WorldWideScience

Sample records for clinical review critical

  1. Reproducibility of clinical research in critical care: a scoping review.

    Science.gov (United States)

    Niven, Daniel J; McCormick, T Jared; Straus, Sharon E; Hemmelgarn, Brenda R; Jeffs, Lianne; Barnes, Tavish R M; Stelfox, Henry T

    2018-02-21

    The ability to reproduce experiments is a defining principle of science. Reproducibility of clinical research has received relatively little scientific attention. However, it is important as it may inform clinical practice, research agendas, and the design of future studies. We used scoping review methods to examine reproducibility within a cohort of randomized trials examining clinical critical care research and published in the top general medical and critical care journals. To identify relevant clinical practices, we searched the New England Journal of Medicine, The Lancet, and JAMA for randomized trials published up to April 2016. To identify a comprehensive set of studies for these practices, included articles informed secondary searches within other high-impact medical and specialty journals. We included late-phase randomized controlled trials examining therapeutic clinical practices in adults admitted to general medical-surgical or specialty intensive care units (ICUs). Included articles were classified using a reproducibility framework. An original study was the first to evaluate a clinical practice. A reproduction attempt re-evaluated that practice in a new set of participants. Overall, 158 practices were examined in 275 included articles. A reproduction attempt was identified for 66 practices (42%, 95% CI 33-50%). Original studies reported larger effects than reproduction attempts (primary endpoint, risk difference 16.0%, 95% CI 11.6-20.5% vs. 8.4%, 95% CI 6.0-10.8%, P = 0.003). More than half of clinical practices with a reproduction attempt demonstrated effects that were inconsistent with the original study (56%, 95% CI 42-68%), among which a large number were reported to be efficacious in the original study and to lack efficacy in the reproduction attempt (34%, 95% CI 19-52%). Two practices reported to be efficacious in the original study were found to be harmful in the reproduction attempt. A minority of critical care practices with research published

  2. Resveratrol and diabetes: A critical review of clinical studies.

    Science.gov (United States)

    Öztürk, Ebru; Arslan, Ayşe Kübra Karaboğa; Yerer, Mükerrem Betül; Bishayee, Anupam

    2017-11-01

    Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia. The disease results from the defects of insulin secretion and/or action. Resveratrol is a non-flavonoid polyphenol that naturally occurs as phytoalexin. The shell and stem of Vitis vinifera L. (Vitaceae) are the richest source of this compound. In addition to various in vitro and in vivo studies revealing the effectiveness of resveratrol in DM, there are many clinical trials indicating that resveratrol has the potential to benefit in DM patients. The therapeutic action of this compound in relation to diabetes is complex and involves in several beneficial roles. In view of this, clinical studies are necessary to elucidate these roles. In the near future, the use of resveratrol, alone or in combination with current anti-diabetic therapies, might be a conventional approach to effectively manage DM or its complications. This mini-review provides a critical overview of currently available clinical studies examining the effects of resveratrol in DM last decade. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  3. Critical Review

    DEFF Research Database (Denmark)

    Rosenbaum, Ralph K.; Olsen, Stig Irving

    2018-01-01

    Manipulation and mistakes in LCA studies are as old as the tool itself, and so is its critical review. Besides preventing misuse and unsupported claims, critical review may also help identifying mistakes and more justifiable assumptions as well as generally improve the quality of a study. It thus...... supports the robustness of an LCA and increases trust in its results and conclusions. The focus of this chapter is on understanding what a critical review is, how the international standards define it, what its main elements are, and what reviewer qualifications are required. It is not the objective...... of this chapter to learn how to conduct a critical review, neither from a reviewer nor from a practitioner perspective. The foundation of this chapter and the basis for any critical review of LCA studies are the International Standards ISO 14040:2006, ISO 14044:2006 and ISO TS 14071:2014....

  4. Clinical review: International comparisons in critical care - lessons learned.

    Science.gov (United States)

    Murthy, Srinivas; Wunsch, Hannah

    2012-12-12

    Critical care medicine is a global specialty and epidemiologic research among countries provides important data on availability of critical care resources, best practices, and alternative options for delivery of care. Understanding the diversity across healthcare systems allows us to explore that rich variability and understand better the nature of delivery systems and their impact on outcomes. However, because the delivery of ICU services is complex (for example, interplay of bed availability, cultural norms and population case-mix), the diversity among countries also creates challenges when interpreting and applying data. This complexity has profound influences on reported outcomes, often obscuring true differences. Future research should emphasize determination of resource data worldwide in order to understand current practices in different countries; this will permit rational pandemic and disaster planning, allow comparisons of in-ICU processes of care, and facilitate addition of pre- and post-ICU patient data to better interpret outcomes.

  5. A critical review of clinical trials in systemic lupus erythematosus

    Science.gov (United States)

    Mahieu, Mary A.; Strand, Vibeke; Simon, Lee S.; Lipsky, Peter E.; Ramsey-Goldman, Rosalind

    2016-01-01

    One challenge in caring for patients with systemic lupus erythematosus (SLE) is a paucity of approved therapeutics for treatment of the diverse disease manifestations. In the last 60 years, only one drug, belimumab, has been approved for SLE treatment. Critical evaluation of investigator initiated and pharma-sponsored randomized controlled trials (RCTs) highlights barriers to successful drug development in SLE, including disease heterogeneity, inadequate trial size or duration, insufficient dose finding before initiation of large trials, handling of background medications, and choice of primary endpoint. Herein we examine lessons learned from landmark SLE RCTs and subsequent advances in trial design, as well as discuss efforts to address limitations in current SLE outcome measures that will improve detection of true therapeutic responses in future RCTs. PMID:27497257

  6. Models of clinical reasoning with a focus on general practice: A critical review.

    Science.gov (United States)

    Yazdani, Shahram; Hosseinzadeh, Mohammad; Hosseini, Fakhrolsadat

    2017-10-01

    Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings. A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized. Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed.

  7. Models of clinical reasoning with a focus on general practice: a critical review

    Directory of Open Access Journals (Sweden)

    SHAHRAM YAZDANI

    2017-10-01

    Full Text Available Introduction: Diagnosis lies at the heart of general practice. Every day general practitioners (GPs visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings Methods: A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized Results: Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. Conclusion: A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties

  8. Management of language discordance in clinical nursing practice--A critical review.

    Science.gov (United States)

    Probst, Sebastian; Imhof, Lorenz

    2016-05-01

    Language plays an essential role in the provision of nursing care, since successful communication is a vital prerequisite to being able to provide appropriate nursing care efficiently and effectively. It is not known what kinds of interventions are effective in overcoming language discordance in nursing practice. This critical review aimed to examine the interventions that are most successfully used to overcome language discordance in nursing. A critical review of the literature was performed and 24 relevant research papers were included. A search was carried out between January 2004 and September 2014 in MEDLINE, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychinfo, Germanistic online, Pragmatis and Linguistic & Language Behaviour Abstracts (LLBA). Both authors independently screened the titles (n=299), abstracts and full texts to decide which articles should be chosen. The inclusion criteria were: (1) articles examine the problem of language discordance in various health care settings and (2) articles published in English, German, French or Italian. Articles were included irrespective of their design. Data were analysed using the Critical Appraisal Skills Program Tool (CASP). In total, 24 publications met the inclusion criteria. Most of the studies (n=20) were focused on the nursing intervention of using an interpreter and three were describing the nursing assessment. The study designs of the included studies were mainly non-experimental studies, qualitative studies or reviews. The only suggested intervention described in the articles is the use of ad-hoc or professional interpreters for communicating with patients who do not speak the local language. Health care institutions should provide more strategies for clinical practice to overcome language discordance. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Clinical review: optimizing enteral nutrition for critically ill patients - a simple data-driven formula

    Science.gov (United States)

    2011-01-01

    In modern critical care, the paradigm of 'therapeutic nutrition' is replacing traditional 'supportive nutrition'. Standard enteral formulas meet basic macro- and micronutrient needs; therapeutic enteral formulas meet these basic needs and also contain specific pharmaconutrients that may attenuate hyperinflammatory responses, enhance the immune responses to infection, or improve gastrointestinal tolerance. Choosing the right enteral feeding formula may positively affect a patient's outcome; targeted use of therapeutic formulas can reduce the incidence of infectious complications, shorten lengths of stay in the ICU and in the hospital, and lower risk for mortality. In this paper, we review principles of how to feed (enteral, parenteral, or both) and when to feed (early versus delayed start) patients who are critically ill. We discuss what to feed these patients in the context of specific pharmaconutrients in specialized feeding formulations, that is, arginine, glutamine, antioxidants, certain ω-3 and ω-6 fatty acids, hydrolyzed proteins, and medium-chain triglycerides. We summarize current expert guidelines for nutrition in patients with critical illness, and we present specific clinical evidence on the use of enteral formulas supplemented with anti-inflammatory or immune-modulating nutrients, and gastrointestinal tolerance-promoting nutritional formulas. Finally, we introduce an algorithm to help bedside clinicians make data-driven feeding decisions for patients with critical illness. PMID:22136305

  10. Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice

    Science.gov (United States)

    Houghton, Pamela; Anthony, Joseph; Rennie, Sandy; Shay, Barbara L.; Hoens, Alison M.

    2017-01-01

    Purpose: In response to requests from physiotherapists for guidance on optimal stimulation of muscle using neuromuscular electrical stimulation (NMES), a review, synthesis, and extraction of key data from the literature was undertaken by six Canadian physical therapy (PT) educators, clinicians, and researchers in the field of electrophysical agents. The objective was to identify commonly treated conditions for which there was a substantial body of literature from which to draw conclusions regarding the effectiveness of NMES. Included studies had to apply NMES with visible and tetanic muscle contractions. Method: Four electronic databases (CINAHL, Embase, PUBMED, and SCOPUS) were searched for relevant literature published between database inceptions until May 2015. Additional articles were identified from bibliographies of the systematic reviews and from personal collections. Results: The extracted data were synthesized using a consensus process among the authors to provide recommendations for optimal stimulation parameters and application techniques to address muscle impairments associated with the following conditions: stroke (upper or lower extremity; both acute and chronic), anterior cruciate ligament reconstruction, patellofemoral pain syndrome, knee osteoarthritis, and total knee arthroplasty as well as critical illness and advanced disease states. Summaries of key details from each study incorporated into the review were also developed. The final sections of the article outline the recommended terminology for describing practice using electrical currents and provide tips for safe and effective clinical practice using NMES. Conclusion: This article provides physiotherapists with a resource to enable evidence-informed, effective use of NMES for PT practice. PMID:29162949

  11. Critical review of willingness to pay for clinical oral health interventions.

    Science.gov (United States)

    Tan, Sharon Hui Xuan; Vernazza, Christopher R; Nair, Rahul

    2017-09-01

    This critical review aimed to identify, consolidate and evaluate the quality of Willingness to Pay (WTP) studies applied to clinical contexts in the field of dentistry. PubMed and Web of Science databases were systematically searched for relevant publications. Screening and data extraction was then performed. Primary literature in English-language were included to assess the WTP for oral health interventions, when the valuations were applied to a clinical measure. Twenty-six publications met the inclusion criteria. WTP was elicited mainly via face-to-face interviews (13 publications) and questionnaires (12 publications). The majority (24) of publications selected an out-of-pocket payment vehicle. Eleven publications adopted a bidding method, nine publications adopted an open-ended format, and the remaining six studies adopted a payment card or choice method. Pre-testing was reported in only nine publications, and few studies accounted for starting point bias. Eight of 11 publications found that higher incomes were associated with higher WTP values. The female gender, a younger age and higher education levels were associated with a higher WTP in select studies. Only a small minority of the studies used strategies to avoid well documented biases related to WTP elicitation. Cost versus benefit of many clinical scenarios remain uninvestigated. WTP studies in dentistry may benefit from pre-testing and the inclusion of a script to minimise hypothetical bias. They may also be better conducted face-to-face and via a shuffled payment card method. Income levels, and potentially education levels, gender and age, should be assessed for their influence on WTP values. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  12. Clinical review: Helmet and non-invasive mechanical ventilation in critically ill patients.

    Science.gov (United States)

    Esquinas Rodriguez, Antonio M; Papadakos, Peter J; Carron, Michele; Cosentini, Roberto; Chiumello, Davide

    2013-04-25

    Non-invasive mechanical ventilation (NIV) has proved to be an excellent technique in selected critically ill patients with different forms of acute respiratory failure. However, NIV can fail on account of the severity of the disease and technical problems, particularly at the interface. The helmet could be an alternative interface compared to face mask to improve NIV success. We performed a clinical review to investigate the main physiological and clinical studies assessing the efficacy and related issues of NIV delivered with a helmet. A computerized search strategy of MEDLINE/PubMed (January 2000 to May 2012) and EMBASE (January 2000 to May 2012) was conducted limiting the search to retrospective, prospective, nonrandomized and randomized trials. We analyzed 152 studies from which 33 were selected, 12 physiological and 21 clinical (879 patients). The physiological studies showed that NIV with helmet could predispose to CO₂ rebreathing and increase the patients' ventilator asynchrony. The main indications for NIV were acute cardiogenic pulmonary edema, hypoxemic acute respiratory failure (community-acquired pneumonia, postoperative and immunocompromised patients) and hypercapnic acute respiratory failure. In 9 of the 21 studies the helmet was compared to a face mask during either continous positive airway pressure or pressure support ventilation. In eight studies oxygenation was similar in the two groups, while the intubation rate was similar in four and lower in three studies for the helmet group compared to face mask group. The outcome was similar in six studies. The tolerance was better with the helmet in six of the studies. Although these data are limited, NIV delivered by helmet could be a safe alternative to the face mask in patients with acute respiratory failure.

  13. An integrated review of the correlation between critical thinking ability and clinical decision-making in nursing.

    Science.gov (United States)

    Lee, Daphne Sk; Abdullah, Khatijah Lim; Subramanian, Pathmawathi; Bachmann, Robert Thomas; Ong, Swee Leong

    2017-12-01

    To explore whether there is a correlation between critical thinking ability and clinical decision-making among nurses. Critical thinking is currently considered as an essential component of nurses' professional judgement and clinical decision-making. If confirmed, nursing curricula may be revised emphasising on critical thinking with the expectation to improve clinical decision-making and thus better health care. Integrated literature review. The integrative review was carried out after a comprehensive literature search using electronic databases Ovid, EBESCO MEDLINE, EBESCO CINAHL, PROQuest and Internet search engine Google Scholar. Two hundred and 22 articles from January 1980 to end of 2015 were retrieved. All studies evaluating the relationship between critical thinking and clinical decision-making, published in English language with nurses or nursing students as the study population, were included. No qualitative studies were found investigating the relationship between critical thinking and clinical decision-making, while 10 quantitative studies met the inclusion criteria and were further evaluated using the Quality Assessment and Validity Tool. As a result, one study was excluded due to a low-quality score, with the remaining nine accepted for this review. Four of nine studies established a positive relationship between critical thinking and clinical decision-making. Another five studies did not demonstrate a significant correlation. The lack of refinement in studies' design and instrumentation were arguably the main reasons for the inconsistent results. Research studies yielded contradictory results as regard to the relationship between critical thinking and clinical decision-making; therefore, the evidence is not convincing. Future quantitative studies should have representative sample size, use critical thinking measurement tools related to the healthcare sector and evaluate the predisposition of test takers towards their willingness and ability to think

  14. Metaphor-related figurative language comprehension in clinical populations: a critical review

    Directory of Open Access Journals (Sweden)

    Maity Siqueira

    2016-12-01

    Full Text Available This paper aims to critically review current studies with respect to definitions,methods, and results on the comprehension of metaphor, metonymy,idioms, and proverbs under the following clinical conditions: aphasia,Alzheimer’s disease, autism, brain injuries, specific language impairment,and Williams Syndrome. A comprehensive search of experimentalpsycholinguistic research was conducted using EBSCOhost, PsychInfo,PUBMED, and Web of Science databases. Thirty-eight studies met thereview inclusion criteria. Results point to deficits in figurative languagecomprehension in all conditions considered, lack of clear definitions ofthe phenomena investigated, and varied methods throughout the sample.Patients’ difficulties are attributed to multiple factors, such as a lack ofTheory of Mind, executive dysfunctions, and poor semantic knowledge.The study of nonliteral aspects of language comprehension in clinicalpopulations reveals a range of disparate impairments. There was no specificfeature about metaphor-related phenomena identified that could, on its own,account for the difficulty some populations have to understand figurativelanguage. Rather, metaphor-related language comprehension difficultiesare often part of pragmatic, linguistic, and/or cognitive impairments.Keywords: Figurative language. Metaphor. Metonymy. Proverb. Clinicalpopulations

  15. Evidence Based Clinical Assessment of Child and Adolescent Social Phobia: A Critical Review of Rating Scales

    Science.gov (United States)

    Tulbure, Bogdan T.; Szentagotai, Aurora; Dobrean, Anca; David, Daniel

    2012-01-01

    Investigating the empirical support of various assessment instruments, the evidence based assessment approach expands the scientific basis of psychotherapy. Starting from Hunsley and Mash's evaluative framework, we critically reviewed the rating scales designed to measure social anxiety or phobia in youth. Thirteen of the most researched social…

  16. Clinical reasoning and critical thinking.

    Science.gov (United States)

    da Silva Bastos Cerullo, Josinete Aparecida; de Almeida Lopes Monteiro da Cruz, Diná

    2010-01-01

    This study identifies and analyzes nursing literature on clinical reasoning and critical thinking. A bibliographical search was performed in LILACS, SCIELO, PUBMED and CINAHL databases, followed by selection of abstracts and the reading of full texts. Through the review we verified that clinical reasoning develops from scientific and professional knowledge, is permeated by ethical decisions and nurses values and also that there are different personal and institutional strategies that might improve the critical thinking and clinical reasoning of nurses. Further research and evaluation of educational programs on clinical reasoning that integrate psychosocial responses to physiological responses of people cared by nurses is needed.

  17. Critical Care Follow-up Clinics: A Scoping Review of Interventions and Outcomes.

    Science.gov (United States)

    Lasiter, Sue; Oles, Sylwia K; Mundell, James; London, Susan; Khan, Babar

    2016-01-01

    The purpose of this scoping review is to identify evidence describing benefits of interventions provided in intensive care unit (ICU) survivor follow-up clinics. Advances in ICU treatments have increased the number of survivors who require specialized care for ICU-related sequelae. Intensive care unit survivor follow-up clinics exist, yet little is known about the nature and impact of interventions provided in such clinics. A scoping review of publications about in-person post-ICU follow-up care was undertaken. Ten databases were searched yielding 111 relevant unique publication titles and abstracts. Sample heterogeneity supported using a scoping review method. After excluding nonrelated publications, 33 reports were fully reviewed. Twenty international publications were included that described ICU follow-up clinic interventions and/or outcomes. Authors discussed very diverse interventions in 15 publications, and 9 reported some level of intervention effectiveness. Evidence was strongest that supported the use of prospective diaries as an intervention to prevent or improve psychological symptoms, whereas evidence to support implementation of other interventions was weak. Although ICU follow-up clinics exist, evidence for interventions and effectiveness of treatments in these clinics remains underexplored. Intensive care unit survivor follow-up clinics provide a venue for further interdisciplinary intervention research that could lead to better health outcomes for ICU survivors.

  18. Cognitive-behavioral therapy for somatization and symptom syndromes: a critical review of controlled clinical trials.

    Science.gov (United States)

    Kroenke, K; Swindle, R

    2000-01-01

    Few treatments for somatization have been proven effective. In the past decade, however, clinical trials of cognitive-behavioral therapy (CBT) have been promising. Our aim was to critically review and synthesize the evidence from these trials. A search of the Medline database from 1966 through July 1999 was conducted to identify controlled trials designed to evaluate the efficacy of CBT in patients with somatization or symptom syndromes. A total of 31 controlled trials (29 randomized and 2 nonrandomized) were identified. Twenty-five studies targeted a specific syndrome (e.g. chronic fatigue, irritable bowel, pain) while 6 focused on more general somatization or hypochondriasis. Primary outcome assessment included physical symptoms, psychological distress and functional status in 28, 26 and 19 studies, respectively. Physical symptoms appeared the most responsive: CBT-treated patients improved more than control subjects in 71% of the studies and showed possibly greater improvement (i.e., a trend) in another 11% of the studies. A definite or possible advantage of CBT for reducing psychological distress was demonstrated in only 38 and 8% of studies, and for improving functional status in 47 and 26%. Group therapy and interventions as brief as 5 sessions proved efficacious. Benefits were sustained for up to 12 months. CBT can be an effective treatment for patients with somatization or symptom syndromes. Benefits can occur whether or not psychological distress is ameliorated. Since chronic symptoms are exceptionally common and most studies were conducted in referral populations, the optimal sequencing of CBT in treating primary care patients and the identification of those most likely to accept and respond to therapy should be further evaluated. Copyright 2000 S. Karger AG, Basel.

  19. The Clinical Use of Robots for Individuals with Autism Spectrum Disorders: A Critical Review

    Science.gov (United States)

    Diehl, Joshua J.; Schmitt, Lauren M.; Villano, Michael; Crowell, Charles R.

    2012-01-01

    We examined peer-reviewed studies in order to understand the current status of empirically based evidence on the clinical applications of robots in the diagnosis and treatment of Autism Spectrum Disorders (ASD). Studies are organized into four broad categories: (a) the response of individuals with ASD to robots or robot-like behavior in comparison…

  20. Clinical assessment of spasticity in children with cerebral palsy: a critical review of available instruments

    NARCIS (Netherlands)

    Scholtes, Vanessa A. B.; Becher, Jules G.; Beelen, Anita; Lankhorst, Gustaaf J.

    2006-01-01

    This study reviews the instruments used for the clinical assessment of spasticity in children with cerebral palsy, and evaluates their compliance with the concept of spasticity, defined as a velocity-dependent increase in muscle tone to passive stretch. Searches were performed in Medline, Embase,

  1. Clinical implications of in silico mathematical modeling for glioblastoma: a critical review.

    Science.gov (United States)

    Protopapa, Maria; Zygogianni, Anna; Stamatakos, Georgios S; Antypas, Christos; Armpilia, Christina; Uzunoglu, Nikolaos K; Kouloulias, Vassilis

    2018-01-01

    Glioblastoma remains a clinical challenge in spite of years of extensive research. Novel approaches are needed in order to integrate the existing knowledge. This is the potential role of mathematical oncology. This paper reviews mathematical models on glioblastoma from the clinical doctor's point of view, with focus on 3D modeling approaches of radiation response of in vivo glioblastomas based on contemporary imaging techniques. As these models aim to provide a clinically useful tool in the era of personalized medicine, the integration of the latest advances in molecular and imaging science and in clinical practice by the in silico models is crucial for their clinical relevance. Our aim is to indicate areas of GBM research that have not yet been addressed by in silico models and to point out evidence that has come up from in silico experiments, which may be worth considering in the clinic. This review examines how close these models have come in predicting the outcome of treatment protocols and in shaping the future of radiotherapy treatments.

  2. Clinical review

    DEFF Research Database (Denmark)

    Groth, Kristian; Skakkebæk, Anne; Høst, Christian

    2013-01-01

    Recently, new clinically important information regarding Klinefelter syndrome (KS) has been published. We review aspects of epidemiology, endocrinology, metabolism, body composition, and neuropsychology with reference to recent genetic discoveries.......Recently, new clinically important information regarding Klinefelter syndrome (KS) has been published. We review aspects of epidemiology, endocrinology, metabolism, body composition, and neuropsychology with reference to recent genetic discoveries....

  3. Radium-223 in the Treatment of Osteoblastic Metastases: A Critical Clinical Review

    Energy Technology Data Exchange (ETDEWEB)

    Humm, John L. [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Sartor, Oliver [Departments of Medicine and Urology, Tulane Cancer Center, Tulane University School of Medicine, New Orleans, Louisiana (United States); Parker, Chris [Department of Clinical Oncology, Institute of Cancer Research, Sutton (United Kingdom); Bruland, Oyvind S. [Department of Oncology, Norwegian Radium Hospital and Institute for Clinical Medicine, University of Oslo, Oslo (Norway); Macklis, Roger, E-mail: rmmacklis@gmail.com [Department of Radiation Oncology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio (United States)

    2015-04-01

    The element radium (Ra) was discovered by the Curies in 1898 and within a decade was in broad scientific testing for the management of several forms of cancer. The compound was known to give rise to a series of both high-energy particulate and penetrating γ-emissions. The latter found an important role in early 20th century brachytherapy applications, but the short-range α-particles seemed much less useful. Although highly cytotoxic when released within a few cell diameters of critical cell nuclei, the dense double-strand break damage was poorly repaired, and concerns regarding treatment-related toxicities and secondary malignancies halted clinical development. Moreover, the most common isotope of Ra has an exceptionally long half-life (>1600 years for {sup 226}Ra) that proved daunting when aiming for a systemic cancer therapy. Fortunately, other radium isotopes have more convenient half-lives while still producing cytotoxic α particles. Radium-223 dichloride has a half-life of 11.4 days, and this isotope was identified as an excellent candidate for radionuclide therapy of cancers metastatic to bone. The calcium-mimetic chemical properties of the radium allowed intravenous infusion with rapid uptake to sites of new bone formation. The highly efficient bone localization suggested a potential therapeutic role for osteoblastic bone metastases, and a series of phase 1, 2, and 3 clinical trials was undertaken to explore this possibility. This series of clinical explorations culminated in the ALSYMPCA trial, an international, placebo-controlled, phase 3 study that accrued 921 symptomatic men with bone-metastatic, castrate-resistant prostate cancer. Results of this trial demonstrated a prolongation of overall survival, and regulatory agencies around the world have now approved this product as a treatment for advanced prostate cancer.

  4. Occlusal changes secondary to temporomandibular joint conditions: a critical review and implications for clinical practice

    Science.gov (United States)

    CALDAS, Waleska; CONTI, Ana Cláudia de Castro Ferreira; JANSON, Guilherme; Paulo César Rodrigues, CONTI

    2016-01-01

    ABSTRACT The relationship between Temporomandibular Disorders (TMD) and malocclusion is an extremely critical issue in dentistry. Contrary to the old concept that malocclusion causes TMD, occlusal changes, especially those observed as sudden, may be secondary and reflect joint or muscle disorders due to the obvious connection between these structures and the dental occlusion. Objectives The aim of this article is to present the most commonly occlusal changes secondary to TMD. Methods The clinical presentation of these conditions is discussed. Details regarding diagnosis, treatment, and follow-up of patients presenting TMD prior or during treatment are also presented. Conclusions All plans for irreversible therapy should be preceded by a meticulous analysis of TMD signs and symptoms in such a way that patients are not submitted to irreversible treatment, based on an untrue occlusal relationship, secondary to articular and/or muscular disorders. When present, TMD symptoms must always be controlled to reestablish a “normal” occlusion and allow proper treatment strategy. PMID:27556214

  5. [The clinic of apathy in schizophrenia: a critical review of the issue].

    Science.gov (United States)

    Yazbek, H; Raffard, S; Del-Monte, J; Pupier, F; Larue, A; Boulenger, J-P; Gély-Nargeot, M-C; Capdevielle, D

    2014-06-01

    Today the concept of apathy is subject to many questions. This psychological state is present and predominant in different disorders such as neurodegenerative and psychiatric diseases or neurological acquired disorders. Apathy is a part of the clinical vocabulary, however, we can note that in the literature there remains confusion in its definition, and we can find an amalgam with other clinical symptoms. The aim of this review is to provide a clarification of the concept of apathy in clinical practice in schizophrenia as well as to highlight the gaps that exist. Apathy belongs to the negative symptoms of schizophrenia. For its understanding, it is necessary to define apathy as a multidimensional syndrome (cognitive, emotional, and behavioral) manifesting as a quantitative reduction of voluntary behaviors directed toward one or several goals. However, at present, we are witnessing a reductionist and simplistic conception of the syndrome of apathy and this especially in the Anglo-Saxon literature. Several authors reduce apathy to its behavioral component, so in other words, to avolition/amotivation. Avolition refers to a loss of self-initiated and spontaneous behaviors. In this definition only observable behavior is taken into account and not the underlying mechanisms (cognitive and emotional). In order to understand the syndrome of apathy, it is necessary to have a holistic and multidimensional outlook. Some authors have proposed diagnostic criteria for apathy by taking into account the different dimensions of apathy. Moreover not only is apathy confused with avolition, but it is also still difficult to distinguish it from depression. Apathy and depression share common clinical signs (i.e. loss of interest), but they also have distinct clinical signs (lack of motivation for apathy, and suicidal ideation for depression). Authors have shown that the presence of one symptom (apathy or depression) does not predict the presence of the other. An apathetic patient does

  6. The Objective Structured Clinical Examination (OSCE) as a strategy for assessing clinical competence in midwifery education in Ireland: a critical review.

    Science.gov (United States)

    Smith, Valerie; Muldoon, Kathryn; Biesty, Linda

    2012-09-01

    In Ireland, to register as a midwife, all student midwives must be deemed competent to practice with the assessment of competence an essential component of midwifery education. A variety of assessment strategies, including observed practice, clinical interviews, portfolios of reflection, the Objective Structured Clinical Examination (OSCE) and written examination papers, are utilised to assess midwifery students' clinical competence. In this paper, a critical review of the OSCE as a strategy for assessing clinical competence in one third level institution in Ireland is offered. Although utilised for assessing competence across a range of areas (e.g. obstetric emergencies and pharmacology/drug administration), the use of the OSCE for assessing midwifery students' competence in lactation and infant feeding practices, as an example for this paper, is described. The advantages, disadvantages, validity and reliability of the OSCE, as an assessment strategy, are critically explored. Recognising that no single assessment strategy can provide all the information required to assess something as complex as clinical performance, the OSCE, when viewed alongside other forms of assessment, and with relevance to the topic under examination, may be considered a valuable strategy for enhancing the assessment of students' clinical competence, and for embracing diversity within midwifery education and training. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. Spondylolysis: a critical review

    Science.gov (United States)

    Standaert, C; Herring, S

    2000-01-01

    Aim—To provide an understanding of the current concepts in the natural history, pathophysiology, diagnosis, and treatment of spondylolysis based on the available medical literature. Methods—Articles were selected for review by the following methods: (a) MEDLINE searches with review of abstracts to select relevant articles; (b) review of multiple textbooks considered likely to contain information on spondylolysis; (c) review of references in articles identified by (a) and (b). Over 125 articles were ultimately reviewed fully. Publications were selected for inclusion in this article on the basis of perceived scientific and historical merit, particularly as thought to be relevant to achieving the stated purpose of this review. As no controlled clinical trials were identified, this could not be used as an inclusion criterion. Conclusions—Isthmic spondylolysis is considered to represent a fatigue fracture of the pars interarticularis of the neural arch. There is a relatively high incidence of radiographically identified spondylolysis in the general population, but the vast majority of these lesions probably occur without associated symptoms. Symptomatic pars lesions appear to be particularly a clinical problem in adolescents, especially adolescent athletes. The optimal diagnostic and treatment algorithms are not well identified in the current literature. Multiple imaging studies may have a role in the diagnosis of a pars lesion, and treatment seems likely to require at least relative rest and physical rehabilitation with consideration of bracing or, rarely, surgical intervention depending on the clinical context. Key Words: spondylolysis; spondylolisthesis; spine; back; neural arch; pars interarticularis PMID:11131228

  8. Clinical review: Ethics and end-of-life care for critically ill patients in China

    OpenAIRE

    Li, Li Bin

    2013-01-01

    Critical care medicine in China has made great advances in recent decades. This has led to an unavoidable issue: end-of-life ethics. With advances in medical technology and therapeutics allowing the seemingly limitless maintenance of life, the exact time of death of an individual patient is often determined by the decision to limit life support. How to care for patients at the end of life is not only a medical problem but also a social, ethical, and legal issue. A lot of factors, besides cult...

  9. Clinical implications of calcifying nanoparticles in dental diseases: a critical review

    Directory of Open Access Journals (Sweden)

    Alenazy MS

    2013-12-01

    Full Text Available Mohammed S Alenazy,1 Hezekiah A Mosadomi2,3 1Restorative Dentistry Department, 2Oral and Maxillofacial Pathology Department, 3Research Center, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia Background: Unknown cell-culture contaminants were described by Kajander and Ciftçioğlu in 1998. These contaminants were called nanobacteria initially and later calcifying nanoparticles (CNPs. Their exact nature is unclear and controversial. CNPs have unique and unusual characteristics, which preclude placing them into any established evolutionary branch of life. Aim: The aim of this systematic review was to assess published data concerning CNPs since 1998 in general and in relation to dental diseases in particular. Materials and methods: The National Library of Medicine (PubMed and Society of Photographic Instrumentation Engineers (SPIE electronic and manual searches were conducted. Nanobacteria and calcifying nanoparticles were used as keywords. The search yielded 135 full-length papers. Further screening of the titles and abstracts that followed the review criteria resulted in 43 papers that met the study aim. Conclusion: The review showed that the existence of nanobacteria is still controversial. Some investigators have described a possible involvement of CNPs in pulpal and salivary gland calcifications, as well as the possible therapeutic use of CNPs in the treatment of cracked and/or eroded teeth. Keywords: calcifying nanoparticles, nanobacteria, sialolith, pulp stone, enamel repair

  10. Hormones in pain modulation and their clinical implications for pain control: a critical review.

    Science.gov (United States)

    Chen, Xueyin; Zhang, Jinyuan; Wang, Xiangrui

    2016-07-01

    Recently, more and more studies have found that pain generation, transmission and modulation are under hormonal regulation. Indeed, hormonal dysregulation is a common component of chronic pain syndromes. Studies have attempted to determine whether the relationship between the pain and its perception and hormones is a causative relationship and how these processes interrelate. This review summarizes and analyzes the current experimental data and provides an overview of the studies addressing these questions. The relationship between pain perception and endocrine effects suggests that hormones can be used as important biomarkers of chronic pain syndromes and/or be developed into therapeutic agents in the fight against pain.

  11. The Effects of Bikram Yoga on Health: Critical Review and Clinical Trial Recommendations

    Directory of Open Access Journals (Sweden)

    Zoe L. Hewett

    2015-01-01

    Full Text Available Bikram yoga is a style of hatha yoga involving a standarized series of asanas performed to an instructional dialogue in a heated environment (40.6°C, 40% humidity. Several studies evaluating the effect of Bikram yoga on health-related outcomes have been published over the past decade. However, to date, there are no comprehensive reviews of this research and there remains a lack of large-scale, robustly-designed randomised controlled trials (RCT of Bikram yoga training. The purpose of this review is to contextualise and summarise trials that have evaluated the effects of Bikram yoga on health and to provide recommendations for future research. According to published literature, Bikram yoga has been shown to improve lower body strength, lower and upper body range of motion, and balance in healthy adults. Non-RCTs report that Bikram yoga may, in some populations, improve glucose tolerance, bone mineral density, blood lipid profile, arterial stiffness, mindfulness, and perceived stress. There is vast potential for further, improved research into the effects of Bikram yoga, particularly in unhealthy populations, to better understand intervention-related adaptations and their influence on the progression of chronic disease. Future research should adhere to CONSORT guidelines for better design and reporting to improve research quality in this field.

  12. Clinical review: Ethics and end-of-life care for critically ill patients in China.

    Science.gov (United States)

    Li, Li Bin

    2013-12-04

    Critical care medicine in China has made great advances in recent decades. This has led to an unavoidable issue: end-of-life ethics. With advances in medical technology and therapeutics allowing the seemingly limitless maintenance of life, the exact time of death of an individual patient is often determined by the decision to limit life support. How to care for patients at the end of life is not only a medical problem but also a social, ethical, and legal issue. A lot of factors, besides culture, come into play in determining a person's ethical attitudes or behaviors, such as experience, education, religion, individual attributes, and economic considerations. Chinese doctors face ethical problems similar to those of their Western counterparts; however, since Chinese society is different from that of Western countries in cultural traditions, customs, religious beliefs, and ethnic backgrounds, there is a great difference between China and the Western world in regard to ethics at the end of life, and there is also a huge controversy within China.

  13. The Rorschach test in clinical diagnosis: a critical review, with a backward look at Garfield (1947).

    Science.gov (United States)

    Wood, J M; Lilienfeld, S O; Garb, H N; Nezworski, M T

    2000-03-01

    The present article comments on a classic study by Garfield (1947) then reviews research on the Rorschach and psychiatric diagnoses. Despite a few positive findings, the Rorschach has demonstrated little validity as a diagnostic tool. Deviant verbalizations and bad form on the Rorschach, and indices based on these variables, are related to Schizophrenia and perhaps to Bipolar Disorder and Schizotypal Personality Disorder. Patients with Borderline Personality Disorder also seem to give an above-average number of deviant verbalizations. Otherwise the Rorschach has not shown a well-demonstrated relationship to these disorders or to Major Depressive Disorder, Posttraumatic Stress Disorder (PTSD), anxiety disorders other than PTSD, Dissociative Identity Disorder, Dependent, Narcissistic, or Antisocial Personality Disorders, Conduct Disorder, or psychopathy.

  14. Epidemiologic and clinical updates on impulse control disorders: a critical review

    Science.gov (United States)

    Altamura, A. Carlo; Allen, Andrea; Marazziti, Donatella; Hollander, Eric

    2006-01-01

    The article reviews the current knowledge about the impulse control disorders (ICDs) with specific emphasis on epidemiological and pharmacological advances. In addition to the traditional ICDs present in the DSM-IV—pathological gambling, trichotillomania, kleptomania, pyromania and intermittent explosive disorder—a brief description of the new proposed ICDs—compulsive–impulsive (C–I) Internet usage disorder, C–I sexual behaviors, C–I skin picking and C–I shopping—is provided. Specifically, the article summarizes the phenomenology, epidemiology and comorbidity of the ICDs. Particular attention is paid to the relationship between ICDs and obsessive–compulsive disorder (OCD). Finally, current pharmacological options for treating ICDs are presented and discussed. PMID:16960655

  15. Clinical use of coping in affective disorder, a critical review of the literature

    DEFF Research Database (Denmark)

    Christensen, Maj Vinberg; Kessing, Lars Vedel

    2005-01-01

    /or avoidance coping styles are associated with a higher risk of developing affective disorder, so this hypothesis remains unclear. Most studies shows that emotion-oriented and avoidance coping strategies are associated with relapse of depressive episodes. Conversely, problem-focused and task-oriented coping......BACKGROUND: The relationship between life stressors, coping and affective disorder is interesting when predicting onset of a affective disorder and relapse of mood episodes. METHODS: A literature review of cross-sectional and longitudinal studies concerning coping and affective disorder in adults...... including a Medline and Embase search was conducted. RESULTS: 11 cross-sectional studies and 17 longitudinal studies concerning affective disorder and coping were found, among these, two studies include patients with bipolar disorder exclusively. Only four studies elucidate whether emotion-oriented and...

  16. Critical thinking versus clinical reasoning versus clinical judgment: differential diagnosis.

    Science.gov (United States)

    Victor-Chmil, Joyce

    2013-01-01

    Concepts of critical thinking, clinical reasoning, and clinical judgment are often used interchangeably. However, they are not one and the same, and understanding subtle difference among them is important. Following a review of the literature for definitions and uses of the terms, the author provides a summary focused on similarities and differences in the processes of critical thinking, clinical reasoning, and clinical judgment and notes suggested methods of measuring each.

  17. Clinical validity of a normal pulmonary angiogram in patients with suspected pulmonary embolism - A critical review

    International Nuclear Information System (INIS)

    Beek, Edwin J.R. van; Brouwers, Elise M.J.; Song Bin; Stein, Paul D.; Oudkerk, Matthijs

    2001-01-01

    AIM: To determine the validity of a normal pulmonary angiogram in the exclusion of pulmonary embolism (PE), based on the safety of withholding anticoagulant therapy in patients with a normal pulmonary angiogram. MATERIALS AND METHODS: A review of English reports published between 1965 and April 1999 was carried out. Eligible articles described prospective studies in patients with suspected PE and a normal pulmonary angiogram, who remained untreated and were followed-up for a minimum of 3 months. Articles were evaluated by two authors, using pre-defined criteria for strength of design. End points consisted of fatal and non-fatal recurrent thromboembolic events. A sensitivity analysis was performed, by removing one study at a time from the overall results and by comparing pre- and post-1990 publications. RESULTS: Among 1050 patients in eight articles included in the analysis, recurrent thromboembolic events were described in 18 patients (1.7% 95% CI: 1.0-2.7%). These were fatal in three patients (0.3% 95% CI: 0.02-0.7%). The recurrence rate of PE decreased from 2.9% (95% CI: 1.4-6.8%) before 1990 to 1.1% (95% CI: 0.5-2.2%) after 1990. CONCLUSION: It would appear that the ability to exclude PE by angiography has improved over the years, as indicated by recurrence rate of PE. The low recurrence rate of PE supports the validity of a normal pulmonary angiogram for the exclusion of PE. Beek, E.J.R. van et al. (2001)

  18. Clinical review

    DEFF Research Database (Denmark)

    Overgaard-Steensen, Christian; Ring, Troels

    2013-01-01

    exception is hyperglycaemia, where P-[Na+] may be reduced despite plasma hypertonicity. The patient is first treated to secure airway, breathing and circulation to diminish secondary organ damage. Symptoms are critical when handling a patient with hyponatraemia. Severe symptoms are treated with 2 ml/kg 3......Disturbances in sodium concentration are common in the critically ill patient and associated with increased mortality. The key principle in treatment and prevention is that plasma [Na+] (P-[Na+]) is determined by external water and cation balances. P-[Na+] determines plasma tonicity. An important......% NaCl bolus infusions irrespective of the supposed duration of hyponatraemia. The goal is to reduce cerebral symptoms. The bolus therapy ensures an immediate and controllable rise in P-[Na+]. A maximum of three boluses are given (increases P-[Na+] about 6 mmol/l). In all patients with hyponatraemia...

  19. Photodesorption: a critical review

    International Nuclear Information System (INIS)

    Lichtman, D.; Shapira, Y.

    1975-01-01

    A critical review of the literature in the field of photodesorption is presented. Material is covered through December 1975. Although it is impossible to include every paper ever published which is in some way related to photodesorption, it is felt that the material covered is sufficiently complete to permit reasonable conclusions to be reached. The literature naturally falls into two basic categories, namely, papers involved with metal substrates and those involved with semiconductor substrates. Since the effects on these two kinds of surfaces are very different, they are each considered in separate sections. Photodesorption from metals seems to be an extremely inefficient process if it occurs at all. That is, cross sections are equal to or less than 10 -23 cm 2 . The reason for this extremely low cross section is not yet well understood. Photodesorption from semiconductors seems to be a very efficient process with cross sections as high as 10 -17 cm 2 . On most substrates studied, e.g. ZnO, TiO 2 , CdS, the chrome oxide surface of stainless steel, etc., impurity carbon atoms play a very significant role. On all these materials, the single or dominant process involves chemisorption of molecular oxygen onto the impurity carbon surface atoms. Electrons are captured from the conduction band to produce a chemisorbed CO 2 - complex. The application of band gap and higher energy radiation produces electron-hole pairs. Some of the photogenerated holes migrate to the surface where they combine with the negative ion complex. The resulting physisorbed CO 2 is then thermally desorbed

  20. Clinical review

    DEFF Research Database (Denmark)

    Hjortrup, Peter Buhl; Haase, Nicolai; Wetterslev, Mik

    2013-01-01

    Neutrophil gelatinase-associated lipocalin (NGAL) may be an early marker of acute kidney injury (AKI), but elevated NGAL occurs in a wide range of systemic diseases. Because intensive care patients have high levels of comorbidity, our objective was to conduct a systematic review of the literature...

  1. Use of Machine-Learning Approaches to Predict Clinical Deterioration in Critically Ill Patients: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Tadashi Kamio

    2017-06-01

    Full Text Available Introduction: Early identification of patients with unexpected clinical deterioration is a matter of serious concern. Previous studies have shown that early intervention on a patient whose health is deteriorating improves the patient outcome, and machine-learning-based approaches to predict clinical deterioration may contribute to precision improvement. To date, however, no systematic review in this area is available. Methods: We completed a search on PubMed on January 22, 2017 as well as a review of the articles identified by study authors involved in this area of research following the preferred reporting items for systematic reviews and meta-analyses (PRISMA guidelines for systematic reviews. Results: Twelve articles were selected for the current study from 273 articles initially obtained from the PubMed searches. Eleven of the 12 studies were retrospective studies, and no randomized controlled trials were performed. Although the artificial neural network techniques were the most frequently used and provided high precision and accuracy, we failed to identify articles that showed improvement in the patient outcome. Limitations were reported related to generalizability, complexity of models, and technical knowledge. Conclusions: This review shows that machine-learning approaches can improve prediction of clinical deterioration compared with traditional methods. However, these techniques will require further external validation before widespread clinical acceptance can be achieved.

  2. Critical Review of Data Evaluation in Teaching Clinics of Traditional Chinese Medicine Outside China: Implications for Education.

    Science.gov (United States)

    Jiang, Jian; Peng, Wenbo; Gu, Tieguang; King, Catherine; Yin, J Kevin

    2016-01-01

    The increasing acceptance of traditional Chinese medicine (TCM) worldwide has highlighted the importance of ensuring the provision of high-quality TCM clinical education. This clinical training should be partly guided by a robust assessment of patient data outcomes in TCM teaching clinics. We undertook a comprehensive literature review to examine the data evaluation in TCM teaching clinics outside China and its implications for TCM education. Literature was retrieved via MEDLINE (from 1946 to January 2015), EMBASE (from 1980 to February 2015), and Google Scholar for studies conducted outside China. The search was restricted to English articles reporting empirical findings related to the assessments of patient data in TCM teaching clinics, with implications for TCM education in countries other than China. Only seven articles from six studies met the inclusion criteria. The characteristics and main symptoms of patients who received any TCM treatment in the context of teaching clinics among all included studies were similar. Symptom relief as well as a high level of patient satisfaction with TCM treatment were found in TCM teaching clinics. Conventional healthcare providers and other complementary practitioners were not the main source of referral to TCM practitioners but rather patients׳ friends/relatives. Patients received acupuncture treatment more frequently than treatments utilizing Chinese herbal medicine in teaching clinics. A standardized and consistent framework for patient records within TCM teaching clinics is currently lacking. There was no robust study which "translated" TCM clinic data evaluation findings into implications for TCM education and clinical training. Recognizing that TCM evolves over time and its practice varies in different settings, there is an urgent need to conduct large-scale, rigorous evaluations of TCM clinic data to address the findings of our review, with the purpose of better informing TCM education and clinical training in

  3. Clinical Pharmacology Studies in Critically Ill Children

    Science.gov (United States)

    Thakkar, Nilay; Salerno, Sara; Hornik, Christoph P.; Gonzalez, Daniel

    2016-01-01

    Developmental and physiological changes in children contribute to variation in drug disposition with age. Additionally, critically ill children suffer from various life-threatening conditions that can lead to pathophysiological alterations that further affect pharmacokinetics (PK). Some factors that can alter PK in this patient population include variability in tissue distribution caused by protein binding changes and fluid shifts, altered drug elimination due to organ dysfunction, and use of medical interventions that can affect drug disposition (e.g., extracorporeal membrane oxygenation and continuous renal replacement therapy). Performing clinical studies in critically ill children is challenging because there is large inter-subject variability in the severity and time course of organ dysfunction; some critical illnesses are rare, which can affect subject enrollment; and critically ill children usually have multiple organ failure, necessitating careful selection of a study design. As a result, drug dosing in critically ill children is often based on extrapolations from adults or non-critically ill children. Dedicated clinical studies in critically ill children are urgently needed to identify optimal dosing of drugs in this population. This review will summarize the effect of critical illness on pediatric PK, the challenges associated with performing studies in this vulnerable subpopulation, and the clinical PK studies performed to date for commonly used drugs. PMID:27585904

  4. Acoustics Critical Readiness Review

    Science.gov (United States)

    Ballard, Kenny

    2010-01-01

    This presentation reviews the status of the acoustic equipment from the medical operations perspective. Included is information about the acoustic dosimeters, sound level meter, and headphones that are planned for use while on orbit. Finally there is information about on-orbit hearing assessments.

  5. Deliberate teaching tools for clinical teaching encounters: A critical scoping review and thematic analysis to establish definitional clarity.

    Science.gov (United States)

    Sidhu, Navdeep S; Edwards, Morgan

    2018-04-27

    We conducted a scoping review of tools designed to add structure to clinical teaching, with a thematic analysis to establish definitional clarity. Six thousand and forty nine citations were screened, 434 reviewed for eligibility, and 230 identified as meeting study inclusion criteria. Eighty-nine names and 51 definitions were identified. Based on a post facto thematic analysis, we propose that these tools be named "deliberate teaching tools" (DTTs) and defined as "frameworks that enable clinicians to have a purposeful and considered approach to teaching encounters by incorporating elements identified with good teaching practice." We identified 46 DTTs in the literature, with 38 (82.6%) originally described for the medical setting. Forty justification articles consisted of 16 feedback surveys, 13 controlled trials, seven pre-post intervention studies with no control group, and four observation studies. Current evidence of efficacy is not entirely conclusive, and many studies contain methodology flaws. Forty-nine clarification articles comprised 12 systematic reviews and 37 narrative reviews. The most number of DTTs described by any review was four. A common design theme was identified in approximately three-quarters of DTTs. Applicability of DTTs to specific alternate settings should be considered in context, and appropriately designed justification studies are warranted to demonstrate efficacy.

  6. Immunology in the clinic review series; focus on type 1 diabetes and viruses: the enterovirus link to type 1 diabetes: critical review of human studies

    Science.gov (United States)

    Stene, L C; Rewers, M

    2012-01-01

    OTHER THEMES PUBLISHED IN THIS IMMUNOLOGY IN THE CLINIC REVIEW SERIES Metabolic diseases, host responses, cancer, autoinflammatory diseases, allergy. The hypothesis that under some circumstances enteroviral infections can lead to type 1 diabetes (T1D) was proposed several decades ago, based initially on evidence from animal studies and sero-epidemiology. Subsequently, enterovirus RNA has been detected more frequently in serum of patients than in control subjects, but such studies are susceptible to selection bias and reverse causality. Here, we review critically recent evidence from human studies, focusing on longitudinal studies with potential to demonstrate temporal association. Among seven longitudinal birth cohort studies, the evidence that enterovirus infections predict islet autoimmunity is quite inconsistent in our interpretation, due partially, perhaps, to heterogeneity in study design and a limited number of subjects studied. An association between enterovirus and rapid progression from autoimmunity to T1D was reported by one longitudinal study, but although consistent with evidence from animal models, this novel observation awaits replication. It is possible that a potential association with initiation and/or progression of islet autoimmunity can be ascribed to a subgroup of the many enterovirus serotypes, but this has still not been investigated properly. There is a need for larger studies with frequent sample intervals and collection of specimens of sufficient quality and quantity for detailed characterization of enterovirus. More research into the molecular epidemiology of enteroviruses and enterovirus immunity in human populations is also warranted. Ultimately, this knowledge may be used to devise strategies to reduce the risk of T1D in humans. PMID:22385232

  7. Clinical review: Distinguishing constitutional delay of growth and puberty from isolated hypogonadotropic hypogonadism: critical appraisal of available diagnostic tests.

    Science.gov (United States)

    Harrington, Jennifer; Palmert, Mark R

    2012-09-01

    Determining the etiology of delayed puberty during initial evaluation can be challenging. Specifically, clinicians often cannot distinguish constitutional delay of growth and puberty (CDGP) from isolated hypogonadotropic hypogonadism (IHH), with definitive diagnosis of IHH awaiting lack of spontaneous puberty by age 18 yr. However, the ability to make a timely, correct diagnosis has important clinical implications. The aim was to describe and evaluate the literature regarding the ability of diagnostic tests to distinguish CDGP from IHH. A PubMed search was performed using key words "puberty, delayed" and "hypogonadotropic hypogonadism," and citations within retrieved articles were reviewed to identify studies that assessed the utility of basal and stimulation tests in the diagnosis of delayed puberty. Emphasis was given to a test's ability to distinguish prepubertal adolescents with CDGP from those with IHH. Basal gonadotropin and GnRH stimulation tests have limited diagnostic specificity, with overlap in gonadotropin levels between adolescents with CDGP and IHH. Stimulation tests using more potent GnRH agonists and/or human chorionic gonadotropin may have better discriminatory value, but small study size, lack of replication of diagnostic thresholds, and prolonged protocols limit clinical application. A single inhibin B level in two recent studies demonstrated good differentiation between groups. Distinguishing IHH from CDGP is an important clinical issue. Basal inhibin B may offer a simple, discriminatory test if results from recent studies are replicated. However, current literature does not allow for recommendation of any diagnostic test for routine clinical use, making this an important area for future investigation.

  8. Tank farm nuclear criticality review

    International Nuclear Information System (INIS)

    Bratzel, D.R.

    1996-01-01

    The technical basis for the nuclear criticality safety of stored wastes at the Hanford Site Tank Farm Complex was reviewed by a team of senior technical personnel whose expertise covered all appropriate aspects of fissile materials chemistry and physics. The team concluded that the detailed and documented nucleonics-related studies underlying the waste tanks criticality safety basis were sound. The team concluded that, under current plutonium inventories and operating conditions, a nuclear criticality accident is incredible in any of the Hanford single-shell tanks (SST), double-shell tanks (DST), or double-contained receiver tanks (DCRTS) on the Hanford Site

  9. Metrological approach to quantitative analysis of clinical samples by LA-ICP-MS: A critical review of recent studies.

    Science.gov (United States)

    Sajnóg, Adam; Hanć, Anetta; Barałkiewicz, Danuta

    2018-05-15

    Analysis of clinical specimens by imaging techniques allows to determine the content and distribution of trace elements on the surface of the examined sample. In order to obtain reliable results, the developed procedure should be based not only on the properly prepared sample and performed calibration. It is also necessary to carry out all phases of the procedure in accordance with the principles of chemical metrology whose main pillars are the use of validated analytical methods, establishing the traceability of the measurement results and the estimation of the uncertainty. This review paper discusses aspects related to sampling, preparation and analysis of clinical samples by laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) with emphasis on metrological aspects, i.e. selected validation parameters of the analytical method, the traceability of the measurement result and the uncertainty of the result. This work promotes the introduction of metrology principles for chemical measurement with emphasis to the LA-ICP-MS which is the comparative method that requires studious approach to the development of the analytical procedure in order to acquire reliable quantitative results. Copyright © 2018 Elsevier B.V. All rights reserved.

  10. Milrinone for cardiac dysfunction in critically ill adult patients: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis.

    Science.gov (United States)

    Koster, Geert; Bekema, Hanneke J; Wetterslev, Jørn; Gluud, Christian; Keus, Frederik; van der Horst, Iwan C C

    2016-09-01

    Milrinone is an inotrope widely used for treatment of cardiac failure. Because previous meta-analyses had methodological flaws, we decided to conduct a systematic review of the effect of milrinone in critically ill adult patients with cardiac dysfunction. This systematic review was performed according to The Cochrane Handbook for Systematic Reviews of Interventions. Searches were conducted until November 2015. Patients with cardiac dysfunction were included. The primary outcome was serious adverse events (SAE) including mortality at maximum follow-up. The risk of bias was evaluated and trial sequential analyses were conducted. The quality of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation criteria. A total of 31 randomised clinical trials fulfilled the inclusion criteria, of which 16 provided data for our analyses. All trials were at high risk of bias, and none reported the primary composite outcome SAE. Fourteen trials with 1611 randomised patients reported mortality data at maximum follow-up (RR 0.96; 95% confidence interval 0.76-1.21). Milrinone did not significantly affect other patient-centred outcomes. All analyses displayed statistical and/or clinical heterogeneity of patients, interventions, comparators, outcomes, and/or settings and all featured missing data. The current evidence on the use of milrinone in critically ill adult patients with cardiac dysfunction suffers from considerable risks of both bias and random error and demonstrates no benefits. The use of milrinone for the treatment of critically ill patients with cardiac dysfunction can be neither recommended nor refuted. Future randomised clinical trials need to be sufficiently large and designed to have low risk of bias.

  11. Stress ulcer prophylaxis versus placebo or no prophylaxis in critically ill patients. A systematic review of randomised clinical trials with meta-analysis and trial sequential analysis

    DEFF Research Database (Denmark)

    Krag, Mette; Perner, Anders; Wetterslev, Jørn

    2014-01-01

    PURPOSE: To assess the effects of stress ulcer prophylaxis (SUP) versus placebo or no prophylaxis on all-cause mortality, gastrointestinal (GI) bleeding and hospital-acquired pneumonia in adult critically ill patients in the intensive care unit (ICU). METHODS: We performed a systematic review using...... meta-analysis and trial sequential analysis (TSA). Eligible trials were randomised clinical trials comparing proton pump inhibitors or histamine 2 receptor antagonists with either placebo or no prophylaxis. Two reviewers independently assessed studies for inclusion and extracted data. The Cochrane...... of bias. There was no statistically significant difference in mortality (fixed effect: RR 1.00, 95% CI 0.84-1.20; P = 0.87; I(2) = 0%) or hospital-acquired pneumonia (random effects: RR 1.23, 95% CI 0.86-1.78; P = 0.28; I(2) = 19%) between SUP patients and the no prophylaxis/placebo patients...

  12. Critical review of Compton imaging

    International Nuclear Information System (INIS)

    Guzzardi, R.; Licitra, G.

    1987-01-01

    This paper reviews the basic aspects, problems, and applications of Compton imaging including those related to nonmedical applications. The physics and technology at the base of this specific methodology are analyzed and the relative differences and merits with respect to other imaging techniques, using ionizing radiations, are reviewed. The basic Compton imaging approaches, i.e., point-by-point, line-by-line, and plane-by-plane, are analyzed. Specifically, physical design and technological aspects are reviewed and discussed. Furthermore, the most important clinical applications of the different methods are presented and discussed. Finally, possibilities and applications of the Compton imaging method to other nonmedical fields, as in the case of the important area of object defects recognition, are analyzed and reviewed. 56 references

  13. A review of criticality accidents

    International Nuclear Information System (INIS)

    Stratton, W.R.; Smith, D.R.

    1989-03-01

    Criticality accidents and the characteristics of prompt power excursions are discussed. Forty-one accidental power transients are reviewed. In each case where available, enough detail is given to help visualize the physical situation, the cause or causes of the accident, the history and characteristics of the transient, the energy release, and the consequences, if any, to personnel and property. Excursions associated with large power reactors are not included in this study, except that some information on the major accident at the Chernobyl reactor in April 1986 is provided in the Appendix. 67 refs., 21 figs., 2 tabs

  14. Application of machine learning classification for structural brain MRI in mood disorders: Critical review from a clinical perspective.

    Science.gov (United States)

    Kim, Yong-Ku; Na, Kyoung-Sae

    2018-01-03

    Mood disorders are a highly prevalent group of mental disorders causing substantial socioeconomic burden. There are various methodological approaches for identifying the underlying mechanisms of the etiology, symptomatology, and therapeutics of mood disorders; however, neuroimaging studies have provided the most direct evidence for mood disorder neural substrates by visualizing the brains of living individuals. The prefrontal cortex, hippocampus, amygdala, thalamus, ventral striatum, and corpus callosum are associated with depression and bipolar disorder. Identifying the distinct and common contributions of these anatomical regions to depression and bipolar disorder have broadened and deepened our understanding of mood disorders. However, the extent to which neuroimaging research findings contribute to clinical practice in the real-world setting is unclear. As traditional or non-machine learning MRI studies have analyzed group-level differences, it is not possible to directly translate findings from research to clinical practice; the knowledge gained pertains to the disorder, but not to individuals. On the other hand, a machine learning approach makes it possible to provide individual-level classifications. For the past two decades, many studies have reported on the classification accuracy of machine learning-based neuroimaging studies from the perspective of diagnosis and treatment response. However, for the application of a machine learning-based brain MRI approach in real world clinical settings, several major issues should be considered. Secondary changes due to illness duration and medication, clinical subtypes and heterogeneity, comorbidities, and cost-effectiveness restrict the generalization of the current machine learning findings. Sophisticated classification of clinical and diagnostic subtypes is needed. Additionally, as the approach is inevitably limited by sample size, multi-site participation and data-sharing are needed in the future. Copyright

  15. Evaluating critical thinking in clinical practice.

    Science.gov (United States)

    Oermann, M H

    1997-01-01

    Although much has been written about measurement instruments for evaluating critical thinking in nursing, this article describes clinical evaluation strategies for critical thinking. Five methods are discussed: 1) observation of students in practice; 2) questions for critical thinking, including Socratic questioning; 3) conferences; 4) problem-solving strategies; and 5) written assignments. These methods provide a means of evaluating students' critical thinking within the context of clinical practice.

  16. Optimizing therapeutic efficacy of chemopreventive agents: A critical review of delivery strategies in oral cancer chemoprevention clinical trials

    OpenAIRE

    Andrew S Holpuch; Kashappa-Goud H Desai; Steven P Schwendeman; Susan R Mallery

    2011-01-01

    Due to its characterized progression from recognized premalignant oral epithelial changes (i.e., oral epithelial dysplasia) to invasive cancer, oral squamous cell carcinoma represents an optimal disease for chemopreventive intervention prior to malignant transformation. The primary goal of oral cancer chemoprevention is to reverse, suppress, or inhibit the progression of premalignant lesions to cancer. Over the last several decades, numerous oral cancer chemoprevention clinical trials have as...

  17. Activity trackers: a critical review.

    Science.gov (United States)

    Lee, Jeon; Finkelstein, Joseph

    2014-01-01

    The wearable consumer health devices can be mainly divided into activity trackers, sleep trackers, and stress management devices. These devices are widely advertised to provide positive effects on the user's daily behaviours and overall heath. However, objective evidence supporting these claims appears to be missing. The goal of this study was to review available evidence pertaining to performance of activity trackers. A comprehensive review of available information has been conducted for seven representative devices and the validity of marketing claims was assessed. The device assessment was based on availability of verified output metrics, theoretical frameworks, systematic evaluation, and FDA clearance. The review identified critical absence of supporting evidence of advertised functions and benefits for the majority of the devices. Six out of seven devices did not provide any information on sensor accuracy and output validity at all. Possible underestimation or overestimation of specific health indicators reported to consumers was not clearly disclosed to the public. Furthermore, significant limitations of these devices which can be categorized into user restrictions, user responsibilities and company disclaimers could not be easily found or comprehended by unsophisticated users and may represent a serious health hazard.

  18. Systems pathology: a critical review.

    Science.gov (United States)

    Costa, Jose

    2012-02-01

    The technological advances of the last twenty years together with the dramatic increase in computational power have injected new life into systems-level thinking in Medicine. This review emphasizes the close relationship of Systems Pathology to Systems Biology and delineates the differences between Systems Pathology and Clinical Systems Pathology. It also suggests an algorithm to support the application of systems-level thinking to clinical research, proposes applying systems-level thinking to the health care systems and forecasts an acceleration of preventive medicine as a result of the coupling of personal genomics with systems pathology. Copyright © 2011 Federation of European Biochemical Societies. Published by Elsevier B.V. All rights reserved.

  19. Milrinone for cardiac dysfunction in critically ill adult patients : a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis

    NARCIS (Netherlands)

    Koster, Geert; Bekema, Hanneke J.; Wetterslev, Jorn; Gluud, Christian; Keus, Frederik; van der Horst, Iwan C. C.

    Milrinone is an inotrope widely used for treatment of cardiac failure. Because previous meta-analyses had methodological flaws, we decided to conduct a systematic review of the effect of milrinone in critically ill adult patients with cardiac dysfunction. This systematic review was performed

  20. Clinical review: Riedel's thyroiditis: a clinical review.

    Science.gov (United States)

    Hennessey, James V

    2011-10-01

    Riedel's thyroiditis is a rare inflammatory process involving the thyroid and surrounding cervical tissues and is associated with various forms of systemic fibrosis. Riedel's presentation is complex, including a thyroid mass associated with local symptoms, characteristic biochemical abnormalities such as hypocalcemia and hypothyroidism, as well as the involvement of a wide range of other organ systems. Diagnosis of Riedel's thyroiditis requires histopathological confirmation, but due to high complication rates, the role of surgical intervention is limited to airway decompression and diagnostic tissue retrieval. Unique among processes of the thyroid, Riedel's is commonly treated with long-term antiinflammatory medications to arrest progression and maintain a symptom-free course. Due to its rarity, Riedel's may not be immediately diagnosed, so clinicians benefit from recognizing the constellation of findings that should make prompt diagnosis possible. A review of print and electronic reviews was conducted. Source references were identified, and available literature was reviewed. A search of the PubMed database using the search term "Riedel's thyroiditis" was cross-referenced with associated clinical findings, systemic fibrosis diagnoses, and therapeutic search terms. Because most of the literature consisted of case reports and very small series, inclusion of identified articles was based on clinical descriptions of the subjects included and the criteria for diagnosis reported. More weight was attributed to series, using contemporary criteria for diagnosis. Case reports were included if the diagnosis was clear and clinical presentation was unique to illustrate the spectrum of disease. Because the majority of therapeutic intervention data were based upon case reports and very small series, an evidence-based approach was problematic, but information is presented as objectively and with as much balance as the limited quality of the data allows. Clinical awareness of the

  1. Healthcare avoidance: a critical review.

    Science.gov (United States)

    Byrne, Sharon K

    2008-01-01

    The purpose of this study is to provide a critical review and synthesis of theoretical and research literature documenting the impact of avoidance on healthcare behaviors, identify the factors that influence healthcare avoidance and delay in the adult population, and propose a direction for future research. The Theory of Reasoned Action, Theory of Planned Behavior, Theory of Care-Seeking Behavior, the Transtheoretical Model, and the Behavioral Model of Health Services Use/Utilization are utilized to elaborate on the context within which individual intention to engage in healthcare behaviors occurs. Research literature on the concept of healthcare avoidance obtained by using computerized searches of CINAHL, MEDLINE, PSYCH INFO, and HAPI databases, from 1995 to 2007, were reviewed. Studies were organized by professional disciplines. Healthcare avoidance is a common and highly variable experience. Multiple administrative, demographic, personal, and provider factors are related to healthcare avoidance, for example, distrust of providers and/or the science community, health beliefs, insurance status, or socioeconomic/income level. Although the concept is recognized by multiple disciplines, limited research studies address its impact on healthcare decision making. More systematic research is needed to determine correlates of healthcare avoidance. Such studies will help investigators identify patients at risk for avoidant behaviors and provide the basis for health-promoting interventions. Methodological challenges include identification of characteristics of individuals and environments that hinder healthcare behaviors, as well as, the complexity of measuring healthcare avoidance. Studies need to systematically explore the influence of avoidance behaviors on specific healthcare populations at risk.

  2. Critical Appraisal of International Clinical Practice Guidelines in Kidney Transplantation Using the Appraisal of Guidelines for Research and Education (AGREE) II Tool: A Systematic Review.

    Science.gov (United States)

    OʼDonoghue, Katriona Jane Marie; Reed, Rhiannon D; Knight, Simon R; O'Callaghan, John M; Ayaz-Shah, Anam A; Hassan, Sevda; Weissenbacher, Annemarie; Morris, Peter J; Pengel, Liset H M

    2018-05-22

    Whilst Clinical Practice Guidelines (CPGs) are used for the development of local protocols in kidney transplantation (Ktx), the quality of their methodology is variable. This systematic review aimed to critically appraise international CPGs in all aspects of Ktx using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. CPGs in Ktx and donation published between 2010 and 2017 were identified from MEDLINE, Embase, National Guideline Clearinghouse, NHS and NICE Evidence Searches, and the websites of transplant societies. Using AGREE II, 3 appraisers assessed the quality of CPGs. Interrater reliability was measured using the intraclass correlation coefficient (ICC). Searches identified 3,168 records and 115 CPGs were included. The highest scoring AGREE II domain was 'Scope and Purpose' (80%; Range 30-100%), followed by 'Clarity of Presentation' (77%; Range 43-98%), 'Editorial independence' (52%; Range 0-94%), 'Rigour of Development' (47%; Range 6-97%) and 'Stakeholder Involvement' (41%; Range 11-85%). The poorest scoring domain was 'Applicability' (31%; Range 3-74%). Most CPGs were recommended for future use either with (63%) or without modifications (18%). A small number were not recommended for future use (14%) or reviewers did not agree on recommending the CPG (5%). The overall mean CPG quality score was 4 out of 7 (Range 2-7). The mean ICC of 0.74 indicated substantial agreement between reviewers. The quality of international CPGs in Ktx was variable, and most CPGs lacked key aspects of methodological robustness and transparency. Improvements in methodology, patient involvement and strategies for implementation are required.

  3. Unruptured Intracranial Aneurysms. A Critical Review of the International Study of Unruptured Intracranial Aneurysms (ISUIA) and of Appropriate Methods to Address the Clinical Problem.

    Science.gov (United States)

    Raymond, J; Guillemin, F; Proust, F; Molyneux, A J; Fox, A J; Claiborne, J S; Meder, J F; Rouleau, I

    2008-03-30

    The preventive treatment of unruptured aneurysms has been performed for decades despite the lack of evidence of a clinical benefit. Reports of observational studies such as the International Study of Unruptured Intracranial Aneurysms (ISUIA) suggest that preventive treatments are rarely justified. Are these reports compelling enough to guide clinical practice? The ISUIA methods and data are reviewed and analysed in a more conventional manner. The design of the appropriate clinical research program is approached by steps, reviewing potential problems, from the formulation of the precise research question to the interpretation of subgroup analyses, including sample size, representativity, duration of observation period, blinding, definition of outcome events, analysis of cross-overs, losses to follow-up, and data reporting. Unruptured intracranial aneurysms observed in ISUIA ruptured at a minimal annual rate of 0.8% (0.5-1%), despite multiple methodological difficulties biased in favour of a benign natural history. Available registries do not have the power or the design capable of providing normative guidelines for clinical decisions. The appropriate method to solve the clinical dilemma is a multicentric trial comparing the incidence of a hard clinical outcome events in approximately 2000 patients randomly allocated to a treatment group and a deferred treatment group, all followed for ten years or more. Observational studies have failed to provide reliable evidence in favour or against the preventive treatment of unruptured aneurysms. A randomized trial is in order to clarify what is the role of prevention in this common clinical problem.

  4. A systematic review of critical thinking in nursing education.

    Science.gov (United States)

    Chan, Zenobia C Y

    2013-03-01

    This review aimed to explore how critical thinking is perceived in previous studies of nursing education, and analyse the obstacles and strategies in teaching and learning critical thinking mentioned in these studies. Systematic review. This review was based on the following five databases: The British Nursing Index, Ovid Medline, CINAHL, PsycINFO and Scopus. After the screening process and evaluation through using the Critical Appraisal Skills Programme tool, 17 studies were identified that met the inclusion and quality criteria. The studies were read through several times and analysed through thematic synthesis. A total of three themes were developed. The first theme, components for critical thinkers, suggests the abilities and attitudes that critical thinkers should have. The other two themes, influential factors of critical thinking in nursing education, and strategies to promote critical thinking, describe the obstacles and strategies in teaching and learning critical thinking. The 17 studies illustrated that the definition and concept of critical thinking may change from time to time, and hence there is a need to clarify educators' perspective towards critical thinking. There is also a need to evaluate the efficacy of the new strategies mentioned in several selected studies, such as art-based, questioning, cross-cultural nursing experience, and preceptorship. With a better understanding of critical thinking in nursing education, educators and nursing faculty are able to develop better strategies in enhancing critical thinking development in nursing students, in turn preparing them for future clinical practice. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. Korsakoff's syndrome: A critical review

    NARCIS (Netherlands)

    Arts, N.J.M.; Walvoort, S.J.W.; Kessels, R.P.C.

    2017-01-01

    In this review, we present a survey on Korsakoff's syndrome (KS), a residual syndrome in patients who suffered from a Wernicke encephalopathy (WE) that is predominantly characterized by global amnesia, and in more severe cases also by cognitive and behavioral dysfunction. We describe the history of

  6. Critical review on biofilm methods

    DEFF Research Database (Denmark)

    Azeredo, Joana; F. Azevedo, Nuno; Briandet, Romain

    2017-01-01

    Biofilms are widespread in nature and constitute an important strategy implemented by microorganisms to survive in sometimes harsh environmental conditions. They can be beneficial or have a negative impact particularly when formed in industrial settings or on medical devices. As such, research in...... and limitations of several methods. Accordingly, this review aims at helping scientists in finding the most appropriate and up-to-date methods to study their biofilms....

  7. Tianeptine - A Clinical Review.

    Directory of Open Access Journals (Sweden)

    More Patil Vidita

    2016-06-01

    Full Text Available Depression is a wide spread disorder. The development of effective pharmacotherapy for major depression is important because it is such a widespread and debilitating mental disorder. The following review is based on the preclinical and clinical studies carried out on Tianeptine, an atypical antidepressant that lowers the adverse effects of stress on brain and memory. It is one of the many drugs being tested these days in the market as nootropics; it is presented as a “Smart Drug”. These are believed to be of low-risk and work to improve, enhance, or repair damage done to the brain via injury or disease.

  8. A critical review of inflation

    CERN Document Server

    Turok, N G

    2002-01-01

    The theory of cosmic inflation offers an attractive resolution of some of the great paradoxes in cosmology: why the universe is so large, flat and uniform on large scales, and how density variations arose. Inflation has rightly dominated cosmological thinking for the past two decades, helping stimulate the development of high-precision observational programmes. The survival of simple inflationary models in the face of an impressive observational onslaught has been interpreted as convincing evidence of the correctness of the basic idea. In this paper, I review inflation, but highlight its weaknesses, explaining my reasons for believing that a more complete theory may supersede inflation without necessarily incorporating it.

  9. A critical review of inflation

    International Nuclear Information System (INIS)

    Turok, Neil

    2002-01-01

    The theory of cosmic inflation offers an attractive resolution of some of the great paradoxes in cosmology: why the universe is so large, flat and uniform on large scales, and how density variations arose. Inflation has rightly dominated cosmological thinking for the past two decades, helping stimulate the development of high-precision observational programmes. The survival of simple inflationary models in the face of an impressive observational onslaught has been interpreted as convincing evidence of the correctness of the basic idea. In this paper, I review inflation, but highlight its weaknesses, explaining my reasons for believing that a more complete theory may supersede inflation without necessarily incorporating it

  10. Year in review 2010: Critical Care - infection

    DEFF Research Database (Denmark)

    Pagani, Leonardo; Afshari, Arash; Harbarth, Stephan

    2011-01-01

    established approaches to the optimal management of infections in the intensive care unit. Rapid infection diagnosis, antibiotic dosing and optimization through pharmacologic indices, progress in the implementation of effective antimicrobial stewardship and infection control programs, and management of fungal...... infections are some of the most relevant issues in this special patient population. During the last 18 months, Critical Care and other journals have provided a wide array of descriptive and interventional clinical studies and scientific reports helping clinical investigators and critical care physicians...

  11. Bruxism and prosthetic treatment: a critical review.

    Science.gov (United States)

    Johansson, Anders; Omar, Ridwaan; Carlsson, Gunnar E

    2011-07-01

    Based on the findings from available research on bruxism and prosthetic treatment published in the dental literature, an attempt was made to draw conclusions about the existence of a possible relationship between the two, and its clinical relevance. MEDLINE/PubMed searches were conducted using the terms 'bruxism' and 'prosthetic treatment', as well as combinations of these and related terms. The few studies judged to be relevant were critically reviewed, in addition to papers found during an additional manual search of reference lists within selected articles. Bruxism is a common parafunctional habit, occurring both during sleep and wakefulness. Usually it causes few serious effects, but can do so in some patients. The etiology is multifactorial. There is no known treatment to stop bruxism, including prosthetic treatment. The role of bruxism in the process of tooth wear is unclear, but it is not considered a major cause. As informed by the present critical review, the relationship between bruxism and prosthetic treatment is one that relates mainly to the effect of the former on the latter. Bruxism may be included among the risk factors, and is associated with increased mechanical and/or technical complications in prosthodontic rehabilitation, although it seems not to affect implant survival. When prosthetic intervention is indicated in a patient with bruxism, efforts should be made to reduce the effects of likely heavy occlusal loading on all the components that contribute to prosthetic structural integrity. Failure to do so may indicate earlier failure than is the norm. Copyright © 2011 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

  12. Nutrition in acute pancreatitis: a critical review

    NARCIS (Netherlands)

    Lodewijkx, Piet J.; Besselink, Marc G.; Witteman, Ben J.; Schepers, Nicolien J.; Gooszen, Hein G.; van Santvoort, Hjalmar C.; Bakker, Olaf J.

    Severe acute pancreatitis poses unique nutritional challenges. The optimal nutritional support in patients with severe acute pancreatitis has been a subject of debate for decades. This review provides a critical review of the available literature. According to current literature, enteral nutrition

  13. [Elaboration and critical evaluation of clinical guidelines].

    Science.gov (United States)

    García Villar, C

    2015-11-01

    Clinical guidelines are documents to help professionals and patients select the best diagnostic or therapeutic option. Elaborating guidelines requires an efficient literature search and a critical evaluation of the articles found to select the most appropriate ones. After that, the recommendations are formulated and then must be externally evaluated before they can be disseminated. Even when the guidelines are very thorough and rigorous, it is important to know whether they fulfill all the methodological requisites before applying them. With this aim, various scales have been developed to critically appraise guidelines. Of these, the AGREE II instrument is currently the most widely used. This article explains the main steps in elaborating clinical guidelines and the main aspects that should be analyzed to know whether the guidelines are well written. Copyright © 2015 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  14. Critical thinking of student nurses during clinical accompaniment.

    Science.gov (United States)

    Uys, B Y; Meyer, S M

    2005-08-01

    The purpose of this study was to investigate the methods of clinical accompaniment used by clinical facilitators in practice. The findings of the study also reflected facilitators' perceptions regarding critical thinking and the facilitation thereof. A quantitative research design was used. A literature study was conducted to identify the methods of accompaniment that facilitate critical thinking. Data was collected by means of a questionnaire developed for that purpose. Making a content-related validity judgment, and involving seven clinical facilitators in an academic institution, ensured the validity of the questionnaire. The results of the study indicated that various clinical methods of accompaniment were used. To a large extent, these methods correlated with those discussed in the literature review. The researcher further concluded that the concepts 'critical thinking' and 'facilitation' were not interpreted correctly by the respondents, and would therefore not be implemented in a proper manner in nursing practice. Furthermore, it seemed evident that tutor-driven learning realised more often than student-driven learning. In this regard, the requirement of outcomes-based education was not satisfied. The researcher is therefore of the opinion that a practical programme for the development of critical thinking skills during clinical accompaniment must be developed within the framework of outcomes-based education.

  15. Critical thinking of student nurses during clinical accompaniment

    Directory of Open Access Journals (Sweden)

    BY Uys

    2005-09-01

    Full Text Available The purpose of this study was to investigate the methods of clinical accompaniment used by clinical facilitators in practice. The findings of the study also reflected facilitators’ perceptions regarding critical thinking and the facilitation thereof. A quantitative research design was used. A literature study was conducted to identify the methods of accompaniment that facilitate critical thinking. Data was collected by means of a questionnaire developed for that purpose. Making a content-related validity judgment, and involving seven clinical facilitators in an academic institution, ensured the validity of the questionnaire. The results of the study indicated that various clinical methods of accompaniment were used. To a large extent, these methods correlated with those discussed in the literature review. The researcher further concluded that the concepts ‘critical thinking’ and ‘facilitation’ were not interpreted correctly by the respondents, and would therefore not be implemented in a proper manner in nursing practice. Furthermore, it seemed evident that tutor-driven learning realised more often than student-driven learning. In this regard, the requirement of outcomes-based education was not satisfied. The researcher is therefore of the opinion that a practical programme for the development of critical thinking skills during clinical accompaniment must be developed within the framework of outcomes-based education.

  16. Evaluating clinical librarian services: a systematic review.

    Science.gov (United States)

    Brettle, Alison; Maden-Jenkins, Michelle; Anderson, Lucy; McNally, Rosalind; Pratchett, Tracey; Tancock, Jenny; Thornton, Debra; Webb, Anne

    2011-03-01

      Previous systematic reviews have indicated limited evidence and poor quality evaluations of clinical librarian (CL) services. Rigorous evaluations should demonstrate the value of CL services, but guidance is needed before this can be achieved.   To undertake a systematic review which examines models of CL services, quality, methods and perspectives of clinical librarian service evaluations.   Systematic review methodology and synthesis of evidence, undertaken collaboratively by a group of 8 librarians to develop research and critical appraisal skills.   There are four clear models of clinical library service provision. Clinical librarians are effective in saving health professionals time, providing relevant, useful information and high quality services. Clinical librarians have a positive effect on clinical decision making by contributing to better informed decisions, diagnosis and choice of drug or therapy. The quality of CL studies is improving, but more work is needed on reducing bias and providing evidence of specific impacts on patient care. The Critical Incident Technique as part of a mixed method approach appears to offer a useful approach to demonstrating impact.   This systematic review provides practical guidance regarding the evaluation of CL services. It also provides updated evidence regarding the effectiveness and impact of CL services. The approach used was successful in developing research and critical appraisal skills in a group of librarians. © 2010 The authors. Health Information and Libraries Journal © 2010 Health Libraries Group.

  17. Music in Peacebuilding: A Critical Literature Review

    Science.gov (United States)

    Sandoval, Elaine

    2016-01-01

    The critical literature review summarizes and appraises studies that have been pursued by music scholars examining the contributions of music to peacebuilding as well as the role of music in violence. These two bodies of literature are rarely brought into dialogue, but I juxtapose them in order to confront the idea of music's exceptionalism as…

  18. USING POWDERED ACTIVATED CARBON: A CRITICAL REVIEW

    Science.gov (United States)

    Because the performance of powdered activated carbon (PAC) for uses other than taste and odor control is poorly documented, the purpose of this article is to critically review uses that have been reported (i.e., pesticides and herbicides, synthetic organic chemicals, and trihalom...

  19. A critical review of clarifier modelling

    DEFF Research Database (Denmark)

    Plósz, Benedek; Nopens, Ingmar; Rieger, Leiv

    This outline paper aims to provide a critical review of secondary settling tank (SST) modelling approaches used in current wastewater engineering and develop tools not yet applied in practice. We address the development of different tier models and experimental techniques in the field...

  20. Review of critical factors for SEA implementation

    Energy Technology Data Exchange (ETDEWEB)

    Zhang Jie, E-mail: jasmine@plan.aau.dk; Christensen, Per; Kornov, Lone

    2013-01-15

    The implementation process involved in translating Strategic Environmental Assessment (SEA) intention into action is vital to an effective SEA. Many factors influence implementation and thus the effectiveness of an SEA. Empirical studies have identified and documented some factors influencing the implementation of an SEA. This research is fragmented, however, and it is still not clear what are the most critical factors of effective SEA performance, and how these relate to different stages of the implementation process or other contextual circumstances. The paper takes its point of departure in implementation theory. Firstly, we introduce implementation theory, and then use it in practice to establish a more comprehensive model related to the stages in the implementation process. Secondly, we identify the critical factors in order to see how they are related to the different stages of SEA or are more general in character. Finally we map the different critical factors and how they influence the overall results of an SEA. Based on a literature review, we present a comprehensive picture of the critical factors and where they are found in the process. We conclude that most of the critical factors identified are of a more general character influencing the SEA process as such, while only one out of four of these factors relates to the specific stages of the SEA. Based on this mapping we can sketch a picture of the totality of critical factors. In this study 266 notions of critical factors were identified. Seen at the level of notions of critical factors, only 24% of these relate to specific stages while for 76% the critical factors are of a more general nature. These critical factors interact in complex ways and appear in different combinations in different stages of the implementation process so tracing the cause and effect is difficult. The pervasiveness of contextual and general factors also clearly suggests that there is no single way to put SEA into practice. The

  1. Review of critical factors for SEA implementation

    International Nuclear Information System (INIS)

    Zhang Jie; Christensen, Per; Kørnøv, Lone

    2013-01-01

    The implementation process involved in translating Strategic Environmental Assessment (SEA) intention into action is vital to an effective SEA. Many factors influence implementation and thus the effectiveness of an SEA. Empirical studies have identified and documented some factors influencing the implementation of an SEA. This research is fragmented, however, and it is still not clear what are the most critical factors of effective SEA performance, and how these relate to different stages of the implementation process or other contextual circumstances. The paper takes its point of departure in implementation theory. Firstly, we introduce implementation theory, and then use it in practice to establish a more comprehensive model related to the stages in the implementation process. Secondly, we identify the critical factors in order to see how they are related to the different stages of SEA or are more general in character. Finally we map the different critical factors and how they influence the overall results of an SEA. Based on a literature review, we present a comprehensive picture of the critical factors and where they are found in the process. We conclude that most of the critical factors identified are of a more general character influencing the SEA process as such, while only one out of four of these factors relates to the specific stages of the SEA. Based on this mapping we can sketch a picture of the totality of critical factors. In this study 266 notions of critical factors were identified. Seen at the level of notions of critical factors, only 24% of these relate to specific stages while for 76% the critical factors are of a more general nature. These critical factors interact in complex ways and appear in different combinations in different stages of the implementation process so tracing the cause and effect is difficult. The pervasiveness of contextual and general factors also clearly suggests that there is no single way to put SEA into practice. The

  2. English language learning materials a critical review

    CERN Document Server

    Tomlinson

    2010-01-01

    This research collection presents a critical review of the materials used for learning English around the world. The first section includes a discussion of materials for specific learners and purposes, such as young learners, self-study, academic writing and general proficiency. The second section presents a detailed study of the materials used in Europe, Asia, North America, South America, Africa and Australia, and critically evaluates their effectiveness in the teaching of English to speakers of other languages. Taking both the teacher's and the learner's needs into consideration, the book m

  3. EPR and Bell's theorem: A critical review

    International Nuclear Information System (INIS)

    Stapp, H.P.

    1991-01-01

    The argument of Einstein, Podolsky, and Rosen is reviewed with attention to logical structure and character of assumptions. Bohr's reply is discussed. Bell's contribution is formulated without use of hidden variables, and efforts to equate hidden variables to realism are critically examined. An alternative derivation of nonlocality that makes no use of hidden variables, microrealism, counterfactual definiteness, or any other assumption alien to orthodox quantum thinking is described in detail, with particular attention to the quartet or broken-square question

  4. Plant safety review from mass criticality accident

    International Nuclear Information System (INIS)

    Susanto, B.G.

    2000-01-01

    The review has been done to understand the resent status of the plant in facing postulated mass criticality accident. From the design concept of the plant all the components in the system including functional groups have been designed based on favorable mass/geometry safety principle. The criticality safety for each component is guaranteed because all the dimensions relevant to criticality of the components are smaller than dimensions of 'favorable mass/geometry'. The procedures covering all aspects affecting quality including the safety related are developed and adhered to at all times. Staff are indoctrinated periodically in short training session to warn the important of the safety in process of production. The plant is fully equipped with 6 (six) criticality detectors in strategic places to alert employees whenever the postulated mass criticality accident occur. In the event of Nuclear Emergency Preparedness, PT BATAN TEKNOLOGI has also proposed the organization structure how promptly to report the crisis to Nuclear Energy Control Board (BAPETEN) Indonesia. (author)

  5. Critical review of directional neutron survey meters

    International Nuclear Information System (INIS)

    Balmer, Matthew J.I.; Gamage, Kelum A.A.; Taylor, Graeme C.

    2014-01-01

    Having been overlooked for many years, research is now starting to take into account the directional distribution of the neutron work place field. The impact of not taking this into account has led to overly conservative estimates of dose in neutron workplace fields. This paper provides a critical review of this existing research into directional survey meters which could improve these estimates of dose. Instruments which could be adapted for use as directional neutron survey meters are also considered within this review. Using Monte-Carlo techniques, two of the most promising existing designs are evaluated; a boron-doped liquid scintillator and a multi-detector directional spectrometer. As an outcome of these simulations, possible adaptations to these instruments are suggested with a view to improving the portability of the instrument. -- Highlights: • We critically review the existing literature into directional survey meters. • Instruments which could be adapted for this purpose are also reviewed. • Investigate the potential of much lighter portable real-time instrument. • Improvements to existing instruments are suggested to improve their design. • Boron-Doped liquid scintillator design is the most promising, but needs further work

  6. Development of critical digital review procedure

    International Nuclear Information System (INIS)

    Huang Huiwen; Liao Benching; Tseng Maosheng; Chung Hsianghan; Cheng Tsungchieh; Chen Minghuei

    2011-01-01

    This paper describes the critical digital review (CDR) procedure, which was developed by Institute of Nuclear Energy Research (INER), and sponsored by Taiwan Power Company (TPC). A preliminary CDR application experience which was performed by INER, is also described in this paper. Currently, CDR becomes one of the policies for digital Instrumentation and Control (I and C) system replacement in TPC. The contents of this CDR procedure include: Scope, Responsibility, Operation Procedure, Operation Flow Chart, CDR review items. The 'CDR Review Items' chapter proposes optional review items, including the comparison of the design change, Software Verification and Validation (SV and V), Failure Mode and Effects Analysis (FMEA), Evaluation of Watchdog Timer, Evaluation of Electromagnetic Compatibility (EMC), Evaluation of Grounding for System/Component, Seismic Evaluation, HFE Evaluation, Witness and Inspection, Lessons Learnt from the Digital I and C Failure Events. Since CDR has become a TPC policy, Chin Shan Nuclear Power Plant (NPP) performed the CDR practice of Automatic Voltage Regulator (AVR) digital I and C replacement, even though the project had been on the half way. The major review items of this CDR were: the comparison of the design change, SV and V, FMEA, Evaluation of Watchdog Timer, Evaluation of Electromagnetic Compatibility (EMC), Evaluation of Grounding for System/ Component, Witness and Inspection, Lessons Learnt from the Digital I and C Failure Events. The experience of the CDR showed the importance of preparation of the documents by the vendor. This means the communication with the vendors for the bid preparation is crucial. (author)

  7. Breckinridge Project, initial effort. Report XI, Volume V. Critical review of the design basis. [Critical review

    Energy Technology Data Exchange (ETDEWEB)

    None

    1982-01-01

    Report XI, Technical Audit, is a compendium of research material used during the Initial Effort in making engineering comparisons and decisions. Volumes 4 and 5 of Report XI present those studies which provide a Critical Review of the Design Basis. The Critical Review Report, prepared by Intercontinental Econergy Associates, Inc., summarizes findings from an extensive review of the data base for the H-Coal process design. Volume 4 presents this review and assessment, and includes supporting material; specifically, Design Data Tabulation (Appendix A), Process Flow Sheets (Appendix B), and References (Appendix C). Volume 5 is a continuation of the references of Appendix C. Studies of a proprietary nature are noted and referenced, but are not included in these volumes. They are included in the Limited Access versions of these reports and may be reviewed by properly cleared personnel in the offices of Ashland Synthetic Fuels, Inc.

  8. Blood parasites of penguins: a critical review.

    Science.gov (United States)

    Vanstreels, Ralph Eric Thijl; Braga, Érika Martins; Catão-Dias, José Luiz

    2016-07-01

    Blood parasites are considered some of the most significant pathogens for the conservation of penguins, due to the considerable morbidity and mortality they have been shown to produce in captive and wild populations of these birds. Parasites known to occur in the blood of penguins include haemosporidian protozoans (Plasmodium, Leucocytozoon, Haemoproteus), piroplamid protozoans (Babesia), kinetoplastid protozoans (Trypanosoma), spirochete bacteria (Borrelia) and nematode microfilariae. This review provides a critical and comprehensive assessment of the current knowledge on these parasites, providing an overview of their biology, host and geographic distribution, epidemiology, pathology and implications for public health and conservation.

  9. Critical Review of Membrane Bioreactor Models

    DEFF Research Database (Denmark)

    Naessens, W.; Maere, T.; Ratkovich, Nicolas Rios

    2012-01-01

    Membrane bioreactor technology exists for a couple of decades, but has not yet overwhelmed the market due to some serious drawbacks of which operational cost due to fouling is the major contributor. Knowledge buildup and optimisation for such complex systems can heavily benefit from mathematical...... modelling. In this paper, the vast literature on hydrodynamic and integrated modelling in MBR is critically reviewed. Hydrodynamic models are used at different scales and focus mainly on fouling and only little on system design/optimisation. Integrated models also focus on fouling although the ones...

  10. Critical review of directional neutron survey meters

    Science.gov (United States)

    Balmer, Matthew J. I.; Gamage, Kelum A. A.; Taylor, Graeme C.

    2014-01-01

    Having been overlooked for many years, research is now starting to take into account the directional distribution of the neutron work place field. The impact of not taking this into account has led to overly conservative estimates of dose in neutron workplace fields. This paper provides a critical review of this existing research into directional survey meters which could improve these estimates of dose. Instruments which could be adapted for use as directional neutron survey meters are also considered within this review. Using Monte-Carlo techniques, two of the most promising existing designs are evaluated; a boron-doped liquid scintillator and a multi-detector directional spectrometer. As an outcome of these simulations, possible adaptations to these instruments are suggested with a view to improving the portability of the instrument.

  11. Critical Review of Directional Neutron Survey Meters

    International Nuclear Information System (INIS)

    Balmer, M.J.I.; Gamage, K.A.A.; Taylor, G.C.

    2013-06-01

    Having been overlooked for many years, research is now starting to take into account the directional distribution of the neutron work place field. The impact of not taking this into account has led to overly conservative estimates of dose in neutron workplace fields. This paper provides a critical review of this existing research into directional survey meters which could improve these estimates of dose. Instruments which could be adapted for use as directional neutron survey meters are also considered within this review. Using Monte-Carlo techniques, two of the most promising existing designs are evaluated; a boron-doped liquid scintillator and a multi-detector directional spectrometer. As an outcome of these simulations, possible adaptations to these instruments are suggested with a view to improving the portability of the instrument. (authors)

  12. Consumer sleep tracking devices: a critical review.

    Science.gov (United States)

    Lee, Jeon; Finkelstein, Joseph

    2015-01-01

    Consumer sleep tracking devices are widely advertised as effective means to monitor and manage sleep quality and to provide positive effects on overall heath. However objective evidence supporting these claims is not always readily available. The goal of this study was to perform a comprehensive review of available information on six representative sleep tracking devices: BodyMedia FIT, Fitbit Flex, Jawbone UP, Basis Band, Innovative Sleep Solutions SleepTracker, and Zeo Sleep Manager Pro. The review was conducted along the following dimensions: output metrics, theoretical frameworks, systematic evaluation, and FDA clearance. The review identified a critical lack of basic information about the devices: five out of six devices provided no supporting information on their sensor accuracy and four out of six devices provided no information on their output metrics accuracy. Only three devices were found to have related peer-reviewed articles. However in these articles wake detection accuracy was revealed to be quite low and to vary widely (BodyMedia, 49.9±3.6%; Fitbit, 19.8%; Zeo, 78.9% to 83.5%). No supporting evidence on how well tracking devices can help mitigate sleep loss and manage sleep disturbances in practical life was provided.

  13. Critical Review of NOAA's Observation Requirements Process

    Science.gov (United States)

    LaJoie, M.; Yapur, M.; Vo, T.; Templeton, A.; Bludis, D.

    2017-12-01

    NOAA's Observing Systems Council (NOSC) maintains a comprehensive database of user observation requirements. The requirements collection process engages NOAA subject matter experts to document and effectively communicate the specific environmental observation measurements (parameters and attributes) needed to produce operational products and pursue research objectives. User observation requirements documented using a structured and standardized manner and framework enables NOAA to assess its needs across organizational lines in an impartial, objective, and transparent manner. This structure provides the foundation for: selecting, designing, developing, acquiring observing technologies, systems and architectures; budget and contract formulation and decision-making; and assessing in a repeatable fashion the productivity, efficiency and optimization of NOAA's observing system enterprise. User observation requirements are captured independently from observing technologies. Therefore, they can be addressed by a variety of current or expected observing capabilities and allow flexibility to be remapped to new and evolving technologies. NOAA's current inventory of user observation requirements were collected over a ten-year period, and there have been many changes in policies, mission priorities, and funding levels during this time. In light of these changes, the NOSC initiated a critical, in-depth review to examine all aspects of user observation requirements and associated processes during 2017. This presentation provides background on the NOAA requirements process, major milestones and outcomes of the critical review, and plans for evolving and connecting observing requirements processes in the next year.

  14. REVIEWS OF TOPICAL PROBLEMS: Critical opalescence

    Science.gov (United States)

    Zubkov, L. A.; Romanov, Vadim P.

    1988-04-01

    Studies of critical opalescence near phase transitions in different systems are reviewed. The fundamentals of the modern approach to the description of the propagation and scattering of light in media with large nonuniformities are presented. The experimental data on the coefficient of extinction and integrated intensity of the scattered light are analyzed and different models for the correlation function are discussed. Different methods for studying multiple scattering of light and methods for eliminating it from the measured intensity are examined. The kinetic properties of systems in the critical region are examined. Attention is devoted primarily to the experimental data obtained by the methods of correlation spectroscopy and to the comparison of these data with the predictions of different theoretical models. Significant attention is devoted to the study of phase transitions in liquids by the methods of light scattering as well as the problem of propagation and scattering of light in the nematic phase, where fluctuations of the director exhibit the same behavior as at the critical point. In conclusion, phase transformations in micellar solutions, to which a great deal of attention has been devoted in recent years, are studied.

  15. A Review of Criticality Accidents 2000 Revision

    Energy Technology Data Exchange (ETDEWEB)

    Thomas P. McLaughlin; Shean P. Monahan; Norman L. Pruvost; Vladimir V. Frolov; Boris G. Ryazanov; Victor I. Sviridov

    2000-05-01

    Criticality accidents and the characteristics of prompt power excursions are discussed. Sixty accidental power excursions are reviewed. Sufficient detail is provided to enable the reader to understand the physical situation, the chemistry and material flow, and when available the administrative setting leading up to the time of the accident. Information on the power history, energy release, consequences, and causes are also included when available. For those accidents that occurred in process plants, two new sections have been included in this revision. The first is an analysis and summary of the physical and neutronic features of the chain reacting systems. The second is a compilation of observations and lessons learned. Excursions associated with large power reactors are not included in this report.

  16. Critical review: medical students' motivation after failure.

    Science.gov (United States)

    Holland, Chris

    2016-08-01

    About 10 % of students in each years' entrants to medical school will encounter academic failure at some stage in their programme. The usual approach to supporting these students is to offer them short term remedial study programmes that often enhance approaches to study that are orientated towards avoiding failure. In this critical review I will summarise the current theories about student motivation that are most relevant to this group of students and describe how they are enhanced or not by various contextual factors that medical students experience during their programme. I will conclude by suggesting ways in which support programmes for students who have encountered academic failure might be better designed and researched in the future.

  17. A Review of Criticality Accidents 2000 Revision

    International Nuclear Information System (INIS)

    McLaughlin, Thomas P.; Monahan, Shean P.; Pruvost, Norman L.; Frolov, Vladimir V.; Ryazanov, Boris G.; Sviridov, Victor I.

    2000-01-01

    Criticality accidents and the characteristics of prompt power excursions are discussed. Sixty accidental power excursions are reviewed. Sufficient detail is provided to enable the reader to understand the physical situation, the chemistry and material flow, and when available the administrative setting leading up to the time of the accident. Information on the power history, energy release, consequences, and causes are also included when available. For those accidents that occurred in process plants, two new sections have been included in this revision. The first is an analysis and summary of the physical and neutronic features of the chain reacting systems. The second is a compilation of observations and lessons learned. Excursions associated with large power reactors are not included in this report

  18. Green Adsorbents for Wastewaters: A Critical Review

    Directory of Open Access Journals (Sweden)

    George Z. Kyzas

    2014-01-01

    Full Text Available One of the most serious environmental problems is the existence of hazardous and toxic pollutants in industrial wastewaters. The major hindrance is the simultaneous existence of many/different types of pollutants as (i dyes; (ii heavy metals; (iii phenols; (iv pesticides and (v pharmaceuticals. Adsorption is considered to be one of the most promising techniques for wastewater treatment over the last decades. The economic crisis of the 2000s led researchers to turn their interest in adsorbent materials with lower cost. In this review article, a new term will be introduced, which is called “green adsorption”. Under this term, it is meant the low-cost materials originated from: (i agricultural sources and by-products (fruits, vegetables, foods; (ii agricultural residues and wastes; (iii low-cost sources from which most complex adsorbents will be produced (i.e., activated carbons after pyrolysis of agricultural sources. These “green adsorbents” are expected to be inferior (regarding their adsorption capacity to the super-adsorbents of previous literature (complex materials as modified chitosans, activated carbons, structurally-complex inorganic composite materials etc., but their cost-potential makes them competitive. This review is a critical approach to green adsorption, discussing many different (maybe in some occasions doubtful topics such as: (i adsorption capacity; (ii kinetic modeling (given the ultimate target to scale up the batch experimental data to fixed-bed column calculations for designing/optimizing commercial processes and (iii critical techno-economical data of green adsorption processes in order to scale-up experiments (from lab to industry with economic analysis and perspectives of the use of green adsorbents.

  19. Green Adsorbents for Wastewaters: A Critical Review

    Science.gov (United States)

    Kyzas, George Z.; Kostoglou, Margaritis

    2014-01-01

    One of the most serious environmental problems is the existence of hazardous and toxic pollutants in industrial wastewaters. The major hindrance is the simultaneous existence of many/different types of pollutants as (i) dyes; (ii) heavy metals; (iii) phenols; (iv) pesticides and (v) pharmaceuticals. Adsorption is considered to be one of the most promising techniques for wastewater treatment over the last decades. The economic crisis of the 2000s led researchers to turn their interest in adsorbent materials with lower cost. In this review article, a new term will be introduced, which is called “green adsorption”. Under this term, it is meant the low-cost materials originated from: (i) agricultural sources and by-products (fruits, vegetables, foods); (ii) agricultural residues and wastes; (iii) low-cost sources from which most complex adsorbents will be produced (i.e., activated carbons after pyrolysis of agricultural sources). These “green adsorbents” are expected to be inferior (regarding their adsorption capacity) to the super-adsorbents of previous literature (complex materials as modified chitosans, activated carbons, structurally-complex inorganic composite materials etc.), but their cost-potential makes them competitive. This review is a critical approach to green adsorption, discussing many different (maybe in some occasions doubtful) topics such as: (i) adsorption capacity; (ii) kinetic modeling (given the ultimate target to scale up the batch experimental data to fixed-bed column calculations for designing/optimizing commercial processes) and (iii) critical techno-economical data of green adsorption processes in order to scale-up experiments (from lab to industry) with economic analysis and perspectives of the use of green adsorbents. PMID:28788460

  20. Nutritional risk assessment in critically ill cancer patients: systematic review

    Science.gov (United States)

    Fruchtenicht, Ana Valéria Gonçalves; Poziomyck, Aline Kirjner; Kabke, Geórgia Brum; Loss, Sérgio Henrique; Antoniazzi, Jorge Luiz; Steemburgo, Thais; Moreira, Luis Fernando

    2015-01-01

    Objective To systematically review the main methods for nutritional risk assessment used in critically ill cancer patients and present the methods that better assess risks and predict relevant clinical outcomes in this group of patients, as well as to discuss the pros and cons of these methods according to the current literature. Methods The study consisted of a systematic review based on analysis of manuscripts retrieved from the PubMed, LILACS and SciELO databases by searching for the key words “nutritional risk assessment”, “critically ill” and “cancer”. Results Only 6 (17.7%) of 34 initially retrieved papers met the inclusion criteria and were selected for the review. The main outcomes of these studies were that resting energy expenditure was associated with undernourishment and overfeeding. The high Patient-Generated Subjective Global Assessment score was significantly associated with low food intake, weight loss and malnutrition. In terms of biochemical markers, higher levels of creatinine, albumin and urea were significantly associated with lower mortality. The worst survival was found for patients with worse Eastern Cooperative Oncologic Group - performance status, high Glasgow Prognostic Score, low albumin, high Patient-Generated Subjective Global Assessment score and high alkaline phosphatase levels. Geriatric Nutritional Risk Index values < 87 were significantly associated with mortality. A high Prognostic Inflammatory and Nutritional Index score was associated with abnormal nutritional status in critically ill cancer patients. Among the reviewed studies that examined weight and body mass index alone, no significant clinical outcome was found. Conclusion None of the methods reviewed helped to define risk among these patients. Therefore, assessment by a combination of weight loss and serum measurements, preferably in combination with other methods using scores such as Eastern Cooperative Oncologic Group - performance status, Glasgow Prognostic

  1. Rationing in health systems: A critical review.

    Science.gov (United States)

    Keliddar, Iman; Mosadeghrad, Ali Mohammad; Jafari-Sirizi, Mehdi

    2017-01-01

    Background: It is difficult to provide health care services to all those in need of such services due to limited resources and unlimited demands. Thus, priority setting and rationing have to be applied. This study aimed at critically examining the concept of rationing in health sector and identifying its purposes, influencing factors, mechanisms, and outcomes. Methods: The critical interpretive synthesis methodology was used in this study. PubMed, Cochrane, and Proquest databases were searched using the related key words to find related documents published between 1970 and 2015. In total, 161 published reports were reviewed and included in the study. Thematic content analysis was applied for data analysis. Results: Health services rationing means restricting the access of some people to useful or potentially useful health services due to budgetary limitation. The inherent features of the health market and health services, limited resources, and unlimited needs necessitate health services rationing. Rationing can be applied in 4 levels: health care policy- makers, health care managers, health care providers, and patients. Health care rationing can be accomplished through fixed budget, benefit package, payment mechanisms, queuing, copayments, and deductibles. Conclusion: This paper enriched our understanding of health services rationing and its mechanisms at various levels and contributed to the literature by broadly conceptualizing health services rationing.

  2. Radiopharmaceuticals drug interactions: a critical review

    International Nuclear Information System (INIS)

    Santos-Oliveira, Ralph; Smith, Sheila W.; Carneiro-Leao, Ana Maria A.

    2008-01-01

    Radiopharmaceuticals play a critical role in modern medicine primarily for diagnostic purposes, but also for monitoring disease progression and response to treatment. As the use of image has been increased, so has the use of prescription medications. These trends increase the risk of interactions between medications and radiopharmaceuticals. These interactions which have an impact on image by competing with the radiopharmaceutical for binding sites for example can lead to false negative results. Drugs that accelerate the metabolism of the radiopharmaceutical can have a positive impact (i.e. speeding its clearance) or, if repeating image is needed, a negative impact. In some cases, for example in cardiac image among patients taking doxirubacin, these interactions may have a therapeutic benefit. The incidence of drug-radiopharmaceuticals adverse reactions is unknown, since they may not be reported or even recognized. Here, we compiled the medical literature, using the criteria of a systematic review established by the Cochrane Collaboration, on pharmaceutical-drug interactions to provide a summary of documented interactions by organ system and radiopharmaceuticals. The purpose is to provide a reference on drug interactions that could inform the nuclear medicine staff in their daily routine. Efforts to increase adverse event reporting, and ideally consolidate reports worldwide, can provide a critically needed resource for prevention of drug-radiopharmaceuticals interactions. (author)

  3. [Clinical pharmacy and surgery: Review].

    Science.gov (United States)

    Jarfaut, A; Nivoix, Y; Vigouroux, D; Kehrli, P; Gaudias, J; Kempf, J-F; Levêque, D; Gourieux, B

    2014-05-01

    Clinical pharmacy has been developed and evaluated in various medical hospital activities. Reviews conducted in this area reported a higher value of this discipline. In surgical services, evenly adverse drug events may occur, so clinical pharmacy activities must also help to optimize the management of drug's patient. The objectives of this literature review is to determine the profile of clinical pharmacy activities developed in surgical services and identify indicators. The research was conducted on Pubmed(®) database with the following keywords (2000-2013), "surgery", "pharmacy", "pharmacist", "pharmaceutical care", "impact" and limited to French or English papers. Studies dealing on simultaneously medical and surgical areas were excluded. Twenty-one papers were selected. The most frequently developed clinical pharmacy activities were history and therapeutic drug monitoring (antibiotics or anticoagulants). Two types of indicators were identified: activity indicators with the number of pharmaceutical interventions, their description and clinical signification, the acceptance rate and workload. Impact indicators were mostly clinical and economic impacts. The development of clinical pharmacy related to surgical patients is documented and appears to have, as for medical patients, a clinical and economical value. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  4. A Critical Review of Low Back Pain Guidelines.

    Science.gov (United States)

    Chetty, Laran

    2017-09-01

    Low back pain (LBP) remains one of the most common and challenging musculoskeletal conditions encountered by health care professionals and is a leading cause of absenteeism. Clinical guidelines are often considered best evidence in health care. The aim of this critical review was to assess the quality and recommendations of LBP guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. Electronic databases were used to identify LBP guidelines published between 2000 and 2015. Nine guidelines were selected for review from a total of 17. Only five guidelines effectively addressed the AGREE scoring. On the basis of the appraisal and domain scores, only four guidelines were strongly recommended. Improved translation of research evidence from guidelines to clinical practice is needed.

  5. [Second victim : Critical incident stress management in clinical medicine].

    Science.gov (United States)

    Schiechtl, B; Hunger, M S; Schwappach, D L; Schmidt, C E; Padosch, S A

    2013-09-01

    Critical incidents in clinical medicine can have far-reaching consequences on patient health. In cases of severe medical errors they can seriously harm the patient or even lead to death. The involvement in such an event can result in a stress reaction, a so-called acute posttraumatic stress disorder in the healthcare provider, the so-called second victim of an adverse event. Psychological distress may not only have a long lasting impact on quality of life of the physician or caregiver involved but it may also affect the ability to provide safe patient care in the aftermath of adverse events. A literature review was performed to obtain information on care giver responses to medical errors and to determine possible supportive strategies to mitigate negative consequences of an adverse event on the second victim. An internet search and a search in Medline/Pubmed for scientific studies were conducted using the key words "second victim, "medical error", "critical incident stress management" (CISM) and "critical incident stress reporting system" (CIRS). Sources from academic medical societies and public institutions which offer crisis management programs where analyzed. The data were sorted by main categories and relevance for hospitals. Analysis was carried out using descriptive measures. In disaster medicine and aviation navigation services the implementation of a CISM program is an efficient intervention to help staff to recover after a traumatic event and to return to normal functioning and behavior. Several other concepts for a clinical crisis management plan were identified. The integration of CISM and CISM-related programs in a clinical setting may provide efficient support in an acute crisis and may help the caregiver to deal effectively with future error events and employee safety.

  6. A critical review on tablet disintegration.

    Science.gov (United States)

    Quodbach, Julian; Kleinebudde, Peter

    2016-09-01

    Tablet disintegration is an important factor for drug release and can be modified with excipients called tablet disintegrants. Tablet disintegrants act via different mechanisms and the efficacy of these excipients is influenced by various factors. In this review, the existing literature on tablet disintegration is critically reviewed. Potential disintegration mechanisms, as well as impact factors on the disintegration process will be discussed based on experimental evidence. Search terms for Scopus and Web of Science included "tablet disintegration", "mechanism tablet disintegration", "superdisintegrants", "disintegrants", "swelling force", "disintegration force", "disintegration mechanisms", as well as brand names of commonly applied superdisintegrants. References of identified papers were screened as well. Experimental data supports swelling and shape recovery as main mechanisms of action of disintegrants. Other tablet excipients and different manufacturing techniques greatly influence the disintegration process. The use of different excipients, experimental setups and manufacturing techniques, as well as the demand for original research led to a distinct patchwork of knowledge. Broader, more systematic approaches are necessary not only to structure the past but also future findings.

  7. A critical review of classical bouncing cosmologies

    Energy Technology Data Exchange (ETDEWEB)

    Battefeld, Diana, E-mail: dbattefe@astro.physik.uni-goettingen.de [Institut for Astrophysics, University of Goettingen, Friedrich-Hund Platz 1, D-37077 (Germany); Peter, Patrick, E-mail: peter@iap.fr [Institut d’Astrophysique de Paris, UMR 7095-CNRS, Université Pierre et Marie Curie, 98 bis boulevard Arago, 75014 Paris (France)

    2015-04-01

    Given the proliferation of bouncing models in recent years, we gather and critically assess these proposals in a comprehensive review. The PLANCK data shows an unmistakably red, quasi scale-invariant, purely adiabatic primordial power spectrum and no primary non-Gaussianities. While these observations are consistent with inflationary predictions, bouncing cosmologies aspire to provide an alternative framework to explain them. Such models face many problems, both of the purely theoretical kind, such as the necessity of violating the NEC and instabilities, and at the cosmological application level, as exemplified by the possible presence of shear. We provide a pedagogical introduction to these problems and also assess the fitness of different proposals with respect to the data. For example, many models predict a slightly blue spectrum and must be fine-tuned to generate a red spectral index; as a side effect, large non-Gaussianities often result. We highlight several promising attempts to violate the NEC without introducing dangerous instabilities at the classical and/or quantum level. If primordial gravitational waves are observed, certain bouncing cosmologies, such as the cyclic scenario, are in trouble, while others remain valid. We conclude that, while most bouncing cosmologies are far from providing an alternative to the inflationary paradigm, a handful of interesting proposals have surfaced, which warrant further research. The constraints and lessons learned as laid out in this review might guide future research.

  8. Historical and Critical Review on Biophysical Economics

    Science.gov (United States)

    Adigüzel, Yekbun

    2016-07-01

    Biophysical economics is initiated with the long history of the relation of economics with ecological basis and biophysical perspectives of the physiocrats. It inherently has social, economic, biological, environmental, natural, physical, and scientific grounds. Biological entities in economy like the resources, consumers, populations, and parts of production systems, etc. could all be dealt by biophysical economics. Considering this wide scope, current work is a “biophysical economics at a glance” rather than a comprehensive review of the full range of topics that may just be adequately covered in a book-length work. However, the sense of its wide range of applications is aimed to be provided to the reader in this work. Here, modern approaches and biophysical growth theory are presented after the long history and an overview of the concepts in biophysical economics. Examples of the recent studies are provided at the end with discussions. This review is also related to the work by Cleveland, “Biophysical Economics: From Physiocracy to Ecological Economics and Industrial Ecology” [C. J. Cleveland, in Advances in Bioeconomics and Sustainability: Essay in Honor of Nicholas Gerogescu-Roegen, eds. J. Gowdy and K. Mayumi (Edward Elgar Publishing, Cheltenham, England, 1999), pp. 125-154.]. Relevant parts include critics and comments on the presented concepts in a parallelized fashion with the Cleveland’s work.

  9. Clinical Competence Certification: A Critical Appraisal.

    Science.gov (United States)

    Woolliscroft, James O.; And Others

    1984-01-01

    The American Board of Internal Medicine has requested that residency program directors certify the clinical competence of their candidates. The clinical evaluation exercise (CEX) was used by residents at the University of Michigan Hospitals and the results raised questions as to the validity of the CEX. (Author/MLW)

  10. Cultivating Critical Thinking in the Clinical Learning Environment.

    Science.gov (United States)

    Behar-Horenstein, Linda S.; Dolan, Teresa A.; Courts, Frank J.; Mitchell, Gail S.

    2000-01-01

    Used qualitative research methods to assess the frequency and nature of teaching critical thinking skills in the University of Florida College of Dentistry predoctoral student clinics. Observation of 13 faculty and 44 students in six clinics found critical thinking skills were infrequently taught and teacher-dominated instruction predominated.…

  11. A Critical Review of the Critical Period Research.

    Science.gov (United States)

    Scovel, Thomas

    2000-01-01

    Discusses how perspectives on the critical period hypothesis (CPH) have shifted over the last 20-20 years, because of the work of applied linguistics and other disciplines. Advises caution into translating CPH research into personal practice or public policy. (Author/VWL)

  12. Long-term clinical outcome in patients with stage-i nonseminomatous germ cell cancer: a critical review of own treatment modalities in a retrospective study

    Directory of Open Access Journals (Sweden)

    Sandra Seseke

    2008-12-01

    Full Text Available PURPOSE: The optimal management of patients with clinical stage I non-seminomatous germ cell testicular cancer (NSGCT I was considered controversial until the European Germ Cell Cancer Consensus Group determined unambiguous treatment strategies. In order to assess the long-term outcome we evaluated the data of patients with NSGCT I. MATERIALS AND METHODS: In a retrospective evaluation, we included 52 patients with a mean age of 26 years (range 15-58 who were treated with different modalities at our department between 1989 and 2003. Mean follow-up was 5.9 years (range 2-14 years. After orchiectomy, 39 patients were treated with chemotherapy, 7 patients underwent retroperitoneal lymph node dissection and 6 men were managed using a surveillance strategy. Survival, recurrence rate and time of recurrence were evaluated. The histological staging and treatment modality was related to the relapse. RESULTS: Tumor specific overall mortality was 3.8%. The mortality and relapse rate of the surveillance strategy, retroperitoneal lymph node dissection and chemotherapy was 16.7% / 50%, 14.3% / 14.3% and 0% / 2.5% respectively. All relapsed patients in the surveillance group as well as in the RPLND group had at least one risk factor for developing metastatic disease. CONCLUSIONS: Following the European consensus on diagnosis and treatment of germ cell cancer in patients with NSGCT Stage I any treatment decision must be individually related to the patient according to prognostic factors and care capacity of the treating centre. In case of doubt, adjuvant chemotherapy should be the treatment of choice, as it provides the lowest risk of relapse or tumor related death.

  13. A review of costing methodologies in critical care studies.

    Science.gov (United States)

    Pines, Jesse M; Fager, Samuel S; Milzman, David P

    2002-09-01

    Clinical decision making in critical care has traditionally been based on clinical outcome measures such as mortality and morbidity. Over the past few decades, however, increasing competition in the health care marketplace has made it necessary to consider costs when making clinical and managerial decisions in critical care. Sophisticated costing methodologies have been developed to aid this decision-making process. We performed a narrative review of published costing studies in critical care during the past 6 years. A total of 282 articles were found, of which 68 met our search criteria. They involved a mean of 508 patients (range, 20-13,907). A total of 92.6% of the studies (63 of 68) used traditional cost analysis, whereas the remaining 7.4% (5 of 68) used cost-effectiveness analysis. None (0 of 68) used cost-benefit analysis or cost-utility analysis. A total of 36.7% (25 of 68) used hospital charges as a surrogate for actual costs. Of the 43 articles that actually counted costs, 37.2% (16 of 43) counted physician costs, 27.9% (12 of 43) counted facility costs, 34.9% (15 of 43) counted nursing costs, 9.3% (4 of 43) counted societal costs, and 90.7% (39 of 43) counted laboratory, equipment, and pharmacy costs. Our conclusion is that despite considerable progress in costing methodologies, critical care studies have not adequately implemented these techniques. Given the importance of financial implications in medicine, it would be prudent for critical care studies to use these more advanced techniques. Copyright 2002, Elsevier Science (USA). All rights reserved.

  14. Detailed clinical models: a review.

    Science.gov (United States)

    Goossen, William; Goossen-Baremans, Anneke; van der Zel, Michael

    2010-12-01

    Due to the increasing use of electronic patient records and other health care information technology, we see an increase in requests to utilize these data. A highly level of standardization is required during the gathering of these data in the clinical context in order to use it for analyses. Detailed Clinical Models (DCM) have been created toward this purpose and several initiatives have been implemented in various parts of the world to create standardized models. This paper presents a review of DCM. Two types of analyses are presented; one comparing DCM against health care information architectures and a second bottom up approach from concept analysis to representation. In addition core parts of the draft ISO standard 13972 on DCM are used such as clinician involvement, data element specification, modeling, meta information, and repository and governance. SIX INITIATIVES WERE SELECTED: Intermountain Healthcare, 13606/OpenEHR Archetypes, Clinical Templates, Clinical Contents Models, Health Level 7 templates, and Dutch Detailed Clinical Models. Each model selected was reviewed for their overall development, involvement of clinicians, use of data types, code bindings, expressing semantics, modeling, meta information, use of repository and governance. Using both a top down and bottom up approach to comparison reveals many commonalties and differences between initiatives. Important differences include the use of or lack of a reference model and expressiveness of models. Applying clinical data element standards facilitates the use of conceptual DCM models in different technical representations.

  15. Haloperidol for delirium in critically ill patients - protocol for a systematic review

    DEFF Research Database (Denmark)

    Barbateskovic, M; Kraus, S R; Collet, M O

    2018-01-01

    , relatives, and societies is considerable. The objective of this systematic review was to critically access the evidence of randomised clinical trials on the effects of haloperidol vs. placebo or any other agents for delirium in critically ill patients. METHODS: We will search for randomised clinical trials...... decision makers on the use of or future trials with haloperidol for the management of delirium in critically ill patients....

  16. Radiotherapy for Vestibular Schwannomas: A Critical Review

    International Nuclear Information System (INIS)

    Murphy, Erin S.; Suh, John H.

    2011-01-01

    Vestibular schwannomas are slow-growing tumors of the myelin-forming cells that cover cranial nerve VIII. The treatment options for patients with vestibular schwannoma include active observation, surgical management, and radiotherapy. However, the optimal treatment choice remains controversial. We have reviewed the available data and summarized the radiotherapeutic options, including single-session stereotactic radiosurgery, fractionated conventional radiotherapy, fractionated stereotactic radiotherapy, and proton beam therapy. The comparisons of the various radiotherapy modalities have been based on single-institution experiences, which have shown excellent tumor control rates of 91-100%. Both stereotactic radiosurgery and fractionated stereotactic radiotherapy have successfully improved cranial nerve V and VII preservation to >95%. The mixed data regarding the ideal hearing preservation therapy, inherent biases in patient selection, and differences in outcome analysis have made the comparison across radiotherapeutic modalities difficult. Early experience using proton therapy for vestibular schwannoma treatment demonstrated local control rates of 84-100% but disappointing hearing preservation rates of 33-42%. Efforts to improve radiotherapy delivery will focus on refined dosimetry with the goal of reducing the dose to the critical structures. As future randomized trials are unlikely, we suggest regimented pre- and post-treatment assessments, including validated evaluations of cranial nerves V, VII, and VIII, and quality of life assessments with long-term prospective follow-up. The results from such trials will enhance the understanding of therapy outcomes and improve our ability to inform patients.

  17. Cities and Energy Consumption: a Critical Review

    Directory of Open Access Journals (Sweden)

    Carmela Gargiulo

    2017-12-01

    Full Text Available The relationship between cities and energy consumption has been of great interest for the scientific community for over twenty years. Most of the energy consumption, indeed, occurs in cities because of the high concentration of human activities. Thus, cities are responsible for a big share of carbon dioxide emissions (CO2. However, the debate on this topic is still open, mainly because of the heterogeneity of published studies in the selection, definition and measurement of the urban features influencing energy consumption and CO2 emissions, as well as in the choice of the energy sectors to be considered, in the territorial scale of analysis, and in the geographical distribution of the sample. Therefore, the goal of this research is to systematize and compare the approach, methodology and results of the relevant literature on the relationship between cities and energy consumption over the last twenty years. Furthermore, this critical review identifies the knowledge gap between what is known and what is still under debate and, based on that, it proposes a conceptual framework that will help to outline a new direction for future research and support local policy makers in the definition of strategies and actions that can effectively reduce urban energy use and CO2 emissions.

  18. Critical thinking in clinical nurse education: application of Paul's model of critical thinking.

    Science.gov (United States)

    Andrea Sullivan, E

    2012-11-01

    Nurse educators recognize that many nursing students have difficulty in making decisions in clinical practice. The ability to make effective, informed decisions in clinical practice requires that nursing students know and apply the processes of critical thinking. Critical thinking is a skill that develops over time and requires the conscious application of this process. There are a number of models in the nursing literature to assist students in the critical thinking process; however, these models tend to focus solely on decision making in hospital settings and are often complex to actualize. In this paper, Paul's Model of Critical Thinking is examined for its application to nursing education. I will demonstrate how the model can be used by clinical nurse educators to assist students to develop critical thinking skills in all health care settings in a way that makes critical thinking skills accessible to students. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. Clinical review: Percutaneous dilatational tracheostomy

    Science.gov (United States)

    Al-Ansari, Mariam A; Hijazi, Mohammed H

    2006-01-01

    As the number of critically ill patients requiring tracheotomy for prolonged ventilation has increased, the demand for a procedural alternative to the surgical tracheostomy (ST) has also emerged. Since its introduction, percutaneous dilatational tracheostomies (PDT) have gained increasing popularity. The most commonly cited advantages are the ease of the familiar technique and the ability to perform the procedure at the bedside. It is now considered a viable alternative to (ST) in the intensive care unit. Evaluation of PDT procedural modifications will require evaluation in randomized clinical trials. Regardless of the PDT technique, meticulous preoperative and postoperative management are necessary to maintain the excellent safety record of PDT. PMID:16356203

  20. Economics of Malignant Gliomas: A Critical Review.

    Science.gov (United States)

    Raizer, Jeffrey J; Fitzner, Karen A; Jacobs, Daniel I; Bennett, Charles L; Liebling, Dustin B; Luu, Thanh Ha; Trifilio, Steven M; Grimm, Sean A; Fisher, Matthew J; Haleem, Meraaj S; Ray, Paul S; McKoy, Judith M; DeBoer, Rebecca; Tulas, Katrina-Marie E; Deeb, Mohammed; McKoy, June M

    2015-01-01

    Approximately 18,500 persons are diagnosed with malignant glioma in the United States annually. Few studies have investigated the comprehensive economic costs. We reviewed the literature to examine costs to patients with malignant glioma and their families, payers, and society. A total of 18 fully extracted studies were included. Data were collected on direct and indirect costs, and cost estimates were converted to US dollars using the conversion rate calculated from the study's publication date, and updated to 2011 values after adjustment for inflation. A standardized data abstraction form was used. Data were extracted by one reviewer and checked by another. Before approval of effective chemotherapeutic agents for malignant gliomas, estimated total direct medical costs in the United States for surgery and radiation therapy per patient ranged from $50,600 to $92,700. The addition of temozolomide (TMZ) and bevacizumab to glioblastoma treatment regimens has resulted in increased overall costs for glioma care. Although health care costs are now less front-loaded, they have increased over the course of illness. Analysis using a willingness-to-pay threshold of $50,000 per quality-adjusted life-year suggests that the benefits of TMZ fall on the edge of acceptable therapies. Furthermore, indirect medical costs, such as productivity losses, are not trivial. With increased chemotherapy use for malignant glioma, the paradigm for treatment and associated out-of-pocket and total medical costs continue to evolve. Larger out-of-pocket costs may influence the choice of chemotherapeutic agents, the economic implications of which should be evaluated prospectively. Copyright © 2015 by American Society of Clinical Oncology.

  1. Critical concepts in adaptive clinical trials

    Directory of Open Access Journals (Sweden)

    Park JJH

    2018-03-01

    Full Text Available Jay JH Park,1 Kristian Thorlund,2,3 Edward J Mills2,3 1Department of Medicine, University of British Columbia, Vancouver, BC, Canada; 2Department of Health Research Methods, Evidence, and Impact (HEI, McMaster University, Hamilton, ON, Canada; 3The Bill and Melinda Gates Foundation, Seattle, WA, USA Abstract: Adaptive clinical trials are an innovative trial design aimed at reducing resources, decreasing time to completion and number of patients exposed to inferior interventions, and improving the likelihood of detecting treatment effects. The last decade has seen an increasing use of adaptive designs, particularly in drug development. They frequently differ importantly from conventional clinical trials as they allow modifications to key trial design components during the trial, as data is being collected, using preplanned decision rules. Adaptive designs have increased likelihood of complexity and also potential bias, so it is important to understand the common types of adaptive designs. Many clinicians and investigators may be unfamiliar with the design considerations for adaptive designs. Given their complexities, adaptive trials require an understanding of design features and sources of bias. Herein, we introduce some common adaptive design elements and biases and specifically address response adaptive randomization, sample size reassessment, Bayesian methods for adaptive trials, seamless trials, and adaptive enrichment using real examples. Keywords: adaptive designs, response adaptive randomization, sample size reassessment, Bayesian adaptive trials, seamless trials, adaptive enrichment

  2. What is bizarre in bizarre delusions? A critical review

    DEFF Research Database (Denmark)

    Cermolacce, Michel René Joseph; Jensen, Lars Meldgaard Sass; Parnas, J

    2010-01-01

    . These studies provide highly heterogenous results because they are based on different experimental paradigms, in terms of definition, clinical sample, and number of raters. Here, we first discuss the psychopathological sources of the concept of BD, which were initially described as either nonsensical...... or incomprehensible. Then, we provide a critical review of contemporary studies on the reliability of BD and their methodological and conceptual limitations. Current approaches have focused intensely on BD's reliability and have defined BD strictly in terms of delusional content--mainly in terms of the physical...... impossibility or the cultural or historical incomprehensibility of the delusional claims. These approaches have neglected formal features of experience that underlie BD and the crucial issue of the nature and validity of BD. In the discussion, we argue that clinical diagnosis of BD cannot be limited...

  3. Radioiodine Remnant Ablation: A Critical Review

    International Nuclear Information System (INIS)

    Bal, Chandra Sekhar; Padhy, Ajit Kumar

    2015-01-01

    Radioiodine remnant ablation (RRA) is considered a safe and effective method for eliminating residual thyroid tissue, as well as microscopic disease if at all present in thyroid bed following thyroidectomy. The rationale of RRA is that in the absence of thyroid tissue, serum thyroglobulin (Tg) measurement can be used as an excellent tumor marker. Other considerations are like the presence of significant remnant thyroid tissue makes detection and treatment of nodal or distant metastases difficult. Rarely, microscopic disease in the thyroid bed if not ablated, in the future, could be a source of anaplastic transformation. On the other hand, microscopic tumor emboli in distant sites could be the cause of distant metastasis too. The ablation of remnant tissue would in all probability eliminate these theoretical risks. It may be noted that all these are unproven contentious issues except postablation serum Tg estimation that could be a good tumor marker for detecting early biochemical recurrence in long-term follow-up strategy. Radioactive iodine is administered as a form of “adjuvant therapy” for remnant ablation. There have been several reports with regard to the administered dose for remnant ablation. The first report of a prospective randomized clinical trial was published from India by a prospective randomized study conducted at the All India Institute of Medical Sciences, New Delhi in the year 1996. The study reported that increasing the empirical 131 I initial dose to more than 50 mCi results in plateauing of the dose-response curve and thus, conventional high-dose remnant ablation needs critical evaluation. Recently, two important studies were published: One from French group and the other from UK on a similar line. Interestingly, all three studies conducted in three different geographical regions of the world showed exactly similar conclusion. The new era of low-dose remnant ablation has taken a firm scientific footing across the continents

  4. Critical thinking of student nurses during clinical accompaniment

    OpenAIRE

    BY Uys; SM Meyer

    2005-01-01

    The purpose of this study was to investigate the methods of clinical accompaniment used by clinical facilitators in practice. The findings of the study also reflected facilitators’ perceptions regarding critical thinking and the facilitation thereof. A quantitative research design was used. A literature study was conducted to identify the methods of accompaniment that facilitate critical thinking. Data was collected by means of a questionnaire developed for that purpose. Making a content-rela...

  5. [Clinical reasoning in undergraduate nursing education: a scoping review].

    Science.gov (United States)

    Menezes, Sáskia Sampaio Cipriano de; Corrêa, Consuelo Garcia; Silva, Rita de Cássia Gengo E; Cruz, Diná de Almeida Monteiro Lopes da

    2015-12-01

    This study aimed at analyzing the current state of knowledge on clinical reasoning in undergraduate nursing education. A systematic scoping review through a search strategy applied to the MEDLINE database, and an analysis of the material recovered by extracting data done by two independent reviewers. The extracted data were analyzed and synthesized in a narrative manner. From the 1380 citations retrieved in the search, 23 were kept for review and their contents were summarized into five categories: 1) the experience of developing critical thinking/clinical reasoning/decision-making process; 2) teaching strategies related to the development of critical thinking/clinical reasoning/decision-making process; 3) measurement of variables related to the critical thinking/clinical reasoning/decision-making process; 4) relationship of variables involved in the critical thinking/clinical reasoning/decision-making process; and 5) theoretical development models of critical thinking/clinical reasoning/decision-making process for students. The biggest challenge for developing knowledge on teaching clinical reasoning seems to be finding consistency between theoretical perspectives on the development of clinical reasoning and methodologies, methods, and procedures in research initiatives in this field.

  6. Radiopharmaceuticals drug interactions: a critical review

    Directory of Open Access Journals (Sweden)

    Ralph Santos-Oliveira

    2008-12-01

    Full Text Available Radiopharmaceuticals play a critical role in modern medicine primarily for diagnostic purposes, but also for monitoring disease progression and response to treatment. As the use of image has been increased, so has the use of prescription medications. These trends increase the risk of interactions between medications and radiopharmaceuticals. These interactions which have an impact on image by competing with the radiopharmaceutical for binding sites for example can lead to false negative results. Drugs that accelerate the metabolism of the radiopharmaceutical can have a positive impact (i.e. speeding its clearance or, if repeating image is needed, a negative impact. In some cases, for example in cardiac image among patients taking doxirubacin, these interactions may have a therapeutic benefit. The incidence of drug-radiopharmaceuticals adverse reactions is unknown, since they may not be reported or even recognized. Here,we compiled the medical literature, using the criteria of a systematic review established by the Cochrane Collaboration, on pharmaceutical-drug interactions to provide a summary of documented interactions by organ system and radiopharmaceuticals. The purpose is to provide a reference on drug interactions that could inform the nuclear medicine staff in their daily routine. Efforts to increase adverse event reporting, and ideally consolidate reports worldwide, can provide a critically needed resource for prevention of drug-radiopharmaceuticals interactions.Os radiofármacos desempenham função crítica na medicina moderna, primariamente para fins diagnósticos, mas também no monitoramento da progressão de doenças assim como na avaliação de respostas ao tratamento. O uso da tecnologia por imagem tem crescido e conseqüentemente as prescrições de medicamentos (radiofármacos em especial com esse propósito. Este fato, aumenta o risco de interações entre medicamentos e radiofármacos. Interações que podem ter um impacto na

  7. Static Magnetic Field Therapy: A Critical Review of Treatment Parameters

    Directory of Open Access Journals (Sweden)

    Agatha P. Colbert

    2009-01-01

    Full Text Available Static magnetic field (SMF therapy, applied via a permanent magnet attached to the skin, is used by people worldwide for self-care. Despite a lack of established SMF dosage and treatment regimens, multiple studies are conducted to evaluate SMF therapy effectiveness. Our objectives in conducting this review are to: (i summarize SMF research conducted in humans; (ii critically evaluate reporting quality of SMF dosages and treatment parameters and (iii propose a set of criteria for reporting SMF treatment parameters in future clinical trials. We searched 27 electronic databases and reference lists. Only English language human studies were included. Excluded were studies of electromagnetic fields, transcranial magnetic stimulation, magnets placed on acupuncture points, animal studies, abstracts, posters and editorials. Data were extracted on clinical indication, study design and 10 essential SMF parameters. Three reviewers assessed quality of reporting and calculated a quality assessment score for each of the 10 treatment parameters. Fifty-six studies were reviewed, 42 conducted in patient populations and 14 in healthy volunteers. The SMF treatment parameters most often and most completely described were site of application, magnet support device and frequency and duration of application. Least often and least completely described were characteristics of the SMF: magnet dimensions, measured field strength and estimated distance of the magnet from the target tissue. Thirty-four (61% of studies failed to provide enough detail about SMF dosage to permit protocol replication by other investigators. Our findings highlight the need to optimize SMF dosing parameters for individual clinical conditions before proceeding to a full-scale clinical trial.

  8. Dental Students' Use of AMSTAR to Critically Appraise Systematic Reviews.

    Science.gov (United States)

    Teich, Sorin T; Heima, Masahiro; Lang, Lisa

    2015-09-01

    The idea of basing clinical procedures upon evidence gathered by observation is less than 200 years old, with the first set of evidence-based position papers dating back only to the early 1970s. The relationship between evidence-based education and health outcomes is difficult to test and may be indirect, but teaching critical appraisal skills may be beneficial in developing knowledge. Systematic reviews have a central role in the process of clinical decision making in practice and therefore should be of high quality, following a rigorous protocol that can be evaluated with validated tools. The aim of this study was to assess how dental students utilized the Assessment of Multiple Systematic Reviews (AMSTAR) appraisal tool to evaluate systematic reviews in the context of a treatment planning course. During the in-class final exam, students were required to appraise the quality of a systematic review and to justify their answers. Of the 74 third-year students who took the exam, 100% answered all questions on the AMSTAR form. The mean number of correct answers was nine (SD=1.047, Min=6, Max=10), with no student providing all 11 correct answers. The fact that nearly 90% of the students provided eight or more correct answers suggests that AMSTAR can be used by students to evaluate the methodological quality of systematic reviews. It also was evident that although the AMSTAR tool requires less than 15 minutes to complete an evaluation, using it requires extensive training and repetition to achieve consistent and reliable results.

  9. A critical review of objective personality inventories with sex offenders.

    Science.gov (United States)

    Davis, Karen M; Archer, Robert P

    2010-12-01

    This review provides a critical analysis of the ability of multiscale inventories to distinguish between sex offender and nonoffender control groups, as well as to discriminate sex offenders from other types of offenders. In addition to expanding upon previous reviews that examined the utility of the Minnesota Multiphasic Personality Inventory (MMPI) with this population (e.g., Levin & Stava, 1987), the current review included studies that utilized other multiscale inventories commonly used in forensic practice (i.e., MMPI-2, Millon Clinical Multiaxial Inventory-III [MCMI-III], Personality Assessment Inventory) and, when possible, provides effect sizes to evaluate group differences. Based on the review, the various forms of the MMPI and MCMI are clearly the most widely used instruments in sex offender populations. The MMPI Pd scale has shown moderate to large effect sizes when distinguishing between sex offender and nonsex offender groups, but this relationship may be reflective of antisocial behavior in general rather than traits specific to sex offenders. Recommendations to standardize future research classification strategies and more effectively utilize these instruments when assessing sex offenders are also provided. © 2010 Wiley Periodicals, Inc.

  10. Clinical education and student satisfaction: An integrative literature review

    Directory of Open Access Journals (Sweden)

    Karen F. Phillips, EdD, MSN, IBCLC, ICCE

    2017-04-01

    Full Text Available The clinical component of undergraduate clinical education is a critical area in nursing programs. Faculty shortages have made recruitment of clinical faculty and clinical teaching more challenging. As such, alternate models of clinical faculty assignments are being explored to address faculty shortages. This article contains an extensive literature review conducted to survey models of clinical education and student satisfaction with the clinical environment. The purpose of this paper is to examine student satisfaction in the clinical learning environment using articles employing the Clinical Learning Environment Inventory (CLEI along with examining the use of alternate clinical staffing models in differing levels of undergraduate nursing students. A literature search focusing on studies published between 2002 and 2015 was conducted from 5 electronic databases. Thirty-five articles were reviewed and 22 were selected for this literature review. The studies reviewed concluded that students favored a more positive and favorable clinical environment than they perceived as being actually present. A supportive clinical learning environment is of paramount importance in securing positive teaching learning outcomes. Nurse educators can apply the results of this review in order to develop and maintain quality clinical teaching and to promote a positive, student-centric, clinical learning environment.

  11. Papers, Please as Critical Making: A Review

    Directory of Open Access Journals (Sweden)

    Eddie Lohmeyer

    2017-06-01

    Full Text Available This article examines Lucas Pope’s independent game Papers, Please as an instantiation of critical making within the discipline of the digital humanities. By confronting the player with moral decisions in their capacity as an immigration officer allowing or denying entry to immigrants within a totalitarian state, the game introduces an expressive form of game design in which conceptual practices are used to examine political and social realities. This type of critical media practice introduces a political ethic to the digital humanities that is arguably scarce within the discipline.

  12. Do consumer critics write differently from professional critics? A genre analysis of online film reviews

    NARCIS (Netherlands)

    De Jong, I.K.E.; Burgers, C.F.

    2013-01-01

    Consumers often base their choices to purchase experience goods like movies on online reviews. These reviews can be written by professional critics or by other consumers. However, little is known on the issue how the texts written by these two groups of reviewers differ. To answer this question, we

  13. Hypersexuality: A Critical Review and Introduction to the "Sexhavior Cycle".

    Science.gov (United States)

    Walton, Michael T; Cantor, James M; Bhullar, Navjot; Lykins, Amy D

    2017-11-01

    An empirical review of hypersexuality is timely as "compulsive sexual behavior" is being considered as an impulse control disorder for inclusion in the forthcoming International Classification of Diseases, 11th ed. Specifically, hypersexuality has been conceptualized in the literature as the inability to regulate one's sexual behavior that is a source of significant personal distress. Various theoretical models have been posited in an attempt to understand the occurrence of hypersexuality, although disagreement about these divergent conceptualizations of the condition has made assessment and treatment of hypersexual clients more challenging. Theories of sexual compulsivity, sexual impulsivity, dual control (sexual inhibition/excitation), and sex addiction are critically examined, as are the diagnostic criteria for clinically assessing hypersexuality as a sexual disorder. Our discussion of hypersexuality covers a diversity of research and clinical perspectives. We also address various challenges associated with reliably defining, psychometrically measuring, and diagnosing hypersexuality. Furthermore, literature is reviewed that expresses concerns regarding whether hypersexuality (conceptualized as a disorder) exists, whether it is simply normophilic behavior at the extreme end of sexual functioning, or alternatively is a presenting problem that requires treatment rather than a clinical diagnosis. Following our literature review, we developed the "sexhavior cycle of hypersexuality" to potentially explain the neuropsychology and maintenance cycle of hypersexuality. The sexhavior cycle suggests that, for some hypersexual persons, high sexual arousal may temporarily and adversely impact cognitive processing (cognitive abeyance) and explain a repeated pattern of psychological distress when interpreting one's sexual behavior (sexual incongruence). We also suggest that further research is required to validate whether hypersexuality is a behavioral disorder (such as

  14. Knowledge translation interventions for critically ill patients: a systematic review*.

    Science.gov (United States)

    Sinuff, Tasnim; Muscedere, John; Adhikari, Neill K J; Stelfox, Henry T; Dodek, Peter; Heyland, Daren K; Rubenfeld, Gordon D; Cook, Deborah J; Pinto, Ruxandra; Manoharan, Venika; Currie, Jan; Cahill, Naomi; Friedrich, Jan O; Amaral, Andre; Piquette, Dominique; Scales, Damon C; Dhanani, Sonny; Garland, Allan

    2013-11-01

    We systematically reviewed ICU-based knowledge translation studies to assess the impact of knowledge translation interventions on processes and outcomes of care. We searched electronic databases (to July, 2010) without language restrictions and hand-searched reference lists of relevant studies and reviews. Two reviewers independently identified randomized controlled trials and observational studies comparing any ICU-based knowledge translation intervention (e.g., protocols, guidelines, and audit and feedback) to management without a knowledge translation intervention. We focused on clinical topics that were addressed in greater than or equal to five studies. Pairs of reviewers abstracted data on the clinical topic, knowledge translation intervention(s), process of care measures, and patient outcomes. For each individual or combination of knowledge translation intervention(s) addressed in greater than or equal to three studies, we summarized each study using median risk ratio for dichotomous and standardized mean difference for continuous process measures. We used random-effects models. Anticipating a small number of randomized controlled trials, our primary meta-analyses included randomized controlled trials and observational studies. In separate sensitivity analyses, we excluded randomized controlled trials and collapsed protocols, guidelines, and bundles into one category of intervention. We conducted meta-analyses for clinical outcomes (ICU and hospital mortality, ventilator-associated pneumonia, duration of mechanical ventilation, and ICU length of stay) related to interventions that were associated with improvements in processes of care. From 11,742 publications, we included 119 investigations (seven randomized controlled trials, 112 observational studies) on nine clinical topics. Interventions that included protocols with or without education improved continuous process measures (seven observational studies and one randomized controlled trial; standardized

  15. Brain SPECT in neurology: A critical review

    International Nuclear Information System (INIS)

    Bartenstein, P.; Essen Univ.; Weiller, C.; Essen Univ.

    1994-01-01

    SPECT of the brain with radiopharmaceuticals monitoring regional cerebral blood flow, receptor binding and metabolism offers a wide variety of potentially clinically useful applications. These can be found in neuro-oncology, epilepsy, cerebrovascular diseases, extrapyramidal disorders, dementia and the determination of brain death. The evaluation of the benefit of these methods in routine use requires a close cooperation between nuclear medicine physicians and neurologists, not only in the interpretation and analysis of the actual clinical studies, but also in the design and realization of clinically oriented research with large series of patients. (orig.) [de

  16. Relevance of collagen piezoelectricity to "Wolff's Law": a critical review.

    Science.gov (United States)

    Ahn, Andrew C; Grodzinsky, Alan J

    2009-09-01

    According to "Wolff's Law", bone is deposited and reinforced at areas of greatest stress. From a clinical perspective, this "law" is supported by the strong association between bone density and physical activity. From a mechanistic standpoint, however, the law presents a challenge to scientists seeking to understand how osteocytes and osteoblasts sense the mechanical load. In the 1960s, collagen piezoelectricity was invoked as a potential mechanism by which osteocytes could detect areas of greater stress but piezoelectricity diminished in importance as more compelling mechanisms, such as streaming potential, were identified. In addition, accumulating evidence for the role of fluid-related shear stress in osteocyte's mechanosensory function has made piezoelectricity seemingly more obsolete in bone physiology. This review critically evaluates the role of collagen piezoelectricity (if any) in Wolff's Law--specifically, the evidence regarding its involvement in strain-generated potentials, existing alternate mechanisms, the present understanding of bone mechanosensation, and whether piezoelectricity serves an influential role within the context of this newly proposed mechanism. In addition to reviewing the literature, this review generates several hypotheses and proposes future research to fully address the relevance of piezoelectricity in bone physiology.

  17. Fournier's gangrene. A clinical review.

    Science.gov (United States)

    Singh, Ariana; Ahmed, Kamran; Aydin, Abdullatif; Khan, Muhammad Shamim; Dasgupta, Prokar

    2016-10-05

    Fournier's gangrene is a rare, necrotising fasciitis of the external genitalia, perineal or perianal regions. The disease has a higher incidence in males and risk factors for development include diabetes, HIV, alcoholism and other immune-compromised states. The aggressive disease process is associated with a high mortality rate of 20-30%. In addition, the increasing age and prevalence of diabetes in the population, begs the need for increased clinical awareness of Fournier's gangrene with emphasis on early diagnosis and management. This review aims to highlight the relevant research surrounding Fournier's gangrene, in particular the various prognostic indicators and management strategies. A search was conducted on the MEDLINE database for all applicable research; clinical reviews, retrospective studies and case reports. In addition to which a search of the European Association of Urology, the British Association for Urological Surgeons and the British Medical Journal was conducted for the most recent recommendations. Immediate broad-spectrum antibiotic therapy and urgent surgical debridement are the core managerial principles of Fournier's gangrene. The use of adjunctive therapies such as hyperbaric oxygen and vacuum assisted closure are supported in some aspects of the literature and disputed in others. The lack of randomized controlled studies limits the use of these potential additional therapies to patients unresponsive to conventional management. The value of unprocessed honey as a topical antimicrobial agent has been highlighted in the literature for small lesions in uncomplicated patients. Fournier's gangrene is a urological emergency with a high mortality rate despite advances in the medical and surgical fields. The aggressive nature of the infection advocates the need for early recognition allowing immediate surgical intervention. The opposing results of available research as well as the lack of high quality evidence surrounding emergent therapies prevents

  18. Using clinical journaling to capture critical thinking across the curriculum.

    Science.gov (United States)

    Ruthman, Jacklyn; Jackson, Janet; Cluskey, Maureen; Flannigan, Peggy; Folse, Victoria N; Bunten, Jo

    2004-01-01

    Clinical journaling is used as an integrated teaching methodology throughout the practicum component of a baccalaureate nursing curriculum. Two disciplines, Nursing and English, collaborated to develop clinical journaling guidelines to provide a consistent framework for student learning and evaluation in a variety of clinical settings. Students complete a weekly log for each clinical rotation. They identify learning goals, analyze events and relate them to nursing practice, use critical thinking to connect theory and practice, and reflect on the experience.A collegiate standard of writing is used. As the student advances through the program, a pattern of accomplishments and a cumulative integration of skills is evidenced to provide consistent standards for student evaluation.

  19. Abortion law, policy and services in India: a critical review.

    Science.gov (United States)

    Hirve, Siddhivinayak S

    2004-11-01

    Despite 30 years of liberal legislation, the majority of women in India still lack access to safe abortion care. This paper critically reviews the history of abortion law and policy in India since the 1960s and research on abortion service delivery. Amendments in 2002 and 2003 to the 1971 Medical Termination of Pregnancy Act, including devolution of regulation of abortion services to the district level, punitive measures to deter provision of unsafe abortions, rationalisation of physical requirements for facilities to provide early abortion, and approval of medical abortion, have all aimed to expand safe services. Proposed amendments to the MTP Act to prevent sex-selective abortions would have been unethical and violated confidentiality, and were not taken forward. Continuing problems include poor regulation of both public and private sector services, a physician-only policy that excludes mid-level providers and low registration of rural compared to urban clinics; all restrict access. Poor awareness of the law, unnecessary spousal consent requirements, contraceptive targets linked to abortion, and informal and high fees also serve as barriers. Training more providers, simplifying registration procedures, de-linking clinic and provider approval, and linking policy with up-to-date technology, research and good clinical practice are some immediate measures needed to improve women's access to safe abortion care.

  20. Narrative research in psychotherapy: a critical review.

    Science.gov (United States)

    Avdi, Evrinomy; Georgaca, Eugenie

    2007-09-01

    This paper is a review of studies which utilise the notion of narrative to analyse psychotherapy. Its purpose is to systematically present this diverse field of research, to highlight common themes and divergences between different strands and to further the development and integration of narrative research in psychotherapy. The paper reviews studies which employ an applied textual analysis of narratives produced in the context of psychotherapy. Criteria for inclusion of studies are, firstly, the analysis of therapeutic and therapy-related texts and, secondly, the adoption of a narrative psychological perspective. The studies were examined on the basis of the notion of narrative they employ and the aspects of client narratives they focus on, and were grouped accordingly in the review. The majority of the studies reviewed assume a constructivist approach to narrative, adopt a representational view of language, focus primarily on client micro-narratives and relate to cognitive-constructivist and process-experiential psychotherapeutic approaches. A smaller group of studies assume a social constructionist approach to narrative and a functional view of language, focus on micro-narratives, highlight the interactional and wider social aspects of narrative and relate to postmodern trends in psychotherapy. The range of conceptualisations of narrative in the studies reviewed, from a representational psychological view to a constructionist social view, reflects tensions within narrative psychology itself. Moreover, two trends can be discerned in the field reviewed, narrative analysis of therapy, which draws from narrative theory and utilises the analytic approaches of narrative research to study psychotherapy, and analyses of narrative in therapy, which study client narratives using non-narrative qualitative methods. Finally, the paper highlights the need for integration of this diverse field of research and urges for the development of narrative studies of psychotherapy

  1. Intersectionality and Educational Leadership: A Critical Review

    Science.gov (United States)

    Agosto, Vonzell; Roland, Ericka

    2018-01-01

    In this review of research, we explore intersectionality in the literature on K-12 educational leadership. We seek to understand how researchers have used intersectionality and what their findings or arguments reveal about the work of leading to reduce inequities in education. We ask, What traditions and trends associated with intersectionality…

  2. Critical value reporting: a survey of 36 clinical laboratories in South Africa.

    Science.gov (United States)

    Schapkaitz, Elise; Mafika, Zipho

    2013-10-11

    Critical value policies are used by clinical laboratories to decide when to notify caregivers of life-threatening results. Despite their widespread use, critical value policies have not been published locally. A survey was designed to determine critical value policies for haematology tests in South Africa. A survey was carried out on 136 identified laboratories across South Africa in January 2013. Of these, 36 responded. Data collected included critical value policies, critical values for haematology parameters, and critical value reporting. Of the 36 laboratories surveyed, 11.1% (n=4) were private, 33.3% (n=12) were affiliated to academic institutions and 55.6% (n=20) were peripheral or regional National Health Laboratory Service laboratories. All the laboratories confirmed that they had a critical value policy, and 83.3% of such policies were derived from local clinical opinion. Mean low and high critical limits for the most frequently listed tests were as follows: haemoglobin 20 g/dl, platelet count 1 000 ×10(9)/l, white cell count 46 ×10(9)/l, activated partial thromboplastin time >101 seconds, and international normalised ratio >6. In almost all cases critical value reporting was performed by the technologist on duty (97.2%). The majority of laboratories required that the person notified of the critical value be the doctor who ordered the test or the caregiver directly involved in the patient's care (83.3%); 73.3% of laboratories indicated that they followed an algorithm if the doctor/caregiver could not be reached. Each laboratory is responsible for establishing clinically relevant critical limits. Clinicians should be involved in developing the laboratory's critical value policy. The findings of this survey may be of value to local laboratories that are in the process of establishing or reviewing critical value policies.

  3. Highly effective cystic fibrosis clinical research teams: critical success factors.

    Science.gov (United States)

    Retsch-Bogart, George Z; Van Dalfsen, Jill M; Marshall, Bruce C; George, Cynthia; Pilewski, Joseph M; Nelson, Eugene C; Goss, Christopher H; Ramsey, Bonnie W

    2014-08-01

    Bringing new therapies to patients with rare diseases depends in part on optimizing clinical trial conduct through efficient study start-up processes and rapid enrollment. Suboptimal execution of clinical trials in academic medical centers not only results in high cost to institutions and sponsors, but also delays the availability of new therapies. Addressing the factors that contribute to poor outcomes requires novel, systematic approaches tailored to the institution and disease under study. To use clinical trial performance metrics data analysis to select high-performing cystic fibrosis (CF) clinical research teams and then identify factors contributing to their success. Mixed-methods research, including semi-structured qualitative interviews of high-performing research teams. CF research teams at nine clinical centers from the CF Foundation Therapeutics Development Network. Survey of site characteristics, direct observation of team meetings and facilities, and semi-structured interviews with clinical research team members and institutional program managers and leaders in clinical research. Critical success factors noted at all nine high-performing centers were: 1) strong leadership, 2) established and effective communication within the research team and with the clinical care team, and 3) adequate staff. Other frequent characteristics included a mature culture of research, customer service orientation in interactions with study participants, shared efficient processes, continuous process improvement activities, and a businesslike approach to clinical research. Clinical research metrics allowed identification of high-performing clinical research teams. Site visits identified several critical factors leading to highly successful teams that may help other clinical research teams improve clinical trial performance.

  4. Korsakoff’s syndrome: a critical review

    Science.gov (United States)

    Arts, Nicolaas JM; Walvoort, Serge JW; Kessels, Roy PC

    2017-01-01

    In this review, we present a survey on Korsakoff’s syndrome (KS), a residual syndrome in patients who suffered from a Wernicke encephalopathy (WE) that is predominantly characterized by global amnesia, and in more severe cases also by cognitive and behavioral dysfunction. We describe the history of KS and its definition, its epidemiology, and the lack of consensus criteria for its diagnosis. The cognitive and behavioral symptoms of KS, which include anterograde and retrograde amnesia, executive dysfunction, confabulation, apathy, as well as affective and social-cognitive impairments, are discussed. Moreover, recent insights into the underlying neurocognitive mechanisms of these symptoms are presented. In addition, the evidence so far on the etiology of KS is examined, highlighting the role of thiamine and alcohol and discussing the continuity hypothesis. Furthermore, the neuropathology of KS is reviewed, focusing on abnormalities in the diencephalon, including the mammillary bodies and thalamic nuclei. Pharmacological treatment options and nonpharmacological interventions, such as those based on cognitive rehabilitation, are discussed. Our review shows that thiamine deficiency (TD) is a crucial factor in the etiology of KS. Although alcohol abuse is by far the most important context in which TD occurs, there is no convincing evidence for an essential contribution of ethanol neurotoxicity (EN) to the development of WE or to the progression of WE to KS. Future research on the postmortem histopathological analysis of brain tissues of KS patients is crucial for the advancement of our knowledge of KS, especially for associating its symptoms with lesions in various thalamic nuclei. A necessary requirement for the advancement of studies on KS is the broad acceptance of a comprehensive definition and definite diagnostic criteria. Therefore, in this review, we propose such a definition of KS and draft outlines for prospective diagnostic criteria. PMID:29225466

  5. Korsakoff’s syndrome: a critical review

    Directory of Open Access Journals (Sweden)

    Arts NJM

    2017-11-01

    Full Text Available Nicolaas JM Arts,1,2 Serge JW Walvoort,1 Roy PC Kessels1,3,4 1Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, 2Neuropsychiatry Center Thalamus, Institution for Integrated Mental Health Care Pro Persona, Wolfheze, 3Department of Neuropsychology and Rehabilitation Psychology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, 4Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands Abstract: In this review, we present a survey on Korsakoff’s syndrome (KS, a residual syndrome in patients who suffered from a Wernicke encephalopathy (WE that is predominantly characterized by global amnesia, and in more severe cases also by cognitive and behavioral dysfunction. We describe the history of KS and its definition, its epidemiology, and the lack of consensus criteria for its diagnosis. The cognitive and behavioral symptoms of KS, which include anterograde and retrograde amnesia, executive dysfunction, confabulation, apathy, as well as affective and social-cognitive impairments, are discussed. Moreover, recent insights into the underlying neurocognitive mechanisms of these symptoms are presented. In addition, the evidence so far on the etiology of KS is examined, highlighting the role of thiamine and alcohol and discussing the continuity hypothesis. Furthermore, the neuropathology of KS is reviewed, focusing on abnormalities in the diencephalon, including the mammillary bodies and thalamic nuclei. Pharmacological treatment options and nonpharmacological interventions, such as those based on cognitive rehabilitation, are discussed. Our review shows that thiamine deficiency (TD is a crucial factor in the etiology of KS. Although alcohol abuse is by far the most important context in which TD occurs, there is no convincing evidence for an essential contribution of ethanol neurotoxicity (EN to the development of WE or to

  6. Pesticides in Brazilian freshwaters: a critical review.

    Science.gov (United States)

    Albuquerque, A F; Ribeiro, J S; Kummrow, F; Nogueira, A J A; Montagner, C C; Umbuzeiro, G A

    2016-07-13

    The widespread use of pesticides in agriculture can lead to water contamination and cause adverse effects on non-target organisms. Brazil has been the world's top pesticide market consumer since 2008, with 381 approved pesticides for crop use. This study provides a comprehensive literature review on the occurrence of pesticide residues in Brazilian freshwaters. We searched for information in official agency records and peer-reviewed scientific literature. Risk quotients were calculated to assess the potential risk posed to aquatic life by the individual pesticides based on their levels of water contamination. Studies about the occurrence of pesticides in freshwaters in Brazil are scarce and concentrated in few sampling sites in 5 of the 27 states. Herbicides (21) accounted for the majority of the substances investigated, followed by fungicides (11), insecticides (10) and plant growth regulators (1). Insecticides are the class of major concern. Brazil would benefit from the implementation of a nationwide pesticide freshwater monitoring program to support preventive, remediation and enforcement actions.

  7. Energy Healing for Cancer: A Critical Review

    DEFF Research Database (Denmark)

    Agdal, Rita; von Bornemann Hjelmborg, Jacob; Johannessen, Helle

    2011-01-01

    Background: This article explores the evidence base of efficacy and effectiveness of ‘energy healing’ for cancer patients. The term ‘energy healing’ refers to a wide variety of therapies which are based on the premise that the healer transfers energy to the patient. Among the most researched form...... the complex character of potential outcomes, cross-disciplinary methodologies may be relevant. To extend the scope of clinical trials, psychosocial processes should be taken into account and explored, rather than dismissed as placebo....

  8. Nanostructured delivery systems with improved leishmanicidal activity: a critical review.

    Science.gov (United States)

    Bruni, Natascia; Stella, Barbara; Giraudo, Leonardo; Della Pepa, Carlo; Gastaldi, Daniela; Dosio, Franco

    2017-01-01

    Leishmaniasis is a vector-borne zoonotic disease caused by protozoan parasites of the genus Leishmania , which are responsible for numerous clinical manifestations, such as cutaneous, visceral, and mucocutaneous leishmaniasis, depending on the site of infection for particular species. These complexities threaten 350 million people in 98 countries worldwide. Amastigotes living within macrophage phagolysosomes are the principal target of antileishmanial treatment, but these are not an easy target as drugs must overcome major structural barriers. Furthermore, limitations on current therapy are related to efficacy, toxicity, and cost, as well as the length of treatment, which can increase parasitic resistance. Nanotechnology has emerged as an attractive alternative as conventional drugs delivered by nanosized carriers have improved bioavailability and reduced toxicity, together with other characteristics that help to relieve the burden of this disease. The significance of using colloidal carriers loaded with active agents derives from the physiological uptake route of intravenous administered nanosystems (the phagocyte system). Nanosystems are thus able to promote a high drug concentration in intracellular mononuclear phagocyte system (MPS)-infected cells. Moreover, the versatility of nanometric drug delivery systems for the deliberate transport of a range of molecules plays a pivotal role in the design of therapeutic strategies against leishmaniasis. This review discusses studies on nanocarriers that have greatly contributed to improving the efficacy of antileishmaniasis drugs, presenting a critical review and some suggestions for improving drug delivery.

  9. Fibromyalgia: A Critical and Comprehensive Review.

    Science.gov (United States)

    Borchers, Andrea T; Gershwin, M Eric

    2015-10-01

    Fibromyalgia is a disorder that is part of a spectrum of syndromes that lack precise classification. It is often considered as part of the global overview of functional somatic syndromes that are otherwise medically unexplained or part of a somatization disorder. Patients with fibromyalgia share symptoms with other functional somatic problems, including issues of myalgias, arthralgias, fatigue and sleep disturbances. Indeed, there is often diagnostic and classification overlap for the case definitions of a variety of somatization disorders. Fibromyalgia, however, is a critically important syndrome for physicians and scientists to be aware of. Patients should be taken very seriously and provided optimal care. Although inflammatory, infectious, and autoimmune disorders have all been ascribed to be etiological events in the development of fibromyalgia, there is very little data to support such a thesis. Many of these disorders are associated with depression and anxiety and may even be part of what has been sometimes called affected spectrum disorders. There is no evidence that physical trauma, i.e., automobile accidents, is associated with the development or exacerbation of fibromyalgia. Treatment should be placed on education, patient support, physical therapy, nutrition, and exercise, including the use of drugs that are approved for the treatment of fibromyalgia. Treatment should not include opiates and patients should not become poly pharmacies in which the treatment itself can lead to significant morbidities. Patients with fibromyalgia are living and not dying of this disorder and positive outlooks and family support are key elements in the management of patients.

  10. Birth-weight charts and immigrant populations: A critical review.

    Science.gov (United States)

    Urquia, Marcelo L; Sørbye, Ingvil K; Wanigaratne, Susitha

    2016-04-01

    There is an increasing body of literature focusing on differences in newborn size between different population subgroups defined by racial, ethnic, and immigration status. The interpretation of these differences as pathological or as merely reflecting normal variability is not straightforward and may have consequences for the provision of obstetric and neonatal care to minority populations. In this review, we critically assess some methodological issues affecting the assessment of newborn size and their potential implications for minority populations. In particular, we discuss the pros and cons of different types of newborn birth-weight (BW) charts (i.e., single local population-based references, minority-specific references, and a single international standard) to determine abnormal newborn size, with emphasis on immigrant populations. We conclude that size alone is not enough to inform clinical decisions and that all newborn size charts should be used as screening tools, not as diagnostic tools. Parental minority status may be regarded as a marker and used to further inquire about individual risk factors, particularly among immigrants who may not have a complete medical history in the new country. Finally, we outline areas for further research and recommendations for clinical practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. SPI Project Criticality Task Force initial review and assessment

    International Nuclear Information System (INIS)

    McKinley, K.B.; Cannon, J.W.; Marsden, R.S.; Worle, H.A.

    1980-03-01

    The Slagging Pyrolysis Incinerator (SPI) Facility is being developed to process transuranic waste stored and buried at the Idaho National Engineering Laboratory (INEL) into a chemically inert, physically stable, basalt-like residue acceptable for a Federal Repository. A task force was established by the SPI Project Division to review and assess all aspects of criticality safety for the SPI Facility. This document presents the initial review, evaluations, and recommendations of the task force and includes the following: background information on waste characterization, and criticality control approaches and philosophies, a description of the SPI Facility Waste Processing Building, a review and assessment of potentially relevant codes and regulations; a review and assessment of the present state of criticality and assaying/monitoring studies, and recommendations for changes in and additions to these studies. The review and assessment of potentially relevant codes and regulations indicate that ERDAM 0530, Nuclear Criticality Safety should be the controlling document for criticality safety for the SPI Project. In general, the criticality control approaches and philosophies for the SPI Project comply with this document

  12. Clinical examination, critical care ultrasonography and outcomes in the critically ill

    DEFF Research Database (Denmark)

    Hiemstra, Bart; Eck, Ruben J; Koster, Geert

    2017-01-01

    PURPOSE: In the Simple Intensive Care Studies-I (SICS-I), we aim to unravel the value of clinical and haemodynamic variables obtained by physical examination and critical care ultrasound (CCUS) that currently guide daily practice in critically ill patients. We intend to (1) measure all available...... patient used for guiding diagnostics, prognosis and interventions. Repeated evaluations of these sets of variables are needed for continuous improvement of the diagnostic and prognostic models. Future plans include: (1) more advanced imaging; (2) repeated clinical and haemodynamic measurements; (3...... clinical and haemodynamic variables, (2) train novices in obtaining values for advanced variables based on CCUS in the intensive care unit (ICU) and (3) create an infrastructure for a registry with the flexibility of temporarily incorporating specific (haemodynamic) research questions and variables...

  13. Drugs and bruxism: a critical review.

    Science.gov (United States)

    Winocur, Ephraim; Gavish, Anat; Voikovitch, Michal; Emodi-Perlman, Alona; Eli, Ilana

    2003-01-01

    Bruxism associated with drugs can be destructive, resulting in severe consequences to health that include destruction of tooth structure, irreversible harm to the temporomandibular joint, severe myofascial pain, and muscle contraction headache. However, reports concerning a possible association between bruxism and various pharmacologic drugs are scarce and mostly anecdotal. The purpose of this article was to review the existing literature concerning the exacerbating or ameliorating effect of drugs on bruxism in humans. A search of the MEDLINE, EMBASE, and PsicINFO databases from 1982 to 2001 was conducted, and the term bruxism and one of the following terms were used: drugs, medicine(s), pharmaceutical, movement disorders, akathisia, dyskinesia, dystonia, central or autonomic nervous system, dopamine, serotonin, and GABA. Furthermore, a search using the term bruxism was carried out on the weekly journal Reactions, which deals with side effects of drugs. Several chemical terms were searched separately (e.g., caffeine, nicotine). Relevant information was also derived from reference lists of the retrieved publications. The search yielded complex information referring to the association between bruxism and dopamine-related drugs, antidepressant drugs, sedative and anxiolytic drugs, and drugs of abuse. There is insufficient evidence-based data to draw definite conclusions concerning the effects of various drugs on bruxism. Although certain substances related to the dopaminergic, serotonergic, and adrenergic systems suppress or exacerbate bruxist activity in humans and animals, the literature is still controversial, and based mostly on anecdotal case reports. More controlled, evidence-based research on this under-explored subject is needed.

  14. HIV communication capacity strengthening: a critical review.

    Science.gov (United States)

    Lettenmaier, Cheryl; Kraft, Joan Marie; Raisanen, Keris; Serlemitsos, Elizabeth

    2014-08-15

    HIV communication is most effective and sustainable when it is designed and implemented locally and tailored to the local context. This requires capacity strengthening at national, subnational, and community levels. Through a review of the published and selected "grey" literature, we examine HIV communication capacity strengthening: definitions, measurements, implementation, and effects. We found limited documentation of HIV communication capacity needs or systematic approaches to address them. Most HIV communication capacity strengthening to date has focused on building individual competencies to design and manage social and behavior change communication programs through training courses, often coupled with networking opportunities for participants, post-training mentoring, and technical assistance. A few of these efforts have been evaluated through pre- and post-training tests and qualitative interviews with participants and have shown potential for improvement in individual skills and knowledge. Health communication capacity assessment tools that measure individual and organizational competencies exist, but they have most often been used to identify capacity building needs, not for evaluating capacity strengthening efforts. A new definition of capacity strengthening, grown out of recent efforts to improve effectiveness of international health and development programs, focuses on improving organizational and societal systems that support performance and individual competencies. We propose a holistic model for HIV communication capacity strengthening and call for rigorous documentation and evaluation to determine and scale-up optimal capacity building interventions for strengthening social and behavior change communication for HIV prevention, care, and treatment in developing countries.

  15. Neuroimaging of child abuse: A critical review

    Directory of Open Access Journals (Sweden)

    Heledd eHart

    2012-03-01

    Full Text Available Childhood maltreatment is a severe stressor that can lead to the development of behaviour problems and affect brain structure and function. This review summarizes the current evidence for the effects of early childhood maltreatment on behavior, cognition and the brain in adults and children. Neuropsychological studies suggest an association between child abuse and deficits in IQ, memory, executive function and emotion discrimination. Structural neuroimaging studies provide evidence for deficits in brain volume, grey and white matter of several regions, most prominently the dorsolateral and ventromedial prefrontal cortex but also hippocampus, amygdala, and corpus callosum. Diffusion tensor imaging studies show evidence for deficits in structural interregional connectivity between these areas, suggesting neural network abnormalities. Functional imaging studies support this evidence by reporting atypical activation in the same brain regions during executive function and emotion processing. There are, however, several limitations of the abuse research literature which are discussed, most prominently the lack of control for co-morbid psychiatric disorders, which make it difficult to disentangle which of the above effects are due to maltreatment, the associated psychiatric conditions or a combination or interaction between both. Overall, the better controlled studies that show a direct correlation between childhood abuse and brain measures suggest that the most prominent deficits associated with early childhood abuse are in the function and structure of lateral and ventromedial fronto-limbic brain areas and networks that mediate behavioural and affect control. Future, large scale multimodal neuroimaging studies in medication-naïve subjects, however, are needed that control for psychiatric co-morbidities in order to elucidate the structural and functional brain sequelae that are associated with early environmental adversity, independently of secondary

  16. Music and epilepsy: a critical review.

    Science.gov (United States)

    Maguire, Melissa Jane

    2012-06-01

    The effect of music on patients with epileptic seizures is complex and at present poorly understood. Clinical studies suggest that the processing of music within the human brain involves numerous cortical areas, extending beyond Heschl's gyrus and working within connected networks. These networks could be recruited during a seizure manifesting as musical phenomena. Similarly, if certain areas within the network are hyperexcitable, then there is a potential that particular sounds or certain music could act as epileptogenic triggers. This occurs in the case of musicogenic epilepsy, whereby seizures are triggered by music. Although it appears that this condition is rare, the exact prevalence is unknown, as often patients do not implicate music as an epileptogenic trigger and routine electroencephalography does not use sound in seizure provocation. Music therapy for refractory epilepsy remains controversial, and further research is needed to explore the potential anticonvulsant role of music. Dopaminergic system modulation and the ambivalent action of cognitive and sensory input in ictogenesis may provide possible theories for the dichotomous proconvulsant and anticonvulsant role of music in epilepsy. The effect of antiepileptic drugs and surgery on musicality should not be underestimated. Altered pitch perception in relation to carbamazepine is rare, but health care professionals should discuss this risk or consider alternative medication particularly if the patient is a professional musician or native-born Japanese. Studies observing the effect of epilepsy surgery on musicality suggest a risk with right temporal lobectomy, although the extent of this risk and correlation to size and area of resection need further delineation. This potential risk may bring into question whether tests on musical perception and memory should form part of the preoperative neuropsychological workup for patients embarking on surgery, particularly that of the right temporal lobe. Wiley

  17. A critical review of Electric Earthquake Precursors

    Directory of Open Access Journals (Sweden)

    F. Vallianatos

    2001-06-01

    and can guarantee reliable electric field measurements, although improvements are still possible with new generation electrodes and smart measurement schemes facilitating noise suppression. It is increasingly apparent that simultaneous electric and magnetic measurements are indispensable and conducted in most new experiments. There is also an emerging trend towards multi-parametric, broadband observations that should provide far better data and constraints on the source processes. The physics of electrification mechanisms are beginning to clarify, as also is the potential of solid state effects: charge and current densities under controlled conditions are such, that if scaled up to the size of seismogenic zones, they would yield observable EEP. However, there are still many unknowns, requiring careful experimentation and theoretical development. Research is also directed towards decoding the physics of stress/strain changes that cause electrification, exploiting properties such as are the fractal nature of faulting and Self-Organised Criticality (SOC. The first evidence of possible electromagnetic precursors due to a SOC system has been published recently. Modelling of the source processes from first principles is stepping up and certain classes of observed signals can now be predicted by theory, providing new and more rigorous means of data authentication; such models have also established the feasibility of long range EEP signals. Although progress is apparent, the knowledge is still grossly incomplete and EEP data are not indisputable, if tested with the full rigour of scientific verification methods. The new research philosophy requires time and vigilance before it begins to pay off, but it appears to have taken a more promising course.

  18. A critical review of electric earthquake precursors

    Energy Technology Data Exchange (ETDEWEB)

    Tzanis, A. [Athens Univ., Athens (Italy). Dept. of Geophysics and Geothermy; Valliantos, F. [Technological Educational Institute of Crete, Chania (Greece)

    2001-04-01

    reliable electric field measurements, although improvements are still possible with new generation and smart measurement schemes facilitating noise suppression. It is increasingly apparent that simultaneous electric and magnetic measurements are indispensable and conducted in most new experiments. There is also an emerging trend towards multi-parametric, broadband observations that should provide far better data and constraints on the source processes. The physics of electrification mechanisms are beginning to clarify, as also is the potential of solid state effects: charge and current densities under controlled conditions are such, that if scaled up to the size of seismogenic zones, they would yield observable EEP. However, there are still many unknowns, requiring careful experimentation and theoretical development. Research is also directed towards decoding the physics of stress/strain changes that cause electrification, exploiting properties such as are the fractal nature of faulting and Self-Organised Critically (SOC). The first evidence of possible electromagnetic precursors due to a SOC system has been published recently. Modelling of the source processes from first principles is stepping up and certain classes of observed signals can now be predicted by theory, providing new and more rigorous means of data authentication; such models have also established the feasibility of long range EEP signals. Although progress is apparent, the knowledge is still grossly incomplete and EEP data are not indisputable, if tested with the full rigour of scientific verification methods. The new research philosophy requires time and vigilance before it begins to pay off, but it appears to have taken a more promising course.

  19. SRTC criticality safety technical review of SRT-CMA-930039

    International Nuclear Information System (INIS)

    Rathbun, R.

    1993-01-01

    Review of SRT-CMA-930039, ''Nuclear Criticality Safety Evaluation (NCSE): DWPF Melter-Batch 1,'' December 1, 1993, has been performed by the Savannah River Technical Center (SRTC) Applied Physics Group. The NCSE is a criticality assessment of the Melt Cell in the DWPF. Additionally, this pertains only to Batch 1 operation, which differs from batches to follow. Plans for subsequent batch operations call for fissile material in the Salt Cell feed-stream, which necessitates a separate criticality evaluation in the future. The NCSE under review concludes that the process is safe from criticality events, even in the event that all lithium and boron neutron poisons are lost, provided uranium enrichments are less than 40%. Furthermore, if all the lithium and as much as 98% of the boron would be lost, uranium enrichments of 100% would be allowable. After a thorough review of the NCSE, this reviewer agrees with that conclusion. This technical review consisted of: an independent check of the methods and models employed, independent calculations application of ANSI/ANS 8.1, verification of WSRC Nuclear Criticality Safety Manual( 2 ) procedures

  20. Clinical decision regret among critical care nurses: a qualitative analysis.

    Science.gov (United States)

    Arslanian-Engoren, Cynthia; Scott, Linda D

    2014-01-01

    Decision regret is a negative cognitive emotion associated with experiences of guilt and situations of interpersonal harm. These negative affective responses may contribute to emotional exhaustion in critical care nurses (CCNs), increased staff turnover rates and high medication error rates. Yet, little is known about clinical decision regret among CCNs or the conditions or situations (e.g., feeling sleepy) that may precipitate its occurrence. To examine decision regret among CCNs, with an emphasis on clinical decisions made when nurses were most sleepy. A content analytic approach was used to examine the narrative descriptions of clinical decisions by CCNs when sleepy. Six decision regret themes emerged that represented deviations in practice or performance behaviors that were attributed to fatigued CCNs. While 157 CCNs disclosed a clinical decision they made at work while sleepy, the prevalence may be underestimated and warrants further investigation. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Critical thinking and the role of the clinical ultrasound tutor

    International Nuclear Information System (INIS)

    Edwards, Hazel

    2006-01-01

    As radiographers continue to extend their role and take on more procedures associated traditionally with radiologists, it is essential that their critical thinking abilities keep pace with the new practical skills they are learning. This is particularly important in ultrasound where student sonographers must master a number of new skills including the technical dexterity required to perform a scan, the ability to form and discard hypotheses when trying to interpret the image, and the communication of their findings as a written report. Interpreting the image and producing an accurate, appropriate report involves the higher level cognitive processes of analysis, synthesis and evaluation. In other words, the student sonographer must be able to think critically to become a successful practitioner. This paper attempts to define and discuss critical thinking, and considers a range of simple strategies that the clinical teacher of ultrasound can employ to help develop critical thinking skills in their students. These methods are appropriate for use not only by clinical teachers of ultrasound but for all teachers and mentors wishing to improve reasoning skills in their pupils

  2. Validation of a clinical critical thinking skills test in nursing

    OpenAIRE

    Shin, Sujin; Jung, Dukyoo; Kim, Sungeun

    2015-01-01

    Purpose: The purpose of this study was to develop a revised version of the clinical critical thinking skills test (CCTS) and to subsequently validate its performance. Methods: This study is a secondary analysis of the CCTS. Data were obtained from a convenience sample of 284 college students in June 2011. Thirty items were analyzed using item response theory and test reliability was assessed. Test-retest reliability was measured using the results of 20 nursing college and graduate school stud...

  3. [Mood induction procedures: a critical review].

    Science.gov (United States)

    Gilet, A-L

    2008-06-01

    For a long period in the history of psychological research, emotion and cognition have been studied independently, as if one were irrelevant to the other. The renewed interest of researchers for the study of the relations between cognition and emotion has led to the development of a range of laboratory methods for inducing temporary mood states. This paper aims to review the main mood induction procedures allowing the induction of a negative mood as well as a positive mood, developed since the pioneer study of Schachter and Singer [Psychol Rev 69 (1962) 379-399] and to account for the usefulness and problems related to the use of such techniques. The first part of this paper deals with the detailed presentation of some of the most popular mood induction procedures according to their type: simple (use of only one mood induction technique) or combined (association of two or more techniques at once). The earliest of the modern techniques is the Velten Mood Induction Procedure [Behav Res Ther 6 (1968) 473-482], which involves reading aloud sixty self-referent statements progressing from relative neutral mood to negative mood or dysphoria. Some researchers have varied the procedure slightly by changing the number of the statements [Behav Res Ther 21 (1983) 233-239, Br J Clin Psychol 21 (1982) 111-117, J Pers Soc Psychol 35 (1977) 625-636]. Various other mood induction procedures have been developed including music induction [Cogn Emotion 11 (1997) 403-432, Br J Med Psychol 55 (1982) 127-138], film clip induction [J Pers Soc Psychol 20 (1971) 37-43, Cogn Emotion 7 (1993) 171-193, Rottenberg J, Ray RR, Gross JJ. Emotion elicitation using films. In: Coan JA, Allen JJB, editors. The handbook of emotion elicitation and assessment. New York: Oxford University Press, 2007], autobiographical recall [J Clin Psychol 36 (1980) 215-226, Jallais C. Effets des humeurs positives et négatives sur les structures de connaissances de type script. Thèse de doctorat non publi

  4. Tank waste remediation system nuclear criticality safety program management review

    International Nuclear Information System (INIS)

    BRADY RAAP, M.C.

    1999-01-01

    This document provides the results of an internal management review of the Tank Waste Remediation System (TWRS) criticality safety program, performed in advance of the DOE/RL assessment for closure of the TWRS Nuclear Criticality Safety Issue, March 1994. Resolution of the safety issue was identified as Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) Milestone M-40-12, due September 1999

  5. Mixed-methods research in nursing - a critical review.

    Science.gov (United States)

    Bressan, Valentina; Bagnasco, Annamaria; Aleo, Giuseppe; Timmins, Fiona; Barisone, Michela; Bianchi, Monica; Pellegrini, Ramona; Sasso, Loredana

    2017-10-01

    To review the use of mixed-methods research in nursing with a particular focus on the extent to which current practice informs nurse researchers. It also aimed to highlight gaps in current knowledge, understanding and reporting of this type of research. Mixed-methods research is becoming increasingly popular among nurses and healthcare professionals. Emergent findings from this type of research are very useful for nurses in practice. The combination of both quantitative and qualitative methods provides a scientific base for practice but also richness from the qualitative enquiry. However, at the same time mixed-methods research is underdeveloped. This study identified mixed-methods research papers and critically evaluated their usefulness for research practice. To support the analysis, we performed a two-stage search using CINAHL to find papers with titles that included the key term 'mixed method'. An analysis of studies that used mixed-methods research revealed some inconsistencies in application and reporting. Attempts to use two distinct research methods in these studies often meant that one or both aspects had limitations. Overall methods were applied in a less rigorous way. This has implications for providing somewhat limited direction for novice researchers. There is also potential for application of evidence in healthcare practice that limited validity. This study highlights current gaps in knowledge, understanding and reporting of mixed-methods research. While these methods are useful to gain insight into clinical problems nurses lack guidance with this type of research. This study revealed that the guidance provided by current mixed-methods research is inconsistent and incomplete and this compounds the lack of available direction. There is an urgent need to develop robust guidelines for using mixed-methods research so that findings may be critically implemented in practice. © 2016 John Wiley & Sons Ltd.

  6. Added value of FM – a critical review

    DEFF Research Database (Denmark)

    Jensen, Per Anker; van der Voordt, Theo

    2015-01-01

    The purpose of this paper is to provide a state of the art of how the topic “Added value of FM” has been treated recently in research and practice. The paper is based on research papers from EFMC 2013 and 2014. The paper provides an overview and a critical review of this research. A main focus...... is to examine to which degree there is a cumulative knowledge building in this field. The paper also summarises findings about value adding management in practice and reflects on implications for research and practice. The critical review shows that some of the papers have a strong foundation in former research...

  7. Venous thromboembolism and coffee: critical review and meta-analysis.

    Science.gov (United States)

    Lippi, Giuseppe; Mattiuzzi, Camilla; Franchini, Massimo

    2015-07-01

    Among the various risk factors of venous thromboembolism (VTE), nutrients seem to play a significant role in the pathogenesis of this condition. This study aimed to clarify the relationship between coffee intake and venous thrombosis, and we performed a critical review of clinical studies that have been published so far. An electronic search was carried out in Medline, Scopus and ISI Web of Science with the keywords "coffee" AND "venous thromboembolism" OR "deep vein thrombosis" OR "pulmonary embolism" in "Title/Abstract/Keywords", with no language and date restriction. According to our criteria, three studies (two prospective and one case-control) were finally selected (inter-study heterogeneity: 78%; P<0.001). Cumulative data suggests that a modest intake of coffee (i.e., 1-4 cups/day) may be associated with an 11% increased risk of VTE compared to abstainers, whereas a larger intake (i.e., ≥5 coffee/day) may be associated with a 25% decreased risk. Our analysis of published data seemingly confirm the existence of a U-shape relationship between coffee intake and VTE, thus exhibiting a trend that overlaps with that previously reported for cardiovascular disease (CVD).

  8. Lithium safety and tolerability in mood disorders: a critical review

    Directory of Open Access Journals (Sweden)

    Ivan Aprahamian

    2014-04-01

    Full Text Available Background : Lithium is a first-line treatment for bipolar disorder in all phases, also indicated as add-on drug for unipolar depression and suicide prevention. This study encompasses a broad critical review on the safety and tolerability of lithium for mood disorders. Methods : A computerized search for English written human studies was made in MEDLINE, using the keywords “lithium” and “mood disorders”, starting from July 1993 through July 2013 (n = 416. This initial search aimed to select clinical trials, prospective data, and controlled design studies of lithium treatment for mood disorders reporting adverse effects (n = 36. The final selection yielded 91 studies. Results : The most common general side effects in patients on lithium treatment were thirst, frequent urination, dry mouth, weight gain, fatigue and cognitive complaints. Lithium users showed a high prevalence of hypothyroidism, hyperparathyroidism, and decrease in urinary concentration ability. Reduction of glomerular filtration rate in patients using lithium was also observed, but in a lesser extent. The evidence of teratogenicity associated with lithium use is not well established. Anti-inflammatory non-steroidal drugs, thiazide diuretics, angiotensin-converting enzyme inhibitors, and alprazolam may increase serum lithium and the consequent risk for intoxication. Discussion : Short-term lithium treatment is associated with mild side effects. Medium and long-term lithium treatment, however, might have effects on target organs which may be prevented by periodical monitoring. Overall, lithium is still a safe option for the treatment of mood disorders.

  9. Alexithymia and eating disorders: a critical review of the literature

    Science.gov (United States)

    2013-01-01

    Alexithymia is characterized by difficulties identifying feelings and differentiating between feelings and bodily sensations, difficulties communicating feelings, and a concrete cognitive style focused on the external environment. Individuals with eating disorders have elevated levels of alexithymia, particularly difficulties identifying and describing their feelings. A number of theoretical models have suggested that individuals with eating disorders may find emotions unacceptable and/or frightening and may use their eating disorder symptoms (i.e., restricting food intake, bingeing, and/or purging) as a way to avoid or cope with their feelings. The current critical review synthesizes the literature on alexithymia and eating disorders and examines alexithymia levels across eating disorders (i.e., anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified), the role of alexithymia in binge eating disorder, and the influence of alexithymia on the development of eating disorders as well as treatment outcome. The clinical implications of the research conducted to date and directions for future research are discussed. PMID:24999402

  10. Notes on critical care-review of seminal management and leadership papers in the United Kingdom.

    Science.gov (United States)

    Coombs, Maureen

    2009-06-01

    Review of recent critical care provision reveals substantial changes in clinical unit operating, and policy drivers influencing international critical care delivery. Practitioners who have worked in healthcare environments over this time, will have witnessed substantial shifts in healthcare policy, changes in professional body guidance and greater service evaluation have impacted on critical care management and leadership. This paper offers a personal perspective on seminal management and leadership papers published in the critical care literature over the past decade. Presenting a range of national and international work that utilise diverse approaches, ten key papers are highlighted that have impacted in the United Kingdom setting. Through this, the influence of the modernisation agenda, the increasing significance of outcome studies, and the need for flexible, interdependent practice emerges. A key message to surface from this paper is the need for all in critical care to engage with, and understand the wider implications of management and leadership change for critical care delivery.

  11. Epigenetics of psoriatic disease: A systematic review and critical appraisal.

    Science.gov (United States)

    Pollock, Remy A; Abji, Fatima; Gladman, Dafna D

    2017-03-01

    Psoriasis is an inflammatory disease of the skin that is sometimes accompanied by an auto-inflammatory arthritis called psoriatic arthritis (PsA). Psoriasis and PsA are multifactorial diseases that result from complex interactions of environmental and genetic risk factors. Epigenetic marks, which are labile chemical marks with diverse functions, form a layer of biological information that sits at the interface of genetics and the environment. Aberrant epigenetic regulation has been previously implicated in other rheumatological disorders. The purpose of this review is to summarize and critically evaluate the nascent literature on epigenetics in psoriasis and PsA. A systematic review yielded 52 primary articles after applying inclusion and exclusion criteria. Data were extracted using a standardized template and study quality assessed using a methodological quality checklist. Studies reflect a broad range of epigenetic sub-disciplines, the most common being DNA methylation, followed by the parent of origin effect or genomic imprinting, expression or activity of epigenetic modifying enzymes, and histone modifications. Epidemiological studies demonstrating excessive paternal transmission provided the earliest evidence of epigenetic deregulation in psoriatic disease, however few studies have examined its molecular mechanisms. Methylation studies evolved rapidly from low resolution global to targeted analyses of known psoriatic disease susceptibility loci such as HLA-C*0602. The recent explosion of epigenome-wide association studies has provided us with novel insights into psoriasis pathogenesis, and the mechanism of action of UVB, methotrexate, and anti-TNF therapies, as well as molecular signatures of psoriasis that may have clinical relevance. Finally, recent studies of pharmacological inhibitors of epigenetic modifier enzymes demonstrate their potential applicability as novel treatment modalities for psoriasis. Challenges of epigenetics research in psoriasis and Ps

  12. Critical success factors in implementing clinical pathways/case management.

    Science.gov (United States)

    Choo, J

    2001-07-01

    With the advent of casemix reimbursement implementation, rapid technological changes, an ageing population and changing consumer behaviour, the Singapore health care industry is faced with the impetus to provide a cost-effective and efficient care delivery system. One ubiquitous tool used is the establishment of a clinical pathway/case management programme within the hospital. As the concept of clinical pathway for patient care is a relatively new concept in Singapore, several critical factors must be considered to ensure successful implementation of clinical pathway/case management programme. One key success factor lies in continued clinician support and acceptance. Other factors include top management leadership and support and a dedicated team of case managers, nurses and paramedical professionals.

  13. Motivation Measures in Sport: A Critical Review and Bibliometric Analysis

    OpenAIRE

    Clancy, Rachel B.; Herring, Matthew P.; Campbell, Mark J.

    2017-01-01

    Motivation is widely-researched, in both sport psychology and other fields. As rigorous measurement is essential to understanding this latent construct, a critical appraisal of measurement instruments is needed. Thus, the purpose of this review was to evaluate the six most highly cited motivation measures in sport. Peer-reviewed articles published prior to August 2016 were searched to identify the six most highly cited motivation questionnaires in sport: Sport Motivation Scale (SMS), Intrinsi...

  14. A review of clinical guidelines.

    LENUS (Irish Health Repository)

    Andrews, E J

    2012-02-03

    BACKGROUND: Clinical guidelines are increasingly used in patient management but few clinicians are familiar with their origin or appropriate application. METHODS: A Medline search using the terms \\'clinical guidelines\\' and \\'practice guidelines\\' was conducted. Additional references were sourced by manual searching from the bibliographies of articles located. RESULTS AND CONCLUSION: Clinical guidelines originated in the USA in the early 1980s, initially as a cost containment exercise. Significant improvements in the process and outcomes of care have been demonstrated following their introduction, although the extent of improvement varies considerably. The principles for the development of guidelines are well established but many published guidelines fall short of these basic quality criteria. Guidelines are only one aspect of improving quality and should be used within a wider framework of promoting clinical effectiveness. Understanding their limitations as well as their potential benefits should enable clinicians to have a clearer view of their place in everyday practice.

  15. SRTC criticality safety technical review: Nuclear Criticality Safety Evaluation 93-04 enriched uranium receipt

    International Nuclear Information System (INIS)

    Rathbun, R.

    1993-01-01

    Review of NMP-NCS-930087, open-quotes Nuclear Criticality Safety Evaluation 93-04 Enriched Uranium Receipt (U), July 30, 1993, close quotes was requested of SRTC (Savannah River Technology Center) Applied Physics Group. The NCSE is a criticality assessment to determine the mass limit for Engineered Low Level Trench (ELLT) waste uranium burial. The intent is to bury uranium in pits that would be separated by a specified amount of undisturbed soil. The scope of the technical review, documented in this report, consisted of (1) an independent check of the methods and models employed, (2) independent HRXN/KENO-V.a calculations of alternate configurations, (3) application of ANSI/ANS 8.1, and (4) verification of WSRC Nuclear Criticality Safety Manual procedures. The NCSE under review concludes that a 500 gram limit per burial position is acceptable to ensure the burial site remains in a critically safe configuration for all normal and single credible abnormal conditions. This reviewer agrees with that conclusion

  16. Review of teaching methods and critical thinking skills.

    Science.gov (United States)

    Kowalczyk, Nina

    2011-01-01

    Critical information is needed to inform radiation science educators regarding successful critical thinking educational strategies. From an evidence-based research perspective, systematic reviews are identified as the most current and highest level of evidence. Analysis at this high level is crucial in analyzing those teaching methods most appropriate to the development of critical thinking skills. To conduct a systematic literature review to identify teaching methods that demonstrate a positive effect on the development of students' critical thinking skills and to identify how these teaching strategies can best translate to radiologic science educational programs. A comprehensive literature search was conducted resulting in an assessment of 59 full reports. Nineteen of the 59 reports met inclusion criteria and were reviewed based on the level of evidence presented. Inclusion criteria included studies conducted in the past 10 years on sample sizes of 20 or more individuals demonstrating use of specific teaching interventions for 5 to 36 months in postsecondary health-related educational programs. The majority of the research focused on problem-based learning (PBL) requiring standardized small-group activities. Six of the 19 studies focused on PBL and demonstrated significant differences in student critical thinking scores. PBL, as described in the nursing literature, is an effective teaching method that should be used in radiation science education. ©2011 by the American Society of Radiologic Technologists.

  17. A Critical Review of the Literature on Electronic Records ...

    African Journals Online (AJOL)

    This article provides a critical review of existing articles addressing the management of electronic records in the Eastern and Southern African Regional Branch of the International Council on Archives (ESARBICA) region. The article argues that while the literature in developed countries has come up with practical solutions ...

  18. "Theorizing Teacher Mobility": A Critical Review of Literature

    Science.gov (United States)

    Vagi, Robert; Pivovarova, Margarita

    2017-01-01

    In this critical review of literature, we summarize the major theoretical frameworks that have been used to study teacher mobility. In total we identified 40 teacher mobility studies that met our inclusion criteria. We conclude that relatively few theoretical frameworks have been used to study teacher mobility and those that have been used are…

  19. Automatic Generation and Ranking of Questions for Critical Review

    Science.gov (United States)

    Liu, Ming; Calvo, Rafael A.; Rus, Vasile

    2014-01-01

    Critical review skill is one important aspect of academic writing. Generic trigger questions have been widely used to support this activity. When students have a concrete topic in mind, trigger questions are less effective if they are too general. This article presents a learning-to-rank based system which automatically generates specific trigger…

  20. Critical factors for EIA implementation: literature review and research options.

    Science.gov (United States)

    Zhang, Jie; Kørnøv, Lone; Christensen, Per

    2013-01-15

    After decades of development, the gap between expectations of Environment Impact Assessments (EIA) and their practical performance remains significant. Research has been done to identify the critical factors for an effective implementation of EIA. However, this research, to a large extent, has not been cumulated and analysed comprehensively according to the stages of the EIA process. This paper contributes to the critical review of the literature on EIA implementation and effectiveness by cumulating mainly empirical findings in an implementation theoretical perspective. It focuses on the links between different critical factors and how they relate to different stages in the EIA and thus influence the decision making process. After reviewing 33 refereed journal articles published between 1999 and 2011, we identified 203 notions of critical factors. Of these, 102 related to different stages defined in our comprehensive EIA implementation model, and 101 were identified as general factors related to the whole EIA system. The number of notions of stage factors and general factors is thus about equal. An overlap between stage factors and general factors was found, which demonstrates that critical factors function differently in different cases. The function of the critical factors is complex and it is difficult to determine contingencies and causations. In the sources we examined, there is evidently an imbalance between in-depth empirical research and general knowledge, and the paper offers some suggestions for future research. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Integration of Mobile Health Technology in the Treatment of Chronic Pain: A Critical Review.

    Science.gov (United States)

    Sundararaman, Lalitha V; Edwards, Robert R; Ross, Edgar L; Jamison, Robert N

    This article provides a critical overview and best-evidence synthesis of the use of mobile health (mHealth) technology among persons with chronic pain and their health care providers and examines the future benefits and barriers of implementing mHealth technology in clinical care. We critically review articles about electronic pain diaries, pain assessment programs, text messaging, and smartphone pain apps for management of persons with pain. Also presented are findings on the utility of activity trackers and use of telehealth to deliver cognitive behavioral therapy. Finally, barriers, study gaps, and future challenges of incorporating mobile technology for chronic pain are discussed. Although the future of mHealth technology and telemedicine in clinical practice is promising, this critical review highlights the need for rigorous studies to establish an association of the use of mHealth technology with improved quality of life, functional autonomy, and decreased hospital use.

  2. Enhancing Critical Thinking Via a Clinical Scholar Approach.

    Science.gov (United States)

    Simpson, Vicki; McComb, Sara A; Kirkpatrick, Jane M

    2017-11-01

    Safety, quality improvement, and a systems perspective are vital for nurses to provide quality evidence-based care. Responding to the call to prepare nurses with these perspectives, one school of nursing used a clinical scholar approach, enhanced by systems engineering to more intentionally develop the ability to clinically reason and apply evidence-based practice. A two-group, repeated-measures control trial was used to determine the effects of systems engineering content and support on nursing students' clinical judgment and critical thinking skills. Findings indicated this approach had a positive effects on student's clinical judgment and clinical reasoning skills. This approach helped students view health care issues from a broader perspective and use evidence to guide solution development, enhancing the focus on evidence-based practice, and quality improvement. Intentional integration of an evidence-based, systems perspective by nursing faculty supports development of nurses who can function safely and effectively in the current health care system. [J Nurs Educ. 2017;56(11):679-682.]. Copyright 2017, SLACK Incorporated.

  3. A CRITICAL REVIEW OF THE MODEL MINORITY STEREOTYPE SHIBBOLETH

    Directory of Open Access Journals (Sweden)

    Nicholas Daniel Hartlep

    2012-04-01

    Full Text Available The author conducted a thematic review of the literature on the model minority stereotype  (MMS.  MMS  writings  (n  =  246  included  peer-reviewed  and  non-peer-reviewed materials spanning from the 1960s to present. Writings were reviewed if their title included “model minority.”  The purpose  was to review the MMS critically.  Six major themes were found to recurrently appear in the MMS literature. Those themes were the following: (1 critiquing colorblindness, (2 countering meritocracy, (3 demystifying Asian  American  exceptionalism,  (4  uncovering  divide  and  conquer  stratagem,  (5 problematizing Asian American homogenization, and (6 unmasking the “yellow peril” stereotype. Implications for the education of Asian students in America and abroad are shared.

  4. Utility of repeat testing of critical values: a Q-probes analysis of 86 clinical laboratories.

    Science.gov (United States)

    Lehman, Christopher M; Howanitz, Peter J; Souers, Rhona; Karcher, Donald S

    2014-06-01

    A common laboratory practice is to repeat critical values before reporting the test results to the clinical care provider. This may be an unnecessary step that delays the reporting of critical test results without adding value to the accuracy of the test result. To determine the proportions of repeated chemistry and hematology critical values that differ significantly from the original value as defined by the participating laboratory, to determine the threshold differences defined by the laboratory as clinically significant, and to determine the additional time required to analyze the repeat test. Participants prospectively reviewed critical test results for 4 laboratory tests: glucose, potassium, white blood cell count, and platelet count. Participants reported the following information: initial and repeated test result; time initial and repeat results were first known to laboratory staff; critical result notification time; if the repeat result was still a critical result; if the repeat result was significantly different from the initial result, as judged by the laboratory professional or policy; significant difference threshold, as defined by the laboratory; the make and model of the instrument used for primary and repeat testing. Routine, repeat analysis of critical values is a common practice. Most laboratories did not formally define a significant difference between repeat results. Repeated results were rarely considered significantly different. Median repeated times were at least 17 to 21 minutes for 10% of laboratories. Twenty percent of laboratories reported at least 1 incident in the last calendar year of delayed result reporting that clinicians indicated had adversely affected patient care. Routine repeat analysis of automated chemistry and hematology critical values is unlikely to be clinically useful and may adversely affect patient care.

  5. Selecting physician leaders for clinical service lines: critical success factors.

    Science.gov (United States)

    Epstein, Andrew L; Bard, Marc A

    2008-03-01

    Clinical service lines and interdisciplinary centers have emerged as important strategic programs within academic health centers (AHCs). Effective physician leadership is significant to their success, but how these leaders are chosen has not been well studied. The authors conducted a study to identify current models for selecting the physician leaders of clinical service lines, determine critical success factors, and learn how the search process affected service line performance. In 2003 and 2004, the authors interviewed clinical and executive personnel involved in 14 programs to establish, or consider establishing, heart or cancer service lines, at 13 AHCs. The responses were coded to identify and analyze trends and themes. The key findings of the survey were (1) the goals and expectations that AHCs set for their service line leaders vary greatly, depending on both the strategic purpose of the service line in the AHC and the service line's stage of development, (2) the matrix organizational structure employed by most AHCs limits the leader's authority over necessary resources, and calls forth a variety of compensating strategies if the service line is to succeed, (3) the AHCs studied used relatively informal processes to identify, evaluate, and select service line leaders, and (4) the leader's job is vitally shaped by the AHC's strategic, structural, and political context, and selection criteria should be determined accordingly. Institutions should be explicit about the strategic purpose and stage of development of their clinical service lines and be clear about their expectations and requirements in hiring service line leaders.

  6. Factors associated with clinical inertia: an integrative review

    Science.gov (United States)

    Aujoulat, Isabelle; Jacquemin, Patricia; Rietzschel, Ernst; Scheen, André; Tréfois, Patrick; Wens, Johan; Darras, Elisabeth; Hermans, Michel P

    2014-01-01

    Failure to initiate or intensify therapy according to evidence-based guidelines is increasingly being acknowledged as a phenomenon that contributes to inadequate management of chronic conditions, and is referred to as clinical inertia. However, the number and complexity of factors associated with the clinical reasoning that underlies the decision-making processes in medicine calls for a critical examination of the consistency of the concept. Indeed, in the absence of information on and justification of treatment decisions that were made, clinical inertia may be only apparent, and actually reflect good clinical practice. This integrative review seeks to address the factors generally associated with clinical inaction, in order to better delineate the concept of true clinical inertia. PMID:24868181

  7. Radically Reducing the Costs of Panel Critical Reviews According to ISO 14040

    DEFF Research Database (Denmark)

    Weidema, Bo Pedersen; Christiansen, Kim; Wernet, Gregor

    2013-01-01

    We suggest a procedure that radically reduces the critical review costs without compromising their thoroughness and overall quality. This procedure has 3 elements: A fixed panel for all reviews, an already critically reviewed background database, and a software-supported review procedure. The pre....... The presentation discusses these elements in the light of the upcoming ISO 14071 on critical review....

  8. Fission, critical mass and safety-a historical review

    International Nuclear Information System (INIS)

    Meggitt, Geoff

    2006-01-01

    Since the discovery of fission, the notion of a chain reaction in a critical mass releasing massive amounts of energy has haunted physicists. The possibility of a bomb or a reactor prompted much of the early work on determining a critical mass, but the need to avoid an accidental critical excursion during processing or transport of fissile material drove much that took place subsequently. Because of the variety of possible situations that might arise, it took some time to develop adequate theoretical tools for criticality safety and the early assessments were based on direct experiment. Some extension of these experiments to closely similar situations proved possible, but it was not until the 1960s that theoretical methods (and computers to run them) developed enough for them to become reliable assessment tools. Validating such theoretical methods remained a concern, but by the end of the century they formed the backbone of criticality safety assessment. This paper traces the evolution of these methods, principally in the UK and USA, and summarises some related work concerned with the nature of criticality accidents and their radiological consequences. It also indicates how the results have been communicated and used in ensuring nuclear safety. (review)

  9. Online counseling: a narrative and critical review of the literature.

    Science.gov (United States)

    Richards, Derek; Viganó, Noemi

    2013-09-01

    This article aimed to critically review the literature on online counseling. Database and hand-searches were made using search terms and eligibility criteria, yielding a total of 123 studies. The review begins with what characterizes online counseling. Outcome and process research in online counseling is reviewed. Features and cyberbehaviors of online counseling such as anonymity and disinhibition, convenience, time-delay, the loss of social signaling, and writing behavior in cyberspace are discussed. Ethical behavior, professional training, client suitability, and clients' and therapists' attitudes and experiences of online counseling are reviewed. A growing body of knowledge to date is positive in showing that online counseling can have a similar impact and is capable of replicating the facilitative conditions as face-to-face encounters. A need remains for stronger empirical evidence to establish efficacy and effectiveness and to understand better the unique mediating and facilitative variables. © 2013 Wiley Periodicals, Inc.

  10. Characteristics of leadership that influence clinical learning: a narrative review.

    Science.gov (United States)

    Walker, Rachel; Cooke, Marie; Henderson, Amanda; Creedy, Debra K

    2011-11-01

    Leadership has been consistently implied in fostering clinical learning. However there is a lack of clarity about the form leadership should take. Limited quantitative research indicated a narrative approach to review literature from a broad perspective. A framework to guide the synthesis was developed to ensure a rigorous review process. Preliminary reading and review of papers using search terms nursing and leadership and clinical learning and learning culture narrowed the inclusion criteria to 245 papers published between 2000 and 2010. Given the diversity of the papers' focus, aim and context, a refined screening process justified the inclusion of twenty-six papers in the review. A critical appraisal of these peer-reviewed quantitative, qualitative and commentary papers identified factors/elements integral to effective leadership. Across the literature leadership was discussed in relation to two broad themes: influence of leadership on organisational learning and development and; influence of leadership on undergraduate clinical education. The factors central to leadership emerged as transformative principles, the role of the nurse unit/ward manager, collaboration and relationship building and role-modelling. The review has raised some suggestions for future research aimed at examining the impact of a leadership capacity building intervention that supports clinical learning. Copyright © 2010 Elsevier Ltd. All rights reserved.

  11. Huntington's disease: a clinical review

    Directory of Open Access Journals (Sweden)

    Roos Raymund AC

    2010-12-01

    Full Text Available Abstract Huntington disease (HD is a rare neurodegenerative disorder of the central nervous system characterized by unwanted choreatic movements, behavioral and psychiatric disturbances and dementia. Prevalence in the Caucasian population is estimated at 1/10,000-1/20,000. Mean age at onset of symptoms is 30-50 years. In some cases symptoms start before the age of 20 years with behavior disturbances and learning difficulties at school (Juvenile Huntington's disease; JHD. The classic sign is chorea that gradually spreads to all muscles. All psychomotor processes become severely retarded. Patients experience psychiatric symptoms and cognitive decline. HD is an autosomal dominant inherited disease caused by an elongated CAG repeat (36 repeats or more on the short arm of chromosome 4p16.3 in the Huntingtine gene. The longer the CAG repeat, the earlier the onset of disease. In cases of JHD the repeat often exceeds 55. Diagnosis is based on clinical symptoms and signs in an individual with a parent with proven HD, and is confirmed by DNA determination. Pre-manifest diagnosis should only be performed by multidisciplinary teams in healthy at-risk adult individuals who want to know whether they carry the mutation or not. Differential diagnoses include other causes of chorea including general internal disorders or iatrogenic disorders. Phenocopies (clinically diagnosed cases of HD without the genetic mutation are observed. Prenatal diagnosis is possible by chorionic villus sampling or amniocentesis. Preimplantation diagnosis with in vitro fertilization is offered in several countries. There is no cure. Management should be multidisciplinary and is based on treating symptoms with a view to improving quality of life. Chorea is treated with dopamine receptor blocking or depleting agents. Medication and non-medical care for depression and aggressive behavior may be required. The progression of the disease leads to a complete dependency in daily life, which

  12. [Critical role of clinical laboratories in hospital infection control].

    Science.gov (United States)

    Yagi, Tetsuya

    2010-11-01

    The hospital infection control and prevention is recognized to be more and more important according to the advances in modern medical treatment and care. Clinical microbiology laboratory play critical roles in the hospital infection control as a member of infection control team (ICT). They are the first in a hospital to identify outbreak of MRSA in NICU and molecular epidemiological analysis of the isolates lead proper intervention of ICT to the concerned ward. From a viewpoint of infectious disease specialist, rapid and precise microbiological information is essential for the appropriate diagnosis and treatment of infectious diseases. Each medical technologist need to make efforts to understand the characteristics of the examinations for infectious diseases and send out information useful for clinical practices. In our hospital, with the participation of all members of medical technologists, rapid reporting system was developed for blood culture examinations, which greatly contribute to the appropriate treatment of bloodstream infections. Collaborations of clinical microbiology laboratory with other members of ICT realize high quality hospital infection control. They also need to be aware of themselves as good practitioners of infection control measures to prevent hospital infections.

  13. A critical review of regional economic integration in China

    OpenAIRE

    Wang RUI

    2015-01-01

    Under the circumstances of economic globalization, regional economic integration has become the mainstream of current economic development for each country, so China has to pay more attention to it. The critical review on regional economic integration in China can lay a certain foundation and provide experience for the in-depth research. Main contents of regional economic integration are refined according to the previous studies and realities, including the integration of regional economic re...

  14. Critical Review of rate constants for reacitons of hydrated electrons

    International Nuclear Information System (INIS)

    Buxton, G.V.; Greenstock, C.L.; Phillips Helman, W.; Ross, A.B.

    1988-01-01

    Kinetic data for the radicals Hx and xOH in aqueous solution,and the corresponding radical anions, xO - and e/sub =/, have been critically reviewed. Reactions of the radicals in aqueous solution have been studied by pulse radiolysis, flash photolysis and other methods. Rate constants for over 3500 reaction are tabulated, including reaction with molecules, ions and other radicals derived from inorganic and organic solutes

  15. Pediatric Critical Care Telemedicine Program: A Single Institution Review.

    Science.gov (United States)

    Hernandez, Maria; Hojman, Nayla; Sadorra, Candace; Dharmar, Madan; Nesbitt, Thomas S; Litman, Rebecca; Marcin, James P

    2016-01-01

    Rural and community emergency departments (EDs) often receive and treat critically ill children despite limited access to pediatric expertise. Increasingly, pediatric critical care programs at children's hospitals are using telemedicine to provide consultations to these EDs with the goal of increasing the quality of care. We conducted a retrospective review of a pediatric critical care telemedicine program at a single university children's hospital. Between the years 2000 and 2014, we reviewed all telemedicine consultations provided to children in rural and community EDs, classified the visits using a comprehensive evidence-based set of chief complaints, and reported the consultations' impact on patient disposition. We also reviewed the total number of pediatric ED visits to calculate the relative frequency with which telemedicine consultations were provided. During the study period, there were 308 consultations provided to acutely ill and/or injured children for a variety of chief complaints, most commonly for respiratory illnesses, acute injury, and neurological conditions. Since inception, the number of consultations has been increasing, as has the number of participating EDs (n = 18). Telemedicine consultations were conducted on 8.6% of seriously ill children, the majority of which resulted in admission to the receiving hospital (n = 150, 49%), with a minority of patients requiring transport to the university children's hospital (n = 103, 33%). This single institutional, university children's hospital-based review demonstrates that a pediatric critical care telemedicine program used to provide consultations to seriously ill children in rural and community EDs is feasible, sustainable, and used relatively infrequently, most typically for the sickest pediatric patients.

  16. Oligometastases. The new paradigm and options for radiotherapy. A critical review

    Energy Technology Data Exchange (ETDEWEB)

    Badakhshi, H.; Gruen, A.; Stromberger, C.; Budach, V.; Boehmer, D. [Charite Universitaetsmedizin Berlin (Germany). Dept. for Radiation Oncology

    2013-05-15

    Traditional oncology distinguishes between two separate and incommensurable states in the evolution of solid malignancies: the localized disease, which is curable; and the disseminated status, which is per se palliative. Recently, a huge body of evidence suggests a fundamental change in the understanding of cancer, indicating an intermediate state in the trajectory of solid malignancies: the oligometastatic state. The following review will critically analyse existing hypotheses and facts from the basic sciences and try to contextualize it in regard to the clinical evidence available to date. Consecutively, it will try to draw possible clinical consequences for application of radiotherapy in this specific clinical scenario. (orig.)

  17. TWTF project criticality task force final review and assessment

    International Nuclear Information System (INIS)

    McKinley, K.B.; Cannon, J.W.; Wheeler, F.J.; Worle, H.A.

    1980-11-01

    The Transuranic Waste Treatment Facility (TWTF) is being developed to process transuranic waste, stored and buried at the Idaho National Engineering Laboratory, into a chemically inert, physically stable basalt-like residue acceptable at a federal repository. A task force was assembled by the TWTF Project Division to review and assess all aspects of criticality safety for the TWTF. This document presents the final review, assessments, and recommendations of this task force. The following conclusions were made: Additional criticality studies are needed for the entire envelope of feed compositions and temperature effects. Safe operating k/sub eff/'s need to be determined for process components. Criticality analyses validation experiments may also be required. SRP neutron interrogation should be replaced by DDT neutron interrogation. Accuracy studies need to be performed for the proposed assaying techniques. Time-correlated neutron monitoring needs to be mocked up for process components to prove feasibility and determine accuracy. The criticality control techniques developed for the TWTF conceptual design are in compliance with ERDAM 0530, including the Double Contingency Rule. Detailed procedures and controls need to be developed

  18. Short- and long-term impact of critical illness on relatives: literature review.

    Science.gov (United States)

    Paul, Fiona; Rattray, Janice

    2008-05-01

    This paper is a report of a literature review undertaken to identify the short- and long-term impact of critical illness on relatives. Patients in intensive care can experience physical and psychological consequences, and their relatives may also experience such effects. Although it is recognized that relatives have specific needs, it is not clear whether these needs are always met and whether further support is required, particularly after intensive care. The following databases were searched for the period 1950-2007: Medline, British Nursing Index and Archive, EMBASE, CINAHL, PsycINFO and EMB Reviews--Cochrane Central Register of Clinical Trials. Search terms focused on adult relatives of critically ill adult patients during and after intensive care. Recurrent topics were categorized to structure the review, i.e. 'relatives needs', 'meeting relatives' needs', 'interventions', 'satisfaction', 'psychological outcomes' and 'coping'. Studies have mainly identified relatives' immediate needs using the Critical Care Family Needs Inventory. There are few studies of interventions to meet relatives' needs and the short- and long-term effects of critical illness on relatives. Despite widespread use of the Critical Care Family Needs Inventory, factors such as local or cultural differences may influence relatives' needs. Relatives may also have unidentified needs, and these needs should be explored. Limited research has been carried out into interventions to meet relatives' needs and the effects of critical illness on their well-being, yet some relatives may experience negative psychological consequences far beyond the acute phase of the illness.

  19. Validation of a clinical critical thinking skills test in nursing

    Directory of Open Access Journals (Sweden)

    Sujin Shin

    2015-01-01

    Full Text Available Purpose: The purpose of this study was to develop a revised version of the clinical critical thinking skills test (CCTS and to subsequently validate its performance. Methods: This study is a secondary analysis of the CCTS. Data were obtained from a convenience sample of 284 college students in June 2011. Thirty items were analyzed using item response theory and test reliability was assessed. Test-retest reliability was measured using the results of 20 nursing college and graduate school students in July 2013. The content validity of the revised items was analyzed by calculating the degree of agreement between instrument developer intention in item development and the judgments of six experts. To analyze response process validity, qualitative data related to the response processes of nine nursing college students obtained through cognitive interviews were analyzed. Results: Out of initial 30 items, 11 items were excluded after the analysis of difficulty and discrimination parameter. When the 19 items of the revised version of the CCTS were analyzed, levels of item difficulty were found to be relatively low and levels of discrimination were found to be appropriate or high. The degree of agreement between item developer intention and expert judgments equaled or exceeded 50%. Conclusion: From above results, evidence of the response process validity was demonstrated, indicating that subjects respondeds as intended by the test developer. The revised 19-item CCTS was found to have sufficient reliability and validity and will therefore represents a more convenient measurement of critical thinking ability.

  20. Validation of a clinical critical thinking skills test in nursing.

    Science.gov (United States)

    Shin, Sujin; Jung, Dukyoo; Kim, Sungeun

    2015-01-27

    The purpose of this study was to develop a revised version of the clinical critical thinking skills test (CCTS) and to subsequently validate its performance. This study is a secondary analysis of the CCTS. Data were obtained from a convenience sample of 284 college students in June 2011. Thirty items were analyzed using item response theory and test reliability was assessed. Test-retest reliability was measured using the results of 20 nursing college and graduate school students in July 2013. The content validity of the revised items was analyzed by calculating the degree of agreement between instrument developer intention in item development and the judgments of six experts. To analyze response process validity, qualitative data related to the response processes of nine nursing college students obtained through cognitive interviews were analyzed. Out of initial 30 items, 11 items were excluded after the analysis of difficulty and discrimination parameter. When the 19 items of the revised version of the CCTS were analyzed, levels of item difficulty were found to be relatively low and levels of discrimination were found to be appropriate or high. The degree of agreement between item developer intention and expert judgments equaled or exceeded 50%. From above results, evidence of the response process validity was demonstrated, indicating that subjects respondeds as intended by the test developer. The revised 19-item CCTS was found to have sufficient reliability and validity and will therefore represents a more convenient measurement of critical thinking ability.

  1. Critical thinking in nursing: Scoping review of the literature.

    Science.gov (United States)

    Zuriguel Pérez, Esperanza; Lluch Canut, Maria Teresa; Falcó Pegueroles, Anna; Puig Llobet, Montserrat; Moreno Arroyo, Carmen; Roldán Merino, Juan

    2015-12-01

    This article seeks to analyse the current state of scientific knowledge concerning critical thinking in nursing. The methodology used consisted of a scoping review of the main scientific databases using an applied search strategy. A total of 1518 studies published from January 1999 to June 2013 were identified, of which 90 met the inclusion criteria. The main conclusion drawn is that critical thinking in nursing is experiencing a growing interest in the study of both its concepts and its dimensions, as well as in the development of training strategies to further its development among both students and professionals. Furthermore, the analysis reveals that critical thinking has been investigated principally in the university setting, independent of conceptual models, with a variety of instruments used for its measurement. We recommend (i) the investigation of critical thinking among working professionals, (ii) the designing of evaluative instruments linked to conceptual models and (iii) the identification of strategies to promote critical thinking in the context of providing nursing care. © 2014 Wiley Publishing Asia Pty Ltd.

  2. Iatrogenic Opioid Withdrawal in Critically Ill Patients: A Review of Assessment Tools and Management.

    Science.gov (United States)

    Chiu, Ada W; Contreras, Sofia; Mehta, Sangeeta; Korman, Jennifer; Perreault, Marc M; Williamson, David R; Burry, Lisa D

    2017-12-01

    To (1) provide an overview of the epidemiology, clinical presentation, and risk factors of iatrogenic opioid withdrawal in critically ill patients and (2) conduct a literature review of assessment and management of iatrogenic opioid withdrawal in critically ill patients. We searched MEDLINE (1946-June 2017), EMBASE (1974-June 2017), and CINAHL (1982-June 2017) with the terms opioid withdrawal, opioid, opiate, critical care, critically ill, assessment tool, scale, taper, weaning, and management. Reference list of identified literature was searched for additional references as well as www.clinicaltrials.gov . We restricted articles to those in English and dealing with humans. We identified 2 validated pediatric critically ill opioid withdrawal assessment tools: (1) Withdrawal Assessment Tool-Version 1 (WAT-1) and (2) Sophia Observation Withdrawal Symptoms Scale (SOS). Neither tool differentiated between opioid and benzodiazepine withdrawal. WAT-1 was evaluated in critically ill adults but not found to be valid. No other adult tool was identified. For management, we identified 5 randomized controlled trials, 2 prospective studies, and 2 systematic reviews. Most studies were small and only 2 studies utilized a validated assessment tool. Enteral methadone, α-2 agonists, and protocolized weaning were studied. We identified 2 validated assessment tools for pediatric intensive care unit patients; no valid tool for adults. Management strategies tested in small trials included methadone, α-2 agonists, and protocolized sedation/weaning. We challenge researchers to create validated tools assessing specifically for opioid withdrawal in critically ill children and adults to direct management.

  3. Methodology of clinical trials evaluating the incorporation of new drugs in the first-line treatment of patients with diffuse large B-cell lymphoma (DLBCL): a critical review.

    Science.gov (United States)

    Iacoboni, G; Zucca, E; Ghielmini, M; Stathis, A

    2018-05-01

    The first-line treatment of diffuse large B-cell lymphoma (DLBCL) is the combination of rituximab with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy, curing approximately 60% of patients. Many clinical trials have been carried out over the last 10 years trying to improve the results of this treatment, but the appropriateness of their planning strategies could be rediscussed. Reports of phase III trials evaluating the addition of molecularly targeted agents or new monoclonal antibodies to the classic R-CHOP backbone in first-line induction or maintenance treatment were reviewed. The trial design, primary end point, number of patients enrolled, patient selection criteria, treatment schedule and results were registered for each one. In addition, the phases I and II trials which preceded these phase III trials were also reviewed. Among six phase III trials with results, only one trial evaluating lenalidomide maintenance after response to R-CHOP induction was positive and reached its primary end point. The other five trials did not show an improved outcome with the addition of the new agent. The preceding phases I and II trials were very heterogeneous in their end points and design. Even though most of these trials were considered positive, thus encouraging further investigation, so far they failed to predict the results of the subsequent phase III trials. The standard of care for DLBCL is still R-CHOP. Phase I/II trials failed to predict the results of subsequent phase III trials evaluating non-chemotherapeutic agents added to R-CHOP. The methodology of phase II trials evaluating new agents in DLBCL needs to be better defined in the future.

  4. The effect of chronotherapy on delirium in critical care - a systematic review.

    Science.gov (United States)

    Luther, Roseanne; McLeod, Anne

    2017-05-15

    Delirium is highly prevalent within critical care and is linked to adverse clinical outcomes, increased mortality and impaired quality of life. Development of delirium is thought to be caused by multiple risk factors, including disruption of the circadian rhythm. Chronotherapeutic interventions, such as light therapy, music and use of eye shades, have been suggested as an option to improve circadian rhythm within intensive care units. This review aims to answer the question: Can chronotherapy reduce the prevalence of delirium in adult patients in critical care? This study is a systematic review of quantitative studies. Six major electronic databases were searched, and a hand search was undertaken using selected key search terms. Research quality was assessed using the critical appraisal skills programme tools. The studies were critically appraised by both authors independently, and data were extracted. Four themes addressing the research question were identified and critically evaluated. Six primary research articles that investigated different methods of chronotherapy were identified, and the results suggest that multi-component non-pharmacological interventions are the most effective for reducing the prevalence of delirium in critical care. The melatonergic agonist Ramelteon demonstrated statistically significant reductions in delirium; however, the reliability of the results in answering the review question was limited by the research design. The use of bright light therapy (BLT) and dynamic light application had mixed results, with issues with the research design and outcomes measured limiting the validity of the findings. Multi-component non-pharmacological interventions, such as noise and light control, can reduce delirium in critical care, whereas other interventions, such as BLT, have mixed outcomes. Melatonin, as a drug, may be a useful alternative to sedative-hypnotics. Chronotherapy can reduce the incidence of delirium within critical care, although

  5. Radio-frequency glow discharge spectrometry: A critical review

    International Nuclear Information System (INIS)

    Winchester, Michael R.; Payling, Richard

    2004-01-01

    This paper presents a critical review of analytical radio frequency glow discharge spectrometry (rf-GDS). The historical foundations of rf-GDS are described, and current knowledge of the fundamental physics of analytical rf glow discharges is discussed. Additionally, instrumentation, methodologies, and applications of rf glow discharge optical emission spectrometry (rf-GDOES) and mass spectrometry (rf-GDMS) are reviewed. Although other rf-GDS techniques have appeared [e.g. rf glow discharge atomic absorption spectrophotometry (rf-GDAAS)], the emphasis is placed upon rf-GDOES and rf-GDMS, because they have received by far the most interest from analytical chemical metrologists. This review also provides explanations of some developments that are needed for further progress in the field of analytical rf-GDS

  6. [Mixed depression and DSM-5: A critical review].

    Science.gov (United States)

    Weibel, S; Bertschy, G

    2016-02-01

    Mixed depression is a depressive syndrome characterized by the presence, along with the typical depressive symptoms of depression, of those of over activation and excitation. If sometimes this activation is expressed by classical hypomanic symptoms, it is often observed by means of more subtle expression: inner tension, crowded thoughts, dramatic expression suffering, and unproductive agitation. It is important to identify mixed depression because such patients are particularly at risk of suicidal behaviors, substance abuse and therapeutic resistance. Even if therapeutic strategies continue to be discussed, treatments should rely on mood stabilizers and antipsychotics instead of antidepressants as in pure depression. Even though the concept of mixed depression has been described for more than twenty years, first by Koukopoulos and then by other authors, it had been little studied, especially because it did not appear in international psychiatric classifications. The DSM-IV supported a very narrow conception of the mixed states because the criteria required simultaneous full manic and full depressive syndromes, corresponding only to some dysphoric manias. The recently published DSM-5 proposes modifications in mood and bipolar disorder classifications, and especially introduces the possibility to specify depressive and manic episodes with "mixed features". To diagnose depression with mixed features, a full depressive syndrome has to be present together most of time with three hypomanic symptoms, except symptoms that are considered as overlapping (that can be observed either in mania or in depression), i.e. agitation, irritability and distractibility. Critical analysis of DSM criteria and review of literature. We first analyzed the clinical relevance of the definition of depression with mixed features which could correspond to mixed depression. The problem is that the hypomanic symptoms allowed by the manual lead to symptom associations that are rather illogical (as

  7. Review on modeling and simulation of interdependent critical infrastructure systems

    International Nuclear Information System (INIS)

    Ouyang, Min

    2014-01-01

    Modern societies are becoming increasingly dependent on critical infrastructure systems (CISs) to provide essential services that support economic prosperity, governance, and quality of life. These systems are not alone but interdependent at multiple levels to enhance their overall performance. However, recent worldwide events such as the 9/11 terrorist attack, Gulf Coast hurricanes, the Chile and Japanese earthquakes, and even heat waves have highlighted that interdependencies among CISs increase the potential for cascading failures and amplify the impact of both large and small scale initial failures into events of catastrophic proportions. To better understand CISs to support planning, maintenance and emergency decision making, modeling and simulation of interdependencies across CISs has recently become a key field of study. This paper reviews the studies in the field and broadly groups the existing modeling and simulation approaches into six types: empirical approaches, agent based approaches, system dynamics based approaches, economic theory based approaches, network based approaches, and others. Different studies for each type of the approaches are categorized and reviewed in terms of fundamental principles, such as research focus, modeling rationale, and the analysis method, while different types of approaches are further compared according to several criteria, such as the notion of resilience. Finally, this paper offers future research directions and identifies critical challenges in the field. - Highlights: • Modeling approaches on interdependent critical infrastructure systems are reviewed. • I mainly review empirical, agent-based, system-dynamics, economic, network approaches. • Studies by each approach are sorted out in terms of fundamental principles. • Different approaches are further compared with resilience as the main criterion

  8. Strategies used for the promotion of critical thinking in nursing undergraduate education: A systematic review.

    Science.gov (United States)

    Carvalho, Diana P S R P; Azevedo, Isabelle C; Cruz, Giovanna K P; Mafra, Gabriela A C; Rego, Anna L C; Vitor, Allyne F; Santos, Viviane E P; Cogo, Ana L P; Ferreira Júnior, Marcos A

    2017-10-01

    Identifying the strategies used to promote critical thinking (CT) during undergraduate education in nursing courses. Systematic review. Five electronic databases were searched without language, publication time or geographic filters. A systematic review of the literature. Including experimental studies that considered at least one teaching strategy to promote critical thinking of undergraduate students in Nursing courses. The search for studies occurred in three phases: title and summary review, complete text and implementation of a clinical form of selection according to predetermined criteria. All included studies were assessed for quality through a classification tool for experimental studies. Six studies were selected. The results were grouped into three key themes: an evaluation of the quality of the selected studies, characterization of the studies and the strategies used to promote critical thinking. All selected studies were in English, with significant conceptual similarity of Critical Thinking and dominance in choosing the approached theme during strategies in clinical nursing education with an emphasis on the nursing process. The most widely used teaching intervention was Problem-Based Learning. Nursing education mediated by strategies that stimulate CT is considered a positive difference in undergraduate curriculums. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Developing critical practitioners: A review of teaching methods in the Bachelor of Radiography and Medical Imaging

    International Nuclear Information System (INIS)

    Mc Inerney, J.; Baird, M.

    2016-01-01

    Background: The capacity to apply critical thinking clinically is no longer an option for radiographers. Radiographers are obliged by their registration board to embrace a contemporary and integrated conceptualisation of competence, including the capacity to think critically and reflectively to resolve clinical challenges. The study examines the complexity of critical thinking, identifies the skill set and personal traits necessary to enact it practically. Methods: Third and final year radiography students' perceptions of three teaching approaches used within the undergraduate course were explored using peer reviewed survey instruments. Thematic analysis and descriptive analyses were applied to the data to make sense of the responses. Conclusions: Students are exhibiting the capacity to formulate, evaluate and revise their own work practices through critical thinking. Educational activities that have been proven effective in empowering students with the skills necessary to meet professional standards and the personal traits required to enact them should be prioritised in curricula. The study has shown that establishment of an audit trail for the educational activities in use within radiography programs can facilitate the acquisition of evidence-based and reflective practice skills amongst students. An assessment of student's perceptions of the learning activities they engage with is an important step on this trail, though a before and after measure could be applied. - Highlights: • Examines the concept of critical thinking including the personal traits required to enact it. • Reviews three teaching activities aimed at teaching critical thinking. • Assesses student perceptions of the activities in facilitating critical thinking skills. • Students who acquire critical thinking skills can undergo transformative learning. • Establishing an audit trail can ensure teaching activities are having desired effect.

  10. A systematic review on critical thinking in medical education.

    Science.gov (United States)

    Chan, Zenobia C Y

    2016-04-18

    Critical thinking is the ability to raise discriminating questions in an attempt to search for better ideas, a deeper understanding and better solutions relating to a given issue. This systematic review provides a summary of efforts that have been made to enhance and assess critical thinking in medical education. Nine databases [Ovid MEDLINE(R), AMED, Academic Search Premier, ERIC, CINAHL, Web of Science, JSTOR, SCOPUS and PsycINFO] were searched to identify journal articles published from the start of each database to October 2012. A total of 41 articles published from 1981 to 2012 were categorised into two main themes: (i) evaluation of current education on critical thinking and (ii) development of new strategies about critical thinking. Under each theme, the teaching strategies, assessment tools, uses of multimedia and stakeholders were analysed. While a majority of studies developed teaching strategies and multimedia tools, a further examination of their quality and variety could yield some insights. The articles on assessment placed a greater focus on learning outcomes than on learning processes. It is expected that more research will be conducted on teacher development and students' voices.

  11. BIOCHAR: PYROGENIC CARBON FOR AGRICULTURAL USE - A CRITICAL REVIEW

    Directory of Open Access Journals (Sweden)

    Etelvino Henrique Novotny

    2015-04-01

    Full Text Available Biochar (carbonized biomass for agricultural use has been used worldwide as soil amendment and is a technology of particular interest for Brazil, since its "inspiration" is from the historical Terra Preta de Índios(Amazon Dark Earth, and also because Brazil is the world's largest charcoal producer, generating enormous residue quantities in form of fine charcoal and due to the availability of different residual biomasses, mainly from agroindustry (e.g., sugar-cane bagasse; wood and paper-mill wastes; residues from biofuel industries; sewage sludge etc, that can be used for biochar production, making Brazil a key actor in the international scenario in terms of biochar research and utilization. In the last decade, numerous studies on biochar have been carried out and now a vast literature, and excellent reviews, are available. The objective of this paper is therefore to deliver a critical review with some highlights on biochar research, rather than an exhaustive bibliographic review. To this end, some key points considered critical and relevant were selected and the pertinent literature "condensed", with a view to guide future research, rather than analyze trends of the past.

  12. Entropy in the Critical Zone: A Comprehensive Review

    Directory of Open Access Journals (Sweden)

    Juan Quijano

    2014-06-01

    Full Text Available Thermodynamic entropy was initially proposed by Clausius in 1865. Since then it has been implemented in the analysis of different systems, and is seen as a promising concept to understand the evolution of open systems in non-equilibrium conditions. Information entropy was proposed by Shannon in 1948, and has become an important concept to measure information in different systems. Both thermodynamic entropy and information entropy have been extensively applied in different fields related to the Critical Zone, such as hydrology, ecology, pedology, and geomorphology. In this study, we review the most important applications of these concepts in those fields, including how they are calculated, and how they have been utilized to analyze different processes. We then synthesize the link between thermodynamic and information entropies in the light of energy dissipation and organizational patterns, and discuss how this link may be used to enhance the understanding of the Critical Zone.

  13. A critical review of treatment approaches for gambling disorders.

    Science.gov (United States)

    Stea, Jonathan N; Hodgins, David C

    2011-06-01

    This review presents the theoretical model, evidence base, and theoretical and methodological issues for seven treatment approaches to gambling disorders: 1) psychoanalytic and psychodynamic treatments, 2) Gamblers Anonymous, 3) behavioural treatments, 4) cognitive and cognitive-behavioural therapies, 5) brief, motivational, and self-directed interventions, 6) pharmacotherapies, and 7) family therapy approaches. Throughout the review, broader clinical and research issues are also discussed, including barriers to treatment-seeking, controlled gambling versus abstinence as a treatment goal, comorbidity, and the evaluation of treatment efficacy and effectiveness.

  14. Enteral nutrition therapy for critically ill adult patients; critical review and algorithm creation.

    Science.gov (United States)

    Araújo-Junqueira, L; De-Souza, Daurea A

    2012-01-01

    Undernutrition directly affects critically ill patient's clinical outcome and mortality rates. Interdisciplinar algorithm creation aiming to optimize the enteral nutrition therapy for critically ill adult patients. Pubmed, SciELO, Scholar Google, Web of Science, Scopus, with research of these key words: protocols, enteral nutrition, nutritional support, critical care, undernutrition, fasting. Intensive Care Unit, Hospital de Clínicas, Federal University of Uberlándia, MG, Brazil. Were established in the algorithm a following sequential steps: After a clinical-surgical diagnosis, including the assessment of hemodynamic stability, were requested passage of a feeding tube in post-pyloric position and a drainage tube in gastric position. After hemodynamic stability it should be done the nutritional status diagnosis, calculated nutritional requirements, as well as chosen formulation of enteral feeding. Unless contraindicated, aiming to increase tolerance was started infusion with small volumes (15 ml/h) of a semi-elemental diet, normocaloric, hypolipidic (also hyperproteic, with addition of glutamine). To ensure infusion of the diet, as well as the progressive increase of infusion rates, the patient was monitored for moderate or severe intestinal intolerance. The schedule and infusion rates were respected and diet was not routinely suspended for procedures and diagnostic tests, unless indicated by the medical team. For nutrition therapy success it is essential routine monitoring and extensive interaction between the professionals involved. Nutritional conducts should be reevaluated and improved, seeking complete and specialized care to the critically ill patients. Adherence to new practices is challenging, though instruments such as protocols and algorithms help making information more accessible and comprehensible.

  15. Randomized clinical trials in pediatric critical care: Rarely done but desperately needed.

    Science.gov (United States)

    Randolph, Adrienne G.; Lacroix, Jacques

    2002-04-01

    OBJECTIVE: To review the benefits and challenges of using the randomized, controlled trial (RCT) study design to evaluate preventive and therapeutic interventions in pediatric critical care medicine. CONCLUSIONS: The RCT design is able to control for many sources of potential bias that other types of study designs cannot. The findings of RCTs often contradict the findings of less rigorous study designs. Before performing an RCT, there must exist a state of clinical equipoise, a sufficient number of eligible patients must be available, and the epidemiology of the disorder in question must be well studied. There are many challenges to performing high-quality RCTs. Studying multiple element support strategies in the critically ill patient population is more complex than studying a single drug therapy. High patient and practice variability and hazy diagnostic definitions can dilute the signal-to-noise ratio. Most interventions in critical care are expected to have a modest or small effect. This markedly increases the requisite sample size. There is a paucity of accepted clinically important measurements of the outcome of critical care, making mortality a common outcome to evaluate with a not-so-common incidence. Developmental issues, the inability to give informed consent, and the failure to perform the appropriate pharmacokinetic and safety studies are additional challenges facing pediatric investigators. Despite these limitations, a good RCT remains the best way to prove that an intervention is working or not. Indeed, RCTs are and will remain the "gold standard" method to estimate the efficacy of a therapeutic or prophylactic intervention.

  16. SRTC criticality safety technical review: Nuclear criticality safety evaluation 94-02, uranium solidification facility pencil tank module spacing

    International Nuclear Information System (INIS)

    Rathbun, R.

    1994-01-01

    Review of NMP-NCS-94-0087, ''Nuclear Criticality Safety Evaluation 94-02: Uranium Solidification Facility Pencil Tank Module Spacing (U), April 18, 1994,'' was requested of the SRTC Applied Physics Group. The NCSE is a criticality assessment to show that the USF process module spacing, as given in Non-Conformance Report SHM-0045, remains safe for operation. The NCSE under review concludes that the module spacing as given in Non-Conformance Report SHM-0045 remains in a critically safe configuration for all normal and single credible abnormal conditions. After a thorough review of the NCSE, this reviewer agrees with that conclusion

  17. What is bizarre in bizarre delusions? A critical review

    DEFF Research Database (Denmark)

    Cermolacce, Michel René Joseph; Jensen, Lars Meldgaard Sass; Parnas, J

    2010-01-01

    or incomprehensible. Then, we provide a critical review of contemporary studies on the reliability of BD and their methodological and conceptual limitations. Current approaches have focused intensely on BD's reliability and have defined BD strictly in terms of delusional content--mainly in terms of the physical...... to delusional contents alone and requires taking into account the subjective side of BD (how altered experience manifests itself) as well as the conditions of intersubjective encounter (how BD are expressed to and experienced by the clinician). The notion of "bizarreness" in schizophrenia is not purely...

  18. Developments in solar still desalination systems: A critical review

    KAUST Repository

    Ayoub, George M.

    2012-10-01

    Solar still desalination uses a sustainable and pollution-free source to produce high-quality water. The main limitation is low productivity and this has been the focus of intensive research. A major concern while increasing productivity is to maintain economic feasibility and simplicity. The authors present a critical review of the research work conducted on solar stills development. Studies addressing each parameter of concern are grouped together and results compared. Novelty in design and newly introduced features are presented. Modeling efforts of flow circulation within the still and methods to estimate internal heat transfer coefficients are discussed and future research needs are outlined. © 2012 Taylor & Francis Group, LLC.

  19. Computerized tomography and schizophrenia: critical review of the literature

    International Nuclear Information System (INIS)

    Krakauer Huebner, C.V.; Gattaz, W.F.

    1988-01-01

    A critical review of the literature regarding structural brain abnormalities in Schizophrenia is presented. It is reported that the prevalence and the localization of the abnormalities vary widely among studies. These differences might stem from samples heterogeneity, from the choice of the computer tomographic (CT) parameter to be investigated and from the use of different criteria for defining abnormalities. It seems established that at least one subgroup of Schizophrenia patients shows mild or moderate brain atrophy, in spite of some contradictory findings. (M.A.C.)

  20. Clinical use of lactate monitoring in critically ill patients

    NARCIS (Netherlands)

    J. Bakker (Jan); M.W.N. Nijsten (Maarten); T.C. Jansen (Tim)

    2013-01-01

    textabstractIncreased blood lactate levels (hyperlactataemia) are common in critically ill patients. Although frequently used to diagnose inadequate tissue oxygenation, other processes not related to tissue oxygenation may increase lactate levels. Especially in critically ill patients, increased

  1. A critical review of the neuroimaging literature on synesthesia.

    Directory of Open Access Journals (Sweden)

    Jean-Michel eHupé

    2015-03-01

    Full Text Available Synesthesia refers to additional sensations experienced by some people for specific stimulations, such as the systematic arbitrary association of colors to letters for the most studied type. Here we review all the studies (based mostly on functional and structural MRI that have searched for the neural correlates of this subjective experience, as well as structural differences related to synesthesia. Most differences claimed for synesthetes are unsupported, due mainly to low statistical power, statistical errors and methodological limitations. Our critical review therefore casts some doubts on whether any neural correlate of the synesthetic experience has been established yet. Rather than being a neurological condition (i.e., a structural or functional brain anomaly, synesthesia could be reconsidered as a special kind of childhood memory, whose signature in the brain may be out of reach with present brain imaging techniques.

  2. A Critical Review of Recent Literature on Populism

    Directory of Open Access Journals (Sweden)

    John Abromeit

    2017-12-01

    Full Text Available This is a review article of the following five recent studies on populism: 1 Ruth Wodak’s The Politics of Fear: What Right-Wing Populist Discourses Mean (Sage, 2015; 2 Benjamin Moffitt’s The Global Rise of Populism: Performance, Political Style and Representation (Stanford University Press, 2016; 3 Cas Mudde and Cristóbal Rovira Kaltwasser’s Populism: A Very Short Introduction (Oxford University Press, 2017; 4 Jan-Werner Müller’s What is Populism? (University of Pennsylvania Press, 2016; and 5 John B. Judis’ The Populist Explosion: How the Great Recession Transformed American and European Politics (Columbia Global Reports, 2016. The review argues for a return to early Frankfurt School Critical Theory to address some of the shortcomings of these studies.

  3. Outcome measures for adult critical care: a systematic review.

    Science.gov (United States)

    Hayes, J A; Black, N A; Jenkinson, C; Young, J D; Rowan, K M; Daly, K; Ridley, S

    2000-01-01

    1. To identify generic and disease specific measures of impairment, functional status and health-related quality of life that have been used in adult critical care (intensive and high-dependency care) survivors. 2. To review the validity, reliability and responsiveness of the measures in adult critical care survivors. 3. To consider the implications for future policy and to make recommendations for further methodological research. 4. To review what is currently known of the outcome of adult critical care. Searches of electronic databases (MEDLINE, EMBASE, CINAHL, PsycLIT, The Cochrane Library and SIGLE) from 1970 to August 1998. Manual searches of five journals (1985-98) not indexed in electronic databases and relevant conference proceedings (1993-98). Reference lists of six existing reviews, plus snowballing from reference lists of all relevant articles identified. Randomised trials, non-randomised trials (cohort studies) and case series that included data on outcomes after discharge from adult (16 years and over) critical care. If reported, the following data were extracted from each paper: patient characteristics (age, gender, severity of illness, diagnostic category) number of patients eligible for study, follow-up period, number of deaths before follow-up, number and proportion of survivors included in follow-up method of presentation of outcome data - proportion normal as defined by reference values, or aggregate value (e.g. mean or median), or aggregate values plus an indication of variance (e.g. standard deviation or inter-quartile range). Evidence for three measurement properties was sought for each outcome measure that had been used in at least two studies - their validity, reliability and responsiveness in adult critical care. If the authors did not report these aspects explicitly, an attempt was made to use the data provided to provide these measurement properties. For measures that were used in at least ten studies, information on actual reported

  4. Early enteral nutrition in critically ill patients with hemodynamic instability: an evidence-based review and practical advice.

    Science.gov (United States)

    Yang, Shuofei; Wu, Xingjiang; Yu, Wenkui; Li, Jieshou

    2014-02-01

    Early enteral nutrition (EEN) in critically ill patients is associated with significant benefit as well as elevated risk of complications. Concomitant use of EEN with vasopressors has been associated with nonocclusive bowel necrosis in critically ill patients with hemodynamic instability. The decision when to initiate enteral nutrition in hemodynamically unstable patients that require vasoactive substances remains a clinical dilemma. This review summarizes the effect of EEN and vasoactive agents on gastrointestinal blood flow and perfusion in critically ill patients, based on current evidence. Animal and clinical data involving simultaneous administration of EEN and vasoactive agents for hemodynamic instability are reviewed, and the factors related to the safety and effectiveness of EEN support in this patient population are analyzed. Moreover, practical recommendations are provided. Additional randomized clinical trials are warranted to provide cutting-edge evidence-based guidance about this issue for practitioners of critical care.

  5. Landslide Susceptibility Statistical Methods: A Critical and Systematic Literature Review

    Science.gov (United States)

    Mihir, Monika; Malamud, Bruce; Rossi, Mauro; Reichenbach, Paola; Ardizzone, Francesca

    2014-05-01

    Landslide susceptibility assessment, the subject of this systematic review, is aimed at understanding the spatial probability of slope failures under a set of geomorphological and environmental conditions. It is estimated that about 375 landslides that occur globally each year are fatal, with around 4600 people killed per year. Past studies have brought out the increasing cost of landslide damages which primarily can be attributed to human occupation and increased human activities in the vulnerable environments. Many scientists, to evaluate and reduce landslide risk, have made an effort to efficiently map landslide susceptibility using different statistical methods. In this paper, we do a critical and systematic landslide susceptibility literature review, in terms of the different statistical methods used. For each of a broad set of studies reviewed we note: (i) study geography region and areal extent, (ii) landslide types, (iii) inventory type and temporal period covered, (iv) mapping technique (v) thematic variables used (vi) statistical models, (vii) assessment of model skill, (viii) uncertainty assessment methods, (ix) validation methods. We then pulled out broad trends within our review of landslide susceptibility, particularly regarding the statistical methods. We found that the most common statistical methods used in the study of landslide susceptibility include logistic regression, artificial neural network, discriminant analysis and weight of evidence. Although most of the studies we reviewed assessed the model skill, very few assessed model uncertainty. In terms of geographic extent, the largest number of landslide susceptibility zonations were in Turkey, Korea, Spain, Italy and Malaysia. However, there are also many landslides and fatalities in other localities, particularly India, China, Philippines, Nepal and Indonesia, Guatemala, and Pakistan, where there are much fewer landslide susceptibility studies available in the peer-review literature. This

  6. HYPNOSIS FOR ACUTE PROCEDURAL PAIN: A Critical Review

    Science.gov (United States)

    Kendrick, Cassie; Sliwinski, Jim; Yu, Yimin; Johnson, Aimee; Fisher, William; Kekecs, Zoltán; Elkins, Gary

    2015-01-01

    Clinical evidence for the effectiveness of hypnosis in the treatment of acute, procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions. PMID:26599994

  7. Hypnosis for Acute Procedural Pain: A Critical Review.

    Science.gov (United States)

    Kendrick, Cassie; Sliwinski, Jim; Yu, Yimin; Johnson, Aimee; Fisher, William; Kekecs, Zoltán; Elkins, Gary

    2016-01-01

    Clinical evidence for the effectiveness of hypnosis in the treatment of acute procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions.

  8. [Team approaches to critical bleeding (massive bleeding and transfusion) - chairmen's introductory remarks. Questionnaire survey on current status of hospital clinical laboratories evaluating critical hemorrhage].

    Science.gov (United States)

    Kino, Shuichi; Suwabe, Akira

    2014-12-01

    In 2007, "the Guidelines for Actions against Intraoperative Critical Hemorrhage" were established by the Japanese Society of Anaesthesiologists and the Japanese Society of Blood transfusion and Cell Therapy. The documentation of in-hospital procedures for critical hemorrhage, especially about how to select RBC units, has widely standardized hospital practice. Patients with intraoperative critical hemorrhage sometimes suffer from massive blood loss. In this situation, some patients develop coagulopathy. To treat them, we need to evaluate their coagulation status based on laboratory test results. So, we performed a nationwide questionnaire survey on the current status of hospital clinical laboratories evaluating critical hemorrhage. From the results of this survey, it was recommended that central hospital laboratories should try to reduce the turn-around time required to test for coagulation parameters as much as possible for appropriate substitution therapy. (Review).

  9. A critical review of the nursing shortage in Malaysia.

    Science.gov (United States)

    Barnett, T; Namasivayam, P; Narudin, D A A

    2010-03-01

    This paper describes and critically reviews steps taken to address the nursing workforce shortage in Malaysia. To address the shortage and to build health care capacity, Malaysia has more than doubled its nursing workforce over the past decade, primarily through an increase in the domestic supply of new graduates. Government reports, policy documents and ministerial statements were sourced from the Ministry of Health Malaysia website and reviewed and analysed in the context of the scholarly literature published about the health care workforce in Malaysia and more generally about the global nursing shortage. An escalation in student numbers and the unprecedented number of new graduates entering the workforce has been associated with other impacts that have been responded to symptomatically rather than through workplace reform. Whilst growing the domestic supply of nurses is a critical key strategy to address workforce shortages, steps should also be taken to address structural and other problems of the workplace to support both new graduates and the retention of more experienced staff. Nursing shortages should not be tackled by increasing the supply of new graduates alone. The creation of a safe and supportive work environment is important to the long-term success of current measures taken to grow the workforce and retain nurses within the Malaysian health care system.

  10. Learning from critical case reviews: emergent themes and their impact on practice.

    Science.gov (United States)

    Crofts, Linda

    2006-12-01

    This paper describes the process of conducting critical case reviews as part of a leadership programme for critical care. Forty-five cases were reviewed over 2 years in five different hospitals and permission was sought from local research ethics committees and research and development committees for the discussions to be treated as research data. Typically the cases presented were patients with complex needs whose trajectory of care had not gone smoothly. Key themes to emerge from the case reviews were: The case reviews themselves were: Communication failures between professional groups, between professional themselves, between staff and families, between wards and departments and between different hospitals. Documentation was also often less than satisfactory. Teams often had problems in working together as a team and different professionals often had different expectations of other members of the team. Individual action may compensate for weaknesses in formal clinical risk system. The case reviews themselves were showcases of the difficulties the health service faces every day and the challenges of communicating effectively. The case reviews provided an effective medium to both resolve those difficulties and model a means through which teams could effectively manage and communicate patient care issues. Furthermore their strength as a learning tool was attributed to team learning as a powerful catalyst for change.

  11. Antidiabetic plant-derived nutraceuticals: a critical review.

    Science.gov (United States)

    Naveen, Jayapal; Baskaran, Vallikannan

    2018-06-01

    Diabetes mellitus (DM) is one of the major health problems in the world, especially amongst the urban population. Chemically synthesized drugs used to decrease the ill effects of DM and its secondary complications cause adverse side effects, viz., weight gain, gastrointestinal disturbances, and heart failure. Currently, various other approaches, viz., diet control, physical exercise and use of antidiabetic plant-derived molecules/foods are advocated to manage DM, as they are economical with fewer or no side effects. This review mainly focuses on antidiabetic plants, chemically characterized plant molecules and plant-based foods in the treatment of DM. Very little science-based evidence is available on the mechanism of action of plant-derived food molecules on the DM targets. Critical DM targets include α-amylase, α-glucosidase, DPP-IV, aldose reductase, PPAR-γ, AMP kinase and GLUT4. In-depth studies carried out on a few of those targets with specific mechanisms of action are addressed in this review. This review may help future researchers in identifying a right plant molecule to treat DM or to develop food formulations for DM management.

  12. Physical Exercise for Treatment of Mood Disorders: A Critical Review

    Science.gov (United States)

    Hearing, CM; Chang, WC; Szuhany, KL; Deckersbach, T; Nierenberg, AA; Sylvia, LG

    2016-01-01

    Purpose of the review The purpose of this review is to critically assess the evidence for exercise as an adjunct intervention for major depressive disorder and bipolar disorder, chronic conditions characterized by frequent comorbid conditions as well as interepisodic symptoms with poor quality of life and impaired functioning. Individuals with these mood disorders are at higher risk of cardiovascular disease and premature death in part because of increased rates of obesity, inactivity, and diabetes mellitus compared to the general population. Exercise may not only mitigate the increased risk of cardiovascular disease, but could also potentially improve the long term outcomes of mood disorders. Recent findings We conducted a literature review on the impact of exercise on mood disorders and associated comorbid conditions as well as possible biological mechanisms. We found that exercise impacts both the physical health parameters of mood disorders as well as mental health outcomes. Exercise also positively impacts conditions frequently comorbid with mood disorders (i.e. anxiety, pain, and insomnia). There are multiple candidate biomarkers for exercise, with brain-derived neurotrophic factor and oxidative stress as two main promising components of exercise’s anti-depressant effect. Summary Exercise appears to be a promising adjunct treatment for mood disorders. We conclude with recommendations for future research of exercise as an adjunct intervention for mood disorders. PMID:28503402

  13. Sustainable development based energy policy making frameworks, a critical review

    International Nuclear Information System (INIS)

    Meyar-Naimi, H.; Vaez-Zadeh, S.

    2012-01-01

    This paper, in the first step, presents an overview of the origination and formulation of sustainable development (SD) concept and the related policy making frameworks. The frameworks include Pressure–State–Response (PSR), Driving Force–State–Response (DSR), Driving Force–Pressure–State–Impact–Response (DPSIR), Driving Force–Pressure–State–Effect–Action (DPSEA) and Driving Force-Pressure-State-Exposure-Effect-Action (DPSEEA). In this regard, 40 case studies using the reviewed frameworks reported during 1994–2011 are surveyed. Then, their application area and application intensity are investigated. It is concluded that PSR, and DPSEA and DPSEEA have the higher and lower application intensities, respectively. Moreover, using Analytical Hierarchy Process (AHP) with a set of criteria, it is shown that PSR and DPSIR have the highest and lowest priorities. Finally, the shortcomings of frameworks applications are discussed. The paper is helpful in selecting appropriate policy making frameworks and presents some hints for future research in the area for developing more comprehensive models especially for sustainable electric energy policy making. - Highlights: ► The origination and formulation of sustainable development (SD) concept is reviewed. ► SD based frameworks (PSR, DSR, DPSIR, DPSEA and DPSEEA) are also reviewed. ► Then, the frameworks application area and intensity in recent years are investigated. ► Finally, the SD concept and the SD based frameworks are criticized. ► It will be helpful for developing more comprehensive energy policy making models.

  14. Clinical review: Management of difficult airways

    Science.gov (United States)

    Langeron, Olivier; Amour, Julien; Vivien, Benoît; Aubrun, Frédéric

    2006-01-01

    Difficulties or failure in airway management are still important factors in morbidity and mortality related to anesthesia and intensive care. A patent and secure airway is essential to manage anesthetized or critically ill patients. Oxygenation maintenance during tracheal intubation is the cornerstone of difficult airway management and is always emphasized in guidelines. The occurrence of respiratory adverse events has decreased in claims for injuries due to inadequate airway management mainly at induction of anesthesia. Nevertheless, claim reports emphasize that airway emergencies, tracheal extubation and/or recovery of anesthesia phases are still associated with death or brain damage, indicating that additional educational support and management strategies to improve patient safety are required. The present brief review analyses specific problems of airway management related to difficult tracheal intubation and to difficult mask ventilation prediction. The review will focus on basic airway management including preoxygenation, and on some oxygenation and tracheal intubation techniques that may be performed to solve a difficult airway. PMID:17184555

  15. Clinical review: management of difficult airways.

    Science.gov (United States)

    Langeron, Olivier; Amour, Julien; Vivien, Benoît; Aubrun, Frédéric

    2006-01-01

    Difficulties or failure in airway management are still important factors in morbidity and mortality related to anesthesia and intensive care. A patent and secure airway is essential to manage anesthetized or critically ill patients. Oxygenation maintenance during tracheal intubation is the cornerstone of difficult airway management and is always emphasized in guidelines. The occurrence of respiratory adverse events has decreased in claims for injuries due to inadequate airway management mainly at induction of anesthesia. Nevertheless, claim reports emphasize that airway emergencies, tracheal extubation and/or recovery of anesthesia phases are still associated with death or brain damage, indicating that additional educational support and management strategies to improve patient safety are required. The present brief review analyses specific problems of airway management related to difficult tracheal intubation and to difficult mask ventilation prediction. The review will focus on basic airway management including preoxygenation, and on some oxygenation and tracheal intubation techniques that may be performed to solve a difficult airway.

  16. Critical Review of Dual Diagnosis Training for Mental Health Professionals

    DEFF Research Database (Denmark)

    Pinderup, Pernille; Thylstrup, Birgitte; Hesse, Morten

    2016-01-01

    To review evidence on the effects of training programs in dual diagnosis treatment for mental health professionals. Three databases were searched. Included studies were evaluated by an adapted version of Kirkpatrick’s Training Evaluation Model, which evaluates participant perception of training, ...... of dual diagnosis training programs for mental health professionals should involve control groups, validated measures, follow-ups, and patient outcomes.......To review evidence on the effects of training programs in dual diagnosis treatment for mental health professionals. Three databases were searched. Included studies were evaluated by an adapted version of Kirkpatrick’s Training Evaluation Model, which evaluates participant perception of training...... level showed mixed results. Training mental health professionals in dual diagnosis treatment may have a positive effect on professional competencies and clinical practice. Any conclusion regarding the overall training effect is premature due to limitations in study designs. Future studies on the effects...

  17. A critical evaluation of the validity of episodic future thinking: A clinical neuropsychology perspective.

    Science.gov (United States)

    Ward, Amanda M

    2016-11-01

    Episodic future thinking is defined as the ability to mentally simulate a future event. Although episodic future thinking has been studied extensively in neuroscience, this construct has not been explored in depth from the perspective of clinical neuropsychology. The aim of this critical narrative review is to assess the validity and clinical implications of episodic future thinking. A systematic review of episodic future thinking literature was conducted. PubMed and PsycInfo were searched through July 2015 for review and empirical articles with the following search terms: "episodic future thinking," "future mental simulation," "imagining the future," "imagining new experiences," "future mental time travel," "future autobiographical experience," and "prospection." The review discusses evidence that episodic future thinking is important for adaptive functioning, which has implications for neurological populations. To determine the validity of episodic future thinking, the construct is evaluated with respect to related constructs, such as imagination, episodic memory, autobiographical memory, prospective memory, narrative construction, and working memory. Although it has been minimally investigated, there is evidence of convergent and discriminant validity for episodic future thinking. Research has not addressed the incremental validity of episodic future thinking. Practical considerations of episodic future thinking tasks and related constructs in a clinical neuropsychological setting are considered. The utility of episodic future thinking is currently unknown due to the lack of research investigating the validity of episodic future thinking. Future work is discussed, which could determine whether episodic future thinking is an important missing piece in standard clinical neuropsychological assessment. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  18. A critical appraisal of clinical practice guidelines for the treatment of lower-limb osteoarthritis

    Science.gov (United States)

    Pencharz, James N; Grigoriadis, Elizabeth; Jansz, Gwenderlyn F; Bombardier, Claire

    2002-01-01

    Clinical practice guidelines are important tools to assist clinical decision-making. Recently, several guidelines addressing the management of osteoarthritis (OA) have been published. Clinicians treating patients with OA must ensure that these guidelines are developed with consistency and methodological rigour. We undertook a qualitative summary and critical appraisal of six medical treatment guidelines for the management of lower-limb OA published in the medical literature within the past 5 years. A review of these six guidelines revealed that each possesses strengths and weakness. While most described the scope and intended patient populations, the guidelines varied considerably in the rigour of their development, coverage of implementation issues, and disclosure of conflicts of interest. PMID:11879536

  19. Bioethical conflicts of gene therapy: a brief critical review

    Directory of Open Access Journals (Sweden)

    José Ednésio da Cruz Freire

    2014-12-01

    Full Text Available Methods and techniques employed in gene therapy are reviewed in parallel with pertinent ethical conflicts. Clinical interventions based on gene therapy techniques preferentially use vectors for the transportation of therapeutic genes, however little is known about the potential risks and damages to the patient. Thus, attending carefully to the clinical complications arising as well as to security is essential. Despite the scientific and technological advances, there are still many uncertainties about the side effects of gene therapy. Moreover, there is a need, above all, to understand the principles of bioethics as both science and ethics, in accordance with its socioecological responsibility, in order to prioritize the health and welfare of man and nature, using properly natural resources and technology. Therefore, it is hard to determine objective results and to which extent the insertion of genes can affect the organism, as well as the ethical implication

  20. Review of the Latest Percutaneous Devices in Critical Limb Ischemia.

    Science.gov (United States)

    Haghighat, Leila; Altin, Sophia Elissa; Attaran, Robert R; Mena-Hurtado, Carlos; Regan, Christopher J

    2018-04-14

    Critical limb ischemia (CLI) is a terminal stage of peripheral arterial disease that, in the absence of intervention, may lead to lower extremity amputation or death. Endovascular interventions have become a first-line approach to the management of CLI and have advanced considerably within the past decade. This review summarizes the types of percutaneous devices and the techniques that are available for the management of CLI and the data supporting their use. These include devices that establish and maintain vessel patency, including percutaneous transluminal angioplasty, drug-coated balloons, bare metal stents, drug-eluting stents, bioresorbable vascular scaffolds, and atherectomy; devices that provide protection from embolization; and, cell-based therapies. Additionally, ongoing trials with important implications for the field are discussed.

  1. Review of the Latest Percutaneous Devices in Critical Limb Ischemia

    Directory of Open Access Journals (Sweden)

    Leila Haghighat

    2018-04-01

    Full Text Available Critical limb ischemia (CLI is a terminal stage of peripheral arterial disease that, in the absence of intervention, may lead to lower extremity amputation or death. Endovascular interventions have become a first-line approach to the management of CLI and have advanced considerably within the past decade. This review summarizes the types of percutaneous devices and the techniques that are available for the management of CLI and the data supporting their use. These include devices that establish and maintain vessel patency, including percutaneous transluminal angioplasty, drug-coated balloons, bare metal stents, drug-eluting stents, bioresorbable vascular scaffolds, and atherectomy; devices that provide protection from embolization; and, cell-based therapies. Additionally, ongoing trials with important implications for the field are discussed.

  2. The critical incident technique in dental research: A review

    Directory of Open Access Journals (Sweden)

    Binu Santha

    2016-01-01

    Full Text Available Research is a scientific quest to find answers to certain questions. It makes us think with curiosity and wonderment about how to make something better. Research contributes in a major way to the development and maintenance of health and health care systems. Qualitative research is concerned with qualitative phenomena and includes subjective assessment of attitudes, opinions, and behavior. It is especially important in the behavioral sciences where the aim is to discover the underlying motives of human behavior. The critical incident technique (CIT is a well-established qualitative research tool used in many areas of health sciences including nursing, medicine, dentistry, and their respective education systems. This technique is described as consisting of “a set of procedures for collecting direct observations of human behavior in such a way as to facilitate their potential usefulness in solving practical problems.” This review gives a gist of CIT and its application in different aspects of dental research.

  3. A review of critical care nursing and disease outbreak preparedness.

    Science.gov (United States)

    Makamure, Miranda; Makamure, Muriel; Mendiola, Williane; Renteria, Daisy; Repp, Melissa; Willden, Azshwee

    2013-01-01

    The impact of disease outbreaks continues to increase globally. As frontline staff, critical care nurses (CCNs) are more likely to be confronted with the need to care for affected patients. With different pathological diseases emerging, CCNs play an integral role in disease outbreaks. The advanced skill set of CCNs is pivotal in the management and care of patients during an outbreak. Lack of planning and preparation before disease outbreaks leads to detrimental patient outcomes. Panic, chaos, and fear for personal safety cause stress and anxiety for unprepared nurses. However, this problem can be resolved. Comprehensive planning, training, and education can better prepare intensive care unit nurses for disease outbreaks. This article reviews some of the current literature on intensive care unit nurse preparedness for disease outbreaks in the United States. This article also offers strategies that may be used to better prepare CCNs for disease outbreaks.

  4. SERVICE MARKETING MIX OF INDIAN HOSPITALS: A CRITICAL REVIEW

    Directory of Open Access Journals (Sweden)

    Dharmesh, MOTWANI

    2014-07-01

    Full Text Available Sreenivas, Srinivasarao and Srinivasa (2013 said that “The health care market has become consumer centered and expecting high quality care at a reasonable price. The mushroomed development of corporate hospitals in India, competition is also bringing massive changes in industry structure. In this context, hospital services’ marketing is slowly and surely coming of age and is being woven into the fabric of hospitals planning and public relations programmes.” The essence of any marketing activity is marketing mix, and the central theme of the present paper revolves around the contemporary service marketing mix offered by Indian hospitals. In this paper author has critically reviewed 51 papers to describe elements of hospital service marketing mix; product, price, place, promotion, people, process and physical evidence.

  5. Stable isotope analysis in primatology: a critical review.

    Science.gov (United States)

    Sandberg, Paul A; Loudon, James E; Sponheimer, Matt

    2012-11-01

    Stable isotope analysis has become an important tool in ecology over the last 25 years. A wealth of ecological information is stored in animal tissues in the relative abundances of the stable isotopes of several elements, particularly carbon and nitrogen, because these isotopes navigate through ecological processes in predictable ways. Stable carbon and nitrogen isotopes have been measured in most primate taxonomic groups and have yielded information about dietary content, dietary variability, and habitat use. Stable isotopes have recently proven useful for addressing more fine-grained questions about niche dynamics and anthropogenic effects on feeding ecology. Here, we discuss stable carbon and nitrogen isotope systematics and critically review the published stable carbon and nitrogen isotope data for modern primates with a focus on the problems and prospects for future stable isotope applications in primatology. © 2012 Wiley Periodicals, Inc.

  6. A Critical Review of Motivation in Second Language Acquisition Research

    Institute of Scientific and Technical Information of China (English)

    欧阳晓娟

    2009-01-01

    As one of the major factors affecting second language learners' success to their acquisition achievement, motivation has been examined in a wide variety of research papers. It is thus instructive to conduct a critical review of both theoretical and empirical developments in SLA research from over the last few decades. This approach will provide a broad, and integrated perspective onto the current understanding of the complex topic of motivation. Such an undertaking is valuable for teachers, and researchers alike, in developing useful teaching methods, and finding future avenues of SLA motivation research respectively.The following paper provides an overview of recent theoretical and empirical findings, examines some of the problems and contradictions found/11 current SLA research, and gives an initial departure point for future directions of research in the area of motivation. The paper concludes with a discussion of some of the implications for teachers, and possible classroom strategies that axe drawn from the current body of motivation research.

  7. Electron beam processing of fresh produce - A critical review

    Science.gov (United States)

    Pillai, Suresh D.; Shayanfar, Shima

    2018-02-01

    To meet the increasing global demand for fresh produce, robust processing methods that ensures both the safety and quality of fresh produce are needed. Since fresh produce cannot withstand thermal processing conditions, most of common safety interventions used in other foods are ineffective. Electron beam (eBeam) is a non-thermal technology that can be used to extend the shelf life and ensure the microbiological safety of fresh produce. There have been studies documenting the application of eBeam to ensure both safety and quality in fresh produce, however, there are still unexplored areas that still need further research. This is a critical review on the current literature on the application of eBeam technology for fresh produce.

  8. Developing and understanding biofluid vibrational spectroscopy: a critical review.

    Science.gov (United States)

    Baker, Matthew J; Hussain, Shawn R; Lovergne, Lila; Untereiner, Valérie; Hughes, Caryn; Lukaszewski, Roman A; Thiéfin, Gérard; Sockalingum, Ganesh D

    2016-04-07

    Vibrational spectroscopy can provide rapid, label-free, and objective analysis for the clinical domain. Spectroscopic analysis of biofluids such as blood components (e.g. serum and plasma) and others in the proximity of the diseased tissue or cell (e.g. bile, urine, and sputum) offers non-invasive diagnostic/monitoring possibilities for future healthcare that are capable of rapid diagnosis of diseases via specific spectral markers or signatures. Biofluids offer an ideal diagnostic medium due to their ease and low cost of collection and daily use in clinical biology. Due to the low risk and invasiveness of their collection they are widely welcomed by patients as a diagnostic medium. This review underscores recent research within the field of biofluid spectroscopy and its use in myriad pathologies such as cancer and infectious diseases. It highlights current progresses, advents, and pitfalls within the field and discusses future spectroscopic clinical potentials for diagnostics. The requirements and issues surrounding clinical translation are also considered.

  9. Research Review: A Critical Review of Studies on the Developmental Trajectories of Antisocial Behavior in Females

    Science.gov (United States)

    Fontaine, Nathalie; Carbonneau, Rene; Vitaro, Frank; Barker, Edward D.; Tremblay, Richard E.

    2009-01-01

    Background: Knowledge on the onset and the development of antisocial behavior in females is limited, because most of the research in this domain is based on males. Methods: We critically reviewed 46 empirical studies that examined developmental trajectories of antisocial behavior in females, notably to help determine whether or not an…

  10. A Critical Review on the Concept of Social Technology

    Directory of Open Access Journals (Sweden)

    Bettina Leibetseder

    2013-08-01

    Full Text Available Purpose—A critical analysis of the term social technology from a social science point of view.Design/Methodology/Approach—Review of the term “social technology” from a social science point of perspective in connection to the study of governmentality and power in a Foucauldian way.Findings—The article covers the perspective that social technology provides social science knowledge for a purpose. Such a notion allows an in depth debate about the meaning of social order in modern societies. Establishing distinctive techniques now forms the basis of the modern state and governance. Social technology forms the basis of governmental decisions; it allows for a use of social theories and methods for a purpose in politics and introduces a specific conception of power between the individual and public powers. Therefore, it alters government in three ways: It provides expert power to define solutions for social problems based on social science knowledge. It transforms government. Social technology exemplifies a support system for an ordered method of the way of government, it allows for the conduct of others and self based on scientific expertise. It can define new areas of problems in need of a change of government.Research limitations/implications—Consequently, social technology requests a critical analysis using a governmental approach. Such an approach focuses on problems on the governed subject and how governing works and why it has evolved in that way towards the subject and what kind of ideas and thinking lies within the discourse.Research type—general review.

  11. Critical reading and critical thinking--study design and methodology: a personal approach on how to read the clinical literature.

    Science.gov (United States)

    Lipman, Timothy O

    2013-04-01

    The volume of medical literature grows exponentially. Yet we are faced with the necessity to make clinical decisions based on the availability and quality of scientific information. The general strength (reliability, robustness) of any interpretation that guides us in clinical decision making is dependent on how information was obtained. All information and medical studies and, consequently, all conclusions are not created equal. It is incumbent upon us to be able to assess the quality of the information that guides us in the care of our patients. Being able to assess medical literature critically requires use of critical reading and critical thinking skills. To achieve these skills, to be able to analyze medical literature critically, takes a combination of education and practice, practice, and more practice.

  12. Plasma-Lyte 148: A clinical review

    Science.gov (United States)

    Weinberg, Laurence; Collins, Neil; Van Mourik, Kiara; Tan, Chong; Bellomo, Rinaldo

    2016-01-01

    AIM To outline the physiochemical properties and specific clinical uses of Plasma-Lyte 148 as choice of solution for fluid intervention in critical illness, surgery and perioperative medicine. METHODS We performed an electronic literature search from Medline and PubMed (via Ovid), anesthesia and pharmacology textbooks, and online sources including studies that compared Plasma-Lyte 148 to other crystalloid solutions. The following keywords were used: “surgery”, “anaesthesia”, “anesthesia”, “anesthesiology”, “anaesthesiology”, “fluids”, “fluid therapy”, “crystalloid”, “saline”, “plasma-Lyte”, “plasmalyte”, “hartmann’s”, “ringers” “acetate”, “gluconate”, “malate”, “lactate”. All relevant articles were accessed in full. We summarized the data and reported the data in tables and text. RESULTS We retrieved 104 articles relevant to the choice of Plasma-Lyte 148 for fluid intervention in critical illness, surgery and perioperative medicine. We analyzed the data and reported the results in tables and text. CONCLUSION Plasma-Lyte 148 is an isotonic, buffered intravenous crystalloid solution with a physiochemical composition that closely reflects human plasma. Emerging data supports the use of buffered crystalloid solutions in preference to saline in improving physicochemical outcomes. Further large randomized controlled trials assessing the comparative effectiveness of Plasma-Lyte 148 and other crystalloid solutions in measuring clinically important outcomes such as morbidity and mortality are needed. PMID:27896148

  13. Feasibility and reliability of frailty assessment in the critically ill: a systematic review.

    Science.gov (United States)

    Pugh, Richard J; Ellison, Amy; Pye, Kate; Subbe, Christian P; Thorpe, Chris M; Lone, Nazir I; Clegg, Andrew

    2018-02-26

    For healthcare systems, an ageing population poses challenges in the delivery of equitable and effective care. Frailty assessment has the potential to improve care in the intensive care setting, but applying assessment tools in critical illness may be problematic. The aim of this systematic review was to evaluate evidence for the feasibility and reliability of frailty assessment in critical care. Our primary search was conducted in Medline, Medline In-process, EMBASE, CINAHL, PsycINFO, AMED, Cochrane Database of Systematic Reviews, and Web of Science (January 2001 to October 2017). We included observational studies reporting data on feasibility and reliability of frailty assessment in the critical care setting in patients 16 years and older. Feasibility was assessed in terms of timing of evaluation, the background, training and expertise required for assessors, and reliance upon proxy input. Reliability was assessed in terms of inter-rater reliability. Data from 11 study publications are included, representing 8 study cohorts and 7761 patients. Proxy involvement in frailty assessment ranged from 58 to 100%. Feasibility data were not well-reported overall, but the exclusion rate due to lack of proxy availability ranged from 0 to 45%, the highest rate observed where family involvement was mandatory and the assessment tool relatively complex (frailty index, FI). Conventional elements of frailty phenotype (FP) assessment required modification prior to use in two studies. Clinical staff tended to use a simple judgement-based tool, the clinical frailty scale (CFS). Inter-rater reliability was reported in one study using the CFS and although a good level of agreement was observed between clinician assessments, this was a small and single-centre study. Though of unproven reliability in the critically ill, CFS was the tool used most widely by critical care clinical staff. Conventional FP assessment required modification for general application in critical care, and an FI

  14. A critical review on the scaling theory of dispersion

    Science.gov (United States)

    Zech, Alraune; Mai, Juliane; Attinger, Sabine; Dietrich, Peter; Teutsch, Georg; Fiori, Aldo; Rubin, Yoram

    2014-05-01

    The phenomenon of dispersive mixing of solutes in aquifers is subject of research since decades. The characterization of dispersivity at a particular field site is a prerequisite to predict the movement and spreading of a contaminant plume. Experimental investigations have shown, that field-scale dispersivities vary over orders of magnitude, which apparently depends on the scale of measurement. Gelhar et al. [1992] and Schulze-Makuch [2005] have reviewed a large number of transport experiments reported in the literature. Based on that data Schulze-Makuch [2005] performed a trend analysis of longitudinal dispersivity, fostering the empirical relationship of a power law between dispersivities and the scale of measurement without an upper bound. The goal of our study is to critically revisit not only the data used for the trend analysis but the power-law scale dependence of longitudinal dispersivity (e.g. Neuman [1990], Xu and Eckstein [1995]). Our particular focus is on the reported dispersivities of large amount (larger than 100m) and large measurement scales (in the order of kilometers). We aim to evaluate current theories of transport against a critical "mass" of field experiments and to bracket the conditions of their applicability. We further aim to evaluate the adequacy of the field sampling techniques that were employed from the perspective of more than 30 years development in modeling and field characterization. Given the tremendous progress in field data acquisition techniques and new insights gained, it is reasonable to expect that interpretations of past experiments may be flawed due to the limitations or inadequacy of field sampling techniques. Gelhar, L.W., C. Welty, and K.R. Rehfeldt, 1992, A critical review of data on field-scale dispersion in aquifers, Water Resources Research 28, No. 7: 1955-1974. Schulze-Makuch, D., 2005, Longitudinal dispersivity data and implications for scaling behavior, Ground Water, Vol. 43, No. 3, 443-456. Neuman, S.P., 1990

  15. Challenges of assessing critical thinking and clinical judgment in nurse practitioner students.

    Science.gov (United States)

    Gorton, Karen L; Hayes, Janice

    2014-03-01

    The purpose of this study was to determine whether there was a relationship between critical thinking skills and clinical judgment in nurse practitioner students. The study used a convenience, nonprobability sampling technique, engaging participants from across the United States. Correlational analysis demonstrated no statistically significant relationship between critical thinking skills and examination-style questions, critical thinking skills and scores on the evaluation and reevaluation of consequences subscale of the Clinical Decision Making in Nursing Scale, and critical thinking skills and the preceptor evaluation tool. The study found no statistically significant relationships between critical thinking skills and clinical judgment. Educators and practitioners could consider further research in these areas to gain insight into how critical thinking is and could be measured, to gain insight into the clinical decision making skills of nurse practitioner students, and to gain insight into the development and measurement of critical thinking skills in advanced practice educational programs. Copyright 2014, SLACK Incorporated.

  16. Critical care clinician perceptions of factors leading to Medical Emergency Team review.

    Science.gov (United States)

    Currey, Judy; Allen, Josh; Jones, Daryl

    2018-03-01

    The introduction of rapid response systems has reduced the incidence of in-hospital cardiac arrest; however, many instances of clinical deterioration are unrecognised. Afferent limb failure is common and may be associated with unplanned intensive care admissions, heightened mortality and prolonged length of stay. Patients reviewed by a Medical Emergency Team are inherently vulnerable with a high in-hospital mortality. To explore perceptions of intensive care unit (ICU) staff who attend deteriorating acute care ward patients regarding current problems, barriers and potential solutions to recognising and responding to clinical deterioration that culminates in a Medical Emergency Team review. A descriptive exploratory design was used. Registered intensive care nurses and medical staff (N=207) were recruited during a professional conference using purposive sampling for experience in attending deteriorating patients. Written response surveys were used to address the study aim. Data were analysed using content analysis. Four major themes were identified: Governance, Teamwork, Clinical Care Delivery and End of Life Care. Participants perceived there was a lack of sufficient and senior staff with the required theoretical knowledge; and inadequate assessment and critical thinking skills for anticipating, recognising and responding to clinical deterioration. Senior doctors were perceived to inappropriately manage End of Life Care issues and displayed Teamwork behaviours rendering ward clinicians feeling fearful and intimidated. A lack of System and Clinical Governance hindered identification of clinical deterioration. To improve patient safety related to recognising and responding to clinical deterioration, suboptimal care due to professionals' knowledge, skills and behaviours need addressing, along with End of Life Care and Governance. Copyright © 2017 Australian College of Critical Care Nurses Ltd. All rights reserved.

  17. Exosomes in HIV infection: A review and critical look.

    Science.gov (United States)

    Ellwanger, Joel Henrique; Veit, Tiago Degani; Chies, José Artur Bogo

    2017-09-01

    Exosomes are nanovesicles released into the extracellular medium by different cell types. These vesicles carry a variety of protein and RNA cargos, and have a central role in cellular signaling and regulation. A PubMed search using the term "exosomes" finds 67 articles published in 2006. Ten years later, the same search returns approximately 1200 results for 2016 alone. The growing interest in exosomes within the scientific community reflects the different roles exerted by extracellular vesicles in biological systems and diseases. However, the increase in academic production addressing the biological function of exosomes causes much confusion, especially where the focus is on the role of exosomes in pathological situations. In this review, we critically interpret the current state of the research on exosomes and HIV infection. It is plausible to assume that exosomes influence the pathogenesis of HIV infection through their biological cargo (primarily membrane proteins and microRNAs). On the other hand, evidence for a usurpation of the exosomal budding and trafficking machinery by HIV during infection is limited, although such a mechanism cannot be ruled out. This review also discusses several biological aspects of exosomal function in the immune system. Finally, the limitations of current exosome research are pointed out. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Xerostomia related to HIV infection /AIDS: a critical review

    Directory of Open Access Journals (Sweden)

    Adriana Maria Fuzer Grael TINÓS

    Full Text Available Introduction: The presence of oral manifestations in HIV positive individuals is quite common. Xerostomia appears as one of the most frequent problems and may lead to a reduction in the quality of life of this population. Objective: This study was a critical review of the relationship between xerostomia and HIV infection, to attract the attention of dentists on the importance of dental care to these patients. Material and method: We included articles published between 2000 and 2009, indexed in PUBMED database. The descriptors used were "HIV" and "xerostomia", the exclusion criteria adopted were: the absence of these descriptors associated, non-location of the full-text, articles based on case studies or case series and the absence of the abstract in the database. Result: Based on studies in the review, it can be said that the xerostomia is a common manifestation of HIV infection, predisposing the patient to several other oral problems. Among the risk factors for its occurrence it was reported: low counts of CD4+ T cells, high plasma viral load, the use of some medications and antiretroviral therapy. Conclusion: The HIV/AIDS can change the salivary glands, and were considered important risk factors for the occurrence of xerostomia the presence of didanosine and the drug class which corresponds to protease inhibitors in antiretroviral therapy.

  19. Strategies to control odours in livestock facilities: a critical review

    Directory of Open Access Journals (Sweden)

    Y. Ubeda

    2013-11-01

    Full Text Available Odours generated in livestock buildings constitute one of the most relevant air quality issues of intensive livestock production. Reducing nuisance episodes related to odour exposure is therefore essential for a sustainable livestock production. In this study, the state-of-the-art on odour mitigation techniques in livestock housing is critically reviewed. Scientific advances in the last decade are revised and research needs are also identified. The complex nature of livestock odours is firstly reviewed and examined. Then, the most relevant odour control strategies are analyzed in terms of present knowledge and future needs. The strategies considered are: nutritional strategies, manure additives, building design, air filtration, manure covers, manure treatment systems and windbreaks. Finally, future research needs and priorities when establishing mitigation techniques are identified. Despite important recent advances, there are still some challenges for scientists, producers and regulators, particularly related to field evaluation of odours. Therefore, to control livestock odours effectively, using standardized field assessment techniques will be required. Also, investigating measurement and model errors may be useful to better understand the limitations of the current methods, as well as to identify research priorities.

  20. Selenium speciation from food source to metabolites: a critical review

    Energy Technology Data Exchange (ETDEWEB)

    Dumont, Emmie; Vanhaecke, Frank; Cornelis, Rita [Ghent University, Department of Analytical Chemistry, Ghent (Belgium)

    2006-08-15

    Especially in the last decade, a vast number of papers on Se and its role in health issues have been published. This review gives a brief, critical overview of the main analytical findings reported in these papers. Of particular interest is the Se content in different food sources worldwide and the extent to which their consumption is reflected in the Se content of human tissues and body fluids. Several food sources, both natural (Brazil nuts, garlic, Brassica juncea) and Se-enriched (yeast-based supplements), are discussed as to origin, characteristics, Se metabolism and impact of their consumption on the human body. The continuous development of new and improvement of existing analytical techniques has provided different powerful tools to unravel the Se species and their function. An up-to-date literature study on Se speciation analysis is given, illustrating how analytical chemistry in its different facets aids in the identification of Se compounds and provides insight into the complete metabolic pathway of Se throughout the human body. This review includes a detailed image of the current state-of-the-art of Se speciation analysis in these food sources and in human tissues and body fluids. (orig.)

  1. Motivation Measures in Sport: A Critical Review and Bibliometric Analysis.

    Science.gov (United States)

    Clancy, Rachel B; Herring, Matthew P; Campbell, Mark J

    2017-01-01

    Motivation is widely-researched, in both sport psychology and other fields. As rigorous measurement is essential to understanding this latent construct, a critical appraisal of measurement instruments is needed. Thus, the purpose of this review was to evaluate the six most highly cited motivation measures in sport. Peer-reviewed articles published prior to August 2016 were searched to identify the six most highly cited motivation questionnaires in sport: Sport Motivation Scale (SMS), Intrinsic Motivation Inventory (IMI), Situational Motivational Scale (SIMS), Perceptions of Success Questionnaire (POSQ), Behavioural Regulation in Sport Questionnaire (BRSQ), and Task and Ego Orientation in Sport Questionnaire (TEOSQ). The questionnaires were then evaluated and discussed in four sections: Development, Reliability, Correlates, and Summary. Bibliometric data were also calculated (average weighted impact factor) and assessed (e.g., citations per year) to evaluate the impact of the use of each questionnaire. Despite some variance in their psychometric properties, conceptualization, structure, and utility, the six questionnaires are psychometrically strong instruments for quantifying motivation that are widely supported in the literature. Bibliometric analyses suggested that the IMI ranks first and the SMS ranks sixth according to the average weighted impact factors of their original publications. Consideration of each questionnaire's psychometric strengths/limitations, and conceptualization of motivation in the context of specific research questions should guide researchers in selecting the most appropriate instrument to measure motivation in sport. The average weighted impact factor of each questionnaire is a useful value to consider as well. With these points in mind, recommendations are provided.

  2. Motivation Measures in Sport: A Critical Review and Bibliometric Analysis

    Science.gov (United States)

    Clancy, Rachel B.; Herring, Matthew P.; Campbell, Mark J.

    2017-01-01

    Motivation is widely-researched, in both sport psychology and other fields. As rigorous measurement is essential to understanding this latent construct, a critical appraisal of measurement instruments is needed. Thus, the purpose of this review was to evaluate the six most highly cited motivation measures in sport. Peer-reviewed articles published prior to August 2016 were searched to identify the six most highly cited motivation questionnaires in sport: Sport Motivation Scale (SMS), Intrinsic Motivation Inventory (IMI), Situational Motivational Scale (SIMS), Perceptions of Success Questionnaire (POSQ), Behavioural Regulation in Sport Questionnaire (BRSQ), and Task and Ego Orientation in Sport Questionnaire (TEOSQ). The questionnaires were then evaluated and discussed in four sections: Development, Reliability, Correlates, and Summary. Bibliometric data were also calculated (average weighted impact factor) and assessed (e.g., citations per year) to evaluate the impact of the use of each questionnaire. Despite some variance in their psychometric properties, conceptualization, structure, and utility, the six questionnaires are psychometrically strong instruments for quantifying motivation that are widely supported in the literature. Bibliometric analyses suggested that the IMI ranks first and the SMS ranks sixth according to the average weighted impact factors of their original publications. Consideration of each questionnaire's psychometric strengths/limitations, and conceptualization of motivation in the context of specific research questions should guide researchers in selecting the most appropriate instrument to measure motivation in sport. The average weighted impact factor of each questionnaire is a useful value to consider as well. With these points in mind, recommendations are provided. PMID:28337165

  3. Breastfeeding Self-efficacy: A Critical Review of Available Instruments

    Science.gov (United States)

    Tuthill, Emily L.; McGrath, Jacqueline M.; Graber, Melanie; Cusson, Regina M.; Young, Sera L.

    2016-01-01

    Increasing breastfeeding rates in the United States is a national priority. Yet, initiation and duration of breastfeeding remains below national targets. Breastfeeding self-efficacy has been shown to be a strong predictor of both breastfeeding initiation and duration and is therefore an important characteristic to be able to measure. However, there is currently a myriad of instruments for measuring breastfeeding self-efficacy, which makes selection of an appropriate instrument difficult. Thus, our aim was to identify, compare, and critically review available breastfeeding self-efficacy instruments. In a systematic review, 6 breastfeeding self-efficacy instruments were identified. The instruments’ purposes, theoretical framework, final scale development, and application in 5 most recent settings were analyzed. The 6 breastfeeding self-efficacy instruments apply a number of theoretical and conceptual frameworks in their development, with Bandura’s social cognitive theory being most common. Content, construct, and predictive validity were strong for most scales. Some, but not all, have been successfully adapted to novel settings. In sum, there are several measurements of breastfeeding self-efficacy that can and should be employed to better understand reasons for suboptimal breastfeeding rates and the effects of interventions on breastfeeding self-efficacy. Instrument selection should be based on domains of primary interest, time available, peripartum timing, and assessment of previous adaptations. Failure to apply appropriate measures in research may garner results that are inconclusive, inaccurate, or nonrepresentative of true study effects. PMID:26319113

  4. Immune Monitoring in Cancer Vaccine Clinical Trials: Critical Issues of Functional Flow Cytometry-Based Assays

    Directory of Open Access Journals (Sweden)

    Iole Macchia

    2013-01-01

    Full Text Available The development of immune monitoring assays is essential to determine the immune responses against tumor-specific antigens (TSAs and tumor-associated antigens (TAAs and their possible correlation with clinical outcome in cancer patients receiving immunotherapies. Despite the wide range of techniques used, to date these assays have not shown consistent results among clinical trials and failed to define surrogate markers of clinical efficacy to antitumor vaccines. Multiparameter flow cytometry- (FCM- based assays combining different phenotypic and functional markers have been developed in the past decade for informative and longitudinal analysis of polyfunctional T-cells. These technologies were designed to address the complexity and functional heterogeneity of cancer biology and cellular immunity and to define biomarkers predicting clinical response to anticancer treatment. So far, there is still a lack of standardization of some of these immunological tests. The aim of this review is to overview the latest technologies for immune monitoring and to highlight critical steps involved in some of the FCM-based cellular immune assays. In particular, our laboratory is focused on melanoma vaccine research and thus our main goal was the validation of a functional multiparameter test (FMT combining different functional and lineage markers to be applied in clinical trials involving patients with melanoma.

  5. Clinical Nurse Specialists Guide Staff Nurses to Promote Practice Accountability Through Peer Review.

    Science.gov (United States)

    Semper, Julie; Halvorson, Betty; Hersh, Mary; Torres, Clare; Lillington, Linda

    2016-01-01

    The aim of the study was to describe the clinical nurse specialist role in developing and implementing a staff nurse education program to promote practice accountability using peer review principles. Peer review is essential for professional nursing practice demanding a significant culture change. Clinical nurse specialists in a Magnet-designated community hospital were charged with developing a staff nurse peer review education program. Peer review is a recognized mechanism of professional self-regulation to ensure delivery of quality care. The American Nurses Association strongly urges incorporating peer review in professional nursing practice models. Clinical nurse specialists play a critical role in educating staff nurses about practice accountability. Clinical nurse specialists developed an education program guided by the American Nurses Association's principles of peer review. A baseline needs assessment identified potential barriers and learning needs. Content incorporated tools and strategies to build communication skills, collaboration, practice change, and peer accountability. The education program resulted in increased staff nurse knowledge about peer review and application of peer review principles in practice. Clinical nurse specialists played a critical role in helping staff nurses understand peer review and its application to practice. The clinical nurse specialist role will continue to be important in sustaining the application of peer review principles in practice.

  6. The clinical educator and complexity: a review.

    Science.gov (United States)

    Schoo, Adrian; Kumar, Koshila

    2018-02-08

    Complexity science perspectives have helped in examining fundamental assumptions about learning and teaching in the health professions. The implications of complexity thinking for how we understand the role and development of the clinical educator is less well articulated. This review article outlines: the key principles of complexity science; a conceptual model that situates the clinical educator in a complex system; and the implications for the individual, organisation and the system. Our conceptual model situates the clinical educator at the centre of a complex and dynamic system spanning four domains and multiple levels. The four domains are: personal (encompassing personal/professional needs and expectations); health services (health agencies and their consumers); educational (educational institutions and their health students); and societal (local community/region and government). The system also comprises: micro or individual, meso or organisational, and macro or socio-political levels. Our model highlights that clinical educators are situated within a complex system comprising different agents and connections. It emphasises that individuals, teams and organisations need to recognise and be responsive to the unpredictability, interconnectedness and evolving nature of this system. Importantly, our article also calls for an epistemological shift from faculty development to capacity building in health professions education, aimed at developing individual, team, organisational and system capabilities to work with(in) complexity. Clinical educators are situated within a complex system comprising different agents and connections. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  7. Rethinking Heat Injury in the SOF Multipurpose Canine: A Critical Review.

    Science.gov (United States)

    Baker, Janice L; Hollier, Paul J; Miller, Laura; Lacy, Ward A

    2012-01-01

    Heat injury is a significant concern of the Special Operations Forces Multipurpose Canine (SOF MPC). The unique athletic abilities and working environment of the SOF MPC differ from that of companion dogs or even conventional military working dogs. This should be considered in the prevention, diagnosis, and treatment of heat injury of the SOF MPC. A critical review of the literature on canine heat injury as it pertains to working dogs demonstrates limited scientific evidence on best practices for immediate clinical management of heat injury in SOF MPCs. A majority of management guidelines for heat injury in veterinary reference books and journals are based on review articles or professional opinion of the author vs. evidence from original research. In addition, guidelines are written primarily for companion animal populations vs. SOF MPCs and focus on measures to be undertaken in a clinical setting vs. point of injury. The phenomenon of ?circular referencing? is also prevalent in the heat injury literature. Current guidelines supported by review articles and textbooks often provide no citation or cite other review articles for clinical standards such as normal temperature ranges, treatment methods, and recurrence of heat injury. This ?circular referencing? phenomenon misrepresents anecdotal evidence and professional opinion as scientifically validated, reinforcing concepts and recommendations that are not truly supported by the evidence. Further study is needed to fully understand heat injury in SOF MPCs and how this applies to prevention, diagnosis and treatment guidelines. In order to provide SOF canine programs with best clinical advice and care, SOF Veterinarians must make clinical judgments based on evaluation of the most accurate and valid information possible. Clinical guidelines are fluid and should be reviewed regularly for relevance to the defined population in question. Clinical Guidelines should also be utilized as guiding principles in conjunction with

  8. Critical care nurse practitioners and clinical nurse specialists interface patterns with computer-based decision support systems.

    Science.gov (United States)

    Weber, Scott

    2007-11-01

    The purposes of this review are to examine the types of clinical decision support systems in use and to identify patterns of how critical care advanced practice nurses (APNs) have integrated these systems into their nursing care patient management practices. The decision-making process itself is analyzed with a focus on how automated systems attempt to capture and reflect human decisional processes in critical care nursing, including how systems actually organize and process information to create outcome estimations based on patient clinical indicators and prognosis logarithms. Characteristics of APN clinicians and implications of these characteristics on decision system use, based on the body of decision system user research, are introduced. A review of the Medline, Ovid, CINAHL, and PubMed literature databases was conducted using "clinical decision support systems,"computerized clinical decision making," and "APNs"; an examination of components of several major clinical decision systems was also undertaken. Use patterns among APNs and other clinicians appear to vary; there is a need for original research to examine how APNs actually use these systems in their practices in critical care settings. Because APNs are increasingly responsible for admission to, and transfer from, critical care settings, more understanding is needed on how they interact with this technology and how they see automated decision systems impacting their practices. APNs who practice in critical care settings vary significantly in how they use the clinical decision systems that are in operation in their practice settings. These APNs must have an understanding of their use patterns with these systems and should critically assess whether their patient care decision making is affected by the technology.

  9. Critical care providers refer to information tools less during communication tasks after a critical care clinical information system introduction.

    Science.gov (United States)

    Ballermann, Mark; Shaw, Nicola T; Mayes, Damon C; Gibney, R T Noel

    2011-01-01

    Electronic documentation methods may assist critical care providers with information management tasks in Intensive Care Units (ICUs). We conducted a quasi-experimental observational study to investigate patterns of information tool use by ICU physicians, nurses, and respiratory therapists during verbal communication tasks. Critical care providers used tools less at 3 months after the CCIS introduction. At 12 months, care providers referred to paper and permanent records, especially during shift changes. The results suggest potential areas of improvement for clinical information systems in assisting critical care providers in ensuring informational continuity around their patients.

  10. The effectiveness of concept mapping on development of critical thinking in nursing education: A systematic review and meta-analysis.

    Science.gov (United States)

    Yue, Meng; Zhang, Meng; Zhang, Chunmei; Jin, Changde

    2017-05-01

    As an essential skill in daily clinical nursing practice, critical thinking ability has been an important objective in nursing education. Concept mapping enables nursing students connect new information to existing knowledge and integrates interdisciplinary knowledge. However, there is a lack of evidence related to critical thinking ability and concept mapping in nursing education. The purpose of this systematic review and meta-analysis was to assess the effect of concept mapping in developing critical thinking in nursing education. This systematic review was reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A search was conducted in PubMed, Web of science, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health (CINAHL) and China National Knowledge Infrastructure (CNKI). Randomized controlled trials (RCT) comparing concept mapping and traditional teaching method were retrieved. Data were collected by two reviewers according to the data extraction tables. The methodological quality of included studies was assessed by other two reviewers. The results of meta-analysis were presented using mean difference (MD). Thirteen trials were summarized in the systematic review and eleven trials were included in the meta-analysis. The pooled effect size showed that, comparing with traditional methods, concept mapping could improve subjects' critical thinking ability measured by California Critical Thinking Disposition Inventory (CCTDI), California Critical Thinking Skill Test (CCTST) and Critical Thinking Scale (CTS). The subgroup analyses showed that concept mapping improved the score of all subscales. The result of this review indicated that concept mapping could affect the critical thinking affective dispositions and critical thinking cognitive skills. Further high quality research using uniform evaluation is required. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Bayesian methodology for the design and interpretation of clinical trials in critical care medicine: a primer for clinicians.

    Science.gov (United States)

    Kalil, Andre C; Sun, Junfeng

    2014-10-01

    To review Bayesian methodology and its utility to clinical decision making and research in the critical care field. Clinical, epidemiological, and biostatistical studies on Bayesian methods in PubMed and Embase from their inception to December 2013. Bayesian methods have been extensively used by a wide range of scientific fields, including astronomy, engineering, chemistry, genetics, physics, geology, paleontology, climatology, cryptography, linguistics, ecology, and computational sciences. The application of medical knowledge in clinical research is analogous to the application of medical knowledge in clinical practice. Bedside physicians have to make most diagnostic and treatment decisions on critically ill patients every day without clear-cut evidence-based medicine (more subjective than objective evidence). Similarly, clinical researchers have to make most decisions about trial design with limited available data. Bayesian methodology allows both subjective and objective aspects of knowledge to be formally measured and transparently incorporated into the design, execution, and interpretation of clinical trials. In addition, various degrees of knowledge and several hypotheses can be tested at the same time in a single clinical trial without the risk of multiplicity. Notably, the Bayesian technology is naturally suited for the interpretation of clinical trial findings for the individualized care of critically ill patients and for the optimization of public health policies. We propose that the application of the versatile Bayesian methodology in conjunction with the conventional statistical methods is not only ripe for actual use in critical care clinical research but it is also a necessary step to maximize the performance of clinical trials and its translation to the practice of critical care medicine.

  12. A critical scoping review of external uses of comfrey (Symphytum spp.).

    Science.gov (United States)

    Frost, R; MacPherson, H; O'Meara, S

    2013-12-01

    External preparations of the herb comfrey (most commonly Symphytum officinale L.) are widely available for over-the-counter, practitioner and healthcare professional usage. Traditional practice suggests comfrey can be used to treat musculoskeletal disorders, wounds and various other conditions; however a full and critical coverage of the evidence base has not yet been undertaken. A critical scoping review was undertaken. Six bibliographic databases, 10 grey literature databases and nine trials registers were searched plus reference lists of included studies and a descriptive overview of comfrey. Randomised or non-randomised clinical trials assessing the external use of comfrey for any indication were included and methodological and reporting quality were assessed. Observational studies were included only in the assessment of adverse events. Studies were grouped and summarised according to the type of indication treated. Of 1348 identified records, 64 full texts were screened for inclusion and 26 were included in the review - 13 RCTs, 5 non-randomised controlled trials and 8 observational studies evaluating treatments for ankle distortion, back pain, abrasion wounds, venous leg ulcers and osteoarthritis. The majority of included trials had an overall unclear risk of bias due to poor quality of reporting. Few adverse events were reported. Individual clinical trials showed evidence of benefit for ankle distortion, back pain, abrasion wounds and osteoarthritis. Topical application appears to be safe but further rigorous assessment is needed. Systematic reviews focussing on particular indications may clarify the treatment effect and safety of external comfrey preparations. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. EVIDENCE-BASED MEDICINE – II. CLINICAL USE AND CRITICS

    Directory of Open Access Journals (Sweden)

    Angela Čuk

    2004-01-01

    Full Text Available Background. Evidence-based medicine employs systematic searching, evaluation and use of current research findings as the basis for clinical decision-making. However, there are some problems and uncertainties hindering introduction and spreading of the use of the method in clinical practice. Physicians often have no time for literature searching and for use of the method in practice. For certain questions in clinical practice there are no answers in medical literature. Most of the evidences in medical literature are only available in English. Introduction of the method is hampered also by the fact that clinical decision-making is complex and does not allow procedures prescribed in advance. Rigidity and universality of decisions resulting from the evidence may appear impersonal and may affect the relationship between the physician and the patient. Trends towards evidence based medicine are followed also by big multinational pharmaceutical corporations. They carry out large and expensive clinical trials using the results for promotional purposes. In this way, they get the competitive advantage and influence the objectivity of physicians’ clinical decision-making.Conclusions. With introduction of evidence based medicine into clinical practice physicians acquire new information and use a new form of continuing education by following new developments in their field. This way, new findings from medical literature get into clinical practice faster and more efficiently. In addition, physicians get more professional satisfaction and quality in clinical practice is higher.

  14. The critical review of methodologies and approaches to assess the inherent skin sensitization potential (skin allergies) of chemicals. Part II

    DEFF Research Database (Denmark)

    Thyssen, Jacob P; Giménez-Arnau, Elena; Lepoittevin, Jean-Pierre

    2012-01-01

    To identify specific cases, classes or specific use situations of chemicals for which 'safety thresholds' or 'safety limits' were set (in regulations, standards, in scientific research/clinical work, etc.) and critically review the scientific and methodological parameters used to set those limits....

  15. The Relation between Child Maltreatment and Adolescent Suicidal Behavior: A Systematic Review and Critical Examination of the Literature

    Science.gov (United States)

    Miller, Adam B.; Esposito-Smythers, Christianne; Weismoore, Julie T.; Renshaw, Keith D.

    2013-01-01

    A large body of research suggests that child maltreatment (CM) is associated with adolescent suicidal ideation and attempts. These studies, however, have not been critically examined and summarized in a manner that allows us to draw firm conclusions and make recommendations for future research and clinical work in this area. In this review, we…

  16. Herbal Medicine in Mexico: A Cause of Hepatotoxicity. A Critical Review.

    Science.gov (United States)

    Valdivia-Correa, Bárbara; Gómez-Gutiérrez, Cristina; Uribe, Misael; Méndez-Sánchez, Nahum

    2016-02-15

    In Mexico, herbal products are commonly used as therapeutic tools. The analysis of several publications reveals that there are dozens of different herbs and herbal products used for different reasons, some of which have been implicated in causing toxic liver disease. However, methodological aspects limit the attribution of causality, and the precise incidence and clinical manifestations of herb-induced liver injury have not been well characterized. This review outlines the history of traditional herbal medicine in Mexico, critically summarizes the mechanisms and adverse effects of commonly used herbal plants, and examines the regulatory issues regarding the legal use of these products.

  17. Clinical Aspects of Feline Retroviruses: A Review

    Directory of Open Access Journals (Sweden)

    Katrin Hartmann

    2012-10-01

    Full Text Available Feline leukemia virus (FeLV and feline immunodeficiency virus (FIV are retroviruses with global impact on the health of domestic cats. The two viruses differ in their potential to cause disease. FeLV is more pathogenic, and was long considered to be responsible for more clinical syndromes than any other agent in cats. FeLV can cause tumors (mainly lymphoma, bone marrow suppression syndromes (mainly anemia, and lead to secondary infectious diseases caused by suppressive effects of the virus on bone marrow and the immune system. Today, FeLV is less commonly diagnosed than in the previous 20 years; prevalence has been decreasing in most countries. However, FeLV importance may be underestimated as it has been shown that regressively infected cats (that are negative in routinely used FeLV tests also can develop clinical signs. FIV can cause an acquired immunodeficiency syndrome that increases the risk of opportunistic infections, neurological diseases, and tumors. In most naturally infected cats, however, FIV itself does not cause severe clinical signs, and FIV-infected cats may live many years without any health problems. This article provides a review of clinical syndromes in progressively and regressively FeLV-infected cats as well as in FIV-infected cats.

  18. Critical thinking competence and disposition of clinical nurses in a medical center.

    Science.gov (United States)

    Feng, Rung-Chuang; Chen, Mei-Jung; Chen, Mei-Chuan; Pai, Yu-Chu

    2010-06-01

    Critical thinking is essential in nursing practice. Promoting critical thinking competence in clinical nurses is an important way to improve problem solving and decision-making competence to further improve the quality of patient care. However, using an adequate tool to test nurses' critical thinking competence and disposition may provide the reference criteria for clinical nurse characterization, training planning, and resource allocation for human resource management. The purpose of this study was to measure the critical thinking competence and critical thinking disposition of clinical nurses as well as to explore the related factors of critical thinking competence. Clinical nurses from four different clinical ladders selected from one medical center were stratified randomly. All qualified subjects who submitted valid questionnaires were included in the study. A Taiwan version of the modified Watson-Glaser Critical Thinking Appraisal and Critical Thinking Disposition Inventory was developed to measure the critical thinking competence and critical thinking disposition of clinical nurses. Validity was evaluated using the professional content test (content validity index = .93). Reliability was assessed with a Cronbach's alpha coefficient of .85. Data were analyzed using the SPSS for Windows (Version 12.0; SPSS Inc., Chicago, IL). Results showed that competence of interpretation was the highest critical thinking competence factor. Inference was the lowest, and reflective thinking as a critical thinking disposition was more positive. In addition, age, years of nursing experience, and experiences in other hospitals significantly influenced critical thinking competence (p critical thinking disposition scores. Clinical ladder N4 nurses had the highest scores in both competence and disposition. A significant relationship was found between critical thinking competence and disposition scores, with 29.3% of the variance in critical thinking competence potentially explained

  19. Critical Thinking and Clinical Judgment in Novice Registered Nurses

    Science.gov (United States)

    Tyne, Sheila L.

    2018-01-01

    The health care field has become increasingly more complex, requiring new nurses to be prepared upon graduation to respond to a variety of complex situations. Unfortunately, many graduates from associate degree nursing (ADN) programs are not able to think critically upon entering the work force. This presents a major problem for the nurse and for…

  20. SRTC criticality technical review: Nuclear Criticality Safety Evaluation 93-18 Uranium Solidification Facility's Waste Handling Facility

    International Nuclear Information System (INIS)

    Rathbun, R.

    1993-01-01

    Separate review of NMP-NCS-930058, open-quotes Nuclear Criticality Safety Evaluation 93-18 Uranium Solidification Facility's Waste Handling Facility (U), August 17, 1993,close quotes was requested of SRTC Applied Physics Group. The NCSE is a criticality assessment to determine waste container uranium limits in the Uranium Solidification Facility's Waste Handling Facility. The NCSE under review concludes that the NDA room remains in a critically safe configuration for all normal and single credible abnormal conditions. The ability to make this conclusion is highly dependent on array limitation and inclusion of physical barriers between 2x2x1 arrays of boxes containing materials contaminated with uranium. After a thorough review of the NCSE and independent calculations, this reviewer agrees with that conclusion

  1. Morcellation of undiagnosed uterine sarcoma: A critical review.

    Science.gov (United States)

    Bogani, Giorgio; Chiappa, Valentina; Ditto, Antonino; Martinelli, Fabio; Donfrancesco, Cristina; Indini, Alice; Lorusso, Domenica; Raspagliesi, Francesco

    2016-02-01

    In the recent decades, laparoscopy has replaced open abdominal procedures in the setting of gynecologic surgery. Extraction of large specimens (e.g., large uteri or myomas) following operative laparoscopy is technically challenging. Technological attempts allow the removal of large and solid pelvic masses via small abdominal incisions (using instruments called morcellators), thus reducing unnecessary laparotomies and improving short-term patients' outcomes. However, morcellation of undiagnosed uterine malignancies may lead to worse survival outcomes. Therefore, the Food and Drug Administration (FDA) warns about the use of power morcellators, thus causing ongoing concerns on the applicability of minimally invasive approaches for myomectomy and the removal of large uteri. In the present review, we sought to assess pro and cons regarding minimally invasive morcellation. This review will discuss the effects of morcellation of undiagnosed uterine malignancies, focusing on possible techniques for preoperative detection of uterine sarcoma and for avoiding intra-abdominal dissemination of potentially malignant tissues. Further efforts are necessary in order to identify tools to make a more accurate and reliable preoperative diagnosis of uterine masses. However, on the light of the current evidence, intra-abdominal morcellation should be banned from clinical practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. Book Review: Critical Condition: Replacing Critical Thinking with Creativity by Patrick Finn

    OpenAIRE

    Matthews, Jodie

    2016-01-01

    In Critical Condition: Replacing Critical Thinking with Creativity, Patrick Finn expands upon his 2011 TEDx Talk, ‘Loving Communication’, to suggest that critical thinking implies disapproval and unnecessary judgement originating from a particular mode of Classical thought. Jodie Matthews argues that Finn’s discussion is dependent upon a crudely drawn straw man and neglects to consider thinking critically as a necessary corollary, rather than antithesis, to thinking creatively.

  3. Masked hypertension definition, impact, outcomes: a critical review.

    Science.gov (United States)

    Papadopoulos, Dimitris P; Makris, Thomas K

    2007-12-01

    The phenomenon of masked hypertension (MH) is defined as a clinical condition in which a patient's office blood pressure (BP) level is hypertensive range. The prevalence in the population is about the same as that of isolated office hypertension; about 1 in 7 or 8 persons with a normal office BP level may fall into this category. The high prevalence of MH would suggest the necessity for measuring out-of-office BP in persons with apparently normal or well-controlled office BP. Reactivity to daily life stressors and behavioral factors such as smoking, alcohol use, contraceptive use in women, and sedentary habits can selectively influence MH. MH should be searched for in individuals who are at increased risk for cardiovascular complications including patients with kidney disease or diabetes. Individuals with MH have been shown to have a greater-than-normal prevalence of organ damage, particularly with an increased prevalence of metabolic risk factors, left ventricular mass index, carotid intima-media thickness, and impaired large artery distensibility compared with patients with a truly normal BP level in and out of the clinic or office. Also, outcome studies have suggested that MH increases cardiovascular risk, which appears to be close to that of in-office and out-of-office hypertension. The aim of this review was to define the entity of MH, to describe its prevalence in the general population, and to discuss its correlation with cardiovascular events.

  4. Neurofeedback with fMRI: A critical systematic review.

    Science.gov (United States)

    Thibault, Robert T; MacPherson, Amanda; Lifshitz, Michael; Roth, Raquel R; Raz, Amir

    2018-05-15

    Neurofeedback relying on functional magnetic resonance imaging (fMRI-nf) heralds new prospects for self-regulating brain and behavior. Here we provide the first comprehensive review of the fMRI-nf literature and the first systematic database of fMRI-nf findings. We synthesize information from 99 fMRI-nf experiments-the bulk of currently available data. The vast majority of fMRI-nf findings suggest that self-regulation of specific brain signatures seems viable; however, replication of concomitant behavioral outcomes remains sparse. To disentangle placebo influences and establish the specific effects of neurofeedback, we highlight the need for double-blind placebo-controlled studies alongside rigorous and standardized statistical analyses. Before fMRI-nf can join the clinical armamentarium, research must first confirm the sustainability, transferability, and feasibility of fMRI-nf in patients as well as in healthy individuals. Whereas modulating specific brain activity promises to mold cognition, emotion, thought, and action, reducing complex mental health issues to circumscribed brain regions may represent a tenuous goal. We can certainly change brain activity with fMRI-nf. However, it remains unclear whether such changes translate into meaningful behavioral improvements in the clinical domain. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Clinical review: Ethnic differences in bone mass--clinical implications.

    Science.gov (United States)

    Leslie, William D

    2012-12-01

    Differences in bone mineral density (BMD) as assessed with dual-energy x-ray absorptiometry are observed between geographic and ethnic groups, with important implications in clinical practice. PubMed was employed to identify relevant studies. A review of the literature was conducted, and data were summarized and integrated. The available data highlight the complex ethnic variations in BMD, which only partially account for observed variations in fracture rates. Factors contributing to ethnic differences include genetics, skeletal size, body size and composition, lifestyle, and social determinants. Despite BMD differences, the gradient of risk for fracture from BMD and other clinical risk factors appears to be similar across ethnic groups. Furthermore, BMD variation is greater within an ethnic population than between ethnic populations. New imaging technologies have identified ethnic differences in bone geometry, volumetric density, microarchitecture, and estimated bone strength that may contribute to a better understanding of ethnic differences in fracture risk. Factors associated with ethnicity affect BMD and fracture risk through direct and indirect mechanisms.

  6. Bipolar disorders in the Arab world: a critical review.

    Science.gov (United States)

    Kronfol, Ziad; Zakaria Khalil, Mostafa; Kumar, Pankaj; Suhre, Karsten; Karam, Elie; McInnis, Melvin

    2015-05-01

    Bipolar disorders are common psychiatric disorders that affect 1-5% of the population worldwide. Major advances in the epidemiology, pathophysiology, and treatment of the disorders have recently occurred. The majority of published reports, however, originate from the Western hemisphere, mostly Europe and the United States. There is a shortage of data from the Arab world on bipolar disorders. In an era of globalization and rapid communication, it is not clear to what extent research findings pertaining to one part of the world are by necessity applicable to other parts. Psychiatric disorders are known to be affected by the culture in which they occur, and knowledge of variations in illness presentation in different ethnic groups is also increasing. However, knowledge of variations affecting Arab populations remains quite limited. This paper provides a critical review of the literature on bipolar affective disorders in the Arab world, pointing to major gaps in knowledge and future opportunities to fill these gaps. © 2015 New York Academy of Sciences.

  7. Review of the critical heat flux correlations for liquid metals

    International Nuclear Information System (INIS)

    Lee, Yong Bum; Han, H. D.; Chang, W. P.; Kwon, Y. M.

    1999-09-01

    The CHF phenomenon in the two-phase convective flows has been an important issue in the fields of design and safety analysis of light water reactor (LWR) as well as sodium cooled liquid metal reactor (LMR). Especially in the LWR application, many physical aspects of the CHF phenomenon are understood and reliable correlations and mechanistic models to predict the CHF condition have been proposed over the past three decades. Most of the existing CHF correlations have been developed for light water reactor core applications. Compared with water, liquid metals show a divergent picture of boiling pattern. This can be attributed to the consequence that special CHF conditions obtained from investigations with water cannot be applied to liquid metals. Numerous liquid metal boiling heat transfer and two-phase flow studies have put emphasis on development of models and understanding of the mechanism for improving the CHF predictions. Thus far, no overall analytical solution method has been obtained and the reliable prediction method has remained empirical. The principal objectives of the present report are to review the state of the art in connection with liquid metal critical heat flux under low pressure and low flow conditions and to discuss the basic mechanisms. (author)

  8. Liquid-liquid extraction in flow analysis: A critical review

    Energy Technology Data Exchange (ETDEWEB)

    Silvestre, Cristina I.C.; Santos, Joao L.M. [REQUIMTE, Servico de Quimica-Fisica, Faculdade de Farmacia, Universidade do Porto, R. Anibal Cunha, 164, 4099-030 Porto (Portugal); Lima, Jose L.F.C., E-mail: limajlfc@ff.up.pt [REQUIMTE, Servico de Quimica-Fisica, Faculdade de Farmacia, Universidade do Porto, R. Anibal Cunha, 164, 4099-030 Porto (Portugal); Zagatto, Elias A.G. [Centro de Energia Nuclear na Agricultura, Universidade de Sao Paulo, P.O. Box 96, Piracicaba 13400-970 (Brazil)

    2009-10-12

    Liquid-liquid extractions (LLE) are a common sample pre-treatment in many analytical applications. This review aims at providing a critical overview of the distinct automated continuous flow-based approaches that were developed for liquid-liquid extraction with the purpose of pre-concentration and/or separation of multiple analytes, such as ultra-trace metal and metalloid species, phenolic compounds, surfactants, pharmaceuticals, etc., hyphenated with many detection technique such as UV/vis spectrophotometry, atomic spectrometric detection systems and luminescent detectors, including distinct extraction strategies and applications like single and multiple extraction schemes, wetting film extraction, supported liquid membrane extraction, back extraction, closed-loop systems and the utilisation of zone sampling, chromatomembranes and iterative reversal techniques. The analytical performance of the developed flow-based LLE methods and the influence of flow manifold components such as the segmenter, extraction coil and phase separator, is emphasised and object of discussion. An overall presentation of each system components, selectivity, advantages and shortcomings is carried out and exemplified with selected applications.

  9. Planning and the Public Interest. A Critical Review

    Directory of Open Access Journals (Sweden)

    JÚLIA A. NAGY

    2015-12-01

    Full Text Available From an ethical perspective, the biggest difficulty for planners is to take the best approach in responding to the decision makers and in acting in the public interest because it always becomes subject of pressures arising with the governmental change, on the one hand, and the societal change on the other hand. Even though many debates arise regarding its existence, for planners, as well as for the planning profession, the public interest has always been legitimizing principles as a norm of practice (Alexander, 2002. The paper critically analyses the planning activity in relation to the public interest and highlights the importance of reciprocity between the two. In order to analyse this issue, the article starts with the presentation of different perspectives regarding the public interest, touching upon its conceptual meaning which is followed by a historical review of its origins and transformation. The third section presents its contextual meaning, its representatives, and the change of its content starting from the 19th century until nowadays and discusses the planners’ ability to represent it. The final part comprises the conclusions that indicate that the planning activity should serve the public interest and, by that, it would serve also the interest of planning as a profession. It emphasises two important issues of the present days: the definition of the public interest and the rational decision making within the planning process.

  10. Critical review of studies on atmospheric dispersion in coastal regions

    International Nuclear Information System (INIS)

    Shearer, D.L.; Kaleel, R.J.

    1982-09-01

    This study effort was required as a preliminary step prior to initiation of field measurements of atmospheric dispersion in coastal regions. The Nuclear Regulatory Commission (NRC) is in the process of planning an extensive field measurement program to generate data which will serve as improved data bases for licensing decisions, confirmation of regulations, standards, and guides, and for site characterizations. The study being reported here is an effort directed to obtaining as much information as is possible from existing studies that is relevant toward NRC's objectives. For this study, reports covering research and meteorological measurements conducted for industrial purposes, utility needs, military objectives, and academic studies were obtained and critically reviewed in light of NRC's current data needs. This report provides an interpretation of the extent of existing usable information, an indication of the potential for tailoring existing research toward current NRC information needs, and recommendations for several follow-on studies which could provide valuable additional information through reanalysis of the data. Recommendations are also offered regarding new measurement programs. Emphasis is placed on the identification and acquisition of data from atmospheric tracer studies conducted in coastal regions. A total of 225 references were identified which deal with the coastal atmosphere, including meteorological and tracer measurement programs, theoretical descriptions of the relevant processes, and dispersion models

  11. Critical Success Factors for Malaysian Construction Projects: An Investigative Review

    Directory of Open Access Journals (Sweden)

    Yee Cheong Yong

    2017-05-01

    Full Text Available Construction projects play an important role in the advancement of a nation through infrastructure development that leads to economic growth. They are planned carefully to accomplish certain goals. However, not all the projects achieved the goals as per planned. Many factors contribute to the successes and failures, and it becomes an interesting arena for research. The primary objective of this paper is to outline the development trend of project success measurement globally and locally. The research method employed was to make selected reviews on critical success factors' (CSFs literature and to compare international standards and progress in incorporating human behavioural aspects of project management to the situation in Malaysia. A somewhat similar pattern can be observed in Malaysia where the studies have departed from the usual criteria of time, cost and quality, to define project success in a more holistic way. However, the domestic industry has failed to respond to the emerging trend globally as there has yet been any widely published research on the importance of human-related factors towards project success. A consolidated framework of CSFs has therefore, been proposed in responding to the findings. This paper fulfils an identified need as there has been a dearth of research on the subject matter locally.

  12. A critical review of the Chilean civil nuclear liability regime

    International Nuclear Information System (INIS)

    Gonzalez Cruz, Francisco Javier; Acevedo Ferrer, Santiago

    2013-01-01

    This article reviews the Chilean civil nuclear liability regime. The Nuclear Security Act (Law 18.302), enacted in 1984, and the Vienna Convention on Civil Liability for Nuclear Damage, ratified ed by Chile in 1989, are the fundamental laws of the current regime. Although Chile has no nuclear power plants, it is still important to analyze how the Chilean legislation would protect citizens from nuclear damages. This paper does not consider the policy reasons for and against the promotion of atomic energy. Rather, it critically examines the current status of the Chilean nuclear regime. Undoubtedly, if in the future Chile chooses to include nuclear sources in its energy mix, it will not be enough to introduce some isolated legal amendments, but it will be necessary to build a new Chilean Energy Regime which includes nuclear energy. In that scenario, though, it will be useful to know and understand how the current nuclear liability regime works. From this point of view, the reforms this article proposes to the current nuclear liability regime might be helpful to academics and policy makers alike

  13. Should we mobilise critically ill patients? A review.

    LENUS (Irish Health Repository)

    O'Connor, Enda D

    2009-12-01

    Neuromuscular weakness, a frequent complication of prolonged bed rest and critical illness, is associated with morbidity and mortality. Mobilisation physiotherapy has widespread application in patients hospitalised with non-critical illness.

  14. Clinical Management of Priapism: A Review

    Directory of Open Access Journals (Sweden)

    Kazuyoshi Shigehara

    2016-04-01

    Full Text Available Priapism is defined as a persistent and painful erection lasting longer than four hours without sexual stimulation. Based on episode history and pathophysiology, priapism is classified into three subtypes: ischemic (low-flow, non-ischemic (high-flow, and stuttering priapism. Ischemic priapism is characterized by a persistent, painful erection with remarkable rigidity of the corpora cavernosa caused by a disorder of venous blood outflow from this tissue mass, and is similar to penile compartment syndrome. Stuttering priapism is characterized by a self-limited, recurrent, and intermittent erection, frequently occurring in patients with sickle cell disease. Non-ischemic priapism is characterized by a painless, persistent nonsexual erection that is not fully rigid and is caused by excess arterial blood flow into the corpora cavernosa. Because ischemic and non-ischemic priapism differ based on emergency status and treatment options, appropriate discrimination of each type of priapism is required to initiate adequate clinical management. The goal of management of priapism is to achieve detumescence of the persistent penile erection and to preserve erectile function after resolution of the priapism. To achieve successful management, urologists should address this emergency clinical condition. In the present article, we review the diagnosis and clinical management of the three types of priapism.

  15. Nutraceuticals in the management of osteoarthritis : a critical review.

    Science.gov (United States)

    Ragle, Ryan L; Sawitzke, Allen D

    2012-09-01

    Osteoarthritis (OA) is a chronic, highly prevalent and disabling disease that is expected to increase in prevalence secondary to longer life expectancy and a disproportionately aging population. Treatment of OA is only marginally effective and has been focused primarily on symptom control using weight loss, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, intra-articular steroids or viscosupplementation, topical NSAIDs and analgesics, diacerein (an oral interleukin-1β inhibitor) and finally joint replacement surgery. The use of nutraceuticals in the treatment of OA is common, and scientific studies examining the effects of nutraceuticals on the pathogenesis and treatment of OA are increasing. This review examines the efficacy and safety of select nutraceuticals for the treatment of OA. The reviewed nutraceuticals include glucosamine, chondroitin, collagen hydrolysates (CHs) and avocado-soybean unsaponifiables (ASUs). There have been several clinical trials examining the efficacy of these products and the results demonstrate significant heterogeneity. Significant improvements in pain, function and structural outcomes have been shown for some of the treatment arms or subgroups of patients, but the effects are not consistent across the studies. Glucosamine, chondroitin and the two in combination have been the most extensively studied. Significant improvement in pain and functional indices and a decrease in the loss of joint space width were demonstrated in some but not all studies. CHs showed significant improvement in pain and functional indices for several subgroups of patients, but these findings were not pervasive amongst the treatment arms. ASU has demonstrated positive results with respect to decreased NSAID use in several studies and functional and pain end points in most of the reviewed studies; however, in the two studies examining structural end points, the results were mixed. The safety of these nutraceuticals has been

  16. Glucose monitoring as a guide to diabetes management. Critical subject review.

    Science.gov (United States)

    Koch, B

    1996-06-01

    To encourage a balanced approach to blood glucose monitoring in diabetes by a critical review of the history, power and cost of glucose testing. The Cambridge Data Base was searched and was supplemented by a random review of other relevant sources, including textbooks, company pamphlets, and laboratory manuals. Keywords used were "glucosuria diagnosis," "blood glucose self-monitoring," "glycosylated hemoglobin," and "fructosamine" for the 10-year period ending 1992, restricted to English language and human. About 200 titles were retrieved and reviewed according to the author's judgment of relevance. "Snapshot tests" (venous and capillary blood glucose) and "memory tests" (urine glucose, glycated hemoglobin fractions and fructosamine) must be employed according to individual patients treatment goals. Day-to-day metabolic guidance is facilitated by capillary blood glucose testing for patients receiving insulin and by urine glucose testing for others. Capillary blood glucose testing is mandatory in cases of hypoglycemia unawareness (inability to sense hypoglycemia because of neuropathy) but is not a substitute for a knowledge of clinical hypoglycemia self-care. Criteria by reason (clinical judgement and cost effectiveness) must be separated from criteria by emotion (preoccupation with technology and marketing). No randomized studies show that any of these tests consistently improve clinical outcome. Optimal metabolic control and cost savings can be expected from a rational selection of tests.

  17. A Method to Evaluate Critical Factors for Successful Implementation of Clinical Pathways.

    Science.gov (United States)

    Dong, W; Huang, Z

    2015-01-01

    Clinical pathways (CPs) have been viewed as a multidisciplinary tool to improve the quality and efficiency of evidence-based care. Despite widespread enthusiasm for CPs, research has shown that many CP initiatives are unsuccessful. To this end, this study provides a methodology to evaluate critical success factors (CSFs) that can aid healthcare organizations to achieve successful CP implementation. This study presents a new approach to evaluate CP implementation CSFs, with the aims being: (1) to identify CSFs for implementation of CPs through a comprehensive literature review and interviews with collaborative experts; (2) to use a filed study data with a robust fuzzy DEMATEL (the decision making trial and evaluation laboratory) approach to visualize the structure of complicated causal relationships between CSFs and obtain the influence level of these factors. The filed study data is provided by ten clinical experts of a Chinese hospital. 23 identified CSF factors which are initially identified through a review of the literature and interviews with collaborative experts. Then, a number of direct and indirect relationships are derived from the data such that different perceptions can be integrated into a compromised cause and effect model of CP implementation. The results indicate that the proposed approach can systematically evaluate CSFs and realize the importance of each factor such that the most common causes of failure of CP implementation could be eliminated or avoided. Therefore, the tool proposed would help healthcare organizations to manage CP implementation in a more effective and proactive way.

  18. Review and classification of variability analysis techniques with clinical applications.

    Science.gov (United States)

    Bravi, Andrea; Longtin, André; Seely, Andrew J E

    2011-10-10

    Analysis of patterns of variation of time-series, termed variability analysis, represents a rapidly evolving discipline with increasing applications in different fields of science. In medicine and in particular critical care, efforts have focussed on evaluating the clinical utility of variability. However, the growth and complexity of techniques applicable to this field have made interpretation and understanding of variability more challenging. Our objective is to provide an updated review of variability analysis techniques suitable for clinical applications. We review more than 70 variability techniques, providing for each technique a brief description of the underlying theory and assumptions, together with a summary of clinical applications. We propose a revised classification for the domains of variability techniques, which include statistical, geometric, energetic, informational, and invariant. We discuss the process of calculation, often necessitating a mathematical transform of the time-series. Our aims are to summarize a broad literature, promote a shared vocabulary that would improve the exchange of ideas, and the analyses of the results between different studies. We conclude with challenges for the evolving science of variability analysis.

  19. Review and classification of variability analysis techniques with clinical applications

    Science.gov (United States)

    2011-01-01

    Analysis of patterns of variation of time-series, termed variability analysis, represents a rapidly evolving discipline with increasing applications in different fields of science. In medicine and in particular critical care, efforts have focussed on evaluating the clinical utility of variability. However, the growth and complexity of techniques applicable to this field have made interpretation and understanding of variability more challenging. Our objective is to provide an updated review of variability analysis techniques suitable for clinical applications. We review more than 70 variability techniques, providing for each technique a brief description of the underlying theory and assumptions, together with a summary of clinical applications. We propose a revised classification for the domains of variability techniques, which include statistical, geometric, energetic, informational, and invariant. We discuss the process of calculation, often necessitating a mathematical transform of the time-series. Our aims are to summarize a broad literature, promote a shared vocabulary that would improve the exchange of ideas, and the analyses of the results between different studies. We conclude with challenges for the evolving science of variability analysis. PMID:21985357

  20. Review of studies on criticality safety evaluation and criticality experiment methods

    International Nuclear Information System (INIS)

    Naito, Yoshitaka; Yamamoto, Toshihiro; Misawa, Tsuyoshi; Yamane, Yuichi

    2013-01-01

    Since the early 1960s, many studies on criticality safety evaluation have been conducted in Japan. Computer code systems were developed initially by employing finite difference methods, and more recently by using Monte Carlo methods. Criticality experiments have also been carried out in many laboratories in Japan as well as overseas. By effectively using these study results, the Japanese Criticality Safety Handbook was published in 1988, almost the intermediate point of the last 50 years. An increased interest has been shown in criticality safety studies, and a Working Party on Nuclear Criticality Safety (WPNCS) was set up by the Nuclear Science Committee of Organisation Economic Co-operation and Development in 1997. WPNCS has several task forces in charge of each of the International Criticality Safety Benchmark Evaluation Program (ICSBEP), Subcritical Measurement, Experimental Needs, Burn-up Credit Studies and Minimum Critical Values. Criticality safety studies in Japan have been carried out in cooperation with WPNCS. This paper describes criticality safety study activities in Japan along with the contents of the Japanese Criticality Safety Handbook and the tasks of WPNCS. (author)

  1. Reasons For Physicians Not Adopting Clinical Decision Support Systems: Critical Analysis.

    Science.gov (United States)

    Khairat, Saif; Marc, David; Crosby, William; Al Sanousi, Ali

    2018-04-18

    Clinical decision support systems (CDSSs) are an integral component of today's health information technologies. They assist with interpretation, diagnosis, and treatment. A CDSS can be embedded throughout the patient safety continuum providing reminders, recommendations, and alerts to health care providers. Although CDSSs have been shown to reduce medical errors and improve patient outcomes, they have fallen short of their full potential. User acceptance has been identified as one of the potential reasons for this shortfall. The purpose of this paper was to conduct a critical review and task analysis of CDSS research and to develop a new framework for CDSS design in order to achieve user acceptance. A critical review of CDSS papers was conducted with a focus on user acceptance. To gain a greater understanding of the problems associated with CDSS acceptance, we conducted a task analysis to identify and describe the goals, user input, system output, knowledge requirements, and constraints from two different perspectives: the machine (ie, the CDSS engine) and the user (ie, the physician). Favorability of CDSSs was based on user acceptance of clinical guidelines, reminders, alerts, and diagnostic suggestions. We propose two models: (1) the user acceptance and system adaptation design model, which includes optimizing CDSS design based on user needs/expectations, and (2) the input-process-output-engagemodel, which reveals to users the processes that govern CDSS outputs. This research demonstrates that the incorporation of the proposed models will improve user acceptance to support the beneficial effects of CDSSs adoption. Ultimately, if a user does not accept technology, this not only poses a threat to the use of the technology but can also pose a threat to the health and well-being of patients. ©Saif Khairat, David Marc, William Crosby, Ali Al Sanousi. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 18.04.2018.

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

    Science.gov (United States)

    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.

  3. Yogurt and Cardiometabolic Diseases: A Critical Review of Potential Mechanisms.

    Science.gov (United States)

    Fernandez, Melissa Anne; Panahi, Shirin; Daniel, Noémie; Tremblay, Angelo; Marette, André

    2017-11-01

    Associations between yogurt intake and risk of diet-related cardiometabolic diseases (CMDs) have been the subject of recent research in epidemiologic nutrition. A healthy dietary pattern has been identified as a pillar for the prevention of weight gain and CMDs. Epidemiologic studies suggest that yogurt consumption is linked to healthy dietary patterns, lifestyles, and reduced risk of CMDs, particularly type 2 diabetes. However, to our knowledge, few to no randomized controlled trials have investigated yogurt intake in relation to cardiometabolic clinical outcomes. Furthermore, there has been little attempt to clarify the mechanisms that underlie the potential beneficial effects of yogurt consumption on CMDs. Yogurt is a nutrient-dense dairy food and has been suggested to reduce weight gain and prevent CMDs by contributing to intakes of protein, calcium, bioactive lipids, and several other micronutrients. In addition, fermentation with bacterial strains generates bioactive peptides, resulting in a potentially greater beneficial effect of yogurt on metabolic health than nonfermented dairy products such as milk. To date, there is little concrete evidence that the mechanisms proposed in observational studies to explain positive results of yogurt on CMDs or parameters are valid. Many proposed mechanisms are based on assumptions that commercial yogurts contain strain-specific probiotics, that viable yogurt cultures are present in adequate quantities, and that yogurt provides a minimum threshold dose of nutrients or bioactive components capable of exerting a physiologic effect. Therefore, the primary objective of this review is to investigate the plausibility of potential mechanisms commonly cited in the literature in order to shed light on the inverse associations reported between yogurt intake and various cardiometabolic health parameters that are related to its nutrient profile, bacterial constituents, and food matrix. This article reviews current gaps and challenges

  4. Defining recovery in chronic fatigue syndrome: a critical review.

    Science.gov (United States)

    Adamowicz, Jenna L; Caikauskaite, Indre; Friedberg, Fred

    2014-11-01

    In chronic fatigue syndrome (CFS), the lack of consensus on how recovery should be defined or interpreted has generated controversy and confusion. The purpose of this paper was to systematically review, compare, and evaluate the definitions of recovery reported in the CFS literature and to make recommendations about the scope of recovery assessments. A search was done using the MEDLINE, PubMed, PsycINFO, CINAHL, and Cochrane databases for peer review papers that contained the search terms "chronic fatigue syndrome" and "recovery," "reversal," "remission," and/or "treatment response." From the 22 extracted studies, recovery was operationally defined by reference with one or more of these domains: (1) pre-morbid functioning; (2) both fatigue and function; (3) fatigue (or related symptoms) alone; (4) function alone; and/or (5) brief global assessment. Almost all of the studies measuring recovery in CFS did so differently. The brief global assessment was the most common outcome measure used to define recovery. Estimates of recovery ranged from 0 to 66 % in intervention studies and 2.6 to 62 % in naturalistic studies. Given that the term "recovery" was often based on limited assessments and less than full restoration of health, other more precise and accurate labels (e.g., clinically significant improvement) may be more appropriate and informative. In keeping with common understandings of the term recovery, we recommend a consistent definition that captures a broad-based return to health with assessments of both fatigue and function as well as the patient's perceptions of his/her recovery status.

  5. Best teaching practices in anatomy education: A critical review.

    Science.gov (United States)

    Estai, Mohamed; Bunt, Stuart

    2016-11-01

    In this report we review the range of teaching resources and strategies used in anatomy education with the aim of coming up with suggestions about the best teaching practices in this area. There is much debate about suitable methods of delivering anatomical knowledge. Competent clinicians, particularly surgeons, need a deep understanding of anatomy for safe clinical procedures. However, because students have had very limited exposure to anatomy during clinical training, there is a concern that medical students are ill-prepared in anatomy when entering clerkships and residency programs. Therefore, developing effective modalities for teaching anatomy is essential to safe medical practice. Cadaver-based instruction has survived as the main instructional tool for hundreds of years, however, there are differing views on whether full cadaver dissection is still appropriate for a modern undergraduate training. The limitations on curricular time, trained anatomy faculty and resources for gross anatomy courses in integrated or/and system-based curricula, have led many medical schools to abandon costly and time-consuming dissection-based instruction in favour of alternative methods of instruction including prosection, medical imaging, living anatomy and multimedia resources. To date, no single teaching tool has been found to meet curriculum requirements. The best way to teach modern anatomy is by combining multiple pedagogical resources to complement one another, students appear to learn more effectively when multimodal and system-based approaches are integrated. Our review suggests that certain professions would have more benefit from certain educational methods or strategies than others. Full body dissection would be best reserved for medical students, especially those with surgical career intentions, while teaching based on prosections and plastination is more suitable for dental, pharmacy and allied health science students. There is a need to direct future research

  6. Do Dental X-Rays Induce Genotoxicity and Cytotoxicity in Oral Mucosa Cells? A Critical Review.

    Science.gov (United States)

    Angelieri, Fernanda; Yujra, Veronica Quispe; Oshima, Celina Tizuko Fujiyama; Ribeiro, Daniel Araki

    2017-10-01

    Dental X-rays are widely used in clinical practice, since the technique is an important approach for diagnosing diseases in dental and periodontal tissues. However, it is widely known that radiation is capable of causing damage to cellular systems, such as genotoxicity or cytotoxicity. Thus, the aim of this review was to present a critical analysis regarding the studies published on genotoxicity and cytotoxicity induced by dental X-rays in oral mucosa cells. Such studies have revealed that some oral cell types are more sensitive than others following exposure to dental X-rays. Certainly, this review will contribute to a better understanding of this matter as well as to highlighting perspectives for further studies. Ultimately, such data will promote better safety for both patients and dental professionals. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  7. Inverse Problems in Systems Biology: A Critical Review.

    Science.gov (United States)

    Guzzi, Rodolfo; Colombo, Teresa; Paci, Paola

    2018-01-01

    Systems Biology may be assimilated to a symbiotic cyclic interplaying between the forward and inverse problems. Computational models need to be continuously refined through experiments and in turn they help us to make limited experimental resources more efficient. Every time one does an experiment we know that there will be some noise that can disrupt our measurements. Despite the noise certainly is a problem, the inverse problems already involve the inference of missing information, even if the data is entirely reliable. So the addition of a certain limited noise does not fundamentally change the situation but can be used to solve the so-called ill-posed problem, as defined by Hadamard. It can be seen as an extra source of information. Recent studies have shown that complex systems, among others the systems biology, are poorly constrained and ill-conditioned because it is difficult to use experimental data to fully estimate their parameters. For these reasons was born the concept of sloppy models, a sequence of models of increasing complexity that become sloppy in the limit of microscopic accuracy. Furthermore the concept of sloppy models contains also the concept of un-identifiability, because the models are characterized by many parameters that are poorly constrained by experimental data. Then a strategy needs to be designed to infer, analyze, and understand biological systems. The aim of this work is to provide a critical review to the inverse problems in systems biology defining a strategy to determine the minimal set of information needed to overcome the problems arising from dynamic biological models that generally may have many unknown, non-measurable parameters.

  8. A PEDAGOGICAL CRITICAL REVIEW OF ONLINE LEARNING SYSTEM

    Directory of Open Access Journals (Sweden)

    Dwi SULISWORO

    2016-08-01

    Full Text Available E-learning which have various shapes such as blog, classroom learning which is facilitated the World Wide Web; a mix of online instruction and meeting the class known as additional models or hybrid; or the full online experience, where all assessment and instruction is done electronically. Object relationship of learning and constructivist educational philosophy and confirmed that online learning has the orientation which is basically a constructivist ideology, where the combination of some of the knowledge is an inquiry-oriented activities and authentic and also promote the progress of the construction of new knowledge. Description of the online learning system in theory and practice can be illustrated in a few examples that have been found in the research that has been done and found new discoveries obtained in the study, but not everything can be done because of several factors. Please note that the components in the online learning system can serve as a learning system which is very strong influence on learning in the class. The objective of this research is to a pedagogical critical review of online learning system in theory and practice that can be applied by teachers in the teaching process in the classroom. The results obtained in this study were teachers and students need extra effort to make online classes and virtual. Further research is needed on appropriate strategies in order to determine the next result is more useful. There some advices for any studies that discuss online learning system are done in certain areas, namely the use of electricity and other disciplines such as social and humanities.

  9. Marine monitoring surveys for desalination plants-A critical review

    KAUST Repository

    Lattemann, Sabine

    2013-01-01

    Environmental impact assessment (EIA) studies are standard practice and a regulatory requirement for most new desalination projects today. However, most of the EIA studies are limited to predictive information; that is, they gather information on the project and the project\\'s environment before project implementation to make predictions about likely impacts. The EIAs may involve comprehensive studies, such as field monitoring, laboratory toxicity testing, and modeling studies. Consequently, the"surprising paucity of useful experimental data, either from laboratory tests or from field monitoring studies", which was observed by the US National Research Council in 2008, has been gradually decreasing. However, there is still a long-term research need on the site-specific effects of desalination plants after project commissioning has taken place. A main challenge of field research is the adequate design of the monitoring studies, which have to adequately distinguish the effects of the desalination project from natural processes over long periods of time. The existing monitoring studies have so far used a wide range of approaches and methods to investigate the environmental impacts of desalination plant discharges. Shortfalls are often that they are limited in scope, short-term, or localized. In essence, many studies fall short of recognizing the potentially synergetic effects of the single waste components of the discharges on marine organisms and the complexity of the potential responses by the ecosystem. While the possible risk of damage arising from the concentrate discharge to the marine environment in close proximity to the outfall is at hand, no conclusive evidence can yet be provided concerning the long-term impacts of desalination plant discharges, let alone the cumulative impacts on certain sea areas. This paper conducts a critical review of existing monitoring programs for desalination plants. Shortcomings of current practices are identified and relevant

  10. Reforming EIA systems: A critical review of proposals in Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Fonseca, Alberto, E-mail: albertof@em.ufop.br [Federal University of Ouro Preto, Minas Gerais (Brazil); Sánchez, Luis Enrique [University of São Paulo, São Paulo (Brazil); Ribeiro, José Claudio Junqueira [Escola Superior Dom Helder Câmara, Belo Horizonte, Minas Gerais (Brazil)

    2017-01-15

    Environmental Impact Assessment (EIA) systems are under pressure in many countries, driven by a call for efficiency and streamlining. Such a phenomenon is particularly clear in Brazil, where, in the past few years, a number of influential associations put forward documents proposing significant changes to environmental licensing and impact assessment regulations. So far, there is no publicly available information about any initiative towards scrutinizing those proposals. The objective of this study was to critically review the merits and drawbacks of the changes proposed in those documents. The analysis triangulated content analysis, focus group and online survey data. The focus group included ten seasoned Brazilian EIA specialists; the survey, based on Likert-scale and open-ended questions, resulted in 322 valid responses from EIA professionals. Results show that the proposals generally agree that the current EIA system, while playing a key role in mitigating impacts and enhancing project design, needs many changes. Nonetheless, the proposals neither offered solutions to overcome political, technical and budget barriers, nor established a sense of priority of the most urgent issues. Findings from the focus group and the survey signaled that a number of proposed actions might face public outcry, and that those changes that do not depend on legislative action are more likely to be implementable. Previous studies about EIA reform focused mostly on the context of developed countries after changes had taken place. This study, while addressing the perspective of a large developing country in a “before-reform” stage, shows that capacity-building is a key requirement in EIA reform. - Highlights: • Brazil's EIA system is under strong pressure for change. • Findings corroborate ineffectiveness in current system. • There are tensions as to the best approaches to overcome problems. • Exact effects of proposals are uncertain. • Low institutional capacity can

  11. Critical Review of Diagnostic Methods Used in Chronic Pancreatic Disease

    Directory of Open Access Journals (Sweden)

    Ivan T Beck

    1995-01-01

    Full Text Available This paper provides a balanced assessment of the various pancreatic function tests and imaging techniques used in the differential diagnosis of chronic pancreatic disease. Function tests that study the digestive capacity of the pancreas (fat absorption of dietary lipids, fluorescein- or radiolabelled fats, bentiromide test, etc have high specificity, but very low sensitivity. This is because 90% of pancreas has to be destroyed before steatorrhea or creatorrhea occurs. Tests that directly measure pancreatic bicarbonate and protein secretion (secretin test, etc are more accurate and may detect pancreatic dysfunction even before anatomical changes occur. Measurement of pancreatic enzymes in serum or urine, or the decreased decline of serum amino acids during their incorporation into pancreatic enzymes, are not sufficiently sensitive or specific to help diagnose pancreatic disease. Sensitive and specific tumour markers are not yet available. Thus screening tests are not cost-effective - if they are negative, they do not exclude pancreatic disease; and if positive, they have to be confirmed by more specific tests. Imaging techniques are the most commonly used methods of investigation. The usefulness of abdominal survey films, barium studies, percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography (ERCP, ultrasonography, computed tomographic scan, magnetic resonance imaging and endoscopic ultrasonography is critically reviewed. Most of the radiological methods can be combined with cytology or biopsy. Histology demonstrating malignancy establishes this diagnosis, but negative biopsies do not exclude malignant tumours. Presently only ERCP and endoscopic ultrasound can diagnose cancers sufficiently early to allow for possible `curative' surgery, and only endoscopic ultrasound is capable to stage tumours for the assessment of resectability.

  12. [Clinical decision making and critical thinking in the nursing diagnostic process].

    Science.gov (United States)

    Müller-Staub, Maria

    2006-10-01

    The daily routine requires complex thinking processes of nurses, but clinical decision making and critical thinking are underestimated in nursing. A great demand for educational measures in clinical judgement related with the diagnostic process was found in nurses. The German literature hardly describes nursing diagnoses as clinical judgements about human reactions on health problems / life processes. Critical thinking is described as an intellectual, disciplined process of active conceptualisation, application and synthesis of information. It is gained through observation, experience, reflection and communication and leads thinking and action. Critical thinking influences the aspects of clinical decision making a) diagnostic judgement, b) therapeutic reasoning and c) ethical decision making. Human reactions are complex processes and in their course, human behavior is interpreted in the focus of health. Therefore, more attention should be given to the nursing diagnostic process. This article presents the theoretical framework of the paper "Clinical decision making: Fostering critical thinking in the nursing diagnostic process through case studies".

  13. An Integrative Review of the Concealed Connection: Nurse Educators' Critical Thinking.

    Science.gov (United States)

    Raymond, Christy; Profetto-McGrath, Joanne; Myrick, Florence; Strean, William B

    2017-11-01

    The role of nurse educators in the development of students' critical thinking has been overlooked despite the emphasized need for effective teaching methods. An integrative review was performed to examine both quantitative and qualitative research published from 2000 to 2015 related to nurse educators' critical thinking. Many barriers and facilitators existing on individual, interpersonal, and contextual levels affected nurse educators' critical thinking. Various tools have been used to measure nurse educators' critical thinking. This review also highlighted the continued lack of a consensus definition of critical thinking and the limited presence of conceptual models to guide the use of critical thinking in nursing education. Continued examination of nurse educators' critical thinking is needed, given the limited number of studies that have been completed. Much needs to be explored further, including conceptualizations of critical thinking and confirmation of emerging themes identified in this review. [J Nurs Educ. 2017;56(11):648-654.]. © 2017 Raymond, Profetto-McGrath, Myrick, et al.

  14. The critical current of superconductors: an historical review

    International Nuclear Information System (INIS)

    Dew-Hughes, D.

    2001-01-01

    The most important practical characteristic of a superconductor is its critical current density. This article traces the history, both of the experimental discoveries and of the development of the theoretical ideas that have lead to the understanding of those factors that control critical current densities. These include Silsbee's hypothesis, the Meissner effect, London, Ginsburg-Landau and Abrikosov theories, flux pinning and the critical state, and the control of texture in high temperature superconductors

  15. Antisocial Personality Disorder in Older Adults: A Critical Review.

    Science.gov (United States)

    Holzer, Katherine J; Vaughn, Michael G

    2017-11-01

    Antisocial personality disorder (ASPD) has enormous negative impacts on the affected individuals, their loved ones, and society. This burden is intensified by the social and functional changes related to age. The lower prevalence of ASPD in older adults compared to younger adults is well-documented. This discrepancy, often attributed solely to antisocial "burnout," contributes to the lack of attention given to this disorder in older adults and may signify difficulty measuring ASPD in this population. These measurement issues likely stem from problems with the validity of the diagnostic criteria for older adults which may not effectively capture changes that occur with age. This review focuses on the current literature surrounding the validity of ASPD criteria with older adults and relevant concepts, including the connection between criminality and ASPD. Issues with screening tools and the measurement of ASPD caused by problems with the criteria are also discussed. Finally, recommendations for improvement, including use of dimensional models of personality disorders, a potential geriatric subclassification of criteria, and modification of the existing criteria are presented with clinical implications and suggestions for future research.

  16. Amiodarone-Associated Optic Neuropathy: A Critical Review

    Science.gov (United States)

    Passman, Rod S.; Bennett, Charles L.; Purpura, Joseph M.; Kapur, Rashmi; Johnson, Lenworth N.; Raisch, Dennis W.; West, Dennis P.; Edwards, Beatrice J.; Belknap, Steven M.; Liebling, Dustin B.; Fisher, Mathew J.; Samaras, Athena T.; Jones, Lisa-Gaye A.; Tulas, Katrina-Marie E.; McKoy, June M.

    2011-01-01

    Although amiodarone is the most commonly prescribed antiarrhythmic drug, its use is limited by serious toxicities, including optic neuropathy. Current reports of amiodarone associated optic neuropathy identified from the Food and Drug Administration's Adverse Event Reporting System (FDA-AERS) and published case reports were reviewed. A total of 296 reports were identified: 214 from AERS, 59 from published case reports, and 23 from adverse events reports for patients enrolled in clinical trials. Mean duration of amiodarone therapy before vision loss was 9 months (range 1-84 months). Insidious onset of amiodarone associated optic neuropathy (44%) was the most common presentation, and nearly one-third were asymptomatic. Optic disc edema was present in 85% of cases. Following drug cessation, 58% had improved visual acuity, 21% were unchanged, and 21% had further decreased visual acuity. Legal blindness (< 20/200) was noted in at least one eye in 20% of cases. Close ophthalmologic surveillance of patients during the tenure of amiodarone administration is warranted. PMID:22385784

  17. Meningococcal disease, a clinical and epidemiological review.

    Science.gov (United States)

    Batista, Rodrigo Siqueira; Gomes, Andréia Patrícia; Dutra Gazineo, Jorge Luiz; Balbino Miguel, Paulo Sérgio; Santana, Luiz Alberto; Oliveira, Lisa; Geller, Mauro

    2017-11-01

    Meningococcal disease is the acute infection caused by Neisseria meningitidis, which has humans as the only natural host. The disease is widespread around the globe and is known for its epidemical potential and high rates of lethality and morbidity. The highest number of cases of the disease is registered in the semi-arid regions of sub-Saharan Africa. In Brazil, it is endemic with occasional outbreaks, epidemics and sporadic cases occurring throughout the year, especially in the winter. The major epidemics of the disease occurred in Brazil in the 70's caused by serogroups A and C. Serogroups B, C and Y represent the majority of cases in Europe, the Americas and Australia. However, there has been a growing increase in serogroup W in some areas. The pathogen transmission happens for respiratory route (droplets) and clinically can lead to meningitis and sepsis (meningococcemia). The treatment is made with antimicrobial and supportive care. For successful prevention, we have some measures like vaccination, chemoprophylaxis and droplets' precautions. In this review, we have described and clarify clinical features of the disease caused by N. meningitidis regarding its relevance for healthcare professionals. Copyright © 2017 Hainan Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  18. Osteoarthritis Year in Review 2015: Clinical

    Science.gov (United States)

    Sharma, Leena

    2015-01-01

    The purpose of this review is to highlight clinical research in osteoarthritis. A literature search was conducted using PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) with the search terms “osteoarthritis [All Fields] AND treatment [All Fields]” and the following limits activated: humans, English language, all adult 19+ years, published between April 1, 2014 and April 1, 2015. A second literature search was then conducted with the search terms “osteoarthritis [All Fields] AND epidemiology [All Fields]”, with the same limits. Reports of surgical outcome, case series, surgical technique, tissue sample or culture studies, trial protocols, and pilot studies were excluded. Of 1523, 148 were considered relevant. Among epidemiologic and observational clinical studies, themes included physical activity, early knee OA, and confidence/instability/falls. Symptom outcomes of pharmacologic treatments were reported for methotrexate, adalimumab, anti-nerve growth factor monoclonal antibodies, strontium ranelate, bisphosphonates, glucosamine, and chondroitin sulfate, and structural outcomes of pharmacologic treatments for strontium ranelate, recombinant human fibroblast growth factor 18, and glucosamine and chondroitin sulfate. Symptom outcomes of non-pharmacologic interventions were reported for: neuromuscular exercise, quadriceps strengthening, weight reduction and maintenance, TENS, therapeutic ultrasound, stepped care strategies, cognitive behavior therapy for sleep disturbance, acupuncture, gait modification, booster physical therapy, a web-based therapeutic exercise resource center for knee OA; hip physical therapy for hip OA; and joint protection and hand exercises for hand OA. Structure outcomes of non-pharmacologic interventions were reported for patellofemoral bracing. PMID:26707991

  19. Osteogenesis Imperfecta: A Review with Clinical Examples

    Science.gov (United States)

    van Dijk, F.S.; Cobben, J.M.; Kariminejad, A.; Maugeri, A.; Nikkels, P.G.J.; van Rijn, R.R.; Pals, G.

    2011-01-01

    Osteogenesis imperfecta (OI) is characterized by susceptibility to bone fractures, with a severity ranging from subtle increase in fracture frequency to prenatal fractures. The first scientific description of OI dates from 1788. Since then, important milestones in OI research and treatment have, among others, been the classification of OI into 4 types (the ‘Sillence classification’), the discovery of defects in collagen type I biosynthesis as a cause of most cases of OI and the use of bisphosphonate therapy. Furthermore, in the past 5 years, it has become clear that OI comprises a group of heterogeneous disorders, with an estimated 90% of cases due to a causative variant in the COL1A1 or COL1A2 genes and with the remaining 10% due to causative recessive variants in the 8 genes known so far, or in other currently unknown genes. This review aims to highlight the current knowledge around the history, epidemiology, pathogenesis, clinical/radiological features, management, and future prospects of OI. The text will be illustrated with clinical descriptions, including radiographs and, where possible, photographs of patients with OI. PMID:22570641

  20. Porous silicon for drug delivery applications and theranostics: recent advances, critical review and perspectives.

    Science.gov (United States)

    Kumeria, Tushar; McInnes, Steven J P; Maher, Shaheer; Santos, Abel

    2017-12-01

    Porous silicon (pSi) engineered by electrochemical etching has been used as a drug delivery vehicle to address the intrinsic limitations of traditional therapeutics. Biodegradability, biocompatibility, and optoelectronic properties make pSi a unique candidate for developing biomaterials for theranostics and photodynamic therapies. This review presents an updated overview about the recent therapeutic systems based on pSi, with a critical analysis on the problems and opportunities that this technology faces as well as highlighting pSi's growing potential. Areas covered: Recent progress in pSi-based research includes drug delivery systems, including biocompatibility studies, drug delivery, theranostics, and clinical trials with the most relevant examples of pSi-based systems presented here. A critical analysis about the technical advantages and disadvantages of these systems is provided along with an assessment on the challenges that this technology faces, including clinical trials and investors' support. Expert opinion: pSi is an outstanding material that could improve existing drug delivery and photodynamic therapies in different areas, paving the way for developing advanced theranostic nanomedicines and incorporating payloads of therapeutics with imaging capabilities. However, more extensive in-vivo studies are needed to assess the feasibility and reliability of this technology for clinical practice. The technical and commercial challenges that this technology face are still uncertain.

  1. Review of the CRAC and SILENE Criticality Accident Studies

    International Nuclear Information System (INIS)

    Barbry, F.; Fouillaud, P.; Grivot, P.; Reverdy, L.

    2009-01-01

    In 1967, the Commissariat et l'Energie Atomique (French Atomic Energy Agency) performed its first research on criticality accidents for the purpose of limiting their impact on people, the environment, and nuclear facilities themselves. A criticality accident is accompanied by intense neutron and gamma emissions and release of radioactive fission products-gases and aerosols-gene rating risk of irradiation and contamination. This work has supplemented earlier work in criticality safety, which concentrated on critical mass measurements and computations. Understanding of the consequences of criticality accidents was limited. Emergency planning was hampered by lack of data. Information became available from pulsed reactor experiments, but the experiments were restricted to the established reactor configurations. The objectives of research performed at the Valduc criticality laboratory, mainly on aqueous fissile media, using the CRAC and SILENE facilities, by multidisciplinary teams of physicists, dosimetry specialists, and radio-biologists, were to model criticality accident physics, estimate irradiation risks and radioactive releases, detect excursions, and organize emergency response. The results of the Valduc experiments have contributed toward improved understanding of criticality accident phenomenology and better evaluation of the risks associated with such accidents. (authors)

  2. Review of the CRAC and SILENE Criticality Accident Studies

    Energy Technology Data Exchange (ETDEWEB)

    Barbry, F.; Fouillaud, P.; Grivot, P.; Reverdy, L. [CEA Valduc, Serv Rech Neutron and Critcite, 21 - Is-sur-Tille (France)

    2009-02-15

    In 1967, the Commissariat et l'Energie Atomique (French Atomic Energy Agency) performed its first research on criticality accidents for the purpose of limiting their impact on people, the environment, and nuclear facilities themselves. A criticality accident is accompanied by intense neutron and gamma emissions and release of radioactive fission products-gases and aerosols-gene rating risk of irradiation and contamination. This work has supplemented earlier work in criticality safety, which concentrated on critical mass measurements and computations. Understanding of the consequences of criticality accidents was limited. Emergency planning was hampered by lack of data. Information became available from pulsed reactor experiments, but the experiments were restricted to the established reactor configurations. The objectives of research performed at the Valduc criticality laboratory, mainly on aqueous fissile media, using the CRAC and SILENE facilities, by multidisciplinary teams of physicists, dosimetry specialists, and radio-biologists, were to model criticality accident physics, estimate irradiation risks and radioactive releases, detect excursions, and organize emergency response. The results of the Valduc experiments have contributed toward improved understanding of criticality accident phenomenology and better evaluation of the risks associated with such accidents. (authors)

  3. The scholarship of critical review: improving quality and relevance.

    Science.gov (United States)

    Lawrence, Dana; Ebrall, Phillip

    2008-12-01

    To describe the process of scientific peer review as it is used in the manuscript submission process, assess threats and challenges to the peer review process, and to offer suggestions for enhancing its effectiveness. Peer review is often seen as one of the hallmarks of scientific publication. The primary goal of peer review is to improve the science within papers that are ultimately published, by helping an editor better understand the strengths and weaknesses of a given paper. This process, while fairly well studied within the medical field, has received almost no attention at all within chiropractic. This paper provides guidance to reviewers and potential reviewers which can help them to understand both the scientific and the human aspects of peer review. This is designed to elevate this function to one trusted by the profession rather than seen as simply another hurdle to overcome. Several future directions are offered, including unblinding the review process for transparency, conducting rigorous studies looking at peer review, and developing formal training programs for potential reviewers. Peer review is likely to remain in force as a means to provide guidance to authors and editors about the rigor of submitted papers. However, the nature of peer review may be changing and editors and authors need to stay aware of the implications of these changes. Recommendations to open the process, study it and develop training programs are designed to ensure that the process remains as impartial as possible.

  4. Kombucha: a systematic review of the clinical evidence.

    Science.gov (United States)

    Ernst, E

    2003-04-01

    Kombucha has become a popular complementary remedy. The aim of this systematic review was to critically evaluate the evidence related to its efficacy and safety. Computerised literature searches were carried out to locate all human medical investigations of kombucha regardless of study design. Data were extracted and validated by the present author and are reported in narrative form. No clinical studies were found relating to the efficacy of this remedy. Several case reports and case series raise doubts about the safety of kombucha. They include suspected liver damage, metabolic acidosis and cutaneous anthrax infections. One fatality is on record. On the basis of these data it was concluded that the largely undetermined benefits do not outweigh the documented risks of kombucha. It can therefore not be recommended for therapeutic use. Copyright 2003 S. Karger GmbH, Freiburg

  5. Hepatic lipidosis: Clinical review drawn from collective effort.

    Science.gov (United States)

    Webb, Craig B

    2018-03-01

    Practical relevance: Hepatic lipidosis (HL) is the most common form of liver dysfunction in cats. If recognized early and treated appropriately, the prognosis is good; if not, the prognosis is grave. Clinical challenges: Distinguishing HL as idiopathic or secondary is critical since the presence of a concurrent disease affects the therapeutic plan and the prognosis. Despite the unique and severe nature of a cat's response to anorexia and the complexity of the metabolic changes underlying this condition, the clinical acumen and technical ability to effectively diagnose and treat HL are readily available to all small animal practitioners. Patient group: Although many species develop a 'fatty liver', the cat is one of relatively few species that suffer from HL. The classic presentation is that of an overweight cat that stops eating for days to weeks, losing weight in the process. Equipment: Abdominal ultrasound is frequently employed in the diagnostic work-up of an anorectic cat; ultrasonographic findings often support a presumptive diagnosis, provide samples for cytology and, perhaps most importantly, help identify concurrent conditions that must be addressed for therapeutic success. All of the equipment necessary for essential nutritional intervention in an anorectic cat is readily available and easily affordable. Evidence base: The material for this review draws heavily on a relatively large number of original studies, excellent reviews by recognized experts, and informative communication with experienced clinicians, hence the term 'collective effort'.

  6. Critical Discourse Analysis in Literacy Education: A Review of the Literature

    Science.gov (United States)

    Rogers, Rebecca; Schaenen, Inda

    2014-01-01

    This article is a critical, integrative literature review of scholarship in literacy studies from 2004 to 2012 that draws on critical discourse analysis (CDA). We discuss key issues, trends, and criticisms in the field. Our methodology was carried out in three stages. First, we searched educational databases to locate literacy-focused CDA…

  7. Gold nanoparticles delivery in mammalian live cells: a critical review

    Directory of Open Access Journals (Sweden)

    Raphaël Lévy

    2010-02-01

    Full Text Available Functional nanomaterials have recently attracted strong interest from the biology community, not only as potential drug delivery vehicles or diagnostic tools, but also as optical nanomaterials. This is illustrated by the explosion of publications in the field with more than 2,000 publications in the last 2 years (4,000 papers since 2000; from ISI Web of Knowledge, ‘nanoparticle and cell’ hit. Such a publication boom in this novel interdisciplinary field has resulted in papers of unequal standard, partly because it is challenging to assemble the required expertise in chemistry, physics, and biology in a single team. As an extreme example, several papers published in physical chemistry journals claim intracellular delivery of nanoparticles, but show pictures of cells that are, to the expert biologist, evidently dead (and therefore permeable. To attain proper cellular applications using nanomaterials, it is critical not only to achieve efficient delivery in healthy cells, but also to control the intracellular availability and the fate of the nanomaterial. This is still an open challenge that will only be met by innovative delivery methods combined with rigorous and quantitative characterization of the uptake and the fate of the nanoparticles. This review mainly focuses on gold nanoparticles and discusses the various approaches to nanoparticle delivery, including surface chemical modifications and several methods used to facilitate cellular uptake and endosomal escape. We will also review the main detection methods and how their optimum use can inform about intracellular localization, efficiency of delivery, and integrity of the surface capping. Raphaël Lévy is a BBSRC David Phillips Research Fellow at the University of Liverpool. He graduated in Physics at the University Louis Pasteur in Strasbourg (France. In 2002, after a Master in Soft Condensed Matter Physics, he obtained a PhD in Physics at the University Louis Pasteur. He then moved to

  8. What we know about primary dysmenorrhea today: a critical review.

    Science.gov (United States)

    Iacovides, Stella; Avidon, Ingrid; Baker, Fiona C

    2015-01-01

    Primary dysmenorrhea, or painful menstruation in the absence of pelvic pathology, is a common, and often debilitating, gynecological condition that affects between 45 and 95% of menstruating women. Despite the high prevalence, dysmenorrhea is often poorly treated, and even disregarded, by health professionals, pain researchers, and the women themselves, who may accept it as a normal part of the menstrual cycle. This review reports on current knowledge, particularly with regards to the impact and consequences of recurrent menstrual pain on pain sensitivity, mood, quality of life and sleep in women with primary dysmenorrhea. Comprehensive literature searches on primary dysmenorrhea were performed using the electronic databases PubMed, Google Scholar and the Cochrane Library. Full-text manuscripts published between the years 1944 and 2015 were reviewed for relevancy and reference lists were cross-checked for additional relevant studies. In combination with the word 'dysmenorrhea' one or more of the following search terms were used to obtain articles published in peer-reviewed journals only: pain, risk factors, etiology, experimental pain, clinical pain, adenomyosis, chronic pain, women, menstrual cycle, hyperalgesia, pain threshold, pain tolerance, pain sensitivity, pain reactivity, pain perception, central sensitization, quality of life, sleep, treatment, non-steroidal anti-inflammatory drugs. Women with dysmenorrhea, compared with women without dysmenorrhea, have greater sensitivity to experimental pain both within and outside areas of referred menstrual pain. Importantly, the enhanced pain sensitivity is evident even in phases of the menstrual cycle when women are not experiencing menstrual pain, illustrating that long-term differences in pain perception extend outside of the painful menstruation phase. This enhanced pain sensitivity may increase susceptibility to other chronic pain conditions in later life; dysmenorrhea is a risk factor for fibromyalgia. Further

  9. Fournier’s gangrene. A clinical review

    Directory of Open Access Journals (Sweden)

    Ariana Singh

    2016-10-01

    Full Text Available Introduction and Hypothesis: Fournier’s gangrene is a rare, necrotising fasciitis of the external genitalia, perineal or perianal regions. The disease has a higher incidence in males and risk factors for development include diabetes, HIV, alcoholism and other immune-compromised states. The aggressive disease process is associated with a high mortality rate of 20-30%. In addition, the increasing age and prevalence of diabetes in the population, begs the need for increased clinical awareness of Fournier’s gangrene with emphasis on early diagnosis and management. This review aims to highlight the relevant research surrounding Fournier’s gangrene, in particular the various prognostic indicators and management strategies. Methods: A search was conducted on the MEDLINE database for all applicable research; clinical reviews, retrospective studies and case reports. In addition to which a search of the European Association of Urology, the British Association for Urological Surgeons and the British Medical Journal was conducted for the most recent recommendations. Results: Immediate broad-spectrum antibiotic therapy and urgent surgical debridement are the core managerial principles of Fournier’s gangrene. The use of adjunctive therapies such as hyperbaric oxygen and vacuum assisted closure are supported in some aspects of the literature and disputed in others. The lack of randomized controlled studies limits the use of these potential additional therapies to patients unresponsive to conventional management. The value of unprocessed honey as a topical antimicrobial agent has been highlighted in the literature for small lesions in uncomplicated patients. Conclusion: Fournier’s gangrene is a urological emergency with a high mortality rate despite advances in the medical and surgical fields. The aggressive nature of the infection advocates the need for early recognition allowing immediate surgical intervention. The opposing results of available

  10. A clinical review of phototherapy for psoriasis.

    Science.gov (United States)

    Zhang, Ping; Wu, Mei X

    2018-01-01

    Psoriasis is an autoimmune inflammatory skin disease. In the past several decades, phototherapy has been widely used to treat stable psoriatic lesions, including trunk, scalp, arms and legs, and partial nail psoriasis. A variety of light/lasers with different mechanisms of action have been developed for psoriasis including ultraviolet B (UVB), psoralen ultraviolet A (PUVA), pulsed dye laser (PDL), photodynamic therapy (PDT), intense pulsed light (IPL), light-emitting diodes (LED), and so on. Because light/laser each has specific therapeutic and adverse effects, it is important to adequately choose the sources and parameters in management of psoriasis with different pathogenic sites, severities, and duration of the disorder. This review aims at providing most updated clinic information to physicians about how to select light/laser sources and individual therapeutic regimens. To date, UV light is primarily for stable plaque psoriasis and PDL for topical psoriatic lesions with small area, both of which are safe and effective. On the other hand, PUVA has better curative effects than UVB for managing refractory psoriasis plaques, if its side effects can be better controlled. PDL provides optimal outcomes on nail psoriasis compared with other lasers. Although the trails of low-level light/laser therapy (LLLT) are still small, the near infrared (NIR) and visible red light with low energy show promise for treating psoriasis due to its strong penetration and encouraging photobiomodulation. IPL is rarely reported for psoriasis treatment, but PDT-IPL has been found to offer a moderate effect on nail psoriasis. In brief, various phototherapies have been used either in different combinations or as monotherapy. The modality has become a mainstay in the treatment of mild-to-moderate psoriasis without systemic adverse events in today's clinical practice.

  11. Pre-treatment risk stratification of prostate cancer patients: A critical review.

    Science.gov (United States)

    Rodrigues, George; Warde, Padraig; Pickles, Tom; Crook, Juanita; Brundage, Michael; Souhami, Luis; Lukka, Himu

    2012-04-01

    The use of accepted prostate cancer risk stratification groups based on prostate-specific antigen, T stage and Gleason score assists in therapeutic treatment decision-making, clinical trial design and outcome reporting. The utility of integrating novel prognostic factors into an updated risk stratification schema is an area of current debate. The purpose of this work is to critically review the available literature on novel pre-treatment prognostic factors and alternative prostate cancer risk stratification schema to assess the feasibility and need for changes to existing risk stratification systems. A systematic literature search was conducted to identify original research publications and review articles on prognostic factors and risk stratification in prostate cancer. Search terms included risk stratification, risk assessment, prostate cancer or neoplasms, and prognostic factors. Abstracted information was assessed to draw conclusions regarding the potential utility of changes to existing risk stratification schema. The critical review identified three specific clinically relevant potential changes to the most commonly used three-group risk stratification system: (1) the creation of a very-low risk category; (2) the splitting of intermediate-risk into a low- and high-intermediate risk groups; and (3) the clarification of the interface between intermediate- and high-risk disease. Novel pathological factors regarding high-grade cancer, subtypes of Gleason score 7 and percentage biopsy cores positive were also identified as potentially important risk-stratification factors. Multiple studies of prognostic factors have been performed to create currently utilized prostate cancer risk stratification systems. We propose potential changes to existing systems.

  12. PENERAPAN CRITICAL REVIEW ARTIKEL PEMBELAJARAN IPA UNTUK MENINGKATKAN KEMAMPUAN MAHASISWA DALAM MENYUSUN PROPOSAL SKRIPSI

    Directory of Open Access Journals (Sweden)

    p parmin

    2016-02-01

    Full Text Available The aims of this research is to improve students’ ability in develop- ing a proposal thesis by applying critical review of scientific articles come from journals. The research is designed by class action research. The results showed 63% of students thesis proposals on Research Methodology course scored above 80. Based on the results obtained it can be concluded that the application has been critical review or critical study of scientific articles can enhance students’ ability in preparing research proposals.

  13. A missing ethical competency? A review of critical reflection in health promotion.

    Science.gov (United States)

    Tretheway, Rebecca; Taylor, Jane; O'Hara, Lily; Percival, Nikki

    2015-12-01

    There is increasing emphasis in the health promotion literature on the ethical imperative for the profession to move towards critical practice. A key challenge for health promotion is that critical practice appears both under-developed and under-practiced. This is evident in the omission of critical reflection from Australian and international competencies for health promotion practitioners. A narrative literature review was undertaken to explore the current use of critical reflection in health promotion. Critical reflection models relevant to health promotion were identified and critiqued. There was a dearth of literature on critical reflection within health promotion, despite recognition of its potential to support critical practice. The discipline of critical social work provided literature on the use, effect and outcome of critical reflection in practice. The interdisciplinary critical reflection model was identified as the model most applicable to health promotion. Underpinned by critical theory, this model emphasises both critical and ethical practice. Critical reflection is a core competency for health promotion practitioners to address the ethical imperative to move towards critical practice. There is a need to explore the application of a critical reflection model in health promotion to determine how it may support critical and ethical practice. So what? If health promotion is to meet its ethical responsibilities, then critical reflection needs to be articulated as a core health promotion competency and a model for its application in health promotion developed.

  14. Vitamin D in schizophrenia: a clinical review.

    Science.gov (United States)

    Chiang, Mathew; Natarajan, Radhika; Fan, Xiaoduo

    2016-02-01

    Vitamin D (vitD) is known for its essential role in calcium homeostasis and bone health. VitD is made endogenously in the skin from UVB radiation from sunlight. VitD is now considered as a potent neurosteroid hormone, critical to brain development and normal brain function, and is known for its anti-inflammatory property affecting various aspects of human health. VitD ligand-receptor, a receptor that mediates much of vitD's biological actions, has been found throughout the body including the central nervous system. VitD deficiency is common in patients with severe mental illness such as schizophrenia. Schizophrenia is a debilitating chronic mental illness characterised by positive symptoms, such as hallucinations and delusions, and negative symptoms including flat affect and lack of motivation. Several environmental risk factors for schizophrenia, such as season of birth, latitude and migration, have been linked to vitD deficiency. Recent studies have suggested a potential role of vitD in the development of schizophrenia. For example, neonatal vitD status is associated with the risk of developing schizophrenia in later life obesity, insulin resistance, diabetes, hyperlipidaemia and cardiovascular disease, which are commonly seen in patients with schizophrenia. It has been well established that vitD deficiency is related to these metabolic problems. The biological mechanism is most likely related to vitD's action on the regulation of inflammatory and immunological processes, consequently affecting the manifestation of clinical symptoms and treatment response of schizophrenia. Potential benefits of vitD supplementation to improve schizophrenia symptoms as well as physical health in patients with schizophrenia should be further explored in future studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. Clinical concept mapping: Does it improve discipline-based critical thinking of nursing students?

    Science.gov (United States)

    Moattari, Marzieh; Soleimani, Sara; Moghaddam, Neda Jamali; Mehbodi, Farkhondeh

    2014-01-01

    Background: Enhancing nursing students’ critical thinking is a challenge faced by nurse educators. This study aimed at determining the effect of clinical concept mapping on discipline-based critical thinking of nursing students. Materials and Methods: In this quasi-experimental post-test only design, a convenient sample of 4th year nursing students (N = 32) participated. They were randomly divided into two groups. The experimental group participated in a 1-day workshop on clinical concept mapping. They were also assigned to use at least two clinical concepts mapping during their clinical practice. Post-test was done using a specially designed package consisting of vignettes for measurement of 17 dimensions of critical thinking in nursing under two categories of cognitive critical thinking skills and habits of mind. They were required to write about how they would use a designated critical thinking skills or habits of mind to accomplish the nursing actions. The students’ responses were evaluated based on identification of critical thinking, justification, and quality of the student's response. The mean score of both groups was compared by Mann-Whitney test using SPSS version 16.5. Results: The results of the study revealed a significant difference between the two groups’ critical thinking regarding identification, justification, and quality of responses, and overall critical thinking scores, cognitive thinking skills, and habits of mind. The two groups also differed significantly from each other in 11 out of 17 dimensions of critical thinking. Conclusion: Clinical concept mapping is a valuable strategy for improvement of critical thinking of nursing students. However, further studies are recommended to generalize this result to nursing students in their earlier stage of education. PMID:24554963

  16. Clinical concept mapping: Does it improve discipline-based critical thinking of nursing students?

    Science.gov (United States)

    Moattari, Marzieh; Soleimani, Sara; Moghaddam, Neda Jamali; Mehbodi, Farkhondeh

    2014-01-01

    Enhancing nursing students' critical thinking is a challenge faced by nurse educators. This study aimed at determining the effect of clinical concept mapping on discipline-based critical thinking of nursing students. In this quasi-experimental post-test only design, a convenient sample of 4(th) year nursing students (N = 32) participated. They were randomly divided into two groups. The experimental group participated in a 1-day workshop on clinical concept mapping. They were also assigned to use at least two clinical concepts mapping during their clinical practice. Post-test was done using a specially designed package consisting of vignettes for measurement of 17 dimensions of critical thinking in nursing under two categories of cognitive critical thinking skills and habits of mind. They were required to write about how they would use a designated critical thinking skills or habits of mind to accomplish the nursing actions. The students' responses were evaluated based on identification of critical thinking, justification, and quality of the student's response. The mean score of both groups was compared by Mann-Whitney test using SPSS version 16.5. The results of the study revealed a significant difference between the two groups' critical thinking regarding identification, justification, and quality of responses, and overall critical thinking scores, cognitive thinking skills, and habits of mind. The two groups also differed significantly from each other in 11 out of 17 dimensions of critical thinking. Clinical concept mapping is a valuable strategy for improvement of critical thinking of nursing students. However, further studies are recommended to generalize this result to nursing students in their earlier stage of education.

  17. A national survey on pediatric critical values used in clinical laboratories across Canada.

    Science.gov (United States)

    Gong, Yanping; Adeli, Khosrow

    2009-11-01

    Notification of critical values to clinical staff is an important post-analytical process in all acute care clinical laboratories. No data are available however on how laboratories obtain or establish critical values, particularly in pediatric settings. This study was designed to examine and compare critical values used for pediatric patients in biochemistry laboratories in Canada and assess potential interlaboratory variability. Fourteen clinical laboratories, including two in pediatric hospitals and twelve in hospitals caring for both children and adults, participated in a survey that included 14 pre-selected STAT chemistry tests and 19 pre-selected therapeutic drug monitoring (TDM) tests. Among fourteen chemistry tests, good agreement was observed for critical values used for sodium and pH at both low and high levels within 14 participant laboratories. Significant interlaboratory variability existed for glucose critical values at the high end, magnesium at high end, and PO2 at the low end. For 19 TDM tests, the majority of laboratories did not have alert values to report values over the therapeutic level but not toxic. For critical values greater than the toxic range, significant variability existed at both trough and peak levels among laboratories surveyed. When asked to provide the source for critical values established at each site, only a limited number of laboratories identified their sources as either internal decision or published references. Although all laboratories have established and routinely use critical values to alert clinical staff, considerable variability exists in both the critical limits reported as well as the source of such values. There is a clear need for new national efforts to standardize pediatric critical value reporting and establish evidence-based critical limits for all medical laboratories across Canada.

  18. Current trials to reduce surgical intervention in ductal carcinoma in situ of the breast: Critical review.

    Science.gov (United States)

    Toss, M; Miligy, I; Thompson, A M; Khout, H; Green, A R; Ellis, I O; Rakha, E A

    2017-10-01

    The high proportion of ductal carcinoma in situ (DCIS) presented in mammographic screening and the relatively low risk of progression to invasive disease have raised questions related to overtreatment. Following a review of current DCIS management protocols a more conservative approach has been suggested. Clinical trials have been introduced to evaluate the option of avoiding surgical intervention in a proportion of patients with DCIS defined as "low-risk" using certain clinicopathological criteria. These trials can potentially provide evidence-based models of active surveillance (with or without endocrine therapy) as a future management approach. Despite the undisputable fact of our need to address the obvious overtreatment of screen-detected DCIS, some important questions need to be considered regarding these trials including the eligibility criteria and definition of risk, the proportion of patient eligible for inclusion, and the length of time required for proper analysis of the trials' outcome in view of the long-term natural history of DCIS progression particularly the low-risk group. These factors can potentially affect the practicality and future impact of such trials. This review provides critical analysis of current DCIS management trials and highlights critical issues related to their practicality and the expected outcome. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Behavioral, cognitive, and emotional coping strategies of women with endometriosis: a critical narrative review.

    Science.gov (United States)

    Zarbo, Cristina; Brugnera, Agostino; Frigerio, Luigi; Malandrino, Chiara; Rabboni, Massimo; Bondi, Emi; Compare, Angelo

    2018-02-01

    Endometriosis is a disabling and long-term medical condition affecting quality of life and mental health. Behavioral, cognitive, and emotional coping strategies, emotional intelligence, and metacognition could in part explain the link between the disease and impaired psychological and life functioning. This critical narrative review aimed at examining the state of the art of the relationships between endometriosis and these factors. According to PRISMA principles, we performed a systematic search for quantitative and qualitative studies on multiple electronic databases as regards coping strategies, emotional intelligence, and metacognition in women with endometriosis. Studies were subjected to interpretative and critical narrative synthesis. A total of 9 papers were included in the review. Three main categories were identified in thematic analysis and resumed in the manuscript. Findings suggested that (a) pain is considered the major stressor; (b) they usually use both adaptive and maladaptive coping strategies; (c) women with endometriosis and related chronic pain seem to repress emotions more likely than healthy ones; (d) suppressing own emotions, pain catastrophizing, and having a passive coping style are related to higher self-reported pain; and (e) emotional and avoidance coping styles are associated to poor mental status, while positive coping strategies focusing on the problem or on emotions, detached and rational styles are associated to better mental health. Few studies with mixed results and some methodological flaws have focused on coping strategies in women with endometriosis. No studies focusing on metacognition or emotional intelligence were found. Methodological biases, suggestions for future research, and implications for clinical practice were discussed.

  20. Palliative Care in Critical Care Settings: A Systematic Review of Communication-Based Competencies Essential for Patient and Family Satisfaction.

    Science.gov (United States)

    Schram, Andrew W; Hougham, Gavin W; Meltzer, David O; Ruhnke, Gregory W

    2017-11-01

    There is an emerging literature on the physician competencies most meaningful to patients and their families. However, there has been no systematic review on physician competency domains outside direct clinical care most important for patient- and family-centered outcomes in critical care settings at the end of life (EOL). Physician competencies are an essential component of palliative care (PC) provided at the EOL, but the literature on those competencies relevant for patient and family satisfaction is limited. A systematic review of this important topic can inform future research and assist in curricular development. Review of qualitative and quantitative empirical studies of the impact of physician competencies on patient- and family-reported outcomes conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines for systematic reviews. The data sources used were PubMed, MEDLINE, Web of Science, and Google Scholar. Fifteen studies (5 qualitative and 10 quantitative) meeting inclusion and exclusion criteria were identified. The competencies identified as critical for the delivery of high-quality PC in critical care settings are prognostication, conflict mediation, empathic communication, and family-centered aspects of care, the latter being the competency most frequently acknowledged in the literature identified. Prognostication, conflict mediation, empathic communication, and family-centered aspects of care are the most important identified competencies for patient- and family-centered PC in critical care settings. Incorporation of education on these competencies is likely to improve patient and family satisfaction with EOL care.

  1. Promoting Clinical Reasoning in Undergraduate Physical Therapy Education: A Review of Strategies and Approaches

    DEFF Research Database (Denmark)

    Brekke, Anders Falk

    2015-01-01

    Title: Promoting Clinical Reasoning in Undergraduate Physical Therapy Education: A Review of Strategies and Approaches Juneja H1, Brekke A F2 1,2 Physical Therapy Education, University College Zealand, Denmark Background: Clinical reasoning (CR) also referred to as “critical thinking” or “decision....... It is imperative that physical therapy educators utilize innovative pedagogical methods to facilitate learning of reasoning skills in students. Purpose: The review is an attempt to highlight and discuss selected pedagogical strategies and approaches to enhance clinical reasoning skills in undergraduate physical...... programs was shortlisted for the review. References of pertinent literature were scanned to identify further relevant citations. Results: The review provides a detailed insight into the interwoven nature of pedagogical techniques to promote clinical reasoning being used by different physical therapy...

  2. Clinical profile and outcome of critically ill pregnant females with H1N1 influenza

    Directory of Open Access Journals (Sweden)

    Minal Shastri

    2016-12-01

    Full Text Available Background Record based review of the 2009 H1N1 Influenza pandemic suggests that pregnant women are at higher risk for hospitalization and death due to H1N1 Influenza. Aims To study the clinical profile and outcome of critically ill pregnant females admitted in intensive care unit (ICU with real-time recombinant polymerase chain reaction (rRT-PCR proven positive H1N1 cases. Methods A retrospective record-review based study was conducted at Sir SayajiRao General Hospital (SSGH and Medical College, Vadodara on data of confirmed rRT-PCR H1N1 pregnant females admitted during the pandemics of 2010and 2015. Demographics, clinical profile and laboratory investigations were recorded and outcomes (survived or expired were analysed. Results There were a total of 20 H1N1 positive pregnant females requiring ICU admission. With equal demographic distribution among rural and urban population, cough and fever were the most common presenting complaints. 65 per cent were in third trimester, the subgroup which also had the highest mortality. Mean days from onset until presentation was 5.05 days. 12 (60 per cent patients’ required invasive mode of ventilation and all died. Average hospital stay was 7 days. Foetus had favourable outcome in patients who recovered from H1N1 acute illness. Conclusion Pregnant females in our study had 60 per cent mortality. Thus, awareness, early diagnosis and treatment should be provided to them. Guidelines, policy changes and government protocols are required specifically for pregnant females with H1N1 Influenza A infection. Our study was an observational study and comparisons with non-pregnant females were not done, conclusions applicable to entire pregnant population was not derived.

  3. Contraceptive Health Programs for Adolescents: A Critical Review.

    Science.gov (United States)

    Lagana, Luciana; Hayes, David M.

    1993-01-01

    Reviews some contraceptive education programs designed for adolescents that differ in educational process based on delivery setting. Reviews school-based, community-based, and college/university-based programs and discusses them in terms of their effectiveness, potential, and limitations. Notes that educational accountability in each setting…

  4. A Critical Review of the Literature for Sales Educators

    Science.gov (United States)

    Cummins, Shannon; Peltier, James W.; Erffmeyer, Robert; Whalen, Joel

    2013-01-01

    The "Journal of Marketing Education" is publishing a special issue on Sales Education and Training in August 2014. In this article, we review the sales education literature from four primary journals and the business literature at large. The four primary journals are the "Journal of Marketing Education," "Marketing Education Review," "Journal of…

  5. A Review on the Linear and Nonlinear Critical Speeds

    DEFF Research Database (Denmark)

    True, Hans

    2013-01-01

    In recent years several authors have proposed 'easier numerical methods' to find multiple attractors and the critical speed in railway dynamical problems. Actually, the methods do function in some cases, but they are not safe in the sense that you will calculate the relevant critical parameter...... values with a reasonable accuracy. In some cases the 'easier numerical methods' are really just a gamble. In this presentation the methods will be discussed. For this purpose linearisations of the nonlinear dynamical problem are made. A linearisation of the nonlinear dynamical problem simplifies...... the calculations and may give relevant answers to important questions such as the possibility of resonance phenomena in the designs, but a linearisation is not always allowed, and it does not help to find the critical speed of a railway vehicle. We shall also address the curious fact that the hunting motion...

  6. An analysis of narratives to identify critical thinking contexts in psychiatric clinical practice.

    Science.gov (United States)

    Mun, Mi Suk

    2010-02-01

    The development of students' critical thinking abilities is one of the greatest challenges facing contemporary nursing educators. Nursing educators should know about what kind of contents or situations need critical thinking. The research was undertaken to identify the critical thinking contexts that nursing students confront in psychiatric clinical practices. Students were asked to document their everyday experience. The narratives were analysed and interpreted from the philosophical notion of hermeneutics. Four themes emerged as critical thinking contexts: anxiety, conflict, hyper-awareness, dilemmas. Writing narratives appear to provide opportunities for reflection in addition to facilitating critical thinking and communicative skills in students. Also, for the instructor, students' clinical narratives could provide insight to understand how students are thinking and to share student's personal difficulties.

  7. Wiki Activities in Blended Learning for Health Professional Students: Enhancing Critical Thinking and Clinical Reasoning Skills

    Science.gov (United States)

    Snodgrass, Suzanne

    2011-01-01

    Health professionals use critical thinking, a key problem solving skill, for clinical reasoning which is defined as the use of knowledge and reflective inquiry to diagnose a clinical problem. Teaching these skills in traditional settings with growing class sizes is challenging, and students increasingly expect learning that is flexible and…

  8. PENERAPAN CRITICAL REVIEW ARTIKEL PEMBELAJARAN IPA UNTUK MENINGKATKAN KEMAMPUAN MAHASISWA DALAM MENYUSUN PROPOSAL SKRIPSI

    Directory of Open Access Journals (Sweden)

    Parmin -

    2012-10-01

    Full Text Available Penelitian bertujuan untuk meningkatkan kemampuan mahasiswa dalam menyusun proposal skripsi melalui penerapan critical review artikel ilmiah bersumber dari jurnal. Penelitian dirancang dengan metode penelitian tindakan kelas. Hasil penelitian menunjukkan 63% proposal skripsi mahasiswa pada mata kuliah Metodologi Penelitian mendapatkan nilai diatas 80. Berdasarkan hasil yang telah diperoleh dapat disimpulkan penerapan critical review atau kajian kritis terhadap artikel ilmiah dapat meningkatkan kemampuan mahasiswa dalam menyusun proposal penelitian.   The aims of this research is to improve students' ability in developing a proposal thesis by applying critical review of scientific articles come from journals. The research is designed by class action research. The results showed 63% of students thesis proposals on Research Methodology course scored above 80. Based on the results obtained it can be concluded that the application has been critical review or critical study of scientific articles can enhance students' ability in preparing research proposals.

  9. O tratamento farmacológico do transtorno bipolar: uma revisão sistemática e crítica dos aspectos metodológicos dos estudos clínicos modernos The pharmacological treatment of bipolar disorder: a systematic and critical review of the methodological aspects of modern clinical trials

    Directory of Open Access Journals (Sweden)

    Elie Cheniaux

    2011-03-01

    Full Text Available OBJETIVO: Revisar sistematicamente os principais estudos clínicos sobre o tratamento farmacológico do transtorno bipolar e fazer uma análise crítica de seus aspectos metodológicos. MÉTODO: Realizou-se uma busca nas bases de dados Medline, ISI e PsycINFO, utilizando-se os seguintes termos de busca: "bipolar", "randomized", "placebo" e "controlled". Foram selecionados estudos clínicos randomizados, duplo-cegos e controlados por placebo sobre o tratamento farmacológico do transtorno bipolar. Além disso, de acordo com os nossos critérios, as amostras deveriam ser de no mínimo 100 pacientes e a substância testada deveria ser usada como monoterapia. RESULTADOS: 34 artigos se adequaram aos critérios de seleção. Todas as substâncias atualmente indicadas para mania, depressão bipolar e para o tratamento de manutenção foram mais eficazes que o placebo em pelo menos um estudo. Todavia, esses estudos tiveram amostras altamente selecionadas, altas taxas de abandono e baixas taxas de resposta clínica. CONCLUSÃO: Os modernos estudos clínicos sobre o tratamento farmacológico do transtorno bipolar apresentam algumas importantes limitações metodológicas. Assim, seus resultados devem ser considerados com cautela.OBJECTIVE: To review systematically the main clinical trials on the pharmacological treatment of bipolar disorder and to make a critical analysis of their methodological aspects. METHOD: A search in Medline, ISI and PsycINFO databases was conducted, using the following search terms: "bipolar", "randomized", "placebo" e "controlled". Randomized, double-blind, placebo-controlled clinical trials on the pharmacological treatment of bipolar disorder were selected. Besides, according to our criteria, samples had to consist of at least 100 patients and experimental drug had to be used as monotherapy. RESULTS: 34 articles met our selection criteria. All drugs currently indicated for mania, bipolar depression and maintenance treatment of

  10. Relationships between critical thinking ability and nursing competence in clinical nurses.

    Science.gov (United States)

    Chang, Mei Jen; Chang, Ying-Ju; Kuo, Shih-Hsien; Yang, Yi-Hsin; Chou, Fan-Hao

    2011-11-01

    To examine the relationships between critical thinking ability and nursing competence in clinical nurses. There are few evidance-based data related to the relationship between critical thinking ability and nursing competence of clinical nurses. A cross-sectional and correlation research design was used. A total of 570 clinical nurses at a medical centre in southern Taiwan were recruited into this study. Two self-report questionnaires, the Watson-Glaser Critical Thinking Appraisal (WGCTA) and the Nursing Competence Scale (NCS), were used to collect data. The critical thinking ability of clinical nurses was at the middle level. The highest score for the subscales of the WGCTA was 'interpretation ability' and the lowest was 'inference ability'. The nursing competence of clinical nurses was at the middle level and above. The highest score for the subscales was 'caring ability' and the lowest was 'research ability'. Critical thinking ability had a significantly positive correlation with nursing competence. Critical thinking, working years, educational levels and position/title were the significant predictors of nursing competence, accounting for 32·9% of the variance. Critical thinking ability had a significantly positive correlation with nursing competence. The critical thinking ability of clinical nurses with a master's degree was significantly better than those with a bachelor's degree or a diploma and nurses with over five working years was significantly better than those with under five years. The findings of this study can further serve as a reference for nursing education to improve nursing curricula and teaching strategies for nurse preparation. It could also be a guideline for nursing administration personnel in on-the-job training and orientation programs for nursing staff. © 2011 Blackwell Publishing Ltd.

  11. Current technological advances in magnetic resonance with critical impact for clinical diagnosis and therapy.

    Science.gov (United States)

    Runge, Val M

    2013-12-01

    The last 5 years of technological advances with major impact on clinical magnetic resonance (MR) are discussed, with greater emphasis on those that are most recent. These developments have already had a critical positive effect on clinical diagnosis and therapy and presage continued rapid improvements for the next 5 years. This review begins with a discussion of 2 topics that encompass the breadth of MR, in terms of anatomic applications, contrast media, and MR angiography. Subsequently, innovations are discussed by anatomic category, picking the areas with the greatest development, starting with the brain, moving forward to the liver and kidney, and concluding with the musculoskeletal system, breast, and prostate. Two final topics are then considered, which will likely, with time, become independent major fields in their own right, interventional MR and MR positron emission tomography (PET).The next decade will bring a new generation of MR contrast media, with research focused on substantial improvements (>100-fold) in relaxivity (contrast effect), thus providing greater efficacy, safety, and tissue targeting. Magnetic resonance angiography will see major advances because of the use of compressed sensing, in terms of spatial and temporal resolution, with movement away from nondynamic imaging. The breadth of available techniques and tissue contrast has greatly expanded in brain imaging, benefiting both from the introduction of new basic categories of imaging techniques, such as readout-segmented echo planar imaging and 3D fast spin echo imaging with variable flip angles, and from new refinements specific to anatomic areas, such as double inversion recovery and MP2RAGE. Liver imaging has benefited from the development of techniques to easily and rapidly assess lipid, and will see, overall, a marked improvement in the next 5 years from new techniques on the verge of clinical introduction, such as controlled aliasing in parallel imaging results in higher acceleration

  12. Critical thinking dispositions of nursing students in Asian and non-Asian countries: a literature review.

    Science.gov (United States)

    Salsali, Mahvash; Tajvidi, Mansooreh; Ghiyasvandian, Shahrzad

    2013-09-26

    Critical thinking disposition represents an inclination of a person to use possessed skills in relation to critical thinking. The trend of critical thinking has been described as inner motivation to solve problems and make decisions by thinking. In nursing as a practical profession, the concept of critical thinking dispositions is important component in helping to manage complex health situations and to deal with patient issues effectively. Willingness to think critically is a prerequisite for safe and subtly performance. The results of studies show critical thinking dispositions of nursing students in Asian countries are different from non-Asian countries. Aim of this literature review was to compare critical thinking dispositions of nursing students in Asian and non-Asian countries. Literature review was done in English and Persian databases. The results showed of the 795 articles published in English and Persian language that studied critical thinking, 73 ones studied critical thinking skills and dispositions in nursing education, and relationship between teaching methods and critical thinking skills and dispositions in nursing education of different countries. Fifteen of seventy three articles assessed critical thinking dispositions in nursing students. Limited studies showed that the Asian nursing students had mostly undermining score of the critical thinking dispositions, while non-Asian countries tend to positive scores. The reasons for these differences could be due to issues such as environmental, educational methods and cultural differences. However, future studies should measure critical thinking disposition by discipline-based tools.

  13. Critical Thinking Dispositions of Nursing Students in Asian and Non-Asian Countries: A Literature Review

    Science.gov (United States)

    Salsali, Mahvash; Tajvidi, Mansooreh; Ghiyasvandian, Shahrzad

    2013-01-01

    Critical thinking disposition represents an inclination of a person to use possessed skills in relation to critical thinking. The trend of critical thinking has been described as inner motivation to solve problems and make decisions by thinking. In nursing as a practical profession, the concept of critical thinking dispositions is important component in helping to manage complex health situations and to deal with patient issues effectively. Willingness to think critically is a prerequisite for safe and subtly performance. The results of studies show critical thinking dispositions of nursing students in Asian countries are different from non-Asian countries. Aim of this literature review was to compare critical thinking dispositions of nursing students in Asian and non-Asian countries. Literature review was done in English and Persian databases. The results showed of the 795 articles published in English and Persian language that studied critical thinking, 73 ones studied critical thinking skills and dispositions in nursing education, and relationship between teaching methods and critical thinking skills and dispositions in nursing education of different countries. Fifteen of seventy three articles assessed critical thinking dispositions in nursing students. Limited studies showed that the Asian nursing students had mostly undermining score of the critical thinking dispositions, while non-Asian countries tend to positive scores. The reasons for these differences could be due to issues such as environmental, educational methods and cultural differences. However, future studies should measure critical thinking disposition by discipline-based tools. PMID:24171885

  14. Critical Factors in Mobile Learning: A Quasi-Systematic Review

    Science.gov (United States)

    Rodrigues, Sergio Assis; dos Santos, Rodrigo Pereira; Arnaud, Lucas; de Souza, Jano Moreira

    2013-01-01

    The advance of mobile industry and research has expanded e-learning in order to support an efficient and effective educational process. However, the promised benefits are as much attractive as the existing difficulties and barriers. In this paper, we intend to identify and summarize the critical factors in mobile learning through a…

  15. A Review on Developing Critical Thinking Skills through Literary Texts

    Directory of Open Access Journals (Sweden)

    Noraini Ahmad Shukri

    2015-04-01

    Full Text Available Many ESL instructors are generally in agreement with the belief that it is essential that students should be assisted in developing critical thinking skills while being engaged in their language learning process especially those learning the target language at higher level (Stern, 1985; Dickinson, 1991; McKay, 2001; Terry, 2007; Van, 2009; Odenwald, 2010. As it enables language learners to engage in a more purposeful and self-regulatory in judgment, helping them in their evaluation of the arguments of others and of their own, coming to well-reasoned resolutions to any complex problems and to be able to resolve conflicts encountered in their daily lives. Critical thinking requires them to be actively involved in their own learning process as they attempt to individually understand and apply the information they are exposed to during the classroom interaction (Landsberger, 1999; Tung & Chang, 2009. The many advantageous and feasibility of teaching instruction that incorporates the study of literature in the ESL classroom which suggests that literature texts, if correctly chosen and instructed, can prove to be beneficial to ESL students’ overall level of literacy and critical thinking skills. Numerous empirical researches also asserted that literary texts that are authentic, enjoyable, and motivating would naturally increase both their knowledge of the target language patterns and cultural awareness. Keywords: Critical thinking, ESL classroom, literature, literary text

  16. Theoretical approaches to social innovation – A critical literature review

    NARCIS (Netherlands)

    Butzin, A.; Davis, A.; Domanski, D.; Dhondt, S.; Howaldt, J.; Kaletka, C.; Kesselring, A.; Kopp, R.; Millard, J.; Oeij, P.; Rehfeld, D.; Schaper-Rinkel, P.; Schwartz, M.; Scoppetta, A.; Wagner-Luptacik, P.; Weber, M.

    2014-01-01

    The SI-DRIVE report “Theoretical approaches to Social Innovation – A Critical Literature Review” delivers a comprehensive overview on the state of the art of theoretically relevant building blocks for advancing a theoretical understanding of social innovation. It collects different theoretical

  17. "The Bell Curve" and Its Critical Progeny: A Review.

    Science.gov (United States)

    Davis, Alan

    1997-01-01

    Discusses R. Herrnstein's and C. Murray's attempt to persuade an educated white readership that they, the readers, are genetically, socially, and intellectually superior. The most effective criticisms are those that rely on scientific evidence about the manipulation of data and flawed analyses rather than the display of moral outrage. (SLD)

  18. A Critical Review of the IELTS Writing Test

    Science.gov (United States)

    Uysal, Hacer Hande

    2010-01-01

    Administered at local centres in 120 countries throughout the world, IELTS (International English Language Testing System) is one of the most widely used large-scale ESL tests that also offers a direct writing test component. Because of its popularity and its use for making critical decisions about test takers, it is crucial to draw attention to…

  19. Kinetic aspects of the Maillard reaction: a critical review

    NARCIS (Netherlands)

    Boekel, van M.A.J.S.

    2001-01-01

    The literature concerning the kinetics of the Maillard reaction was critically discussed according to the initial, intermediate and advanced stages, as this is the way the Maillard reaction is traditionally analysed. For each stage, a division is made between simple kinetics and complex kinetics.

  20. A Critical Review of Qualitative Interviews in Applied Linguistics

    Science.gov (United States)

    Mann, Steve

    2011-01-01

    This article asks what applied linguistics can learn from related disciplines with regard to the collection, analysis and representation of qualitative interviews. It assesses the contributions of qualitative sociology, anthropology, discursive psychology and outlines four "discourse dilemmas" which might provide the basis for a more critical and…

  1. The Younger Dryas impact hypothesis: A critical review

    NARCIS (Netherlands)

    van Hoesel, A.; Hoek, W.Z.; Pennock, G.M.; Drury, Martyn

    2014-01-01

    The Younger Dryas impact hypothesis suggests that multiple extraterrestrial airbursts or impacts resulted in the Younger Dryas cooling, extensive wildfires, megafaunal extinctions and changes in human population. After the hypothesis was first published in 2007, it gained much criticism, as the

  2. Melatonin and melatonin agonists to prevent and treat delirium in critical illness: a systematic review protocol

    Directory of Open Access Journals (Sweden)

    Jennifer Foster

    2016-11-01

    Full Text Available Abstract Background Delirium is a syndrome characterized by acute fluctuations and alterations in attention and arousal. Critically ill patients are at particularly high risk, and those that develop delirium are more likely to experience poor clinical outcomes such as prolonged duration of ICU and hospital length of stay, and increased mortality. Melatonin and melatonin agonists (MMA have the potential to decrease the incidence and severity of delirium through their hypnotic and sedative-sparing effects, thus improving health-related outcomes. The objective of this review is to synthesize the available evidence pertaining to the efficacy and safety of MMA for the prevention and treatment of ICU delirium. Methods We will search Ovid MEDLINE, Web of Science, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials (CENTRAL, and CINAHL to identify studies evaluating MMA in critically ill populations. We will also search http://apps.who.int/trialsearch for ongoing and unpublished studies and PROSPERO for registered reviews. We will not impose restrictions on language, date, or journal of publication. Authors will independently screen for eligible studies using pre-defined criteria; data extraction from eligible studies will be performed in duplicate. The Cochrane Risk of Bias Scale and the Newcastle-Ottawa Scale will be used to assess the risk of bias and quality of randomized and non-randomized studies, respectively. Our primary outcome of interest is delirium incidence, and secondary outcomes include duration of delirium, number of delirium- and coma-free days, use of physical and chemical (e.g., antipsychotics or benzodiazepines restraints, duration of mechanical ventilation, ICU and hospital length of stay, mortality, long-term neurocognitive outcomes, hospital discharge disposition, and adverse events. We will use Review Manager (RevMan to pool effect estimates from included studies. We will present results as relative risks with

  3. Scapulothoracic bursitis and snapping scapula syndrome: a critical review of current evidence.

    Science.gov (United States)

    Warth, Ryan J; Spiegl, Ulrich J; Millett, Peter J

    2015-01-01

    Symptomatic scapulothoracic disorders, such as painful scapular crepitus and/or bursitis, are uncommon; however, they can produce significant pain and disability in many patients. To review the current knowledge pertaining to snapping scapula syndrome and to identify areas of further research that may be helpful to improve clinical outcomes and patient satisfaction. Systematic review. We performed a preliminary search of the PubMed and Embase databases using the search terms "snapping scapula," "scapulothoracic bursitis," "partial scapulectomy," and "superomedial angle resection" in September 2013. All nonreview articles related to the topic of snapping scapula syndrome were included. The search identified a total of 167 unique articles, 81 of which were relevant to the topic of snapping scapula syndrome. There were 36 case series of fewer than 10 patients, 16 technique papers, 11 imaging studies, 9 anatomic studies, and 9 level IV outcomes studies. The level of evidence obtained from this literature search was inadequate to perform a formal systematic review or meta-analysis. Therefore, a critical review of current evidence is presented. Snapping scapula syndrome, a likely underdiagnosed condition, can produce significant shoulder dysfunction in many patients. Because the precise origin is typically unknown, specific treatments that are effective for some patients may not be effective for others. Nevertheless, bursectomy with or without partial scapulectomy is currently the most effective primary method of treatment in patients who fail nonoperative therapy. However, many patients experience continued shoulder disability even after surgical intervention. Future studies should focus on identifying the modifiable factors associated with poor outcomes after operative and nonoperative management for snapping scapula syndrome in an effort to improve clinical outcomes and patient satisfaction. © 2014 The Author(s).

  4. The muscular flexibility training and the range of movement improvement: a critical literature review

    Directory of Open Access Journals (Sweden)

    L.F. Coelho

    2008-01-01

    Full Text Available The muscular flexibility training put in evidence a train of neurophysiological principals and an intricate amount of muscular and viscous-elastic properties. There are a lot of stretching methods, used on the clinical and sport contexts. Despite its common utilization, it isn’t usual the health and educational professionals reflect about the compounds and efficacy of the diverse stretching methods. In this article, we realize a critical review about the diverse methods used on the flexibility training, as the principles and parameters related with that. We will done special emphasis to the principles of the proprioceptive neuromuscular facilitation and the diverse local relaxation methods, like warming. We will also have in count the revealing data relating to the Elasticity Coefficient paradox, witch can help to conceive an intervention philosophy of the flexibility training different from what it have being defended and practiced.

  5. Learning styles and critical thinking relationship in baccalaureate nursing education: a systematic review.

    Science.gov (United States)

    Andreou, Christos; Papastavrou, Evridiki; Merkouris, Anastasios

    2014-03-01

    Critical thinking is a desirable competency for contemporary nurses although there are growing concerns supporting a disturbing paucity in its achievement. Learning styles reflect habitual behaviors which determine distinct preferences within learning situations. Evidence suggests that critical thinking could evolve through learning processes. Variances in critical thinking achievement by nursing students might therefore be influenced by individual learning preferences. The concepts "learning styles" and "critical thinking" have been independently examined in the nursing literature. No reviews were found however exploring their association in nursing education. To identify the potential relationships between learning styles and critical thinking in baccalaureate nursing students. Systematic review. Eleven electronic databases were utilized without geographical and time publishing filters. Hand-searching journals and scanning references from retrieved studies were also performed. Databases were searched for descriptive correlational studies which considered the relationship between learning styles and critical thinking in baccalaureate nursing students. The authors independently progressed three stage screening. Retrieved articles were reviewed at title, abstract and full text levels according to predetermined criteria. All included studies were quality appraised using a rating tool for descriptive studies. Six studies were finally included. Findings were grouped under four key themes: predominant learning styles, critical thinking scoring, critical thinking evolution across academic progress and learning styles-critical thinking correlations. Learning styles' diversities, weak critical thinking and inconsistent evolution through academic progress were revealed across studies. Critical thinking differed significantly between learning styles. Commonly accepted models in nursing education were lacking in both learning styles and critical thinking. Within studies

  6. Increment 23/24 Critical Readiness Review Health Maintenance System

    Science.gov (United States)

    Nieschwitz, Linda

    2010-01-01

    This slide presentation reviews the Health Maintenance System. It includes information on the carbon dioxide (CO2) and moisture removal system (CMRS), the variable oxygen system,rendevous station panels, and the crew contamination protection kit (CCPK).

  7. Nanofluidic technology for biomolecule applications: a critical review

    NARCIS (Netherlands)

    Napoli, M.; Eijkel, Jan C.T.; Pennathur, S.

    2010-01-01

    In this review, we present nanofluidic phenomena, particularly as they relate to applications involving analysis of biomolecules within nanofabricated devices. The relevant length scales and physical phenomena that govern biomolecule transport and manipulation within nanofabricated nanofluidic

  8. Why general practitioners and consultants change their clinical practice: a critical incident study.

    OpenAIRE

    Allery, L. A.; Owen, P. A.; Robling, M. R.

    1997-01-01

    OBJECTIVE: To describe the complete range of factors which doctors recognise as changing their clinical practice and provide a measure of how often education is involved in change. DESIGN: Interviews using the critical incident technique. SETTING: Primary and secondary care. SUBJECTS: Random sample of 50 general practitioners and 50 consultants. MAIN OUTCOME MEASURES: Categories of reasons for change in clinical practice. RESULTS: Doctors described 361 changes in clinical practice, with an av...

  9. Critical success factors for competitiveness of construction companies: A critical review

    Science.gov (United States)

    Hanafi, Abdul Ghafur; Nawi, Mohd Nasrun Mohd

    2016-08-01

    Making progress basically, a fundamental issue for the construction companies to get by in a highly competitive industry. From time to time, industry players are facing stiff and tough competition due to large number of players, whether existing or new players involved from various background and track record. Furthermore, the large numbers of component deciding the competitiveness of contractors, whose organization structures and governance have turned out to be more muddled. Different construction companies have their own unique criteria which may differ from one to another. The enormous amount of issues needs to bring down to manageable numbers so that measures can be identified and scrutinized to enhance competitiveness. This paper discusses the result from the critical investigation from past studies in the Asian countries, namely China, India, Thailand, Singapore and Malaysia. Several fundamental factors have been identified as CSFs in construction companies in respective country. Also highlighted a critical survey based upon various literatures written on this subject where critical success factors (CSFs) as a yardstick to gauge the relationship among CSFs in various construction companies in the Asian region. Far reaching estimation of an organization's performance and resulting input to its supervision is crucial for business change. Estimation additionally empowers organizations to be contrasted from one another on the premise of institutionalized data, permitting best practices to be distinguished and connected more widely. Different countries have their own set of critical success factors (CSFs) which may differ in term of priority and at the same time share common elements of success factor in accomplishment as a construction companies. The study, which is exploratory in nature, embraced the content investigation and inductive technique to accomplish its objectives.

  10. RELEVANCE OF COLLAGEN PIEZOELECTRICITY TO “WOLFF’S LAW”: A CRITICAL REVIEW

    Science.gov (United States)

    Ahn, Andrew C.; Grodzinsky, Alan J.

    2009-01-01

    According to “Wolff’s Law”, bone is deposited and reinforced at areas of greatest stress. From a clinical perspective, this “law” is supported by the strong association between bone density and physical activity. From a mechanistic standpoint, however, the law presents a challenge to scientists seeking to understand how osteocytes and osteoblasts sense the mechanical load. In the 1960’s, collagen piezoelectricity was invoked as a potential mechanism by which osteocytes could detect areas of greater stress but piezoelectricity diminished in importance as more compelling mechanisms, such as streaming potential, were identified. In addition, accumulating evidence for the role of fluid-related shear stress in osteocyte’s mechanosensory function has made piezoelectricity seemingly more obsolete in bone physiology. This review critically evaluates the role of collagen piezoelectricity (if any) in Wolff’s Law – specifically, the evidence regarding its involvement in strain-generated potentials, existing alternate mechanisms, the present understanding of bone mechanosensation, and whether piezoelectricity serves an influential role within the context of this newly proposed mechanism. In addition to reviewing the literature, this review generates several hypotheses and proposes future research to fully address the relevance of piezoelectricity in bone physiology. PMID:19286413

  11. Military service member and veteran reintegration: A critical review and adapted ecological model.

    Science.gov (United States)

    Elnitsky, Christine A; Blevins, Cara L; Fisher, Michael P; Magruder, Kathryn

    2017-01-01

    Returning military service members and veterans (MSMVs) experience a wide range of stress-related disorders in addition to social and occupational difficulties when reintegrating to the community. Facilitating reintegration of MSMVs following deployment is a societal priority. With an objective of identifying challenges and facilitators for reintegration of MSMVs of the current war era, we critically review and identify gaps in the literature. We searched 8 electronic databases and identified 1,764 articles. Screening of abstracts and full-text review based on our inclusion/exclusion criteria, yielded 186 articles for review. Two investigators evaluating relevant articles independently found a lack of clear definition or comprehensive theorizing about MSMV reintegration. To address these gaps, we linked the findings from the literature to provide a unified definition of reintegration and adapted the social ecological systems theory to guide research and practice aimed at MSMV reintegration. Furthermore, we identified individual, interpersonal, community, and societal challenges related to reintegration. The 186 studies published from 2001 (the start of the current war era) to 2015 included 6 experimental studies or clinical trials. Most studies do not adequately account for context or more than a narrow set of potential influences on MSMV reintegration. Little evidence was found that evaluated interventions for health conditions, rehabilitation, and employment, or effective models of integrated delivery systems. We recommend an ecological model of MSMV reintegration to advance research and practice processes and outcomes at 4 levels (individual, interpersonal, organizational, and societal). (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  12. A review of critical in-flight events research methodology

    Science.gov (United States)

    Giffin, W. C.; Rockwell, T. H.; Smith, P. E.

    1985-01-01

    Pilot's cognitive responses to critical in-flight events (CIFE's) were investigated, using pilots, who had on the average about 2540 flight hours each, in four experiments: (1) full-mission simulation in a general aviation trainer, (2) paper and pencil CIFE tests, (3) interactive computer-aided scenario testing, and (4) verbal protocols in fault diagnosis tasks. The results of both computer and paper and pencil tests showed only 50 percent efficiency in correct diagnosis of critical events. The efficiency in arriving at a diagnosis was also low: over 20 inquiries were made for 21 percent of the scenarios diagnosed. The information-seeking pattern was random, with frequent retracing over old inquiries. The measures for developing improved cognitive skills for CIFE's are discussed.

  13. Von Glaserfeld`s Radical Constructivism: A Critical Review

    Science.gov (United States)

    Hardy, Michael D.

    We explore Ernst von Glaserfelds radical constructivism, its criticisms, and our own thoughts on what it promises for the reform of science and mathematics teaching. Our investigation reveals that many criticisms of radical constructivism are unwarranted; nevertheless, in its current cognitivist form radical constructivism may be insufficient to empower teachers to overcome objectivist cultural traditions. Teachers need to be empowered with rich understandings of philosophies of science and mathematics that endorse relativist epistemologies; for without such they are unlikely to be prepared to reconstruct their pedagogical practices. More importantly, however, is a need for a powerful social epistemology to serve as a referent for regenerating the culture of science education. We recommend blending radical constructivism with Habermas theory of communicative action to provide science teachers with a moral imperative for adopting a constructivist epistemology.

  14. A critical review of qualitative interviews in applied linguistics

    OpenAIRE

    Mann, Steve J.

    2011-01-01

    This article asks what applied linguistics can learn from related disciplines with regard to the collection, analysis and representation of qualitative interviews. It assesses the contributions of qualitative sociology, anthropology, discursive psychology and outlines four ‘discourse dilemmas’ which might provide the basis for a more critical and reflective dimension to the use of qualitative interviews in applied linguistics. Summarizing important contributions that have already been made in...

  15. State of the evidence on acute asthma management in children: a critical appraisal of systematic reviews

    NARCIS (Netherlands)

    Boluyt, Nicole; van der Lee, Johanna H.; Moyer, Virginia A.; Brand, Paul L. P.; Offringa, Martin

    2007-01-01

    OBJECTIVE: Our goal was to evaluate clinical, methodologic, and reporting aspects of systematic reviews on the management of acute asthma in children. METHODS: We undertook a systematic review of systematic reviews on acute asthma management in children. We identified eligible reviews by searching

  16. Automatic detection of rhythmic and periodic patterns in critical care EEG based on American Clinical Neurophysiology Society (ACNS) standardized terminology.

    Science.gov (United States)

    Fürbass, F; Hartmann, M M; Halford, J J; Koren, J; Herta, J; Gruber, A; Baumgartner, C; Kluge, T

    2015-09-01

    Continuous EEG from critical care patients needs to be evaluated time efficiently to maximize the treatment effect. A computational method will be presented that detects rhythmic and periodic patterns according to the critical care EEG terminology (CCET) of the American Clinical Neurophysiology Society (ACNS). The aim is to show that these detected patterns support EEG experts in writing neurophysiological reports. First of all, three case reports exemplify the evaluation procedure using graphically presented detections. Second, 187 hours of EEG from 10 critical care patients were used in a comparative trial study. For each patient the result of a review session using the EEG and the visualized pattern detections was compared to the original neurophysiology report. In three out of five patients with reported seizures, all seizures were reported correctly. In two patients, several subtle clinical seizures with unclear EEG correlation were missed. Lateralized periodic patterns (LPD) were correctly found in 2/2 patients and EEG slowing was correctly found in 7/9 patients. In 8/10 patients, additional EEG features were found including LPDs, EEG slowing, and seizures. The use of automatic pattern detection will assist in review of EEG and increase efficiency. The implementation of bedside surveillance devices using our detection algorithm appears to be feasible and remains to be confirmed in further multicenter studies. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  17. The role of nutritional support in the physical and functional recovery of critically ill patients: a narrative review.

    Science.gov (United States)

    Bear, Danielle E; Wandrag, Liesl; Merriweather, Judith L; Connolly, Bronwen; Hart, Nicholas; Grocott, Michael P W

    2017-08-26

    The lack of benefit from randomised controlled trials has resulted in significant controversy regarding the role of nutrition during critical illness in terms of long-term recovery and outcome. Although methodological caveats with a failure to adequately appreciate biological mechanisms may explain these disappointing results, it must be acknowledged that nutritional support during early critical illness, when considered alone, may have limited long-term functional impact.This narrative review focuses specifically on recent clinical trials and evaluates the impact of nutrition during critical illness on long-term physical and functional recovery.Specific focus on the trial design and methodological limitations has been considered in detail. Limitations include delivery of caloric and protein targets, patient heterogeneity, short duration of intervention, inappropriate clinical outcomes and a disregard for baseline nutritional status and nutritional intake in the post-ICU period.With survivorship at the forefront of critical care research, it is imperative that nutrition studies carefully consider biological mechanisms and trial design because these factors can strongly influence outcomes, in particular long-term physical and functional outcome. Failure to do so may lead to inconclusive clinical trials and consequent rejection of the potentially beneficial effects of nutrition interventions during critical illness.

  18. A Clinical and Genetic Review of Aniridia

    Directory of Open Access Journals (Sweden)

    Reza Jafari

    2015-07-01

    Full Text Available Aniridia is a congenital pan-ocular, bilateral disorder. The term aniridia is a misleading misnomer, since at least a rudimentary iris is always present. Varied forms range from almost total absence to only mild hypoplasia of the iris. It is inherent in a number of syndromes, including Wilms tumor Aniridia-Genital anomalies-retardation (WAGR. Aniridia has been shown to be associated with mutations in the PAX6 gene, located on chromosome 11p13, telomeric to the Wilms’ tumor predisposition gene (WT1. The pair box gene 6 (PAX6 situated at 11p13 has been confirmed to be the leading gene associated with aniridia. The PAX6 mutation is present in individuals worldwide and has been studied in Indian, Malaysian, Chinese and Mexican families. Several categories of PAX6 mutations include: nonsense mutations, splicing mutations, frameshift mutations (deletion or insertion, in-frame insertion or deletion, missense mutations and run-on mutations. A novel de novo frameshift mutation in PAX6 most possibly occurred in the paternal gamete. Mutation in PAX6 brings about amino acid substitution for instance proline to glutamine. Deletion of 11p13 involves the PAX6 (aniridia locus and the adjacent WT1 (Wilms tumor locus. Haploinsufficiency at the PAX6 locus brings on aniridia, a pan-ocular eye condition characterized by iris hypoplasia and various other anterior and posterior eye defects, subtle hypogonadotropic hypogonadism and borderline Growth Hormone (GH deficiency. Aniridia may also be affiliated with retinal tears and detachments. Electroretinograms (ERGs done in aniridia illustrate definite retinal dysfunction. Other clinical aspects related to aniridia are ptosis with reduced levator function and anterior polar cataracts. The PAX6 gene mutation was also associated with early-onset diabetes mellitus and aniridia. Aniridia combined with zonular cataract and polydactyly was also described in a patient with Bardet-Biedl syndrome. Aniridia with sensorineural

  19. Informed consent for clinical trials: a review | Lema | East African ...

    African Journals Online (AJOL)

    Data sources: Published original research findings and reviews in the English literature, together with anecdotal information from our current professional experiences with clinical trials. Design: Review of peer-reviewed articles. Data extraction: Online searches were done and requests for reprints from corresponding ...

  20. How to measure comorbidity. a critical review of available methods.

    NARCIS (Netherlands)

    de Groot, V.; Beckerman, H.; Lankhorst, G.J.; Bouter, L.M.

    2003-01-01

    The object of this article was to systematically review available methods to measure comorbidity and to assess their validity and reliability. A search was made in Medline and Embase, with the keywords comorbidity and multi-morbidity, to identify articles in which a method to measure comorbidity was

  1. How to measure comorbidity. A critical review of available methods

    NARCIS (Netherlands)

    de Groot, V; Beckerman, H; Lankhorst, G J; Bouter, L M

    2003-01-01

    The object of this article was to systematically review available methods to measure comorbidity and to assess their validity and reliability. A search was made in Medline and Embase, with the keywords comorbidity and multi-morbidity, to identify articles in which a method to measure comorbidity was

  2. Critical Review on Affect of Personality on Learning Styles

    Science.gov (United States)

    Kamarulzaman, Wirawani

    2012-01-01

    This paper is intended to review the affect of personality on learning styles. Costa and McCrae's Five-Factor Model of Personality (The Big 5) is explored against Kolb Learning Styles. The Big 5 factors are extraversion, neuroticism, openness, agreeableness and conscientiousness, whereas Kolb Learning Styles are divergers, assimilators,…

  3. Analytical approaches for arsenic determination in air: A critical review

    Energy Technology Data Exchange (ETDEWEB)

    Sánchez-Rodas, Daniel, E-mail: rodas@uhu.es [Centre for Research in Sustainable Chemistry-CIQSO, Associated Unit CSIC-University of Huelva “Atmospheric Pollution”, Campus El Carmen, University of Huelva, 21071 Huelva (Spain); Department of Chemistry and Materials Science, University of Huelva, 21071 Huelva (Spain); Sánchez de la Campa, Ana M. [Centre for Research in Sustainable Chemistry-CIQSO, Associated Unit CSIC-University of Huelva “Atmospheric Pollution”, Campus El Carmen, University of Huelva, 21071 Huelva (Spain); Department of Mining, Mechanic and Energetic Engineering, ETSI, University of Huelva, 21071 Huelva (Spain); Alsioufi, Louay [Centre for Research in Sustainable Chemistry-CIQSO, Associated Unit CSIC-University of Huelva “Atmospheric Pollution”, Campus El Carmen, University of Huelva, 21071 Huelva (Spain)

    2015-10-22

    This review describes the different steps involved in the determination of arsenic in air, considering the particulate matter (PM) and the gaseous phase. The review focuses on sampling, sample preparation and instrumental analytical techniques for both total arsenic determination and speciation analysis. The origin, concentration and legislation concerning arsenic in ambient air are also considered. The review intends to describe the procedures for sample collection of total suspended particles (TSP) or particles with a certain diameter expressed in microns (e.g. PM10 and PM2.5), or the collection of the gaseous phase containing gaseous arsenic species. Sample digestion of the collecting media for PM is described, indicating proposed and established procedures that use acids or mixtures of acids aided with different heating procedures. The detection techniques are summarized and compared (ICP-MS, ICP-OES and ET-AAS), as well those techniques capable of direct analysis of the solid sample (PIXE, INAA and XRF). The studies about speciation in PM are also discussed, considering the initial works that employed a cold trap in combination with atomic spectroscopy detectors, or the more recent studies based on chromatography (GC or HPLC) combined with atomic or mass detectors (AFS, ICP-MS and MS). Further trends and challenges about determination of As in air are also addressed. - Highlights: • Review about arsenic in the air. • Sampling, sample treatment and analysis of arsenic in particulate matter and gaseous phase. • Total arsenic determination and arsenic speciation analysis.

  4. Progress in electrical energy storage system:A critical review

    Institute of Scientific and Technical Information of China (English)

    Haisheng Chen; Thang Ngoc Cong; Wei Yang; Chunqing Tan; Yongliang Li; Yulong Ding

    2009-01-01

    Electrical energy storage technologies for stationary applications are reviewed.Particular attention is paid to pumped hydroelectric storage,compressed air energy storage,battery,flow battery,fuel cell,solar fuel,superconducting magnetic energy storage, flywheel, capacitor/supercapacitor,and thermal energy torage.Comparison is made among these technologies in terms of technical characteris-tics,applications and deployment status.

  5. Guardianship for crime prevention: A critical review of the literature

    NARCIS (Netherlands)

    Hollis-Peel, M.; Reynald, D.M.; van Bavel, M.L.; Elffers, H.; Welsh, B.C.

    2011-01-01

    Cohen and Felson's (Cohen and Felson American Sociological Review 44(4):588-608, 1979) routine activity theory posits that for a crime to occur three necessary elements must converge in time and space: motivated offenders, suitable targets, and the absence of capable guardianship. Capable guardians

  6. Critical Readiness Review EHS Water Quality and Microbiology

    Science.gov (United States)

    Woo, Cindy

    2010-01-01

    Presentation reviews the status in reference to the Environmental, Health and Safety (EHS) of the water quality and microbiology for the International Space Station. It includes information about crew training, hardware delivery, and those items that will be returned for study.

  7. A Critical Review of Digital Storyline-Enhanced Learning

    Science.gov (United States)

    Novak, Elena

    2015-01-01

    Storyline is one of the major motivators that lead people to play video games. However, little empirical evidence exists on the instructional effectiveness of integrating a storyline into digital learning materials. This systematic literature review presents current empirical findings on the effects of a storyline game design element for human…

  8. Are Effective Counselors Made or Born? A Critical Review.

    Science.gov (United States)

    DeCsipkes, Robert A.; And Others

    The purpose of this review was to investigate the relationship between counselor characteristics and reports of effectiveness. The theoretical position appears to focus on two opposing views. The humanists emphasize the influence of intuition, genuineness, and spontaneity, while the behaviorists place importance on technique, analysis of…

  9. Abortion Care in Ghana: A Critical Review of the Literature ...

    African Journals Online (AJOL)

    The Government of Ghana has taken important steps to mitigate the impact of unsafe abortion. However, the expected decline in maternal deaths is yet to be realized. This literature review aims to present findings from empirical research directly related to abortion provision in Ghana and identify gaps for future research.

  10. A critical review of the literature on school dropout

    NARCIS (Netherlands)

    de Witte, K.; Cabus, S.; Thyssen, G.; Groot, W.; Maassen van den Brink, H.

    2013-01-01

    This paper reviews the growing literature on early school leaving. We clarify what is at stake with early school leaving, and touch upon underlying problems and methodological issues raised in the literature. The paper investigates the levels, the methods and models with which the topic has been

  11. Problems with quantizing the Skyrmion: a critical review

    International Nuclear Information System (INIS)

    Ralston, J.P.

    1984-01-01

    We review the motivation and construction of the chiral soliton picture of baryons. We discuss the semi-classical quantization procedure of Adkins, Nappi and Witten and the stability of the semi-classical solution under the collective coordinate quantization. By studying the behavior in the chiral limit and specific numerical predictions, we conclude that the collective coordinate procedure is inadequate

  12. The Department of Energy's Atmospheric Chemistry Program: A critical review

    International Nuclear Information System (INIS)

    1991-01-01

    In response to a request from the Department of Energy's (DOE) Office of Health and Environmental Research (OHER), the Committee on Atmospheric Chemistry has reviewed OHER's Atmospheric Chemistry Program (ACP). This report contains the committee's evaluation and critique arising from that review. The review process included a two-day symposium held at the National Academy of Sciences on September 25 and 26, 1990, that focused on presenting the ACP's current components, recent scientific accomplishments, and scientific plans. Following the symposium, committee members met in a one-day executive session to formulate and outline this report. In undertaking this review, OHER and ACP management requested that the committee attempt to answer several specific questions involving the program's technical capability and productivity, its leadership and organization, and its future direction. These questions are given in the Appendix. This report represents the committee's response to the questions posed in the Appendix. Chapter I explores the committee's view of the role that atmospheric chemistry could and should assume within the DOE and its prospective National Energy Strategy. Chapter 2 assesses the current ACP, Chapter 3 presents recommendations for revising and strengthening it, and Chapter 4 restates the committee's conclusions and recommendations

  13. Atmospheric emission of NOx from mining explosives: A critical review

    Science.gov (United States)

    Oluwoye, Ibukun; Dlugogorski, Bogdan Z.; Gore, Jeff; Oskierski, Hans C.; Altarawneh, Mohammednoor

    2017-10-01

    High-energy materials such as emulsions, slurries and ammonium-nitrate fuel-oil (ANFO) explosives play crucial roles in mining, quarrying, tunnelling and many other infrastructure activities, because of their excellent transport and blasting properties. These explosives engender environmental concerns, due to atmospheric pollution caused by emission of dust and nitrogen oxides (NOx) from blasts, the latter characterised by the average emission factor of 5 kg (t AN explosive)-1. This first-of-its-kind review provides a concise literature account of the formation of NOx during blasting of AN-based explosives, employed in surface operations. We estimate the total NOx emission rate from AN-based explosives as 0.05 Tg (i.e., 5 × 104 t) N per annum, compared to the total global annual anthropogenic NOx emissions of 41.3 × 106 t N y-1. Although minor in the global sense, the large localised plumes from blasting exhibit high NOx concentration (500 ppm) exceeding up to 3000 times the international standards. This emission has profound consequences at mining sites and for adjacent atmospheric environment, necessitating expensive management of exclusion zones. The review describes different types of AN energetic materials for civilian applications, and summarises the essential properties and terminologies pertaining to their use. Furthermore, we recapitulate the mechanisms that lead to the formation of the reactive nitrogen species in blasting of AN-based explosives, review their implications to atmospheric air pollution, and compare the mechanisms with those experienced in other thermal and combustion operations. We also examine the mitigation approaches, including guidelines and operational-control measures. The review discusses the abatement technologies such as the formulation of new explosive mixtures, comprising secondary fuels, spin traps and other additives, in light of their effectiveness and efficiency. We conclude the review with a summary of unresolved problems

  14. Retinal vein occlusion and macular edema – critical evaluation of the clinical value of ranibizumab

    Directory of Open Access Journals (Sweden)

    Keane PA

    2011-06-01

    Full Text Available Pearse A Keane1, Srinivas R Sadda21NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; 2Doheny Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USAAbstract: Retinal vein occlusions (RVOs constitute the second most common cause of retinal vascular disease after diabetic retinopathy, with a prevalence of between 1% and 2% in persons older than 40 years of age. Despite the existence of numerous potential therapeutic options, none is entirely satisfactory, and many patients with RVO suffer irreversible visual loss. Fortunately however, the recent introduction of antivascular endothelial growth factor (VEGF agents, such as ranibizumab (Lucentis®, Genentech, South San Francisco, CA and bevacizumab (Avastin®, Genentech, offers a potentially new treatment approach for clinicians managing this disorder. The results of the BRAVO and CRUISE trials have provided the first definitive evidence for the efficacy and safety of ranibizumab in the treatment of RVO. As a result, ranibizumab has recently been approved by the US Food and Drug Administration for the treatment of RVO-associated macular edema. In this review, we provide a critical evaluation of clinical trial data for the safety and efficacy of ranibizumab, and address unresolved issues in the management of this disorder. Keywords: ranibizumab, retinal vein occlusion, vascular endothelial growth factor, macular edema

  15. High-power FEL design issues - a critical review

    Energy Technology Data Exchange (ETDEWEB)

    Litvinenko, V.N.; Madey, J.M.J.; O`Shea, P.G. [Duke Univ., Durham, NC (United States)

    1995-12-31

    The high-average power capability of FELs has been much advertised but little realized. In this paper we provide a critical analysis of the technological and economic issues associated with high-average power FEL operation from the UV to near IR. The project of IR FEL for the Siberian Center of photochemical researches is described. The distinguished features of this project are the use of the race-track microtron-recuperator and the {open_quotes}electron output of radiation{close_quotes}. The building for the machine is under reconstruction now. About half of hardware has been manufactured. The assembly of installation began.

  16. The myth of individualism-collectivism: a critical review.

    Science.gov (United States)

    Voronov, Maxim; Singer, Jefferson A

    2002-08-01

    The authors critically assess the dimension of individualism-collectivism (I-C) and its various uses in cross-cultural psychology. They argue that I-C research is characterized largely by insufficient conceptual clarity and a lack of systematic data. As a result, they call into question the utility of I-C as an explanatory tool for cultural variation in behavior, suggest alternative dimensions for cross-cultural research, and interpret the weaknesses of research on I-C as illustrative of a general trend in social psychology.

  17. Modeling the role of microplastics in Bioaccumulation of organic chemicals to marine aquatic organisms. Critical Review

    NARCIS (Netherlands)

    Koelmans, A.A.

    2015-01-01

    It has been shown that ingestion of microplastics may increase bioaccumulation of organic chemicals by aquatic organisms. This paper critically reviews the literature on the effects of plastic ingestion on the bioaccumulation of organic chemicals, emphasizing quantitative approaches and mechanistic

  18. A Review of Accident Modelling Approaches for Complex Critical Sociotechnical Systems

    National Research Council Canada - National Science Library

    Qureshi, Zahid H

    2008-01-01

    .... This report provides a review of key traditional accident modelling approaches and their limitations, and describes new system-theoretic approaches to the modelling and analysis of accidents in safety-critical systems...

  19. Anticonvulsant pharmacotherapy for generalized and localized vulvodynia : a critical review of the literature

    NARCIS (Netherlands)

    Spoelstra, Symen K.; Borg, Charmaine; Schultz, Willibrord C. M. Weijmar

    Anticonvulsant therapy has occasionally been recommended to treat vulvodynia. However, convincing evidence to support this therapeutic option is lacking. The goal of this study was to critically review studies published on the effectiveness of anticonvulsants for the treatment of vulvodynia.

  20. International entrepreneurship research in emerging economies : A critical review and research agenda

    NARCIS (Netherlands)

    Kiss, A.N.; Danis, W.D.; Cavusgil, S.T.

    This article systematically reviews and critically examines international entrepreneurship research in emerging economies (IEEE research), and articulates its importance, timeliness and relevance in consideration of the growing influence of emerging markets in the global economy. A systematic

  1. Re-examining the Evidence in Radiation Dermatitis Management Literature: An Overview and a Critical Appraisal of Systematic Reviews

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Raymond Javan, E-mail: email.rchan@gmail.com [Cancer Care Services, Royal Brisbane and Women' s Hospital (Australia); School of Nursing and Midwifery, University of Queensland, and Research Centre for Clinical and Community Practice Innovation, Griffith University (Australia); Larsen, Emily; Chan, Philip [Cancer Care Services, Royal Brisbane and Women' s Hospital (Australia)

    2012-11-01

    Purpose: To provide an overview and a critical appraisal of systematic reviews (SRs) of published interventions for the prevention/management of radiation dermatitis. Methods and Materials: We searched Medline, CINAHL, Embase, and the Cochrane Library. We also manually searched through individual reference lists of potentially eligible articles and a number of key journals in the topic area. Two authors screened all potential articles and included eligible SRs. Two authors critically appraised and extracted key findings from the included reviews using AMSTAR (the measurement tool for 'assessment of multiple systematic reviews'). Results: Of 1837 potential titles, 6 SRs were included. A number of interventions have been reported to be potentially beneficial for managing radiation dermatitis. Interventions evaluated in these reviews included skin care advice, steroidal/nonsteroidal topical agents, systemic therapies, modes of radiation delivery, and dressings. However, all the included SRs reported that there is insufficient evidence supporting any single effective intervention. The methodological quality of the included studies varied, and methodological shortfalls in these reviews might create biases to the overall results or recommendations for clinical practice. Conclusions: An up-to-date high-quality SR in the prevention/management of radiation dermatitis is needed to guide practice and direction for future research. We recommend that clinicians or guideline developers critically evaluate the information of SRs in their decision making.

  2. A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care

    DEFF Research Database (Denmark)

    Langhorn, Leanne; Sorensen, Jens C; Pedersen, Preben U

    2010-01-01

    A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care......A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care...

  3. A Critical Review of Models of Perinatal Infection

    NARCIS (Netherlands)

    Dean, Justin M.; Shi, Zhongjie; Fleiss, Bobbi; Gunn, Katherine C.; Groenendaal, Floris; Van Bel, Frank; Derrick, Matthew; Juul, Sandra E.; Tan, Sidhartha; Gressens, Pierre; Mallard, Carina; Bennet, Laura; Gunn, Alistair J.

    2015-01-01

    One of the central, unanswered questions in perinatology is why preterm infants continue to have such poor long-term neurodevelopmental, cognitive and learning outcomes, even though severe brain injury is now rare. There is now strong clinical evidence that one factor underlying disability may be

  4. Clinical review: Current state and future perspectives in the diagnosis of diabetes insipidus: a clinical review.

    Science.gov (United States)

    Fenske, Wiebke; Allolio, Bruno

    2012-10-01

    The differential diagnosis of diabetes insipidus (DI) is often challenging but essential, because treatment may vary substantially. This article analyzes the database and performance of currently used differential diagnostic tests for DI and discusses future perspectives for diagnostic improvement. A review of electronic and print data comprising original and review articles retrieved from the PubMed or Cochrane Library database up to January 2012 was conducted. The search term "polyuria polydipsia syndrome" was cross-referenced with underlying forms of disease and associated clinical, diagnostic, and therapeutic MeSH terms. In addition, references from review articles and textbook chapters were screened for papers containing original data. Search results were narrowed to articles containing primary data with a description of criteria for the differential diagnosis of DI. Fifteen articles on differential diagnosis of DI were identified, mainly consisting of small series of patients, and mostly covering only part of the differential diagnostic spectrum of DI. Test protocols differed, and prospective validation of diagnostic criteria was consistently missing. Inconsistent data were reported on the diagnostic superiority of direct plasma arginine vasopressin determination over the indirect water deprivation test. Both test methods revealed limitations, especially in the differentiation of disorders with a milder phenotype. The available data demonstrate limitations of current biochemical tests for the differential diagnosis of DI, potentially leading to incorrect diagnosis and treatment. The newly available assay for copeptin, the C terminus of the vasopressin precursor, holds promise for a higher diagnostic specificity and simplification of the differential diagnostic protocol in DI.

  5. Critical review of jatropha biodiesel promotion policies in India

    International Nuclear Information System (INIS)

    Kumar, Sunil; Chaube, Alok; Jain, Shashi Kumar

    2012-01-01

    Jatropha, a non-edible oil seed yielding plant has been identified by the Government of India to produce biodiesel under National Biodiesel Mission. Failure of phase-I of National Biodiesel Mission and likely failure of phase-II requires critical analysis of policy frameworks related to its long term sustainability. Indian biofuel promotion policies like Biodiesel Purchase Policy and National Biofuel Policy have failed to yield any visible results. No tangible ground work is visible as of now to ensure success of various government plans and policies related to adoption of jatropha biodiesel. It is clearly evident that some serious bottlenecks are delaying the adoption of jatropha biodiesel. Present work identifies important policy bottlenecks like availability of land, non-remunerative pricing policy and state fear relating to loss of revenue in the case of zero duty regimes. This paper attempts to explore and critically analyze present policies and possible options taking into account the recent Indian experiences for successful adoption of jatropha biodiesel. - Highlights: ► Wrong waste land estimates for jatropha has failed Biodiesel Mission. ► No redressal of technological problems with biodiesel usage. ► Present estimated costing of jatropha biodiesel is Rs. 46.45 per liter. ► Promotion of any biofuel needs central government assistance to the states. ► Targets under National Biofuel Policy are also unlikely to be met.

  6. Devil in the Details: A Critical Review of "Theoretical Loss".

    Science.gov (United States)

    Tom, Matthew A; Shaffer, Howard J

    2016-09-01

    In their review of Internet gambling studies, Auer and Griffiths (J Gambl Stud 30(4), 879-887, 2014) question the validity of using bet size as an indicator of gambling intensity. Instead, in that review and in a response (Auer and Griffiths, J Gambl Stud 31(3), 921-931, 2015) to a previous comment (Braverman et al., J Gambl Stud 31(2), 359-366, 2015), Auer and Griffiths suggested using "theoretical loss" as a preferable measure of gambling intensity. This comment extends and advances the discussion about measures of gambling intensity. In this paper, we describe previously identified problems that Auer and Griffiths need to address to sustain theoretical loss as a viable measure of gambling intensity and add details to the discussion that demonstrate difficulties associated with the use of theoretical loss with certain gambling games.

  7. Knowledge Management : Review of the Critical Success Factors and Development of a Conceptual Classification Model

    NARCIS (Netherlands)

    Sedighi, M.; Zand, F.

    2012-01-01

    Knowledge management is a critical issue in today's business world. Knowledge is considered as one of the most strategic resources of the firm and sources of competitive advantage. This research provides a comprehensive review of the literature on the Critical Success Factors (CSFs) and identifies

  8. Cultural Value and Inequality: A Critical Literature Review

    OpenAIRE

    Oakley, K; O'Brien, D

    2015-01-01

    Inequality has become essential to understanding contemporary British society and is at the forefront of media, political and practice discussions of the future of the arts in the UK. Whilst there is a wealth of work on traditional areas of inequality, such as those associated with income or gender, the relationship between culture, specifically cultural value, and inequality is comparatively under-researched. The literature review considers inequality and cultural value from two points of vi...

  9. Pollution biomarkers in estuarine animals: critical review and new perspectives.

    Science.gov (United States)

    Monserrat, José M; Martínez, Pablo E; Geracitano, Laura A; Amado, Lílian Lund; Martins, Camila Martinez Gaspar; Pinho, Grasiela Lopes Leães; Chaves, Isabel Soares; Ferreira-Cravo, Marlize; Ventura-Lima, Juliane; Bianchini, Adalto

    2007-01-01

    In this review, recent developments in monitoring toxicological responses in estuarine animals are analyzed, considering the biomarker responses to different classes of pollutants. The estuarine environment imposes stressful conditions to the organisms that inhabit it, and this situation can alter their sensitivity to many pollutants. The specificity of some biomarkers like metallothionein tissue concentration is discussed in virtue of its dependence on salinity, which is highly variable in estuaries. Examples of cholinesterase activity measurements are also provided and criteria to select sensitive enzymes to detect pesticides and toxins are discussed. Regarding non-specific biomarkers, toxic responses in terms of antioxidant defenses and/or oxidative damage are also considered in this review, focusing on invertebrate species. In addition, the presence of an antioxidant gradient along the body of the estuarine polychaete Laeonereis acuta (Nereididae) and its relationship to different strategies, which deal with the generation of oxidative stress, is reviewed. Also, unusual antioxidant defenses against environmental pro-oxidants are discussed, including the mucus secreted by L. acuta. Disruption of osmoregulation by pollutants is of paramount importance in several estuarine species. In some cases such as in the estuarine crab Chasmagnathus granulatus, there is a trade off between bioavailability of toxicants (e.g. metals) and their interaction with key enzymes such as Na(+)-K(+)-ATPase and carbonic anhydrase. Thus, the metal effect on osmoregulation is also discussed in the present review. Finally, field case studies with fish species like the croaker Micropogonias furnieri (Scianidae) are used to illustrate the application of DNA damage and immunosuppressive responses as potential biomarkers of complex mixture of pollutants.

  10. The Revised Hierarchical Model: A critical review and assessment

    OpenAIRE

    Kroll, Judith F.; van Hell, Janet G.; Tokowicz, Natasha; Green, David W.

    2010-01-01

    Brysbaert and Duyck (2009) suggest that it is time to abandon the Revised Hierarchical Model (Kroll and Stewart, 1994) in favor of connectionist models such as BIA+ (Dijkstra and Van Heuven, 2002) that more accurately account for the recent evidence on nonselective access in bilingual word recognition. In this brief response, we first review the history of the Revised Hierarchical Model (RHM), consider the set of issues that it was proposed to address, and then evaluate the evidence that supp...

  11. GM crops and the rat digestive tract: a critical review.

    Science.gov (United States)

    Zdziarski, I M; Edwards, J W; Carman, J A; Haynes, J I

    2014-12-01

    The aim of this review is to examine the relationship between genetically modified (GM) crops and health, based on histopathological investigations of the digestive tract in rats. We reviewed published long-term feeding studies of crops containing one or more of three specific traits: herbicide tolerance via the EPSPS gene and insect resistance via cry1Ab or cry3Bb1 genes. These genes are commonly found in commercialised GM crops. Our search found 21 studies for nine (19%) out of the 47 crops approved for human and/or animal consumption. We could find no studies on the other 38 (81%) approved crops. Fourteen out of the 21 studies (67%) were general health assessments of the GM crop on rat health. Most of these studies (76%) were performed after the crop had been approved for human and/or animal consumption, with half of these being published at least nine years after approval. Our review also discovered an inconsistency in methodology and a lack of defined criteria for outcomes that would be considered toxicologically or pathologically significant. In addition, there was a lack of transparency in the methods and results, which made comparisons between the studies difficult. The evidence reviewed here demonstrates an incomplete picture regarding the toxicity (and safety) of GM products consumed by humans and animals. Therefore, each GM product should be assessed on merit, with appropriate studies performed to indicate the level of safety associated with them. Detailed guidelines should be developed which will allow for the generation of comparable and reproducible studies. This will establish a foundation for evidence-based guidelines, to better determine if GM food is safe for human and animal consumption. Copyright © 2014. Published by Elsevier Ltd.

  12. Secondary Sclerosing Cholangitis in Critically Ill Patients: Clinical Presentation, Cholangiographic Features, Natural History, and Outcome

    Science.gov (United States)

    Leonhardt, Silke; Veltzke-Schlieker, Wilfried; Adler, Andreas; Schott, Eckart; Eurich, Dennis; Faber, Wladimir; Neuhaus, Peter; Seehofer, Daniel

    2015-01-01

    Abstract Secondary sclerosing cholangitis in critically ill patients (SSC-CIP) is an important differential diagnosis in patients presenting with cholestasis and PSC-like cholangiographic changes in endoscopic retrograde cholangiography (ERC). As a relatively newly described entity, SSC-CIP is still underdiagnosed, and the diagnosis is often delayed. The present study aims to improve the early detection of SSC-CIP and the identification of its complications. A total of 2633 records of patients who underwent or were listed for orthotopic liver transplantation at the University Hospital Charité, Berlin, were analyzed retrospectively. The clinical presentation and outcome (mean follow-up 62.7 months) of the 16 identified SSC-CIP cases were reviewed. Cholestasis was the first sign of SSC-CIP. GGT was the predominant enzyme of cholestasis. Hypercholesterolemia occurred in at least 75% of the patients. SSC-CIP provoked a profound weight loss (mean 18 kg) in 94% of our patients. SSC-CIP was diagnosed by ERC in all patients. The 3 different cholangiographic features detected correspond roughly to the following stages: (I) evidence of biliary casts, (II) progressive destruction of intrahepatic bile ducts, and (III) picture of pruned tree. Biliary cast formation is a hallmark of SSC-CIP and was seen in 87% of our cases. In 75% of the patients, the clinical course was complicated by cholangiosepsis, cholangitic liver abscesses, acalculous cholecystitis, or gallbladder perforation. SSC-CIP was associated with worse prognosis; transplant-free survival was ∼40 months (mean). Because of its high rate of serious complications and unfavorable prognosis, it is imperative to diagnose SSC-CIP early and to differentiate SSC-CIP from other types of sclerosing cholangitis. Specific characteristics enable identification of SSC-CIP. Early cooperation with a transplant center and special attention to biliary complications are required after diagnosis of SSC-CIP. PMID:26656347

  13. Operations and Maintenance Cost for Stratified Buildings: A Critical Review

    Directory of Open Access Journals (Sweden)

    Che-Ghani Nor Zaimah

    2016-01-01

    Full Text Available Building maintenance is essential in preserving buildings’ appearance and performance. It needs to upkeep the building performance to prolong its value and building life cycle. Malaysia is still lacking in managing cost for building operation and maintenance. It has been found that the cost for housing maintenance is high due to poor maintenance practices. In order to get better understanding on how to manage the cost, this study reviews the contributing factors that affecting operation and maintenance cost of stratified buildings in Malaysia. The research first identified the factors through extensive literature review and scrutinize on factors that affecting and can minimize operation and maintenance cost. This literature review offers insight into building maintenance scenario in Malaysia focusing on the issues and challenges. The study also finds that operation and maintenance cost for housing in Malaysia is still in poor state. Interestingly, this paper revealed that operation and maintenance cost is also influenced by three significant factors like expectation of tenants, building characteristics and building defects. Measures to reduce the housing operation and maintenance cost are also highlighted so that this study can be a stepping stone towards proposing efficient and effective facilities management strategies for affordable housing in future.

  14. Muscle dysmorphia: a critical review of the proposed criteria.

    Science.gov (United States)

    Chung, B

    2001-01-01

    While body-image related disorders such as anorexia nervosa have focused on thinness, only recently have clinical criteria for a disorder that centers around muscularity--muscle dysmorphia--been proposed. An individual affected by muscle dysmorphia is overly concerned with his or her degree of muscularity. This preoccupation is manifested in the individual's behavior (excessive weight lifting, excessive attention to diet, social impairment). This article examines the historical aspects and proposed criteria for muscle dysmorphia and contrasts them with those of anorexia nervosa. While the authors of the proposed criteria have suggested that muscle dysmorphia be classified as a subcategory of body dysmorphic disorder, both the historical and clinical aspects of this syndrome are more consistent with its classification as an obsessive-compulsive disorder.

  15. Tracheal intubation in critically ill patients: a comprehensive systematic review of randomized trials.

    Science.gov (United States)

    Cabrini, Luca; Landoni, Giovanni; Baiardo Radaelli, Martina; Saleh, Omar; Votta, Carmine D; Fominskiy, Evgeny; Putzu, Alessandro; Snak de Souza, Cézar Daniel; Antonelli, Massimo; Bellomo, Rinaldo; Pelosi, Paolo; Zangrillo, Alberto

    2018-01-20

    We performed a systematic review of randomized controlled studies evaluating any drug, technique or device aimed at improving the success rate or safety of tracheal intubation in the critically ill. We searched PubMed, BioMed Central, Embase and the Cochrane Central Register of Clinical Trials and references of retrieved articles. Finally, pertinent reviews were also scanned to detect further studies until May 2017. The following inclusion criteria were considered: tracheal intubation in adult critically ill patients; randomized controlled trial; study performed in Intensive Care Unit, Emergency Department or ordinary ward; and work published in the last 20 years. Exclusion criteria were pre-hospital or operating theatre settings and simulation-based studies. Two investigators selected studies for the final analysis. Extracted data included first author, publication year, characteristics of patients and clinical settings, intervention details, comparators and relevant outcomes. The risk of bias was assessed with the Cochrane Collaboration's Risk of Bias tool. We identified 22 trials on use of a pre-procedure check-list (1 study), pre-oxygenation or apneic oxygenation (6 studies), sedatives (3 studies), neuromuscular blocking agents (1 study), patient positioning (1 study), video laryngoscopy (9 studies), and post-intubation lung recruitment (1 study). Pre-oxygenation with non-invasive ventilation (NIV) and/or high-flow nasal cannula (HFNC) showed a possible beneficial role. Post-intubation recruitment improved oxygenation , while ramped position increased the number of intubation attempts and thiopental had negative hemodynamic effects. No effect was found for use of a checklist, apneic oxygenation (on oxygenation and hemodynamics), videolaryngoscopy (on number and length of intubation attempts), sedatives and neuromuscular blockers (on hemodynamics). Finally, videolaryngoscopy was associated with severe adverse effects in multiple trials. The limited available

  16. Clinical tooth preparations and associated measuring methods: a systematic review.

    Science.gov (United States)

    Tiu, Janine; Al-Amleh, Basil; Waddell, J Neil; Duncan, Warwick J

    2015-03-01

    The geometries of tooth preparations are important features that aid in the retention and resistance of cemented complete crowns. The clinically relevant values and the methods used to measure these are not clear. The purpose of this systematic review was to retrieve, organize, and critically appraise studies measuring clinical tooth preparation parameters, specifically the methodology used to measure the preparation geometry. A database search was performed in Scopus, PubMed, and ScienceDirect with an additional hand search on December 5, 2013. The articles were screened for inclusion and exclusion criteria and information regarding the total occlusal convergence (TOC) angle, margin design, and associated measuring methods were extracted. The values and associated measuring methods were tabulated. A total of 1006 publications were initially retrieved. After removing duplicates and filtering by using exclusion and inclusion criteria, 983 articles were excluded. Twenty-three articles reported clinical tooth preparation values. Twenty articles reported the TOC, 4 articles reported margin designs, 4 articles reported margin angles, and 3 articles reported the abutment height of preparations. A variety of methods were used to measure these parameters. TOC values seem to be the most important preparation parameter. Recommended TOC values have increased over the past 4 decades from an unachievable 2- to 5-degree taper to a more realistic 10 to 22 degrees. Recommended values are more likely to be achieved under experimental conditions if crown preparations are performed outside of the mouth. We recommend that a standardized measurement method based on the cross sections of crown preparations and standardized reporting be developed for future studies analyzing preparation geometry. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  17. Adenoid cystic carcinoma: a retrospective clinical review.

    Science.gov (United States)

    Khan, A J; DiGiovanna, M P; Ross, D A; Sasaki, C T; Carter, D; Son, Y H; Haffty, B G

    2001-06-20

    Adenoid cystic carcinoma (ACC) are uncommon tumors, representing about 10% to 15% of head and neck tumors. We compare the survival and control rates at our institution with those reported in the literature, and examine putative predictors of outcome. All patients registered with the tumor registry as having had ACC were identified. Demographic and survival variables were retrieved from the database. Additionally, a chart review of all patients was done to obtain specific information. Minor gland tumors were staged using the American Joint Committee on Cancer's criteria for squamous cell carcinomas in identical sites. Histopathologic variables retrieved included grade of the tumor, margins, and perineural invasion. Treatment modalities, field sizes, and radiation doses were recorded in applicable cases. An effort to retrieve archival tumor specimens for immunohistochemical analysis was undertaken. A total of 69 patients were treated for ACC from 1955 to 1999. One patient, who presented with fatal brain metastasis, was excluded from further analysis. Of the remaining 68 patients, 30 were men and 38 were women. The average age at diagnosis was 52 years, and mean follow-up was 13.2 years. Mean survival was 7.7 years. Overall survival (OS) rates at 5, 10, and 15 years were 72%, 44%, and 34%, and cause-specific survival was 83%, 71%, and 55%, respectively. Recurrence-free survival rates were 65%, 52%, and 30% at 5, 10, and 15 years, with a total of 29 of 68 (43%) eventually suffering a recurrence. Overall survival was adversely affected by advancing T and AJCC stage. Higher tumor grades were also associated with decreased OS, although the numbers compared were small. Primaries of the nasosinal region fared poorly when compared with other locations. Total recurrence-free survival, local and distant recurrence rates were distinctly better in primaries of the oral cavity/oropharynx when compared with those in other locations. Reduced distant recurrence-free survival was

  18. Job stress and cardiovascular disease: a theoretic critical review.

    Science.gov (United States)

    Kristensen, T S

    1996-07-01

    During the last 15 years, the research on job stress and cardiovascular diseases has been dominated by the job strain model developed by R. Karasek (1979) and colleagues (R. Karasek & T. Theorell, 1990). In this article the results of this research are briefly summarized, and the theoretical and methodological basis is discussed and criticized. A sociological interpretation of the model emphasizing theories of technological change, qualifications of the workers, and the organization of work is proposed. Furthermore, improvements with regard to measuring the job strain dimensions and to sampling the study base are suggested. Substantial improvements of the job strain research could be achieved if the principle of triangulation were used in the measurements of stressors, stress, and sickness and if occupation-based samples were used instead of large representative samples.

  19. Biomedical Engineering curriculum at UAM-I: a critical review.

    Science.gov (United States)

    Martinez Licona, Fabiola; Azpiroz-Leehan, Joaquin; Urbina Medal, E Gerardo; Cadena Mendez, Miguel

    2014-01-01

    The Biomedical Engineering (BME) curriculum at Universidad Autónoma Metropolitana (UAM) has undergone at least four major transformations since the founding of the BME undergraduate program in 1974. This work is a critical assessment of the curriculum from the point of view of its results as derived from an analysis of, among other resources, institutional databases on students, graduates and their academic performance. The results of the evaluation can help us define admission policies as well as reasonable limits on the maximum duration of undergraduate studies. Other results linked to the faculty composition and the social environment can be used to define a methodology for the evaluation of teaching and the implementation of mentoring and tutoring programs. Changes resulting from this evaluation may be the only way to assure and maintain leadership and recognition from the BME community.

  20. Automatic process control in anaerobic digestion technology: A critical review.

    Science.gov (United States)

    Nguyen, Duc; Gadhamshetty, Venkataramana; Nitayavardhana, Saoharit; Khanal, Samir Kumar

    2015-10-01

    Anaerobic digestion (AD) is a mature technology that relies upon a synergistic effort of a diverse group of microbial communities for metabolizing diverse organic substrates. However, AD is highly sensitive to process disturbances, and thus it is advantageous to use online monitoring and process control techniques to efficiently operate AD process. A range of electrochemical, chromatographic and spectroscopic devices can be deployed for on-line monitoring and control of the AD process. While complexity of the control strategy ranges from a feedback control to advanced control systems, there are some debates on implementation of advanced instrumentations or advanced control strategies. Centralized AD plants could be the answer for the applications of progressive automatic control field. This article provides a critical overview of the available automatic control technologies that can be implemented in AD processes at different scales. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Critical review of pH sensing with optical fibers

    Science.gov (United States)

    Baldini, Francesco

    1999-02-01

    The chemical parameter most investigated with optical fibers is doubtless pH. The first pH optical fiber sensor was described in 1980. Since then, more than one hundred and twenty original papers describing different pH sensors have been published, based on absorption-based indicators on fluorophores. Such interest is perfectly justified, since pH detection is essential in many fields of application, ranging from the environment and medicine to industry and process control. Moreover, pH transduction can be used for measuring different chemical species, such as carbon dioxide, ammonia and pesticides. Notwithstanding the great number of prototypes realized in different laboratories all over the world, only a few products are available on the market. A critical analysis of the state of art in pH sensing using optical fibers is described, outlining the advantages and disadvantages of an optical approach.

  2. Review article: Critical Care Airway Management eLearning modules.

    Science.gov (United States)

    Doshi, Deepak; McCarthy, Sally; Mowatt, Elizabeth; Cahill, Angela; Peirce, Bronwyn; Hawking, Geoff; Osborne, Ruth; Hibble, Belinda; Ebbs, Katharine

    2017-11-16

    The Australasian College for Emergency Medicine (ACEM) has recently launched the Critical Care Airway Management eLearning modules to support emergency medicine trainees in developing their airway management skills in the ED. A team of emergency physicians and trainees worked collaboratively to develop the eLearning resources ensuring extensive stakeholder consultation. A comprehensive resource manual was written to provide learners with knowledge that underpins the modules. ACEM provided project coordination as well as administrative and technical team support to the production. Although specifically developed with early ACEM trainees in mind, it is envisaged the resources will be useful for all emergency clinicians. The project was funded by the Australian Commonwealth Department of Health. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  3. Defining Small and Medium Enterprises: a critical review

    Directory of Open Access Journals (Sweden)

    Gentrit Berisha

    2015-03-01

    Full Text Available The OECD estimates that small and medium enterprises account for 90% of firms and employ 63% of the workforce in the world (Munro: 2013. Small and medium enterprises account for that amount of businesses thatit is senseless the arbitrariness with which they are defined. Language mainly used for definition is numbers, but it is difficult to find two institutions, statistical agencies or countries who speak the same language in terms of small and medium enterprises. Academics, authors, policy makers apply SMEdefinitions in terms of dichotomy between universality and standardization of a unique definition and relativity and sectored specialization. Although qualitative criteria-characteristics of SMEs easily distinguish them from large businesses, quantitative criteria are mainlyused for their dimensional classification. This paper deals with a critical approachto the definition of small and medium enterprises, inconsistencies in criteria and various proposed approaches to the definition towards universal acceptance.

  4. Safety impacts of bicycle infrastructure: A critical review.

    Science.gov (United States)

    DiGioia, Jonathan; Watkins, Kari Edison; Xu, Yanzhi; Rodgers, Michael; Guensler, Randall

    2017-06-01

    This paper takes a critical look at the present state of bicycle infrastructure treatment safety research, highlighting data needs. Safety literature relating to 22 bicycle treatments is examined, including findings, study methodologies, and data sources used in the studies. Some preliminary conclusions related to research efficacy are drawn from the available data and findings in the research. While the current body of bicycle safety literature points toward some defensible conclusions regarding the safety and effectiveness of certain bicycle treatments, such as bike lanes and removal of on-street parking, the vast majority treatments are still in need of rigorous research. Fundamental questions arise regarding appropriate exposure measures, crash measures, and crash data sources. This research will aid transportation departments with regard to decisions about bicycle infrastructure and guide future research efforts toward understanding safety impacts of bicycle infrastructure. Copyright © 2017 Elsevier Ltd and National Safety Council. All rights reserved.

  5. A critical review of lexical analysis and Big Five model

    Directory of Open Access Journals (Sweden)

    María Cristina Richaud de Minzi

    2002-06-01

    Full Text Available In the last years the idea has resurfaced that traits can be measured in a reliable and valid and this can be useful inthe prediction of human behavior. The five-factor model appears to represent a conceptual and empirical advances in the field of personality theory. Necessary orthogonal factors (Goldberg, 1992, p. 26 to show the relationships between the descriptors of the features in English is five, and its nature can be summarized through the broad concepts of Surgency, Agreeableness, Responsibility, Emotional Stability versus neuroticism and openness to experience (John, 1990, p96 Furthermore, despite the criticisms that have been given to the model, represents a breakthrough in the field of personality assessment. This approach means a contribution to the study of personality, without being the integrative model of personality.

  6. Molecular Diagnosis of Thalassemias and Hemoglobinopathies: An ACLPS Critical Review.

    Science.gov (United States)

    Sabath, Daniel E

    2017-07-01

    To describe the use of molecular diagnostic techniques for patients with hemoglobin disorders. A clinical scenario is presented in which molecular diagnosis is important for genetic counseling. Globin disorders, techniques for their diagnosis, and the role of molecular genetic testing in managing patients with these disorders are described in detail. Hemoglobin disorders, including thalassemias and hemoglobinopathies, are among the commonest genetic diseases, and the clinical laboratory is essential for the diagnosis of patients with these abnormalities. Most disorders can be diagnosed with protein-based techniques such as electrophoresis and chromatography. Since severe syndromes can result due to inheritance of combinations of globin genetic disorders, genetic counseling is important to prevent adverse outcomes. Protein-based methods cannot always detect potentially serious thalassemia disorders; in particular, α-thalassemia may be masked in the presence of β-thalassemia. Deletional forms of β-thalassemia are also sometimes difficult to diagnose definitively with standard methods. Molecular genetic testing serves an important role in identifying individuals carrying thalassemia traits that can cause adverse outcomes in offspring. Furthermore, prenatal genetic testing can identify fetuses with severe globin phenotypes. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  7. A critical review of nanotechnologies for composite aerospace structures

    Science.gov (United States)

    Kostopoulos, Vassilis; Masouras, Athanasios; Baltopoulos, Athanasios; Vavouliotis, Antonios; Sotiriadis, George; Pambaguian, Laurent

    2017-03-01

    The past decade extensive efforts have been invested in understanding the nano-scale and revealing the capabilities offered by nanotechnology products to structural materials. Integration of nano-particles into fiber composites concludes to multi-scale reinforced composites and has opened a new wide range of multi-functional materials in industry. In this direction, a variety of carbon based nano-fillers has been proposed and employed, individually or in combination in hybrid forms, to approach the desired performance. Nevertheless, a major issue faced lately more seriously due to the interest of industry is on how to incorporate these nano-species into the final composite structure through existing manufacturing processes and infrastructure. This interest originates from several industrial applications needs that request the development of new multi-functional materials which combine enhanced mechanical, electrical and thermal properties. In this work, an attempt is performed to review the most representative processes and related performances reported in literature and the experience obtained on nano-enabling technologies of fiber composite materials. This review focuses on the two main composite manufacturing technologies used by the aerospace industry; Prepreg/Autoclave and Resin Transfer technologies. It addresses several approaches for nano-enabling of composites for these two routes and reports latest achieved results focusing on performance of nano-enabled fiber reinforced composites extracted from literature. Finally, this review work identifies the gap between available nano-technology integration routes and the established industrial composite manufacturing techniques and the challenges to increase the Technology Readiness Level to reach the demands for aerospace industry applications.

  8. Equilibrium models of trade equations : a critical review

    OpenAIRE

    Portugal, Marcelo Savino

    1993-01-01

    Neste artigo, revisa-se a literatura teórica sobre equações de comércio exterior, inclusive o modelo de comércio baseado na teoria da produção. Discute-se vários problemas comumente encontrados em trabalhos empíricos e também a literatura existente sobre equações relativas ao comércio exterior brasileiro. In this paper we review the theoretical literature on trade equation models, including the production theory approach. We discuss several empirical problems commonly found in the applied ...

  9. Critical review of the probability of causation method

    International Nuclear Information System (INIS)

    Cox, L.A. Jr.; Fiksel, J.R.

    1985-01-01

    In a more controversial report than the others in the study, the authors use one scientific discipline to review the work of another discipline. Their proposal recognizes the imprecision that develops in moving from group to individual interpretations of causal effects by substituting the term assigned share for probability of causation. The authors conclude that the use of a formula will not provide reliable measures of risk attribution in individual cases. The gap between scientific certainty and assigning shares of responsibility must be filled by subjective value judgments supplied by the scientists. 22 references, 2 figures, 4 tables

  10. A Critical Review of Recent Literature on Populism

    OpenAIRE

    John Abromeit

    2017-01-01

    This is a review article of the following five recent studies on populism: 1) Ruth Wodak’s The Politics of Fear: What Right-Wing Populist Discourses Mean (Sage, 2015); 2) Benjamin Moffitt’s The Global Rise of Populism: Performance, Political Style and Representation (Stanford University Press, 2016); 3) Cas Mudde and Cristóbal Rovira Kaltwasser’s Populism: A Very Short Introduction (Oxford University Press, 2017); 4) Jan-Werner Müller’s What is Populism? (University of Pennsylvania Press, 201...

  11. Hotel revenue management – a critical literature review

    OpenAIRE

    Ivanov, Stanislav; Zhechev, Vladimir

    2012-01-01

    The paper presents a literature review of the main concepts of hotel revenue management (RM) and current state-of-the-art of its theoretical research. The article emphasises on the different directions of hotel RM research and is structured around the elements of the hotel RM system and the stages of RM process. The elements of the hotel RM system discussed in the paper include hotel RM centres (room division, F&B, function rooms, spa & fitness facilities, golf courses, casino and gambling fa...

  12. The Relationship of Critical-Thinking Skills and the Clinical-Judgment Skills of Baccalaureate Nursing Students.

    Science.gov (United States)

    Bowles, Kathleen

    2000-01-01

    Nursing graduates (n=65) completed a critical thinking instrument and clinical decision-making scale. The critical thinking subscales of inference and inductive reasoning were positively correlated to clinical judgment. A significant relationship was found between critical thinking score and grade point average in nursing. (SK)

  13. Patient-important outcomes in randomized controlled trials in critically ill patients: a systematic review.

    Science.gov (United States)

    Gaudry, Stéphane; Messika, Jonathan; Ricard, Jean-Damien; Guillo, Sylvie; Pasquet, Blandine; Dubief, Emeline; Boukertouta, Tanissia; Dreyfuss, Didier; Tubach, Florence

    2017-12-01

    Intensivists' clinical decision making pursues two main goals for patients: to decrease mortality and to improve quality of life and functional status in survivors. Patient-important outcomes are gaining wide acceptance in most fields of clinical research. We sought to systematically review how well patient-important outcomes are reported in published randomized controlled trials (RCTs) in critically ill patients. Literature search was conducted to identify eligible trials indexed from January to December 2013. Articles were eligible if they reported an RCT involving critically ill adult patients. We excluded phase II, pilot and physiological crossover studies. We assessed study characteristics. All primary and secondary outcomes were collected, described and classified using six categories of outcomes including patient-important outcomes (involving mortality at any time on the one hand and quality of life, functional/cognitive/neurological outcomes assessed after ICU discharge on the other). Of the 716 articles retrieved in 2013, 112 RCTs met the inclusion criteria. Most common topics were mechanical ventilation (27%), sepsis (19%) and nutrition (17%). Among the 112 primary outcomes, 27 (24%) were patient-important outcomes (mainly mortality, 21/27) but only six (5%) were patient-important outcomes besides mortality assessed after ICU discharge (functional disability = 4; quality of life = 2). Among the 598 secondary outcomes, 133 (22%) were patient-important outcomes (mainly mortality, 92/133) but only 41 (7%) were patient-important outcomes besides mortality assessed after ICU discharge (quality of life = 20, functional disability = 14; neurological/cognitive performance = 5; handicap = 1; post-traumatic stress = 1). Seventy-three RCTs (65%) reported at least one patient-important outcome but only 11 (10%) reported at least one patient-important outcome besides mortality assessed after ICU discharge. Patient-important outcomes are rarely primary

  14. Clinical review: Management of difficult airways

    OpenAIRE

    Langeron, Olivier; Amour, Julien; Vivien, Benoît; Aubrun, Frédéric

    2006-01-01

    Difficulties or failure in airway management are still important factors in morbidity and mortality related to anesthesia and intensive care. A patent and secure airway is essential to manage anesthetized or critically ill patients. Oxygenation maintenance during tracheal intubation is the cornerstone of difficult airway management and is always emphasized in guidelines. The occurrence of respiratory adverse events has decreased in claims for injuries due to inadequate airway management mainl...

  15. Attributes of clinical leadership in contemporary nursing: an integrative review.

    Science.gov (United States)

    Mannix, Judy; Wilkes, Lesley; Daly, John

    2013-08-01

    Effective clinical leadership is offered as the key to healthy, functional and supportive work environments for nurses and other health professionals. However, as a concept it lacks a standard definition and is poorly understood. This paper reports on an integrative review undertaken to uncover current understandings of defining attributes of contemporary clinical leadership in nursing. Data collection involved a search of relevant electronic databases for a 10-year period. Keywords for the search were 'clinical leadership' and 'nursing'. Ten research papers met the inclusion criteria for the integrative review. Analysis of these studies indicated clinical leadership attributes had a clinical focus, a follower/team focus or a personal qualities focus; attributes necessary to sustain supportive workplaces and build the capacity and resilience of nursing workforces. The small number of research-based studies yielded for the review indicates the need for further research in the area of clinical leadership.

  16. Dietary Guidelines for Breast Cancer Patients: A Critical Review.

    Science.gov (United States)

    Limon-Miro, Ana Teresa; Lopez-Teros, Veronica; Astiazaran-Garcia, Humberto

    2017-07-01

    Current dietary guidelines for breast cancer patients (BCPs) fail to address adequate dietary intakes of macro- and micronutrients that may improve patients' nutritional status. This review includes information from the PubMed and Biomed Central databases over the last 15 y concerning dietary guidelines for BCPs and the potential impact of a personalized, nutrient-specific diet on patients' nutritional status during and after antineoplastic treatment. Results indicated that BCPs should receive a nutritional assessment immediately after diagnosis. In addition, they should be encouraged to pursue and maintain a healthy body weight [body mass index (BMI; in kg/m 2 ) 20-24.9], preserving their lean mass and avoiding an increase in fat mass. Therefore, after nutritional status diagnosis, a conservative energy restriction of 500-1000 kcal/d could be considered in the dietary intervention when appropriate. Based on the reviewed information, we propose a personalized nutrition intervention for BCPs during and after antineoplastic treatment. Specifications in the nutritional therapy should be based on the patients' nutritional status, dietary habits, schedule, activities, and cultural preferences. BCPs' daily energy intake should be distributed as follows: vegetables (∼75 g/serving) should be encouraged. Garlic and cruciferous vegetables must also be part of the nutrition therapy. Adequate dietary intakes of food-based macro- and micronutrients rich in β-carotene and vitamins A, E, and C can both prevent deterioration in BCPs' nutritional status and improve their overall health and prognosis. © 2017 American Society for Nutrition.

  17. Ecotoxicology of Hexavalent Chromium in Freshwater Fish: A Critical Review

    Science.gov (United States)

    Velma, Venkatramreddy; Vutukuru, S.S.; Tchounwou, Paul B.

    2010-01-01

    Chromium (Cr) is a naturally occurring element found in rocks, animals, plants, and soil, predominantly in its insoluble trivalent form [Cr(III)]. Intense industrialization and other anthropogenic activities have led to the global occurrence of soluble Cr(VI), which is readily leached from soil to groundwater or surface water, in concentrations above permissible levels. The ecotoxicology of Cr(VI) is linked to its environmental persistence and the ability to induce a variety of adverse effects in biologic systems, including fish. In aquatic ecosystems, Cr(VI) exposure poses a significant threat to aquatic life. This paper reviews the fate and transport of Cr(VI) in the environment and its acute and chronic effects on fish. We also discuss Cr(VI) toxicity at the cellular, biochemical, and genetic levels. An attempt is made in this review to comprehend the staggered data on the toxic effects of Cr(VI) to various species of fish. Such data are extremely useful to the scientific community and public officials involved in health risk assessment and management of environmental contaminants as a guide to the best course of action to restore ecosystems and, in turn, to preserve human health. PMID:19658319

  18. A review on critical heat flux in horizontal tubes

    International Nuclear Information System (INIS)

    Baburajan, P.K.; Gaikwad, Avinash; Prabhu, S.V.

    2015-01-01

    Coolant channels of PHWR during accident similar to loss of coolant accident (LOCA) may experience different flow transients with low pressure and low flow conditions. In the advanced PHWRs it is desired to have small amount of positive quality at the exit of the coolant channel to increase the thermal efficiency. Investigation on pressure drop and heat transfer coefficient under subcooled boiling condition is important in the design and operation of the PHWRs. Understanding of thermal hydraulic phenomena associated with horizontal flow is also important in the safety and accident management in these reactors. A detailed experimental investigation on the important thermal hydraulic phenomena of horizontal tubes under low pressure and low flow conditions is carried out. The phenomena covered in this work are measurement of diabatic single phase and subcooled boiling pressure drop and local heat transfer coefficients, steady state CHF, effect of upstream flow restrictions on flow transients and CHF, CHF under oscillatory flow and flow decreasing transients. A detailed literature review is carried out on CHF in horizontal channels to take stock of the works being carried out along with current state of the art and to justify the motivation for the experimental study. This paper presents the review of available literature on horizontal CHF with the results of the experimental work. (author)

  19. Use of recycled plastics in concrete: A critical review.

    Science.gov (United States)

    Gu, Lei; Ozbakkaloglu, Togay

    2016-05-01

    Plastics have become an essential part of our modern lifestyle, and the global plastic production has increased immensely during the past 50years. This has contributed greatly to the production of plastic-related waste. Reuse of waste and recycled plastic materials in concrete mix as an environmental friendly construction material has drawn attention of researchers in recent times, and a large number of studies reporting the behavior of concrete containing waste and recycled plastic materials have been published. This paper summarizes the current published literature until 2015, discussing the material properties and recycling methods of plastic and the influence of plastic materials on the properties of concrete. To provide a comprehensive review, a total of 84 studies were considered, and they were classified into sub categories based on whether they dealt with concrete containing plastic aggregates or plastic fibers. Furthermore, the morphology of concrete containing plastic materials is described in this paper to explain the influence of plastic aggregates and plastic fibers on the properties of concrete. The properties of concretes containing virgin plastic materials were also reviewed to establish their similarities and differences with concrete containing recycled plastics. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Emerging desalination technologies for water treatment: a critical review.

    Science.gov (United States)

    Subramani, Arun; Jacangelo, Joseph G

    2015-05-15

    In this paper, a review of emerging desalination technologies is presented. Several technologies for desalination of municipal and industrial wastewater have been proposed and evaluated, but only certain technologies have been commercialized or are close to commercialization. This review consists of membrane-based, thermal-based and alternative technologies. Membranes based on incorporation of nanoparticles, carbon nanotubes or graphene-based ones show promise as innovative desalination technologies with superior performance in terms of water permeability and salt rejection. However, only nanocomposite membranes have been commercialized while others are still under fundamental developmental stages. Among the thermal-based technologies, membrane distillation and adsorption desalination show the most promise for enhanced performance with the availability of a waste heat source. Several alternative technologies have also been developed recently; those based on capacitive deionization have shown considerable improvements in their salt removal capacity and feed water recovery. In the same category, microbial desalination cells have been shown to desalinate high salinity water without any external energy source, but to date, scale up of the process has not been methodically evaluated. In this paper, advantages and drawbacks of each technology is discussed along with a comparison of performance, water quality and energy consumption. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. A review of molecular imaging studies reaching the clinical stage

    International Nuclear Information System (INIS)

    Wong, Franklin C.; Kim, E. Edmund

    2009-01-01

    The practice of molecular imaging in the clinics is examined across various imaging modalities to assess the current status of clinical molecular imaging. The various physiologic and scientific bases of clinical molecular imaging are surveyed to assess the possibilities and opportunities for the deployment of the different imaging modalities in the near future. The requisites for successful candidate(s) of clinical molecular imaging are reviewed for future development.

  2. How do psychiatrists in India construct their professional identity? A critical literature review

    Science.gov (United States)

    Bayetti, Clement; Jadhav, Sushrut; Deshpande, Smita N.

    2017-01-01

    Psychiatric practice in India is marked by an increasing gulf between largely urban-based mental health professionals and a majority rural population. Based on the premise that any engagement is a mutually constructed humane process, an understanding of the culture of psychiatry including social process of local knowledge acquisition by trainee psychiatrists is critical. This paper reviews existing literature on training of psychiatrists in India, the cultural construction of their professional identities and autobiographical reflections. The results reveal a scarcity of research on how identities, knowledge, and values are constructed, contested, resisted, sustained, and operationalized through practice. This paper hypothesizes that psychiatric training and practice in India continues to operate chiefly in an instrumental fashion and bears a circular relationship between cultural, hierarchical training structures and patient–carer concerns. The absence of interpretative social science training generates a professional identity that predominantly focuses on the patient and his/her social world as the site of pathology. Infrequent and often superfluous critical cultural reflexivity gained through routine clinical practice further alienates professionals from patients, caregivers, and their own social landscapes. This results in a peculiar brand of theory and practice that is skewed toward a narrow understanding of what constitutes suffering. The authors argue that such omissions could be addressed through nuanced ethnographies on the professional development of psychiatrists during postgraduate training, including the political economies of their social institutions and local cultural landscapes. Further research will also help enhance culturally sensitive epistemology and shape locally responsive mental health training programs. This is critical for majority rural Indians who place their trust in State biomedical care. PMID:28529358

  3. Additive Manufacturing Techniques in Prosthodontics: Where Do We Currently Stand? A Critical Review.

    Science.gov (United States)

    Alharbi, Nawal; Wismeijer, Daniel; Osman, Reham B

    The aim of this article was to critically review the current application of additive manufacturing (AM)/3D-printing techniques in prosthodontics and to highlight the influence of various technical factors involved in different AM technologies. A standard approach of searching MEDLINE, EMBASE, and Google Scholar databases was followed. The following search terms were used: (Prosth* OR Restoration) AND (Prototype OR Additive Manufacture* OR Compute* OR 3D-print* OR CAD/CAM) AND (Dentistry OR Dental). Hand searching the reference lists of the included articles and personal connections revealed additional relevant articles. Selection criteria were any article written in English and reporting on the application of AM in prosthodontics from 1990 to February 2016. From a total of 4,290 articles identified, 33 were seen as relevant. Of these, 3 were narrative reviews, 18 were in vitro studies, and 12 were clinical in vivo studies. Different AM technologies are applied in prosthodontics, directly and indirectly for the fabrication of fixed metal copings, metal frameworks for removable partial dentures, and plastic mock-ups and resin patterns for further conventional metal castings. Technical factors involved in different AM techniques influence the overall quality, the mechanical properties of the printed parts, and the total cost and manufacturing time. AM is promising and offers new possibilities in the field of prosthodontics, though its application is still limited. An understanding of these limitations and of developments in material science is crucial prior to considering AM as an acceptable method for the fabrication of dental prostheses.

  4. Not the Sum of Its Parts: A Critical Review of the MacDonald Triad.

    Science.gov (United States)

    Parfitt, Charlotte Hannah; Alleyne, Emma

    2018-01-01

    The MacDonald triad posits that animal cruelty, fire setting, and bed wetting in childhood is indicative of later aggressive and violent behavior in adults. Researchers refer to this phenomenon as a precursor to later antisocial behaviors including serial and sexual murder; while practitioners cite the triad in clinical formulations and risk assessments. However, there is yet to be a critical review and consolidation of the literature that establishes whether there is empirical support. This article explores the validity of the triad. We conducted a narrative review of the relevant studies examining the MacDonald triad and its individual constituents. There is evidence that any one of the triad behaviors could predict future violent offending, but it is very rare to find all three behaviors together as predictors. Thus, the empirical research on the MacDonald triad does not fully substantiate its premise. Rather, it would appear that the triad, or its individual constituents, is better used as an indicator of dysfunctional home environments, or poor coping skills in children. Future research is needed with robust and rigorous methodologies (e.g., adequate control groups, longitudinal designs) to fully establish the MacDonald triad's validity. Finally, further consideration is needed as to whether the triad behaviors are more indicative of other problematic outcomes (e.g., maladaptive coping to life stressors).

  5. Tablet Use in Schools: A Critical Review of the Evidence for Learning Outcomes

    Science.gov (United States)

    Haßler, B.; Major, L.; Hennessy, S.

    2016-01-01

    The increased popularity of tablets in general has led to uptake in education. We critically review the literature reporting use of tablets by primary and secondary school children across the curriculum, with a particular emphasis on learning outcomes. The systematic review methodology was used, and our literature search resulted in 33 relevant…

  6. Instrumented Measurement of Balance and Postural Control in Individuals with Lower Limb Amputation: A Critical Review

    Science.gov (United States)

    Jayakaran, Prasath; Johnson, Gillian M.; Sullivan, S. John; Nitz, Jennifer C.

    2012-01-01

    Measurement of balance and postural performance that underpins activities of daily living is important in the rehabilitation of individuals with a lower limb amputation (LLA), and there are a number of methods and strategies available for this purpose. To provide an evidence-based choice of approach, this review aims to critically review the tasks…

  7. School Uniforms: A Critical Review of the Literature. From Inquiry to Practice.

    Science.gov (United States)

    Brunsma, David L.

    The debate surrounding the effectiveness of school-uniform policies, as well as discussions concerning when and how to implement them, is rooted in anecdote. This review summarizes anecdotal literature on which the current debate is based and critically reviews the empirical literature, including theoretical underpinnings, findings, and…

  8. Critical Discourse Analysis in Education: A Review of the Literature, 2004 to 2012

    Science.gov (United States)

    Rogers, Rebecca; Schaenen, Inda; Schott, Christopher; O'Brien, Kathryn; Trigos-Carrillo, Lina; Starkey, Kim; Chasteen, Cynthia Carter

    2016-01-01

    This article reviews critical discourse analysis scholarship in education research from 2004 to 2012. Our methodology was carried out in three stages. First, we searched educational databases. Second, we completed an analytic review template for each article and encoded these data into a digital spreadsheet to assess macro-trends in the field.…

  9. Peer-to-Peer Teaching in Higher Education: A Critical Literature Review

    Science.gov (United States)

    Stigmar, Martin

    2016-01-01

    The aim of my critical literature review is to identify studies where students are engaged as partners in teaching in higher education and to analyze how tutors and tutees benefit from peer teaching. Thirty studies were included for review. Thirteen countries are represented and two thirds of the studies conducted in the United States of America…

  10. A critical review of advance directives in Germany: attitudes, use and healthcare professionals’ compliance

    NARCIS (Netherlands)

    Evans, N.; Bausewein, C.; Meñaca, A.; Andrew, E.V.W.; Higginson, I.J.; Harding, R.; Pool, R.; Gysels, M.

    2012-01-01

    Objective Recent legal changes in Germany make non-compliance with advance directives (ADs) a criminal offence. This article assesses the evidence on attitudes towards, use of, and physician compliance with ADs in Germany. Methods Critical review: studies on ADs, identified from a systematic review

  11. Openness in Adoption: What We Know So Far--A Critical Review of the Literature

    Science.gov (United States)

    Wolfgram, Susan M.

    2008-01-01

    What are the factors that keep adoptive parents and birth parents connected and sustain their kinship relationships over time? This is the central research question critically reviewed across studies dating from 1987 to 2000. A preliminary review of the literature revealed 15 to 20 studies within this 13-year scope limited to the perspective of…

  12. Liposome Delivery Systems for Inhalation: A Critical Review Highlighting Formulation Issues and Anticancer Applications.

    Science.gov (United States)

    Rudokas, Mindaugas; Najlah, Mohammad; Alhnan, Mohamed Albed; Elhissi, Abdelbary

    2016-01-01

    This is a critical review on research conducted in the field of pulmonary delivery of liposomes. Issues relating to the mechanism of nebulisation and liposome composition were appraised and correlated with literature reports of liposome formulations used in clinical trials to understand the role of liposome size and composition on therapeutic outcome. A major highlight was liposome inhalation for the treatment of lung cancers. Many in vivo studies that explored the potential of liposomes as anticancer carrier systems were evaluated, including animal studies and clinical trials. Liposomes can entrap anticancer drugs and localise their action in the lung following pulmonary delivery. The safety of inhaled liposomes incorporating anticancer drugs depends on the anticancer agent used and the amount of drug delivered to the target cancer in the lung. The difficulty of efficient targeting of liposomal anticancer aerosols to the cancerous tissues within the lung may result in low doses reaching the target site. Overall, following the success of liposomes as inhalable carriers in the treatment of lung infections, it is expected that more focus from research and development will be given to designing inhalable liposome carriers for the treatment of other lung diseases, including pulmonary cancers. The successful development of anticancer liposomes for inhalation may depend on the future development of effective aerosolisation devices and better targeted liposomes to maximise the benefit of therapy and reduce the potential for local and systemic adverse effects. © 2016 S. Karger AG, Basel.

  13. Beethoven recordings reviewed: a systematic method for mapping the content of music performance criticism.

    Science.gov (United States)

    Alessandri, Elena; Williamson, Victoria J; Eiholzer, Hubert; Williamon, Aaron

    2015-01-01

    Critical reviews offer rich data that can be used to investigate how musical experiences are conceptualized by expert listeners. However, these data also present significant challenges in terms of organization, analysis, and interpretation. This study presents a new systematic method for examining written responses to music, tested on a substantial corpus of music criticism. One hundred critical reviews of Beethoven's piano sonata recordings, published in the Gramophone between August 1934 and July 2010, were selected using in-depth data reduction (qualitative/quantitative approach). The texts were then examined using thematic analysis in order to generate a visual descriptive model of expert critical review. This model reveals how the concept of evaluation permeates critical review. It also distinguishes between two types of descriptors. The first characterizes the performance in terms of specific actions or features of the musical sound (musical parameters, technique, and energy); the second appeals to higher-order properties (artistic style, character and emotion, musical structure, communicativeness) or assumed performer qualities (understanding, intentionality, spontaneity, sensibility, control, and care). The new model provides a methodological guide and conceptual basis for future studies of critical review in any genre.

  14. Health Impacts of the Great Recession: A Critical Review.

    Science.gov (United States)

    Margerison-Zilko, Claire; Goldman-Mellor, Sidra; Falconi, April; Downing, Janelle

    2016-03-01

    The severity, sudden onset, and multipronged nature of the Great Recession (2007-2009) provided a unique opportunity to examine the health impacts of macroeconomic downturn. We comprehensively review empirical literature examining the relationship between the Recession and mental and physical health outcomes in developed nations. Overall, studies reported detrimental impacts of the Recession on health, particularly mental health. Macro- and individual-level employment- and housing-related sequelae of the Recession were associated with declining fertility and self-rated health, and increasing morbidity, psychological distress, and suicide, although traffic fatalities and population-level alcohol consumption declined. Health impacts were stronger among men and racial/ethnic minorities. Importantly, strong social safety nets in some European countries appear to have buffered those populations from negative health effects. This literature, however, still faces multiple methodological challenges, and more time may be needed to observe the Recession's full health impact. We conclude with suggestions for future work in this field.

  15. Biomimetics in drug delivery systems: A critical review.

    Science.gov (United States)

    Sheikhpour, Mojgan; Barani, Leila; Kasaeian, Alibakhsh

    2017-05-10

    Today, the advanced drug delivery systems have been focused on targeted drug delivery fields. The novel drug delivery is involved with the improvement of the capacity of drug loading in drug carriers, cellular uptake of drug carriers, and the sustained release of drugs within target cells. In this review, six groups of therapeutic drug carriers including biomimetic hydrogels, biomimetic micelles, biomimetic liposomes, biomimetic dendrimers, biomimetic polymeric carriers and biomimetic nanostructures, are studied. The subject takes advantage of the biomimetic methods of productions or the biomimetic techniques for the surface modifications, similar to what accrues in natural cells. Moreover, the effects of these biomimetic approaches for promoting the drug efficiency in targeted drug delivery are visible. The study demonstrates that the fabrication of biomimetic nanocomposite drug carriers could noticeably promote the efficiency of drugs in targeted drug delivery systems. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Resistance Training in Children and Young Adults: A Critical Review

    Directory of Open Access Journals (Sweden)

    Rami Shenouda

    2017-01-01

    Full Text Available Resistance training is a method used by many athletes to increase their levels of performance. The benefits of this method are known to be increased strength, power and endurance. Resistance training in children has been a topic that has been long debated and there are some widely accepted beliefs and principles that guide clinicians involved in the discipline of sport and exercise medicine. While weight training is a form of resistance training that has proven beneficial effects on health and wellbeing, powerlifting and heavy weight training should be avoided, as lifting maximal weights through various ranges of motion as fast as possible can lead to serious limb injuries. In order to determine the risks and benefits of resistance training in children and adolescents, it is important to review the literature to find a clear consensus. Further prospective research should be completed to determine the long-term sequelae of resistance training in children in comparison to the general population.

  17. NSSS aging review: critical systems operating measures and monitoring

    International Nuclear Information System (INIS)

    Quero, J.R.

    1985-05-01

    How long the nuclear plants can get. In this question we can find three main aspects: Economic - Licensing - and Technical ones. The final answer to this question will include compulsory elements coming from these three areas, each of them being a deciding factor. The presentation is focused on the technical aspect; but before a few comments are done on economic and licensing factors. Then, some particular technical items dealing with aging or life time of our nuclear plants are reviewed: electrical equipment, heat exchangers (steam generators), wear: primary pump, embrittlement: Reactor Pressure Vessel (Austeno-ferritic parts), fatigue (Thermo-hydraulic transients). By the way, some information about how this problem is handled, at the present time, explicitely or implicitely in France are given

  18. Membrane contactors for CO2 capture processes - critical review

    Science.gov (United States)

    Nogalska, Adrianna; Trojanowska, Anna; Garcia-Valls, Ricard

    2017-07-01

    The use of membrane contactor in industrial processes is wide, and lately it started to be used in CO2 capture process mainly for gas purification or to reduce the emission. Use of the membrane contactor provides high contact surface area so the size of the absorber unit significantly decreases, which is an important factor for commercialization. The research has been caried out regarding the use of novel materials for the membrane production and absorbent solution improvements. The present review reveals the progress in membrane contactor systems for CO2 capture processes concerning solution for ceramic membrane wetting, comparison study of different polymers used for fabrication and methods of enzyme immobilization for biocomposite membrane. Also information about variety of absorbent solutions is described.

  19. Financing Renewable Energy Projects in Developing Countries: A Critical Review

    Science.gov (United States)

    Donastorg, A.; Renukappa, S.; Suresh, S.

    2017-08-01

    Access to clean and stable energy, meeting sustainable development goals, the fossil fuel dependency and depletion are some of the reasons that have impacted developing countries to transform the business as usual economy to a more sustainable economy. However, access and availability of finance is a major challenge for many developing countries. Financing renewable energy projects require access to significant resources, by multiple parties, at varying points in the project life cycles. This research aims to investigate sources and new trends in financing RE projects in developing countries. For this purpose, a detail and in-depth literature review have been conducted to explore the sources and trends of current RE financial investment and projects, to understand the gaps and limitations. This paper concludes that there are various internal and external sources of finance available for RE projects in developing countries.

  20. Treatment of textile wastewater with membrane bioreactor: A critical review.

    Science.gov (United States)

    Jegatheesan, Veeriah; Pramanik, Biplob Kumar; Chen, Jingyu; Navaratna, Dimuth; Chang, Chia-Yuan; Shu, Li

    2016-03-01

    Membrane bioreactor (MBR) technology has been used widely for various industrial wastewater treatments due to its distinct advantages over conventional bioreactors. Treatment of textile wastewater using MBR has been investigated as a simple, reliable and cost-effective process with a significant removal of contaminants. However, a major drawback in the operation of MBR is membrane fouling, which leads to the decline in permeate flux and therefore requires membrane cleaning. This eventually decreases the lifespan of the membrane. In this paper, the application of aerobic and anaerobic MBR for textile wastewater treatment as well as fouling and control of fouling in MBR processes have been reviewed. It has been found that long sludge retention time increases the degradation of pollutants by allowing slow growing microorganisms to establish but also contributes to membrane fouling. Further research aspects of MBR for textile wastewater treatment are also considered for sustainable operations of the process. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Effects of radiation on coal mine environment -a critical review

    International Nuclear Information System (INIS)

    Singh, A.K.; Varma, N.K.; Sahay, N.; Ahmad, I.

    2001-01-01

    Due to mass-scale industrialization, world's environment is being polluted every day endangering the existence of living beings on the earth. This has attracted the attention of environmental engineers, medical practitioners, planners and researchers throughout the world. Attempts are being made to make air, water and atmosphere clean and to prevent likely hazards arising out of various industrial activities. In addition, the radiation from natural sources is all around us and has been here since time immemorial. Coal miners have small occupational radiation which arise from naturally occurring radioactive substance(s) underground. The predominant source of natural radiation present in coal mines is the radon gas. This paper describes the origin of radon and its radiological hazards. An attempt has been made to review the status of the problem likely to be caused by the different radioactive elements present in Indian coal, coal ash and allied coal-based industries. (author)

  2. Critical variables of business failure: a review and classification framework

    Directory of Open Access Journals (Sweden)

    Marius Pretorius

    2011-08-01

    Full Text Available Failure is a phenomenon that ventures face during all stages of the life cycle and requires insight into its causes before it can be reversed. The scientific literature on failure is, however, spread over multiple disciplines. This study’s line of enquiry firstly reviews the documented research (both theoretical and empirical encompassing the phenomenon ‘business failure’ on a multi-disciplinary basis. A conceptual framework is then proposed for categorising variables into four sub-domains namely: signs and prediction; causes and preconditions; recovery; and cognition and learning. Better understanding of the failure phenomenon is achieved. The methodology applied is fundamentally based on grounded theory interpretation with a focus on classifying the identified relevant variables.

  3. Social and ethical aspects of forensic genetics: A critical review.

    Science.gov (United States)

    Williams, R; Wienroth, M

    2017-07-01

    This review describes the social and ethical responses to the history of innovations in forensic genetics and their application to criminal investigations. Following an outline of the three recurrent social perspectives that have informed these responses (crime management, due process, and genetic surveillance), it goes on to introduce the repertoire of ethical considerations by describing a series of key reports that have shaped subsequent commentaries on forensic DNA profiling and databasing. Four major ethical concerns form the focus of the remainder of the paper (dignity, privacy, justice, and social solidarity), and key features of forensic genetic practice are examined in the light of these concerns. The paper concludes with a discussion of the concept of "proportionality" as a resource for balancing the social and ethical risks and benefits of the use of forensic genetics in support of criminal justice. Copyright © 2017 Central Police University.

  4. Black Phosphorus: Critical Review and Potential for Water Splitting Photocatalyst

    Directory of Open Access Journals (Sweden)

    Tae Hyung Lee

    2016-10-01

    Full Text Available A century after its first synthesis in 1914, black phosphorus has been attracting significant attention as a promising two-dimensional material in recent years due to its unique properties. Nowadays, with the development of its exfoliation method, there are extensive applications of black phosphorus in transistors, batteries and optoelectronics. Though, because of its hardship in mass production and stability problems, the potential of the black phosphorus in various fields is left unexplored. Here, we provide a comprehensive review of crystal structure, electronic, optical properties and synthesis of black phosphorus. Recent research works about the applications of black phosphorus is summarized. Among them, the possibility of black phosphorous as a solar water splitting photocatalyst is mainly discussed and the feasible novel structure of photocatalysts based on black phosphorous is proposed.

  5. Nattokinase: an updated critical review on challenges and perspectives.

    Science.gov (United States)

    Selvarajan, Ethiraj; Bhatnagar, Niharika

    2017-12-07

    Natto, a fermented soybean food, has been consumed by oriental people for more than 1000 years. Nattokinase, formerly called subtilisin NAT is a well studied protease of microbial origin that possesses fibrinolytic (anti-clotting) activities. Due to its strong fibrinolytic and thrombolytic activity, Nattokinase is regarded as a precious dietary supplement or nutraceutical for the oral thrombolytic therapy. Nattokinase is witnessed to be a useful enzyme for the com-plete removal of the vitreous and associated proliferative tissues in proliferative vitreo retinal disorders. This review focuses on the native and recombinant Nattokinase from bacteria and other sources, their production, purification, immobilization and nano-immobilization studies, which aid in ameliorating their properties to suit the targeted industrial applications. Recent development in these fields are presented and discussed, and prospective developments are suggested. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  6. A Critical Review of OSHA Heat Enforcement Cases: Lessons Learned.

    Science.gov (United States)

    Arbury, Sheila; Lindsley, Matthew; Hodgson, Michael

    2016-04-01

    The aim of the study was to review the Occupational Safety and Health Administration's (OSHA) 2012 to 2013 heat enforcement cases, using identified essential elements of heat illness prevention to evaluate employers' programs and make recommendations to better protect workers from heat illness. (1) Identify essential elements of heat illness prevention; (2) develop data collection tool; and (3) analyze OSHA 2012 to 2013 heat enforcement cases. OSHA's database contains 84 heat enforcement cases in 2012 to 2013. Employer heat illness prevention programs were lacking in essential elements such as providing water and shade; adjusting the work/rest proportion to allow for workload and effective temperature; and acclimatizing and training workers. In this set of investigations, most employers failed to implement common elements of illness prevention programs. Over 80% clearly did not rely on national standard approaches to heat illness prevention.

  7. Retention systems for extraoral maxillofacial prosthetic implants: a critical review.

    Science.gov (United States)

    Cobein, M V; Coto, N P; Crivello Junior, O; Lemos, J B D; Vieira, L M; Pimentel, M L; Byrne, H J; Dias, R B

    2017-10-01

    We describe the techniques available for retention of implant-supported prostheses: bar-clips, O-rings, and magnets. We present reported preferences and, although this is limited by the heterogeneity of methods used and patients studied, we hope we have identified the best retention systems for maxillofacial prosthetic implants. If practitioners know the advantages and disadvantages of each system, they can choose the most natural and comfortable prosthesis. We searched the PubMed and Scopus databases, and restricted our search to papers published 2001-13. MeSH terms used were Maxillofacial prosthesis and Craniofacial prosthesis OR Craniofacial prostheses. We found a total of 2630 papers, and after duplicates had been removed we analysed the rest and found 25 papers for review. Of these, 12 were excluded because they were case reports or non-systematic reviews. Of the remaining 13, 10 described group analyses and seemed appropriate to find practitioner's choices, as cited in the abstract (n=1611 prostheses). Three papers did not mention the type of prosthetic connection used, so were excluded. The most popular choices for different conditions were analysed, though the sites and retention systems were not specified in all 10 papers. The bar-clip system was the most used in auricular (6/10 papers) and nasal prostheses (4/10). For the orbital region, 6/10 favoured magnets. Non-osseointegrated mechanical or adhesive retention techniques are the least expensive and have no contraindications. When osseointegrated implants are possible, each facial region has a favoured system. The choice of system is influenced by two factors: standard practice and the abilities of the maxillofacial surgeon and maxillofacial prosthetist. Copyright © 2017 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  8. A critical review of neonicotinoid insecticides for developmental neurotoxicity

    Science.gov (United States)

    Sheets, Larry P.; Li, Abby A.; Minnema, Daniel J.; Collier, Richard H.; Creek, Moire R.; Peffer, Richard C.

    2016-01-01

    Abstract A comprehensive review of published and previously unpublished studies was performed to evaluate the neonicotinoid insecticides for evidence of developmental neurotoxicity (DNT). These insecticides have favorable safety profiles, due to their preferential affinity for nicotinic receptor (nAChR) subtypes in insects, poor penetration of the mammalian blood–brain barrier, and low application rates. Nevertheless, examination of this issue is warranted, due to their insecticidal mode of action and potential exposure with agricultural and residential uses. This review identified in vitro, in vivo, and epidemiology studies in the literature and studies performed in rats in accordance with GLP standards and EPA guidelines with imidacloprid, acetamiprid, thiacloprid, clothianidin, thiamethoxam, and dinotefuran, which are all the neonicotinoids currently registered in major markets. For the guideline-based studies, treatment was administered via the diet or gavage to primiparous female rats at three dose levels, plus a vehicle control (≥20/dose level), from gestation day 0 or 6 to lactation day 21. F1 males and females were evaluated using measures of motor activity, acoustic startle response, cognition, brain morphometry, and neuropathology. The principal effects in F1 animals were associated with decreased body weight (delayed sexual maturation, decreased brain weight, and morphometric measurements) and acute toxicity (decreased activity during exposure) at high doses, without neuropathology or impaired cognition. No common effects were identified among the neonicotinoids that were consistent with DNT or the neurodevelopmental effects associated with nicotine. Findings at high doses were associated with evidence of systemic toxicity, which indicates that these insecticides do not selectively affect the developing nervous system. PMID:26513508

  9. Critical review of the building downwash algorithms in AERMOD.

    Science.gov (United States)

    Petersen, Ron L; Guerra, Sergio A; Bova, Anthony S

    2017-08-01

    The only documentation on the building downwash algorithm in AERMOD (American Meteorological Society/U.S. Environmental Protection Agency Regulatory Model), referred to as PRIME (Plume Rise Model Enhancements), is found in the 2000 A&WMA journal article by Schulman, Strimaitis and Scire. Recent field and wind tunnel studies have shown that AERMOD can overpredict concentrations by factors of 2 to 8 for certain building configurations. While a wind tunnel equivalent building dimension study (EBD) can be conducted to approximately correct the overprediction bias, past field and wind tunnel studies indicate that there are notable flaws in the PRIME building downwash theory. A detailed review of the theory supported by CFD (Computational Fluid Dynamics) and wind tunnel simulations of flow over simple rectangular buildings revealed the following serious theoretical flaws: enhanced turbulence in the building wake starting at the wrong longitudinal location; constant enhanced turbulence extending up to the wake height; constant initial enhanced turbulence in the building wake (does not vary with roughness or stability); discontinuities in the streamline calculations; and no method to account for streamlined or porous structures. This paper documents theoretical and other problems in PRIME along with CFD simulations and wind tunnel observations that support these findings. Although AERMOD/PRIME may provide accurate and unbiased estimates (within a factor of 2) for some building configurations, a major review and update is needed so that accurate estimates can be obtained for other building configurations where significant overpredictions or underpredictions are common due to downwash effects. This will ensure that regulatory evaluations subject to dispersion modeling requirements can be based on an accurate model. Thus, it is imperative that the downwash theory in PRIME is corrected to improve model performance and ensure that the model better represents reality.

  10. Vagus nerve stimulation magnet activation for seizures: a critical review.

    Science.gov (United States)

    Fisher, R S; Eggleston, K S; Wright, C W

    2015-01-01

    Some patients receiving VNS Therapy report benefit from manually activating the generator with a handheld magnet at the time of a seizure. A review of 20 studies comprising 859 subjects identified patients who reported on-demand magnet mode stimulation to be beneficial. Benefit was reported in a weighted average of 45% of patients (range 0-89%) using the magnet, with seizure cessation claimed in a weighted average of 28% (range 15-67%). In addition to seizure termination, patients sometimes reported decreased intensity or duration of seizures or the post-ictal period. One study reported an isolated instance of worsening with magnet stimulation (Arch Pediatr Adolesc Med, 157, 2003 and 560). All of the reviewed studies assessed adjunctive magnet use. No studies were designed to provide Level I evidence of efficacy of magnet-induced stimulation. Retrospective analysis of one pivotal randomized trial of VNS therapy showed significantly more seizures terminated or improved in the active stimulation group vs the control group. Prospective, controlled studies would be required to isolate the effect and benefit of magnet mode stimulation and to document that the magnet-induced stimulation is the proximate cause of seizure reduction. Manual application of the magnet to initiate stimulation is not always practical because many patients are immobilized or unaware of their seizures, asleep or not in reach of the magnet. Algorithms based on changes in heart rate at or near the onset of the seizure provide a methodology for automated responsive stimulation. Because literature indicates additional benefits from on-demand magnet mode stimulation, a potential role exists for automatic activation of stimulation. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. A critical review of neonicotinoid insecticides for developmental neurotoxicity.

    Science.gov (United States)

    Sheets, Larry P; Li, Abby A; Minnema, Daniel J; Collier, Richard H; Creek, Moire R; Peffer, Richard C

    2016-02-01

    A comprehensive review of published and previously unpublished studies was performed to evaluate the neonicotinoid insecticides for evidence of developmental neurotoxicity (DNT). These insecticides have favorable safety profiles, due to their preferential affinity for nicotinic receptor (nAChR) subtypes in insects, poor penetration of the mammalian blood-brain barrier, and low application rates. Nevertheless, examination of this issue is warranted, due to their insecticidal mode of action and potential exposure with agricultural and residential uses. This review identified in vitro, in vivo, and epidemiology studies in the literature and studies performed in rats in accordance with GLP standards and EPA guidelines with imidacloprid, acetamiprid, thiacloprid, clothianidin, thiamethoxam, and dinotefuran, which are all the neonicotinoids currently registered in major markets. For the guideline-based studies, treatment was administered via the diet or gavage to primiparous female rats at three dose levels, plus a vehicle control (≥20/dose level), from gestation day 0 or 6 to lactation day 21. F1 males and females were evaluated using measures of motor activity, acoustic startle response, cognition, brain morphometry, and neuropathology. The principal effects in F1 animals were associated with decreased body weight (delayed sexual maturation, decreased brain weight, and morphometric measurements) and acute toxicity (decreased activity during exposure) at high doses, without neuropathology or impaired cognition. No common effects were identified among the neonicotinoids that were consistent with DNT or the neurodevelopmental effects associated with nicotine. Findings at high doses were associated with evidence of systemic toxicity, which indicates that these insecticides do not selectively affect the developing nervous system.

  12. Re-examining the Evidence in Radiation Dermatitis Management Literature: An Overview and a Critical Appraisal of Systematic Reviews

    International Nuclear Information System (INIS)

    Chan, Raymond Javan; Larsen, Emily; Chan, Philip

    2012-01-01

    Purpose: To provide an overview and a critical appraisal of systematic reviews (SRs) of published interventions for the prevention/management of radiation dermatitis. Methods and Materials: We searched Medline, CINAHL, Embase, and the Cochrane Library. We also manually searched through individual reference lists of potentially eligible articles and a number of key journals in the topic area. Two authors screened all potential articles and included eligible SRs. Two authors critically appraised and extracted key findings from the included reviews using AMSTAR (the measurement tool for “assessment of multiple systematic reviews”). Results: Of 1837 potential titles, 6 SRs were included. A number of interventions have been reported to be potentially beneficial for managing radiation dermatitis. Interventions evaluated in these reviews included skin care advice, steroidal/nonsteroidal topical agents, systemic therapies, modes of radiation delivery, and dressings. However, all the included SRs reported that there is insufficient evidence supporting any single effective intervention. The methodological quality of the included studies varied, and methodological shortfalls in these reviews might create biases to the overall results or recommendations for clinical practice. Conclusions: An up-to-date high-quality SR in the prevention/management of radiation dermatitis is needed to guide practice and direction for future research. We recommend that clinicians or guideline developers critically evaluate the information of SRs in their decision making.

  13. Critical review of the responsive neurostimulator system for epilepsy

    Directory of Open Access Journals (Sweden)

    Thomas GP

    2015-10-01

    Full Text Available George P Thomas, Barbara C Jobst Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA Abstract: Patients with medically refractory epilepsy have historically had few effective treatment options. Electrical brain stimulation for seizures has been studied for decades and ongoing technological refinements have made possible the development of an implantable electrical brain stimulator. The NeuroPace responsive neurostimulator was recently approved by the FDA for clinical use and the initial reports are encouraging. This device continually monitors brain activity and delivers an electric stimulus when abnormal activity is detected. Early reports of efficacy suggest that the device is well tolerated and offers a reduction in seizure frequency by approximately half at 2 years. Keywords: medically refractory epilepsy, seizures, brain surgery, brain stimulation, neurostimulation

  14. Promotion of Critical Thinking in Clinical Nursing Post Conferences: A Peer Interactive Approach

    Science.gov (United States)

    Stevens, Joanne

    2009-01-01

    Several workshops presented at the 2005 Lilly Conference on College Teaching in Oxford, Ohio, provided the inspiration for redesigning the clinical post conference for a foundational nursing course. Given the complexity and acuity of patient conditions today, fostering critical thinking in student nurses is central to quality patient care. The…

  15. Therapeutic potential of oncolytic Newcastle disease virus: a critical review.

    Science.gov (United States)

    Tayeb, Shay; Zakay-Rones, Zichria; Panet, Amos

    2015-01-01

    Newcastle disease virus (NDV) features a natural preference for replication in many tumor cells compared with normal cells. The observed antitumor effect of NDV appears to be a result of both selective killing of tumor cells and induction of immune responses. Genetic manipulations to change viral tropism and arming the virus with genes encoding for cytokines improved the oncolytic capacity of NDV. Several intracellular proteins in tumor cells, including antiapoptotic proteins (Livin) and oncogenic proteins (H-Ras), are relevant for the oncolytic activity of NDV. Defects in the interferon system, found in some tumor cells, also contribute to the oncolytic selectivity of NDV. Notwithstanding, NDV displays effective oncolytic activity in many tumor types, despite having intact interferon signaling. Taken together, several cellular systems appear to dictate the selective oncolytic activity of NDV. Some barriers, such as neutralizing antibodies elicited during NDV treatment and the extracellular matrix in tumor tissue appear to interfere with spread of NDV and reduce oncolysis. To further understand the oncolytic activity of NDV, we compared two NDV strains, ie, an attenuated virus (NDV-HUJ) and a pathogenic virus (NDV-MTH-68/H). Significant differences in amino acid sequence were noted in several viral proteins, including the fusion precursor (F0) glycoprotein, an important determinant of replication and pathogenicity. However, no difference in the oncolytic activity of the two strains was noted using human tumor tissues maintained as organ cultures or in mouse tumor models. To optimize virotherapy in clinical trials, we describe here a unique organ culture methodology, using a biopsy taken from a patient's tumor before treatment for ex vivo infection with NDV to determine the oncolytic potential on an individual basis. In conclusion, oncolytic NDV is an excellent candidate for cancer therapy, but more knowledge is needed to ensure success in clinical trials.

  16. Judicial Performance Review in Arizona: A Critical Assessment

    Directory of Open Access Journals (Sweden)

    Rebecca White Berch

    2014-12-01

    Full Text Available Judicial performance evaluations are a relatively new tool for assessing judges and providing information to voters to help them determine whether to retain judges in contested or retention elections. Arizona implemented its judicial evaluation program about 20 years ago, and since that time, the state has continually strived to improve its process. The result is that today Arizona has one of the most progressive and comprehensive judicial performance evaluation programs in the United States. This article takes a critical look at the strengths and weaknesses of Arizona’s program, keeping in mind two key values that the system seeks to protect: judicial accountability and judicial independence. Las evaluaciones del rendimiento judicial son una herramienta relativamente nueva para evaluar a los jueces y ofrecer información a los votantes, que les ayude a decidir si quieren reelegir a los jueces en las elecciones. Arizona implementó su programa de evaluación judicial hace unos 20 años, y desde ese momento, el Estado se ha esforzado continuamente en mejorar el proceso. El resultado es que hoy en día, Arizona tiene uno de los programas de evaluación del rendimiento judicial más progresistas e integrales de los Estados Unidos. Este artículo ofrece una mirada crítica a las fortalezas y debilidades del programa de Arizona, teniendo en cuenta dos valores clave que el sistema trata de proteger: la responsabilidad judicial y la independencia judicial. DOWNLOAD THIS PAPER FROM SSRN: http://ssrn.com/abstract=2533868

  17. A critical literature review of focused electron beam induced deposition

    International Nuclear Information System (INIS)

    Dorp, W. F. van; Hagen, C. W.

    2008-01-01

    An extensive review is given of the results from literature on electron beam induced deposition. Electron beam induced deposition is a complex process, where many and often mutually dependent factors are involved. The process has been studied by many over many years in many different experimental setups, so it is not surprising that there is a great variety of experimental results. To come to a better understanding of the process, it is important to see to which extent the experimental results are consistent with each other and with the existing model. All results from literature were categorized by sorting the data according to the specific parameter that was varied (current density, acceleration voltage, scan patterns, etc.). Each of these parameters can have an effect on the final deposit properties, such as the physical dimensions, the composition, the morphology, or the conductivity. For each parameter-property combination, the available data are discussed and (as far as possible) interpreted. By combining models for electron scattering in a solid, two different growth regimes, and electron beam induced heating, the majority of the experimental results were explained qualitatively. This indicates that the physical processes are well understood, although quantitatively speaking the models can still be improved. The review makes clear that several major issues remain. One issue encountered when interpreting results from literature is the lack of data. Often, important parameters (such as the local precursor pressure) are not reported, which can complicate interpretation of the results. Another issue is the fact that the cross section for electron induced dissociation is unknown. In a number of cases, a correlation between the vertical growth rate and the secondary electron yield was found, which suggests that the secondary electrons dominate the dissociation rather than the primary electrons. Conclusive evidence for this hypothesis has not been found. Finally

  18. Clinical Pharmacology of Furosemide in Neonates: A Review

    Directory of Open Access Journals (Sweden)

    Gian Maria Pacifici

    2013-09-01

    Full Text Available Furosemide is the diuretic most used in newborn infants. It blocks the Na+-K+-2Cl− symporter in the thick ascending limb of the loop of Henle increasing urinary excretion of Na+ and Cl−. This article aimed to review the published data on the clinical pharmacology of furosemide in neonates to provide a critical, comprehensive, authoritative and, updated survey on the metabolism, pharmacokinetics, pharmacodynamics and side-effects of furosemide in neonates. The bibliographic search was performed using PubMed and EMBASE databases as search engines; January 2013 was the cutoff point. Furosemide half-life (t1/2 is 6 to 20-fold longer, clearance (Cl is 1.2 to 14-fold smaller and volume of distribution (Vd is 1.3 to 6-fold larger than the adult values. t1/2 shortens and Cl increases as the neonatal maturation proceeds. Continuous intravenous infusion of furosemide yields more controlled diuresis than the intermittent intravenous infusion. Furosemide may be administered by inhalation to infants with chronic lung disease to improve pulmonary mechanics. Furosemide stimulates prostaglandin E2 synthesis, a potent dilator of the patent ductus arteriosus, and the administration of furosemide to any preterm infants should be carefully weighed against the risk of precipitation of a symptomatic patent ductus arteriosus. Infants with low birthweight treated with chronic furosemide are at risk for the development of intra-renal calcifications.

  19. Clinical and diagnostic importance of proteinuria: A review | Oni ...

    African Journals Online (AJOL)

    Clinical and diagnostic importance of proteinuria: A review. ... shown that diabetis mellitus, cardiovascular disease and hypertension could provoke secondary ... Proteinuria is also significant in some non-pathological cases such as pregnancy

  20. Childhood bruxism: a clinical review and case report.

    Science.gov (United States)

    Gupta, B; Marya, C M; Anegundi, R

    2010-01-01

    The present case report refers to a patient who reported to the department with the complaint of teeth grinding (Bruxism). A brief review of the literature is reported concerning the aetiology, clinical diagnosis and the therapeutic approach of the disease.

  1. Obstructive sleep apnea: a clinical review

    Directory of Open Access Journals (Sweden)

    M. Marvisi

    2013-05-01

    Full Text Available BACKGROUND Since the original classification of the obstructive nature of obstructive sleep apnea syndrome (OSAS in 1965, much has been learned about the disorder. In 1990 respiratory disturbances during sleep have come to be recognized as extremely common disorders with important clinical consequences. DISCUSSION It is a condition with high prevalence of obesity as a major risk factor. Premenopausal women are relatively protected from the disorder: its prevalence in women rises after menopause. Although OSAS is a risk factor for excessive daytime sleepiness, there is developing evidence that it is also a risk factor for hypertension, acute cardiovascular events, and insulin resistance. Definitive diagnosis still depends on in-laboratory polysomnography. This involves recording of multiple variables during sleep, including electroencephalogram. There is a considerable interest in the role of unattended home sleep-monitoring and some evidence of its usefulness has yet to be established. The first line of therapy is nasal continuous positive airway pressure (CPAP. Data into the efficacy of CPAP in severe OSAS have come from randomized, placebo-controlled clinical trials the endpoints of which being sleepiness, quality of life, and 24-h ambulatory blood pressure. Data are currently less convincing for treatment outcomes in mild to moderate OSAS, and new clinical trails to assess outcomes in this group are underway. CONCLUSION The field of sleep medicine has now firmly entered the mainstream of clinical practice, substantial progress has been made, and OSAS has increasingly emerged as a major public health concern. The Internal Medicine specialist has to recognize this clinical entity.

  2. Folklore and Folk Songs of Chittagong: A Critical Review

    Directory of Open Access Journals (Sweden)

    Amir Mohammad Khan

    2017-04-01

    Full Text Available Folk Songs stems from Folklore are very rich in the southern region of Chittagong. In this part of the world Folk Songs play pivotal role in the lifestyle of people as a heart-touching and heavenly connection exists between human, nature and Folk Songs. Folk Songs in this area are special because we found the theme of Nature Conservation in them. We took the southern part of Chittagong (Lohagara, Satkania, Chandanaish and Patiya as our research area, selected a village namely Chunati in the systematic sampling and more than 100 people were interviewed through focus group discussion and key informant interviews. The sufficient literature review is also done. People in this area love nature a lot. Here music personnel were born from time to time who not only worked for the musical development but also created consciousness among people to love nature and save it. We discussed about the origin of Folk Songs, pattern of Folk Songs to clarify the importance of Folk Songs of Chittagong for its connection to Folklore and at the same time for promoting the idea of Nature Conservation. Of course, this part of studies deserves more attention in the field of research. Our ultimate goal should be to conserve and promote Folk Songs of Chittagong with yearlong heritage that automatically will later enrich Folklore and Nature Conservation.

  3. A critical review on factors influencing fermentative hydrogen production.

    Science.gov (United States)

    Kothari, Richa; Kumar, Virendra; Pathak, Vinayak V; Ahmad, Shamshad; Aoyi, Ochieng; Tyagi, V V

    2017-03-01

    Biohydrogen production by dark fermentation of different waste materials is a promising approach to produce bio-energy in terms of renewable energy exploration. This communication has reviewed various influencing factors of dark fermentation process with detailed account of determinants in biohydrogen production. It has also focused on different factors such as improved bacterial strain, reactor design, metabolic engineering and two stage processes to enhance the bioenergy productivity from substrate. The study also suggest that complete utilization of substrates for biological hydrogen production requires the concentrated research and development for efficient functioning of microorganism with integrated application for energy production and bioremediation. Various studies have been taken into account here, to show the comparative efficiency of different substrates and operating conditions with inhibitory factors and pretreatment option for biohydrogen production. The study reveals that an extensive research is needed to observe field efficiency of process using low cost substrates and integration of dark and photo fermentation process. Integrated approach of fermentation process will surely compete with conventional hydrogen process and replace it completely in future.

  4. Spanish-language screening scales: A critical review.

    Science.gov (United States)

    Torres-Castro, S; Mena-Montes, B; González-Ambrosio, G; Zubieta-Zavala, A; Torres-Carrillo, N M; Acosta-Castillo, G I; Espinel-Bermúdez, M C

    2018-05-09

    Dementia is a chronic, degenerative disease with a strong impact on families and health systems. The instruments currently in use for measuring cognitive impairment have different psychometric characteristics in terms of application time, cut-off point, reliability, and validity. The objective of this review is to describe the characteristics of the validated, Spanish-language versions of the Mini-Cog, Clock-Drawing Test, and Mini-Mental State Examination scales for cognitive impairment screening. We performed a three-stage literature search of articles published on Medline since 1953. We selected articles on validated, Spanish-language versions of the scales that included data on reliability, validity, sensitivity, and specificity. The 3 screening tools assessed in this article provide support for primary care professionals. Timely identification of mild cognitive impairment and dementia is crucial for the prognosis of these patients. Copyright © 2018 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. A critical review on textile wastewater treatments: Possible approaches.

    Science.gov (United States)

    Holkar, Chandrakant R; Jadhav, Ananda J; Pinjari, Dipak V; Mahamuni, Naresh M; Pandit, Aniruddha B

    2016-11-01

    Waste water is a major environmental impediment for the growth of the textile industry besides the other minor issues like solid waste and resource waste management. Textile industry uses many kinds of synthetic dyes and discharge large amounts of highly colored wastewater as the uptake of these dyes by fabrics is very poor. This highly colored textile wastewater severely affects photosynthetic function in plant. It also has an impact on aquatic life due to low light penetration and oxygen consumption. It may also be lethal to certain forms of marine life due to the occurrence of component metals and chlorine present in the synthetic dyes. So, this textile wastewater must be treated before their discharge. In this article, different treatment methods to treat the textile wastewater have been presented along with cost per unit volume of treated water. Treatment methods discussed in this paper involve oxidation methods (cavitation, photocatalytic oxidation, ozone, H2O2, fentons process), physical methods (adsorption and filtration), biological methods (fungi, algae, bacteria, microbial fuel cell). This review article will also recommend the possible remedial measures to treat different types of effluent generated from each textile operation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Black carbon emissions in Russia: A critical review

    Science.gov (United States)

    Evans, Meredydd; Kholod, Nazar; Kuklinski, Teresa; Denysenko, Artur; Smith, Steven J.; Staniszewski, Aaron; Hao, Wei Min; Liu, Liang; Bond, Tami C.

    2017-08-01

    This study presents a comprehensive review of estimated black carbon (BC) emissions in Russia from a range of studies. Russia has an important role regarding BC emissions given the extent of its territory above the Arctic Circle, where BC emissions have a particularly pronounced effect on the climate. We assess underlying methodologies and data sources for each major emissions source based on their level of detail, accuracy and extent to which they represent current conditions. We then present reference values for each major emissions source. In the case of flaring, the study presents new estimates drawing on data on Russia's associated petroleum gas and the most recent satellite data on flaring. We also present estimates of organic carbon (OC) for each source, either based on the reference studies or from our own calculations. In addition, the study provides uncertainty estimates for each source. Total BC emissions are estimated at 688 Gg in 2014, with an uncertainty range 401 Gg-1453 Gg, while OC emissions are 9224 Gg with uncertainty ranging between 5596 Gg and 14,736 Gg. Wildfires dominated and contributed about 83% of the total BC emissions: however, the effect on radiative forcing is mitigated in part by OC emissions. We also present an adjusted estimate of Arctic forcing from Russia's BC and OC emissions. In recent years, Russia has pursued policies to reduce flaring and limit particulate emissions from on-road transport, both of which appear to significantly contribute to the lower emissions and forcing values found in this study.

  7. Wearable Electronics and Smart Textiles: A Critical Review

    Directory of Open Access Journals (Sweden)

    Matteo Stoppa

    2014-07-01

    Full Text Available Electronic Textiles (e-textiles are fabrics that feature electronics and interconnections woven into them, presenting physical flexibility and typical size that cannot be achieved with other existing electronic manufacturing techniques. Components and interconnections are intrinsic to the fabric and thus are less visible and not susceptible of becoming tangled or snagged by surrounding objects. E-textiles can also more easily adapt to fast changes in the computational and sensing requirements of any specific application, this one representing a useful feature for power management and context awareness. The vision behind wearable computing foresees future electronic systems to be an integral part of our everyday outfits. Such electronic devices have to meet special requirements concerning wearability. Wearable systems will be characterized by their ability to automatically recognize the activity and the behavioral status of their own user as well as of the situation around her/him, and to use this information to adjust the systems’ configuration and functionality. This review focuses on recent advances in the field of Smart Textiles and pays particular attention to the materials and their manufacturing process. Each technique shows advantages and disadvantages and our aim is to highlight a possible trade-off between flexibility, ergonomics, low power consumption, integration and eventually autonomy.

  8. Incineration of hazardous waste: A critical review update

    International Nuclear Information System (INIS)

    Dempsey, C.R.; Oppelt, E.T.

    1993-01-01

    Over the last 15 years, concern over improper disposal practices of the past has manifested itself in the passage of a series of federal and state-level hazardous waste cleanup and control statutes of unprecedented scope. The more traditional and lowest-cost methods of direct landfilling, storage in surface impoundments and deep-well injection are being replaced in large measure by waste minimization at the source of generation, waste reuse, physical/chemical/biological treatment, incineration and chemical stabilization/solidification methods. Of all of the 'permanent' treatment technologies, properly designed incineration systems are capable of the highest overall degree of destruction and control for the broadest range of hazardous waste streams. Substantial design and operation experience exists in this area and a wide variety of commercial systems are available. Consequently, significant growth is anticipated in the use of incineration and other thermal destruction methods. The objective of this review is to examine the current state of knowledge regarding hazardous waste incineration in an effort to put these technological and environmental issues into perspective

  9. Synaesthesia and learning: A critical review and novel theory

    Directory of Open Access Journals (Sweden)

    Marcus Robert Watson

    2014-02-01

    Full Text Available Learning and synaesthesia are profoundly interconnected. On the one hand, the development of synaesthesia is clearly influenced by learning. Synaesthetic inducers—the stimuli that evoke these unusual experiences—often involve the perception of complex properties learned in early childhood, e.g. letters, musical notes, numbers, months of the year and even swimming strokes. Further, recent research has shown that the associations individual synaesthetes make with these learned inducers are not arbitrary, but are strongly influenced by the structure of the learnt do- main. For instance, the synaesthetic colours of letters are partially determined by letter frequency and the relative positions of letters in the alphabet. On the other hand, there is also a small, but growing, body of literature which shows that synaesthesia can influence or be helpful in learning. For instance, synaesthetes appear to be able to use their unusual experiences as mnemonic de- vices and can even exploit them while learning novel abstract categories. Here we review these two directions of influence and argue that they are interconnected. We propose that synaesthesia arises, at least in part, because of the cognitive demands of learning in childhood, and that it is used to aid perception and understanding of a variety of learned categories. Our thesis is that the structural similarities between synaesthetic triggering stimuli and synaesthetic experiences are the remnants, the fossilized traces, of past learning challenges for which synasethesia was helpful.

  10. Gamification in Stress Management Apps: A Critical App Review

    Science.gov (United States)

    Christmann, Corinna A; Bleser, Gabriele

    2017-01-01

    Background In today’s society, stress is more and more often a cause of disease. This makes stress management an important target of behavior change programs. Gamification has been suggested as one way to support health behavior change. However, it remains unclear to which extend available gamification techniques are integrated in stress management apps, and if their occurrence is linked to the use of elements from behavior change theory. Objective The aim of this study was to investigate the use of gamification techniques in stress management apps and the cooccurrence of these techniques with evidence-based stress management methods and behavior change techniques. Methods A total of 62 stress management apps from the Google Play Store were reviewed on their inclusion of 17 gamification techniques, 15 stress management methods, and 26 behavior change techniques. For this purpose, an extended taxonomy of gamification techniques was constructed and applied by 2 trained, independent raters. Results Interrater-reliability was high, with agreement coefficient (AC)=.97. Results show an average of 0.5 gamification techniques for the tested apps and reveal no correlations between the use of gamification techniques and behavior change techniques (r=.17, P=.20), or stress management methods (r=.14, P=.26). Conclusions This leads to the conclusion that designers of stress management apps do not use gamification techniques to influence the user’s behaviors and reactions. Moreover, app designers do not exploit the potential of combining gamification techniques with behavior change theory. PMID:28592397

  11. Methyl methacrylate and respiratory sensitization: A Critical review

    Science.gov (United States)

    Borak, Jonathan; Fields, Cheryl; Andrews, Larry S; Pemberton, Mark A

    2011-01-01

    Methyl methacrylate (MMA) is a respiratory irritant and dermal sensitizer that has been associated with occupational asthma in a small number of case reports. Those reports have raised concern that it might be a respiratory sensitizer. To better understand that possibility, we reviewed the in silico, in chemico, in vitro, and in vivo toxicology literature, and also epidemiologic and occupational medicine reports related to the respiratory effects of MMA. Numerous in silico and in chemico studies indicate that MMA is unlikely to be a respiratory sensitizer. The few in vitro studies suggest that MMA has generally weak effects. In vivo studies have documented contact skin sensitization, nonspecific cytotoxicity, and weakly positive responses on local lymph node assay; guinea pig and mouse inhalation sensitization tests have not been performed. Cohort and cross-sectional worker studies reported irritation of eyes, nose, and upper respiratory tract associated with short-term peaks exposures, but little evidence for respiratory sensitization or asthma. Nineteen case reports described asthma, laryngitis, or hypersensitivity pneumonitis in MMA-exposed workers; however, exposures were either not well described or involved mixtures containing more reactive respiratory sensitizers and irritants.The weight of evidence, both experimental and observational, argues that MMA is not a respiratory sensitizer. PMID:21401327

  12. The domestic benefits of tropical forests: a critical review.

    Science.gov (United States)

    Chomitz, K M; Kumari, K

    1998-02-01

    This review focuses on forests in the humid tropics and on two of their potentially most important benefits. These include hydrological benefits, such as erosion control and regulation of stream flows, and non-timber forest products, such as rubber, rattan, fruits, and nuts. The first benefit is motivational. Host countries capture only a small proportion of the global benefits, which stem from biodiversity conservation. Demonstration of palpable local benefits could help to build support for biodiversity-oriented projects. The second benefit is the magnitude of domestic benefits that could influence project financing. Sufficiently large net domestic benefits could justify financing of a project on narrow economic grounds, with biodiversity conservation as a by-product. Overall, it is noted that the quantifiable benefits of forest preservation in providing hydrological services and non-timber forest products are highly variable. These classes of domestic benefits may in general be smaller than popularly supposed. In view of this, the need for financing conservation from the Global Environmental Facility or other global sources is emphasized rather than placing the burden on domestic resources.

  13. Bio-nano interface and environment: A critical review.

    Science.gov (United States)

    Pulido-Reyes, Gerardo; Leganes, Francisco; Fernández-Piñas, Francisca; Rosal, Roberto

    2017-12-01

    The bio-nano interface is the boundary where engineered nanomaterials (ENMs) meet the biological system, exerting the biological function for which they have been designed or inducing adverse effects on other cells or organisms when they reach nontarget scenarios (i.e., the natural environment). Research has been performed to determine the fate, transport, and toxic properties of ENMs, but much of it is focused on pristine or so-called as-manufactured ENMs, or else modifications of the materials were not assessed. We review the most recent progress regarding the bio-nano interface and the transformations that ENMs undergo in the environment, paying special attention to the adsorption of environmental biomolecules on the surface of ENMs. Whereas the protein corona has received considerable attention in the fields of biomedics and human toxicology, its environmental analogue (the eco-corona) has been much less studied. A section dedicated to the analytical methods for studying and characterizing the eco-corona is also presented. We conclude by presenting and discussing the key problems and knowledge gaps that need to be resolved in the near future regarding the bio-nano interface and the eco-corona. Environ Toxicol Chem 2017;36:3181-3193. © 2017 SETAC. © 2017 SETAC.

  14. LPG diesel dual fuel engine – A critical review

    Directory of Open Access Journals (Sweden)

    B. Ashok

    2015-06-01

    Full Text Available The engine, which uses both conventional diesel fuel and LPG fuel, is referred to as ‘LPG–diesel dual fuel engines’. LPG dual fuel engines are modified diesel engines which use primary fuel as LPG and secondary fuel as diesel. LPG dual fuel engines have a good thermal efficiency at high output but the performance is less during part load conditions due to the poor utilization of charges. This problem can be overcome by varying factors such as pilot fuel quantity, injection timing, composition of the gaseous fuel and intake charge conditions, for improving the performance, combustion and emissions of dual fuel engines. This article reviews about the research work done by the researchers in order to improve the performance, combustion and emission parameters of a LPG–diesel dual fuel engines. From the studies it is shown that the use of LPG in diesel engine is one of the capable methods to reduce the PM and NOx emissions but at same time at part load condition there is a drop in efficiency and power output with respect to diesel operation.

  15. Oklo. A review and critical evaluation of literature

    International Nuclear Information System (INIS)

    Zetterstroem, Lena

    2000-10-01

    The Oklo natural fossil fission reactors in Gabon, Equatorial Africa, have been studied as a natural analogue for spent nuclear fuel in a geological environment. For these studies, it is important to know what has happened to these reactors since they formed. This review is focussed on existing geological and geochronological information concerning the Oklo reactors and the surrounding ore. A sequence of geological and geochemical events in the Oklo area, as described in the literature, is given. The data and the studies behind this established geochronology are discussed and evaluated. Of the regional geology, special attention is given to the dating of the Francevillian sediments, and the intrusion of a dolerite dyke swarm. The processes that led to the mineralisation at Oklo, the subsequent formation of the nuclear reactors and later migration of fission products are described. Further discussion concerns the studies of the dolerite dyke swarm, since this appears to be one of the most important events related to fission product migration. A close look at the data related to this event shows that further study of the age of the dolerite dykes, and their effect on the uraninite in the Oklo reactors, is needed

  16. Recent developments in organic redox flow batteries: A critical review

    Science.gov (United States)

    Leung, P.; Shah, A. A.; Sanz, L.; Flox, C.; Morante, J. R.; Xu, Q.; Mohamed, M. R.; Ponce de León, C.; Walsh, F. C.

    2017-08-01

    Redox flow batteries (RFBs) have emerged as prime candidates for energy storage on the medium and large scales, particularly at the grid scale. The demand for versatile energy storage continues to increase as more electrical energy is generated from intermittent renewable sources. A major barrier in the way of broad deployment and deep market penetration is the use of expensive metals as the active species in the electrolytes. The use of organic redox couples in aqueous or non-aqueous electrolytes is a promising approach to reducing the overall cost in long-term, since these materials can be low-cost and abundant. The performance of such redox couples can be tuned by modifying their chemical structure. In recent years, significant developments in organic redox flow batteries has taken place, with the introduction of new groups of highly soluble organic molecules, capable of providing a cell voltage and charge capacity comparable to conventional metal-based systems. This review summarises the fundamental developments and characterization of organic redox flow batteries from both the chemistry and materials perspectives. The latest advances, future challenges and opportunities for further development are discussed.

  17. Models for Microbial Fuel Cells: A critical review

    Science.gov (United States)

    Xia, Chengshuo; Zhang, Daxing; Pedrycz, Witold; Zhu, Yingmin; Guo, Yongxian

    2018-01-01

    Microbial fuel cells (MFCs) have been widely viewed as one of the most promising alternative sources of renewable energy. A recognition of needs of efficient development methods based on multidisciplinary research becomes crucial for the optimization of MFCs. Modeling of MFCs is an effective way for not only gaining a thorough understanding of the effects of operation conditions on the performance of power generation but also becomes of essential interest to the successful implementation of MFCs. The MFC models encompass the underlying reaction process and limiting factors of the MFC. The models come in various forms, such as the mathematical equations or the equivalent circuits. Different modeling focuses and approaches of the MFC have emerged. In this study, we present a state of the art of MFCs modeling; the past modeling methods are reviewed as well. Models and modeling methods are elaborated on based on the classification provided by Mechanism-based models and Application-based models. Mechanisms, advantages, drawbacks, and application fields of different models are illustrated as well. We exhibit a complete and comprehensive exposition of the different models for MFCs and offer further guidance to promote the performance of MFCs.

  18. Strategic learning and information and communication technology: a critical review

    Directory of Open Access Journals (Sweden)

    Carles Monerero Font

    2013-08-01

    Full Text Available 0 0 1 93 514 USAL 4 1 606 14.0 Normal 0 21 false false false ES JA X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabla normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-ansi-language:ES; mso-fareast-language:EN-US;} This article presents an outline of a learning strategy redefinition, based on recent contributions from learning technologies. This new definition addresses the question of how technological affordances of the software, of the technological tools, or an educational environment, allow a learner or a group of learners develop a new ways to perform a strategic learning action. We review how different characteristics of learning strategy definition have been transformed because of introduction of ICT into education. Finally, the article points toward conceptual challenges and future research questions.

  19. Economic evaluation of targeted cancer interventions: critical review and recommendations.

    Science.gov (United States)

    Elkin, Elena B; Marshall, Deborah A; Kulin, Nathalie A; Ferrusi, Ilia L; Hassett, Michael J; Ladabaum, Uri; Phillips, Kathryn A

    2011-10-01

    Scientific advances have improved our ability to target cancer interventions to individuals who will benefit most and spare the risks and costs to those who will derive little benefit or even be harmed. Several approaches are currently used for targeting interventions for cancer risk reduction, screening, and treatment, including risk prediction algorithms for identifying high-risk subgroups and diagnostic tests for tumor markers and germline genetic mutations. Economic evaluation can inform decisions about the use of targeted interventions, which may be more costly than traditional strategies. However, assessing the impact of a targeted intervention on costs and health outcomes requires explicit consideration of the method of targeting. In this study, we describe the importance of this principle by reviewing published cost-effectiveness analyses of targeted interventions in breast cancer. Few studies we identified explicitly evaluated the relationships among the method of targeting, the accuracy of the targeting test, and outcomes of the targeted intervention. Those that did found that characteristics of targeting tests had a substantial impact on outcomes. We posit that the method of targeting and the outcomes of a targeted intervention are inextricably linked and recommend that cost-effectiveness analyses of targeted interventions explicitly consider costs and outcomes of the method of targeting.

  20. Predictive information processing in music cognition. A critical review.