsia, biomarkers, syncytiotrophoblast stress, and placental capacity.

    PubMed

    Redman, Christopher W G; Staff, Anne Cathrine

    2015-10-01

    The maternal syndrome of preeclampsia is mediated by dysfunctional syncytiotrophoblast (STB). When this is stressed by uteroplacental malperfusion, its signaling to the mother changes, as part of a highly coordinated stress response. The STB signals are both proinflammatory and dysangiogenic such that the preeclamptic mother has a stronger vascular inflammatory response than normal, with an antiangiogenic bias. Angiogenic factors have limitations as preeclampsia biomarkers, especially for prediction and diagnosis of preeclampsia at term. However, if they are recognized as markers of STB stress, their physiological changes at term demonstrate that STB stress develops in all pregnancies. The biomarkers reveal that the duration of pregnancies is restricted by placental capacity, such that there is increasing placental dysfunction, at and beyond term. This capacity includes limitations imposed by the size of the uterus, the capacity of the uteroplacental circulation and, possibly, the supply of villous progenitor trophoblast cells. Limited placental capacity explains the increasing risks of postmaturity, including preeclampsia. Early-onset preeclampsia is predictable because STB stress and changes in its biomarkers are intrinsic to poor placentation, an early pregnancy pathology. Prediction of preeclampsia at term is not good because there is no early STB pathology. Moreover, biomarkers cannot accurately diagnose term preeclampsia against a background of universal STB dysfunction, which may or may not be clinically revealed before spontaneous or induced delivery. In this sense, postterm pregnancy is, at best, a pseudonormal state. However, the markers may prove useful in screening for women with more severe problems of postmaturity.

  5. Reference values for pulmonary diffusing capacity for adult native Finns.

    PubMed

    Kainu, Annette; Toikka, Jyri; Vanninen, Esko; Timonen, Kirsi L

    2017-04-01

    Measurement standards for pulmonary diffusing capacity were updated in 2005 by the ATS/ERS Task Force. However, in Finland reference values published in 1982 by Viljanen et al. have been used to date. The main aim of this study was to produce updated reference models for single-breath diffusing capacity for carbon monoxide for Finnish adults. Single-breath diffusing capacity for carbon monoxide was measured in 631 healthy non-smoking volunteers (41.5% male). Reference values for diffusing capacity (DLCO), alveolar volume (VA), diffusing capacity per unit of lung volume (DLCO/VA), and lung volumes were calculated using a linear regression model. Previously used Finnish reference values were found to produce too low predicted values, with mean predicted DLCO 111.0 and 104.4%, and DLCO/VA of 103.5 and 102.7% in males and females, respectively. With the European Coalition for Steel and Coal (ECSC) reference values there was a significant sex difference in DLCO/VA with mean predicted 105.4% in males and 92.8% in females (p < .001). New reference values for DLCO, DLCO/VA, VA, vital capacity (VC), inspiratory vital capacity (IVC), and inspiratory capacity (IC) are suggested for clinical use to replace technically outdated reference values for clinical applications.

  6. The Capacity to Build Organizational Capacity in Schools

    ERIC Educational Resources Information Center

    King, M. Bruce; Bouchard, Kate

    2011-01-01

    Purpose: Reformers, policymakers, and researchers have given considerable attention to organizational capacity in schools, especially in those schools that perpetuate or exacerbate achievement gaps among diverse student groups and reproduce social inequalities. There is an emerging consensus about key dimensions of school capacity and how they can…

  7. Amplified total internal reflection.

    PubMed

    Fan, J; Dogariu, A; Wang, L J

    2003-02-24

    Totally internal reflected beams can be amplified if the lowerindex medium has gain. We analyze the reflection and refraction of light, and analytically derive the expression for the Goos-Hänchen shifts of a Gaussian beam incident on a lower-index medium, both active and absorptive. We examine the energy flow and the Goos-Hänchen shifts for various cases. The analytical results are consistent with the numerical results. For the TE mode, the Goos-Hänchen shift for the transmitted beam is exactly half of that of the reflected beam, resulting in a "1/2" rule.

  8. The use of reflection in emergency medicine education.

    PubMed

    Bernard, Aaron W; Gorgas, Diane; Greenberger, Sarah; Jacques, Andrew; Khandelwal, Sorabh

    2012-08-01

    Reflection is a cognitive process in which new information and experiences are integrated into existing knowledge structures and mental models, resulting in meaningful learning. Reflection often occurs after an experience is over, promoting professional development and lifelong learning. However, a reflective emergency physician (EP) is also able to apply reflection in real time: self-monitoring, coping with the unexpected, and quickly thinking on his or her feet to solve complicated, unique, and challenging clinical problems. Reflection is a skill that can be taught and developed in medical education. Evidence demonstrating the value of teaching reflection is emerging that substantiates longstanding educational theories. While a few educators have started to explore the use of reflection for emergency medicine (EM) learners, the potential for broader application exists. This review summarizes the literature regarding reflection in medical education and provides a basic primer for teaching reflection.

  9. Seasonal soybean crop reflectance

    NASA Technical Reports Server (NTRS)

    Lemaster, E. W. (Principal Investigator); Chance, J. E.

    1983-01-01

    Data are presented from field measurements of 1980 including 5 acquisitions of handheld radiometer reflectance measurements, 7 complete sets of parameters for implementing the Suits mode, and other biophysical parameters to characterize the soybean canopy. LANDSAT calculations on the simulated Brazilian soybean reflectance are included along with data collected during the summer and fall on 1981 on soybean single leaf optical parameters for three irrigation treatments. Tests of the Suits vegetative canopy reflectance model for the full hemisphere of observer directions as well as the nadir direction show moderate agreement for the visible channels of the MSS and poor agreement in the near infrared channel. Temporal changes in the spectral characteristics of the single leaves were seen to occur as a function of maturity which demonstrates that the absorptance of a soybean single leaf is more a function of thetransmittancee characteristics than the seasonally consistent single leaf reflectance.

  10. [Regeneration capacity of skeletal muscle].

    PubMed

    Wernig, A

    2003-07-01

    The organotypic stem cell of skeletal muscle has previously been known as satellite cell. They allow muscle fiber growth during ontogenesis, enable fiber hypertrophy and are responsible for the very efficient repair of muscle fibers. This efficient apparatus is to some degree counterbalanced by an enormous use of the satellite cell pool: fiber atrophy probably is accompanied by loss of myonuclei such that every reversal of atrophy is bound to use new myonuclei i.e. satellite cells. How often in life does this occur? Hard to say. Moreover, the potent repair capacity is challenged by an unexpected vulnerability of skeletal muscle fibers: Passive stretching of contracted muscles may cause multiple "microdamage," disruption of contractile elements or tiny areas of true necrosis (focal necrosis). How often does this happen? Well, for many of us at least once per year when we go up and down mountains during vacation time, followed by sour muscles. Others may decide to change his/her (locomotor) behaviour by severe onset of jogging; it may happen that they suffer kidney failure on Monday due to muscle microdamage and the transfer of myoproteins into the serum over weekend. Also 20 minutes of stepping up and down something like a chair will do: There is a remarkable increase in kreatin kinase and other muscle derived proteins which lasts for days and is bound to reflect some muscle damage. How about sportsmen and worker who repeatedly use their muscles in such a way? We don't have answers yet to most of these questions, but considerable amount of information has been collected over the last years both in animal and--less--in human. What is common in all cases of growth and repair is the proliferation of the satellite cells and their consequent incorporation and fusion with the parent fiber. This way focal damage is repaired often without visible reminders. We would run out of satellite cells were they not stem cells: After division one daughter remains a satellite cell

  11. Reflecting on 80 years of excellence

    PubMed Central

    Savla, Ushma

    2004-01-01

    A small group of members of the American Society for Clinical Investigation began chatting in 1916 about the possibility of launching a new biomedical research journal. By October 1924, they managed to make the idea a reality with the publication of the first issue of the Journal of Clinical Investigation. Our 80th birthday seems an appropriate time to reflect on the history of biomedical science as it has been played out on our pages. PMID:15489943

  12. Reflectance of aqueous solutions

    NASA Technical Reports Server (NTRS)

    Querry, M. R.

    1972-01-01

    The optical properties and optical constants of water and aqueous solutions were studied to develop an accurate tabulation of graphical representations of the optical constants through a broad spectrum. Manuscripts of articles are presented concerning extinction coefficients, relative specular reflectance, and temperature effect on the water spectrum. Graphs of absolute reflectance, phase shifts, index of refraction, and extinction coefficients for water, heavy water and aqueous solutions are included.

  13. Information capacity of genetic regulatory elements

    NASA Astrophysics Data System (ADS)

    Tkačik, Gašper; Callan, Curtis G., Jr.; Bialek, William

    2008-07-01

    Changes in a cell’s external or internal conditions are usually reflected in the concentrations of the relevant transcription factors. These proteins in turn modulate the expression levels of the genes under their control and sometimes need to perform nontrivial computations that integrate several inputs and affect multiple genes. At the same time, the activities of the regulated genes would fluctuate even if the inputs were held fixed, as a consequence of the intrinsic noise in the system, and such noise must fundamentally limit the reliability of any genetic computation. Here we use information theory to formalize the notion of information transmission in simple genetic regulatory elements in the presence of physically realistic noise sources. The dependence of this “channel capacity” on noise parameters, cooperativity and cost of making signaling molecules is explored systematically. We find that, in the range of parameters probed by recent in vivo measurements, capacities higher than one bit should be achievable. It is of course generally accepted that gene regulatory elements must, in order to function properly, have a capacity of at least one bit. The central point of our analysis is the demonstration that simple physical models of noisy gene transcription, with realistic parameters, can indeed achieve this capacity: it was not self-evident that this should be so. We also demonstrate that capacities significantly greater than one bit are possible, so that transcriptional regulation need not be limited to simple “on-off” components. The question whether real systems actually exploit this richer possibility is beyond the scope of this investigation.

  14. Visuospatial Working Memory Capacity Predicts Physiological Arousal in a Narrative Task.

    PubMed

    Smithson, Lisa; Nicoladis, Elena

    2016-06-01

    Physiological arousal that occurs during narrative production is thought to reflect emotional processing and cognitive effort (Bar-Haim et al. in Dev Psychobiol 44:238-249, 2004). The purpose of this study was to determine whether individual differences in visuospatial working memory and/or verbal working memory capacity predict physiological arousal in a narrative task. Visuospatial working memory was a significant predictor of skin conductance level (SCL); verbal working memory was not. When visuospatial working memory interference was imposed, visuospatial working memory was no longer a significant predictor of SCL. Visuospatial interference also resulted in a significant reduction in SCL. Furthermore, listener ratings of narrative quality were contingent upon the visuospatial working memory resources of the narrator. Potential implications for educators and clinical practitioners are discussed.

  15. Selectively reflective transparent sheets

    NASA Astrophysics Data System (ADS)

    Waché, Rémi; Florescu, Marian; Sweeney, Stephen J.; Clowes, Steven K.

    2015-08-01

    We investigate the possibility to selectively reflect certain wavelengths while maintaining the optical properties on other spectral ranges. This is of particular interest for transparent materials, which for specific applications may require high reflectivity at pre-determined frequencies. Although there exist currently techniques such as coatings to produce selective reflection, this work focuses on new approaches for mass production of polyethylene sheets which incorporate either additives or surface patterning for selective reflection between 8 to 13 μ m. Typical additives used to produce a greenhouse effect in plastics include particles such as clays, silica or hydroxide materials. However, the absorption of thermal radiation is less efficient than the decrease of emissivity as it can be compared with the inclusion of Lambertian materials. Photonic band gap engineering by the periodic structuring of metamaterials is known in nature for producing the vivid bright colors in certain organisms via strong wavelength-selective reflection. Research to artificially engineer such structures has mainly focused on wavelengths in the visible and near infrared. However few studies to date have been carried out to investigate the properties of metastructures in the mid infrared range even though the patterning of microstructure is easier to achieve. We present preliminary results on the diffuse reflectivity using FDTD simulations and analyze the technical feasibility of these approaches.

  16. Goal-neglect links Stroop interference with working memory capacity.

    PubMed

    Morey, Candice C; Elliott, Emily M; Wiggers, Jody; Eaves, Sharon D; Shelton, Jill T; Mall, Jonathan T

    2012-10-01

    Relationships between Stroop interference and working memory capacity may reflect individual differences in resolving conflict, susceptibility to goal neglect, or both of these factors. We compared relationships between working memory capacity and three Stroop tasks: a classic, printed color-word Stroop task, a cross-modal Stroop, and a new version of cross-modal Stroop with a concurrent auditory monitoring component. Each of these tasks showed evidence of interference between the semantic meaning of the color word and the to-be-named color, suggesting these tasks each require resolution of interference. However, only Stroop interference in the print-based task with high proportions of congruent trials correlated significantly with working memory capacity. This evidence suggests that the relationships observed between Stroop interference and working memory capacity are primarily driven by individual differences in the propensity to actively maintain a goal.

  17. Concrete Operations and Attentional Capacity.

    ERIC Educational Resources Information Center

    Chapman, Michael; Lindenberger, Ulman

    1989-01-01

    To test predictions regarding the attentional capacity requirements of Piaget's stage of concrete operations, a battery of concrete operational tasks and two measures of attentional capacity were administered to 120 first-, second-, and third-graders. Findings concern class inclusion, transitivity of length and weight, and multiplication of…

  18. Development and Validation of a Self-Report Measure of Mentalizing: The Reflective Functioning Questionnaire

    PubMed Central

    Fonagy, Peter; Luyten, Patrick; Moulton-Perkins, Alesia; Lee, Ya-Wen; Warren, Fiona; Howard, Susan; Ghinai, Rosanna; Fearon, Pasco; Lowyck, Benedicte

    2016-01-01

    Reflective functioning or mentalizing is the capacity to interpret both the self and others in terms of internal mental states such as feelings, wishes, goals, desires, and attitudes. This paper is part of a series of papers outlining the development and psychometric features of a new self-report measure, the Reflective Functioning Questionnaire (RFQ), designed to provide an easy to administer self-report measure of mentalizing. We describe the development and initial validation of the RFQ in three studies. Study 1 focuses on the development of the RFQ, its factor structure and construct validity in a sample of patients with Borderline Personality Disorder (BPD) and Eating Disorder (ED) (n = 108) and normal controls (n = 295). Study 2 aims to replicate these findings in a fresh sample of 129 patients with personality disorder and 281 normal controls. Study 3 addresses the relationship between the RFQ, parental reflective functioning and infant attachment status as assessed with the Strange Situation Procedure (SSP) in a sample of 136 community mothers and their infants. In both Study 1 and 2, confirmatory factor analyses yielded two factors assessing Certainty (RFQ_C) and Uncertainty (RFQ_U) about the mental states of self and others. These two factors were relatively distinct, invariant across clinical and non-clinical samples, had satisfactory internal consistency and test–retest stability, and were largely unrelated to demographic features. The scales discriminated between patients and controls, and were significantly and in theoretically predicted ways correlated with measures of empathy, mindfulness and perspective-taking, and with both self-reported and clinician-reported measures of borderline personality features and other indices of maladaptive personality functioning. Furthermore, the RFQ scales were associated with levels of parental reflective functioning, which in turn predicted infant attachment status in the SSP. Overall, this study lends

  19. "If That's What I Need, It Could Be What Someone Else Needs." Exploring the Role of Attachment and Reflective Function in Counselling Psychologists' Accounts of How They Use Personal Therapy in Clinical Practice: A Mixed Methods Study

    ERIC Educational Resources Information Center

    Rizq, Rosemary; Target, Mary

    2010-01-01

    Empirical evidence supporting the inclusion of mandatory training therapy for therapists is sparse. We present results from a mixed methods study designed to interrogate how counselling psychologists' attachment status and levels of reflective function (RF) intersect with how they experience, recall and describe using personal therapy in clinical…

  20. The Bremerton enrollment capacity model: an enrollment capacity model supporting the military health system optimization plan.

    PubMed

    Helmers, S

    2001-12-01

    The Department of Defense has launched several initiatives to improve efficiency and quality of care in the military health system. The goal of empaneling 1,300 to 1,500 patients per primary care manager did not correlate well with Naval Hospital Bremerton's experience and did not accurately account for military-specific requirements. The Bremerton Model Task Force was chartered to assess current business practices, identify areas for improvement, and develop a capacity model reflecting military readiness and residency training requirements. Methods included a 12-month review of patient visits and staff surveys of how providers spent their day, with time-and-motion analysis to verify assumptions. Our capacity results (average, 791 enrollees per primary care manager) demonstrated that objective measures at the local level do not support enrollment to Department of Defense-specified levels. Significant changes in "corporate culture" are necessary to accomplish the military health system goals.

  1. The Discourse and Reflections of Teacher Candidates during an Early Field Experience

    ERIC Educational Resources Information Center

    Henning, John E.; Dani, Danielle E.; Weade, Ginger

    2012-01-01

    The purpose of this study was to determine the capacity of teacher candidates to facilitate and reflect on classroom discourse in the context of an early field experience. The classroom discourse and reflections of 10 teacher candidates were examined through interviews, audio and video recordings, and written reflections. The findings indicated…

  2. An International Experience for Social Work Students: Self-Reflection through Poetry and Journal Writing Exercises

    ERIC Educational Resources Information Center

    Furman, Rich; Coyne, Ann; Negi, Nalini Junko

    2008-01-01

    This descriptive article explores the uses of poetry and journaling exercises as means of helping students develop their self-reflective capacities within the context of international social work. First, self-reflection and its importance to social work practice and education is discussed. Second, the importance of self-reflection in international…

  3. Heat capacity, configurational heat capacity and fragility of hydrous magmas

    NASA Astrophysics Data System (ADS)

    Di Genova, D.; Romano, C.; Giordano, D.; Alletti, M.

    2014-10-01

    The glassy and liquid heat capacities of four series of dry and hydrous natural glasses and magma as a function of temperature and water content (up to 19.9 mol%) were investigated using differential scanning calorimetry (DSC). The analyzed compositions are basalt, latite, trachyte and pantellerite. The results of this study indicate that the measured heat capacity of glasses (Cpg) is a linear function of composition and is well reproduced by the empirical model of Richet (1987). For the investigated glasses, the partial molar heat capacity of water can be considered as independent of composition, in agreement with Bouhifd et al. (2006). For hydrous liquids, the heat capacity (Cpliq) decreases nonlinearly with increasing water content. Previously published models, combined with the partial molar heat capacity of water from the literature, are not able to reproduce our experimental data in a satisfactory way. We estimated the partial molar heat capacity of water (CpH2O) in hydrous magma over a broad compositional range. The proposed value is 41 ± 3 J mol-1 K-1. Water strongly affects the configurational heat capacity at the glass transition temperature [Cpconf (Tg)]. An increases of Cpconf (Tg) with water content was measured for the polymerized liquids (trachyte and pantellerite), while the opposite behavior was observed for the most depolymerized liquids (basalt and latite). Structural and rheological implications of this behavior are discussed in light of the presented results.

  4. Nunavut: building nursing capacity.

    PubMed

    Malott, Misty

    2012-03-01

    Recruitment and retention issues associated with the growing nursing shortage in Canada are magnified in Nunavut, where the scope of nursing practice is much broader than in urban settings. The Qikiqtani General Hospital (QGH), a 35-bed hospital in Nunavut's capital, Iqaluit, was the home base for this multi-pronged pilot project that spanned 16 months to March 2011. The goals of the project included creating opportunities for front-line nurses to develop new clinical skills and knowledge and expand their competencies; offering enhanced critical care training relevant to the needs of nurses; and providing a smooth transition to entry to practice in a hospital setting for new graduate nurses. An in-house mentorship program was developed, and contracts were made with three outside parties: the Critical Care Education Network (CRI), the Ottawa Hospital and the Perinatal Partnership Program of Eastern and Southeastern Ontario. A number of professional development opportunities were provided – for example, 26 nurses participated in the CRI's critical care training, and six nurses were trained as CRI trainers.Overall, nurses were satisfied with the accessibility, delivery and applicability of the RTA education opportunities, and all nurses agreed that these opportunities increased their professional skills. A plan for the sustainability of the critical care portion of the Nunavut RTA project is currently in place, and the QGH is in the process of hiring a nurse educator for the hospital. This hiring will be a key piece to sustain the project initiatives. If the mentorship program is to continue, it will be essential to hire someone dedicated to the orientation of new graduates and new nurses.

  5. An evaluation of the 'Designated Research Team' approach to building research capacity in primary care

    PubMed Central

    Cooke, Jo; Nancarrow, Susan; Dyas, Jane; Williams, Martin

    2008-01-01

    Background This paper describes an evaluation of an initiative to increase the research capability of clinical groups in primary and community care settings in a region of the United Kingdom. The 'designated research team' (DRT) approach was evaluated using indicators derived from a framework of six principles for research capacity building (RCB) which include: building skills and confidence, relevance to practice, dissemination, linkages and collaborations, sustainability and infrastructure development. Methods Information was collated on the context, activities, experiences, outputs and impacts of six clinical research teams supported by Trent Research Development Support Unit (RDSU) as DRTs. Process and outcome data from each of the teams was used to evaluate the extent to which the DRT approach was effective in building research capacity in each of the six principles (as evidenced by twenty possible indicators of research capacity development). Results The DRT approach was found to be well aligned to the principles of RCB and generally effective in developing research capabilities. It proved particularly effective in developing linkages, collaborations and skills. Where research capacity was slow to develop, this was reflected in poor alignment between the principles of RCB and the characteristics of the team, their activities or environment. One team was unable to develop a research project and the funding was withdrawn at an early stage. For at least one individual in each of the remaining five teams, research activity was sustained beyond the funding period through research partnerships and funding successes. An enabling infrastructure, including being freed from clinical duties to undertake research, and support from senior management were found to be important determinants of successful DRT development. Research questions of DRTs were derived from practice issues and several projects generated outputs with potential to change daily practice, including the

  6. Modeling Coevolution between Language and Memory Capacity during Language Origin.

    PubMed

    Gong, Tao; Shuai, Lan

    2015-01-01

    Memory is essential to many cognitive tasks including language. Apart from empirical studies of memory effects on language acquisition and use, there lack sufficient evolutionary explorations on whether a high level of memory capacity is prerequisite for language and whether language origin could influence memory capacity. In line with evolutionary theories that natural selection refined language-related cognitive abilities, we advocated a coevolution scenario between language and memory capacity, which incorporated the genetic transmission of individual memory capacity, cultural transmission of idiolects, and natural and cultural selections on individual reproduction and language teaching. To illustrate the coevolution dynamics, we adopted a multi-agent computational model simulating the emergence of lexical items and simple syntax through iterated communications. Simulations showed that: along with the origin of a communal language, an initially-low memory capacity for acquired linguistic knowledge was boosted; and such coherent increase in linguistic understandability and memory capacities reflected a language-memory coevolution; and such coevolution stopped till memory capacities became sufficient for language communications. Statistical analyses revealed that the coevolution was realized mainly by natural selection based on individual communicative success in cultural transmissions. This work elaborated the biology-culture parallelism of language evolution, demonstrated the driving force of culturally-constituted factors for natural selection of individual cognitive abilities, and suggested that the degree difference in language-related cognitive abilities between humans and nonhuman animals could result from a coevolution with language.

  7. Modeling Coevolution between Language and Memory Capacity during Language Origin

    PubMed Central

    Gong, Tao; Shuai, Lan

    2015-01-01

    Memory is essential to many cognitive tasks including language. Apart from empirical studies of memory effects on language acquisition and use, there lack sufficient evolutionary explorations on whether a high level of memory capacity is prerequisite for language and whether language origin could influence memory capacity. In line with evolutionary theories that natural selection refined language-related cognitive abilities, we advocated a coevolution scenario between language and memory capacity, which incorporated the genetic transmission of individual memory capacity, cultural transmission of idiolects, and natural and cultural selections on individual reproduction and language teaching. To illustrate the coevolution dynamics, we adopted a multi-agent computational model simulating the emergence of lexical items and simple syntax through iterated communications. Simulations showed that: along with the origin of a communal language, an initially-low memory capacity for acquired linguistic knowledge was boosted; and such coherent increase in linguistic understandability and memory capacities reflected a language-memory coevolution; and such coevolution stopped till memory capacities became sufficient for language communications. Statistical analyses revealed that the coevolution was realized mainly by natural selection based on individual communicative success in cultural transmissions. This work elaborated the biology-culture parallelism of language evolution, demonstrated the driving force of culturally-constituted factors for natural selection of individual cognitive abilities, and suggested that the degree difference in language-related cognitive abilities between humans and nonhuman animals could result from a coevolution with language. PMID:26544876

  8. Reflection and reflective practice in health professions education: a systematic review.

    PubMed

    Mann, Karen; Gordon, Jill; MacLeod, Anna

    2009-10-01

    The importance of reflection and reflective practice are frequently noted in the literature; indeed, reflective capacity is regarded by many as an essential characteristic for professional competence. Educators assert that the emergence of reflective practice is part of a change that acknowledges the need for students to act and to think professionally as an integral part of learning throughout their courses of study, integrating theory and practice from the outset. Activities to promote reflection are now being incorporated into undergraduate, postgraduate and continuing medical education, and across a variety of health professions. The evidence to support and inform these curricular interventions and innovations remains largely theoretical. Further, the literature is dispersed across several fields, and it is unclear which approaches may have efficacy or impact. We, therefore, designed a literature review to evaluate the existing evidence about reflection and reflective practice and their utility in health professional education. Our aim was to understand the key variables influencing this educational process, identify gaps in the evidence, and to explore any implications for educational practice and research.

  9. CAPACITY OF PATIENTS WITH BRAIN METASTASES TO MAKE TREATMENT DECISIONS

    PubMed Central

    Triebel, Kristen L.; Gerstenecker, Adam; Meneses, Karen; Fiveash, John B.; Meyers, Christina A.; Cutter, Gary; Marson, Daniel C.; Martin, Roy C.; Eakin, Amanda; Watts, Olivia; Nabors, Louis B.

    2015-01-01

    OBJECTIVE To investigate medical decision-making capacity (MDC) in patients with brain metastasis. METHODS Participants were 41 adults with brain metastases with Karnofsky Performance Status scores ≥70 were recruited from an academic medical center and 41 demographically-matched controls recruited from the community. We evaluated MDC using the Capacity to Consent to Treatment Instrument (CCTI) and its four clinically relevant consent standards (expressing a treatment choice, appreciation, reasoning, and understanding). Capacity impairment ratings (no impairment, mild/moderate impairment, and severe impairment) on the consent standards were also assigned to each participant with brain metastasis using cutoff scores derived statistically from the performance of the control group. RESULTS The brain metastases patient group performed significantly below controls on consent standards of understanding and reasoning. Capacity compromise was defined as performance ≤1.5 standard deviations (SD) below the control group mean. Using this definition, approximately 60% of the participants with brain metastases demonstrated capacity compromise on at least one MDC standard. CONCLUSION When defining capacity compromise as performance ≤1.5 SD below the control group mean, over half of patients with brain metastases have reduced capacity to make treatment decisions. This impairment is demonstrated shortly after initial diagnosis of brain metastases and highlights the importance of routine clinical assessment of MDC following diagnosis of brain metastasis. These results also indicate a need for the development and investigation of interventions to support or improve MDC in this patient population. PMID:25613039

  10. Predicting habitual walking performance in multiple sclerosis: relevance of capacity and self-report measures.

    PubMed

    Gijbels, Domien; Alders, Geert; Van Hoof, Elke; Charlier, Caroline; Roelants, Machteld; Broekmans, Tom; Eijnde, Bert Op 't; Feys, Peter

    2010-05-01

    The objective was to establish the extent to which physical functioning capacity and self-report measures are able to predict the habitual walking performance in ambulatory persons with multiple sclerosis. Fifty persons with multiple sclerosis (Expanded Disability Status Scale, EDSS, 1.5-6.5) were tested on leg muscle strength as well as walking and balance capacity, and completed self-report indices on perceived physical functioning. Habitual walking performance, that is, the real amount of steps that is performed in the customary living environment, was registered by means of an ambulant accelerometer-based monitor during seven consecutive days. Mild (EDSS 1.5-4.0, n = 29) and moderate (EDSS 4.5-6.5, n = 21) multiple sclerosis subgroups were additionally distinguished as predictor variables and values were hypothesized to differ depending on multiple sclerosis severity and concomitant ambulatory function. Multiple regression analyses yielded a single most significant predictor for each (sub)group with other variables making no independent contribution to the variation in habitual walking performance. For the total study sample, this was the 6-Minute Walking Test (R(2) = 0.458, p < 0.01). In the mild multiple sclerosis subgroup, the 6-Minute Walking Test was again most predictive, yet to a modest degree (R(2) = 0. 187, p = 0.02). In the moderate multiple sclerosis subgroup, the 2-Minute Walking Test explained over half of the variance (R(2) = 0.532, p < 0.01). Habitual walking performance is best reflected by longer walking capacity tests. The extent to which it can be predicted based on clinical testing is larger in a multiple sclerosis patient sample with more severe walking disability. Ambulatory monitoring, however, includes aspects of community ambulation not captured in the clinic, and must be considered as an additional outcome for evaluating interventions in multiple sclerosis.

  11. Large capacity temporary visual memory

    PubMed Central

    Endress, Ansgar D.; Potter, Mary C.

    2014-01-01

    Visual working memory (WM) capacity is thought to be limited to three or four items. However, many cognitive activities seem to require larger temporary memory stores. Here, we provide evidence for a temporary memory store with much larger capacity than past WM capacity estimates. Further, based on previous WM research, we show that a single factor — proactive interference — is sufficient to bring capacity estimates down to the range of previous WM capacity estimates. Participants saw a rapid serial visual presentation (RSVP) of 5 to 21 pictures of familiar objects or words presented at rates of 4/s or 8/s, respectively, and thus too fast for strategies such as rehearsal. Recognition memory was tested with a single probe item. When new items were used on all trials, no fixed memory capacities were observed, with estimates of up to 9.1 retained pictures for 21-item lists, and up to 30.0 retained pictures for 100-item lists, and no clear upper bound to how many items could be retained. Further, memory items were not stored in a temporally stable form of memory, but decayed almost completely after a few minutes. In contrast, when, as in most WM experiments, a small set of items was reused across all trials, thus creating proactive interference among items, capacity remained in the range reported in previous WM experiments. These results show that humans have a large-capacity temporary memory store in the absence of proactive interference, and raise the question of whether temporary memory in everyday cognitive processing is severely limited as in WM experiments, or has the much larger capacity found in the present experiments. PMID:23937181

  12. Building Capacity for Developing Statistical Literacy in a Developing Country: Lessons Learned from an Intervention

    ERIC Educational Resources Information Center

    North, Delia; Gal, Iddo; Zewotir, Temesgen

    2014-01-01

    This paper aims to contribute to the emerging literature on capacity-building in statistics education by examining issues pertaining to the readiness of teachers in a developing country to teach basic statistical topics. The paper reflects on challenges and barriers to building statistics capacity at grass-roots level in a developing country,…

  13. A California generation capacity market

    SciTech Connect

    Conkling, R.L.

    1998-10-01

    California, overconfident with its new Power Exchange spot market, seems unaware that it could be afflicted by the same turmoil that bludgeoned the Midwest in June. An electricity capacity market should be put in place before crisis strikes. This article outlines a framework for adding an electricity capacity market in California. The new market would not create a new bureaucracy but would function within the state`s now operational PX and independent system operator (ISO) mechanisms. It would be an open market, in which capacity would be traded transparently, with freedom of entree for all willing sellers and all willing buyers.

  14. Biology Reflective Assessment Curriculum

    NASA Astrophysics Data System (ADS)

    Bayley, Cheryl Ann

    Often students and educators view assessments as an obligation and finality for a unit. In the current climate of high-stakes testing and accountability, the balance of time, resources and emphasis on students' scores related to assessment have been slanted considerably toward the summative side. This tension between assessment for accountability and assessment to inform teaching strains instruction and educators' ability to use that information to design learning opportunities that help students develop deeper conceptual understanding. A substantive body of research indicates that formative and reflective assessment can significantly improve student learning. Biology Reflective Assessment Curriculum (BRAC) examines support provided for high school science students through assessment practices. This investigation incorporates the usage of reflective assessments as a guiding practice for differentiated instruction and student choice. Reflective assessment is a metacognitive strategy that promotes self-monitoring and evaluation. The goals of the curriculum are to promote self-efficacy and conceptual understanding in students learning biology through developing their metacognitive awareness. BRAC was implemented in a high school biology classroom. Data from assessments, metacognitive surveys, self-efficacy surveys, reflective journals, student work, a culminating task and field notes were used to evaluate the effectiveness of the curriculum. The results suggest that students who develop their metacognitive skills developed a deeper conceptual understanding and improved feelings of self-efficacy when they were engaged in a reflective assessment unit embedded with student choice. BRAC is a tool for teachers to use assessments to assist students in becoming metacognitive and to guide student choice in learning opportunities.

  15. Radar reflectivity of Titan

    NASA Astrophysics Data System (ADS)

    Muhleman, D. O.; Grossman, A. W.; Butler, B. J.; Slade, M. A.

    1990-05-01

    The low dielectric constant of the liquid hydrocarbon and ethane-methane surface mixture of Titan has as a direct consequence a set of unique microwave-reflection properties which were sought out at 3.5-cm wavelength, using a 70-m transmitting antenna in conjunction with the VLA as a receiving instrument. The statistically significant echoes obtained indicate that Titan is not covered with a deep global ocean of ethane. A global ocean as shallow as about 200 m would have exhibited reflectivities smaller by an order of magnitude, and below the experiment's detection limit.

  16. Focused crossed Andreev reflection

    NASA Astrophysics Data System (ADS)

    Haugen, H.; Brataas, A.; Waintal, X.; Bauer, G. E. W.

    2011-03-01

    We consider non-local transport mediated by Andreev reflection in a two-dimensional electron gas (2DEG) connected to one superconducting and two normal metal terminals. A robust scheme is presented for observing crossed Andreev reflection (CAR) between the normal metal terminals based on electron focusing by weak perpendicular magnetic fields. At slightly elevated temperatures the CAR signature can be easily distinguished from a background of quantum interference fluctuations. The CAR-induced entanglement between electrons can be switched on and off over large distances by the magnetic field.

  17. Decisional Capacity in Amyotrophic Lateral Sclerosis.

    PubMed

    Khin Khin, Eindra; Minor, Darlinda; Holloway, Amanda; Pelleg, Ayla

    2015-06-01

    The cognitive and behavioral changes that can be observed in the neurodegenerative terminal disease amyotrophic lateral sclerosis (ALS), once characterized as purely a motor neuron disease, have become increasingly recognized over the past century. Detecting cognitive deficits earlier and identifying continued changes at regular intervals can lead to improved care, proactive treatments, and earlier discussions about end-of-life wishes. Although medical decisional capacity is required for every treatment decision made, its importance becomes paramount when making decisions on complex medical treatments that will invariably and significantly affect quality of life or life itself. In this review, we conducted a critical analysis of the evidence-based literature on the cognitive and behavioral impairments in ALS that can compromise medical decisional capacity. We review specific ALS-related clinical scenarios in which decisional capacity is of utmost importance and discuss a practical framework for cognitive and behavioral assessment that can be routinely and efficiently used, while being mindful of the confounding factors associated with ALS. Finally, we review models for preserving patient choices that can be used in patients with ALS to help safeguard autonomy and retain dignity toward the end of life.

  18. Psychiatric Issues in Palliative Care: Assessing Mental Capacity

    PubMed Central

    Udo, Itoro; Mohammed, Zeid; Gash, Amanda

    2013-01-01

    Issues surrounding capacity to consent to or refuse treatment are increasingly receiving clinical and legal attention. Through the use of 3 case vignettes that involve different aspects of mental health care in palliative care settings, mental capacity issues are discussed. The vignettes tackle capacity in a patient with newly developed mental illness consequent to physical illness, capacity in a patient with mental illness but without delirium and capacity in a patient with known impairment of the mind. These discussions give credence to best practice position where physicians act in the best interests of their patients at all times. It is important to emphasize that capacity decisions have to be made on a case by case basis, within the remit of legal protection. This is a fundamental requirement of the Mental Capacity Act 2005, England & Wales (MCA). The later is used as the legal basis for these discussions. The psychiatric liaison service is a useful resource to provide consultation, advice and or joint assessment to clinicians encountering complex dilemmas involving decision-making capacity. PMID:25278761

  19. To build capacity, build confidence

    NASA Astrophysics Data System (ADS)

    Hewitson, Bruce

    2015-07-01

    The history of attempts to spread scientific know-how beyond western centres of excellence is littered with failures. Capacity building needs long-term commitment, a critical mass of trainees, and a supportive home environment.

  20. Capacity Markets and Market Stability

    SciTech Connect

    Stauffer, Hoff

    2006-04-15

    The good news is that market stability can be achieved through a combination of longer-term contracts, auctions for far enough in the future to permit new entry, a capacity management system, and a demand curve. The bad news is that if and when stable capacity markets are designed, the markets may seem to be relatively close to where we started - with integrated resource planning. Market ideologues will find this anathema. (author)

  1. Maximizing the optical network capacity

    PubMed Central

    Bayvel, Polina; Maher, Robert; Liga, Gabriele; Shevchenko, Nikita A.; Lavery, Domaniç; Killey, Robert I.

    2016-01-01

    Most of the digital data transmitted are carried by optical fibres, forming the great part of the national and international communication infrastructure. The information-carrying capacity of these networks has increased vastly over the past decades through the introduction of wavelength division multiplexing, advanced modulation formats, digital signal processing and improved optical fibre and amplifier technology. These developments sparked the communication revolution and the growth of the Internet, and have created an illusion of infinite capacity being available. But as the volume of data continues to increase, is there a limit to the capacity of an optical fibre communication channel? The optical fibre channel is nonlinear, and the intensity-dependent Kerr nonlinearity limit has been suggested as a fundamental limit to optical fibre capacity. Current research is focused on whether this is the case, and on linear and nonlinear techniques, both optical and electronic, to understand, unlock and maximize the capacity of optical communications in the nonlinear regime. This paper describes some of them and discusses future prospects for success in the quest for capacity. PMID:26809572

  2. Reflections on "La Esperanza"

    ERIC Educational Resources Information Center

    Cortez, Anita

    2007-01-01

    The author was recently asked to reflect on her "educational journey." As far as she can remember she has been hungry to learn. A friend once described her as having "hambres atrasadas," which he described as a kind of "hunger nipping at her heels." It goes back, of course, to her parents: Her father's and her early…

  3. Reflecting on Data

    ERIC Educational Resources Information Center

    Kraus, Rudolf V.

    2014-01-01

    This article describes a two-day optics laboratory activity that investigates the scientific phenomenon of reflection, which students are generally familiar with but usually have not studied in depth. This investigation can be used on its own or as part of a larger unit on optics. This lesson encourages students to think critically and…

  4. Reflective Database Access Control

    ERIC Educational Resources Information Center

    Olson, Lars E.

    2009-01-01

    "Reflective Database Access Control" (RDBAC) is a model in which a database privilege is expressed as a database query itself, rather than as a static privilege contained in an access control list. RDBAC aids the management of database access controls by improving the expressiveness of policies. However, such policies introduce new interactions…

  5. Reflections on Expectations

    ERIC Educational Resources Information Center

    Santini, Joseph

    2014-01-01

    This article describes a teachers reflections on the matter of student expectations. Santini begins with a common understanding of the "Pygmalion effect" from research projects conducted in earlier years that intimated "people's expectations could influence other people in the world around them." In the world of deaf…

  6. Reflections, 15 Years Later

    ERIC Educational Resources Information Center

    Knox, George

    2016-01-01

    George Knox reflects on his 15-year career as president of Labette Community College in Parsons, Kansas. Knox writes that, as a first-time president coming into a brand new system, he was very fortunate to have many seasoned presidents and mentors in Kansas and from the American Association of Community Colleges' (AACC) Presidents Academy. He says…

  7. Reflections on 1972

    ERIC Educational Resources Information Center

    Gutierrez, Ramon A.

    2007-01-01

    In this article, the author reflects on the events that took place in the year 1972. The author was a junior at the University of New Mexico back then, refusing to eat or buy grapes and lettuce, picketing grocers who did not carry United Farm Workers of America produce. He and his buddies cast their votes against granting Richard Nixon a second…

  8. Lights, Camera, Reflection!

    ERIC Educational Resources Information Center

    Mourlam, Daniel

    2013-01-01

    There are many ways to critique teaching, but few are more effective than video. Personal reflection through the use of video allows one to see what really happens in the classrooms--good and bad--and provides a visual path forward for improvement, whether it be in one's teaching, work with a particular student, or learning environment. This…

  9. Renew, Reflect, and Refresh

    ERIC Educational Resources Information Center

    Texley, Juliana

    2005-01-01

    Is that the sound of the last bus leaving the schoolyard? Or the staff's collective sigh of relief? School's out. Now it's time to nurture the lifelong learner deep inside with a summer reading list that will allow teachers to renew, reflect, and refresh. The National Science Education Standards reminds us, "Becoming an effective science teacher…

  10. Reflections: Children and Literature.

    ERIC Educational Resources Information Center

    And Others; Cianciolo, Patricia J.

    1980-01-01

    Six educational leaders--Patricia J. Cianciolo, Lee Bennett Hopkins, Nancy Larrick, Alan C. Purves, Morton Schindel, and James R. Squire--offer reflections on signficiant developments in children's literature during the 1970s, their hopes for the 1980s, and references that constitute required reading for elementary language arts teachers. (ET)

  11. Reflection by Porro Prisms

    NASA Astrophysics Data System (ADS)

    Greenslade, Thomas B.

    2010-04-01

    Students all know that reflection from a plane mirror produces an image that is reversed right to left and so cannot be read by anyone but Leonardo da Vinci, who kept his notes in mirror writing. A useful counter-example is the Porro prism, which produces an image that is not reversed.

  12. Reflections/Selected Readings.

    ERIC Educational Resources Information Center

    Cook, Gillian; Gorman, Arlene; Junco, Carol; Martinez, Miriam; Perez, Bertha; Torres, Azucena; Tschoepe, Mary

    1998-01-01

    Offers reflections on lingering issues raised in this themed issue on the "Gardendale Family": maintaining the integrity of the family; issues of time; curriculum standards; and effects on the rest of the school. Offers a bibliography of works considering the global concerns which prompted the formation of the Gardendale Family. (SR)

  13. Interactive Reflective Logs

    ERIC Educational Resources Information Center

    Deaton, Cynthia Minchew; Deaton, Benjamin E.; Leland, Katina

    2010-01-01

    The authors created an interactive reflective log (IRL) to provide teachers with an opportunity to use a journal approach to record, evaluate, and communicate student understanding of science concepts. Unlike a traditional journal, the IRL incorporates prompts to encourage students to discuss their understanding of science content and science…

  14. Extracting infrared absolute reflectance from relative reflectance measurements.

    PubMed

    Berets, Susan L; Milosevic, Milan

    2012-06-01

    Absolute reflectance measurements are valuable to the optics industry for development of new materials and optical coatings. Yet, absolute reflectance measurements are notoriously difficult to make. In this paper, we investigate the feasibility of extracting the absolute reflectance from a relative reflectance measurement using a reference material with known refractive index.

  15. Reflective Walkthroughs: The Impact of the Reflective Walkthrough Protocol on Teacher Instructional Practices and Student Proficiency Trends in an Urban Public School

    ERIC Educational Resources Information Center

    Brooks-Long, Wanda

    2012-01-01

    The purpose of this study was to determine if the implementation of a walkthrough protocol combined with reflective practice had the capacity to influence the sample school's objectives of building staff capacity, strengthening instructional delivery in classrooms, and improving student learning. This study's primary focus is to examine the…

  16. Troubling Muddy Waters: Problematizing Reflective Practice in Global Medical Education.

    PubMed

    Naidu, Thirusha; Kumagai, Arno K

    2016-03-01

    The idea of exporting the concept of reflective practice for a global medical education audience is growing. However, the uncritical export and adoption of Western concepts of reflection may be inappropriate in non-Western societies. The emphasis in Western medical education on the use of reflection for a specific end--that is, the improvement of individual clinical practice--tends to ignore the range of reflective practice, concentrating on reflection alone while overlooking critical reflection and reflexivity. This Perspective places the concept of reflective practice under a critical lens to explore a broader view for its application in medical education outside the West. The authors suggest that ideas about reflection in medicine and medical education may not be as easily transferable from Western to non-Western contexts as concepts from biomedical science are. The authors pose the question, When "exporting" Western medical education strategies and principles, how often do Western-trained educators authentically open up to the possibility that there are alternative ways of seeing and knowing that may be valuable in educating Western physicians? One answer lies in the assertion that educators should aspire to turn exportation of educational theory into a truly bidirectional, collaborative exchange in which culturally conscious views of reflective practice contribute to humanistic, equitable patient care. This discussion engages in troubling the already-muddy waters of reflective practice by exploring the global applicability of reflective practice as it is currently applied in medical education. The globalization of medical education demands critical reflection on reflection itself.

  17. Neuropsychologist Experts and Civil Capacity Evaluations: Representative Cases.

    PubMed

    Kaufmann, Paul M

    2016-09-01

    Clinical neuropsychologists accept more forensic referrals now and spend more time in forensic consulting than ever before. Recent surveys show weekly hours devoted to forensic consulting increased 97% in the past decade. During the same time period, the number of board certified neuropsychologists more than doubled. Under recently published Specialty Guidelines for Forensic Psychology, clinical neuropsychologists practice forensic psychology when applying scientific, technical, or specialized knowledge of neuropsychology to the law to assist in addressing legal, contractual, or administrative matters. Among those increasingly varied forensic referrals, clinical neuropsychologists are conducting more civil competency and capacity evaluations. Representative cases from three jurisdictions demonstrate how neuropsychologists provide expertize in matters involving testamentary capacity, contractual capacity, business judgments, and job capacity. Case presentations illustrate some of the strengths and weaknesses of neuropsychological evaluation of civil capacities. The article concludes with a "battle of experts" case involving five neuropsychologists with opposing opinions recently heard in a Federal Appellate court. Implications for neuropschology training and forensic competencies are considered. In offering quality services to the legal profession, neuropsychologists support the truth-seeking function of the judiciary, promote justice, protect the profession, and serve public policy.

  18. A reflective account of a consultation in abortion care.

    PubMed

    Astbury-Ward, Edna

    This article presents a reflective account of a consultation in a pre-assessment clinic for women requesting abortion. The reflection is based on Johns' model. Reflection enabled the author to address important issues that the consultation raised. These included the realisation that nurses do not always have to understand why patients make the choices they do, and the importance of allocating sufficient time for sensitive consultations.

  19. Capacities of quantum amplifier channels

    NASA Astrophysics Data System (ADS)

    Qi, Haoyu; Wilde, Mark M.

    2017-01-01

    Quantum amplifier channels are at the core of several physical processes. Not only do they model the optical process of spontaneous parametric down-conversion, but the transformation corresponding to an amplifier channel also describes the physics of the dynamical Casimir effect in superconducting circuits, the Unruh effect, and Hawking radiation. Here we study the communication capabilities of quantum amplifier channels. Invoking a recently established minimum output-entropy theorem for single-mode phase-insensitive Gaussian channels, we determine capacities of quantum-limited amplifier channels in three different scenarios. First, we establish the capacities of quantum-limited amplifier channels for one of the most general communication tasks, characterized by the trade-off between classical communication, quantum communication, and entanglement generation or consumption. Second, we establish capacities of quantum-limited amplifier channels for the trade-off between public classical communication, private classical communication, and secret key generation. Third, we determine the capacity region for a broadcast channel induced by the quantum-limited amplifier channel, and we also show that a fully quantum strategy outperforms those achieved by classical coherent-detection strategies. In all three scenarios, we find that the capacities significantly outperform communication rates achieved with a naive time-sharing strategy.

  20. Normal-reflection image

    SciTech Connect

    Huang, L.; Fehler, Michael C.

    2003-01-01

    Common-angle wave-equation migration using the double-square-root is generally less accurate than the common-shot migration because the wavefield continuation equation for thc former involves additional approximations compared to that for the latter. We present a common-angle wave-equation migration that has the same accuracy as common-shot wave-equation migration. An image obtained from common-angle migration is a four- to five-dimensional output volume for 3D cases. We propose a normal-reflection imaging condition for common-angle migration to produce a 3D output volume for 3D migration. The image is closely related to the normal-reflection coefficients at interfaces. This imaging condition will allow amplitude-preserving migration to generate an image with clear physical meaning.

  1. Reflection Revisited: The Class Collage

    ERIC Educational Resources Information Center

    Sommers, Jeff

    2011-01-01

    Through the regular use of what Donald Schon has termed reflection-in-action and reflection-on-action, students can learn to improve their "reflection-in-presentation," in Kathleen Blake Yancey's term. Students are often asked to do this type of reflection-in-presentation as a capstone to first-year or basic writing courses. However, a number of…

  2. Landsat surface reflectance data

    USGS Publications Warehouse

    ,

    2015-01-01

    Landsat satellite data have been produced, archived, and distributed by the U.S. Geological Survey since 1972. Users rely on these data for historical study of land surface change and require consistent radiometric data processed to the highest science standards. In support of the guidelines established through the Global Climate Observing System, the U.S. Geological Survey has embarked on production of higher-level Landsat data products to support land surface change studies. One such product is Landsat surface reflectance.

  3. Reflections on the Knife Edge

    PubMed Central

    Murphy, John Patrick Michael

    2011-01-01

    Introduction The accompanying article, written by John Murphy, a retired lawyer and lifelong outdoorsman from his beloved Colorado Rockies, draws the striking parallel between his experiences as a mountain climber and as a patient with metastatic melanoma facing the hope and uncertainty of experimental therapy. Both are life-threatening circumstances, demanding courage and hope, and challenging our soul in a way almost unique to human experience. Both involve a conscious choice to move forward into dangerous and uncertain territory, and require a determination to look death (John's “Reaper”) in the eye. Many remarkable books and films have been written about such experiences. I recall in particular the 2003 documentary film Touching the Void, about the incredible survival of a mountaineer who returned from a perilous fall in Peru. I highly recommend it to the reader. Another is Laura Hillenbrand's Unbroken: A World War II Story of Survival, Resilience, and Redemption (Random House, 2010), about the survival of a prisoner of war, the celebrated miler Louis Zamperini. Again, unbridled courage and undeniable hope turned futility into future. John Murphy's reflections remind us of the daily heroism of our patients who are holding tight to the lifeline offered by clinical research. Good climbing, John. All of us are with you on that Knife Edge, waiting for our turn to ascend... and hoping to be as courageous as you were then on Capitol Peak and are again now on the Knife Edge of a clinical trial. For our turn will come. PMID:21349953

  4. Boomerang pillows and respiratory capacity.

    PubMed

    Roberts, K L; Brittin, M; Cook, M A; deClifford, J

    1994-05-01

    An experimental study was done to determine whether subjects placed on boomerang pillows would have lower vital capacities than subjects placed on straight pillows after 30 minutes. A sample of 42 subjects took part in the study in a nursing laboratory. A crossover design was used in which subjects were measured in both conditions. The findings indicated that there was no significant difference in the vital capacities of subjects in the two conditions. An associated finding was that the vital capacities were significantly lower in a semi-Fowler's position than in a straight chair. It was concluded that boomerang pillows are safe to use for persons without respiratory problems. Further research is needed into the effect of boomerang pillows on persons with respiratory deficits.

  5. Biological variability of transferrin saturation and unsaturated iron binding capacity

    PubMed Central

    Adams, PC; Reboussin, DM; Press, RD; Barton, JC; Acton, RT; Moses, GC; Leiendecker-Foster, C; McLaren, GD; Dawkins, FW; Gordeuk, VR; Lovato, L; Eckfeldt, JH

    2007-01-01

    Background Transferrin saturation is widely considered the preferred screening test for hemochromatosis. Unsaturated iron binding capacity has similar performance at lower cost. However, the within-person biological variability of both these tests may limit their ability at commonly used cut points to detect HFE C282Y homozygous patients. Methods The Hemochromatosis and Iron Overload Screening (HEIRS) Study screened 101,168 primary care participants for iron overload using tansferrin saturation, unsaturated iron binding capacity, ferritin and HFE C282Y and H63D genotyping. Transferrin saturation and unsaturated iron binding capacity were performed at initial screening and again when selected participants and controls returned for a clinical examination several months later. A missed case was defined as a C282Y homozygote who had transferrin saturation below cut point (45 % women, 50 % men) or unsaturated iron binding capacity above cut point (150 μmol/L women, 125 μmol/L men) at either the initial screening or clinical examination, or both, regardless of serum ferritin. Results There were 209 C282Y previously undiagnosed homozygotes with transferrin saturation and unsaturated iron binding capacity testing done at initial screening and clinical examination. Sixty-eight C282Y homozygotes (33%) would have been missed at these transferrin saturation cut points (19 men, 49 women, median SF 170 μg/L, first and third quartiles 50 and 474 μg/L), and 58 homozygotes (28 %) would have been missed at the unsaturated iron binding capacity cut points (20 men, 38 women, median SF 168 μg/L, quartiles 38 and 454 μg/L). There was no advantage to using fasting samples. Conclusions The within-person biological variability of transferrin saturation and unsaturated iron binding capacity limit their usefulness as an initial screening test for expressing C282Y homozygotes. PMID:17976429

  6. Buffer Capacity: An Undergraduate Laboratory Experiment.

    ERIC Educational Resources Information Center

    Russo, Steven O.; Hanania, George I. H.

    1987-01-01

    Describes a quantitative experiment designed to demonstrate buffer action and the measurement of buffer capacity. Discusses how to make acetate buffers, determine their buffer capacity, plot the capacity/pH curve, and interpret the data obtained. (TW)

  7. Superadditivity of classical capacity revisited

    SciTech Connect

    Pilyavets, Oleg V.; Karpov, Evgueni A.; Schäfer, Joachim

    2014-12-04

    We introduce new type of superadditivity for classical capacity of quantum channels, which involves the properties of channels’ environment. By imposing different restrictions on the total energy contained in channels’ environment we can consider different types of superadditivity. Using lossy bosonic and additive noise quantum channels as examples, we demonstrate that their capacities can be either additive or superadditive depending on the values of channels parameters. The parameters corresponding to transition between the additive and superadditive cases are related with recently found critical and supercritical parameters for Gaussian channels.

  8. Free Energy and Heat Capacity

    SciTech Connect

    Kurata, Masaki; Devanathan, Ramaswami

    2015-10-13

    Free energy and heat capacity of actinide elements and compounds are important properties for the evaluation of the safety and reliable performance of nuclear fuel. They are essential inputs for models that describe complex phenomena that govern the behaviour of actinide compounds during nuclear fuel fabrication and irradiation. This chapter introduces various experimental methods to measure free energy and heat capacity to serve as inputs for models and to validate computer simulations. This is followed by a discussion of computer simulation of these properties, and recent simulations of thermophysical properties of nuclear fuel are briefly reviewed.

  9. Characterisation of Balance Capacity in Prader-Willi Patients

    ERIC Educational Resources Information Center

    Capodaglio, Paolo; Menegoni, Francesco; Vismara, Luca; Cimolin, Veronica; Grugni, Graziano; Galli, Manuela

    2011-01-01

    Being severely overweight is a distinctive clinical feature of Prader-Willi Syndrome (PWS). This explorative study aims to characterise balance capacity in PWS as compared to non-genetically obese patients (O) and to a group of normal-weight individuals (CG). We enrolled 14 PWS patients: 8 females and 6 males (BMI = 41.3 [plus or minus] 7.3…

  10. Know yourself and you shall know the other... to a certain extent: multiple paths of influence of self-reflection on mindreading.

    PubMed

    Dimaggio, Giancarlo; Lysaker, Paul H; Carcione, Antonino; Nicolò, Giuseppe; Semerari, Antonio

    2008-09-01

    Social and neurocognitive research suggests that thinking about one's own thinking and thinking about the thinking of others-termed 'mindreading', 'metacognition', 'social cognition' or 'mentalizing' are not identical activities. The ability though to think about thinking in the first person is nevertheless related to the ability to think about other's thoughts in the third person. Unclear is how these phenomena influence one another. In this review, we explore how self-reflection and autobiographical memory influence the capacity to think about the thoughts and emotions of others. We review studies suggesting that the more individuals are able to reflect on and retrieve episodes from their life narratives, the more they are likely to grasp others' thoughts and emotions. We discuss evidence supporting this possibility including studies of the neurocognitive bases of empathy and self-awareness and how different aspects of self-reflection may impact on mindreading. We also draw from clinical reports how improved self-reflection may result in a more nuanced mindreading, namely persons suffering from schizophrenia and narcissistic personality disorder. We finally discuss the implications for research and practice and consider whether there are conditions in which the reverse is true, where self-reflection might impair mindreading or in which mindreading may facilitate self-reflection.

  11. Significance of the percentage of cholesterol efflux capacity and total cholesterol efflux capacity in patients with or without coronary artery disease.

    PubMed

    Norimatsu, Kenji; Kuwano, Takashi; Miura, Shin-Ichiro; Shimizu, Tomohiko; Shiga, Yuhei; Suematsu, Yasunori; Miyase, Yuiko; Adachi, Sen; Nakamura, Ayumi; Imaizumi, Satoshi; Iwata, Atsushi; Nishikawa, Hiroaki; Uehara, Yoshinari; Saku, Keijiro

    2017-01-01

    We hypothesized that cholesterol efflux capacity is more useful than the lipid profile as a marker of the presence and the severity of coronary artery disease (CAD). Therefore, we investigated the associations between the presence and the severity of CAD and both the percentage of cholesterol efflux capacity and total cholesterol efflux capacity and the lipid profile including the high-density lipoprotein cholesterol (HDL-C) level in patients who underwent coronary computed tomography angiography (CTA). The subjects consisted of 204 patients who were clinically suspected to have CAD and underwent CTA. We isolated HDL from plasma by ultracentrifugation and measured the percentage of cholesterol efflux capacity using (3)H-cholesterol-labeled J774 macrophage cells and calculated total cholesterol efflux capacity as follows: the percentage of cholesterol efflux capacity/100× HDL-C levels. While the percentage of cholesterol efflux capacity was not associated with the presence or the severity of CAD, total cholesterol efflux capacity and HDL-C in patients with CAD were significantly lower than those in patients without CAD. In addition, total cholesterol efflux capacity and HDL-C, but not the percentage of cholesterol efflux capacity, significantly decreased as the number of coronary arteries with significant stenosis increased. Total cholesterol efflux capacity was positively correlated with HDL-C, whereas the percentage of cholesterol efflux capacity showed only weak association. In a logistic regression analysis, the presence of CAD was independently associated with total cholesterol efflux capacity, in addition to age and gender. Finally, a receiver-operating characteristic curve analysis indicated that the areas under the curves for total cholesterol efflux capacity and HDL-C were similar. In conclusion, the percentage of cholesterol efflux capacity using the fixed amount of isolated HDL was not associated with CAD. On the other hand, the calculated total

  12. A fiberoptic reflection oximeter.

    PubMed

    Landsman, M L; Knop, N; Kwant, G; Mook, G A; Zijlstra, W G

    1978-03-20

    A catheter tip oximeter is described consisting of a cardiac catheter containing optical fibers, and incandescent light source, a light detection unit and a processing unit. Half of the optical fibers guide the light to the blood at the tip of the catheter, the other half the backscattered (reflected) light to the detection unit. The detection unit contains a dichroic mirror, transmitting most of the light with lambda less than 800 nm and reflecting most of the light with lambda greater than 900 nm, thus splitting the light into two beams. These pass through interference filters with nominal wavelengths of 640 and 920 nm respectively, and are focused on silicium barrier layer photocells. The photocell signals are amplified and fed into a divider giving the ratio of measuring (R640) and compensating (R920) photocell output. The relationship between log R640/R920 and oxygen saturation is represented by a slightly curved line. The relation may be linearized by subtracting a constant voltage from the divided output before taking the logarithm. The slope of the calibration line is dependent on the total haemoglobin concentration. Nonetheless an average calibration line can be used between 70 and 100% oxygen saturation. For 78 measurements of pig blood samples in this range (haemoglobin concentration between 96 and 161 g.1(-1)), the standard deviation of the difference between the fiberoptic oximeter and a Radiometer OSM1 oxygen saturation meter was 1.9% saturation, for 152 samples over the entire saturation range the standard deviation of the difference was 3.1% saturation. The influence of the flow velocity of blood on the light reflection depends on wavelength as well as on oxygen saturation. Therefore, complete compensation for the flow effect is not possible by simple means.

  13. Building Capacity and Sustaining Endeavors

    ERIC Educational Resources Information Center

    Kraybill, Anne; Din, Herminia

    2015-01-01

    In this article, institutional capacity and sustainability is considered. The authors explore a case study from Crystal Bridges Museum of American Art as an example of how museums can leverage not only online technologies to reach more learners regardless of geography, but to increase their reach through strategic partnerships.

  14. [Fasting and physical endurance capacity].

    PubMed

    Schürch, P M

    1993-03-01

    Fasting, or zero calorie diets are used not only by overweight people as a means of losing weight, but by athletes too. Their use is then explained on philosophical grounds, with the aim of even enhancing sports performance. The purpose of this investigation consisted of quantifying the effects of a 10-day fast on maximum performance capacity and endurance (as measured on a bicycle ergometer) of 12 female students of physical education of normal weight. The measurements included resting and exercise metabolism determinants, as well as weight and lean body mass. The main results show that after the diet period the maximum ergometric performance was lower in absolute terms as well as in relation to weight or lean body mass. Performance capacity for submaximal exercise was also reduced. Fat combustion was enhanced both at rest and during exercise. The reduction of maximum performance and endurance capacity may be explained by an enhanced muscle breakdown, an efficiency drop of muscular work, and an inadequate glycogen content of the acting muscles. Shorter fasting periods of 24-36 hours also lead to a lower performance level for exercise bouts extending from several minutes to 1-3 hours. An enhancement of fat combustion was always conspicuous. One may conclude that optimal physical performance is dependent on full hepatic and muscle glycogen stores. Glycogen concentration in the liver decreases sharply as a matter of fact after merely one day of carbohydrate shortage. Zero calorie or low carbohydrate diets are thus at variance with an optimal physical work capacity.

  15. Capacity Issue Looms for Vouchers

    ERIC Educational Resources Information Center

    Zehr, Mary Ann

    2011-01-01

    State-level momentum in support of vouchers and tax credits that help students go to private schools highlights what has been a largely theoretical issue: private school capacity to support voucher-financed enrollment. Academics say the national supply of seats in secular and religious private schools is sufficient to meet short-term demand from…

  16. Force reflection with compliance control

    NASA Technical Reports Server (NTRS)

    Kim, Won S. (Inventor)

    1993-01-01

    Two types of systems for force-reflecting control, which enables high force-reflection gain, are presented: position-error-based force reflection and low-pass-filtered force reflection. Both of the systems are combined with shared compliance control. In the position-error-based class, the position error between the commanded and the actual position of a compliantly controlled robot is used to provide force reflection. In the low-pass-filtered force reflection class, the low-pass-filtered output of the compliance control is used to provide force reflection. The increase in force reflection gain can be more than 10-fold as compared to a conventional high-bandwidth pure force reflection system, when high compliance values are used for the compliance control.

  17. Portable reflectance spectrometer

    NASA Technical Reports Server (NTRS)

    Goetz, A. F. H.; Graham, R. A.; Ozawa, T. (Inventor)

    1977-01-01

    A portable reflectance spectrometer is disclosed. The spectrometer essentially includes an optical unit and an electronic recording unit. The optical unit includes a pair of thermoelectrically-cooled detectors, for detecting total radiance and selected radiance projected through a circular variable filter wheel, and is capable of operating to provide spectral data in the range 0.4 to 2.5 micrometers without requiring coventional substitution of filter elements. The electronic recording unit includes power supplies, amplifiers, and digital recording electronics designed to permit recordation of data on tape casettes. Both the optical unit and electronic recording unit are packaged to be manually portable.

  18. Reflections on Alzheimer's disease.

    PubMed

    Kushnir, S L

    1982-02-01

    As longevity increases, society will face a silent epidemic of idiopathic dementias. The concept, Alzheimer's disease, reflects a cumbersome and vaguely-defined cluster of signs, symptoms and other variables which might more appropriately be labelled as the idiopathic dementias, Alzheimer-type or IDAT. Diagnosis, which is made by exclusion and treatment, primarily custodial, demonstrates the complex nature and unfortunate prognosis of the problem. Dramatic progress, nevertheless, has been made in various scientific aspects of the issue, namely, in histology, genetics and neurochemistry. The resulting evidence warrants further speculation on the role of central cholinergic neurotransmission in cognitive functioning.

  19. Anal melanosis diagnosed by reflectance confocal microscopy.

    PubMed

    Cinotti, Elisa; Chol, Christelle; Perrot, Jean Luc; Labeille, Bruno; Forest, Fabien; Cambazard, Frédéric

    2014-11-01

    Until now, in vivo reflectance-mode confocal microscopy (IVCM) has been applied only to pigmented lesions of the vulvar and oral mucosa, but not to anal mucosa lesions. We present the first case in which IVCM has been used to diagnose anal melanosis. Clinical and dermoscopic features were of concern while IVCM found the draped pattern already described for genital melanosis. IVCM adds information to the clinical and dermatoscopic examination and allows skin biopsies to be avoided. Further studies are needed to define the IVCM features of anal melanosis and to compare the performance of IVCM with the findings of histological examinations.

  20. Intergenerational Transmission of Reflective Functioning

    PubMed Central

    Rosso, Anna M.; Airaldi, Cinzia

    2016-01-01

    The present study investigated whether, and to what extent, reflective functioning (RF) during preadolescence is associated with maternal attachment security and RF, and with the child’s attachment security. Thirty-nine mother–preadolescent child dyads from a non-clinical population participated in the study. Maternal and child RF were assessed by applying the Reflective Functioning Scale to the Adult Attachment Interview (AAI) and to the Child Attachment Interview transcripts. Children of mothers who showed a secure attachment model regarding the relationship with their parents during childhood reported higher levels of RF than the children of mothers who were classified as insecure on the AAI. Child RF was positively associated with maternal “Coherence of the Mind” on the AAI and negatively associated with maternal derogation of attachment. A strong, significant association was also found between child attachment security and child RF. Children who were rated as being more emotionally open, more able to balance positive and negative descriptions of their parents, more prone to support their assertions through examples, and more able to positively resolve conflicts with their parents showed higher RF. On the contrary, children who resorted to a higher extent to idealization and dismissal toward their parents showed a lesser degree of RF. Notably, a very strong association was found between the score on the “Overall coherence” subscale and the child’s ability to mentalize mixed-ambivalent mental states in the context of their family relationships. As expected, child and maternal RF resulted significantly positively correlated with each other. In particular, only maternal RF (and not maternal attachment security) predicted child RF, and only maternal ability to mentalize mixed-ambivalent mental states predicted the corresponding ability in the children. PMID:27999555

  1. Reflected Deck Plan, Reflected Roof Plan, Deck Plan Bridgeport ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Reflected Deck Plan, Reflected Roof Plan, Deck Plan - Bridgeport Covered Bridge, Spanning South Fork of Yuba River at bypassed section of Pleasant Valley Road (originally Virginia Turnpike) in South Yuba River State Park , Bridgeport, Nevada County, CA

  2. Signs of oral dryness in relation to salivary flow rate, pH, buffering capacity and dry mouth complaints

    PubMed Central

    Farsi, Najat MA

    2007-01-01

    Background This study aimed to investigate the signs of oral dryness in relation to different salivary variables and to correlate subjective complaints of oral dryness with salivary flow rate. Methods 312 unmedicated healthy individuals belonging to three age groups, (6–11, 12–17, and 18–40 years) were examined clinically for signs of oral dryness. Resting and stimulated saliva were collected to determine flow rate, pH and buffering capacity. A questionnaire was used to obtain information on subjective sensation of dry mouth. Results Dry lip and dry mucosa were present in 37.5% and 3.2% of the sample respectively. The proportion of subjects who complained of oral dryness (19%) showed a stimulated salivary flow rate significantly lower than non complainers. Dry lip was significantly related to low resting flow rate but pH and buffering capacity did not show any significant relation to dry lip. Dry mucosa was not related to any of the above mentioned parameters. Conclusion The finding that the stimulated salivary flow rate was reduced in subjects complaining of dry mouth is of great clinical relevance, since the reduction is expected to be reflected in compromising various salivary functions. PMID:17996105

  3. Reflection and Non-Reflection of Particle Wavepackets

    ERIC Educational Resources Information Center

    Cox, Timothy; Lekner, John

    2008-01-01

    Exact closed-form solutions of the time-dependent Schrodinger equation are obtained, describing the propagation of wavepackets in the neighbourhood of a potential. Examples given include zero reflection, total reflection and partial reflection of the wavepacket, for the sech[superscript 2]x/a, 1/x[superscript 2] and delta(x) potentials,…

  4. Reflection: Journals and Reflective Questions: A Strategy for Professional Learning

    ERIC Educational Resources Information Center

    Clarke, Maggie

    2004-01-01

    Reflective journals have been used widely in teacher education programs to promote reflective thinking (Freidus, 1998; Carter & Francis, 2000; Yost, Senter & Forlenzo-Bailey, 2000). Smyth (1992) advocated that posing a series of questions to be answered in written journals could enhance reflective thinking. It was for this reason that…

  5. The effects of sleep loss on capacity and effort

    PubMed Central

    Engle-Friedman, Mindy

    2014-01-01

    Sleep loss appears to affect the capacity for performance and access to energetic resources. This paper reviews research examining the physical substrates referred to as resource capacity, the role of sleep in protecting that capacity and the reaction of the system as it attempts to respond with effort to overcome the limitations on capacity caused by sleep loss. Effort is the extent to which an organism will exert itself beyond basic levels of functioning or attempt alternative strategies to maintain performance. The purpose of this review is to bring together research across sleep disciplines to clarify the substrates that constitute and influence capacity for performance, consider how the loss of sleep influences access to those resources, examine cortical, physiological, perceptual, behavioral and subjective effort responses and consider how these responses reflect a system reacting to changes in the resource environment. When sleep deprived, the ability to perform tasks that require additional energy is impaired and the ability of the system to overcome the deficiencies caused by sleep loss is limited. Taking on tasks that require effort including school work, meal preparation, pulling off the road to nap when driving drowsy appear to be more challenging during sleep loss. Sleep loss impacts the effort-related choices we make and those choices may influence our health and safety. PMID:26483932

  6. Renewable liquid reflecting zone plate

    DOEpatents

    Toor, Arthur; Ryutov, Dmitri D.

    2003-12-09

    A renewable liquid reflecting zone plate. Electrodes are operatively connected to a dielectric liquid in a circular or other arrangement to produce a reflecting zone plate. A system for renewing the liquid uses a penetrable substrate.

  7. 10 CFR 904.9 - Excess capacity.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Excess capacity. 904.9 Section 904.9 Energy DEPARTMENT OF... Marketing § 904.9 Excess capacity. (a) If the Uprating Program results in Excess Capacity, Western shall be entitled to such Excess Capacity to integrate the operation of the Boulder City Area Projects and...

  8. High capacity carbon dioxide sorbent

    DOEpatents

    Dietz, Steven Dean; Alptekin, Gokhan; Jayaraman, Ambalavanan

    2015-09-01

    The present invention provides a sorbent for the removal of carbon dioxide from gas streams, comprising: a CO.sub.2 capacity of at least 9 weight percent when measured at 22.degree. C. and 1 atmosphere; an H.sub.2O capacity of at most 15 weight percent when measured at 25.degree. C. and 1 atmosphere; and an isosteric heat of adsorption of from 5 to 8.5 kilocalories per mole of CO.sub.2. The invention also provides a carbon sorbent in a powder, a granular or a pellet form for the removal of carbon dioxide from gas streams, comprising: a carbon content of at least 90 weight percent; a nitrogen content of at least 1 weight percent; an oxygen content of at most 3 weight percent; a BET surface area from 50 to 2600 m.sup.2/g; and a DFT micropore volume from 0.04 to 0.8 cc/g.

  9. Quantitative Hyperspectral Reflectance Imaging

    PubMed Central

    Klein, Marvin E.; Aalderink, Bernard J.; Padoan, Roberto; de Bruin, Gerrit; Steemers, Ted A.G.

    2008-01-01

    Hyperspectral imaging is a non-destructive optical analysis technique that can for instance be used to obtain information from cultural heritage objects unavailable with conventional colour or multi-spectral photography. This technique can be used to distinguish and recognize materials, to enhance the visibility of faint or obscured features, to detect signs of degradation and study the effect of environmental conditions on the object. We describe the basic concept, working principles, construction and performance of a laboratory instrument specifically developed for the analysis of historical documents. The instrument measures calibrated spectral reflectance images at 70 wavelengths ranging from 365 to 1100 nm (near-ultraviolet, visible and near-infrared). By using a wavelength tunable narrow-bandwidth light-source, the light energy used to illuminate the measured object is minimal, so that any light-induced degradation can be excluded. Basic analysis of the hyperspectral data includes a qualitative comparison of the spectral images and the extraction of quantitative data such as mean spectral reflectance curves and statistical information from user-defined regions-of-interest. More sophisticated mathematical feature extraction and classification techniques can be used to map areas on the document, where different types of ink had been applied or where one ink shows various degrees of degradation. The developed quantitative hyperspectral imager is currently in use by the Nationaal Archief (National Archives of The Netherlands) to study degradation effects of artificial samples and original documents, exposed in their permanent exhibition area or stored in their deposit rooms. PMID:27873831

  10. In health--vital capacity is maximum in supine position.

    PubMed

    Roychowdhury, P; Pramanik, T; Prajapati, R; Pandit, R; Singh, S

    2011-06-01

    Vital capacity, frequently measured clinically as an index of pulmonary function, gives useful information about the strength of respiratory muscles and other aspects of lung functions. It is generally noted in sitting position. As in the supine position, respiratory excursions of diaphragm is highest in normal breathing, this study was planned to note whether there occurred any alteration in vital capacity in supine position in comparison to that noted in sitting position. Young sedentary non smoker healthy medial students (n = 100, age 19-22 years) of Nepal Medical College participated as volunteers in this study. Body mass index (BMI) of each of them was calculated. Vital capacity was noted in sitting position and in supine position with the help of a spirometer, following the standard procedure. Result exhibited greater vital capacity in supine posture than in sitting position in the same individual. Diaphragm is the major muscle of inspiration, responsible for some two-thirds of the vital capacity. Naturally, in supine posture the scope of diaphragmatic movements increased and as a result, vital capacity exhibited greater value in comparison to that recorded in sitting posture.

  11. Capacity is the Wrong Paradigm

    DTIC Science & Technology

    2002-01-01

    Florida Gainesville, FL 32611-6120 ABSTRACT At present, \\capacity" is the prevailing paradigm for covert channels. With respect to steganography ...INTRODUCTION Steganography is the art and science of sending a hidden message from Alice to Bob, so that an eavesdropper is not aware that this hidden...discussed a di erent new paradigm con- cerning steganography . The concern of that new paradigm was \\when is something discovered." We feel that both

  12. High Information Capacity Quantum Imaging

    DTIC Science & Technology

    2014-09-19

    High Capacity Quantum Imaging Robert W. Boyd, John C. Howell Department of Physics and Astronomy , University of Rochester, Rochester, New York, 14627...breadth of fields from magnetic resonance imaging [83] to radio astronomy [84] to entanglement characterization [85, 86]. B. Adapting Single Photon...L. Starck, and R. Ottensamer, “Compressed sensing in astronomy ,” Selected Topics in Signal Processing, IEEE Journal of 2, 718–726 (2008). [85] S. T

  13. High capacity immobilized amine sorbents

    DOEpatents

    Gray, McMahan L.; Champagne, Kenneth J.; Soong, Yee; Filburn, Thomas

    2007-10-30

    A method is provided for making low-cost CO.sub.2 sorbents that can be used in large-scale gas-solid processes. The improved method entails treating an amine to increase the number of secondary amine groups and impregnating the amine in a porous solid support. The method increases the CO.sub.2 capture capacity and decreases the cost of utilizing an amine-enriched solid sorbent in CO.sub.2 capture systems.

  14. [Parenting capacity of mothers with schizophrenia].

    PubMed

    Arvaniti, A; Spyropoulou, A; Zervas, I

    2012-01-01

    Recent studies indicate that the pregnancy rates of mothers with schizophrenia do not differ significantly from those of the general population. Mothers' severe mental illness, combined with poor social support and comorbidity, may significantly affect her parenting capacity. However, the poor quality of parenting by psychotic mothers should not be taken for granted, in advance. Some of them may become excellent parents while other may abuse their children and finally lose custody because of this. The parenting capacity is significantly influenced by the existing insight of patient-parent's disease. Assessing the parenting capacity comprises the measurement of insight and of the risk of child abuse as well. Factors associated with increased risk for child abuse are: (a) active psychiatric symptomatology, (b) history of violent behavior in the past, (c) maternal history of abuse during childhood, (d) dangerous domestic environment, (e) stressful events and poor social support to the mother and (f) unrealistic parental expectations. These factors should be assessed both clinically and by using the appropriate psychometric tools. Tools which have been widely used for this purpose are: (a) "Schedule for Assessment of Insight-SAI", (b) "Childhood Trauma Interview", (c) "Home Observation for the Measurement of the Environment Inventory-HOME" and "Home Screening Questionnaire -HSQ", (d) "Parental Stress Inventory-PSI", "Swedish Parenthood Stress Questionnaire-SPSQ", "Arizona Social Support Inventory" (e) "Parent Opinion Questionnaire-POQ". Interventions to ensure a more adequate parenting capacity should be focused on family planning: mothers with severe mental illness have poor knowledge about reproductive and contraception issues. Their pregnancies are mostly not planned. It is important for the family planning to be tailored according to the specific needs of schizophrenic mothers and to take into account the following issues: (a) the severity and the duration

  15. Reflection in Russian Educational Psychology.

    ERIC Educational Resources Information Center

    Nelissen, Jo M. C.; Tomic, Welko

    This paper discusses the cultural-historical school founded by Vygotsky, Luria, and Leontiev as the theoretical background of Russian educational psychologists who have been studying how children learn to reflect. Two approaches to reflection are examined within the cultural-historical tradition: first, reflection--like other higher psychological…

  16. Teacher Reflection: A Phenomenological Study

    ERIC Educational Resources Information Center

    Wilson, Rebecca E.

    2013-01-01

    This study is concerned with the reflective practices of middle school teachers. Based on Dewey's theory of reflective practice and Schon's types of reflection, this experience is one of student learning, relationships, curriculum planning, and lesson delivery. This is a qualitative study using the research method of phenomenology through…

  17. Reflective Practice: Origins and Interpretations

    ERIC Educational Resources Information Center

    Reynolds, Michael

    2011-01-01

    The idea of reflection is central to the theory and practice of learning--especially learning which is grounded in past or current experience. This paper proposes a working definition of reflection and reviews its origins and recent developments. The author also provides an account of "critical reflection", including its rationale and…

  18. Reflections From a Fresnel Lens

    ERIC Educational Resources Information Center

    Keeports, David

    2005-01-01

    Reflection of light by a convex Fresnel lens gives rise to two distinct images. A highly convex inverted real reflective image forms on the object side of the lens, while an upright virtual reflective image forms on the opposite side of the lens. I describe here a set of laser experiments performed upon a Fresnel lens. These experiments provide…

  19. Structures for Facilitating Student Reflection

    ERIC Educational Resources Information Center

    Grossman, Robert

    2009-01-01

    The goal of this article is to describe a continuum of levels of reflection. It briefly focuses on Deanna Kuhn's research into the development of scientific thinking and Robert Kegan's Object-Subject Theory of Development applied to the problems of inspiring students to be able to reflect. Assignments for improving students' ability to reflect are…

  20. Reflective writing and nursing education.

    PubMed

    Craft, Melissa

    2005-02-01

    Reflective writing is a valued tool for teaching nursing students and for documentation, support, and generation of nursing knowledge among experienced nurses. Expressive or reflective writing is becoming widely accepted in both professional and lay publications as a mechanism for coping with critical incidents. This article explores reflective writing as a tool for nursing education.

  1. Information capacity of specific interactions

    PubMed Central

    Huntley, Miriam H.; Murugan, Arvind; Brenner, Michael P.

    2016-01-01

    Specific interactions are a hallmark feature of self-assembly and signal-processing systems in both synthetic and biological settings. Specificity between components may arise from a wide variety of physical and chemical mechanisms in diverse contexts, from DNA hybridization to shape-sensitive depletion interactions. Despite this diversity, all systems that rely on interaction specificity operate under the constraint that increasing the number of distinct components inevitably increases off-target binding. Here we introduce “capacity,” the maximal information encodable using specific interactions, to compare specificity across diverse experimental systems and to compute how specificity changes with physical parameters. Using this framework, we find that “shape” coding of interactions has higher capacity than chemical (“color”) coding because the strength of off-target binding is strongly sublinear in binding-site size for shapes while being linear for colors. We also find that different specificity mechanisms, such as shape and color, can be combined in a synergistic manner, giving a capacity greater than the sum of the parts. PMID:27155013

  2. Solubilisation capacity of Brij surfactants.

    PubMed

    Ribeiro, Maria E N P; de Moura, Carolina L; Vieira, Mariano G S; Gramosa, Nilce V; Chaibundit, Chiraphon; de Mattos, Marcos C; Attwood, David; Yeates, Stephen G; Nixon, S Keith; Ricardo, Nágila M P S

    2012-10-15

    The aim of this study was to investigate the potential of selected Brij non-ionic surfactants for enhancing the solubility of poorly water-soluble drugs. Griseofulvin was selected as a model drug candidate enabling comparisons to be made with the solubilisation capacities of other poly(ethylene oxide)-based copolymers. UV/Vis and (1)H NMR spectroscopies were used to quantify the enhancement of solubility of griseofulvin in 1 wt% aqueous micellar solutions of Brij 78 (C(18)H(37)E(20)), Brij 98 (C(18)H(35)E(20)) and Brij 700 (C(18)H(37)E(100)) (where E represents the OCH(2)CH(2) unit of the poly(ethylene oxide) chain) at 25, 37 and 40 °C. Solubilisation capacities (S(cp) expressed as mg griseofulvin per g Brij) were similar for Brij 78 and 98 (range 6-11 mg g(-1)) but lower for Brij 700 (3-4 mg g(-1)) as would be expected for the surfactant with the higher ethylene oxide content. The drug loading capacity of micelles of Brij 78 was higher than many di- and triblock copolymers with hydrophilic E-blocks specifically designed for enhancement of drug solubility.

  3. Flying Training Capacity Model: Initial Results

    DTIC Science & Technology

    2005-06-21

    numbers by base • FTRAP model is not versatile • Excel spreadsheets based on corporate knowledge • Requires flying training subject matter expert ( SME ... IFR & VFR operations • Capacity given in terms of runway operations per year • AETC Capacity Metrics - Graduates • Based on sortie generation • Consider...Pilots (IPs) from each course • Airspace capacities from base operations SMEs • Runway capacities • Military Operating Area capacities (including aux

  4. Therapist Reflective Functioning, Therapist Attachment Style and Therapist Effectiveness.

    PubMed

    Cologon, John; Schweitzer, Robert D; King, Robert; Nolte, Tobias

    2017-01-28

    This study investigated the relationship between two therapist attributes (reflective functioning and attachment style) and client outcome. Twenty-five therapists treated a total of 1001 clients. Therapists were assessed for reflective functioning and attachment style using the Adult Attachment Interview and the Experiences in Close Relationships Scale. Clinical outcome was measured using the Outcome Questionnaire (OQ-45). Data were analysed using hierarchical linear modelling. Results indicated that therapist reflective functioning predicted therapist effectiveness, whereas attachment style did not. However, there was evidence of an interaction between therapist attachment style and therapist reflective functioning. Secure attachment compensated somewhat for low reflective functioning and high reflective functioning compensated for insecure attachment. Possible implications for the selection of therapy training candidates and therapist training are discussed.

  5. Bidirectional reflectance of zinc oxide

    NASA Technical Reports Server (NTRS)

    Scott, R.

    1973-01-01

    This investigation was undertaken to determine original and useful information about the bidirection reflectance of zinc oxide. The bidirectional reflectance will be studied for the spectra between .25-2.5 microns and the hemisphere above the specimen. The following factors will be considered: (1) surface conditions; (2) specimen preparation; (3) specimen substrate, (4) polarization; (5) depolarization; (6) wavelength; and (7) angles of incident and reflection. The bidirectional reflectance will be checked by experimentally determined angular hemispherical measurements or hemispherical measurements will be used to obtain absolute bidirectional reflectance.

  6. Andreev Reflection in Bosonic Condensates

    SciTech Connect

    Zapata, I.; Sols, F.

    2009-05-08

    We study the bosonic analog of Andreev reflection at a normal-superfluid interface where the superfluid is a boson condensate. We model the normal region as a zone where nonlinear effects can be neglected. Against the background of a decaying condensate, we identify a novel contribution to the current of reflected atoms. The group velocity of this Andreev reflected component differs from that of the normally reflected one. For a three-dimensional planar or two-dimensional linear interface Andreev reflection is neither specular nor conjugate.

  7. Reflections on RSNA 1981

    SciTech Connect

    Zeitler, E.; Abrams, H.L.; Sos, T.A.; Harrington, D.P.

    1982-01-01

    The annual meeting of RSNA has provided the following points. Computed tomography and ultrasound have become well established in routine medical care. Digital technology is becoming increasingly important in many fields of medicine like in radiology (digital substraction angiography), physiologic and clinical information system. Nuclear magnetic resonance (NMR) recently recognised as a more important diagnostic tool may become the technique of choice for the early diagnosis of multiple sclerosis and high pressure hydroencephalus. It is also usefull for the diagnosis of cardiac and vascular diseases.

  8. The Capacity of Cognitive Control Estimated from a Perceptual Decision Making Task

    PubMed Central

    Wu, Tingting; Dufford, Alexander J.; Mackie, Melissa-Ann; Egan, Laura J.; Fan, Jin

    2016-01-01

    Cognitive control refers to the processes that permit selection and prioritization of information processing in different cognitive domains to reach the capacity-limited conscious mind. Although previous studies have suggested that the capacity of cognitive control itself is limited, a direct quantification of this capacity has not been attempted. In this behavioral study, we manipulated the information rate of cognitive control by parametrically varying both the uncertainty of stimul measured as information entropy and the exposure time of the stimuli. We used the relationship between the participants’ response accuracy and the information rate of cognitive control (in bits per second, bps) in the model fitting to estimate the capacity of cognitive control. We found that the capacity of cognitive control was approximately 3 to 4 bps, demonstrating that cognitive control as a higher-level function has a remarkably low capacity. This quantification of the capacity of cognitive control may have significant theoretical and clinical implications. PMID:27659950

  9. The Influence of Age, Health Literacy, and Affluence on Adolescents' Capacity to Consent to Research.

    PubMed

    Nelson, Lance R; Stupiansky, Nathan W; Ott, Mary A

    2016-04-01

    While adults are assumed to have the capacity to consent to medical research, and young children to have no capacity, adolescents' capacity to consent is not well described. Adapting the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), we describe adolescents' capacity to consent to medical research and factors influencing that capacity. Our pilot study included a community-based sample of 30 adolescents, 14 to 21 years of age, who completed the MacCAT-CR after undergoing a simulated informed consent process. We found that adolescents' capacity to consent to research was associated with age, health literacy, and family affluence. These findings suggest that investigators and institutional review boards should be aware that factors other than age may influence capacity to consent, and, for modifiable factors, such as health literacy, consent processes for medical research with adolescents can be modified.

  10. Building operational research capacity in the Pacific.

    PubMed

    Bissell, K; Viney, K; Brostrom, R; Gounder, S; Khogali, M; Kishore, K; Kool, B; Kumar, A M V; Manzi, M; Marais, B; Marks, G; Linh, N N; Ram, S; Reid, S; Roseveare, C; Tayler-Smith, K; Van den Bergh, R; Harries, A D

    2014-06-21

    Operational research (OR) in public health aims to investigate strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of health systems. Attention has recently been drawn to the lack of OR capacity in public health programmes throughout the Pacific Islands, despite considerable investment in implementation. This lack of ongoing and critical reflection may prevent health programme staff from understanding why programme objectives are not being fully achieved, and hinder long-term gains in public health. The International Union Against Tuberculosis and Lung Disease (The Union) has been collaborating with Pacific agencies to conduct OR courses based on the training model developed by The Union and Médecins Sans Frontières Brussels-Luxembourg in 2009. The first of these commenced in 2011 in collaboration with the Fiji National University, the Fiji Ministry of Health, the World Health Organization and other partners. The Union and the Secretariat of the Pacific Community organised a second course for participants from other Pacific Island countries and territories in 2012, and an additional course for Fijian participants commenced in 2013. Twelve participants enrolled in each of the three courses. Of the two courses completed by end 2013, 18 of 24 participants completed their OR and submitted papers by the course deadline, and 17 papers have been published to date. This article describes the context, process and outputs of the Pacific courses, as well as innovations, adaptations and challenges.

  11. Building operational research capacity in the Pacific

    PubMed Central

    Viney, K.; Brostrom, R.; Gounder, S.; Khogali, M.; Kishore, K.; Kool, B.; Kumar, A. M. V.; Manzi, M.; Marais, B.; Marks, G.; Linh, N. N.; Ram, S.; Reid, S.; Roseveare, C.; Tayler-Smith, K.; Van den Bergh, R.; Harries, A. D.

    2014-01-01

    Operational research (OR) in public health aims to investigate strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of health systems. Attention has recently been drawn to the lack of OR capacity in public health programmes throughout the Pacific Islands, despite considerable investment in implementation. This lack of ongoing and critical reflection may prevent health programme staff from understanding why programme objectives are not being fully achieved, and hinder long-term gains in public health. The International Union Against Tuberculosis and Lung Disease (The Union) has been collaborating with Pacific agencies to conduct OR courses based on the training model developed by The Union and Médecins Sans Frontières Brussels-Luxembourg in 2009. The first of these commenced in 2011 in collaboration with the Fiji National University, the Fiji Ministry of Health, the World Health Organization and other partners. The Union and the Secretariat of the Pacific Community organised a second course for participants from other Pacific Island countries and territories in 2012, and an additional course for Fijian participants commenced in 2013. Twelve participants enrolled in each of the three courses. Of the two courses completed by end 2013, 18 of 24 participants completed their OR and submitted papers by the course deadline, and 17 papers have been published to date. This article describes the context, process and outputs of the Pacific courses, as well as innovations, adaptations and challenges. PMID:26477282

  12. Venus Highland Anomalous Reflectivity

    NASA Astrophysics Data System (ADS)

    Simpson, Richard A.; Tyler, G. L.; Häusler, B.; Mattei, R.; Patzold, M.

    2009-09-01

    Maxwell Montes was one of several unusually bright areas identified from early Venus radar backscatter observations. Pioneer Venus' orbiting radar associated low emissivity with the bright areas and established a correlation between reflectivity and altitude. Magellan, using an oblique bistatic geometry, showed that the bright surface dielectric constant was not only large but also imaginary -- i.e., the material was conducting, at least near Cleopatra Patera (Pettengill et al., Science, 272, 1996). Venus Express (VEX) repeated Magellan's bistatic observations over Maxwell, using the more conventional circular polarization carried by most spacecraft. Although VEX signal-to-noise ratio was lower than Magellan's, echoes were sufficiently strong to verify the Magellan conclusions near Cleopatra (see J. Geophys. Res., 114, E00B41, doi:10.1029/2008JE003156). Only about 40% of the surface at Cleopatra scatters specularly, opening the Fresnel (specular) interpretation model to question. Elsewhere in Maxwell, the specular percentage may be even lower. Nonetheless, the echo polarization is reversed throughout Maxwell, a result that is consistent with large dielectric constants and difficult to explain without resorting qualitatively (if not quantitatively) to specular models. VEX was scheduled to explore other high altitude regions when its S-Band (13-cm wavelength) radio system failed in late 2006, so further probing of high altitude targets awaits arrival of a new spacecraft.

  13. Cushing's ulcer: Further reflections

    PubMed Central

    Kemp, William J.; Bashir, Asif; Dababneh, Haitham; Cohen-Gadol, Aaron A.

    2015-01-01

    Background: Brain tumors, traumatic head injury, and other intracranial processes including infections, can cause increased intracranial pressure and lead to overstimulation of the vagus nerve. As a result, increased secretion of gastric acid may occur which leads to gastro-duodenal ulcer formation known as Cushing's ulcer. Methods: A review of original records of Dr. Harvey Cushing's patients suffering from gastro-duodenal ulcers was performed followed by a discussion of the available literature. We also reviewed the clinical records of the patients never reported by Cushing to gain his perspective in describing this phenomenon. Dr. Cushing was intrigued to investigate gastro-duodenal ulcers as he lost patients to acute gastrointestinal perforations following successful brain tumor operations. It is indeed ironic that Harvey Cushing developed a gastro-duodenal ulcer in his later years with failing health. Results: Clinically shown by Cushing's Yale Registry, a tumor or lesion can disrupt this circuitry, leading to gastroduodenal ulceration. Cushing said that it was “reasonable to believe that the perforations following posterior fossa cerebellar operations were produced in like fashion by an irritative disturbance either of fiber tracts or vagal centers in the brain stem.” Conclusion: Harvey Cushing's pioneering work depicted in his Yale registry serves as a milestone for continuing research that can further discern this pathway. PMID:25972936

  14. Achieving change through reflective practice: closing the loop.

    PubMed

    Page, S; Meerabeau, L

    2000-07-01

    This paper draws on a small scale, exploratory study which was conducted in the clinical area in the early 1990s (Page 1992). The study drew on the principles of reflective practice in order to enable practitioners to identify learning needs in relation to cardiopulmonary resuscitation (CPR) procedures. Whilst considerable benefit from the reflective sessions was noted, one unanticipated and unpalatable outcome was what might be termed professional apathy. This was manifest in several ways, most importantly in that issues 'for action', identified through reflection, were not prioritised or acted upon. Whilst partial responsibility for this may lie with the somewhat naive way in which the reflective process was facilitated, some responsibility also rests with the nurses in question. One possible explanation is that, for changes in practice to occur, the planning and management of change should form an integral part of the reflective cycle. This point has been largely absent in the reflection literature to date. Such concerns are reviewed here in the context of nurse education's ongoing involvement with the notion of reflective practice and the role of the educationalist in the clinical area. The current political backdrop of 'quality initiatives' to create and demonstrate high standards of clinical care may be useful in advancing the debate.

  15. The Art of Reflection: Turning the Strange into the Familiar.

    PubMed

    Weingarten, Kaethe

    2016-06-01

    There are a great many useful articles on the dynamics and pragmatics of reflecting teams but few articles address what constitutes a good or inept reflection and why. I provide a conceptual model for thinking about what a good reflection does, distinguishing it from a nice reflection. With some further refinements in place, I then illustrate how reflections can be part of any relationship, not just clinical ones. We have opportunities to make them and to recognize when others make them to us. By using examples from my personal life-as a grandmother, daughter, radio listener, cancer survivor, and client-I attempt to ease the personal/professional binary, a project of mine for the last 35 years. In the second part of the article, I address how writing can serve reflection. Although best offered at the moment one is called for, it is never too late for a reflection. Writing allows people to offer reflections after the fact to those who have shared their stories. Sometimes, it is to ourselves we offer those reflections, when the reflector has long since dropped the thread of obligation or interest. I provide an example of working with iconic imagery to unpack meaning so that reflection can eventually take place, allowing integration to proceed, facilitating the strange becoming the familiar.

  16. Neural correlates of self-reflection.

    PubMed

    Johnson, Sterling C; Baxter, Leslie C; Wilder, Lana S; Pipe, James G; Heiserman, Joseph E; Prigatano, George P

    2002-08-01

    The capacity to reflect on one's sense of self is an important component of self-awareness. In this paper, we investigate some of the neurocognitive processes underlying reflection on the self using functional MRI. Eleven healthy volunteers were scanned with echoplanar imaging using the blood oxygen level-dependent contrast method. The task consisted of aurally delivered statements requiring a yes-no decision. In the experimental condition, participants responded to a variety of statements requiring knowledge of and reflection on their own abilities, traits and attitudes (e.g. 'I forget important things', 'I'm a good friend', 'I have a quick temper'). In the control condition, participants responded to statements requiring a basic level of semantic knowledge (e.g. 'Ten seconds is more than a minute', 'You need water to live'). The latter condition was intended to control for auditory comprehension, attentional demands, decision-making, the motoric response, and any common retrieval processes. Individual analyses revealed consistent anterior medial prefrontal and posterior cingulate activation for all participants. The overall activity for the group, using a random-effects model, occurred in anterior medial prefrontal cortex (t = 13.0, corrected P = 0.05; x, y, z, 0, 54, 8, respectively) and the posterior cingulate (t = 14.7, P = 0.02; x, y, z, -2, -62, 32, respectively; 967 voxel extent). These data are consistent with lesion studies of impaired awareness, and suggest that the medial prefrontal and posterior cingulate cortex are part of a neural system subserving self-reflective thought.

  17. Renal concentration capacity in adult patients with urinary tract infections.

    PubMed

    Sterner, G

    1991-01-01

    The maximal urine concentration capacity was studied in patients with acute pyelonephritis and in patients with clinically diagnosed acute cystitis. In the former group renal concentration ability was reduced in 16 of 22 patients and improved in all but two patients. Among patients with symptoms of acute cystitis 6 of 22 had a concentration capacity below 2 SD of normal values. Several of these patients had raised acute phase proteins and increased their urine osmolality at follow-up indicating that cases of acute pyelonephritis could have been included. It is concluded that the wide overlap between the groups makes the maximal urinary concentration capacity a method of limited value for level diagnosis in acute UTI infection. The test should be reserved for follow-up to reveal permanent renal damage.

  18. Capacity planning and appointment scheduling for new patient oncology consults.

    PubMed

    Ma, Xiang; Sauré, Antoine; Puterman, Martin L; Taylor, Marianne; Tyldesley, Scott

    2016-12-01

    To ensure that patients receive timely access to care, it has become increasingly important to use existing care provider capacity as efficiently as possible and to make informed capacity planning decisions. To support this decision-making process at a regional cancer center in British Columbia (Canada), we undertook a simulation and optimization based study that investigated the simultaneous impact of the available number of new patient consultation slots, appointment scheduling policies and oncologist specialization configurations on the timeliness of patient access to care and physician workload. The key contribution of this paper is the methodological framework it provides to decision makers who manage specialty clinics to ensure that they are using their resources efficiently and making informed strategic short- and mid-term capacity planning decisions for new patient demand.

  19. Developing Ministerial Collaborative Planning Capacity

    DTIC Science & Technology

    2012-03-14

    the MNSTC-I era and, its successor organization the Iraq Training and Advisory Mission for the Ministry of Interior ( ITAM -MoI) that focused on the...organization can exercise influence over.26 The training partnership between the DRMI and the MoI was one of the few success stories in ITAM -MoI’s...efforts to develop institutional capacity within the MoI. Over a nineteen-month period, the DRMI, MoI JRC, and ITAM -MoI partnered to host 14

  20. Global distribution of plant-extractable water capacity of soil

    USGS Publications Warehouse

    Dunne, K.A.; Willmott, C.J.

    1996-01-01

    Plant-extractable water capacity of soil is the amount of water that can be extracted from the soil to fulfill evapotranspiration demands. It is often assumed to be spatially invariant in large-scale computations of the soil-water balance. Empirical evidence, however, suggests that this assumption is incorrect. In this paper, we estimate the global distribution of the plant-extractable water capacity of soil. A representative soil profile, characterized by horizon (layer) particle size data and thickness, was created for each soil unit mapped by FAO (Food and Agriculture Organization of the United Nations)/Unesco. Soil organic matter was estimated empirically from climate data. Plant rooting depths and ground coverages were obtained from a vegetation characteristic data set. At each 0.5?? ?? 0.5?? grid cell where vegetation is present, unit available water capacity (cm water per cm soil) was estimated from the sand, clay, and organic content of each profile horizon, and integrated over horizon thickness. Summation of the integrated values over the lesser of profile depth and root depth produced an estimate of the plant-extractable water capacity of soil. The global average of the estimated plant-extractable water capacities of soil is 8??6 cm (Greenland, Antarctica and bare soil areas excluded). Estimates are less than 5, 10 and 15 cm - over approximately 30, 60, and 89 per cent of the area, respectively. Estimates reflect the combined effects of soil texture, soil organic content, and plant root depth or profile depth. The most influential and uncertain parameter is the depth over which the plant-extractable water capacity of soil is computed, which is usually limited by root depth. Soil texture exerts a lesser, but still substantial, influence. Organic content, except where concentrations are very high, has relatively little effect.

  1. Reflections on 'autistic integrity'.

    PubMed

    Russell, Barbara

    2012-03-01

    Autism, particularly its moderate to severe forms, has prompted considerable scientific study and clinical involvement because the associated behaviours imply disconnections with valued features of a 'good' life, such as close relationships, enjoyment, and adaptability. Proposed causes of autism involve potent philosophical concepts including consciousness, identity, mind, and relationality. The concept of autistic integrity is used by Barnbaum in The Ethics of Autism: Among Them, But Not of Them to help provide moral justification to stop efforts to cure adults with autism, especially if the cause is presumed to be a lack of a theory of mind.(1) This article has two goals: (1) to apply four familiar definitions or characterizations of integrity to the case of moderate to severe autism, and (2) to examine whether autistic integrity does provide the moral justification Barnbaum seeks.

  2. Building Staff Capacity through Reflecting on Collaborative Development of Embedded Academic Literacies Curricula

    ERIC Educational Resources Information Center

    Thies, Linda C.

    2016-01-01

    Most Australian universities articulate some policies around the integration of graduate learning outcomes in courses. This paper draws on a Federal Government funded project that adopted a developmental approach to students' acquisition of course learning outcomes, through the embedding of academic literacies in course curricula. The project was…

  3. Community Capacity-Building in Schools: Parents' and Teachers' Reflections from an Eating Disorder Prevention Program

    ERIC Educational Resources Information Center

    Russell-Mayhew, Shelly; Arthur, Nancy; Ewashen, Carol

    2008-01-01

    A pilot research study to examine the effect of a wellness-based intervention on improving students' body image, personal attitudes, and eating behaviors highlighted the importance of a healthy school environment. Parent and teacher focus groups were conducted to explore the perceived influences of wellness-based interventions designed for…

  4. Control Capacity in Complex Networks

    NASA Astrophysics Data System (ADS)

    Jia, Tao; Liu, Yang-Yu; Slotine, Jean-Jacques; Barabasi, Albert-Laszlo

    2012-02-01

    By combining tools from control theory and network science, an efficient methodology was proposed to identify the minimum sets of driver nodes, whose time-dependent control can guide the whole network to any desired final state. Yet, this minimum driver set (MDS) is usually not unique, but one can often achieve multiple potential control configurations with the same number of driver nodes. Given that some nodes may appear in some MDSs but not in other, a crucial question remain unanswered: what is the role of individual node in controlling a complex system? We first classify a node as critical, redundant, or ordinary if it appears in all, no, or some MDSs. Then we introduce the concept of control capacity as a measure of the frequency that a node is in the MDSs, which quantifies the importance of a given node in maintaining Controllability. To avoid impractical enumeration of all MDSs, we propose an algorithm that uniformly samples the MDS. We use it to explore the control capacity of nodes in complex networks and study how it is related to other characteristics of the network topology.

  5. Variable area light reflecting assembly

    DOEpatents

    Howard, T.C.

    1986-12-23

    Device is described for tracking daylight and projecting it into a building. The device tracks the sun and automatically adjusts both the orientation and area of the reflecting surface. The device may be mounted in either a wall or roof of a building. Additionally, multiple devices may be employed in a light shaft in a building, providing daylight to several different floors. The preferred embodiment employs a thin reflective film as the reflecting device. One edge of the reflective film is fixed, and the opposite end is attached to a spring-loaded take-up roller. As the sun moves across the sky, the take-up roller automatically adjusts the angle and surface area of the film. Additionally, louvers may be mounted at the light entrance to the device to reflect incoming daylight in an angle perpendicular to the device to provide maximum reflective capability when daylight enters the device at non-perpendicular angles. 9 figs.

  6. Variable area light reflecting assembly

    DOEpatents

    Howard, Thomas C.

    1986-01-01

    Device for tracking daylight and projecting it into a building. The device tracks the sun and automatically adjusts both the orientation and area of the reflecting surface. The device may be mounted in either a wall or roof of a building. Additionally, multiple devices may be employed in a light shaft in a building, providing daylight to several different floors. The preferred embodiment employs a thin reflective film as the reflecting device. One edge of the reflective film is fixed, and the opposite end is attached to a spring-loaded take-up roller. As the sun moves across the sky, the take-up roller automatically adjusts the angle and surface area of the film. Additionally, louvers may be mounted at the light entrance to the device to reflect incoming daylight in an angle perpendicular to the device to provide maximum reflective capability when daylight enters the device at non-perpendicular angles.

  7. Cerebral reserve capacity: implications for alcohol and drug abuse.

    PubMed

    Fein, George; Di Sclafani, Victoria

    2004-01-01

    Cerebral reserve capacity (or functional reserve) refers to the brain's ability to maintain function when confronted by degenerative processes. Functional reserve can be estimated by several associated measures, including premorbid brain size, premorbid IQ, and level of education attained. There is accumulating evidence that the magnitude of reserve capacity is important in determining the onset and progression of the clinical manifestations of neurodegenerative brain diseases. Normal aging also whittles away at this cerebral reserve, and there may be a consequent unmasking of morbid effects that was not clinically evident when this compensatory reserve was sufficient. We review the evidence supporting this model for a number of degenerative brain processes, including Alzheimer's disease, presenile dementia, HIV dementia, aging, and chronic (multiyear) substance abuse. The concept of cerebral functional reserve has important implications for alcohol and drug abuse morbidity. First, given the high genetic contribution to substance abuse, there is an increased likelihood that the parents of substance abusers were substance abusers themselves. Substance abuse during pregnancy can inhibit brain growth, resulting in reduced brain size and reduced reserve capacity (and therefore less ability to compensate for loss of function later in life). Second, substance abuse is often coupled with poverty, and both substance abuse and poverty are associated with some of the same conditions that reduce brain growth. Finally, we comment on the most important public health implication of the cerebral reserve capacity model (vis-à-vis addiction).

  8. Unreasonable reasons: normative judgements in the assessment of mental capacity.

    PubMed

    Banner, Natalie F

    2012-10-01

    The recent Mental Capacity Act (2005) sets out a test for assessing a person's capacity to make treatment choices. In some cases, particularly in psychiatry, it is unclear how the criteria ought to be interpreted and applied by clinicians. In this paper, I argue that this uncertainty arises because the concept of capacity employed in the Act, and the diagnostic tools developed to assist its assessment, overlook the inherent normativity of judgements made about whether a person is using or weighing information in the decision-making process. Patients may fail on this criterion to the extent that they do not appear to be handling the information given in an appropriate way, on account of a mental impairment disrupting the way the decision process ought to proceed. Using case law and clinical examples, I describe some of the normative dimensions along which judgements of incapacity can be made, namely epistemic, evaluative and affective dimensions. Such judgements are complex and the normative standards by which a clinician may determine capacity cannot be reduced to a set of criteria. Rather, in recognizing this normativity, clinicians may better understand how clinical judgements are structured and what kinds of assumption may inform their assessment.

  9. Diffuse reflectance spectroscopy of liver tissue

    NASA Astrophysics Data System (ADS)

    Reistad, Nina; Nilsson, Jan; Vilhelmsson Timmermand, Oskar; Sturesson, Christian; Andersson-Engels, Stefan

    2015-06-01

    Diffuse reflectance spectroscopy (DRS) with a fiber-optic contact probe is a cost-effective, rapid, and non-invasive optical method used to extract diagnosis information of tissue. By combining commercially available VIS- and NIR-spectrometers with various fiber-optic contact-probes, we have access to the full wavelength range from around 400 to 1600 nm. Using this flexible and portable spectroscopy system, we have acquired ex-vivo DRS-spectra from murine, porcine, and human liver tissue. For extracting the tissue optical properties from the measured spectra, we have employed and compared predictions from two models for light propagation in tissue, diffusion theory model (DT) and Monte Carlo simulations (MC). The focus in this work is on the capacity of this DRS-technique in discriminating metastatic tumor tissue from normal liver tissue as well as in assessing and characterizing damage to non-malignant liver tissue induced by preoperative chemotherapy for colorectal liver metastases.

  10. Reflectance Confocal Microscopy in Lentigo Maligna.

    PubMed

    Gamo, R; Pampín, A; Floristán, U

    2016-12-01

    Lentigo maligna is the most common type of facial melanoma. Diagnosis is complicated, however, as it shares clinical and dermoscopic characteristics with other cutaneous lesions of the face. Reflectance confocal microscopy is an imaging technique that permits the visualization of characteristic features of lentigo maligna. These include a disrupted honeycomb pattern and pagetoid cells with a tendency to show folliculotropism. These cells typically have a dendritic morphology, although they may also appear as round cells measuring over 20μm with atypical nuclei. Poorly defined dermal papillae and atypical cells may be seen at the dermal-epidermal junction and can form bridges resembling mitochondrial structures. Other characteristic findings include junctional swelling with atypical cells located around the follicles, resembling caput medusae. Reflectance confocal microscopy is a very useful tool for diagnosing lentigo maligna.

  11. Undertaking capacity assessments for people with dementia in general hospitals.

    PubMed

    Murray, Aileen

    2016-08-01

    Ensuring that older patients are discharged from hospital in a safe and appropriate manner is a fundamental aspect of nursing care. However, it is clear from the literature and clinical practice that determining people's capacity and whether they are able to decide where they live on discharge is a significant challenge. There is variation in practice despite the legal framework provided by the Mental Capacity Act (MCA) 2005, covering England and Wales, which raises questions about adherence to the legislation. Using a case study, this article explores aspects of the MCA and clinical practice that affect older patients' outcomes on discharge from general hospital settings. It demonstrates how effective multidisciplinary working, using the legal frameworks available, can ensure that an individual's independence and well-being are maintained.

  12. Atlas of soil reflectance properties

    NASA Technical Reports Server (NTRS)

    Stoner, E. R.; Baumgardner, M. F.; Biehl, L. L.; Robinson, B. F.

    1979-01-01

    A compendium of soil spectral reflectance curves together with soil test results and site information is presented in an abbreviated manner listing those soil properties most important in influencing soil reflectance. Results are presented for 251 soils from 39 states and Brazil. A narrative key describes relationships between soil parameters and reflectance curves. All soils are classified according to the U.S. soil taxonomy and soil series name for ease of identification.

  13. 47 CFR 80.919 - Required capacity.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... capacity. If either the main or reserve power supply includes batteries, these batteries must have sufficient reserve capacity to permit proper operation of the required transmitter and receiver for at...

  14. U.S. Refining Capacity Utilization

    EIA Publications

    1995-01-01

    This article briefly reviews recent trends in domestic refining capacity utilization and examines in detail the differences in reported crude oil distillation capacities and utilization rates among different classes of refineries.

  15. Earnings Capacity, Economic Status, and Poverty

    ERIC Educational Resources Information Center

    Garfinkel, Irwin; Haveman, Robert

    1977-01-01

    "Earnings capacity" is suggested as an alternative to "annual money income" as an indicator of economic status. The socioeconomic and demographic determinants of poverty as measured by earnings capacity and by annual money income are compared and contrasted. (WL)

  16. Teaching Reflective Social Work Practice in Health Care: Promoting Best Practices

    ERIC Educational Resources Information Center

    McCoyd, Judith L. M.; Kerson, Toba S.

    2013-01-01

    Reflection on case material is traditionally believed to promote better clinical practice; recent neurobiological understandings explain why reflection consolidates learning and allows professional heuristics to develop. Here, we describe a practice in context (PIC) framework that requires reflection on the contextual and decisional aspects of a…

  17. Weak-shock reflection factors

    SciTech Connect

    Reichenbach, H.; Kuhl, A.L.

    1993-09-07

    The purpose of this paper is to compare reflection factors for weak shocks from various surfaces, and to focus attention on some unsolved questions. Three different cases are considered: square-wave planar shock reflection from wedges; square-wave planar shock reflection from cylinders; and spherical blast wave reflection from a planar surface. We restrict ourselves to weak shocks. Shocks with a Mach number of M{sub O} < 1.56 in air or with an overpressure of {Delta}{sub PI} < 25 psi (1.66 bar) under normal ambient conditions are called weak.

  18. The French Version of the Reflective Functioning Questionnaire: Validity Data for Adolescents and Adults and Its Association with Non-Suicidal Self-Injury

    PubMed Central

    Badoud, Deborah; Luyten, Patrick; Fonseca-Pedrero, Eduardo; Eliez, Stephan; Fonagy, Peter; Debbané, Martin

    2015-01-01

    Introduction The capacity to understand one’s own actions and those of others in terms of cognitive and affective mental states (i.e., reflective functioning or mentalizing) is thought to play a critical role in both typical and atypical development. To date, however, no self-report tool is available for assessing reflective functioning ability in French-speaking samples. The first aim of this study is to investigate the reliability and validity of the reflective functioning questionnaire (RFQ) in French-speaking adolescents and adults. Secondly, we investigate whether low levels of reflective functioning were associated with non-suicidal self-injury. Methods 130 adolescents (66 females, Mage = 15.72, SDage = 1.74) and 253 adults (168 females, Mage = 23.10, SDage = 2.56) completed a French translation of the RFQ and a battery of self-reported questionnaires to assess a set of clinical (alexithymia; borderline traits; internalizing and externalizing symptoms) and psychological (empathy; mindfulness) variables. Results The current results showed configural invariance of the original two-factor structure of the RFQ across French-speaking adolescents and adults and satisfactory reliability and construct validity of the two subscales. Furthermore, we observed that recent episodes of non-suicidal self-injury were associated with lower levels of reflective functioning in the adult, but not in the adolescent, sample. Discussion The present research has methodological and clinical implications in that it provides the first evidence that the RFQ can be used to reliably assess reflective functioning in French-speaking population. The study further shows that impaired ability to consider mental states that lie behind behaviors might play a role in non-suicidal self-injury, at least in adults. PMID:26714319

  19. Embodied Reflection and the Epistemology of Reflective Practice

    ERIC Educational Resources Information Center

    Kinsella, Elizabeth Anne

    2007-01-01

    Donald Schon's theory of reflective practice has been extensively referred to and has had enormous impact in education and related fields. Nonetheless, there continues to be tremendous conceptual and practical confusion surrounding interpretations of reflective practice and philosophical assumptions underlying the theory. In this paper, I argue…

  20. Studies of the Reflection, Refraction and Internal Reflection of Light

    ERIC Educational Resources Information Center

    Lanchester, P. C.

    2014-01-01

    An inexpensive apparatus and associated experiments are described for studying the basic laws of reflection and refraction of light at an air-glass interface, and multiple internal reflections within a glass block. In order to motivate students and encourage their active participation, a novel technique is described for determining the refractive…

  1. Specular Reflection and Diffuse Reflectance Spectroscopy of Soils

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Studies on the occurrence and effects of specular reflection in mid-infrared spectra of soils have shown that distortions due to specular reflection occur for both organic (humic acid) and non-organic fractions (carbonates, silica, ashed fraction of soil). The results demonstrated explain why the s...

  2. Postgraduate Education to Support Organisation Change: A Reflection on Reflection

    ERIC Educational Resources Information Center

    Stewart, Jim; Keegan, Anne; Stevens, Pam

    2008-01-01

    Purpose: This paper aims to explore how teaching and assessing reflective learning skills can support postgraduate practitioners studying organisational change and explores the challenges for tutors in assessing these journals. Design/methodology/approach: Assessment criteria were developed from the literature on reflective practice and…

  3. Global partnerships for international fieldwork in occupational therapy: reflection and innovation.

    PubMed

    Cameron, Debra; Cockburn, Lynn; Nixon, Stephanie; Parnes, Penny; Garcia, Lesley; Leotaud, Jacqui; MacPherson, Kristina; Mashaka, Peter A; Mlay, Ruth; Wango, Julius; Williams, Trish

    2013-06-01

    International fieldwork placements (IFPs) have become very popular among healthcare students including those in occupational therapy programmes. There are many potential benefits that can accrue to the students; however, there are critiques of international placements especially for students going to underserviced areas. The purpose of this paper is to provide a case study/model programme description that critically reflects on six partnerships in three underserviced countries that provide IFPs to students from one Canadian university. The personal opinions of each partner were collected verbally, by email and by a qualitative review of the past 10 years of partnership interaction. Some of the benefits reported by partners include the development of an increased number of sustainable long-term quality placements, orientation materials, student supports and the involvement of university faculty in research and capacity building projects in partner countries. A number of challenges were identified including the need for an expanded formal agreement, more bilateral feedback and examination of supervision models. This paper examines a limited number of partnerships with only one Canadian partner. Direct input of students is not utilized, although feedback given to co-authors by students is reflected. More research is needed on perspectives of partners in IFPs, impact of IFPs on clinical practice in student's home countries, impact of IFPS on underserviced areas and effective strategies for debriefing.

  4. Institutional capacity for health systems research in East and Central African schools of public health: experiences with a capacity assessment tool

    PubMed Central

    2014-01-01

    Background Despite significant investments in health systems research (HSR) capacity development, there is a dearth of information regarding how to assess HSR capacity. An alliance of schools of public health (SPHs) in East and Central Africa developed a tool for the self-assessment of HSR capacity with the aim of producing institutional capacity development plans. Methods Between June and November 2011, seven SPHs across the Democratic Republic of Congo, Ethiopia, Kenya, Rwanda, Tanzania, and Uganda implemented this co-created tool. The objectives of the institutional assessments were to assess existing capacities for HSR and to develop capacity development plans to address prioritized gaps. A mixed-method approach was employed consisting of document analysis, self-assessment questionnaires, in-depth interviews, and institutional dialogues aimed at capturing individual perceptions of institutional leadership, collective HSR skills, knowledge translation, and faculty incentives to engage in HSR. Implementation strategies for the capacity assessment varied across the SPHs. This paper reports findings from semi-structured interviews with focal persons from each SPH, to reflect on the process used at each SPH to execute the institutional assessments as well as the perceived strengths and weaknesses of the assessment process. Results The assessment tool was robust enough to be utilized in its entirety across all seven SPHs resulting in a thorough HSR capacity assessment and a capacity development plan for each SPH. Successful implementation of the capacity assessment exercises depended on four factors: (i) support from senior leadership and collaborators, (ii) a common understanding of HSR, (iii) adequate human and financial resources for the exercise, and (iv) availability of data. Methods of extracting information from the results of the assessments, however, were tailored to the unique objectives of each SPH. Conclusions This institutional HSR capacity assessment

  5. Working memory is not fixed-capacity: More active storage capacity for real-world objects than for simple stimuli

    PubMed Central

    Brady, Timothy F.; Störmer, Viola S.; Alvarez, George A.

    2016-01-01

    Visual working memory is the cognitive system that holds visual information active to make it resistant to interference from new perceptual input. Information about simple stimuli—colors and orientations—is encoded into working memory rapidly: In under 100 ms, working memory ‟fills up,” revealing a stark capacity limit. However, for real-world objects, the same behavioral limits do not hold: With increasing encoding time, people store more real-world objects and do so with more detail. This boost in performance for real-world objects is generally assumed to reflect the use of a separate episodic long-term memory system, rather than working memory. Here we show that this behavioral increase in capacity with real-world objects is not solely due to the use of separate episodic long-term memory systems. In particular, we show that this increase is a result of active storage in working memory, as shown by directly measuring neural activity during the delay period of a working memory task using EEG. These data challenge fixed-capacity working memory models and demonstrate that working memory and its capacity limitations are dependent upon our existing knowledge. PMID:27325767

  6. Rehabilitation Medicine Summit: Building Research Capacity

    ERIC Educational Resources Information Center

    Frontera, Walter R.; Fuhrer, Marcus J.; Jette, Alan M.; Chan, Leighton; Cooper, Rory A.; Duncan, Pamela W.; Kemp, John D.; Ottenbacher, Kenneth J.; Peckham, P. Hunter; Roth, Elliot J.; Tate, Denise G.

    2006-01-01

    The general objective of the "Rehabilitation Medicine Summit: Building Research Capacity" was to advance and promote research in medical rehabilitation by making recommendations to expand research capacity. The 5 elements of research capacity that guided the discussions were (a) researchers; (b) research culture, environment, and infrastructure;…

  7. 14 CFR 25 - Traffic and Capacity Elements

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Traffic and Capacity Elements Section 25... Traffic Reporting Requirements Section 25 Traffic and Capacity Elements General Instructions. (a) All prescribed reporting for traffic and capacity elements shall conform with the data compilation standards...

  8. 25 CFR 167.6 - Carrying capacities.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false Carrying capacities. 167.6 Section 167.6 Indians BUREAU... Carrying capacities. (a) The Commissioner of Indian Affairs on June 26, 1943, promulgated the authorized carrying capacity for each land management district of the Navajo Reservation. (b) Recommended...

  9. 25 CFR 167.6 - Carrying capacities.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 1 2012-04-01 2011-04-01 true Carrying capacities. 167.6 Section 167.6 Indians BUREAU OF... capacities. (a) The Commissioner of Indian Affairs on June 26, 1943, promulgated the authorized carrying... carrying capacities shall be referred by the Superintendent to District Grazing Committee, Central...

  10. 25 CFR 167.6 - Carrying capacities.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 1 2013-04-01 2013-04-01 false Carrying capacities. 167.6 Section 167.6 Indians BUREAU... Carrying capacities. (a) The Commissioner of Indian Affairs on June 26, 1943, promulgated the authorized carrying capacity for each land management district of the Navajo Reservation. (b) Recommended...

  11. 25 CFR 167.6 - Carrying capacities.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Carrying capacities. 167.6 Section 167.6 Indians BUREAU... Carrying capacities. (a) The Commissioner of Indian Affairs on June 26, 1943, promulgated the authorized carrying capacity for each land management district of the Navajo Reservation. (b) Recommended...

  12. Compressibility and heat capacity of rotating plasma

    NASA Astrophysics Data System (ADS)

    Geyko, V. I.; Fisch, N. J.

    2017-02-01

    A rotating plasma column is shown to exhibit unusual heat capacity effects under compression. For near equilibrium thermodynamics and smooth wall conditions, the heat capacity depends on the plasma density, on the speed of the rotation, and on the mass ratio. For a certain range of parameters, the storage of energy in the electric field produces a significant increase in the heat capacity.

  13. 10 CFR 904.9 - Excess capacity.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 4 2013-01-01 2013-01-01 false Excess capacity. 904.9 Section 904.9 Energy DEPARTMENT OF ENERGY GENERAL REGULATIONS FOR THE CHARGES FOR THE SALE OF POWER FROM THE BOULDER CANYON PROJECT Power Marketing § 904.9 Excess capacity. (a) If the Uprating Program results in Excess Capacity, Western shall...

  14. 10 CFR 904.9 - Excess capacity.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 4 2014-01-01 2014-01-01 false Excess capacity. 904.9 Section 904.9 Energy DEPARTMENT OF ENERGY GENERAL REGULATIONS FOR THE CHARGES FOR THE SALE OF POWER FROM THE BOULDER CANYON PROJECT Power Marketing § 904.9 Excess capacity. (a) If the Uprating Program results in Excess Capacity, Western shall...

  15. 10 CFR 904.9 - Excess capacity.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 4 2011-01-01 2011-01-01 false Excess capacity. 904.9 Section 904.9 Energy DEPARTMENT OF ENERGY GENERAL REGULATIONS FOR THE CHARGES FOR THE SALE OF POWER FROM THE BOULDER CANYON PROJECT Power Marketing § 904.9 Excess capacity. (a) If the Uprating Program results in Excess Capacity, Western shall...

  16. 10 CFR 904.9 - Excess capacity.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 4 2012-01-01 2012-01-01 false Excess capacity. 904.9 Section 904.9 Energy DEPARTMENT OF ENERGY GENERAL REGULATIONS FOR THE CHARGES FOR THE SALE OF POWER FROM THE BOULDER CANYON PROJECT Power Marketing § 904.9 Excess capacity. (a) If the Uprating Program results in Excess Capacity, Western shall...

  17. 30 CFR 56.19001 - Rated capacities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Rated capacities. 56.19001 Section 56.19001 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE... § 56.19001 Rated capacities. Hoists shall have rated capacities consistent with the loads handled...

  18. 30 CFR 57.19001 - Rated capacities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Rated capacities. 57.19001 Section 57.19001 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE... Hoists § 57.19001 Rated capacities. Hoists shall have rated capacities consistent with the loads...

  19. 47 CFR 80.861 - Required capacity.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 5 2010-10-01 2010-10-01 false Required capacity. 80.861 Section 80.861... Required capacity. If the main power supply or the reserve power supply provided for the purpose of... capacity available at all times while the vessel is leaving or attempting to leave a harbor or port for...

  20. 40 CFR 35.2123 - Reserve capacity.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Reserve capacity. 35.2123 Section 35... STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works § 35.2123 Reserve capacity. EPA will limit grant assistance for reserve capacity as follows: (a) If EPA awarded a grant for a Step...

  1. 30 CFR 77.1402 - Rated capacity.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Rated capacity. 77.1402 Section 77.1402 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY... § 77.1402 Rated capacity. Hoists and elevators shall have rated capacities consistent with the...

  2. 30 CFR 56.19001 - Rated capacities.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Rated capacities. 56.19001 Section 56.19001 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE... § 56.19001 Rated capacities. Hoists shall have rated capacities consistent with the loads handled...

  3. 30 CFR 56.19001 - Rated capacities.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Rated capacities. 56.19001 Section 56.19001 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE... § 56.19001 Rated capacities. Hoists shall have rated capacities consistent with the loads handled...

  4. 30 CFR 56.19001 - Rated capacities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Rated capacities. 56.19001 Section 56.19001 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE... § 56.19001 Rated capacities. Hoists shall have rated capacities consistent with the loads handled...

  5. 40 CFR 35.2123 - Reserve capacity.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Reserve capacity. 35.2123 Section 35... STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works § 35.2123 Reserve capacity. EPA will limit grant assistance for reserve capacity as follows: (a) If EPA awarded a grant for a Step...

  6. 30 CFR 57.19001 - Rated capacities.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Rated capacities. 57.19001 Section 57.19001 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE... Hoists § 57.19001 Rated capacities. Hoists shall have rated capacities consistent with the loads...

  7. 47 CFR 80.919 - Required capacity.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 5 2013-10-01 2013-10-01 false Required capacity. 80.919 Section 80.919... capacity. If either the main or reserve power supply includes batteries, these batteries must have sufficient reserve capacity to permit proper operation of the required transmitter and receiver for at...

  8. 40 CFR 35.2123 - Reserve capacity.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Reserve capacity. 35.2123 Section 35... STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works § 35.2123 Reserve capacity. EPA will limit grant assistance for reserve capacity as follows: (a) If EPA awarded a grant for a Step...

  9. 24 CFR 574.410 - Capacity.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 3 2014-04-01 2013-04-01 true Capacity. 574.410 Section 574.410... Project Sponsors § 574.410 Capacity. The grantee shall ensure that any project sponsor with which the grantee contracts to carry out an activity under this part has the capacity and capability to...

  10. 40 CFR 35.2123 - Reserve capacity.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Reserve capacity. 35.2123 Section 35... STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works § 35.2123 Reserve capacity. EPA will limit grant assistance for reserve capacity as follows: (a) If EPA awarded a grant for a Step...

  11. 30 CFR 77.1402 - Rated capacity.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Rated capacity. 77.1402 Section 77.1402 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY... § 77.1402 Rated capacity. Hoists and elevators shall have rated capacities consistent with the...

  12. 47 CFR 80.861 - Required capacity.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 5 2014-10-01 2014-10-01 false Required capacity. 80.861 Section 80.861... Required capacity. If the main power supply or the reserve power supply provided for the purpose of... capacity available at all times while the vessel is leaving or attempting to leave a harbor or port for...

  13. 47 CFR 80.861 - Required capacity.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 5 2011-10-01 2011-10-01 false Required capacity. 80.861 Section 80.861... Required capacity. If the main power supply or the reserve power supply provided for the purpose of... capacity available at all times while the vessel is leaving or attempting to leave a harbor or port for...

  14. 40 CFR 35.2123 - Reserve capacity.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 40 Protection of Environment 1 2012-07-01 2012-07-01 false Reserve capacity. 35.2123 Section 35... STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works § 35.2123 Reserve capacity. EPA will limit grant assistance for reserve capacity as follows: (a) If EPA awarded a grant for a Step...

  15. 47 CFR 80.861 - Required capacity.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 5 2012-10-01 2012-10-01 false Required capacity. 80.861 Section 80.861... Required capacity. If the main power supply or the reserve power supply provided for the purpose of... capacity available at all times while the vessel is leaving or attempting to leave a harbor or port for...

  16. 47 CFR 80.861 - Required capacity.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 47 Telecommunication 5 2013-10-01 2013-10-01 false Required capacity. 80.861 Section 80.861... Required capacity. If the main power supply or the reserve power supply provided for the purpose of... capacity available at all times while the vessel is leaving or attempting to leave a harbor or port for...

  17. 30 CFR 77.1402 - Rated capacity.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Rated capacity. 77.1402 Section 77.1402 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY... § 77.1402 Rated capacity. Hoists and elevators shall have rated capacities consistent with the...

  18. 47 CFR 80.919 - Required capacity.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 47 Telecommunication 5 2011-10-01 2011-10-01 false Required capacity. 80.919 Section 80.919... capacity. If either the main or reserve power supply includes batteries, these batteries must have sufficient reserve capacity to permit proper operation of the required transmitter and receiver for at...

  19. 47 CFR 80.919 - Required capacity.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 47 Telecommunication 5 2012-10-01 2012-10-01 false Required capacity. 80.919 Section 80.919... capacity. If either the main or reserve power supply includes batteries, these batteries must have sufficient reserve capacity to permit proper operation of the required transmitter and receiver for at...

  20. 47 CFR 80.919 - Required capacity.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 47 Telecommunication 5 2014-10-01 2014-10-01 false Required capacity. 80.919 Section 80.919... capacity. If either the main or reserve power supply includes batteries, these batteries must have sufficient reserve capacity to permit proper operation of the required transmitter and receiver for at...