WorldWideScience

Sample records for evidence-based multi-level approach

  1. Optimizing suicide prevention programs and their implementation in Europe (OSPI Europe): an evidence-based multi-level approach.

    LENUS (Irish Health Repository)

    Hegerl, Ulrich

    2009-01-01

    BACKGROUND: Suicide and non-fatal suicidal behaviour are significant public health issues in Europe requiring effective preventive interventions. However, the evidence for effective preventive strategies is scarce. The protocol of a European research project to develop an optimized evidence based program for suicide prevention is presented. METHOD: The groundwork for this research has been established by a regional community based intervention for suicide prevention that focuses on improving awareness and care for depression performed within the European Alliance Against Depression (EAAD). The EAAD intervention consists of (1) training sessions and practice support for primary care physicians,(2) public relations activities and mass media campaigns, (3) training sessions for community facilitators who serve as gatekeepers for depressed and suicidal persons in the community and treatment and (4) outreach and support for high risk and self-help groups (e.g. helplines). The intervention has been shown to be effective in reducing suicidal behaviour in an earlier study, the Nuremberg Alliance Against Depression. In the context of the current research project described in this paper (OSPI-Europe) the EAAD model is enhanced by other evidence based interventions and implemented simultaneously and in standardised way in four regions in Ireland, Portugal, Hungary and Germany. The enhanced intervention will be evaluated using a prospective controlled design with the primary outcomes being composite suicidal acts (fatal and non-fatal), and with intermediate outcomes being the effect of training programs, changes in public attitudes, guideline-consistent media reporting. In addition an analysis of the economic costs and consequences will be undertaken, while a process evaluation will monitor implementation of the interventions within the different regions with varying organisational and healthcare contexts. DISCUSSION: This multi-centre research seeks to overcome major

  2. Optimizing suicide prevention programs and their implementation in Europe (OSPI-Europe): An evidence-based multi-level approach

    LENUS (Irish Health Repository)

    Hegerl, Ulrich

    2009-11-23

    Abstract Background Suicide and non-fatal suicidal behaviour are significant public health issues in Europe requiring effective preventive interventions. However, the evidence for effective preventive strategies is scarce. The protocol of a European research project to develop an optimized evidence based program for suicide prevention is presented. Method The groundwork for this research has been established by a regional community based intervention for suicide prevention that focuses on improving awareness and care for depression performed within the European Alliance Against Depression (EAAD). The EAAD intervention consists of (1) training sessions and practice support for primary care physicians,(2) public relations activities and mass media campaigns, (3) training sessions for community facilitators who serve as gatekeepers for depressed and suicidal persons in the community and treatment and (4) outreach and support for high risk and self-help groups (e.g. helplines). The intervention has been shown to be effective in reducing suicidal behaviour in an earlier study, the Nuremberg Alliance Against Depression. In the context of the current research project described in this paper (OSPI-Europe) the EAAD model is enhanced by other evidence based interventions and implemented simultaneously and in standardised way in four regions in Ireland, Portugal, Hungary and Germany. The enhanced intervention will be evaluated using a prospective controlled design with the primary outcomes being composite suicidal acts (fatal and non-fatal), and with intermediate outcomes being the effect of training programs, changes in public attitudes, guideline-consistent media reporting. In addition an analysis of the economic costs and consequences will be undertaken, while a process evaluation will monitor implementation of the interventions within the different regions with varying organisational and healthcare contexts. Discussion This multi-centre research seeks to overcome major

  3. Exploring multi-level system factors facilitating educator training and implementation of evidence-based practices (EBP): a study protocol.

    Science.gov (United States)

    Stahmer, Aubyn C; Suhrheinrich, Jessica; Schetter, Patricia L; McGee Hassrick, Elizabeth

    2018-01-08

    This study examines how system-wide (i.e., region, district, and school) mechanisms such as leadership support, training requirements, structure, collaboration, and education affect the use of evidence-based practices (EBPs) in schools and how this affects the outcomes for students with autism spectrum disorder (ASD). Despite growing evidence for the positive effects of EBPs for ASD, these practices are not consistently or effectively used in schools. Although special education programs are mandated to use EBPs, there are very few evidence-based methods for selecting, implementing, and sustaining EBPs. Research focuses primarily on teacher training, without attention to contextual factors (e.g., implementation climate, attitudes toward EBPs, resource allocation, and social networks) that may impact outcomes. Using an implementation science framework, this project will prospectively examine relations between system-wide factors and teachers' use of EBPs and student education outcomes. Survey data will be collected from approximately 85 regional special education directors, 170 regional program specialists, 265 district special education directors, 265 behavior specialists, 925 school principals, 3538 special education teachers, and 2700 paraprofessionals. Administrative data for the students with ASD served by participating teachers will be examined. A total of 79 regional-, district-, and school-level personnel will also participate in social network interviews. Mixed methods, including surveys, administrative data, and observational checklists, will be used to gather in-depth information about system-wide malleable factors that relate to positive teacher implementation of EBPs and student outcomes. Multi-level modeling will be used to assess system-wide malleable factors related to EBP implementation which will be linked to the trainer, teacher, and student outcomes and examined based on moderators (e.g., district size, Special Education Local Plan Area structure

  4. Multi-level approach for parametric roll analysis

    Science.gov (United States)

    Kim, Taeyoung; Kim, Yonghwan

    2011-03-01

    The present study considers multi-level approach for the analysis of parametric roll phenomena. Three kinds of computation method, GM variation, impulse response function (IRF), and Rankine panel method, are applied for the multi-level approach. IRF and Rankine panel method are based on the weakly nonlinear formulation which includes nonlinear Froude- Krylov and restoring forces. In the computation result of parametric roll occurrence test in regular waves, IRF and Rankine panel method show similar tendency. Although the GM variation approach predicts the occurrence of parametric roll at twice roll natural frequency, its frequency criteria shows a little difference. Nonlinear roll motion in bichromatic wave is also considered in this study. To prove the unstable roll motion in bichromatic waves, theoretical and numerical approaches are applied. The occurrence of parametric roll is theoretically examined by introducing the quasi-periodic Mathieu equation. Instability criteria are well predicted from stability analysis in theoretical approach. From the Fourier analysis, it has been verified that difference-frequency effects create the unstable roll motion. The occurrence of unstable roll motion in bichromatic wave is also observed in the experiment.

  5. Antecedents of Organisational Creativity: A Multi-Level Approach

    Directory of Open Access Journals (Sweden)

    Ritu Gupta

    2016-06-01

    Full Text Available The purpose of this literature review is to provide a better understanding of the antecedents of organisational creativity with a multi-level approach. Organisational creativity is a sum total of the creativity accounted for by the individual employees of the organisation, the cumulative creativity of a team or group and creativity arising out of different structural components of an organisation. Some of the antecedents identified from the literature include personality, intrinsic motivation, group cohesion, social inhibition, cognitive interference, leader member exchange, organisational culture and climate, amongst others at individual, group and organisational level. Based on the literature review, suggestions for future research and research propositions have been proposed.

  6. Creative teaching an evidence-based approach

    CERN Document Server

    Sale, Dennis

    2015-01-01

    This book contains an evidence-based pedagogic guide to enable any motivated teaching/training professional to be able to teach effectively and creatively. It firstly summarises the extensive research field on human psychological functioning relating to learning and how this can be fully utilised in the design and facilitation of quality learning experiences. It then demonstrates what creativity actually 'looks like' in terms of teaching practices, modelling the underpinning processes of creative learning design and how to apply these in lesson planning. The book, having established an evidence-based and pedagogically driven approach to creative learning design, extensively focuses on key challenges facing teaching professionals today. These include utilising information technologies in blended learning formats, differentiating instruction, and developing self-directed learners who can think well. The main purpose of the book is to demystify what it means to teach creatively, explicitly demonstrating the pr...

  7. A Multi-level Examination of how the Organizational Context Relates to Readiness to Implement Prevention and Evidence-Based Programming in Community Settings

    Science.gov (United States)

    Chilenski, Sarah M.; Olson, Jonathan R.; Schulte, Jill A.; Perkins, Daniel F.; Spoth, Richard

    2015-01-01

    Prior theoretical and empirical research suggests that multiple aspects of an organization’s context are likely related to a number of factors, from their interest and ability to adopt new programming, to client outcomes. A limited amount of the prior research has taken a more community-wide perspective by examining factors that associate with community readiness for change, leaving how these findings generalize to community organizations that conduct prevention or positive youth development programs unknown. Thus for the current study, we examined how the organizational context of the Cooperative Extension System (CES) associates with current attitudes and practices regarding prevention and evidence-based programming. Attitudes and practices have been found in the empirical literature to be key indicators of an organization’s readiness to adopt prevention and evidence-based programming. Based on multi-level mixed models, results indicate that organizational management practices distinct from program delivery may affect an organization’s readiness to adopt and implement new prevention and evidence-based youth programs, thereby limiting the potential public health impact of evidence-based programs. Openness to change, openness of leadership, and communication were the strongest predictors identified within this study. An organization’s morale was also found to be a strong predictor of an organization’s readiness. The findings of the current study are discussed in terms of implications for prevention and intervention. PMID:25463014

  8. Multi-level and hybrid modelling approaches for systems biology.

    Science.gov (United States)

    Bardini, R; Politano, G; Benso, A; Di Carlo, S

    2017-01-01

    During the last decades, high-throughput techniques allowed for the extraction of a huge amount of data from biological systems, unveiling more of their underling complexity. Biological systems encompass a wide range of space and time scales, functioning according to flexible hierarchies of mechanisms making an intertwined and dynamic interplay of regulations. This becomes particularly evident in processes such as ontogenesis, where regulative assets change according to process context and timing, making structural phenotype and architectural complexities emerge from a single cell, through local interactions. The information collected from biological systems are naturally organized according to the functional levels composing the system itself. In systems biology, biological information often comes from overlapping but different scientific domains, each one having its own way of representing phenomena under study. That is, the different parts of the system to be modelled may be described with different formalisms. For a model to have improved accuracy and capability for making a good knowledge base, it is good to comprise different system levels, suitably handling the relative formalisms. Models which are both multi-level and hybrid satisfy both these requirements, making a very useful tool in computational systems biology. This paper reviews some of the main contributions in this field.

  9. An integrated approach for multi-level sample size determination

    International Nuclear Information System (INIS)

    Lu, M.S.; Teichmann, T.; Sanborn, J.B.

    1997-01-01

    Inspection procedures involving the sampling of items in a population often require steps of increasingly sensitive measurements, with correspondingly smaller sample sizes; these are referred to as multilevel sampling schemes. In the case of nuclear safeguards inspections verifying that there has been no diversion of Special Nuclear Material (SNM), these procedures have been examined often and increasingly complex algorithms have been developed to implement them. The aim in this paper is to provide an integrated approach, and, in so doing, to describe a systematic, consistent method that proceeds logically from level to level with increasing accuracy. The authors emphasize that the methods discussed are generally consistent with those presented in the references mentioned, and yield comparable results when the error models are the same. However, because of its systematic, integrated approach the proposed method elucidates the conceptual understanding of what goes on, and, in many cases, simplifies the calculations. In nuclear safeguards inspections, an important aspect of verifying nuclear items to detect any possible diversion of nuclear fissile materials is the sampling of such items at various levels of sensitivity. The first step usually is sampling by ''attributes'' involving measurements of relatively low accuracy, followed by further levels of sampling involving greater accuracy. This process is discussed in some detail in the references given; also, the nomenclature is described. Here, the authors outline a coordinated step-by-step procedure for achieving such multilevel sampling, and they develop the relationships between the accuracy of measurement and the sample size required at each stage, i.e., at the various levels. The logic of the underlying procedures is carefully elucidated; the calculations involved and their implications, are clearly described, and the process is put in a form that allows systematic generalization

  10. Approaches to tobacco control: the evidence base.

    Science.gov (United States)

    Aquilino, M Lober; Lowe, J B

    2004-02-01

    Tobacco production, distribution, and use are international issues with significant health and economic implications. This paper provides an overview of the effective approaches to tobacco control including decreasing demand for tobacco products through taxation, consumer education, research, bans on advertising and promotion, warning labels, and restrictions on public smoking. The effectiveness of reducing the supply of tobacco products through prohibition, restrictions on youth access, crop substitution, trade restrictions, and control of smuggling, will also be discussed. Decreasing smoking, particularly among young people, by preventing or delaying initiation, preventing regular use, and increasing cessation through behavioural approaches for all ages is reviewed. Cessation methods including pharmacological approaches, 'quitlines', Internet programmes, and the targeting of specific populations are discussed. Internet availability of tobacco products and sustainability of current efforts are presented as continuing challenges to tobacco control.

  11. Tabu search approaches for the multi-level warehouse layout problem with adjacency constraints

    Science.gov (United States)

    Zhang, G. Q.; Lai, K. K.

    2010-08-01

    A new multi-level warehouse layout problem, the multi-level warehouse layout problem with adjacency constraints (MLWLPAC), is investigated. The same item type is required to be located in adjacent cells, and horizontal and vertical unit travel costs are product dependent. An integer programming model is proposed to formulate the problem, which is NP hard. Along with a cube-per-order index policy based heuristic, the standard tabu search (TS), greedy TS, and dynamic neighbourhood based TS are presented to solve the problem. The computational results show that the proposed approaches can reduce the transportation cost significantly.

  12. Interactive Approach for Multi-Level Multi-Objective Fractional Programming Problems with Fuzzy Parameters

    Directory of Open Access Journals (Sweden)

    M.S. Osman

    2018-03-01

    Full Text Available In this paper, an interactive approach for solving multi-level multi-objective fractional programming (ML-MOFP problems with fuzzy parameters is presented. The proposed interactive approach makes an extended work of Shi and Xia (1997. In the first phase, the numerical crisp model of the ML-MOFP problem has been developed at a confidence level without changing the fuzzy gist of the problem. Then, the linear model for the ML-MOFP problem is formulated. In the second phase, the interactive approach simplifies the linear multi-level multi-objective model by converting it into separate multi-objective programming problems. Also, each separate multi-objective programming problem of the linear model is solved by the ∊-constraint method and the concept of satisfactoriness. Finally, illustrative examples and comparisons with the previous approaches are utilized to evince the feasibility of the proposed approach.

  13. Interteaching: An Evidence-Based Approach to Instruction

    Science.gov (United States)

    Brown, Thomas Wade; Killingsworth, Kenneth; Alavosius, Mark P.

    2014-01-01

    This paper describes "interteaching" as an evidence-based method of instruction. Instructors often rely on more traditional approaches, such as lectures, as means to deliver instruction. Despite high usage, these methods are ineffective at achieving desirable academic outcomes. We discuss an innovative approach to delivering instruction…

  14. [Evidence-based medicine: an approach without any weakness?].

    Science.gov (United States)

    Junod, A F

    2000-04-06

    Evidence-based medicine is a methodological approach giving access to the best information derived from clinical research for an individual patient. It requires the formulation of a question, a strategy to search for the best information, the selection of the latter, its critical appraisal and its application to the patient. The qualities, but also the limitations of this approach are discussed.

  15. MULTI-LEVEL SAMPLING APPROACH FOR CONTINOUS LOSS DETECTION USING ITERATIVE WINDOW AND STATISTICAL MODEL

    OpenAIRE

    Mohd Fo'ad Rohani; Mohd Aizaini Maarof; Ali Selamat; Houssain Kettani

    2010-01-01

    This paper proposes a Multi-Level Sampling (MLS) approach for continuous Loss of Self-Similarity (LoSS) detection using iterative window. The method defines LoSS based on Second Order Self-Similarity (SOSS) statistical model. The Optimization Method (OM) is used to estimate self-similarity parameter since it is fast and more accurate in comparison with other estimation methods known in the literature. Probability of LoSS detection is introduced to measure continuous LoSS detection performance...

  16. A Learning Object Approach To Evidence based learning

    OpenAIRE

    Zabin Visram; Bruce Elson; Patricia Reynolds

    2005-01-01

    This paper describes the philosophy, development and framework of the body of elements formulated to provide an approach to evidence-based learning sustained by Learning Objects and web based technology Due to the demands for continuous improvement in the delivery of healthcare and in the continuous endeavour to improve the quality of life, there is a continuous need for practitioner's to update their knowledge by accomplishing accredited courses. The rapid advances in medical science has mea...

  17. A Multi-Level Examination of Stakeholder Perspectives of Implementation of Evidence-Based Practices in a Large Urban Publicly-Funded Mental Health System.

    Science.gov (United States)

    Beidas, Rinad S; Stewart, Rebecca E; Adams, Danielle R; Fernandez, Tara; Lustbader, Susanna; Powell, Byron J; Aarons, Gregory A; Hoagwood, Kimberly E; Evans, Arthur C; Hurford, Matthew O; Rubin, Ronnie; Hadley, Trevor; Mandell, David S; Barg, Frances K

    2016-11-01

    Our goal was to identify barriers and facilitators to the implementation of evidence-based practices from the perspectives of multiple stakeholders in a large publicly funded mental health system. We completed 56 interviews with three stakeholder groups: treatment developers (n = 7), agency administrators (n = 33), and system leadership (n = 16). The three stakeholder groups converged on the importance of inner (e.g., agency competing resources and demands, therapist educational background) and outer context (e.g., funding) factors as barriers to implementation. Potential threats to implementation and sustainability included the fiscal landscape of community mental health clinics and an evolving workforce. Intervention characteristics were rarely endorsed as barriers. Inner context, outer context, and intervention characteristics were all seen as important facilitators. All stakeholders endorsed the importance of coordinated collaboration across stakeholder groups within the system to successfully implement evidence-based practices.

  18. Bridging Ayurveda with evidence-based scientific approaches in medicine.

    Science.gov (United States)

    Patwardhan, Bhushan

    2014-01-01

    This article reviews contemporary approaches for bridging Ayurveda with evidence-based medicine. In doing so, the author presents a pragmatic assessment of quality, methodology and extent of scientific research in Ayurvedic medicine. The article discusses the meaning of evidence and indicates the need to adopt epistemologically sensitive methods and rigorous experimentation using modern science. The author critically analyzes the status of Ayurvedic medicine based on personal observations, peer interactions and published research. This review article concludes that traditional knowledge systems like Ayurveda and modern scientific evidence-based medicine should be integrated. The author advocates that Ayurvedic researchers should develop strategic collaborations with innovative initiatives like 'Horizon 2020' involving predictive, preventive and personalized medicine (PPPM).

  19. The ethical approach to evidence-based medicine

    African Journals Online (AJOL)

    research findings as the basis for clinical decisions”.2 The practice ... paper will explore the role of evidence-based medicine in ethical practice of health care professionals. ... based medicine is used for “evidence-based purchasing”, it will.

  20. Presenting a Multi-level Superstructure Optimization Approach for Mechatronic System Design

    DEFF Research Database (Denmark)

    Pedersen, Henrik C.; Andersen, Torben Ole; Bech, Michael Møller

    2010-01-01

    Synergism and integration in the design process is what sets apart a Mechatronic System from a traditional, multidisciplinary system. However the typical design approach has been to divide the design problem into sub problems for each technology area (mechanics, electronics and control) and descr......Synergism and integration in the design process is what sets apart a Mechatronic System from a traditional, multidisciplinary system. However the typical design approach has been to divide the design problem into sub problems for each technology area (mechanics, electronics and control......) and describe the interface between the technologies, whereas the lack of well-established, systematic engineering methods to form the basic set-off in analysis and design of complete mechatronic systems has been obvious. The focus of the current paper is therefore to present an integrated design approach...... for mechatronic system design, utilizing a multi-level superstructure optimization based approach. Finally two design examples are presented and the possibilities and limitations of the approach are outlined....

  1. Evidence-based approach for continuous improvement of occupational health.

    Science.gov (United States)

    Manzoli, Lamberto; Sotgiu, Giovanni; Magnavita, Nicola; Durando, Paolo

    2015-01-01

    It was recognized early on that an Evidence-Based Medicine (EBM) approach could be applied to Public Health (PH), including the area of Occupational Health (OH). The aim of Evidence-Based Occupational Health (EBOH) is to ensure safety, health, and well-being in the workplace. Currently, high-quality research is necessary in order to provide arguments and scientific evidence upon which effective, efficient, and sustainable preventive measures and policies are to be developed in the workplace in Western countries. Occupational physicians need to integrate available scientific evidence and existing recommendations with a framework of national employment laws and regulations. This paper addresses the state of the art of scientific evidence available in the field (i.e., efficacy of interventions, usefulness of education and training of workers, and need of a multidisciplinary strategy integrated within the national PH programs) and the main critical issues for their implementation. Promoting good health is a fundamental part of the smart, inclusive growth objectives of Europe 2020 - Europe's growth strategy: keeping people healthy and active for longer has a positive impact on productivity and competitiveness. It appears clear that health quality and safety in the workplace play a key role for smart, sustainable, and inclusive growth in Western countries.

  2. LEADING CHANGES IN ASSESSMENT USING AN EVIDENCE BASED APPROACH

    Directory of Open Access Journals (Sweden)

    J. O. Macaulay

    2015-08-01

    Full Text Available Introduction and objectivesIt is has been widely accepted that assessment of learning is a critical component of education and that assessment drives/guides student learning through shaping study habits and student approaches to learning. However, although most academics would agree that assessment is a critical aspect of their roles as teachers it is often an aspect of teaching that is regarded more as an additional task rather than an integral component of the teaching/learning continuum. An additional impediment to high quality assessment is the non-evidence based-approach to the decision making process. The overall aim of this project was to improve the quality of assessment in Biochemistry and Molecular Biology undergraduate education by promoting high quality assessment.Materials and methodsTo do this we developed and trialled an audit tool for mapping assessment practices. The audit tool was designed to gather data on current assessment practices and identify areas of good practice in which assessment aligned with the learning objectives and areas in need of improvement. This evidence base will then be used to drive change in assessment.Results and conclusionsUsing the assessment mapping tool we have mapped the assessment regime in a Biochemistry and Molecular Biology major at Monash University. Criteria used included: assessment type, format, timing, assessors, provision of feedback, level of learning (Bloom’s, approaches taken to planning assessment. We have mapped assessment of content and the systematic development of higher order learning and skills progression throughout the program of study. The data has enabled us to examine the assessment at unit (course level as well as the vertical development across the major. This information is now being used to inform a review of the units and the major.

  3. Modeling Performance in C4ISR Sustained Operations: A Multi-Level Approach (Briefing Charts)

    National Research Council Canada - National Science Library

    Barnes, Christopher; Miller, James C; Elliott, Linda; Coovert, Michael

    2003-01-01

    This briefing discusses methodology and preliminary findings focused on the application of multi-level modeling techniques to distinguish effects of sleep loss and task demands on individual and team...

  4. Empirically Examining the Performance of Approaches to Multi-Level Matching to Study the Effect of School-Level Interventions

    Science.gov (United States)

    Hallberg, Kelly; Cook, Thomas D.; Figlio, David

    2013-01-01

    The goal of this paper is to provide guidance for applied education researchers in using multi-level data to study the effects of interventions implemented at the school level. Two primary approaches are currently employed in observational studies of the effect of school-level interventions. One approach employs intact school matching: matching…

  5. MetricForensics: A Multi-Level Approach for Mining Volatile Graphs

    Energy Technology Data Exchange (ETDEWEB)

    Henderson, Keith [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Eliassi-Rad, Tina [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Faloutsos, Christos [Carnegie Mellon Univ., Pittsburgh, PA (United States); Akoglu, Leman [Carnegie Mellon Univ., Pittsburgh, PA (United States); Li, Lei [Carnegie Mellon Univ., Pittsburgh, PA (United States); Maruhashi, Koji [Fujitsu Laboratories Ltd., Kanagawa (Japan); Prakash, B. Aditya [Carnegie Mellon Univ., Pittsburgh, PA (United States); Tong, H [Carnegie Mellon Univ., Pittsburgh, PA (United States)

    2010-02-08

    Advances in data collection and storage capacity have made it increasingly possible to collect highly volatile graph data for analysis. Existing graph analysis techniques are not appropriate for such data, especially in cases where streaming or near-real-time results are required. An example that has drawn significant research interest is the cyber-security domain, where internet communication traces are collected and real-time discovery of events, behaviors, patterns and anomalies is desired. We propose MetricForensics, a scalable framework for analysis of volatile graphs. MetricForensics combines a multi-level “drill down" approach, a collection of user-selected graph metrics and a collection of analysis techniques. At each successive level, more sophisticated metrics are computed and the graph is viewed at a finer temporal resolution. In this way, MetricForensics scales to highly volatile graphs by only allocating resources for computationally expensive analysis when an interesting event is discovered at a coarser resolution first. We test MetricForensics on three real-world graphs: an enterprise IP trace, a trace of legitimate and malicious network traffic from a research institution, and the MIT Reality Mining proximity sensor data. Our largest graph has »3M vertices and »32M edges, spanning 4:5 days. The results demonstrate the scalability and capability of MetricForensics in analyzing volatile graphs; and highlight four novel phenomena in such graphs: elbows, broken correlations, prolonged spikes, and strange stars.

  6. A Learning Object Approach To Evidence based learning

    Directory of Open Access Journals (Sweden)

    Zabin Visram

    2005-06-01

    Full Text Available This paper describes the philosophy, development and framework of the body of elements formulated to provide an approach to evidence-based learning sustained by Learning Objects and web based technology Due to the demands for continuous improvement in the delivery of healthcare and in the continuous endeavour to improve the quality of life, there is a continuous need for practitioner's to update their knowledge by accomplishing accredited courses. The rapid advances in medical science has meant increasingly, there is a desperate need to adopt wireless schemes, whereby bespoke courses can be developed to help practitioners keep up with expanding knowledge base. Evidently, without current best evidence, practice risks becoming rapidly out of date, to the detriment of the patient. There is a need to provide a tactical, operational and effective environment, which allows professional to update their education, and complete specialised training, just-in-time, in their own time and location. Following this demand in the marketplace the information engineering group, in combination with several medical and dental schools, set out to develop and design a conceptual framework which form the basis of pioneering research, which at last, enables practitioner's to adopt a philosophy of life long learning. The body and structure of this framework is subsumed under the term Object oriented approach to Evidence Based learning, Just-in-time, via Internet sustained by Reusable Learning Objects (The OEBJIRLO Progression. The technical pillars which permit this concept of life long learning are pivoted by the foundations of object oriented technology, Learning objects, Just-in-time education, Data Mining, intelligent Agent technology, Flash interconnectivity and remote wireless technology, which allow practitioners to update their professional skills, complete specialised training which leads to accredited qualifications. This paper sets out to develop and

  7. The ethical approach to evidence-based medicine | Kruger | South ...

    African Journals Online (AJOL)

    Abstract. This paper will explore the role of evidence-based medicine in ethical practice of health care professionals. It will also address some of its limitations and potential for negative impact on health care.

  8. Community and evidence-based approaches to healthcare ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2016-04-29

    Apr 29, 2016 ... This project developed community connections, shared cross-cultural teaching experiences, and fostered local community partnerships. Participants in the course were encouraged to continue providing evidence-based care throughout their careers. UniLúrio now plans to include the community-based ...

  9. A multi-level approach to understanding the impact of cyber crime on the financial sector

    OpenAIRE

    Monica Lagazio; Nazneen Sherif; Mike Cushman

    2014-01-01

    This paper puts forward a multi-level model, based on system dynamics methodology, to understand the impact of cyber crime on the financial sector. Consistent with recent findings, our results show that strong dynamic relationships, amongst tangible and intangible factors, affect cyber crime cost and occur at different levels of society and value network. Specifically, shifts in financial companies’ strategic priorities, having the protection of customer trust and loyalty as a key objective, ...

  10. A Multi-step and Multi-level approach for Computer Aided Molecular Design

    DEFF Research Database (Denmark)

    . The problem formulation step incorporates a knowledge base for the identification and setup of the design criteria. Candidate compounds are identified using a multi-level generate and test CAMD solution algorithm capable of designing molecules having a high level of molecular detail. A post solution step...... using an Integrated Computer Aided System (ICAS) for result analysis and verification is included in the methodology. Keywords: CAMD, separation processes, knowledge base, molecular design, solvent selection, substitution, group contribution, property prediction, ICAS Introduction The use of Computer...... Aided Molecular Design (CAMD) for the identification of compounds having specific physic...

  11. Bayesian Mixed Hidden Markov Models: A Multi-Level Approach to Modeling Categorical Outcomes with Differential Misclassification

    Science.gov (United States)

    Zhang, Yue; Berhane, Kiros

    2014-01-01

    Questionnaire-based health status outcomes are often prone to misclassification. When studying the effect of risk factors on such outcomes, ignoring any potential misclassification may lead to biased effect estimates. Analytical challenges posed by these misclassified outcomes are further complicated when simultaneously exploring factors for both the misclassification and health processes in a multi-level setting. To address these challenges, we propose a fully Bayesian Mixed Hidden Markov Model (BMHMM) for handling differential misclassification in categorical outcomes in a multi-level setting. The BMHMM generalizes the traditional Hidden Markov Model (HMM) by introducing random effects into three sets of HMM parameters for joint estimation of the prevalence, transition and misclassification probabilities. This formulation not only allows joint estimation of all three sets of parameters, but also accounts for cluster level heterogeneity based on a multi-level model structure. Using this novel approach, both the true health status prevalence and the transition probabilities between the health states during follow-up are modeled as functions of covariates. The observed, possibly misclassified, health states are related to the true, but unobserved, health states and covariates. Results from simulation studies are presented to validate the estimation procedure, to show the computational efficiency due to the Bayesian approach and also to illustrate the gains from the proposed method compared to existing methods that ignore outcome misclassification and cluster level heterogeneity. We apply the proposed method to examine the risk factors for both asthma transition and misclassification in the Southern California Children's Health Study (CHS). PMID:24254432

  12. CMT: a constrained multi-level thresholding approach for ChIP-Seq data analysis.

    Directory of Open Access Journals (Sweden)

    Iman Rezaeian

    Full Text Available Genome-wide profiling of DNA-binding proteins using ChIP-Seq has emerged as an alternative to ChIP-chip methods. ChIP-Seq technology offers many advantages over ChIP-chip arrays, including but not limited to less noise, higher resolution, and more coverage. Several algorithms have been developed to take advantage of these abilities and find enriched regions by analyzing ChIP-Seq data. However, the complexity of analyzing various patterns of ChIP-Seq signals still needs the development of new algorithms. Most current algorithms use various heuristics to detect regions accurately. However, despite how many formulations are available, it is still difficult to accurately determine individual peaks corresponding to each binding event. We developed Constrained Multi-level Thresholding (CMT, an algorithm used to detect enriched regions on ChIP-Seq data. CMT employs a constraint-based module that can target regions within a specific range. We show that CMT has higher accuracy in detecting enriched regions (peaks by objectively assessing its performance relative to other previously proposed peak finders. This is shown by testing three algorithms on the well-known FoxA1 Data set, four transcription factors (with a total of six antibodies for Drosophila melanogaster and the H3K4ac antibody dataset.

  13. FGP Approach for Solving Multi-level Multi-objective Quadratic Fractional Programming Problem with Fuzzy parameters

    Directory of Open Access Journals (Sweden)

    m. s. osman

    2017-09-01

    Full Text Available In this paper, we consider fuzzy goal programming (FGP approach for solving multi-level multi-objective quadratic fractional programming (ML-MOQFP problem with fuzzy parameters in the constraints. Firstly, the concept of the ?-cut approach is applied to transform the set of fuzzy constraints into a common deterministic one. Then, the quadratic fractional objective functions in each level are transformed into quadratic objective functions based on a proposed transformation. Secondly, the FGP approach is utilized to obtain a compromise solution for the ML-MOQFP problem by minimizing the sum of the negative deviational variables. Finally, an illustrative numerical example is given to demonstrate the applicability and performance of the proposed approach.

  14. Improving survey response rates from parents in school-based research using a multi-level approach.

    Science.gov (United States)

    Schilpzand, Elizabeth J; Sciberras, Emma; Efron, Daryl; Anderson, Vicki; Nicholson, Jan M

    2015-01-01

    While schools can provide a comprehensive sampling frame for community-based studies of children and their families, recruitment is challenging. Multi-level approaches which engage multiple school stakeholders have been recommended but few studies have documented their effects. This paper compares the impact of a standard versus enhanced engagement approach on multiple indicators of recruitment: parent response rates, response times, reminders required and sample characteristics. Parents and teachers were distributed a brief screening questionnaire as a first step for recruitment to a longitudinal study, with two cohorts recruited in consecutive years (cohort 1 2011, cohort 2 2012). For cohort 2, additional engagement strategies included the use of pre-notification postcards, improved study materials, and recruitment progress graphs provided to school staff. Chi-square and t-tests were used to examine cohort differences. Compared to cohort 1, a higher proportion of cohort 2 parents responded to the survey (76% versus 69%; p value of investing in a relatively simple multi-level strategy to maximise parent response rates, and potentially reduce recruitment time and costs.

  15. A Multi-Level Middle-Out Cross-Zooming Approach for Large Graph Analytics

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Pak C.; Mackey, Patrick S.; Cook, Kristin A.; Rohrer, Randall M.; Foote, Harlan P.; Whiting, Mark A.

    2009-10-11

    This paper presents a working graph analytics model that embraces the strengths of the traditional top-down and bottom-up approaches with a resilient crossover concept to exploit the vast middle-ground information overlooked by the two extreme analytical approaches. Our graph analytics model is developed in collaboration with researchers and users, who carefully studied the functional requirements that reflect the critical thinking and interaction pattern of a real-life intelligence analyst. To evaluate the model, we implement a system prototype, known as GreenHornet, which allows our analysts to test the theory in practice, identify the technological and usage-related gaps in the model, and then adapt the new technology in their work space. The paper describes the implementation of GreenHornet and compares its strengths and weaknesses against the other prevailing models and tools.

  16. Improving survey response rates from parents in school-based research using a multi-level approach.

    Directory of Open Access Journals (Sweden)

    Elizabeth J Schilpzand

    Full Text Available While schools can provide a comprehensive sampling frame for community-based studies of children and their families, recruitment is challenging. Multi-level approaches which engage multiple school stakeholders have been recommended but few studies have documented their effects. This paper compares the impact of a standard versus enhanced engagement approach on multiple indicators of recruitment: parent response rates, response times, reminders required and sample characteristics.Parents and teachers were distributed a brief screening questionnaire as a first step for recruitment to a longitudinal study, with two cohorts recruited in consecutive years (cohort 1 2011, cohort 2 2012. For cohort 2, additional engagement strategies included the use of pre-notification postcards, improved study materials, and recruitment progress graphs provided to school staff. Chi-square and t-tests were used to examine cohort differences.Compared to cohort 1, a higher proportion of cohort 2 parents responded to the survey (76% versus 69%; p < 0.001, consented to participate (71% versus 56%; p < 0.001, agreed to teacher participation (90% versus 82%; p < 0.001 and agreed to follow-up contact (91% versus 80%; p < 0.001. Fewer cohort 2 parents required reminders (52% versus 63%; p < 0.001, and cohort 2 parents responded more promptly than cohort 1 parents (mean difference: 19.4 days, 95% CI: 18.0 to 20.9, p < 0.001.These results illustrate the value of investing in a relatively simple multi-level strategy to maximise parent response rates, and potentially reduce recruitment time and costs.

  17. Scheduling and resource allocation of non-conventional power systems via multi level approach

    Energy Technology Data Exchange (ETDEWEB)

    Fahmy, F H [National Research Center, Cairo (Egypt). Electronics Research Inst.

    1996-12-31

    The objective of article is to propose a design technique wit a new economic dispatch analysis. This analysis are used the combined hierarchical approach and N.L. programming. There are three different energy sources which can be used to feed a remote area in Egypt desert: Wind source, PV and Diesel engine. The two subsources are considered here as: Batteries and water Basin: The load demand is to feed the suitable electric energy need for irrigation and domestic services. The optimization problem is composed of set of goals with set of constraints i.e. a multi objective functions system had been studied as a large scale system. Using the developed technique, the complicated stochastic system can be transformed into a simple deterministic scale system for simplicity. The use of developed technique constitute a more forceful approach to find the minimum cost operating point with maximizing the total electric energy generated form the three energy sources. The method also gives greater flexibility in the selection of constraints, permitting the use of equality constraints as well as inequality one. (author)

  18. Scheduling and resource allocation of non-conventional power systems via multi level approach

    Energy Technology Data Exchange (ETDEWEB)

    Fahmy, F.H. [National Research Center, Cairo (Egypt). Electronics Research Inst.

    1995-12-31

    The objective of article is to propose a design technique wit a new economic dispatch analysis. This analysis are used the combined hierarchical approach and N.L. programming. There are three different energy sources which can be used to feed a remote area in Egypt desert: Wind source, PV and Diesel engine. The two subsources are considered here as: Batteries and water Basin: The load demand is to feed the suitable electric energy need for irrigation and domestic services. The optimization problem is composed of set of goals with set of constraints i.e. a multi objective functions system had been studied as a large scale system. Using the developed technique, the complicated stochastic system can be transformed into a simple deterministic scale system for simplicity. The use of developed technique constitute a more forceful approach to find the minimum cost operating point with maximizing the total electric energy generated form the three energy sources. The method also gives greater flexibility in the selection of constraints, permitting the use of equality constraints as well as inequality one. (author)

  19. Scheduling and resource allocation of non-conventional power systems via multi level approach

    International Nuclear Information System (INIS)

    Fahmy, F.H.

    1995-01-01

    The objective of article is to propose a design technique wit a new economic dispatch analysis. This analysis are used the combined hierarchical approach and N.L. programming. There are three different energy sources which can be used to feed a remote area in Egypt desert: Wind source, PV and Diesel engine. The two subsources are considered here as: Batteries and water Basin: The load demand is to feed the suitable electric energy need for irrigation and domestic services. The optimization problem is composed of set of goals with set of constraints i.e. a multi objective functions system had been studied as a large scale system. Using the developed technique, the complicated stochastic system can be transformed into a simple deterministic scale system for simplicity. The use of developed technique constitute a more forceful approach to find the minimum cost operating point with maximizing the total electric energy generated form the three energy sources. The method also gives greater flexibility in the selection of constraints, permitting the use of equality constraints as well as inequality one. (author)

  20. IS ROMANIA “GREEN” ENOUGH? – A MULTI-LEVEL APPROACH

    Directory of Open Access Journals (Sweden)

    Alina CIOMOŞ

    2014-06-01

    Full Text Available Climate changes’ effects are already present in our day to day life. The EU and national public authorities established strategies and public policies in order to enhance a more desirable behavior of the companies and citizens with regard to recycling and use of green energy. The companies try to make production choices that are more eco-friendly and to sustain campaigns helping cities to become “greener”. The environmentalist citizens occupy a growing share in the general population and are more vocal for convincing the others. But even with the “on the wave” eco-friendly attitude, is it done enough? The article will present some conclusions for Romania. The perspective taken is interdisciplinary and tries to draw a short review of the state of the art achievements in greening Romania’s economy, at macroeconomic level, while proposing new marketing approaches for enhancing further sustainable development, through promoting change in the companies and consumers attitudes and behaviors.

  1. The Evidence-Based Approach to Adult-Onset Idiopathic Nephrotic Syndrome.

    Science.gov (United States)

    Canetta, Pietro A A; Radhakrishnan, Jai

    2015-01-01

    Adult-onset nephrotic syndrome (NS) differs from its pediatric counterpart in several important ways. Most importantly, NS in adults is more etiologically heterogeneous compared to children, and thus treatment approaches rely heavily on the histological diagnosis provided by renal biopsy. The evidence-based approach to treatment of adult NS has been critically examined by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines in glomerulonephritis, published in 2012. Here, we examine the strengths and limits of those guidelines and review recent work that expands the evidence-based approach.

  2. The evidence-based approach to adult-onset idiopathic nephrotic syndrome

    Directory of Open Access Journals (Sweden)

    Pietro A. Canetta

    2015-09-01

    Full Text Available Adult-onset nephrotic syndrome differs from its pediatric counterpart in several important ways. Most importantly, nephrotic syndrome in adults is more etiologically heterogeneous compared to children, and thus treatment approaches rely heavily on the histologic diagnosis provided by renal biopsy. The evidence-based approach to treatment of adult nephrotic syndrome has been critically examined by the Kidney Disease Improving Global Outcomes (KDIGO guidelines in glomerulonephritis, published in 2012. Here, we examine the strengths and limits of those guidelines and review recent work that expands the evidence-based approach.

  3. An evidence-based public health approach to climate change adaptation.

    Science.gov (United States)

    Hess, Jeremy J; Eidson, Millicent; Tlumak, Jennifer E; Raab, Kristin K; Luber, George

    2014-11-01

    Public health is committed to evidence-based practice, yet there has been minimal discussion of how to apply an evidence-based practice framework to climate change adaptation. Our goal was to review the literature on evidence-based public health (EBPH), to determine whether it can be applied to climate change adaptation, and to consider how emphasizing evidence-based practice may influence research and practice decisions related to public health adaptation to climate change. We conducted a substantive review of EBPH, identified a consensus EBPH framework, and modified it to support an EBPH approach to climate change adaptation. We applied the framework to an example and considered implications for stakeholders. A modified EBPH framework can accommodate the wide range of exposures, outcomes, and modes of inquiry associated with climate change adaptation and the variety of settings in which adaptation activities will be pursued. Several factors currently limit application of the framework, including a lack of higher-level evidence of intervention efficacy and a lack of guidelines for reporting climate change health impact projections. To enhance the evidence base, there must be increased attention to designing, evaluating, and reporting adaptation interventions; standardized health impact projection reporting; and increased attention to knowledge translation. This approach has implications for funders, researchers, journal editors, practitioners, and policy makers. The current approach to EBPH can, with modifications, support climate change adaptation activities, but there is little evidence regarding interventions and knowledge translation, and guidelines for projecting health impacts are lacking. Realizing the goal of an evidence-based approach will require systematic, coordinated efforts among various stakeholders.

  4. Adapting Evidence-Based Mental Health Treatments in Community Settings: Preliminary Results from a Partnership Approach

    Science.gov (United States)

    Southam-Gerow, Michael A.; Hourigan, Shannon E.; Allin, Robert B., Jr.

    2009-01-01

    This article describes the application of a university-community partnership model to the problem of adapting evidence-based treatment approaches in a community mental health setting. Background on partnership research is presented, with consideration of methodological and practical issues related to this kind of research. Then, a rationale for…

  5. How Evidence-Based Teaching Practices Are Challenged by a Deweyan Approach to Education

    Science.gov (United States)

    Webster, R. Scott

    2009-01-01

    The claim is made in this paper that the discourse of education offers a challenge to evidence-based practices because this latter approach is embedded in the discourse of management. Although claiming the status of being "scientific", this latter development is drawn upon problematically by policy makers to provide the warrant for stipulating…

  6. Adopting a blended learning approach to teaching evidence based medicine: a mixed methods study

    OpenAIRE

    Ilic, Dragan; Hart, William; Fiddes, Patrick; Misso, Marie; Villanueva, Elmer

    2013-01-01

    Background Evidence Based Medicine (EBM) is a core unit delivered across many medical schools. Few studies have investigated the most effective method of teaching a course in EBM to medical students. The objective of this study was to identify whether a blended-learning approach to teaching EBM is more effective a didactic-based approach at increasing medical student competency in EBM. Methods A mixed-methods study was conducted consisting of a controlled trial and focus groups with second ye...

  7. Developing an evidence-based approach to Public Health Nutrition: translating evidence into policy.

    Science.gov (United States)

    Margetts, B; Warm, D; Yngve, A; Sjöström, M

    2001-12-01

    The aim of this paper is to highlight the importance of an evidence-based approach to the development, implementation and evaluation of policies aimed at improving nutrition-related health in the population. Public Health Nutrition was established to realise a population-level approach to the prevention of the major nutrition-related health problems world-wide. The scope is broad and integrates activity from local, national, regional and international levels. The aim is to inform and develop coherent and effective policies that address the key rate-limiting steps critical to improving nutrition-related public health. This paper sets out the rationale for an evidence-based approach to Public Health Nutrition developed under the umbrella of the European Network for Public Health Nutrition.

  8. An Evidence-Based Medicine Approach to Antihyperglycemic Therapy in Diabetes Mellitus to Overcome Overtreatment.

    Science.gov (United States)

    Makam, Anil N; Nguyen, Oanh K

    2017-01-10

    Overtreatment is pervasive in medicine and leads to potential patient harms and excessive costs in health care. Although evidence-based medicine is often derided as practice by rote algorithmic medicine, the appropriate application of key evidence-based medicine principles in clinical decision making is fundamental to preventing overtreatment and promoting high-value, individualized patient-centered care. Specifically, this article discusses the importance of (1) using absolute rather than relative estimates of benefits to inform treatment decisions; (2) considering the time horizon to benefit of treatments; (3) balancing potential harms and benefits; and (4) using shared decision making by physicians to incorporate the patient's values and preferences into treatment decisions. Here, we illustrate the application of these principles to considering the decision of whether or not to recommend intensive glycemic control to patients to minimize microvascular and cardiovascular complications in type 2 diabetes mellitus. Through this lens, this example will illustrate how an evidence-based medicine approach can be used to individualize glycemic goals and prevent overtreatment, and can serve as a template for applying evidence-based medicine to inform treatment decisions for other conditions to optimize health and individualize patient care. © 2017 American Heart Association, Inc.

  9. An Evidence Based Approach to Designing Medical Support for Long Duration, Interplanetary Missions

    Science.gov (United States)

    Watkins, S. D.; McGrath, T. L.; Bauman, D. K.; Wu, J. H.; Barsten, K. N.; Barr, Y. R.; Kerstman, E. L.

    2011-01-01

    The Exploration Medical Capability (ExMC) element is one of six elements under NASA's Human Research Program (HRP). The goal of the ExMC element is to address the risk of the "inability to adequately recognize or treat an ill or injured crewmember." This poster highlights the evidence-based approach that the ExMC element has taken to address this goal, and the ExMC element's current areas of interest.

  10. Ensuring a proactive, evidence-based, patient safety approach to patient assessment.

    Science.gov (United States)

    Considine, Julie; Currey, Judy

    2015-01-01

    To argue that if all nurses were to adopt the primary survey approach (assessment of airway, breathing, circulation and disability) as the first element of patient assessment, they would be more focused on active detection of clinical deterioration rather than passive collection of patient data. Nurses are the professional group that carry the highest level of responsibility for patient assessment, accurate data collection and interpretation. The timely recognition of, and response to deteriorating patients, is dependent on the measurement and interpretation of pertinent physiological data by nurses. Discursive paper. Traditionally taught and commonly used approaches to patient assessment such as 'vital signs' and 'body systems' are not evidence-based nor framed in patient safety. The primary survey approach as the first element in patient assessment has three major advantages: (1) data are collected according to clinical importance; (2) data are collected using the same framework as most organisation's rapid response system activation criteria; and (3) the primary survey acts as a patient safety checklist, thereby decreasing the risk of failure to recognise, and therefore respond to, deteriorating patients. The vital signs and body systems approaches to patient assessment have significant limitations in identifying clinical deterioration. The primary survey approach provides nurses with a consistent, evidence-based and sequenced approach to patient assessment in every clinical setting. All nurses should use a primary survey approach as the first element of patient assessment in every patient encounter as a patient safety strategy. © 2014 John Wiley & Sons Ltd.

  11. An examination of cross-cultural systems implementing evidence-based assessment and intervention approaches

    Directory of Open Access Journals (Sweden)

    Murray Laura K

    2006-01-01

    Full Text Available Implementation of evidence-based assessment and intervention approaches for youth with behavioral and/or emotional problems is rising to recognition worldwide. Feasibility research is critical to examine what characteristics of systems allow for success or barriers to the implementation of evidence-based practices into real-world settings, especially when working cross-culturally. This paper briefly reviews the experience of 4 international sites to understand how the overall structure and specific site variables directed the implementation of the World Health Organization and the World Psychiatry Association project. Discussion includes a thematic summary of the successes and challenges experienced by the sites, and future directions of feasibility studies.

  12. A multi-level surface rebalancing approach for efficient convergence acceleration of 3D full core multi-group fine grid nodal diffusion iterations

    International Nuclear Information System (INIS)

    Geemert, René van

    2014-01-01

    Highlights: • New type of multi-level rebalancing approach for nodal transport. • Generally improved and more mesh-independent convergence behavior. • Importance for intended regime of 3D pin-by-pin core computations. - Abstract: A new multi-level surface rebalancing (MLSR) approach has been developed, aimed at enabling an improved non-linear acceleration of nodal flux iteration convergence in 3D steady-state and transient reactor simulation. This development is meant specifically for anticipating computational needs for solving envisaged multi-group diffusion-like SP N calculations with enhanced mesh resolution (i.e. 3D multi-box up to 3D pin-by-pin grid). For the latter grid refinement regime, the previously available multi-level coarse mesh rebalancing (MLCMR) strategy has been observed to become increasingly inefficient with increasing 3D mesh resolution. Furthermore, for very fine 3D grids that feature a very fine axial mesh as well, non-convergence phenomena have been observed to emerge. In the verifications pursued up to now, these problems have been resolved by the new approach. The novelty arises from taking the interface current balance equations defined over all Cartesian box edges, instead of the nodal volume-integrated process-rate balance equation, as an appropriate restriction basis for setting up multi-level acceleration of fine grid interface current iterations. The new restriction strategy calls for the use of a newly derived set of adjoint spectral equations that are needed for computing a limited set of spectral response vectors per node. This enables a straightforward determination of group-condensed interface current spectral coupling operators that are of crucial relevance in the new rebalancing setup. Another novelty in the approach is a new variational method for computing the neutronic eigenvalue. Within this context, the latter is treated as a control parameter for driving another, newly defined and numerically more fundamental

  13. Evaluation Considerations for Secondary Uses of Clinical Data: Principles for an Evidence-based Approach to Policy and Implementation of Secondary Analysis.

    Science.gov (United States)

    Scott, P J; Rigby, M; Ammenwerth, E; McNair, J Brender; Georgiou, A; Hyppönen, H; de Keizer, N; Magrabi, F; Nykänen, P; Gude, W T; Hackl, W

    2017-08-01

    Objectives: To set the scientific context and then suggest principles for an evidence-based approach to secondary uses of clinical data, covering both evaluation of the secondary uses of data and evaluation of health systems and services based upon secondary uses of data. Method: Working Group review of selected literature and policy approaches. Results: We present important considerations in the evaluation of secondary uses of clinical data from the angles of governance and trust, theory, semantics, and policy. We make the case for a multi-level and multi-factorial approach to the evaluation of secondary uses of clinical data and describe a methodological framework for best practice. We emphasise the importance of evaluating the governance of secondary uses of health data in maintaining trust, which is essential for such uses. We also offer examples of the re-use of routine health data to demonstrate how it can support evaluation of clinical performance and optimize health IT system design. Conclusions: Great expectations are resting upon "Big Data" and innovative analytics. However, to build and maintain public trust, improve data reliability, and assure the validity of analytic inferences, there must be independent and transparent evaluation. A mature and evidence-based approach needs not merely data science, but must be guided by the broader concerns of applied health informatics. Georg Thieme Verlag KG Stuttgart.

  14. Infusion Nursing: An Evidence-Based Approach - Third edition Alexander Mary Infusion Nursing: An Evidence-Based Approach - Third edition 625pp Elsevier 9781416064107 1416064109 [Formula: see text].

    Science.gov (United States)

    2010-11-03

    This book considers all aspects of infusion therapy and provides a solid evidence base. Its 30 chapters are well organised into six sections covering physiological considerations, infusion therapies and nursing practice.

  15. A multi-level approach of evaluating crew resource management training: a laboratory-based study examining communication skills as a function of team congruence.

    Science.gov (United States)

    Sauer, J; Darioly, A; Mast, M Schmid; Schmid, P C; Bischof, N

    2010-11-01

    The article proposes a multi-level approach for evaluating communication skills training (CST) as an important element of crew resource management (CRM) training. Within this methodological framework, the present work examined the effectiveness of CST in matching or mismatching team compositions with regard to hierarchical status and competence. There is little experimental research that evaluated the effectiveness of CRM training at multiple levels (i.e. reaction, learning, behaviour) and in teams composed of members of different status and competence. An experiment with a two (CST: with vs. without) by two (competence/hierarchical status: congruent vs. incongruent) design was carried out. A total of 64 participants were trained for 2.5 h on a simulated process control environment, with the experimental group being given 45 min of training on receptiveness and influencing skills. Prior to the 1-h experimental session, participants were assigned to two-person teams. The results showed overall support for the use of such a multi-level approach of training evaluation. Stronger positive effects of CST were found for subjective measures than for objective performance measures. STATEMENT OF RELEVANCE: This work provides some guidance for the use of a multi-level evaluation of CRM training. It also emphasises the need to collect objective performance data for training evaluation in addition to subjective measures with a view to gain a more accurate picture of the benefits of such training approaches.

  16. Why We Need Evidence-Based, Community-Wide Approaches for Prevention of Teen Pregnancy.

    Science.gov (United States)

    Barfield, Wanda D; Warner, Lee; Kappeler, Evelyn

    2017-03-01

    Teen pregnancy and childbearing have declined over the past two decades to historic lows. The most recent declines have occurred during a time of coordinated national efforts focused on teen pregnancy. This article highlights a federal partnership to reduce teen pregnancy through the implementation of innovative, evidence-based approaches in affected communities, with a focus on reaching African-American and Latino/Hispanic youth. This initiative has the potential to transform the design and implementation of future teen pregnancy prevention efforts and provide a model that can be replicated in communities across the nation. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  17. American Society for Microbiology resources in support of an evidence-based approach to teaching microbiology.

    Science.gov (United States)

    Merkel, Susan M

    2016-08-01

    Numerous national reports have addressed the need for changing how science courses in higher education are taught, so that students develop a deeper understanding of critical concepts and the analytical and cognitive skills needed to address future challenges. This review presents some evidence-based approaches to curriculum development and teaching. Results from discipline-based education research indicate that it is critically important for educators to formulate learning goals, provide frequent and authentic assessments and actively engage students in their learning. Professional societies can play a role in helping to put these changes into practice. To this end, the American Society for Microbiology has developed a number of educational programs and resources, which are described here to encourage the implementation of student-centered learning in microbiology education. © FEMS 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Adopting a blended learning approach to teaching evidence based medicine: a mixed methods study

    Science.gov (United States)

    2013-01-01

    Background Evidence Based Medicine (EBM) is a core unit delivered across many medical schools. Few studies have investigated the most effective method of teaching a course in EBM to medical students. The objective of this study was to identify whether a blended-learning approach to teaching EBM is more effective a didactic-based approach at increasing medical student competency in EBM. Methods A mixed-methods study was conducted consisting of a controlled trial and focus groups with second year graduate medical students. Students received the EBM course delivered using either a didactic approach (DID) to learning EBM or a blended-learning approach (BL). Student competency in EBM was assessed using the Berlin tool and a criterion-based assessment task, with student perceptions on the interventions assessed qualitatively. Results A total of 61 students (85.9%) participated in the study. Competency in EBM did not differ between the groups when assessed using the Berlin tool (p = 0.29). Students using the BL approach performed significantly better in one of the criterion-based assessment tasks (p = 0.01) and reported significantly higher self-perceived competence in critical appraisal skills. Qualitative analysis identified that students had a preference for the EBM course to be delivered using the BL approach. Conclusions Implementing a blended-learning approach to EBM teaching promotes greater student appreciation of EBM principles within the clinical setting. Integrating a variety of teaching modalities and approaches can increase student self-confidence and assist in bridging the gap between the theory and practice of EBM. PMID:24341502

  19. Adopting a blended learning approach to teaching evidence based medicine: a mixed methods study.

    Science.gov (United States)

    Ilic, Dragan; Hart, William; Fiddes, Patrick; Misso, Marie; Villanueva, Elmer

    2013-12-17

    Evidence Based Medicine (EBM) is a core unit delivered across many medical schools. Few studies have investigated the most effective method of teaching a course in EBM to medical students. The objective of this study was to identify whether a blended-learning approach to teaching EBM is more effective a didactic-based approach at increasing medical student competency in EBM. A mixed-methods study was conducted consisting of a controlled trial and focus groups with second year graduate medical students. Students received the EBM course delivered using either a didactic approach (DID) to learning EBM or a blended-learning approach (BL). Student competency in EBM was assessed using the Berlin tool and a criterion-based assessment task, with student perceptions on the interventions assessed qualitatively. A total of 61 students (85.9%) participated in the study. Competency in EBM did not differ between the groups when assessed using the Berlin tool (p = 0.29). Students using the BL approach performed significantly better in one of the criterion-based assessment tasks (p = 0.01) and reported significantly higher self-perceived competence in critical appraisal skills. Qualitative analysis identified that students had a preference for the EBM course to be delivered using the BL approach. Implementing a blended-learning approach to EBM teaching promotes greater student appreciation of EBM principles within the clinical setting. Integrating a variety of teaching modalities and approaches can increase student self-confidence and assist in bridging the gap between the theory and practice of EBM.

  20. Complementary and alternative medicine approaches to blood pressure reduction: An evidence-based review.

    Science.gov (United States)

    Nahas, Richard

    2008-11-01

    ABSTRACTOBJECTIVETo review the evidence supporting complementary and alternative medicine approaches used in the treatment of hypertension.QUALITY OF EVIDENCEMEDLINE and EMBASE were searched from January 1966 to May 2008 combining the key words hypertension or blood pressure with acupuncture, chocolate, cocoa, coenzyme Q10, ubiquinone, melatonin, vitamin D, meditation, and stress reduction. Clinical trials, prospective studies, and relevant references were included.MAIN MESSAGEEvidence from systematic reviews supports the blood pressure-lowering effects of coenzyme Q10, polyphenol-rich dark chocolate, Qigong, slow breathing, and transcendental meditation. Vitamin D deficiency is associated with hypertension and cardiovascular risk; supplementation lowered blood pressure in 2 trials. Acupuncture reduced blood pressure in 3 trials; in 1 of these it was no better than an invasive placebo. Melatonin was effective in 2 small trials, but caution is warranted in patients taking pharmacotherapy.CONCLUSIONSeveral complementary and alternative medicine therapies can be considered as part of an evidence-based approach to the treatment of hypertension. The potential benefit of these interventions warrants further research using cardiovascular outcomes.

  1. An evidence-based approach to perioperative nutrition support in the elective surgery patient.

    Science.gov (United States)

    Miller, Keith R; Wischmeyer, Paul E; Taylor, Beth; McClave, Stephen A

    2013-09-01

    In surgical practice, great attention is given to the perioperative management of the elective surgical patient with regard to surgical planning, stratification of cardiopulmonary risk, and postoperative assessment for complication. However, growing evidence supports the beneficial role for implementation of a consistent and literature-based approach to perioperative nutrition therapy. Determining nutrition risk should be a routine component of the preoperative evaluation. As with the above issues, this concept begins with the clinician's first visit with the patient as risk is assessed and the severity of the surgical insult considered. If the patient is an appropriate candidate for benefit from preoperative support, a plan for initiation and reassessment should be implemented. Once appropriate nutrition end points have been achieved, special consideration should be given to beneficial practices the immediate day preceding surgery that may better prepare the patient for the intervention from a metabolic standpoint. In the operating room, consideration should be given to the potential placement of enteral access during the index operation as well as judicious and targeted intraoperative resuscitation. Immediately following the intervention, adequate resuscitation and glycemic control are key concepts, as is an evidence-based approach to the early advancement of an enteral/oral diet in the postoperative patient. Through the implementation of perioperative nutrition therapy plans in the elective surgery setting, outcomes can be improved.

  2. Evidence-based practice beliefs and behaviors of nurses providing cancer pain management: a mixed-methods approach.

    Science.gov (United States)

    Eaton, Linda H; Meins, Alexa R; Mitchell, Pamela H; Voss, Joachim; Doorenbos, Ardith Z

    2015-03-01

    To describe evidence-based practice (EBP) beliefs and behaviors of nurses who provide cancer pain management. Descriptive, cross-sectional with a mixed-methods approach. Two inpatient oncology units in the Pacific Northwest. 40 RNs.
 Data collected by interviews and web-based surveys. EBP beliefs, EBP implementation, evidence-based pain management. Nurses agreed with the positive aspects of EBP and their implementation ability, although implementation level was low. They were satisfied with their pain management practices. Oncology nursing certification was associated with innovativeness, and innovativeness was associated with EBP beliefs. Themes identified were (a) limited definition of EBP, (b) varied evidence-based pain management decision making, (c) limited identification of evidence-based pain management practices, and (d) integration of nonpharmacologic interventions into patient care. Nurses' low level of EBP implementation in the context of pain management was explained by their trust that standards of care and medical orders were evidence-based. Nurses' EBP beliefs and behaviors should be considered when developing strategies for sustaining evidence-based pain management practices. Implementation of the EBP process by nurses may not be realistic in the inpatient setting; therefore, hospital pain management policies need to be evidence-based and reinforced with nurses.

  3. Using a pedagogical approach to integrate evidence-based teaching in an undergraduate women's health course.

    Science.gov (United States)

    Dawley, Katy; Bloch, Joan Rosen; Suplee, Patricia Dunphy; McKeever, Amy; Scherzer, Gerri

    2011-06-01

    Evidence-based practice (EBP) is promoted as a foundation for nursing practice. However, the 2005 U.S. survey of nurses revealed that they do not have requisite skills for EBP. PURPOSE AND GOALS: To evaluate a pedagogical approach aimed at (1) fostering undergraduate nursing students EBP competencies, and (2) identifying gaps in the literature to direct future women's health research. A secondary analysis of data abstracted from required EBP clinical journals for an undergraduate women's health course in which students (n = 198) were asked to find evidence to answer their clinical questions. Content analysis was used to identify main themes of the topics of inquiry. Students identified 1,808 clinical questions and 30.3% (n = 547) of these could not be answered or supported by evidence in the literature. This assignment was an important teaching and assessment tool for EBP. Questions reflected critical thinking and quest for in-depth knowledge to support nursing practice. Some students lacked skills in searching databases and a significant number of knowledge gaps were identified that can direct women's health research. Copyright ©2010 Sigma Theta Tau International.

  4. Blood component therapy in anesthesia and intensive care: Adoption of evidence based approaches

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2014-01-01

    Full Text Available Transfusion of blood and its components has undergone technological advancement, and its use is increasing both perioperatively as well as in the Intensive Care Unit. The separation of blood into its various components has made it very economical as blood donated from a single donor can be utilized for many recipients at the same time. However, the transfusion of blood and its components do carry the inherent risk of various transfusion reactions as well as transmission of infections. The indications for transfusion should be strictly adhered to for preventing nonjudicious use. The health care persons involved in transfusion should be well aware of implications of the mismatched transfusion and should be able to provide treatment if such mishaps do occur. A health care professional should carefully weigh the benefits of blood transfusion against the risks involved before subjecting the patients to the transfusion. This manuscript aims to comprehensively review the current evidence based approaches in blood and component transfusion which are being followed in anesthesiology and intensive care practice.

  5. A case study: planning a statewide information resource for health professionals: an evidence-based approach

    Science.gov (United States)

    Chew, Katherine; Watson, Linda; Parker, Mary

    2009-01-01

    Question: What is the best approach for implementing a statewide electronic health library (eHL) to serve all health professionals in Minnesota? Setting: The research took place at the University of Minnesota Health Sciences Libraries. Methods: In January 2008, the authors began planning a statewide eHL for health professionals following the five-step process for evidence-based librarianship: formulating the question, finding the best evidence, appraising the evidence, assessing costs and benefits, and evaluating the effectiveness of resulting actions. Main Results: The authors identified best practices for developing a statewide eHL for health professionals relating to audience or population served, information resources, technology and access, funding model, and implementation and sustainability. They were compared to the mission of the eHL project to drive strategic directions by developing recommendations. Conclusion: EBL can guide the planning process for a statewide eHL, but findings must be tailored to the local environment to address information needs and ensure long-term sustainability. PMID:19851487

  6. An evidence-based approach to pre-pregnancy counselling for patients with systemic lupus erythematosus.

    Science.gov (United States)

    Teng, Y K Onno; Bredewold, Edwin O W; Rabelink, Ton J; Huizinga, Tom W J; Eikenboom, H C Jeroen; Limper, Maarten; Fritsch-Stork, Ruth D E; Bloemenkamp, Kitty W M; Sueters, Marieke

    2017-11-20

    Patients with SLE are often young females of childbearing age and a pregnancy wish in this patient group is common. However, SLE patients are at high risk for adverse pregnancy outcomes that require adequate guidance. It is widely acknowledged that pre-pregnancy counselling is the pivotal first step in the management of SLE patients with a wish to become pregnant. Next, management of these patients is usually multidisciplinary and often requires specific expertise from the different physicians involved. Very recently a EULAR recommendation was published emphasizing the need for adequate preconception counselling and risk stratification. Therefore the present review specifically addresses the issue of pre-pregnancy counselling for SLE patients with an evidence-based approach. The review summarizes data retrieved from recently published, high-quality cohort studies that have contributed to a better understanding and estimation of pregnancy-related risks for SLE patients. The present review categorizes risks from a patient-oriented point of view, that is, the influence of pregnancy on SLE, of SLE on pregnancy, of SLE on the foetus/neonate and of SLE-related medication. Lastly, pre-pregnancy counselling of SLE patients with additional secondary APS is reviewed. Collectively these data can guide clinicians to formulate appropriate preventive strategies and patient-tailored monitoring plans during pre-pregnancy counselling of SLE patients. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  7. Multi-Level Model

    Directory of Open Access Journals (Sweden)

    Constanta Nicoleta BODEA

    2008-01-01

    Full Text Available Is an original paper, which contains a hierarchical model with three levels, for determining the linearized non-homogeneous and homogeneous credibility premiums at company level, at sector level and at contract level, founded on the relevant covariance relations between the risk premium, the observations and the weighted averages. We give a rather explicit description of the input data for the multi- level hierarchical model used, only to show that in practical situations, there will always be enough data to apply credibility theory to a real insurance portfolio.

  8. Approaches to learning as predictors of academic achievement: Results from a large scale, multi-level analysis

    DEFF Research Database (Denmark)

    Herrmann, Kim Jesper; McCune, Velda; Bager-Elsborg, Anna

    2017-01-01

    The relationships between university students’ academic achievement and their approaches to learning and studying continuously attract scholarly attention. We report the results of an analysis in which multilevel linear modelling was used to analyse data from 3,626 Danish university students....... Controlling for the effects of age, gender, and progression, we found that the students’ end-of-semester grade point averages were related negatively to a surface approach and positively to organised effort. Interestingly, the effect of the surface approach on academic achievement varied across programmes....... While there has been considerable interest in the ways in which academic programmes shape learning and teaching, the effects of these contexts on the relationship between approaches to learning and academic outcomes is under-researched. The results are discussed in relation to findings from recent meta...

  9. Using the Dynamic Model to develop an evidence-based and theory-driven approach to school improvement

    NARCIS (Netherlands)

    Creemers, B.P.M.; Kyriakides, L.

    2010-01-01

    This paper refers to a dynamic perspective of educational effectiveness and improvement stressing the importance of using an evidence-based and theory-driven approach. Specifically, an approach to school improvement based on the dynamic model of educational effectiveness is offered. The recommended

  10. An Interactive Online Approach to Teaching Evidence-Based Dentistry with Web 2.0 Technology.

    Science.gov (United States)

    Zheng, Meixun; Bender, Daniel; Reid, Laura; Milani, Jim

    2017-08-01

    At many dental schools, evidence-based dentistry (EBD) is taught in a traditional lecture format. To avoid the constraints of lectures, in 2012 the EBD unit was redesigned for online delivery at the Arthur A. Dugoni School of Dentistry at the University of the Pacific with a Web 2.0 tool called Voicethread. The aim of this study was to assess the impact of Voicethread-based online learning on students' perceptions of learning EBD, their participation and engagement, and their acceptance of this new online delivery approach. Students' perceptions were collected from two sources: a self-assessment quiz and a question on their self-reported preparedness in EBD from the 2014 American Dental Education Association (ADEA) Survey of Dental School Seniors. The Voicethread analytics tool provided data on students' participation and engagement. Students' responses to the survey questions on the self-assessment quiz provided data on their acceptance of Voicethread-based learning. The average score of the 124 students (91% of total) taking the quiz was 7.3 out of 8. The percentage of students who reported in the 2014 ADEA survey that they were "well prepared" in EBD was 45.2%, compared with the national average of 31.2%. Responses to this question for the Classes of 2013 and 2015, who received instruction in the traditional lecture format, were 35.2% and 34.6%, respectively. With Voicethread, students actively participated and interacted with their peers through questions and answers. They perceived Voicethread to be more effective than other delivery approaches and reported that it made learning more active and engaging. These findings suggest that Voicethread may be an effective tool for students to learn EBD since it adds interactivity to online learning.

  11. Embedding EfS in Teacher Education through a Multi-Level Systems Approach: Lessons from Queensland

    Science.gov (United States)

    Evans, Neus; Ferreira, Jo-Anne; Davis, Julie; Stevenson, Robert B.

    2016-01-01

    This article reports on the fourth stage of an evolving study to develop a systems model for embedding education for sustainability (EfS) into preservice teacher education. The fourth stage trialled the extension of the model to a comprehensive state-wide systems approach involving representatives from all eight Queensland teacher education…

  12. Challenging empowerment: AIDS-affected South African children and the need for a multi-level relational approach.

    Science.gov (United States)

    Ansell, Nicola

    2014-01-01

    Critics of empowerment have highlighted the concept's mutability, focus on individual transformation, one-dimensionality and challenges of operationalisation. Relating these critiques to children's empowerment raises new challenges. Drawing on scholarship on children's subjecthood and exercise of power, alongside empirical research with children affected by AIDS, I argue that empowerment envisaged as individual self-transformation and increased capacity to act independently offers little basis for progressive change. Rather it is essential to adopt a relational approach that recognises the need to transform power relationships at multiple levels. This analysis has implications for our wider understanding of empowerment in the 21st century.

  13. An Evidence-Based Approach to Reducing Cardiac Telemetry Alarm Fatigue.

    Science.gov (United States)

    Srinivasa, Ekta; Mankoo, Jaspreet; Kerr, Charles

    2017-08-01

    It is estimated that between 80% and 99% of alarms in the clinical areas are in actionable alarms (Gross, Dahl, & Nielson). Alarm management is one of the Joint Commission's National Patient Safety Goals (2014) because sentinel events have directly been linked to the devices generating these alarms. At an acute care facility in Boston, a multidisciplinary team consisting of Nursing, Biomedical Engineers, Patient Safety and Providers was formed to conduct a pilot study on the state of telemetry alarms on a surgical floor. An evidence-based approach was taken utilizing Philips Real-time data exporter alarms tracking software to capture all telemetry alarms during a 43-day time span. Likewise, noise meters were placed near telemetry alarm speakers to track decibel levels within the aforementioned timeframe for 21 days. Analysis of the data showed that clinically insignificant Premature Ventricular Contractions (PVC) alarms accounted for more than 40% of all alarms in the unit within the time span, while also contributing to an average noise level of 58.49 dB. In response to the data, the interdisciplinary team approved to permanently default the settings for PAIR PVC, MULTIFORM PVC, and RUN PVC alarms to off. The results showed a 54% decrease in the rate of alarms per bed per day, and an average noise reduction of 2.3 dB between the two selected noise measurement areas. Organizing a multidisciplinary team provides an effective framework toward analyzing and addressing cardiac telemetry alarm fatigue. Looking at quantitative datasets for clinical care areas through various lenses helps identify opportunities for improvement in regards to highlighting alarms that are not actionable. Pilot changes to alarm parameters can be tested for their environmental impact in the care area. © 2017 Sigma Theta Tau International.

  14. Female genital cutting: an evidence-based approach to clinical management for the primary care physician.

    Science.gov (United States)

    Hearst, Adelaide A; Molnar, Alexandra M

    2013-06-01

    The United States has more than 1.5 million immigrants from countries in Africa and the Middle East where female genital cutting (FGC) is known to occur. Often, FGC occurs in infancy and childhood in the countries where it is practiced, but patients of any age can present with complications. Lack of understanding of this common problem can potentially alienate and lower quality of care for this patient population. We provide an introduction to the practice of FGC and practice guidelines for the primary care physician. We reviewed original research, population-based studies, and legal research from PubMed, Scopus, CINAHL plus, PsycINFO, and Legal Trac. The terms searched included female genital cutting, female genital circumcision, and female genital mutilation alone and with the term complications or health consequences; no limit on date published. Legal databases were searched using the above terms, as well as international law and immigration law. Editorials and review articles were excluded. This review discusses the different types of FGC, important cultural considerations for physicians caring for patients with FGC, the common early and late medical complications and their management, and psychosocial issues associated with FGC. Current laws pertaining to FGC are briefly reviewed, as well as implications for patients seeking asylum status in the United States because of FGC. Finally, the article presents evidence-based, culturally sensitive approaches to discussions of FGC with girls and women for whom this is an issue. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  15. Factors associated with an evidence-based measure of implementation for the Adolescent Community Reinforcement Approach.

    Science.gov (United States)

    Garner, Bryan R; Hunter, Sarah B; Slaughter, Mary E; Han, Bing; Godley, Susan H

    2017-11-01

    An evidence-based measure of implementation (EBMI) is an implementation outcome measure shown to have predictive validity with one or more future-measured constructs of importance. The current study sought to identify correlates and predictors of an EBMI called procedure exposure. Garner et al. (2016) found procedure exposure to be an EBMI for the Adolescent Community Reinforcement Approach (A-CRA). The dataset included 76 community-based substance use treatment organizations located across the United States. Organizational-level regression analyses, which were framed within the context of Chaudoir et al. (2013) framework for predicting implementation outcomes, were used to examine predictors of A-CRA procedure exposure RESULTS: The Washington Circle's treatment initiation performance measure (B=5.05 [SE=1.60], p=0.002), as well as session exposure (B=0.18 [SE=0.06], p=0.003), were significant predictors of A-CRA procedure exposure in the backward stepwise regression analysis (Adjusted R-square=0.55). The Washington Circle's treatment engagement performance measure (B=7.93 [SE=0.77], pCRA procedure exposure but were not retained in the final model. Organizations implementing A-CRA are encouraged to make the following high priorities: (a) scheduling and completing a subsequent treatment session within 14days of their index session (treatment initiation) and (b) providing a targeted number of treatment sessions to each client (session exposure). To the extent organizations do this, they may be more likely to achieve higher levels of A-CRA procedure exposure. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Building national capacity for research mentor training: an evidence-based approach to training the trainers.

    Science.gov (United States)

    Pfund, Christine; Spencer, Kimberly C; Asquith, Pamela; House, Stephanie C; Miller, Sarah; Sorkness, Christine A

    2015-01-01

    Research mentor training (RMT), based on the published Entering Mentoring curricula series, has been shown to improve the knowledge and skills of research mentors across career stages, as self-reported by both the mentors engaged in training and their mentees. To promote widespread dissemination and empower others to implement this evidence-based training at their home institutions, we developed an extensive, interactive, multifaceted train-the-trainer workshop. The specific goals of these workshops are to 1) increase facilitator knowledge of an RMT curriculum, 2) increase facilitator confidence in implementing the curriculum, 3) provide a safe environment to practice facilitation of curricular activities, and 4) review implementation strategies and evaluation tools. Data indicate that our approach results in high satisfaction and significant confidence gains among attendees. Of the 195 diverse attendees trained in our workshops since Fall 2010, 44% report implementation at 39 different institutions, collectively training more than 500 mentors. Further, mentors who participated in the RMT sessions led by our trained facilitators report high facilitator effectiveness in guiding discussion. Implications and challenges to building the national capacity needed for improved research mentoring relationships are discussed. © 2015 C. Pfund, K. C. Spencer, et al. CBE—Life Sciences Education © 2015 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

  17. Diagnosing Appendicitis: Evidence-Based Review of the Diagnostic Approach in 2014

    Science.gov (United States)

    Shogilev, Daniel J.; Duus, Nicolaj; Odom, Stephen R.; Shapiro, Nathan I.

    2014-01-01

    Introduction Acute appendicitis is the most common abdominal emergency requiring emergency surgery. However, the diagnosis is often challenging and the decision to operate, observe or further work-up a patient is often unclear. The utility of clinical scoring systems (namely the Alvarado score), laboratory markers, and the development of novel markers in the diagnosis of appendicitis remains controversial. This article presents an update on the diagnostic approach to appendicitis through an evidence-based review. Methods We performed a broad Medline search of radiological imaging, the Alvarado score, common laboratory markers, and novel markers in patients with suspected appendicitis. Results Computed tomography (CT) is the most accurate mode of imaging for suspected cases of appendicitis, but the associated increase in radiation exposure is problematic. The Alvarado score is a clinical scoring system that is used to predict the likelihood of appendicitis based on signs, symptoms and laboratory data. It can help risk stratify patients with suspected appendicitis and potentially decrease the use of CT imaging in patients with certain Alvarado scores. White blood cell (WBC), C-reactive protein (CRP), granulocyte count and proportion of polymorphonuclear (PMN) cells are frequently elevated in patients with appendicitis, but are insufficient on their own as a diagnostic modality. When multiple markers are used in combination their diagnostic utility is greatly increased. Several novel markers have been proposed to aid in the diagnosis of appendicitis; however, while promising, most are only in the preliminary stages of being studied. Conclusion While CT is the most accurate mode of imaging in suspected appendicitis, the accompanying radiation is a concern. Ultrasound may help in the diagnosis while decreasing the need for CT in certain circumstances. The Alvarado Score has good diagnostic utility at specific cutoff points. Laboratory markers have very limited

  18. Why evidence-based medicine is a good approach in physical and rehabilitation medicine. Thesis.

    Science.gov (United States)

    Negrini, S

    2014-10-01

    According to a good definition, evidence-based medicine (EBM) is: "The explicit, conscientious, and judicious use of the current best evidence in making decisions about the care of individual patients (and populations)". More appropriate in a clinical context like that of physical and rehabilitation medicine (PRM) is looking at evidence based clinical practice (EBCP), whose definition is: "The integration of best research evidence with clinical expertise and patient values". In the past the term evidence-based physical and rehabilitation medicine (EBPRM) was also proposed. In this thesis, after some historical notes on EBM and on PRM, we will discuss why in our view EBPRM must be the real foundation of our everyday PRM clinical practice.

  19. Evidence-based radiology: a new approach to evaluate the clinical practice of radiology

    International Nuclear Information System (INIS)

    Puig, S.; Felder-Puig, R.

    2006-01-01

    Over the last several years, the concept and methodology of evidence-based medicine (EBM) have received significant attention in the scientific community. However, compared to therapeutic medical disciplines, EBM-based radiological publications are still underrepresented. This article summarizes the principles of EBM and discusses the possibilities of their application in radiology. The presented topics include the critical appraisal of studies on the basis on EBM principles, the explanation of EBM-relevant statistical outcome parameters (e.g., ''likelihood ratio'' for diagnostic and ''number needed to treat'' for interventional procedures), as well as the problems facing evidence-based radiology. Evidence-based evaluation of radiological procedures does not only address aspects of cost-effectiveness, but is also particularly helpful in identifying patient-specific usefulness. Therefore it should become an integral part of radiologist training. (orig.)

  20. Practical Biostatistics A Friendly Step-by-Step Approach for Evidence-based Medicine

    CERN Document Server

    Suchmacher, Mendel

    2012-01-01

    Evidence-based medicine aims to apply the best available evidence gained from the scientific method to medical decision making. It is a practice that uses statistical analysis of scientific methods and outcomes to drive further experimentation and diagnosis. The profusion of evidence-based medicine in medical practice and clinical research has produced a need for life scientists and clinical researchers to assimilate biostatistics into their work to meet efficacy and practical standards. Practical Biostatistics provides researchers, medical professionals, and students with a friendly, practica

  1. A Multi-Level Approach to Modeling Rapidly Growing Mega-Regions as a Coupled Human-Natural System

    Science.gov (United States)

    Koch, J. A.; Tang, W.; Meentemeyer, R. K.

    2013-12-01

    The FUTure Urban-Regional Environment Simulation (FUTURES) integrates information on nonstationary drivers of land change (per capita land area demand, site suitability, and spatial structure of conversion events) into spatial-temporal projections of changes in landscape patterns (Meentemeyer et al., 2013). One striking feature of FUTURES is its patch-growth algorithm that includes feedback effects of former development events across several temporal and spatial scales: cell-level transition events are aggregated into patches of land change and their further growth is based on empirically derived parameters controlling its size, shape, and dispersion. Here, we augment the FUTURES modeling framework by expanding its multilevel structure and its representation of human decision making. The new modeling framework is hierarchically organized as nested subsystems including the latest theory on telecouplings in coupled human-natural systems (Liu et al., 2013). Each subsystem represents a specific level of spatial scale and embraces agents that have decision making authority at a particular level. The subsystems are characterized with regard to their spatial representation and are connected via flows of information (e.g. regulations and policies) or material (e.g. population migration). To provide a modeling framework that is applicable to a wide range of settings and geographical regions and to keep it computationally manageable, we implement a 'zooming factor' that allows to enable or disable subsystems (and hence the represented processes), based on the extent of the study region. The implementation of the FUTURES modeling framework for a specific case study follows the observational modeling approach described in Grimm et al. (2005), starting from the analysis of empirical data in order to capture the processes relevant for specific scales and to allow a rigorous calibration and validation of the model application. In this paper, we give an introduction to the basic

  2. The Delphi Method: An Approach for Facilitating Evidence Based Practice in Athletic Training

    Science.gov (United States)

    Sandrey, Michelle A.; Bulger, Sean M.

    2008-01-01

    Objective: The growing importance of evidence based practice in athletic training is necessitating academics and clinicians to be able to make judgments about the quality or lack of the body of research evidence and peer-reviewed standards pertaining to clinical questions. To assist in the judgment process, consensus methods, namely brainstorming,…

  3. Multi-level spondylolysis.

    Science.gov (United States)

    Hersh, David S; Kim, Yong H; Razi, Afshin

    2011-01-01

    The incidence of isthmic spondylolysis is approximately 3% to 6% in the general population. Spondylolytic defects involving multiple vertebral levels, on the other hand, are extremely rare. Only a handful of reports have examined the outcomes of surgical treatment of multi-level spondylolysis. Here, we present one case of bilateral pars defects at L3, L4, and L5. The patient, a 46-year-old female, presented with lower back pain radiating into the left lower extremity. Radiographs and CT scans of the lumbar spine revealed bilateral pars defects at L3-L5. The patient underwent lumbar discectomy and interbody fusion of L4-S1 as well as direct repair of the pars defect at L3. There were no postoperative complications, and by seven months the patient had improved clinically. While previous reports describe the use of either direct repair or fusion in the treatment of spondylolysis, we are unaware of reports describing the use of both techniques at adjacent levels.

  4. Using pedagogical approaches to influence evidence-based practice integration - processes and recommendations: findings from a grounded theory study.

    Science.gov (United States)

    Malik, Gulzar; McKenna, Lisa; Griffiths, Debra

    2017-04-01

    The study aimed to explore the processes undertaken by nurse academics when integrating evidence-based practice (EBP) into their teaching and learning practices. This article focuses on pedagogical approaches employed by academics to influence evidence-based practice integration into undergraduate programs across Australian universities. Nursing academics are challenged to incorporate a variety of teaching and learning strategies to teach evidence-based practice and determine their effectiveness. However, literature suggests that there are limited studies available focusing on pedagogical approaches in evidence-based practice education. A constructivist grounded theory methodology, informed by Charmaz was used for this study. Data were collected during 2014 from 23 nurse academics across Australian universities through semi-structured interviews. Additionally, nine were observed during teaching of undergraduate students. Twenty subject outlines were also analysed following Charmaz's approach of data analysis. 'Influencing EBP integration' describes the pedagogical approaches employed by academics to incorporate EBP knowledge and skills into undergraduate curricula. With the use of various teaching and learning strategies, academics attempted to contextualize EBP by engaging students with activities aiming to link evidence to practice and with the EBP process. Although, some strategies appeared to be engaging, others were traditional and seemed to be disengaging for students due to the challenges experienced by participants that impeded the use of the most effective teaching methods. Study findings offer valuable insights into the teaching practices and identify some key challenges that require the adoption of appropriate strategies to ensure future nurses are well prepared in the paradigm of evidence-based practice. © 2016 John Wiley & Sons Ltd.

  5. A multi-level biological approach to evaluate impacts of a major municipal effluent in wild St. Lawrence River yellow perch (Perca flavescens)

    Energy Technology Data Exchange (ETDEWEB)

    Houde, Magali, E-mail: magali.houde@ec.gc.ca [Centre Saint-Laurent, Environment Canada, 105 McGill Street, Montreal, QC H2Y 2E7 (Canada); Giraudo, Maeva, E-mail: maeva.giraudo@ec.gc.ca [Centre Saint-Laurent, Environment Canada, 105 McGill Street, Montreal, QC H2Y 2E7 (Canada); Douville, Mélanie, E-mail: melanie.douville@ec.gc.ca [Centre Saint-Laurent, Environment Canada, 105 McGill Street, Montreal, QC H2Y 2E7 (Canada); Bougas, Bérénice, E-mail: berenice.bougas.1@ulaval.ca [Institut de biologie intégrative et des systèmes, Université Laval, 1030, avenue de la Médecine, Québec, QC G1V 0A6 (Canada); Institut National de la Recherche Scientifique, Centre Eau Terre Environnement, 490 de la Couronne, Québec, QC G1K 9A9 (Canada); Couture, Patrice, E-mail: patrice.couture@ete.inrs.ca [Institut National de la Recherche Scientifique, Centre Eau Terre Environnement, 490 de la Couronne, Québec, QC G1K 9A9 (Canada); De Silva, Amila O., E-mail: amila.desilva@ec.gc.ca [Canada Centre for Inland Waters, Environment Canada, 867 Lakeshore Road, P.O. Box 5050, Burlington, ON L7R 4A6 (Canada); Spencer, Christine, E-mail: christine.spencer@ec.gc.ca [Canada Centre for Inland Waters, Environment Canada, 867 Lakeshore Road, P.O. Box 5050, Burlington, ON L7R 4A6 (Canada); Lair, Stéphane, E-mail: stephane.lair@umontreal.ca [Centre québécois sur la santé des animaux sauvages, Université de Montréal, C.P. 5000, St-Hyacinthe, QC J2S 7C6 (Canada); and others

    2014-11-01

    The development of integrated ecotoxicological approaches is of great interest in the investigation of global concerns such as impacts of municipal wastewater effluents on aquatic ecosystems. The objective of this study was to investigate the effects of a major wastewater municipal effluent on fish using a multi-level biological approach, from gene transcription and enzyme activities to histological changes. Yellow perch (Perca flavescens) were selected based on their wide distribution, their commercial and recreational importance, and the availability of a customized microarray. Yellow perch were sampled upstream of a major municipal wastewater treatment plant (WWTP) and 4 km and 10 km downstream from its point of discharge in the St. Lawrence River (Quebec, Canada). Concentrations of perfluoroalkyl substances (PFASs), polybrominated diphenyl ethers (PBDEs) and metals/trace elements in whole body homogenates were comparable to those from other industrialized regions of the world. Genomic results indicated that the transcription level of 177 genes was significantly different (p < 0.024) between exposed and non-exposed fish. Among these genes, 38 were found to be differentially transcribed at both downstream sites. Impacted genes were associated with biological processes and molecular functions such as immunity, detoxification, lipid metabolism/energy homeostasis (e.g., peroxisome proliferation), and retinol metabolism suggesting impact of WWTP on these systems. Moreover, antioxidant enzyme activities were more elevated in perch collected at the 4 km site. Biomarkers of lipid metabolism, biosynthetic activity, and aerobic capacities were significantly lower (p < 0.05) in fish residing near the outfall of the effluent. Histological examination of the liver indicated no differences between sites. Correlations between PFAS, PBDE, and metal/trace element tissue concentrations and markers of peroxisomal proliferation, oxidative stress, and retinoid metabolism were found

  6. Dangerous "spin": the probability myth of evidence-based prescribing - a Merleau-Pontyian approach.

    Science.gov (United States)

    Morstyn, Ron

    2011-08-01

    The aim of this study was to examine logical positivist statistical probability statements used to support and justify "evidence-based" prescribing rules in psychiatry when viewed from the major philosophical theories of probability, and to propose "phenomenological probability" based on Maurice Merleau-Ponty's philosophy of "phenomenological positivism" as a better clinical and ethical basis for psychiatric prescribing. The logical positivist statistical probability statements which are currently used to support "evidence-based" prescribing rules in psychiatry have little clinical or ethical justification when subjected to critical analysis from any of the major theories of probability and represent dangerous "spin" because they necessarily exclude the individual , intersubjective and ambiguous meaning of mental illness. A concept of "phenomenological probability" founded on Merleau-Ponty's philosophy of "phenomenological positivism" overcomes the clinically destructive "objectivist" and "subjectivist" consequences of logical positivist statistical probability and allows psychopharmacological treatments to be appropriately integrated into psychiatric treatment.

  7. A Comprehensive Approach in Dissemination of Evidence-Based Care for PTSD

    Science.gov (United States)

    2012-09-01

    Exposure-based therapies, however, are not indicated and should be used with caution for “patients living in dangerous situations (e.g., domestic violence ...Tourigny C, Fraser WD, Dumont A: Evidence-based strategies for implementing guidelines in obstetrics : a systematic review. Obstet Gynecol 2006; 108:1234...PTSD Specific pre-, peri-, and post-trauma events Yes No Unknown Most recent trauma types (motor vehicle crashes, violence , combat- related, sexual

  8. A Comprehensive Approach in Dissemination of Evidence Based Care for PTSD

    Science.gov (United States)

    2010-09-01

    domestic violence ) or for patients with current suicidal ideation, substance abuse not in stable remission, comorbid psychosis, or health problems...M, Audibert F, Tourigny C, Fraser WD, Dumont A: Evidence-based strategies for implementing guidelines in obstetrics : a systematic review. Obstet...cognitive factors. Assess for PTSD Specific pre-, peri-, and post-trauma events Yes No Unknown Most recent trauma types (motor vehicle crashes, violence

  9. Expert consensus v. evidence-based approaches in the revision of the DSM.

    Science.gov (United States)

    Kendler, K S; Solomon, M

    2016-08-01

    The development of DSM-III through DSM-5 has relied heavily on expert consensus. In this essay, we provide an historical and critical perspective on this process. Over the last 40 years, medicine has struggled to find appropriate methods for summarizing research results and making clinical recommendations. When such recommendations are issued by authorized organizations, they can have widespread influence (i.e. DSM-III and its successors). In the 1970s, expert consensus conferences, led by the NIH, reviewed research about controversial medical issues and successfully disseminated results. However, these consensus conferences struggled with aggregating the complex available evidence. In the 1990s, the rise of evidence-based medicine cast doubt on the reliability of expert consensus. Since then, medicine has increasingly relied on systematic reviews, as developed by the evidence-based medicine movement, and advocated for their early incorporation in expert consensus efforts. With the partial exception of DSM-IV, such systematic evidence-based reviews have not been consistently integrated into the development of the DSMs, leaving their development out of step with the larger medical field. Like the recommendations made for the NIH consensus conferences, we argue that the DSM process should be modified to require systematic evidence-based reviews before Work Groups make their assessments. Our suggestions - which would require leadership and additional resources to set standards for appropriate evidence hierarchies, carry out systematic reviews, and upgrade the group process - should improve the objectivity of the DSM, increase the validity of its results, and improve the reception of any changes in nosology.

  10. Increasing the public health impact of evidence-based interventions in behavioral medicine: new approaches and future directions.

    Science.gov (United States)

    Buscemi, Joanna; Janke, E Amy; Kugler, Kari C; Duffecy, Jenna; Mielenz, Thelma J; St George, Sara M; Sheinfeld Gorin, Sherri N

    2017-02-01

    The dissemination and implementation of evidence-based behavioral medicine interventions into real world practice has been limited. The purpose of this paper is to discuss specific limitations of current behavioral medicine research within the context of the RE-AIM framework, and potential opportunities to increase public health impact by applying novel intervention designs and data collection approaches. The MOST framework has recently emerged as an alternative approach to development and evaluation that aims to optimize multicomponent behavioral and bio-behavioral interventions. SMART designs, imbedded within the MOST framework, are an approach to optimize adaptive interventions. In addition to innovative design strategies, novel data collection approaches that have the potential to improve the public-health dissemination include mHealth approaches and considering environment as a potential data source. Finally, becoming involved in advocacy via policy related work may help to improve the impact of evidence-based behavioral interventions. Innovative methods, if increasingly implemented, may have the ability to increase the public health impact of evidence-based behavioral interventions to prevent disease.

  11. Development of evidence-based clinical practice guidelines (CPGs: comparing approaches

    Directory of Open Access Journals (Sweden)

    Harris Claire

    2008-10-01

    Full Text Available Abstract Background While the potential of clinical practice guidelines (CPGs to support implementation of evidence has been demonstrated, it is not currently being achieved. CPGs are both poorly developed and ineffectively implemented. To improve clinical practice and health outcomes, both well-developed CPGs and effective methods of CPG implementation are needed. We sought to establish whether there is agreement on the fundamental characteristics of an evidence-based CPG development process and to explore whether the level of guidance provided in CPG development handbooks is sufficient for people using these handbooks to be able to apply it. Methods CPG development handbooks were identified through a broad search of published and grey literature. Documents published in English produced by national or international organisations purporting to support development of evidence-based CPGs were included. A list of 14 key elements of a CPG development process was developed. Two authors read each handbook. For each handbook a judgement was made as to how it addressed each element; assigned as: 'mentioned and clear guidance provided', 'mentioned but limited practical detail provided ', or 'not mentioned'. Results Six CPG development handbooks were included. These were produced by the Council of Europe, the National Health and Medical Research Council of Australia, the National Institute for Health and Clinical Excellence in the UK, the New Zealand Guidelines Group, the Scottish Intercollegiate Guideline Network, and the World Health Organization (WHO. There was strong concordance between the handbooks on the key elements of an evidence-based CPG development process. All six of the handbooks require and provide guidance on establishment of a multidisciplinary guideline development group, involvement of consumers, identification of clinical questions or problems, systematic searches for and appraisal of research evidence, a process for drafting

  12. Training medical providers in evidence-based approaches to suicide prevention.

    Science.gov (United States)

    DeHay, Tamara; Ross, Sarah; McFaul, Mimi

    2015-01-01

    Suicide is a significant issue in the United States and worldwide, and its prevention is a public health imperative. Primary care practices are an important setting for suicide prevention, as primary care providers have more frequent contact with patients at risk for suicide than any other type of health-care provider. The Western Interstate Commission for Higher Education, in partnership with the Suicide Prevention Resource Center, has developed a Suicide Prevention Toolkit and an associated training curriculum. These resources support the education of primary care providers in evidence-based strategies for identifying and treating patients at risk for suicide. The application of this curriculum to post-graduate medical training is presented here. © The Author(s) 2015.

  13. Promoting community practitioners' use of evidence-based approaches to increase breast cancer screening.

    Science.gov (United States)

    Leeman, Jennifer; Moore, Alexis; Teal, Randall; Barrett, Nadine; Leighton, Ashely; Steckler, Allan

    2013-07-01

    Many women do not get mammography screenings at the intervals recommended for early detection and treatment of breast cancer. The Guide to Community Preventive Services (Community Guide) recommends a range of evidence-based strategies to improve mammography rates. However, nurses and others working in community-based settings make only limited use of these strategies. We report on a dissemination intervention that partnered the University of North Carolina with the Susan G. Komen Triangle Affiliate to disseminate Community Guide breast cancer screening strategies to community organizations. The intervention was guided by social marketing and diffusion of innovation theory and was designed to provide evidence and support via Komen's existing relationships with grantee organizations. The present study reports the findings from a formative evaluation of the intervention, which included a content analysis of 46 grant applications pre- and post intervention and focus groups with 20 grant recipients. © 2013 Wiley Periodicals, Inc.

  14. An outcomes approach to stroke care: the importance of teamwork and evidence-based nursing care.

    Science.gov (United States)

    Middleton, Sandy

    2012-04-01

    The Quality in Acute Stroke Care (QASC) was a cluster randomised control trial (CRCT) which evaluated the effectiveness of evidence-based clinical treatment protocols for the management of fever, hyperglycaemia and swallowing, in conjunction with multidisciplinary team building workshops, and a standardised interactive staff education program (collectively known as the Fever, Sugar, Swallowing (FeSS) intervention) to improve patient outcomes 90-days. We found that patients cared for in stroke units who received our intervention were 15·7% more likely to be alive and independent 90 days following their stroke. They also had significantly: fewer episodes of fever, lower mean temperatures, lower mean blood glucose levels, and better screening for swallowing difficulties. © 2012 The Author. International Journal of Stroke © 2012 World Stroke Organization.

  15. Adapting Evidence-Based Prevention Approaches for Latino Adolescents: The Familia Adelante Program - Revised

    Directory of Open Access Journals (Sweden)

    Richard C. Cervantes

    2012-12-01

    Full Text Available Behavioral health is defined as the absence of mental illness or substance use problems and the presence of positive emotional well being. Although many U.S. Hispanic youth are at increased risk for substance abuse, suicidality, teen pregnancy, unsafe sexual practices and HIV, there exists a lack of available evidence-based practices for Hispanic youth which promotes behavioral health and HIV prevention. The objective of the current research was to adapt and revise the Familia Adelante (FA Program, a behavioral health, drug intervention and prevention program to incorporate an HIV prevention component. Through qualitative community based participatory methods, including an expert panel and members of the target population, the curriculum was redesigned to integrate effective HIV risk reduction strategies. The process of adapting the intervention is described in this paper, as well as recommendations for future research in program adaptation.

  16. Strengthening vaccination policies in Latin America: an evidence-based approach.

    Science.gov (United States)

    Tapia-Conyer, Roberto; Betancourt-Cravioto, Miguel; Saucedo-Martínez, Rodrigo; Motta-Murguía, Lourdes; Gallardo-Rincón, Héctor

    2013-08-20

    Despite many successes in the region, Latin American vaccination policies have significant shortcomings, and further work is needed to maintain progress and prepare for the introduction of newly available vaccines. In order to address the challenges facing Latin America, the Commission for the Future of Vaccines in Latin America (COFVAL) has made recommendations for strengthening evidence-based policy-making and reducing regional inequalities in immunisation. We have conducted a comprehensive literature review to assess the feasibility of these recommendations. Standardisation of performance indicators for disease burden, vaccine coverage, epidemiological surveillance and national health resourcing can ensure comparability of the data used to assess vaccination programmes, allowing deeper analysis of how best to provide services. Regional vaccination reference schemes, as used in Europe, can be used to develop best practice models for vaccine introduction and scheduling. Successful models exist for the continuous training of vaccination providers and decision-makers, with a new Latin American diploma aiming to contribute to the successful implementation of vaccination programmes. Permanent, independent vaccine advisory committees, based on the US Advisory Committee on Immunization Practices (ACIP), could facilitate the uptake of new vaccines and support evidence-based decision-making in the administration of national immunisation programmes. Innovative financing mechanisms for the purchase of new vaccines, such as advance market commitments and cost front-loading, have shown potential for improving vaccine coverage. A common regulatory framework for vaccine approval is needed to accelerate delivery and pool human, technological and scientific resources in the region. Finally, public-private partnerships between industry, government, academia and non-profit sectors could provide new investment to stimulate vaccine development in the region, reducing prices in the

  17. SYMPOSIUM REPORT: An Evidence-Based Approach to IBS and CIC: Applying New Advances to Daily Practice

    Science.gov (United States)

    Chey, William D.

    2017-01-01

    Many nonpharmacologic and pharmacologic therapies are available to manage irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC). The American College of Gastroenterology (ACG) regularly publishes reviews on IBS and CIC therapies. The most recent of these reviews was published by the ACG Task Force on the Management of Functional Bowel Disorders in 2014. The key objective of this review was to evaluate the efficacy of therapies for IBS or CIC compared with placebo or no treatment in randomized controlled trials. Evidence-based approaches to managing diarrhea-predominant IBS include dietary measures, such as a diet low in gluten and fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs); loperamide; antispasmodics; peppermint oil; probiotics; tricyclic antidepressants; alosetron; eluxadoline, and rifaximin. Evidence-based approaches to managing constipation-predominant IBS and CIC include fiber, stimulant laxatives, polyethylene glycol, selective serotonin reuptake inhibitors, lubiprostone, and guanylate cyclase agonists. With the growing evidence base for IBS and CIC therapies, it has become increasingly important for clinicians to assess the quality of evidence and understand how to apply it to the care of individual patients. PMID:28729815

  18. Shrub growth and expansion in the Arctic tundra: an assessment of controlling factors using an evidence-based approach

    Science.gov (United States)

    Martin, Andrew C.; Jeffers, Elizabeth S.; Petrokofsky, Gillian; Myers-Smith, Isla; Macias-Fauria, Marc

    2017-08-01

    Woody shrubs have increased in biomass and expanded into new areas throughout the Pan-Arctic tundra biome in recent decades, which has been linked to a biome-wide observed increase in productivity. Experimental, observational, and socio-ecological research suggests that air temperature—and to a lesser degree precipitation—trends have been the predominant drivers of this change. However, a progressive decoupling of these drivers from Arctic vegetation productivity has been reported, and since 2010, vegetation productivity has also been declining. We created a protocol to (a) identify the suite of controls that may be operating on shrub growth and expansion, and (b) characterise the evidence base for controls on Arctic shrub growth and expansion. We found evidence for a suite of 23 proximal controls that operate directly on shrub growth and expansion; the evidence base focused predominantly on just four controls (air temperature, soil moisture, herbivory, and snow dynamics). 65% of evidence was generated in the warmest tundra climes, while 24% was from only one of 28 floristic sectors. Temporal limitations beyond 10 years existed for most controls, while the use of space-for-time approaches was high, with 14% of the evidence derived via experimental approaches. The findings suggest the current evidence base is not sufficiently robust or comprehensive at present to answer key questions of Pan-Arctic shrub change. We suggest future directions that could strengthen the evidence, and lead to an understanding of the key mechanisms driving changes in Arctic shrub environments.

  19. Evidence-based management of otitis media: a 5S model approach.

    Science.gov (United States)

    Wasson, J D; Yung, M W

    2015-02-01

    The 5S model proposes five hierarchical levels (systems, summaries, synopses, syntheses and studies) of pre-appraised evidence to guide evidence-based practice. This review aimed to identify and summarise pre-appraised evidence at the highest available 5S level for the management of different subsets of otitis media: acute otitis media, otitis media with effusion, chronic suppurative otitis media and cholesteatoma in both adults and children. Data sources were pre-appraised evidence resources. Evidence freely available from sources at the highest available level of the 5S model were summarised for this review. System level evidence exists for acute otitis media and otitis media with effusion. Summary level evidence exists for recurrent acute otitis media and medical management of chronic suppurative otitis media. There is an absence of randomised controlled trials to prove the efficacy of surgical management of chronic suppurative otitis media and cholesteatoma. Until randomised controlled trial data are generated, consensus publications on the surgical management of chronic suppurative otitis media and cholesteatoma should be used to guide best practice.

  20. Teaching evidence-based medicine using a problem-oriented approach.

    Science.gov (United States)

    Hosny, Somaya; Ghaly, Mona S

    2014-04-01

    Faculty of Medicine, Suez Canal University is adopting an innovative curriculum. Evidence-based medicine (EBM) has been integrated into problem based learning (PBL) sessions as a responsive innovative paradigm for the practice and teaching of clinical medicine. To integrate EBM in the problem based sessions of the sixth-year students, and to assess students' and tutor satisfaction with this change. EBM training was conducted for sixth-year students (196) including four theoretical, and eight practical sessions. Sixteen EBM educational scenarios (problems) were formulated, according to sixth-year curriculum. Each problem was discussed in two sessions through steps of EBM, namely: formulating PICO questions, searching for and appraising evidence, applying the evidence to the clinical scenario and analysing the practice. Students and tutors satisfaction were evaluated using a 3-point ratings questionnaire. The majority of students and faculty expressed their satisfaction about integrating EBM with PBL and agreed that the problems were more stimulating. However, 33.6% of students indicated that available time was insufficient for searching literatures. Integrating EBM into PBL sessions tends to be more interesting and stimulating than traditional PBL sessions for final year students and helps them to practice and implement EBM in clinical context.

  1. A social marketing approach to implementing evidence-based practice in VHA QUERI: the TIDES depression collaborative care model

    Science.gov (United States)

    2009-01-01

    Abstract Collaborative care models for depression in primary care are effective and cost-effective, but difficult to spread to new sites. Translating Initiatives for Depression into Effective Solutions (TIDES) is an initiative to promote evidence-based collaborative care in the U.S. Veterans Health Administration (VHA). Social marketing applies marketing techniques to promote positive behavior change. Described in this paper, TIDES used a social marketing approach to foster national spread of collaborative care models. TIDES social marketing approach The approach relied on a sequential model of behavior change and explicit attention to audience segmentation. Segments included VHA national leadership, Veterans Integrated Service Network (VISN) regional leadership, facility managers, frontline providers, and veterans. TIDES communications, materials and messages targeted each segment, guided by an overall marketing plan. Results Depression collaborative care based on the TIDES model was adopted by VHA as part of the new Primary Care Mental Health Initiative and associated policies. It is currently in use in more than 50 primary care practices across the United States, and continues to spread, suggesting success for its social marketing-based dissemination strategy. Discussion and conclusion Development, execution and evaluation of the TIDES marketing effort shows that social marketing is a promising approach for promoting implementation of evidence-based interventions in integrated healthcare systems. PMID:19785754

  2. An approach for setting evidence-based and stakeholder-informed research priorities in low- and middle-income countries.

    Science.gov (United States)

    Rehfuess, Eva A; Durão, Solange; Kyamanywa, Patrick; Meerpohl, Joerg J; Young, Taryn; Rohwer, Anke

    2016-04-01

    To derive evidence-based and stakeholder-informed research priorities for implementation in African settings, the international research consortium Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) developed and applied a pragmatic approach. First, an online survey and face-to-face consultation between CEBHA+ partners and policy-makers generated priority research areas. Second, evidence maps for these priority research areas identified gaps and related priority research questions. Finally, study protocols were developed for inclusion within a grant proposal. Policy and practice representatives were involved throughout the process. Tuberculosis, diabetes, hypertension and road traffic injuries were selected as priority research areas. Evidence maps covered screening and models of care for diabetes and hypertension, population-level prevention of diabetes and hypertension and their risk factors, and prevention and management of road traffic injuries. Analysis of these maps yielded three priority research questions on hypertension and diabetes and one on road traffic injuries. The four resulting study protocols employ a broad range of primary and secondary research methods; a fifth promotes an integrated methodological approach across all research activities. The CEBHA+ approach, in particular evidence mapping, helped to formulate research questions and study protocols that would be owned by African partners, fill gaps in the evidence base, address policy and practice needs and be feasible given the existing research infrastructure and expertise. The consortium believes that the continuous involvement of decision-makers throughout the research process is an important means of ensuring that studies are relevant to the African context and that findings are rapidly implemented.

  3. A social marketing approach to implementing evidence-based practice in VHA QUERI: the TIDES depression collaborative care model.

    Science.gov (United States)

    Luck, Jeff; Hagigi, Fred; Parker, Louise E; Yano, Elizabeth M; Rubenstein, Lisa V; Kirchner, JoAnn E

    2009-09-28

    Collaborative care models for depression in primary care are effective and cost-effective, but difficult to spread to new sites. Translating Initiatives for Depression into Effective Solutions (TIDES) is an initiative to promote evidence-based collaborative care in the U.S. Veterans Health Administration (VHA). Social marketing applies marketing techniques to promote positive behavior change. Described in this paper, TIDES used a social marketing approach to foster national spread of collaborative care models. The approach relied on a sequential model of behavior change and explicit attention to audience segmentation. Segments included VHA national leadership, Veterans Integrated Service Network (VISN) regional leadership, facility managers, frontline providers, and veterans. TIDES communications, materials and messages targeted each segment, guided by an overall marketing plan. Depression collaborative care based on the TIDES model was adopted by VHA as part of the new Primary Care Mental Health Initiative and associated policies. It is currently in use in more than 50 primary care practices across the United States, and continues to spread, suggesting success for its social marketing-based dissemination strategy. Development, execution and evaluation of the TIDES marketing effort shows that social marketing is a promising approach for promoting implementation of evidence-based interventions in integrated healthcare systems.

  4. Employing a Multi-level Approach to Recruit a Representative Sample of Women with Recent Gestational Diabetes Mellitus into a Randomized Lifestyle Intervention Trial.

    Science.gov (United States)

    Nicklas, Jacinda M; Skurnik, Geraldine; Zera, Chloe A; Reforma, Liberty G; Levkoff, Sue E; Seely, Ellen W

    2016-02-01

    The postpartum period is a window of opportunity for diabetes prevention in women with recent gestational diabetes (GDM), but recruitment for clinical trials during this period of life is a major challenge. We adapted a social-ecologic model to develop a multi-level recruitment strategy at the macro (high or institutional level), meso (mid or provider level), and micro (individual) levels. Our goal was to recruit 100 women with recent GDM into the Balance after Baby randomized controlled trial over a 17-month period. Participants were asked to attend three in-person study visits at 6 weeks, 6, and 12 months postpartum. They were randomized into a control arm or a web-based intervention arm at the end of the baseline visit at six weeks postpartum. At the end of the recruitment period, we compared population characteristics of our enrolled subjects to the entire population of women with GDM delivering at Brigham and Women's Hospital (BWH). We successfully recruited 107 of 156 (69 %) women assessed for eligibility, with the majority (92) recruited during pregnancy at a mean 30 (SD ± 5) weeks of gestation, and 15 recruited postpartum, at a mean 2 (SD ± 3) weeks postpartum. 78 subjects attended the initial baseline visit, and 75 subjects were randomized into the trial at a mean 7 (SD ± 2) weeks postpartum. The recruited subjects were similar in age and race/ethnicity to the total population of 538 GDM deliveries at BWH over the 17-month recruitment period. Our multilevel approach allowed us to successfully meet our recruitment goal and recruit a representative sample of women with recent GDM. We believe that our most successful strategies included using a dedicated in-person recruiter, integrating recruitment into clinical flow, allowing for flexibility in recruitment, minimizing barriers to participation, and using an opt-out strategy with providers. Although the majority of women were recruited while pregnant, women recruited in the early postpartum period were

  5. Evidence-based and heuristic approaches for customization of care in cardiometabolic syndrome after spinal cord injury.

    Science.gov (United States)

    Nash, Mark S; Cowan, Rachel E; Kressler, Jochen

    2012-09-01

    Component and coalesced health risks of the cardiometabolic syndrome (CMS) are commonly reported in persons with spinal cord injuries (SCIs). These CMS hazards are also co-morbid with physical deconditioning and elevated pro-atherogenic inflammatory cytokines, both of which are common after SCI and worsen the prognosis for all-cause cardiovascular disease. This article describes a systematic procedure for individualized CMS risk assessment after SCI, and emphasizes evidence-based and intuition-centered countermeasures to disease. A unified approach will propose therapeutic lifestyle intervention as a routine plan for aggressive primary prevention in this risk-susceptible population. Customization of dietary and exercise plans then follow, identifying shortfalls in diet and activity patterns, and ways in which these healthy lifestyles can be more substantially embraced by both stakeholders with SCI and their health care providers. In cases where lifestyle intervention utilizing diet and exercise is unsuccessful in countering risks, available pharmacotherapies and a preferred therapeutic agent are proposed according to authoritative standards. The over-arching purpose of the monograph is to create an operational framework in which existing evidence-based approaches or heuristic modeling becomes best practice. In this way persons with SCI can lead more active and healthy lives.

  6. Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States.

    Science.gov (United States)

    Nahin, Richard L; Boineau, Robin; Khalsa, Partap S; Stussman, Barbara J; Weber, Wendy J

    2016-09-01

    Although most pain is acute and resolves within a few days or weeks, millions of Americans have persistent or recurring pain that may become chronic and debilitating. Medications may provide only partial relief from this chronic pain and can be associated with unwanted effects. As a result, many individuals turn to complementary health approaches as part of their pain management strategy. This article examines the clinical trial evidence for the efficacy and safety of several specific approaches-acupuncture, manipulation, massage therapy, relaxation techniques including meditation, selected natural product supplements (chondroitin, glucosamine, methylsulfonylmethane, S-adenosylmethionine), tai chi, and yoga-as used to manage chronic pain and related disability associated with back pain, fibromyalgia, osteoarthritis, neck pain, and severe headaches or migraines. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  7. [Adolescents suffering from anorexia nervosa: an evidence-based approach of the parent's role in 2018].

    Science.gov (United States)

    Vust, Sophie; Cook-Darzens, Solange; Lier, Françoise; Ambresin, Anne-Emmanuelle

    2018-04-18

    A new paradigm in the management of adolescents with eating disorders promotes different treatment orientations aiming at increasing therapeutic effectiveness as well as offering a more integrated and coherent care for families. Particular attention is given to the process of refeeding to avoid the severe somatic sequelae of eating disorder and the risk of a chronic course for a disorder which is well known for its « addictive » power and influence. The parents and the need for a strong alliance with the healthcare team stand at the centre of this new paradigm. This type of management requires professionals who are trained in these specific approaches and in multidisciplinary work.

  8. Peripheral neuropathy in HIV: an analysis of evidence-based approaches.

    Science.gov (United States)

    Nicholas, Patrice K; Corless, Inge B; Evans, Linda A

    2014-01-01

    Peripheral neuropathy is a common and vexing symptom for people living with HIV infection (PLWH). Neuropathy occurs in several different syndromes and is identified in the literature as distal sensory polyneuropathy or distal sensory peripheral neuropathy. More recently, the HIV literature has focused on the syndrome as painful HIV-associated sensory neuropathy, addressing the symptom rather than the underlying pathophysiology. Assessment of neuropathy in PLWH is critical and must be incorporated into nursing practice for each visit. Neuropathy has been attributed to the direct effects of HIV, exposure to antiretroviral medications (particularly the nucleoside reverse transcriptase inhibitors), advanced immune suppression, and comorbid tuberculosis infection and exposure to antituberculosis medications. Evidence supports the importance of addressing neuropathy in PLWH with pharmacologic treatment regimens and complementary/alternative approaches. This paper examines the pathophysiology, evidence, and approaches to managing peripheral neuropathy. A case study has been included to illustrate a patient's experience with neuropathy symptoms. Copyright © 2014 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

  9. Modeling Multi-Level Systems

    CERN Document Server

    Iordache, Octavian

    2011-01-01

    This book is devoted to modeling of multi-level complex systems, a challenging domain for engineers, researchers and entrepreneurs, confronted with the transition from learning and adaptability to evolvability and autonomy for technologies, devices and problem solving methods. Chapter 1 introduces the multi-scale and multi-level systems and highlights their presence in different domains of science and technology. Methodologies as, random systems, non-Archimedean analysis, category theory and specific techniques as model categorification and integrative closure, are presented in chapter 2. Chapters 3 and 4 describe polystochastic models, PSM, and their developments. Categorical formulation of integrative closure offers the general PSM framework which serves as a flexible guideline for a large variety of multi-level modeling problems. Focusing on chemical engineering, pharmaceutical and environmental case studies, the chapters 5 to 8 analyze mixing, turbulent dispersion and entropy production for multi-scale sy...

  10. Topical retinoids in the management of photodamaged skin: from theory to evidence-based practical approach.

    Science.gov (United States)

    Darlenski, R; Surber, C; Fluhr, J W

    2010-12-01

    Skin, being exposed directly to the environment, represents a unique model for demonstrating the synergistic effects of intrinsic and extrinsic factors on the ageing process. Ultraviolet radiation (UVR) is the major factor among exogenous stressors responsible for premature skin ageing. The problem of skin ageing has captured public attention and has an important social impact. Different therapeutic approaches have been developed to treat cutaneous ageing and to diminish or prevent the negative effects of UVR. Topical retinoids represent an important and powerful class of molecules in the dermatologist's hands for the treatment of photodamaged skin. Since their introduction more than 20 years ago, topical retinoids have shown beneficial efficacy and good safety profiles in the management of photodamaged skin, and as therapeutic anti-ageing agents. This review provides a brief retrospective of the development of topical retinoids in the treatment of photodamaged skin, elucidates their mechanism of action, delineates their use and addresses clinical, pharmaceutical and regulatory issues in connection with their intended use. © 2010 The Authors. BJD © 2010 British Association of Dermatologists.

  11. Decoding the integrated approach to yoga therapy: Qualitative evidence based conceptual framework.

    Science.gov (United States)

    Villacres, Maria Del Carmen; Jagannathan, Aarti; Nagarathna, R; Ramakrsihna, Jayashree

    2014-01-01

    The aim of this study was to define, decode, and append to the conceptual frame-work of the integrated approach to yoga therapy (IAYT). Four stakeholders who followed two in-patients with depression over a period of 2 weeks in the residential center Arogyadhama (of Swami Vivekananda Yoga Anusandana Samsthana, Bangalore, India) were interviewed before the start of the IAYT treatment and prior to discharge of the patient. The patients were also interviewed pre and post and were observed once during their session. The data from the audio recordings from eight in-depth interviews were transcribed manually and qualitative analysis was conducted. The conceptual frame-work of IAYT depicts that patient related factors ("co-operation of patient", "patients awareness of his/her condition"), therapist related factors ("ability to guide", "the assistance to the patients", "explanation of the exercises") and treatment related factors ("combination of psychiatric or Ayurvedic medication with yoga", "counseling during the IAYT treatment", duration of treatment), play an integrated role in reaching the "aim of IAYT" and experiencing "improvements and changes". The IAYT is a holistic program and the ability of the patient to cooperate with and integrate the available factors (therapist related and treatment related) could enable best results.

  12. Treatment for bovine Escherichia coli mastitis - an evidence-based approach.

    Science.gov (United States)

    Suojala, L; Kaartinen, L; Pyörälä, S

    2013-12-01

    Bovine mastitis caused by Escherichia coli can range from being a subclinical infection of the mammary gland to a severe systemic disease. Cow-dependent factors such as lactation stage and age affect the severity of coliform mastitis. Evidence for the efficacy of antimicrobial treatment for E. coli mastitis is very limited. Antimicrobial resistance is generally not a limiting factor for treatment, but it should be monitored to detect changes in resistance profiles. The only antimicrobials for which there is some scientific evidence of beneficial effects in the treatment for E. coli mastitis are fluoroquinolones and cephalosporins. Both are critically important drugs, the use of which in animals destined for food should be limited to specific indications and should be based on bacteriological diagnosis. The suggested routine protocol in dairy herds could target the primary antimicrobial treatment for mastitis, specifically infections caused by gram-positive bacteria. In E. coli mastitis with mild to moderate clinical signs, a non-antimicrobial approach (anti-inflammatory treatment, frequent milking and fluid therapy) should be the first option. In cases of severe E. coli mastitis, parenteral administration of fluoroquinolones, or third- or fourth-generation cephalosporins, is recommended due to the risk of unlimited growth of bacteria in the mammary gland and ensuing bacteremia. Evidence for the efficacy of intramammary-administered antimicrobial treatment for E. coli mastitis is so limited that it cannot be recommended. Nonsteroidal anti-inflammatory drugs have documented the efficacy in the treatment for E. coli mastitis and are recommended for supportive treatment for clinical mastitis. © 2013 John Wiley & Sons Ltd.

  13. An Evidence-Based Approach to Detection by DASI-ELISA and RT-PCR in Dormant Period

    Directory of Open Access Journals (Sweden)

    Antonio Olmos

    2008-01-01

    Full Text Available An evidence-based approach, such as those developed in clinical and veterinary medicine, was applied to the detection of Plum pox virus (PPV during the dormant period. A standardized methodology was used for the calculation of parameters of the operational capacity of DASI-ELISA and RT-PCR in wintertime. These methods are routinely handled to test the sanitary status of plants in national or international trading and in those cases concerning export-import of plant materials. Diagnosis often has to be performed during the dormant period, when plant material is commercialized. Some guidelines to interpret diagnostic results of wintertime are provided in an attempt to minimize risks associated with the methods and over-reliance on the binary outcome of a single assay. In order to evaluate if a complementary test increased the confidence of PPV diagnosis when discordant results between DASI-ELISA and RT-PCR are obtained, NASBA-FH also was included. Likelihood ratios of each method were estimated based on the sensitivity and specificity obtained in wintertime. Subsequently, a Bayesian approach was performed to calculate post-test probability of PPV infection in spring. Results of evidence-based approach show that different PPV prevalences require different screening tests. Thus, at very low PPV prevalence levels DASI-ELISA should be used as the election method, whilst at the highest PPV prevalence levels RT-PCR should be performed. NASBA-FH could be used at medium prevalences to clarify discordances between DASI-ELISA and RT-PCR.

  14. Defining Survivorship Trajectories Across Patients With Solid Tumors: An Evidence-Based Approach.

    Science.gov (United States)

    Dood, Robert L; Zhao, Yang; Armbruster, Shannon D; Coleman, Robert L; Tworoger, Shelley; Sood, Anil K; Baggerly, Keith A

    2018-06-02

    Survivorship involves a multidisciplinary approach to surveillance and management of comorbidities and secondary cancers, overseen by oncologists, surgeons, and primary care physicians. Optimal timing and coordination of care, however, is unclear and often based on arbitrary 5-year cutoffs. To determine high- and low-risk periods for all tumor types that could define when survivorship care might best be overseen by oncologists and when to transition to primary care physicians. In this pan-cancer, longitudinal, observational study, excess mortality hazard, calculated as an annualized mortality risk above a baseline population, was plotted over time. The time this hazard took to stabilize defined a high-risk period. The percent morality elevation above age- and sex-matched controls in the latter low-risk period was reported as a mortality gap. The US population-based Surveillance, Epidemiology, and End Results database defined the cancer population, and the US Census life tables defined controls. Incident cases of patients with cancer were separated into tumor types based on International Classification of Diseases for Oncology definitions. Population-level data on incident cancer cases was compared with the general US population. Overall mortality and cause of death were reported on observed cancer cases. A total of 2 317 185 patients (median age, 63 years; 49.8% female) with 66 primary tumor types were evaluated. High-risk surveillance period durations ranged from less than 1 year (breast, prostate, lip, ocular, and parathyroid cancers) up to 19 years (unspecified gastrointestinal cancers). The annualized mortality gap, representing the excess mortality in the stable period, ranged from a median 0.26% to 9.33% excess annual mortality (thyroid and hypopharyngeal cancer populations, respectively). Cluster analysis produced 6 risk cluster groups: group 1, with median survival of 16.2 (5th to 95th percentile range [PR], 10.7-40.2) years and median high-risk period

  15. Observations on the perspectives and limits of the evidence-based approach in the evaluation of gamification processes

    Directory of Open Access Journals (Sweden)

    Bruni Filippo

    2015-12-01

    Full Text Available As continually greater attention is given to the processes of gamification, the dimension pertaining to evaluation must also be focussed on the purpose of avoiding ineffective forms of banalisation. In reference to the evidence-based approach proposed by Mayer and in highlighting its possibilities and limits, an experiment is herein presented related to teacher training, in which we attempt to unite some traits of the processes of gamification to a first evaluation screen. The data obtained, if they seem on the one hand, indicate an overall positive perception on the part of the attendees, on the other though, they indicate forms of resistance and of saturation with respect to both the excessively competitive mechanisms and the peer evaluation procedures.

  16. Evidence-based approach to HIV/AIDS policy and research prioritization in the Islamic Republic of Iran.

    Science.gov (United States)

    Feizzadeh, A; Nedjat, S; Asghari, S; Keshtkar, A; Heshmat, R; Setayesh, H; Majdzadeh, R

    2010-03-01

    In formulating the second national strategic plan for prevention of HIV/AIDS in the Islamic Republic of Iran a more evidence-based approach was needed. This paper reports on a systematic review of the local evidence about the determinants of HIV/AIDS transmission in 3 categories: poor knowledge and negative attitudes about HIV transmission; injection drug use; and sexual promiscuity. Of 93 reports reviewed, 53 met the inclusion criteria. Information about the prevalence and magnitude of effect for the 3 risk determinants at the national and regional level was scarce. Heterogeneity between studies, even in the same sub-population, was significant. An improved research base and better sharing of information are needed within countries of the Eastern Mediterranean Region.

  17. Effect of evidence-based approach on the customer orientation (Case study: Physicians Health Centers in Isfahan province in 2014)

    Science.gov (United States)

    Esfahani, NG; Maharati, Y

    2015-01-01

    Introduction: The purpose of this research was to examine the approach, based on evidence to customer-orientation attending physicians in the region, them being the subject collection. Research method: This is a definitive-analytic and cross-sectional configuration, which was completed in 2014. The statistical community in this research consists of 212 doctors in the healthcare hubs. The working physicians chose 200 patients by means of a simple accidental sampling. The analysis means was the researcher built survey whose efficacy and reliability were verified. In this research, the fundamental equation design and partial least square technique were applied to examine the presumptions and fitness pattern and the structural design was agreed as adequate. Findings: The outcomes showed four cases linked to the character, a behavior which was meant to treat; traditional origins of evidence were employed to retrieve data based on the reliable evidence and the shortage of limitations to the performance of client orientation strategy of evidence-based influences were meaningful. Two ranges of the doctor's information, the absence of restrictions, and the finding of the sign of dimensions about the client orientation approach were according to the evidence that had no meaningful influence. Conclusion: The utilization of evidence-based training not only increased awareness, character, and abilities of the doctors but also allowed them to answer to the requirements of clients in choosing excellent decisions and presenting a better quality of healthcare, by decreasing treatment prices for patients, bringing satisfaction of patients, and finally having a better effectiveness for patients and institutions. PMID:28316691

  18. Interprofessional primary care protocols: a strategy to promote an evidence-based approach to teamwork and the delivery of care.

    Science.gov (United States)

    Goldman, Joanne; Meuser, Jamie; Lawrie, Lynne; Rogers, Jess; Reeves, Scott

    2010-11-01

    Primary care reform involving interprofessional team-based care is a global phenomenon. In Ontario, Canada, 150 Family Health Teams (FHTs) have been approved in the past few years. The transition to a FHT is complex involving many changes and the processes for collaborative teamwork are not clearly delineated. To support the transition to team-based care in FHTs, a project was undertaken to develop and implement a series of interprofessional protocols in four clinical areas. These interprofessional protocols would contain relevant and evidence-based resources to support both a team and evidence-based approach to care. This paper reports on a qualitative study to examine the process of interprofessional protocol development and pilot implementation. Adopting an exploratory case study approach (Robson, 2002 ), 36 interviews were conducted with health professionals and community group members who participated in the creation and piloting of the protocols, and with project managers. In addition, observational and documentary data were gathered on the protocol development and implementation processes. The findings from the protocol development stage demonstrate the value of the focus on evidence and team, the process of assessing and targeting FHT needs, inter-organizational and interprofessional sharing, the importance of facilitation and support, and expectations for implementation. The findings from the pilot implementation stage report on the importance of champions and leaders, the implementation strategies used, FHT and organizational factors affecting implementation, and outcomes achieved. Findings are discussed in relation to the knowledge translation and interprofessional literature. Research is ongoing to examine the effectiveness of dissemination of the protocols to FHTs across the province of Ontario and its impact on health care outcomes.

  19. Improving risk assessment of violence among military veterans: an evidence-based approach for clinical decision-making.

    Science.gov (United States)

    Elbogen, Eric B; Fuller, Sara; Johnson, Sally C; Brooks, Stephanie; Kinneer, Patricia; Calhoun, Patrick S; Beckham, Jean C

    2010-08-01

    Increased media attention to post-deployment violence highlights the need to develop effective models to guide risk assessment among military Veterans. Ideally, a method would help identify which Veterans are most at risk for violence so that it can be determined what could be done to prevent violent behavior. This article suggests how empirical approaches to risk assessment used successfully in civilian populations can be applied to Veterans. A review was conducted of the scientific literature on Veteran populations regarding factors related to interpersonal violence generally and to domestic violence specifically. A checklist was then generated of empirically-supported risk factors for clinicians to consider in practice. To conceptualize how these known risk factors relate to a Veteran's violence potential, risk assessment scholarship was utilized to develop an evidence-based method to guide mental health professionals. The goals of this approach are to integrate science into practice, overcome logistical barriers, and permit more effective assessment, monitoring, and management of violence risk for clinicians working with Veterans, both in Department of Veteran Affairs settings and in the broader community. Research is needed to test the predictive validity of risk assessment models. Ultimately, the use of a systematic, empirical framework could lead to improved clinical decision-making in the area of risk assessment and potentially help prevent violence among Veterans. Published by Elsevier Ltd.

  20. Evidence-Based Toxicology.

    Science.gov (United States)

    Hoffmann, Sebastian; Hartung, Thomas; Stephens, Martin

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

  1. Concise Arm and Hand Rehabilitation Approach in Stroke (CARAS: A practical and evidence-based framework for clinical rehabilitation management

    Directory of Open Access Journals (Sweden)

    Johan A. Franck

    2015-10-01

    Full Text Available The volume of information on new treatment techniques supporting the restoration of arm-hand function (AHF and arm-hand skill performance (ASHP in stroke survivors overwhelms therapists in everyday clinical practice when choosing the appropriate therapy. The Concise Arm and Hand Rehabilitation Approach in Stroke (CARAS is designed for paramedical staff to structure and implement training of AHF and AHSP in stroke survivors. The CARAS is based on four constructs: (a stratification according to the severity of arm–hand impairment (using the Utrecht Arm/Hand -Test [UAT], (b the individual’s rehabilitation goals and concomitant potential rehabilitation outcomes, (c principles of self-efficacy, and (d possibilities to systematically incorporate (new technology and new evidence-based training elements swiftly. The framework encompasses three programs aimed at treating either the severely (UAT 0-1, moderately (UAT 2-3, or mildly (UAT 4-7 impaired arm-hand. Program themes are: taking care of the limb and prevention of complications (Program 1, task-oriented gross motor grip performance (Program 2, and functional AHSP training (Program 3. Each program is preceded and followed by an assessment. Training modularity facilitates rapid interchange/adaptation of sub-elements. Proof-of-principle in clinical rehabilitation has been established. The CARAS facilitates rapid structured design and provision of state-of-the-art AHF and ASHP treatment in stroke patients.

  2. LifeSteps: An Evidence-based Health Promotion Program for Underserved Populations – A Community Service Learning Approach

    Directory of Open Access Journals (Sweden)

    Melanie Austin-McCain

    2015-04-01

    Full Text Available Chronic diseases are the most common, costly, and preventable of all health problems in the United States. Chronic diseases represent the leading causes of death and are experienced at higher rates by minority populations (CDC, 2012. Innovative community-based health promotion programs are recommended that meet the diverse needs of underserved populations (Yeary, et al., 2011. LifeSteps is being developed as an evidence-based health promotion program focusing on health and wellness, a domain area defined within the Occupational Therapy Practice Framework (OTPF, 2008. LifeSteps will utilize a client-centered approach to coach individuals in making health behavior changes. Fieldwork and service-learning components are incorporated integrating clinical practice, academic study, and collaboration with community providers. Program evaluation measures based on the Transtheoretical Model (TTM have been identified to address all phases of program planning. The LifeSteps health promotion program aligns with local, national, and international objectives and addresses the need for programs that meet the diverse needs of underserved populations. Occupational therapists are in a unique position for implementing community-based interventions that promote health and contribute to a healthier society.

  3. MRI and mammography surveillance of women at increased risk for breast cancer: recommendations using an evidence-based approach.

    Science.gov (United States)

    Granader, Elon J; Dwamena, Ben; Carlos, Ruth C

    2008-12-01

    To evaluate breast cancer screening with mammography and magnetic resonance imaging (MRI) in high-risk populations, including women with the BRCA mutation, using an evidence-based approach. The MEDLINE, PubMed, EBM Reviews, ACP Journal Club, Cochrane Database MEDSEARCH, and SCOPUS databases were accessed and searched for articles up to August 2007. Articles were collected using the following terms and medical subject headings (MeSH) that applied to the focused clinical question: "BRCA1" and "BRCA2" with "mammography," "MRI," "prevention," "screening," and "surveillance." References from retrieved articles were also used to identify relevant papers. Abstracts were screened and relevant papers retrieved. Retrieved papers were graded for quality. Summary performance measures were obtained by random effects modeling of study-specific performance estimates and standard errors derived from the multiple 2 x 2 tables. Additionally, studies meeting the Centre for Evidence-Based Medicine level 2b quality were reviewed. In women with an increased risk without the BRCA gene, cancer detection rates by MRI were 0.011 (95% confidence interval [CI] 0.003-0.019), by mammography 0.005 (95% CI 0.002-0.008), and by a combination of both, 0.012 (95% CI 0.004-0.020). False-positive rates by MRI, mammography, or a combination of both were 0.10 (95% CI 0.03-0.18), 0.05 (95% CI 0.03-0.06), and 0.14 (95% CI 0.04-0.24). In BRCA positive women, cancer detection rates by MRI were 0.027 (95% CI 0.015-0.040), by mammography 0.010 (95% CI 0.005-0.016), and by a combination of both 0.031 (95% CI 0.018-0.045). False-positive rates by MRI, mammography, or a combination of both were 0.10 (95% CI 0.01-0.19), 0.05 (95% CI 0.03-0.07), and 0.14 (95% CI 0.04-0.24), respectively. The data support an essential role for screening MRI in women with an increased risk for breast cancer.

  4. Cognitive schema and naturalistic decision making in evidence-based practices.

    Science.gov (United States)

    Falzer, Paul R

    2004-04-01

    A recent article in this journal proposed a naturalistic approach to decision making that overcomes problems intrinsic to classical decision theory. The approach emphasizes cognitive and multi-level processes, the development of expert reasoning, and the role of decision support in individual and organizational decision making. The current paper builds on this effort by suggesting a naturalistic, multi-level, theory that can facilitate the dissemination of evidence-based practices (EBPs). The paper presents "Image Theory," a theory that has been extensively investigated in other disciplines, but has yet to be utilized in medical decision research. It is suggested that its rich, empirically tested, distinctions among kinds of cognitive and organizational processes and types of decisions and tasks make Image Theory especially valuable in describing impediments to implementing EBPs. The paper discusses how naturalistic theory can assist clinicians, administrators, researchers, and policy makers in achieving a balance between evidence-based medicine and patient-centered practice.

  5. [The Common Risk Factor Approach - An Integrated Population- and Evidence-Based Approach for Reducing Social Inequalities in Oral Health].

    Science.gov (United States)

    Heilmann, A; Sheiham, A; Watt, R G; Jordan, R A

    2016-10-01

    Worldwide, non-communicable diseases including dental caries and periodontal diseases, remain a major public health problem. Moreover, there is a social gradient in health across society that runs from the top to the bottom in a linear, stepwise fashion. Health promoting behaviours become more difficult to sustain further down the social ladder. Oral health inequalities also exist in Germany. Earlier explanations of social inequalities have mainly focused on individual lifestyle factors, ignoring the broader social determinants of health and disease. Until recently, the dominant approaches to general health promotion focused on actions to reduce specific diseases, separating oral health from general health. An alternative approach is the common risk factor approach (CRFA) where risk factors common to a number of major chronic diseases, including diseases of the mouth and teeth, are tackled. The CRFA focuses on the common underlying determinants of health to improve the overall health of populations, thereby reducing social inequalities. The main implication of the CRFA for oral health policies is to work in partnership with a range of other sectors and disciplines. Oral health issues need to be integrated with recommendations to promote general health. Improvements in oral health and a reduction in oral health inequalities are more likely by working in partnership across sectors and disciplines using strategies that focus upstream on the underlying determinants of oral diseases. © Georg Thieme Verlag KG Stuttgart · New York.

  6. A concept mapping approach to identifying the barriers to implementing an evidence-based sports injury prevention programme.

    Science.gov (United States)

    Donaldson, Alex; Callaghan, Aisling; Bizzini, Mario; Jowett, Andrew; Keyzer, Patrick; Nicholson, Matthew

    2018-01-20

    Understanding the barriers to programme use is important to facilitate implementation of injury prevention programmes in real-word settings. This study investigated the barriers to coaches of adolescent female soccer teams, in Victoria, Australia, implementing the evidence-based FIFA 11+ injury prevention programme. Concept mapping with data collected from 19 soccer coaches and administrators. Brainstorming generated 65 statements as barriers to 11+ implementation. After the statements were synthesised and edited, participants sorted 59 statements into groups (mean, 6.2 groups; range, 3-10 groups). Multidimensional scaling and hierarchical cluster analysis identified a six-cluster solution: Lack of 11+ knowledge among coaches (15 statements), Lack of player enjoyment and engagement (14), Lack of link to football-related goals (11), Lack of facilities and resources (8), Lack of leadership (6) and Lack of time at training (5). Statements in the 'Lack of 11+ knowledge among coaches' cluster received the highest mean importance (3.67 out of 5) and feasibility for the Football Federation to address (3.20) rating. Statements in the 'Lack of facilities and resources' cluster received the lowest mean importance rating (2.23), while statements in the 'Lack of time at training' cluster received the lowest mean feasibility rating (2.19). A multistrategy, ecological approach to implementing the 11+-with specific attention paid to improving coach knowledge about the 11+ and how to implement it, linking the 11+ to the primary goal of soccer training, and organisational leadership-is required to improve the uptake of the 11+ among the targeted coaches. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Socio-cultural influences on the behaviour of South Asian women with diabetes in pregnancy: qualitative study using a multi-level theoretical approach.

    Science.gov (United States)

    Greenhalgh, Trisha; Clinch, Megan; Afsar, Nur; Choudhury, Yasmin; Sudra, Rita; Campbell-Richards, Desirée; Claydon, Anne; Hitman, Graham A; Hanson, Philippa; Finer, Sarah

    2015-05-21

    Diabetes in pregnancy is common in South Asians, especially those from low-income backgrounds, and leads to short-term morbidity and longer-term metabolic programming in mother and offspring. We sought to understand the multiple influences on behaviour (hence risks to metabolic health) of South Asian mothers and their unborn child, theorise how these influences interact and build over time, and inform the design of culturally congruent, multi-level interventions. Our sample for this qualitative study was 45 women of Bangladeshi, Indian, Sri Lankan, or Pakistani origin aged 21-45 years with a history of diabetes in pregnancy, recruited from diabetes and antenatal services in two deprived London boroughs. Overall, 17 women shared their experiences of diabetes, pregnancy, and health services in group discussions and 28 women gave individual narrative interviews, facilitated by multilingual researchers, audiotaped, translated, and transcribed. Data were analysed using the constant comparative method, drawing on sociological and narrative theories. Key storylines (over-arching narratives) recurred across all ethnic groups studied. Short-term storylines depicted the experience of diabetic pregnancy as stressful, difficult to control, and associated with negative symptoms, especially tiredness. Taking exercise and restricting diet often worsened these symptoms and conflicted with advice from relatives and peers. Many women believed that exercise in pregnancy would damage the fetus and drain the mother's strength, and that eating would be strength-giving for mother and fetus. These short-term storylines were nested within medium-term storylines about family life, especially the cultural, practical, and material constraints of the traditional South Asian wife and mother role and past experiences of illness and healthcare, and within longer-term storylines about genetic, cultural, and material heritage - including migration, acculturation, and family memories of food

  8. Multi level configuration of ETO products

    DEFF Research Database (Denmark)

    Petersen, Thomas Ditlev; Jørgensen, Kaj Asbjørn; Hvolby, Hans-Henrik

    2007-01-01

    The paper introduces and defines central concepts related to multi level configuration and analyzes which challenges an engineer to order company must deal with to be able to realize a multi level configuration system. It is argued that high flexibility can be achieved and focus can be directed...... in certain business processes if a multi level configuration system is realized....

  9. Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Gulliver, Wayne; Zouboulis, Christos C.; Prens, Errol

    2016-01-01

    Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses that rupture and lead to sinus tracts and scarring. To date, an evidence-based therapeutic approach has not been the standard of care and this is likely due...

  10. Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

    NARCIS (Netherlands)

    W.P. Gulliver (Wayne P.); C.C. Zouboulis (Christos C.); E.P. Prens (Errol); G.B.E. Jemec (Gregor); T. Tzellos (Thrasivoulos)

    2016-01-01

    textabstractHidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses that rupture and lead to sinus tracts and scarring. To date, an evidence-based therapeutic approach has not been the standard of care and this is

  11. Evidence-Based Best Practice is More Political than It Looks: A Case Study of the "Scottish Approach"

    Science.gov (United States)

    Cairney, Paul

    2017-01-01

    National governments use evidence selectively to argue that a successful policy intervention in one local area should be emulated in others ("evidence-based best practice"). However, the value of such evidence is always limited because there is: disagreement on the best way to gather evidence of policy success, uncertainty regarding the…

  12. An exploratory study of lead recovery in lead-acid battery lifecycle in US market: An evidence-based approach

    International Nuclear Information System (INIS)

    Genaidy, A.M.; Sequeira, R.; Tolaymat, T.; Kohler, J.; Rinder, M.

    2008-01-01

    Background: This research examines lead recovery and recycling in lead-acid batteries (LAB) which account for 88% of US lead consumption. We explore strategies to maximize lead recovery and recycling in the LAB lifecycle. Currently, there is limited information on recycling rates for LAB in the published literature and is derived from a single source. Therefore, its recycling efforts in the US has been unclear so as to determine the maximum opportunities for metal recovery and recycling in the face of significant demands for LAB particularly in the auto industry. Objectives: The research utilizes an evidence-based approach to: (1) determine recycling rates for lead recovery in the LAB product lifecycle for the US market; and (2) quantify and identify opportunities where lead recovery and recycling can be improved. Methods: A comprehensive electronic search of the published literature was conducted to gather information on different LAB recycling models and actual data used to calculate recycling rates based on product lifecycle for the US market to identify strategies for increasing lead recovery and recycling. Results: The electronic search yielded five models for calculating LAB recycling rates. The description of evidence was documented for each model. Furthermore, an integrated model was developed to identify and quantify the maximum opportunities for lead recovery and recycling. Results showed that recycling rates declined during the period spanning from 1999 to 2006. Opportunities were identified for recovery and recycling of lead in the LAB product lifecycle. Concluding remarks: One can deduce the following from the analyses undertaken in this report: (1) lead recovery and recycling has been stable between 1999 and 2006; (2) lead consumption has increased at an annual rate of 2.25%, thus, the values derived in this study for opportunities dealing with lead recovery and recycling underestimate the amount of lead in scrap and waste generated; and (3) the

  13. Exploring the potential of a multi-level approach to improve capability for continuous organizational improvement and learning in a Swedish healthcare region.

    Science.gov (United States)

    Nyström, M E; Höög, E; Garvare, R; Andersson Bäck, M; Terris, D D; Hansson, J

    2018-05-24

    Eldercare and care of people with functional impairments is organized by the municipalities in Sweden. Improving care in these areas is complex, with multiple stakeholders and organizations. Appropriate strategies to develop capability for continuing organizational improvement and learning (COIL) are needed. The purpose of our study was to develop and pilot-test a flexible, multilevel approach for COIL capability building and to identify what it takes to achieve changes in key actors' approaches to COIL. The approach, named "Sustainable Improvement and Development through Strategic and Systematic Approaches" (SIDSSA), was applied through an action-research and action-learning intervention. The SIDSSA approach was tested in a regional research and development (R&D) unit, and in two municipalities handling care of the elderly and people with functional impairments. Our approach included a multilevel strategy, development loops of five flexible phases, and an action-learning loop. The approach was designed to support systems understanding, strategic focus, methodological practices, and change process knowledge - all of which required double-loop learning. Multiple qualitative methods, i.e., repeated interviews, process diaries, and documents, provided data for conventional content analyses. The new approach was successfully tested on all cases and adopted and sustained by the R&D unit. Participants reported new insights and skills. The development loop facilitated a sense of coherence and control during uncertainty, improved planning and problem analysis, enhanced mapping of context and conditions, and supported problem-solving at both the individual and unit levels. The systems-level view and structured approach helped participants to explain, motivate, and implement change initiatives, especially after working more systematically with mapping, analyses, and goal setting. An easily understood and generalizable model internalized by key organizational actors is an

  14. Evidence-Based Approaches to Remedy and Also to Prevent Abuse of Community-Dwelling Older Persons

    Directory of Open Access Journals (Sweden)

    Donna M. Wilson

    2011-01-01

    Full Text Available Elder abuse is a global issue, with an estimated 4–10% of older persons in Canada abused each year. Although Canadian legislation has been created to prevent and punish the abuse of older persons living in nursing homes and other care facilities, community-dwelling older persons are at greater risk of abuse. This paper highlights the importance of evidence-based actions targeted at three determinants of health: (a personal health practices and coping skills, (b social support networks, and (c social environments. Two research studies are profiled as case studies that illustrate the ready possibility and value of two specific types of actions on community-based older-person abuse. This paper argues for the immediate and widespread adoption of these evidence-based measures and for additional empirical evidence to guide the correction of underreporting of abuse, raise awareness of its serious nature, and increase options to not only stop it but ultimately prevent it.

  15. Multi-Level Secure Local Area Network

    OpenAIRE

    Naval Postgraduate School (U.S.); Center for Information Systems Studies Security and Research (CISR)

    2011-01-01

    Multi-Level Secure Local Area Network is a cost effective, multi-level, easy to use office environment leveraging existing high assurance technology. The Department of Defense and U.S. Government have an identified need to securely share information classified at differing security levels. Because there exist no commercial solutions to this problem, NPS is developing a MLS LAN. The MLS LAN extends high assurance capabilities of an evaluated multi-level secure system to commercial personal com...

  16. Hybrid approach to structure modeling of the histamine H3 receptor: Multi-level assessment as a tool for model verification.

    Directory of Open Access Journals (Sweden)

    Jakub Jończyk

    Full Text Available The crucial role of G-protein coupled receptors and the significant achievements associated with a better understanding of the spatial structure of known receptors in this family encouraged us to undertake a study on the histamine H3 receptor, whose crystal structure is still unresolved. The latest literature data and availability of different software enabled us to build homology models of higher accuracy than previously published ones. The new models are expected to be closer to crystal structures; and therefore, they are much more helpful in the design of potential ligands. In this article, we describe the generation of homology models with the use of diverse tools and a hybrid assessment. Our study incorporates a hybrid assessment connecting knowledge-based scoring algorithms with a two-step ligand-based docking procedure. Knowledge-based scoring employs probability theory for global energy minimum determination based on information about native amino acid conformation from a dataset of experimentally determined protein structures. For a two-step docking procedure two programs were applied: GOLD was used in the first step and Glide in the second. Hybrid approaches offer advantages by combining various theoretical methods in one modeling algorithm. The biggest advantage of hybrid methods is their intrinsic ability to self-update and self-refine when additional structural data are acquired. Moreover, the diversity of computational methods and structural data used in hybrid approaches for structure prediction limit inaccuracies resulting from theoretical approximations or fuzziness of experimental data. The results of docking to the new H3 receptor model allowed us to analyze ligand-receptor interactions for reference compounds.

  17. Life cycle assessment of greenhouse gas emissions and water-energy optimization for shale gas supply chain planning based on multi-level approach: Case study in Barnett, Marcellus, Fayetteville, and Haynesville shales

    International Nuclear Information System (INIS)

    Chen, Yizhong; He, Li; Guan, Yanlong; Lu, Hongwei; Li, Jing

    2017-01-01

    Highlights: • Detailed model developed for the shale gas supply chain system in the US. • Dynamic integration of multi-level programming and life cycle assessment. • Analysis of the objectives with environmental, economic and energy concerns. • Identification of GHG emissions and water-energy consumption at life cycle stages. • Comparison of management performances obtained from the MLP, MOP, and BLP methods. - Abstract: This study develops a multi-level programming model from a life cycle perspective for performing shale-gas supply chain system. A set of leader-follower-interactive objectives with emphases of environmental, economic and energy concerns are incorporated into the synergistic optimization process, named MGU-MEM-MWL model. The upper-level model quantitatively investigates the life-cycle greenhouse gas (GHG) emissions as controlled by the environmental sector. The middle-level one focuses exclusively on system benefits as determined by the energy sector. The lower-level one aims to recycle water to minimize the life-cycle water supply as required by the enterprises. The capabilities and effectiveness of the developed model are illustrated through real-world case studies of the Barnett, Marcellus, Fayetteville, and Haynesville Shales in the US. An improved multi-level interactive solution algorithm based on satisfactory degree is then presented to improve computational efficiency. Results indicate that: (a) the end-use phase (i.e., gas utilization for electricity generation) would not only dominate the life-cycle GHG emissions, but also account for 76.1% of the life-cycle system profits; (b) operations associated with well hydraulic fracturing would be the largest contributor to the life-cycle freshwater consumption when gas use is not considered, and a majority of freshwater withdrawal would be supplied by surface water; (c) nearly 95% of flowback water would be recycled for hydraulic fracturing activities and only about 5% of flowback water

  18. A structured process to develop scenarios for use in evaluation of an evidence-based approach in clinical decision making

    Directory of Open Access Journals (Sweden)

    Manns PJ

    2012-11-01

    Full Text Available Patricia J Manns, Johanna DarrahDepartment of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, CanadaBackground and purpose: Scenarios are used as the basis from which to evaluate the use of the components of evidence-based practice in decision making, yet there are few examples of a standardized process of scenario writing. The aim of this paper is to describe a step-by-step scenario writing method used in the context of the authors’ curriculum research study.Methods: Scenario writing teams included one physical therapy clinician and one academic staff member. There were four steps in the scenario development process: (1 identify prevalent condition and brainstorm interventions; (2 literature search; (3 develop scenario framework; and (4 write scenario.Results: Scenarios focused only on interventions, not diagnostic or prognostic problems. The process led to two types of scenarios – ones that provided an intervention with strong research evidence and others where the intervention had weak evidence to support its use. The end product of the process was a scenario that incorporates aspects of evidence-based decision making and can be used as the basis for evaluation.Conclusion: The use of scenarios has been very helpful to capture therapists’ reasoning processes. The scenario development process was applied in an education context as part of a final evaluation of graduating clinical physical therapy students.Keywords: physical therapists, clinical decision making, evaluation, curriculum

  19. A hybrid multi-level optimization approach for the dynamic synthesis/design and operation/control under uncertainty of a fuel cell system

    International Nuclear Information System (INIS)

    Kim, Kihyung; Spakovsky, Michael R. von; Wang, M.; Nelson, Douglas J.

    2011-01-01

    During system development, large-scale, complex energy systems require multi-disciplinary efforts to achieve system quality, cost, and performance goals. As systems become larger and more complex, the number of possible system configurations and technologies, which meet the designer's objectives optimally, increases greatly. In addition, both transient and environmental effects may need to be taken into account. Thus, the difficulty of developing the system via the formulation of a single optimization problem in which the optimal synthesis/design and operation/control of the system are achieved simultaneously is great and rather problematic. This difficulty is further heightened with the introduction of uncertainty analysis, which transforms the problem from a purely deterministic one into a probabilistic one. Uncertainties, system complexity and nonlinearity, and large numbers of decision variables quickly render the single optimization problem unsolvable by conventional, single-level, optimization strategies. To address these difficulties, the strategy adopted here combines a dynamic physical decomposition technique for large-scale optimization with a response sensitivity analysis method for quantifying system response uncertainties to given uncertainty sources. The feasibility of such a hybrid approach is established by applying it to the synthesis/design and operation/control of a 5 kW proton exchange membrane (PEM) fuel cell system.

  20. Modeling Fetal Weight for Gestational Age: A Comparison of a Flexible Multi-level Spline-based Model with Other Approaches

    Science.gov (United States)

    Villandré, Luc; Hutcheon, Jennifer A; Perez Trejo, Maria Esther; Abenhaim, Haim; Jacobsen, Geir; Platt, Robert W

    2011-01-01

    We present a model for longitudinal measures of fetal weight as a function of gestational age. We use a linear mixed model, with a Box-Cox transformation of fetal weight values, and restricted cubic splines, in order to flexibly but parsimoniously model median fetal weight. We systematically compare our model to other proposed approaches. All proposed methods are shown to yield similar median estimates, as evidenced by overlapping pointwise confidence bands, except after 40 completed weeks, where our method seems to produce estimates more consistent with observed data. Sex-based stratification affects the estimates of the random effects variance-covariance structure, without significantly changing sex-specific fitted median values. We illustrate the benefits of including sex-gestational age interaction terms in the model over stratification. The comparison leads to the conclusion that the selection of a model for fetal weight for gestational age can be based on the specific goals and configuration of a given study without affecting the precision or value of median estimates for most gestational ages of interest. PMID:21931571

  1. An optimal set of features for predicting type IV secretion system effector proteins for a subset of species based on a multi-level feature selection approach.

    Directory of Open Access Journals (Sweden)

    Zhila Esna Ashari

    Full Text Available Type IV secretion systems (T4SS are multi-protein complexes in a number of bacterial pathogens that can translocate proteins and DNA to the host. Most T4SSs function in conjugation and translocate DNA; however, approximately 13% function to secrete proteins, delivering effector proteins into the cytosol of eukaryotic host cells. Upon entry, these effectors manipulate the host cell's machinery for their own benefit, which can result in serious illness or death of the host. For this reason recognition of T4SS effectors has become an important subject. Much previous work has focused on verifying effectors experimentally, a costly endeavor in terms of money, time, and effort. Having good predictions for effectors will help to focus experimental validations and decrease testing costs. In recent years, several scoring and machine learning-based methods have been suggested for the purpose of predicting T4SS effector proteins. These methods have used different sets of features for prediction, and their predictions have been inconsistent. In this paper, an optimal set of features is presented for predicting T4SS effector proteins using a statistical approach. A thorough literature search was performed to find features that have been proposed. Feature values were calculated for datasets of known effectors and non-effectors for T4SS-containing pathogens for four genera with a sufficient number of known effectors, Legionella pneumophila, Coxiella burnetii, Brucella spp, and Bartonella spp. The features were ranked, and less important features were filtered out. Correlations between remaining features were removed, and dimensional reduction was accomplished using principal component analysis and factor analysis. Finally, the optimal features for each pathogen were chosen by building logistic regression models and evaluating each model. The results based on evaluation of our logistic regression models confirm the effectiveness of our four optimal sets of

  2. The ACTTION-American Pain Society Pain Taxonomy (AAPT): an evidence-based and multidimensional approach to classifying chronic pain conditions.

    Science.gov (United States)

    Fillingim, Roger B; Bruehl, Stephen; Dworkin, Robert H; Dworkin, Samuel F; Loeser, John D; Turk, Dennis C; Widerstrom-Noga, Eva; Arnold, Lesley; Bennett, Robert; Edwards, Robert R; Freeman, Roy; Gewandter, Jennifer; Hertz, Sharon; Hochberg, Marc; Krane, Elliot; Mantyh, Patrick W; Markman, John; Neogi, Tuhina; Ohrbach, Richard; Paice, Judith A; Porreca, Frank; Rappaport, Bob A; Smith, Shannon M; Smith, Thomas J; Sullivan, Mark D; Verne, G Nicholas; Wasan, Ajay D; Wesselmann, Ursula

    2014-03-01

    Current approaches to classification of chronic pain conditions suffer from the absence of a systematically implemented and evidence-based taxonomy. Moreover, existing diagnostic approaches typically fail to incorporate available knowledge regarding the biopsychosocial mechanisms contributing to pain conditions. To address these gaps, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks (ACTTION) public-private partnership with the U.S. Food and Drug Administration and the American Pain Society (APS) have joined together to develop an evidence-based chronic pain classification system called the ACTTION-APS Pain Taxonomy. This paper describes the outcome of an ACTTION-APS consensus meeting, at which experts agreed on a structure for this new taxonomy of chronic pain conditions. Several major issues around which discussion revolved are presented and summarized, and the structure of the taxonomy is presented. ACTTION-APS Pain Taxonomy will include the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial, and functional consequences; and 5) putative neurobiological and psychosocial mechanisms, risk factors, and protective factors. In coming months, expert working groups will apply this taxonomy to clusters of chronic pain conditions, thereby developing a set of diagnostic criteria that have been consistently and systematically implemented across nearly all common chronic pain conditions. It is anticipated that the availability of this evidence-based and mechanistic approach to pain classification will be of substantial benefit to chronic pain research and treatment. The ACTTION-APS Pain Taxonomy is an evidence-based chronic pain classification system designed to classify chronic pain along the following dimensions: 1) core diagnostic criteria; 2) common features; 3) common medical comorbidities; 4) neurobiological, psychosocial

  3. Information literacy as the foundation for evidence-based practice in graduate nursing education: a curriculum-integrated approach.

    Science.gov (United States)

    Jacobs, Susan Kaplan; Rosenfeld, Peri; Haber, Judith

    2003-01-01

    As part of a system-wide initiative to advance evidence-based practice among clinicians, graduate students, and educators, the New York University Division of Nursing embarked on a curricular initiative to integrate components of information literacy in all core courses of the master's program. Increasing competency in information literacy is the foundation for evidence-based practice and provides nursing professionals with the skills to be literate consumers of information in an electronic environment. Competency in information literacy includes an understanding of the architecture of information and the scholarly process; the ability to navigate among a variety of print and electronic tools to effectively access, search, and critically evaluate appropriate resources; synthesize accumulated information into an existing body of knowledge; communicate research results clearly and effectively; and appreciate the social issues and ethical concerns related to the provision, dissemination, and sharing of information. In collaboration with the New York University Division of Libraries' Health Sciences Librarian, instructional modules in information literacy relevant to each of the 5 core nursing master's courses were developed, complemented by a Web-based tutorial: http://library.nyu.edu/research/health/tutorial. The Web site is multifaceted, with fundamentals for the beginner, as well as more complex content for the advanced user. Course assignments were designed to promote specific competencies in information literacy and strategies for evaluating the strength of the evidence found. A survey of information literacy competencies, which assessed students' knowledge, misconceptions, and use of electronic information resources, was administered when students entered the program and at 1-year intervals thereafter.

  4. Historical perspectives on evidence-based nursing.

    Science.gov (United States)

    Beyea, Suzanne C; Slattery, Mary Jo

    2013-04-01

    The authors of this article offer a review and historical perspective on research utilization and evidence-based practice in nursing. They present the evolution of research utilization to the more contemporary framework of evidence-based nursing practice. The authors address the role of qualitative research in the context of evidence-based practice. Finally, some approaches and resources for learning more about the fundamentals of evidence-based healthcare are provided.

  5. 'Better than nothing' is not good enough: challenges to introducing evidence-based approaches for traumatized populations.

    Science.gov (United States)

    Clark, James J; Sprang, Ginny; Freer, Benjamin; Whitt-Woosley, Adrienne

    2012-04-01

    Focus group data were generated by a larger, mixed-methods investigation on treatment practices among therapists working with significantly traumatized populations in a primarily rural, underdeveloped region of the USA. This paper explores reasons behind low utilization of evidence-based practices (EBPs) that putatively would benefit poor communities where these behavioural health care providers serve. Eight focus groups of 45 licensed and certified behavioural health professionals were conducted over a 6-month period of time in 2006. Sites were selected based on Beale code designations with representation from urban, rural, and rural with urban influence providers. Potential respondents were selected from licensing board membership rosters and invited to participate in the study. Focus groups were facilitated by trained interviewers using a semi-structured interview schedule that focused on how participants defined, assessed, and understood trauma, as well as the information therapists utilized to determine interventions for clients with trauma histories. Focus group transcripts were analysed using qualitative data reduction methods and six major themes emerged regarding the limited use of EBPs: complexity of trauma identification, issues with manualized assessment, role of treatment settings, conditions for innovation success and failure, untangling cultural effects, and defining successful treatment outcomes. These findings shed light on the endurance of insufficient behavioural health infrastructures despite therapists' access to scientifically validated treatments for trauma spectrum and co-morbid mental disorders suffered by children and adults. Such insights have implications for the success of global dissemination of validated behavioural health interventions. © 2010 Blackwell Publishing Ltd.

  6. Enhancing capacity among faith-based organizations to implement evidence-based cancer control programs: a community-engaged approach.

    Science.gov (United States)

    Leyva, Bryan; Allen, Jennifer D; Ospino, Hosffman; Tom, Laura S; Negrón, Rosalyn; Buesa, Richard; Torres, Maria Idalí

    2017-09-01

    Evidence-based interventions (EBIs) to promote cancer control among Latinos have proliferated in recent years, though adoption and implementation of these interventions by faith-based organizations (FBOs) is limited. Capacity building may be one strategy to promote implementation. In this qualitative study, 18 community key informants were interviewed to (a) understand existing capacity for health programming among Catholic parishes, (b) characterize parishes' resource gaps and capacity-building needs implementing cancer control EBIs, and (c) elucidate strategies for delivering capacity-building assistance to parishes to facilitate implementation of EBIs. Semi-structured qualitative interviews were conducted. Key informants concurred about the capacity of Catholic parishes to deliver health programs, and described attributes of parishes that make them strong partners in health promotion initiatives, including a mission to address physical and mental health, outreach to marginalized groups, altruism among members, and existing engagement in health programming. However, resource gaps and capacity building needs were also identified. Specific recommendations participants made about how existing resources might be leveraged to address challenges include to: establish parish wellness committees; provide "hands-on" learning opportunities for parishioners to gain program planning skills; offer continuous, tailored, on-site technical assistance; facilitate relationships between parishes and community resources; and provide financial support for parishes. Leveraging parishes' existing resources and addressing their implementation needs may improve adoption of cancer control EBIs.

  7. The catcher in the why: developing an evidence-based approach to the organization, delivery and evaluation of pre-registration nurse educational programmes.

    Science.gov (United States)

    Warne, T; Holland, K; McAndrew, S

    2011-03-01

    Changes to the pedagogy of pre-registration nurse education and training have become a global phenomenon. However, the evidence base to inform responses to these changes and the impact on nursing practice is limited. This paper explores the outcomes of an innovative approach aimed at ensuring responses to these drivers for change, particularly in curriculum development, the organisation, management and delivery of programmes and the enhancement of the student experience, are evidence based. This paper reports on an organisational change project undertaken in a School of Nursing in the North West of England, UK. The project involved 12 interrelated work streams used to explore aspects of the student journey from recruitment through progression to eventual employment. An evidence base was developed through a methodological bricolage that drew upon a robust and authentic mixture of systematic literature reviews, contemporaneous analysis of educational practice and evaluation of the student experience. This was used to underpin the decision making processes required to promote innovation in programme design, to increase the involvement of students in the facilitation and evaluation of their learning experiences, and helped shape the organisational changes required for embedding an evidenced-based culture in the School. Consistent and transformational leadership has been key to the project's success in communicating and managing the changes. Copyright © 2010 Elsevier Ltd. All rights reserved.

  8. Mathematical model comparing of the multi-level economics systems

    Science.gov (United States)

    Brykalov, S. M.; Kryanev, A. V.

    2017-12-01

    The mathematical model (scheme) of a multi-level comparison of the economic system, characterized by the system of indices, is worked out. In the mathematical model of the multi-level comparison of the economic systems, the indicators of peer review and forecasting of the economic system under consideration can be used. The model can take into account the uncertainty in the estimated values of the parameters or expert estimations. The model uses the multi-criteria approach based on the Pareto solutions.

  9. Detecting bots using multi-level traffic analysis

    DEFF Research Database (Denmark)

    Stevanovic, Matija; Pedersen, Jens Myrup

    2016-01-01

    introduces a novel multi-level botnet detection approach that performs network traffic analysis of three protocols widely considered as the main carriers of botnet Command and Control (C&C) and attack traffic, i.e. TCP, UDP and DNS. The proposed method relies on supervised machine learning for identifying...

  10. Multi-level restricted maximum likelihood covariance estimation and kriging for large non-gridded spatial datasets

    KAUST Repository

    Castrillon, Julio; Genton, Marc G.; Yokota, Rio

    2015-01-01

    We develop a multi-level restricted Gaussian maximum likelihood method for estimating the covariance function parameters and computing the best unbiased predictor. Our approach produces a new set of multi-level contrasts where the deterministic

  11. Evidence-based approach to the maintenance of laboratory and medical equipment in resource-poor settings.

    Science.gov (United States)

    Malkin, Robert; Keane, Allison

    2010-07-01

    Much of the laboratory and medical equipment in resource-poor settings is out-of-service. The most commonly cited reasons are (1) a lack of spare parts and (2) a lack of highly trained technicians. However, there is little data to support these hypotheses, or to generate evidence-based solutions to the problem. We studied 2,849 equipment-repair requests (of which 2,529 were out-of-service medical equipment) from 60 resource-poor hospitals located in 11 nations in Africa, Europe, Asia, and Central America. Each piece of equipment was analyzed by an engineer or an engineering student and a repair was attempted using only locally available materials. If the piece was placed back into service, we assumed that the engineer's problem analysis was correct. A total of 1,821 pieces of medical equipment were placed back into service, or 72%, without requiring the use of imported spare parts. Of those pieces repaired, 1,704 were sufficiently documented to determine what knowledge was required to place the equipment back into service. We found that six domains of knowledge were required to accomplish 99% of the repairs: electrical (18%), mechanical (18%), power supply (14%), plumbing (19%), motors (5%), and installation or user training (25%). A further analysis of the domains shows that 66% of the out-of-service equipment was placed back into service using only 107 skills covering basic knowledge in each domain; far less knowledge than that required of a biomedical engineer or biomedical engineering technician. We conclude that a great majority of laboratory and medical equipment can be put back into service without importing spare parts and using only basic knowledge. Capacity building in resource-poor settings should first focus on a limited set of knowledge; a body of knowledge that we call the biomedical technician's assistant (BTA). This data set suggests that a supported BTA could place 66% of the out-of-service laboratory and medical equipment in their hospital back

  12. An evidence-based approach to interactive health communication: a challenge to medicine in the information age. Science Panel on Interactive Communication and Health.

    Science.gov (United States)

    Robinson, T N; Patrick, K; Eng, T R; Gustafson, D

    1998-10-14

    To examine the current status of interactive health communication (IHC) and propose evidence-based approaches to improve the quality of such applications. The Science Panel on Interactive Communication and Health, a 14-member, nonfederal panel with expertise in clinical medicine and nursing, public health, media and instructional design, health systems engineering, decision sciences, computer and communication technologies, and health communication, convened by the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. Published studies, online resources, expert panel opinions, and opinions from outside experts in fields related to IHC. The panel met 9 times during more than 2 years. Government agencies and private-sector experts provided review and feedback on the panel's work. Interactive health communication applications have great potential to improve health, but they may also cause harm. To date, few applications have been adequately evaluated. Physicians and other health professionals should promote and participate in an evidence-based approach to the development and diffusion of IHC applications and endorse efforts to rigorously evaluate the safety, quality, and utility of these resources. A standardized reporting template is proposed to help developers and evaluators of IHC applications conduct evaluations and disclose their results and to help clinicians, purchasers, and consumers judge the quality of IHC applications.

  13. Simultaneous observations of electromagnetically induced transparency (EIT) and absorption (EIA) in a multi-level V-type system of 87Rb and theoretical simulation of the observed spectra using a multi-mode approach.

    Science.gov (United States)

    Das, Bankim Chandra; Bhattacharyya, Dipankar; Das, Arpita; Chakrabarti, Shrabana; De, Sankar

    2016-12-14

    We report here simultaneous experimental observation of Electromagnetically Induced Transparency (EIT) and Electromagnetically Induced Absorption (EIA) in a multi-level V-type system in D 2 transition of Rb87, i.e., F=2→F ' with a strong pump and a weak probe beam. We studied the probe spectrum by locking the probe beam to the transition F=2→F ' =2 while the pump is scanned from F=2→F ' . EIA is observed for the open transition (F=2→F ' =2) whereas EIT is observed in the closed transition (F=2→F ' =3). Sub natural line-width is observed for the EIA. To simulate the observed spectra theoretically, Liouville equation for the three-level V-type system is solved analytically with a multi-mode approach for the density matrix elements. We assumed both the pump and the probe beams can couple the excited states. A multi-mode approach for the coherence terms facilitates the study of all the frequency contributions due to the pump and the probe fields. Since the terms contain higher harmonics of the pump and the probe frequencies, we expressed them in Fourier transformed forms. To simulate the probe spectrum, we have solved inhomogeneous difference equations for the coherence terms using the Green's function technique and continued fraction theory. The experimental line-widths of the EIT and the EIA are compared with our theoretical model. Our system can be useful in optical switching applications as it can be precisely tuned to render the medium opaque and transparent simultaneously.

  14. Effectiveness of an Evidence-Based Quality Improvement Approach to Cultural Competence Training: The Veterans Affairs' "Caring for Women Veterans" Program.

    Science.gov (United States)

    Fox, Annie B; Hamilton, Alison B; Frayne, Susan M; Wiltsey-Stirman, Shannon; Bean-Mayberry, Bevanne; Carney, Diane; Di Leone, Brooke A L; Gierisch, Jennifer M; Goldstein, Karen M; Romodan, Yasmin; Sadler, Anne G; Yano, Elizabeth M; Yee, Ellen F; Vogt, Dawne

    2016-01-01

    Although providing culturally sensitive health care is vitally important, there is little consensus regarding the most effective strategy for implementing cultural competence trainings in the health care setting. Evidence-based quality improvement (EBQI), which involves adapting evidence-based practices to meet local needs, may improve uptake and effectiveness of a variety of health care innovations. Yet, to our knowledge, EBQI has not yet been applied to cultural competence training. To evaluate whether EBQI could enhance the impact of an evidence-based training intended to improve veterans affairs health care staff gender sensitivity and knowledge (Caring for Women Veterans; CWV), we compared the reach and effectiveness of EBQI delivery versus standard web-based implementation strategies of CWV and assessed barriers and facilitators to EBQI implementation. Workgroups at four diverse veterans affairs health care sites were randomized to either an EBQI or standard web-based implementation condition (SI). All EBQI sites selected a group-based implementation strategy. Employees (N = 84) completed pretraining and posttraining assessments of gender sensitivity and knowledge, and focus groups/interviews were conducted with leadership and staff before and after implementation. Reach of CWV was greater in the EBQI condition versus the SI condition. Whereas both gender sensitivity and knowledge improved in the EBQI condition, only gender sensitivity improved in the SI condition. Qualitative analyses revealed that the EBQI approach was well received, although a number of barriers were identified. Findings suggest that EBQI can enhance the uptake and effectiveness of employee trainings. However, the decision to pursue EBQI must be informed by a consideration of available resources.

  15. No. 355-Physiologic Basis of Pain in Labour and Delivery: An Evidence-Based Approach to its Management.

    Science.gov (United States)

    Bonapace, Julie; Gagné, Guy-Paul; Chaillet, Nils; Gagnon, Raymonde; Hébert, Emmanuelle; Buckley, Sarah

    2018-02-01

    To review the evidence relating to nonpharmacological approaches in the management of pain during labour and delivery. To formulate recommendations for the usage of nonpharmacological approaches to pain management. Nonpharmacological methods available for pain management during labour and delivery exist. These should be included in the counselling and care of women. PubMed and Medline were searched for articles in French and English on subjects related to "breastfeeding," "pain," "epidural," "anaesthesia," "analgesia," "labour," "labor," and combined with "gate control theory," "alternative therapies," "massage," "position," "mobility," "TENS," "bathing," "DNIC," "acupuncture," "acupressure," "sterile water injection," "higher center," "control mind," "cognitive structuring," "holistic health," "complementary therapy(ies)," "breathing," "relaxation," "mental imagery," "visualization," "mind focusing," "hypnosis," "auto-hypnosis," "sophrology," "mind and body interventions," "music," "odors," "biofeedback," "Lamaze," "Bonapace," "prenatal training," "gymnastic," "chanting," "haptonomy," "environment," "transcutaneous electrical stimulus-stimulation," "antenatal education," "support," "continuous support," "psychosocial support," "psychosomatic medicine," "supportive care," "companion," "intrapartum care," "nurse," "midwife(ves)," "father," "doula," "caregiver," " hormones," "oxytocin," "endorphin," "prolactin," "catecholamine," "adrenaline," and "noradrenaline" from 1990 to December 2015. Additional studies were identified by screening reference lists from selected studies and from expert suggestions. No language restrictions were applied. The quality of the evidence is rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice are ranked according to the method described in this report. The nonpharmacological method encourages an incremental approach to pain management that contributes to

  16. Using an integrative mock-up simulation approach for evidence-based evaluation of operating room design prototypes.

    Science.gov (United States)

    Bayramzadeh, Sara; Joseph, Anjali; Allison, David; Shultz, Jonas; Abernathy, James

    2018-07-01

    This paper describes the process and tools developed as part of a multidisciplinary collaborative simulation-based approach for iterative design and evaluation of operating room (OR) prototypes. Full-scale physical mock-ups of healthcare spaces offer an opportunity to actively communicate with and to engage multidisciplinary stakeholders in the design process. While mock-ups are increasingly being used in healthcare facility design projects, they are rarely evaluated in a manner to support active user feedback and engagement. Researchers and architecture students worked closely with clinicians and architects to develop OR design prototypes and engaged clinical end-users in simulated scenarios. An evaluation toolkit was developed to compare design prototypes. The mock-up evaluation helped the team make key decisions about room size, location of OR table, intra-room zoning, and doors location. Structured simulation based mock-up evaluations conducted in the design process can help stakeholders visualize their future workspace and provide active feedback. Copyright © 2018 Elsevier Ltd. All rights reserved.

  17. A practical approach to evidence-based dentistry: VIII: How to appraise an article based on a qualitative study.

    Science.gov (United States)

    Sale, Joanna E M; Amin, Maryam; Carrasco-Labra, Alonso; Brignardello-Petersen, Romina; Glick, Michael; Guyatt, Gordon H; Azarpazhooh, Amir

    2015-08-01

    Because of qualitative researchers' abilities to explore social problems and to understand the perspective of patients, qualitative research studies are useful to provide insight about patients' fears, worries, goals, and expectations related to dental care. To benefit fully from such studies, clinicians should be aware of some relevant principles of critical appraisal. In this article, the authors present one approach to critically appraise the evidence from a qualitative research study. Critical appraisal involves assessing whether the results are credible (the selection of participants, research ethics, data collection, data analysis), what are these results, and how they can be applied in clinical practice. The authors also examined how the results could be applied to patient care in terms of offering theory, understanding the context of clinical practice, and helping clinicians understand social interactions in clinical care. By applying these principles, clinicians can consider qualitative studies when trying to achieve the best possible results for their own practices. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

  18. Evidence-based evolution of an integrated nutrition-focused agriculture approach to address the underlying determinants of stunting.

    Science.gov (United States)

    Haselow, Nancy J; Stormer, Ame; Pries, Alissa

    2016-05-01

    Despite progress in reducing hunger and malnutrition since the 1990s, many still suffer from undernutrition and food insecurity, particularly women and young children, resulting in preterm birth, low birthweight and stunting, among other conditions. Helen Keller International (HKI) has addressed malnutrition and household food insecurity through implementation of an Enhanced Homestead Food Production (EHFP) programme that increases year-round availability and intake of diverse micronutrient-rich foods and promotes optimal nutrition and hygiene practices among poor households. This paper reviews the evolution and impact of HKI's EHFP programme and identifies core components of the model that address the underlying determinants of stunting. To date, evaluations of EHFP have shown impact on food production, consumption by women and children and household food security. Sale of surplus produce has increased household income, and the use of a transformative gender approach has empowered women. EHFP has also realized nutrition improvements in many project sites. Results from a randomized control trial (RCT) in Baitadi district, Nepal showed a significant improvement in a range of practices known to impact child growth, although no impact on stunting. Additional non-RCT evaluations in Kailali district of Nepal, demonstrated a 10.5% reduction in stunting and in the Chittagong Hill Tracts in Bangladesh, revealed an 18% decrease in stunting. Based on evidence, the EHFP has evolved into an integrated package that includes agriculture, nutrition, water/hygiene/sanitation, linkages to health care, women's empowerment, income generation and advocacy. Closing the stunting gap requires long-term exposure to targeted multi-sectoral solutions and rigorous evaluation to optimize impact. © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.

  19. An Evidence-Based Approach to Plum Pox Virus Detection by DASI-ELISA and RT-PCR in Dormant Period

    Directory of Open Access Journals (Sweden)

    Antonio Olmos

    2008-01-01

    Full Text Available An evidence-based approach, such as those developed in clinical and veterinary medicine, was applied to the detection of Plum pox virus (PPV during the dormant period. A standardized methodology was used for the calculation of parameters of the operational capacity of DASI-ELISA and RT-PCR in wintertime. These methods are routinely handled to test the sanitary status of plants in national or international trading and in those cases concerning export-import of plant materials. Diagnosis often has to be performed during the dormant period, when plant material is commercialized. Some guidelines to interpret diagnostic results of wintertime are provided in an attempt to minimize risks associated with the methods and over-reliance on the binary outcome of a single assay. In order to evaluate if a complementary test increased the confidence of PPV diagnosis when discordant results between DASI-ELISA and RT-PCR are obtained, NASBA-FH also was included. Likelihood ratios of each method were estimated based on the sensitivity and specificity obtained in wintertime. Subsequently, a Bayesian approach was performed to calculate post-test probability of PPV infection in spring. Results of evidence-based approach show that different PPV prevalences require different screening tests. Thus, at very low PPV prevalence levels DASI-ELISA should be used as the election method, whilst at the highest PPV prevalence levels RT-PCR should be performed. NASBA-FH could be used at medium prevalences to clarify discordances between DASIELISA and RT-PCR.

  20. Cost calculator methods for estimating casework time in child welfare services: A promising approach for use in implementation of evidence-based practices and other service innovations.

    Science.gov (United States)

    Holmes, Lisa; Landsverk, John; Ward, Harriet; Rolls-Reutz, Jennifer; Saldana, Lisa; Wulczyn, Fred; Chamberlain, Patricia

    2014-04-01

    Estimating costs in child welfare services is critical as new service models are incorporated into routine practice. This paper describes a unit costing estimation system developed in England (cost calculator) together with a pilot test of its utility in the United States where unit costs are routinely available for health services but not for child welfare services. The cost calculator approach uses a unified conceptual model that focuses on eight core child welfare processes. Comparison of these core processes in England and in four counties in the United States suggests that the underlying child welfare processes generated from England were perceived as very similar by child welfare staff in California county systems with some exceptions in the review and legal processes. Overall, the adaptation of the cost calculator for use in the United States child welfare systems appears promising. The paper also compares the cost calculator approach to the workload approach widely used in the United States and concludes that there are distinct differences between the two approaches with some possible advantages to the use of the cost calculator approach, especially in the use of this method for estimating child welfare costs in relation to the incorporation of evidence-based interventions into routine practice.

  1. The Integration of Cognitive Remediation Therapy into the Whole Psychosocial Rehabilitation Process: An Evidence-Based and Person-Centered Approach

    Directory of Open Access Journals (Sweden)

    Rafael Penadés

    2012-01-01

    Full Text Available Cognitive remediation therapies seem to ameliorate cognitive impairments in patients with schizophrenia. Interestingly, some improvement in daily functioning can also be expected as a result. However, to achieve these results it is necessary that cognitive remediation is carried out in the context of broader psychosocial rehabilitation involving the learning of other communication, social, and self-control skills. Unfortunately, little is known about how to integrate these different rehabilitation tools in broader rehabilitation programs. Based on both the neurocognitive behavioral approach and the action theory framework, a hierarchical flowchart is represented in this paper to integrate CRT with other evidence-based psychological therapies in outpatient settings. Finally, some evidence is provided in which cognitive abilities need to be targeted in remediation programs to improve functioning. In summary, to improve daily functioning, according to these studies, cognitive remediation needs to include the teaching of some cognitive strategies that target executive skills.

  2. Usability Methods for Ensuring Health Information Technology Safety: Evidence-Based Approaches. Contribution of the IMIA Working Group Health Informatics for Patient Safety.

    Science.gov (United States)

    Borycki, E; Kushniruk, A; Nohr, C; Takeda, H; Kuwata, S; Carvalho, C; Bainbridge, M; Kannry, J

    2013-01-01

    Issues related to lack of system usability and potential safety hazards continue to be reported in the health information technology (HIT) literature. Usability engineering methods are increasingly used to ensure improved system usability and they are also beginning to be applied more widely for ensuring the safety of HIT applications. These methods are being used in the design and implementation of many HIT systems. In this paper we describe evidence-based approaches to applying usability engineering methods. A multi-phased approach to ensuring system usability and safety in healthcare is described. Usability inspection methods are first described including the development of evidence-based safety heuristics for HIT. Laboratory-based usability testing is then conducted under artificial conditions to test if a system has any base level usability problems that need to be corrected. Usability problems that are detected are corrected and then a new phase is initiated where the system is tested under more realistic conditions using clinical simulations. This phase may involve testing the system with simulated patients. Finally, an additional phase may be conducted, involving a naturalistic study of system use under real-world clinical conditions. The methods described have been employed in the analysis of the usability and safety of a wide range of HIT applications, including electronic health record systems, decision support systems and consumer health applications. It has been found that at least usability inspection and usability testing should be applied prior to the widespread release of HIT. However, wherever possible, additional layers of testing involving clinical simulations and a naturalistic evaluation will likely detect usability and safety issues that may not otherwise be detected prior to widespread system release. The framework presented in the paper can be applied in order to develop more usable and safer HIT, based on multiple layers of evidence.

  3. Evidence-based radiography

    International Nuclear Information System (INIS)

    Hafslund, Bjorg; Clare, Judith; Graverholt, Birgitte; Wammen Nortvedt, Monica

    2008-01-01

    Evidence-based practice (EBP) offers the integration of the best research evidence with clinical knowledge and expertise and patient values. EBP is a well known term in health care. This paper discusses the implementation of EBP into radiography and introduces the term evidence-based radiography. Evidence-based radiography is radiography informed and based on the combination of clinical expertise and the best available research-based evidence, patient preferences and resources available. In Norway, EBP in radiography is being debated and radiographers are discussing the challenges of implementing EBP in both academic and clinical practice. This discussion paper explains why EBP needs to be a basis for a radiography curriculum and a part of radiographers' practice. We argue that Norwegian radiographers must increase participation in research and developing practice within their specific radiographic domain

  4. Evidence-based dentistry.

    Science.gov (United States)

    Chambers, David W

    2010-01-01

    Both panegyric and criticism of evidence-based dentistry tend to be clumsy because the concept is poorly defined. This analysis identifies several contributions to the profession that have been made under the EBD banner. Although the concept of clinicians integrating clinical epidemiology, the wisdom of their practices, and patients' values is powerful, its implementation has been distorted by a too heavy emphasis of computerized searches for research findings that meet the standards of academics. Although EBD advocates enjoy sharing anecdotal accounts of mistakes others have made, faulting others is not proof that one's own position is correct. There is no systematic, high-quality evidence that EBD is effective. The metaphor of a three-legged stool (evidence, experience, values, and integration) is used as an organizing principle. "Best evidence" has become a preoccupation among EBD enthusiasts. That overlong but thinly developed leg of the stool is critiqued from the perspectives of the criteria for evidence, the difference between internal and external validity, the relationship between evidence and decision making, the ambiguous meaning of "best," and the role of reasonable doubt. The strongest leg of the stool is clinical experience. Although bias exists in all observations (including searches for evidence), there are simple procedures that can be employed in practice to increase useful and objective evidence there, and there are dangers in delegating policy regarding allowable treatments to external groups. Patient and practitioner values are the shortest leg of the stool. As they are so little recognized, their integration in EBD is problematic and ethical tensions exist where paternalism privileges science over patient's self-determined best interests. Four potential approaches to integration are suggested, recognizing that there is virtually no literature on how the "seat" of the three-legged stool works or should work. It is likely that most dentists

  5. Evidence-based policy

    DEFF Research Database (Denmark)

    Vohnsen, Nina Holm

    2013-01-01

    -makers and the research community (e.g. Boden & Epstein 2006; House of Commons 2006; Cartwright et al 2009; Rod 2010; Vohnsen 2011). This article intends to draw out some general pitfalls in the curious meeting of science and politics by focusing on a particular attempt to make evidence-based legislation in Denmark (for...

  6. Evidence-Based Psychotherapy: Advantages and Challenges.

    Science.gov (United States)

    Cook, Sarah C; Schwartz, Ann C; Kaslow, Nadine J

    2017-07-01

    Evidence-based psychotherapies have been shown to be efficacious and cost-effective for a wide range of psychiatric conditions. Psychiatric disorders are prevalent worldwide and associated with high rates of disease burden, as well as elevated rates of co-occurrence with medical disorders, which has led to an increased focus on the need for evidence-based psychotherapies. This chapter focuses on the current state of evidence-based psychotherapy. The strengths and challenges of evidence-based psychotherapy are discussed, as well as misperceptions regarding the approach that may discourage and limit its use. In addition, we review various factors associated with the optimal implementation and application of evidence-based psychotherapies. Lastly, suggestions are provided on ways to advance the evidence-based psychotherapy movement to become truly integrated into practice.

  7. "Championing GIS, Biostatistics, meteo, m-health and e-health approaches for tailored informed evidence-based agricultural, environment and health interventions in Rwanda"

    Science.gov (United States)

    Karame, P., Sr.

    2016-12-01

    "GIS-Biostatistics-Meteo for Health (GBMH), A consolidated approach"The environmental vulnerability rate due to human-induced threats and climate change has exceeded the capacity of ecosystems and species to adapt naturally. Drastic changes in seasonal and weather patterns have led to a severely intriguing imbalance ecosystem equilibrium, associated to habitat degradation, environmental pollution, shortage of ecosystem services production and shift in species distribution, food insecurity, invasive species and complex species associations. The consequences are particularly disturbing regarding health and wellbeing of human populations. Especially to Sub-Saharan Africa, informed evidence-based statistics are inappropriately if not at all used for developing and implementing coping measures. This makes a regrettable scenario for Rwanda, a research-driven economic transformation country in which mostly expensive long-term interventions remain meaningless and unknowingly approved effective. More important, no single sector can ultimately afford the most informative approaches providing evidence and guiding policy and decisions, due to limited resources. Rwanda dedicates substantial investment to sustain a conducive, robust and flourishing environment promoting research priorities most likely to deliver improved health outcomes. In this framework, the above mentioned approach supports cross-sectoral analyses to evaluate health care quality improvements through impact assessments, policy analysis and forecasting. This approach "Consolidating GIS, Biostatistics, meteo, mobile and e-health approaches (GBMH)" tailors disaster, disease control and prevention, farming options, effective planning, interventions and communication for safe health in sound environment. Under GBMH models, Integrated Time Series analysis completed in R Studio on health interventions from HMIS and DHS and DHSS systems (on environment and disaster management, farming practices and health sector

  8. "GIS, Biostatistics, meteo, m-health and e-health approaches for tailored informed evidence-based agricultural, environment and health interventions in Rwanda"

    Science.gov (United States)

    Karame, P., Sr.; Dushimiyimana, V.

    2016-12-01

    " Championing GIS-Biostatistics-Meteo for Health (GBMH), A consolidated approach"The environmental vulnerability rate due to human-induced threats and climate change has exceeded the capacity of ecosystems and species to adapt naturally. Drastic changes in seasonal and weather patterns have led to a severely intriguing imbalance ecosystem equilibrium, associated to habitat degradation, environmental pollution, shortage of ecosystem services production and shift in species distribution, food insecurity, invasive species and complex species associations. The consequences are particularly disturbing regarding health and wellbeing of human populations. Especially to Sub-Saharan Africa, informed evidence-based statistics are inappropriately if not at all used for developing and implementing coping measures. This makes a regrettable scenario for Rwanda, a research-driven economic transformation country in which mostly expensive long-term interventions remain meaningless and unknowingly approved effective. More important, no single sector can ultimately afford the most informative approaches providing evidence and guiding policy and decisions, due to limited resources. Rwanda dedicates substantial investment to sustain a conducive, robust and flourishing environment promoting research priorities most likely to deliver improved health outcomes. In this framework, the above mentioned approach supports cross-sectoral analyses to evaluate health care quality improvements through impact assessments, policy analysis and forecasting. This approach "Consolidating GIS, Biostatistics, meteo, mobile and e-health approaches (GBMH)" tailors disaster, disease control and prevention, farming options, effective planning, interventions and communication for safe health in sound environment. Under GBMH models, Integrated Time Series analysis completed in R Studio on health interventions from HMIS and DHS and DHSS systems (on environment and disaster management, farming practices and health

  9. Development of an evidence-based approach to external quality assurance for breast cancer hormone receptor immunohistochemistry: comparison of reference values.

    Science.gov (United States)

    Makretsov, Nikita; Gilks, C Blake; Alaghehbandan, Reza; Garratt, John; Quenneville, Louise; Mercer, Joel; Palavdzic, Dragana; Torlakovic, Emina E

    2011-07-01

    External quality assurance and proficiency testing programs for breast cancer predictive biomarkers are based largely on traditional ad hoc design; at present there is no universal consensus on definition of a standard reference value for samples used in external quality assurance programs. To explore reference values for estrogen receptor and progesterone receptor immunohistochemistry in order to develop an evidence-based analytic platform for external quality assurance. There were 31 participating laboratories, 4 of which were previously designated as "expert" laboratories. Each participant tested a tissue microarray slide with 44 breast carcinomas for estrogen receptor and progesterone receptor and submitted it to the Canadian Immunohistochemistry Quality Control Program for analysis. Nuclear staining in 1% or more of the tumor cells was a positive score. Five methods for determining reference values were compared. All reference values showed 100% agreement for estrogen receptor and progesterone receptor scores, when indeterminate results were excluded. Individual laboratory performance (agreement rates, test sensitivity, test specificity, positive predictive value, negative predictive value, and κ value) was very similar for all reference values. Identification of suboptimal performance by all methods was identical for 30 of 31 laboratories. Estrogen receptor assessment of 1 laboratory was discordant: agreement was less than 90% for 3 of 5 reference values and greater than 90% with the use of 2 other reference values. Various reference values provide equivalent laboratory rating. In addition to descriptive feedback, our approach allows calculation of technical test sensitivity and specificity, positive and negative predictive values, agreement rates, and κ values to guide corrective actions.

  10. Towards an evidence-based approach for diagnosis and management of adnexal masses: findings of the International Ovarian Tumour Analysis (IOTA) studies.

    Science.gov (United States)

    Kaijser, J

    2015-01-01

    Whilst the outcomes for patients with ovarian cancer clearly benefit from centralised, comprehensive care in dedicated cancer centres, unfortunately the majority of patients still do not receive appropriate specialist treatment. Any improvement in the accuracy of current triaging and referral pathways whether using new imaging tests or biomarkers would therefore be of value in order to optimise the appropriate selection of patients for such care. An analysis of current evidence shows that such tests are now available, but still await recognition, acceptance and widespread adoption. It is therefore to be hoped that present guidance relating to the classification of ovarian masses will soon become more "evidence-based". These promising tests include the International Ovarian Tumour Analysis (IOTA) LR2 model and ultrasound-based Simple Rules (SR). Based on a comprehensive recent meta-analysis both currently offer the optimal "evidence-based" approach to discriminating between cancer and benign conditions in women with adnexal tumours needing surgery. LR2 and SR are reliable tests having been shown to maintain a high sensitivity for cancer after independent external and temporal validation by the IOTA group in the hands of examiners with various levels of ultrasound expertise. They also offer more accurate triage compared to the existing Risk of Malignancy Index (RMI). The development of the IOTA ADNEX model represents an important step forward towards more individualised patient care in this area. ADNEX is a novel test that enables the more specific subtyping of adnexal cancers (i.e. borderline, stage 1 invasive, stage II-IV invasive, and secondary metastatic malignant tumours) and shares similar levels of accuracy to IOTA LR2 and SR for basic discrimination between cancer and benign disease. The IOTA study has made significant progress in relation to the classification of adnexal masses, however what is now needed is to see if these or new diagnostic tools can assist

  11. Evidence-Based Development

    DEFF Research Database (Denmark)

    Hertzum, Morten; Simonsen, Jesper

    2004-01-01

    Systems development is replete with projects that represent substantial resource investments but result in systems that fail to meet users’ needs. Evidence-based development is an emerging idea intended to provide means for managing customer-vendor relationships and working systematically toward...... meeting customer needs. We are suggesting that the effects of the use of a system should play a prominent role in the contractual definition of IT projects and that contract fulfilment should be determined on the basis of evidence of these effects. Based on two ongoing studies of home-care management...

  12. The 'constructive regulation' of phosphates and phosphogypsum : a new, evidence-based approach to regulating a NORM industry vital to the global community

    International Nuclear Information System (INIS)

    Hilton, Julian; Birky, Brian; Johnston, A.E.

    2008-01-01

    Full text: IAEA has included phosphate production among twelve NORM industries identified for scrutiny and possible regulation. 'Wet' production results in 1) phosphoric acid, as phosphate essential for world-wide food production; and 2) phosphogypsum (PG), which in some countries is used in both agriculture and construction. Phosphate deposits contain 238 U and 232 Th and their decay products; some have sufficient U content for commercial recovery. This puts the industry within the scope of the IAEA Fundamental Safety Principles, and of the International Basic Safety Standards (BSS). Phosphogypsum is a test case for defining and managing NORM industry residues and wastes as typical activity concentrations are extremely low but worldwide stockpiles amount to billions of tonnes. In some jurisdictions, phosphogypsum is regulated as a hazardous, radioactive waste rather than as a resource - with costly results. The phosphate industry is undergoing its most profound change since World War II, led by surging demand from Brazil, Russia, India and China, Established production centres, such as Morocco, are increasing capacity; major new facilities are being built, such as Ma'aden, Saudi Arabia. In consequence, many local jurisdictions face unfamiliar challenges and seek guidance on how to proceed. New research both on phosphate and phosphogypsum has significantly changed our understanding of the domain. A five year study of phosphogypsum use in Huelva, Spain, presents a model of a coherent, evidence-based approach, grounded in sound policy, good science and best practices. The 'constructive regulation' approach builds directly on evidence and lessons learned from a long, continuous tradition of PG use in Spain, Brazil and the United States. It draws on the results of the Stack Free by '53? project to modify John Nash's cooperative game and bargaining theory as a basis for defining a new sustainable point of equilibrium in which phosphogypsum production and consumption are

  13. From market access to patient access: overview of evidence-based approaches for the reimbursement and pricing of pharmaceuticals in 36 European countries.

    Science.gov (United States)

    Panteli, Dimitra; Eckhardt, Helene; Nolting, Alexandra; Busse, Reinhard; Kulig, Michael

    2015-09-25

    Coverage decisions determining the benefit baskets of health systems have been increasingly relying on evidence regarding patient benefit and costs. Relevant structures, methodologies, and processes have especially been established for pharmaceuticals but approaches differ. The objective of this work was thus to identify institutions in a broad range of European countries (n = 36) in charge of determining the value of pharmaceuticals for pricing and reimbursement purposes and to map their decision-making process; to examine the different approaches and consider national and supranational possibilities for best practice. Institutions were identified through websites of international networks, ministries, and published literature. Details on institutional practices were supplemented with information from institution websites and linked online sources. The type and extent of information available varied considerably across countries. Different types of public regulatory bodies are involved in pharmaceutical coverage decisions, assuming a range of responsibilities. As a rule, the assessment of scientific evidence is kept structurally separate from its appraisal. Recommendations on value are uniformly issued by specific committees within or commissioned by responsible institutions; these institutions often also act as decision-makers on reimbursement status and level or market price. While effectiveness and costs are important criteria in all countries, the latter are often considered on a case-by-case basis. In all countries, manufacturer applications, including relevant evidence, are used as one of the main sources of information for the assessment. Transparency of evidence-based coverage decisions should be enhanced. International collaboration can facilitate knowledge exchange, improve efficiency of information production, and strengthen new or developing systems.

  14. A multi-level approach for investigating socio-economic and agricultural risk factors associated with rates of reported cases of Escherichia coli O157 in humans in Alberta, Canada.

    Science.gov (United States)

    Pearl, D L; Louie, M; Chui, L; Doré, K; Grimsrud, K M; Martin, S W; Michel, P; Svenson, L W; McEwen, S A

    2009-10-01

    Using negative binomial and multi-level Poisson models, the authors determined the statistical significance of agricultural and socio-economic risk factors for rates of reported disease associated with Escherichia coli O157 in census subdivisions (CSDs) in Alberta, Canada, 2000-2002. Variables relating to population stability, aboriginal composition of the CSDs, and the economic relationship between CSDs and urban centres were significant risk factors. The percentage of individuals living in low-income households was not a statistically significant risk factor for rates of disease. The statistical significance of cattle density, recorded at a higher geographical level, depended on the method used to correct for overdispersion, the number of levels included in the multi-level models, and the choice of using all reported cases or only sporadic cases. Our results highlight the importance of local socio-economic risk factors in determining rates of disease associated with E. coli O157, but their relationship with individual risk factors requires further evaluation.

  15. The 'Functional Landscape Approach': Building a socio-ecological evidence base for its contribution to adaptation and resilience in wetland catchments.

    Science.gov (United States)

    Carrie, Rachael; Dixon, Alan

    2015-04-01

    approaches that seek to achieve win-win outcomes for environment and society, and that place particular emphasis on embedding such thinking within and across government, local and community-based institutions. We will highlight, that although underpinned by sound environmental and social scientific concepts, and notwithstanding valuable anecdotal information, the FLA currently lacks robust scientific data as evidence in support of its use. Outlining why we attribute this issue partially to challenges associated with interdisciplinarity, we will introduce a project, at the conceptualisation stage, which seeks to build this evidence base. We will conclude by outlining opportunities for potential collaborations and invite contributions from the floor.

  16. The dynamic influence of human resources on evidence-based intervention sustainability and population outcomes: an agent-based modeling approach.

    Science.gov (United States)

    McKay, Virginia R; Hoffer, Lee D; Combs, Todd B; Margaret Dolcini, M

    2018-06-05

    Sustaining evidence-based interventions (EBIs) is an ongoing challenge for dissemination and implementation science in public health and social services. Characterizing the relationship among human resource capacity within an agency and subsequent population outcomes is an important step to improving our understanding of how EBIs are sustained. Although human resource capacity and population outcomes are theoretically related, examining them over time within real-world experiments is difficult. Simulation approaches, especially agent-based models, offer advantages that complement existing methods. We used an agent-based model to examine the relationships among human resources, EBI delivery, and population outcomes by simulating provision of an EBI through a hypothetical agency and its staff. We used data from existing studies examining a widely implemented HIV prevention intervention to inform simulation design, calibration, and validity. Once we developed a baseline model, we used the model as a simulated laboratory by systematically varying three human resource variables: the number of staff positions, the staff turnover rate, and timing in training. We tracked the subsequent influence on EBI delivery and the level of population risk over time to describe the overall and dynamic relationships among these variables. Higher overall levels of human resource capacity at an agency (more positions) led to more extensive EBI delivery over time and lowered population risk earlier in time. In simulations representing the typical human resource investments, substantial influences on population risk were visible after approximately 2 years and peaked around 4 years. Human resources, especially staff positions, have an important impact on EBI sustainability and ultimately population health. A minimum level of human resources based on the context (e.g., size of the initial population and characteristics of the EBI) is likely needed for an EBI to have a meaningful impact on

  17. Community-based human-elephant conflict mitigation: The value of an evidence-based approach in promoting the uptake of effective methods.

    Directory of Open Access Journals (Sweden)

    Donny Gunaryadi

    Full Text Available Human-elephant conflict (HEC is a serious threat to elephants and can cause major economic losses. It is widely accepted that reduction of HEC will often require community-based methods for repelling elephants but there are few tests of such methods. We tested community-based crop-guarding methods with and without novel chili-based elephant deterrents and describe changes in farmers' willingness to adopt these methods following our demonstration of their relative effectiveness. In three separate field-trials that took place over almost two years (October 2005 -May 2007 in two villages adjacent to Way Kambas National Park (WKNP in Indonesia, we found that community-based crop-guarding was effective at keeping Asian elephants (Elephas maximus out of crop fields in 91.2% (52 out of 57, 87.6% (156 out of 178, and 80.0% (16 out of 20 of attempted raids. Once the method had been shown to be effective at demonstration sites, farmers in 16 villages around WKNP voluntarily adopted it during the July 2008 to March 2009 period and were able to repel elephants in 73.9% (150 out of 203 of attempted raids, with seven villages repelling 100% of attempted raids. These 16 villages had all experienced high levels of HEC in the preceding years; e.g. they accounted for >97% of the 742 HEC incidents recorded for the entire park in 2006. Our work shows, therefore, that a simple evidence-based approach can facilitate significant reductions in HEC at the protected area scale.

  18. Top-down, bottom-up, and around the jungle gym: a social exchange and networks approach to engaging afterschool programs in implementing evidence-based practices.

    Science.gov (United States)

    Smith, Emilie Phillips; Wise, Eileen; Rosen, Howard; Rosen, Alison; Childs, Sharon; McManus, Margaret

    2014-06-01

    This paper uses concepts from social networks and social exchange theories to describe the implementation of evidence-based practices in afterschool programs. The members of the LEGACY Together Afterschool Project team have been involved in conducting collaborative research to migrate a behavioral strategy that has been documented to reduce disruptive behaviors in classroom settings to a new setting-that of afterschool programs. We adapted the Paxis Institute's version of the Good Behavior Game to afterschool settings which differ from in-school settings, including more fluid attendance, multiple age groupings, diverse activities that may take place simultaneously, and differences in staff training and experience (Barrish et al. in J Appl Behav Anal 2(2):119-124, 1969; Embry et al. in The Pax Good Behavior Game. Hazelden, Center City, 2003; Hynes et al. in J Child Serv 4(3):4-20, 2009; Kellam et al. in Drug Alcohol Depend 95:S5-S28, 2008; Tingstrom et al. in Behav Modif 30(2):225-253, 2006). This paper presents the experiences of the three adult groups involved in the implementation process who give first-person accounts of implementation: (1) university-based scientist-practitioners, (2) community partners who trained and provided technical assistance/coaching, and (3) an afterschool program administrator. We introduce here the AIMS model used to frame the implementation process conceptualized by this town-gown collaborative team. AIMS builds upon previous work in implementation science using four phases in which the three collaborators have overlapping roles: approach/engagement, implementation, monitoring, and sustainability. Within all four phases principles of Social Exchange Theory and Social Network Theory are highlighted.

  19. Evidence-based radiology: a new approach to evaluate the clinical practice of radiology; Evidenzbasierte Radiologie: Ein neuer Ansatz zur Bewertung von klinisch angewandter radiologischer Diagnostik und Therapie

    Energy Technology Data Exchange (ETDEWEB)

    Puig, S. [Univ.Klinik fuer Radiodiagnostik, Medizinische Univ. Wien (Austria); Forschungsprogramm fuer Evidenzbasierte Medizinische Diagnostik, Inst. fuer Public Health, Paracelsus Medizinische Privatuniversitaet, Salzburg (Austria); Felder-Puig, R. [Ludwig-Boltzmann-Inst. fuer Health Technology Assessment, Vienna (Austria)

    2006-07-15

    Over the last several years, the concept and methodology of evidence-based medicine (EBM) have received significant attention in the scientific community. However, compared to therapeutic medical disciplines, EBM-based radiological publications are still underrepresented. This article summarizes the principles of EBM and discusses the possibilities of their application in radiology. The presented topics include the critical appraisal of studies on the basis on EBM principles, the explanation of EBM-relevant statistical outcome parameters (e.g., ''likelihood ratio'' for diagnostic and ''number needed to treat'' for interventional procedures), as well as the problems facing evidence-based radiology. Evidence-based evaluation of radiological procedures does not only address aspects of cost-effectiveness, but is also particularly helpful in identifying patient-specific usefulness. Therefore it should become an integral part of radiologist training. (orig.)

  20. History of evidence-based medicine

    Directory of Open Access Journals (Sweden)

    Roger L Sur

    2011-01-01

    Full Text Available This essay reviews the historical circumstances surrounding the introduction and evolution of evidence-based medicine. Criticisms of the approach are also considered. Weaknesses of existing standards of clinical practice and efforts to bring more certainty to clinical decision making were the foundation for evidence-based medicine, which integrates epidemiology and medical research. Because of its utility in designing randomized clinical trials, assessing the quality of the literature, and applying medical research at the bedside, evidence-based medicine will continue to have a strong influence on everyday clinical practice.

  1. Exploring the Impact of Parental Psychopathology and Emotion Regulation on Evidence-Based Parenting Interventions: A Transdiagnostic Approach to Improving Treatment Effectiveness

    Science.gov (United States)

    Maliken, Ashley C.; Katz, Lynn Fainsilber

    2013-01-01

    Parenting interventions, particularly those categorized as parent management training (PMT), have a large evidence base supporting their effectiveness with most families who present for treatment of childhood behavior problems. However, data suggest that PMTs are not effective at treating all families who seek services. Parental psychopathology…

  2. Practical Diagnosis and Management of Dementia Due to Alzheimer’s Disease in the Primary Care Setting: An Evidence-Based Approach

    OpenAIRE

    Geldmacher, David S.; Kerwin, Diana R.

    2013-01-01

    Objective: To review evidence-based guidance on the primary care of Alzheimer’s disease and clinical research on models of primary care for Alzheimer’s disease to present a practical summary for the primary care physician regarding the assessment and management of the disease.

  3. Evidence-based management.

    Science.gov (United States)

    Pfeffer, Jeffrey; Sutton, Robert I

    2006-01-01

    For the most part, managers looking to cure their organizational ills rely on obsolete knowledge they picked up in school, long-standing but never proven traditions, patterns gleaned from experience, methods they happen to be skilled in applying, and information from vendors. They could learn a thing or two from practitioners of evidence-based medicine, a movement that has taken the medical establishment by storm over the past decade. A growing number of physicians are eschewing the usual, flawed resources and are instead identifying, disseminating, and applying research that is soundly conducted and clinically relevant. It's time for managers to do the same. The challenge is, quite simply, to ground decisions in the latest and best knowledge of what actually works. In some ways, that's more difficult to do in business than in medicine. The evidence is weaker in business; almost anyone can (and many people do) claim to be a management expert; and a motley crew of sources--Shakespeare, Billy Graham,Jack Welch, Attila the Hunare used to generate management advice. Still, it makes sense that when managers act on better logic and strong evidence, their companies will beat the competition. Like medicine, management is learned through practice and experience. Yet managers (like doctors) can practice their craft more effectively if they relentlessly seek new knowledge and insight, from both inside and outside their companies, so they can keep updating their assumptions, skills, and knowledge.

  4. Evidence-based surgery

    Directory of Open Access Journals (Sweden)

    Miran Rems

    2007-04-01

    Full Text Available Background: Surgery is setting a new ground by the reign of evidence that was brought up by the Evidence Based Medicine (EBM. While experiences and opinion of an expert count the least by the principles of EBM, randomized controlled trials (RCT and other comparative studies have gained their importance. Recommendations that were included in guidelines represent a demanding shift in surgeon’s professional thinking. Their thinking and classical education have not yet been completely based on the results of such studies and are still very very much master-pupil centred. Assessment of someone’s own experiences is threatened by objectivity as negative experiences get recorded in deeper memory. Randomized studies and meta-analyses do appear also in surgery. However, they demand an extra knowledge about critical assessment.Conclusions: Setting a patient to the foreground brings a surgeon’s decision to the field of EBM. The process has already begun and cannot be avoided. Decision hierarchy moves from the experience field to the evidence territory but to a lesser extent when compared to the rest of medicine. There exist objective restrictions with approving a new paradigm. However, these should not stop the process of EBM implementation. Finally, there is an ethic issue to be considered. Too slow activities in research, education and critical assessment can bring the surgeon to the position when a well-informed patient loses his/her trust.

  5. Partnership for Healthier Asians: Disseminating Evidence-Based Practices in Asian-American Communities Using a Market-Oriented and Multilevel Approach

    Science.gov (United States)

    Kim, Karen; Quinn, Michael; Chandrasekar, Edwin; Patel, Reena

    2016-01-01

    Background One of the greatest challenges facing health promotion and disease prevention is translating research findings into evidence-based practices (EBP). There is currently a limited research base to inform the design of dissemination action plans, especially within medically underserved communities. Objective The objective of this paper is to describe an innovative study protocol to disseminate colorectal cancer (CRC) screening guidelines in seven Asian subgroups. Methods This study integrated a market-oriented Push-Pull-Infrastructure Model, Diffusion of Innovation Theory, and community-based participatory research approach to create a community-centered dissemination framework. Consumer research, through focus groups and community-wide surveys, was centered on the adopters to ensure a multilevel intervention was well designed and effective. Results Collaboration took place between an academic institution and eight community-based organizations. These groups worked together to conduct thorough consumer research. A sample of 72 Asian Americans participated in 8 focus groups, and differences were noted across ethnic groups. Furthermore, 464 community members participated in an Individual Client Survey. Most participants agreed that early detection of cancer was important (434/464, 93.5%), cancer could happen to anyone (403/464, 86.9%), CRC could be prevented (344/464, 74.1%), and everyone should screen for CRC (389/464, 83.8%). However, 35.8% (166/464) of participants also felt that people were better off not knowing it they had cancer, and 45.5% (211/464) would screen only when they had symptoms. Most participants indicated that they would screen upon their doctor’s recommendation, but half reported that they only saw a doctor when they were sick. Data collection currently is underway for a multilevel intervention (community health advisor and social marketing campaign) and will conclude March 2016. We expect that analysis and results will be available by

  6. Partnership for Healthier Asians: Disseminating Evidence-Based Practices in Asian-American Communities Using a Market-Oriented and Multilevel Approach.

    Science.gov (United States)

    Kim, Karen; Quinn, Michael; Chandrasekar, Edwin; Patel, Reena; Lam, Helen

    2016-06-16

    One of the greatest challenges facing health promotion and disease prevention is translating research findings into evidence-based practices (EBP). There is currently a limited research base to inform the design of dissemination action plans, especially within medically underserved communities. The objective of this paper is to describe an innovative study protocol to disseminate colorectal cancer (CRC) screening guidelines in seven Asian subgroups. This study integrated a market-oriented Push-Pull-Infrastructure Model, Diffusion of Innovation Theory, and community-based participatory research approach to create a community-centered dissemination framework. Consumer research, through focus groups and community-wide surveys, was centered on the adopters to ensure a multilevel intervention was well designed and effective. Collaboration took place between an academic institution and eight community-based organizations. These groups worked together to conduct thorough consumer research. A sample of 72 Asian Americans participated in 8 focus groups, and differences were noted across ethnic groups. Furthermore, 464 community members participated in an Individual Client Survey. Most participants agreed that early detection of cancer was important (434/464, 93.5%), cancer could happen to anyone (403/464, 86.9%), CRC could be prevented (344/464, 74.1%), and everyone should screen for CRC (389/464, 83.8%). However, 35.8% (166/464) of participants also felt that people were better off not knowing it they had cancer, and 45.5% (211/464) would screen only when they had symptoms. Most participants indicated that they would screen upon their doctor's recommendation, but half reported that they only saw a doctor when they were sick. Data collection currently is underway for a multilevel intervention (community health advisor and social marketing campaign) and will conclude March 2016. We expect that analysis and results will be available by June 2016. This study outlines a

  7. A Container-based Trusted Multi-level Security Mechanism

    Directory of Open Access Journals (Sweden)

    Li Xiao-Yong

    2017-01-01

    Full Text Available Multi-level security mechanism has been widely applied in the military, government, defense and other domains in which information is required to be divided by security-level. Through this type of security mechanism, users at different security levels are provided with information at corresponding security levels. Traditional multi-level security mechanism which depends on the safety of operating system finally proved to be not practical. We propose a container-based trusted multi-level security mechanism in this paper to improve the applicability of the multi-level mechanism. It guarantees multi-level security of the system through a set of multi-level security policy rules and trusted techniques. The technical feasibility and application scenarios are also discussed. The ease of realization, strong practical significance and low cost of our method will largely expand the application of multi-level security mechanism in real life.

  8. A multi-level modeling approach examining PTSD symptom reduction during prolonged exposure therapy: moderating effects of number of trauma types experienced, having an HIV-related index trauma, and years since HIV diagnosis among HIV-positive adults.

    Science.gov (United States)

    Junglen, Angela G; Smith, Brian C; Coleman, Jennifer A; Pacella, Maria L; Boarts, Jessica M; Jones, Tracy; Feeny, Norah C; Ciesla, Jeffrey A; Delahanty, Douglas L

    2017-11-01

    People living with HIV (PLWH) have extensive interpersonal trauma histories and higher rates of posttraumatic stress disorder (PTSD) than the general population. Prolonged exposure (PE) therapy is efficacious in reducing PTSD across a variety of trauma samples; however, research has not examined factors that influence how PTSD symptoms change during PE for PLWH. Using multi-level modeling, we examined the potential moderating effect of number of previous trauma types experienced, whether the index trauma was HIV-related or not, and years since HIV diagnosis on PTSD symptom reduction during a 10-session PE protocol in a sample of 51 PLWH. In general, PTSD symptoms decreased linearly throughout the PE sessions. Experiencing more previous types of traumatic events was associated with a slower rate of PTSD symptom change. In addition, LOCF analyses found that participants with a non-HIV-related versus HIV-related index trauma had a slower rate of change for PTSD symptoms over the course of PE. However, analyses of raw data decreased this finding to marginal. Years since HIV diagnosis did not impact PTSD symptom change. These results provide a better understanding of how to tailor PE to individual clients and aid clinicians in approximating the rate of symptom alleviation. Specifically, these findings underscore the importance of accounting for trauma history and index trauma type when implementing a treatment plan for PTSD in PLWH.

  9. Just how multi-level is leadership research? : A document co-citation analysis 1980–2013 on leadership constructs and outcomes

    NARCIS (Netherlands)

    Batistic, S.; Cerne, Matej; Vogel, Bernd

    2017-01-01

    The use of multi-level theories and methodologies in leadership has gained momentum in recent years. However, the leadership field still suffers from a fragmented and unclear evolution and practice of multi-level approaches. The questions of how and to what extent multi-level research has evolved in

  10. Evidence-based management: a literature review.

    Science.gov (United States)

    Young, Sam K

    2002-05-01

    This paper presents a review of evidence-based management (EBM), exploring whether management activities within healthcare have been, or can be, subject to the same scientific framework as clinical practice. The evidence-based approach was initially examined, noting the hierarchy of evidence ranging from randomized control trials to clinical anecdote. The literature varied in its degree of criticism of this approach; the most common concern referring to the assumed superiority of positivism. However, evidence-based practice was generally accepted as the best way forward. Stewart (1998) offered the only detailed exposition of EBM, outlining a necessary 'attitude of mind' both for EBM and for the creation of a research culture. However, the term 'clinical effectiveness' emerged as a possible replacement buzz-word for EBM (McClarey 1998). The term appears to encompass the sentiments of the evidence-based approach, but with a concomitant concern for economic factors. In this paper the author has examined the divide between those who viewed EBM as an activity for managers to make their own practice accountable and those who believed it to be a facilitative practice to help clinicians with evidence-based practice. Most papers acknowledged the limited research base for management activities within the health service and offered some explanation such as government policy constraints and lack of time. Nevertheless, the overall emphasis is that ideally there should be a management culture firmly based in evidence.

  11. An evidence-based approach to case management model selection for an acute care facility: is there really a preferred model?

    Science.gov (United States)

    Terra, Sandra M

    2007-01-01

    This research seeks to determine whether there is adequate evidence-based justification for selection of one acute care case management model over another. Acute Inpatient Hospital. This article presents a systematic review of published case management literature, resulting in classification specific to terms of level of evidence. This review examines the best available evidence in an effort to select an acute care case management model. Although no single case management model can be identified as preferred, it is clear that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and to form a foundation for the efficacy of hospital case management practice. Although no single case management model can be identified as preferred, this systematic review demonstrates that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and forming a foundation for the efficacy of hospital case management practice. Distinctive aspects of case management frameworks can be used to guide the development of an acute care case management model. The study illustrates: * The effectiveness of case management when there is direct patient contact by the case manager regardless of disease condition: not only does the quality of care increase but also length of stay (LOS) decreases, care is defragmented, and both patient and physician satisfaction can increase. * The preferred case management models result in measurable outcomes that can directly relate to, and demonstrate alignment with, organizational strategy. * Acute care management programs reduce cost and LOS, and improve outcomes. * An integrated case management program that includes social workers, as well as nursing, is the most effective acute care management model. * The successful case management model will recognize physicians, as well as patients, as valued customers with whom partnership can positively affect financial outcomes in terms of

  12. Three essays on multi-level optimization models and applications

    Science.gov (United States)

    Rahdar, Mohammad

    The general form of a multi-level mathematical programming problem is a set of nested optimization problems, in which each level controls a series of decision variables independently. However, the value of decision variables may also impact the objective function of other levels. A two-level model is called a bilevel model and can be considered as a Stackelberg game with a leader and a follower. The leader anticipates the response of the follower and optimizes its objective function, and then the follower reacts to the leader's action. The multi-level decision-making model has many real-world applications such as government decisions, energy policies, market economy, network design, etc. However, there is a lack of capable algorithms to solve medium and large scale these types of problems. The dissertation is devoted to both theoretical research and applications of multi-level mathematical programming models, which consists of three parts, each in a paper format. The first part studies the renewable energy portfolio under two major renewable energy policies. The potential competition for biomass for the growth of the renewable energy portfolio in the United States and other interactions between two policies over the next twenty years are investigated. This problem mainly has two levels of decision makers: the government/policy makers and biofuel producers/electricity generators/farmers. We focus on the lower-level problem to predict the amount of capacity expansions, fuel production, and power generation. In the second part, we address uncertainty over demand and lead time in a multi-stage mathematical programming problem. We propose a two-stage tri-level optimization model in the concept of rolling horizon approach to reducing the dimensionality of the multi-stage problem. In the third part of the dissertation, we introduce a new branch and bound algorithm to solve bilevel linear programming problems. The total time is reduced by solving a smaller relaxation

  13. Practical Diagnosis and Management of Dementia Due to Alzheimer’s Disease in the Primary Care Setting: An Evidence-Based Approach

    Science.gov (United States)

    Kerwin, Diana R.

    2013-01-01

    Objective: To review evidence-based guidance on the primary care of Alzheimer’s disease and clinical research on models of primary care for Alzheimer’s disease to present a practical summary for the primary care physician regarding the assessment and management of the disease. Data Sources: References were obtained via search using keywords Alzheimer’s disease AND primary care OR collaborative care OR case finding OR caregivers OR guidelines. Articles were limited to English language from January 1, 1990, to January 1, 2013. Study Selection: Articles were reviewed and selected on the basis of study quality and pertinence to this topic, covering a broad range of data and opinion across geographical regions and systems of care. The most recent published guidelines from major organizations were included. Results: Practice guidelines contained numerous points of consensus, with most advocating a central role for the primary care physician in the detection, diagnosis, and treatment of Alzheimer’s disease. Review of the literature indicated that optimal medical and psychosocial care for people with Alzheimer’s disease and their caregivers may be best facilitated through collaborative models of care involving the primary care physician working within a wider interdisciplinary team. Conclusions: Evidence-based guidelines assign the primary care physician a critical role in the care of people with Alzheimer’s disease. Research on models of care suggests the need for an appropriate medical/nonmedical support network to fulfill this role. Given the diversity and breadth of services required and the necessity for close coordination, nationwide implementation of team-based, collaborative care programs may represent the best option for improving care standards for patients with Alzheimer’s disease. PMID:24392252

  14. Multi-level converter with auxiliary resonant-commutated pole

    NARCIS (Netherlands)

    Dijkhuizen, F.R.; Duarte, J.L.; Groningen, van W.D.H.

    1998-01-01

    The family of multi-level power converters offers advantages for high-power, high-voltage systems. A multi-level nested-cell structure has the attractive feature of static and dynamic voltage sharing among the switches. This is achieved by using clamping capacitors (floating capacitors) rather than

  15. Multi-level molecular modelling for plasma medicine

    International Nuclear Information System (INIS)

    Bogaerts, Annemie; Khosravian, Narjes; Van der Paal, Jonas; Verlackt, Christof C W; Yusupov, Maksudbek; Kamaraj, Balu; Neyts, Erik C

    2016-01-01

    Modelling at the molecular or atomic scale can be very useful for obtaining a better insight in plasma medicine. This paper gives an overview of different atomic/molecular scale modelling approaches that can be used to study the direct interaction of plasma species with biomolecules or the consequences of these interactions for the biomolecules on a somewhat longer time-scale. These approaches include density functional theory (DFT), density functional based tight binding (DFTB), classical reactive and non-reactive molecular dynamics (MD) and united-atom or coarse-grained MD, as well as hybrid quantum mechanics/molecular mechanics (QM/MM) methods. Specific examples will be given for three important types of biomolecules, present in human cells, i.e. proteins, DNA and phospholipids found in the cell membrane. The results show that each of these modelling approaches has its specific strengths and limitations, and is particularly useful for certain applications. A multi-level approach is therefore most suitable for obtaining a global picture of the plasma–biomolecule interactions. (paper)

  16. Evidence-based management - healthcare manager viewpoints.

    Science.gov (United States)

    Janati, Ali; Hasanpoor, Edris; Hajebrahimi, Sakineh; Sadeghi-Bazargani, Homayoun

    2018-06-11

    Purpose Hospital manager decisions can have a significant impact on service effectiveness and hospital success, so using an evidence-based approach can improve hospital management. The purpose of this paper is to identify evidence-based management (EBMgt) components and challenges. Consequently, the authors provide an improving evidence-based decision-making framework. Design/methodology/approach A total of 45 semi-structured interviews were conducted in 2016. The authors also established three focus group discussions with health service managers. Data analysis followed deductive qualitative analysis guidelines. Findings Four basic themes emerged from the interviews, including EBMgt evidence sources (including sub-themes: scientific and research evidence, facts and information, political-social development plans, managers' professional expertise and ethical-moral evidence); predictors (sub-themes: stakeholder values and expectations, functional behavior, knowledge, key competencies and skill, evidence sources, evidence levels, uses and benefits and government programs); EBMgt barriers (sub-themes: managers' personal characteristics, decision-making environment, training and research system and organizational issues); and evidence-based hospital management processes (sub-themes: asking, acquiring, appraising, aggregating, applying and assessing). Originality/value Findings suggest that most participants have positive EBMgt attitudes. A full evidence-based hospital manager is a person who uses all evidence sources in a six-step decision-making process. EBMgt frameworks are a good tool to manage healthcare organizations. The authors found factors affecting hospital EBMgt and identified six evidence sources that healthcare managers can use in evidence-based decision-making processes.

  17. Unpacking the Black Box: A Formative Research Approach to the Development of Theory-Driven, Evidence-Based, and Culturally Safe Text Messages in Mobile Health Interventions.

    Science.gov (United States)

    Maar, Marion A; Yeates, Karen; Toth, Zsolt; Barron, Marcia; Boesch, Lisa; Hua-Stewart, Diane; Liu, Peter; Perkins, Nancy; Sleeth, Jessica; Wabano, Mary Jo; Williamson, Pamela; Tobe, Sheldon W

    2016-01-22

    Mobile-cellular subscriptions have increased steadily over the past decade. The accessibility of SMS messages over existing mobile networks is high and has almost universal availability even on older and unsophisticated mobile phones and in geographic settings where wireless coverage is weak. There is intensive exploration of this inexpensive mobile telecommunication technology to improve health services and promote behavior change among vulnerable populations. However, a neglected area of research is the documentation and critical analysis of the formative research process required in the development and refinement of effective SMS messages. The objective of this qualitative research study was to identify major factors that may impact on the effectiveness of evidence-based SMS messages designed to reduce health inequities in hypertension management in low resource settings, including Aboriginal populations in high-income countries and rural populations in low-income countries. Specifically, we were interested in uncovering the range of mediators that impact on appropriate message content transmission and, ultimately, on health behavior improvements in a range of these sociocultural settings. Collaborative qualitative research with Canadian Aboriginal and Tanzanian participants was conducted to deconstruct the content and transmission of evidence-based health information contained in SMS messages in the context of an international research project designed to address health inequalities in hypertension, and to develop a grounded theory of the major factors that mediate the effectiveness of this communication. We also examined the interrelationship of these mediators with the three essential conditions of the behavior system of the Behavioral Change Wheel model (capability, opportunity, and motivation) and cultural safety. Four focus groups with a total of 45 participants were conducted. Our grounded theory research revealed how discrepancies develop between the

  18. Evidence-based radiology: why and how?

    International Nuclear Information System (INIS)

    Sardanelli, Francesco; Di Leo, Giovanni; Hunink, Myriam G.; Gilbert, Fiona J.; Krestin, Gabriel P.

    2010-01-01

    To provide an overview of evidence-based medicine (EBM) in relation to radiology and to define a policy for adoption of this principle in the European radiological community. Starting from Sackett's definition of EBM we illustrate the top-down and bottom-up approaches to EBM as well as EBM's limitations. Delayed diffusion and peculiar features of evidence-based radiology (EBR) are defined with emphasis on the need to shift from the demonstration of the increasing ability to see more and better, to the demonstration of a significant change in treatment planning or, at best, of a significant gain in patient outcome. The ''as low as reasonably achievable'' (ALARA) principle is thought as a dimension of EBR while EBR is proposed as part of the core curriculum of radiology residency. Moreover, we describe the process of health technology assessment in radiology with reference to the six-level scale of hierarchy of studies on diagnostic tests, the main sources of bias in studies on diagnostic performance, and levels of evidence and degrees of recommendations according to the Centre for Evidence-Based Medicine (Oxford, UK) as well as the approach proposed by the GRADE working group. Problems and opportunities offered by evidence-based guidelines in radiology are considered. Finally, we suggest nine points to be actioned by the ESR in order to promote EBR. Radiology will benefit greatly from the improvement in practice that will result from adopting this more rigorous approach to all aspects of our work. (orig.)

  19. Evidence-based cancer imaging

    Energy Technology Data Exchange (ETDEWEB)

    Shinagare, Atul B.; Khorasani, Ramin [Dept. of Radiology, Brigham and Women' s Hospital, Boston (Korea, Republic of)

    2017-01-15

    With the advances in the field of oncology, imaging is increasingly used in the follow-up of cancer patients, leading to concerns about over-utilization. Therefore, it has become imperative to make imaging more evidence-based, efficient, cost-effective and equitable. This review explores the strategies and tools to make diagnostic imaging more evidence-based, mainly in the context of follow-up of cancer patients.

  20. [Approach to Evidence-based Medicine Exercises Using Flipped Teaching: Introductory Education for Clinical Practice for 4th-Year Pharmacy Students].

    Science.gov (United States)

    Onda, Mitsuko; Takagaki, Nobumasa

    2018-01-01

     Osaka University of Pharmaceutical Sciences has included an evidence-based medicine (EBM) exercise in the introductory education for clinical practice for 4th-year pharmacy students since 2015. The purpose of this exercise is to learn the process of practice and basic concepts of EBM, especially to cultivate the practical ability to solve patients' problems and answer their questions. Additionally, in 2016, we have attempted flipped teaching. The students are instructed to review the basic knowledge necessary for active learning in this exercise by watching video teaching materials and to bring reports summarizing the contents on the flipped teaching days. The program includes short lectures [overview of EBM, document retrieval, randomized controlled trials (RCTs), and systematic review], exercises [patient, intervention, comparison, outcome (PICO) structuring, critical appraisal of papers in small groups with tutors], and presentations. The program includes: step 1, PICO structuring based on scenarios; step 2, critical appraisal of English-language papers on RCTs using evaluation worksheets; and step 3, reviewing the results of the PICO exercise with patients. The results of the review are shared among groups through general discussion. In this symposium, I discuss students' attitudes, the effectiveness of small group discussions using flipped teaching, and future challenges to be addressed in this program.

  1. Identifying the Factors Affecting Papers' Citability in the Field of Medicine: an Evidence-based Approach Using 200 Highly and Lowly-cited Papers.

    Science.gov (United States)

    Yaminfirooz, Mousa; Ardali, Farzaneh Raeesi

    2018-01-01

    Nowadays, publishing highly-cited papers is important for researchers and editors. In this evidence-based study, the factors influencing the citability of published papers in the field of medicine have been identified. 200 papers indexed in Scopus (in two groups: highly-cited and lowly-cited) with 100 papers in each were studied. Needed data were manually collected with a researcher-made checklist. Data analysis was done in SPSS using descriptive and inferential statistics. Variables such as journal IF, journal rank, journal subject quartile, the first/corresponding author's h-index, the number of documents produced by the first/corresponding author, SJR and SNIP had significantly positive correlation with paper citability (ppaper age, paper type, the number of references, the number of authors, indexing institute and journal kind had not any relationship with paper citability (p> .05). the factors affecting the citability are among indicators relating to authors, publishing journals and published papers. Determining the extent to which these factors influence the citability of a paper needs further large-scaled research. Authors and editors searching for high-citedness should consider these factors when authoring and publishing papers.

  2. Identifying the Factors Affecting Papers’ Citability in the Field of Medicine: an Evidence-based Approach Using 200 Highly and Lowly-cited Papers

    Science.gov (United States)

    Yaminfirooz, Mousa; Ardali, Farzaneh Raeesi

    2018-01-01

    Introduction: Nowadays, publishing highly-cited papers is important for researchers and editors. In this evidence-based study, the factors influencing the citability of published papers in the field of medicine have been identified. Material and Methods: 200 papers indexed in Scopus (in two groups: highly-cited and lowly-cited) with 100 papers in each were studied. Needed data were manually collected with a researcher-made checklist. Data analysis was done in SPSS using descriptive and inferential statistics. Results: Variables such as journal IF, journal rank, journal subject quartile, the first/corresponding author’s h-index, the number of documents produced by the first/corresponding author, SJR and SNIP had significantly positive correlation with paper citability (ppaper age, paper type, the number of references, the number of authors, indexing institute and journal kind had not any relationship with paper citability (p> .05). Conclusion: the factors affecting the citability are among indicators relating to authors, publishing journals and published papers. Determining the extent to which these factors influence the citability of a paper needs further large-scaled research. Authors and editors searching for high-citedness should consider these factors when authoring and publishing papers. PMID:29719306

  3. Social Media for the Promotion of Holistic Self-Participatory Care: An Evidence Based Approach. Contribution of the IMIA Social Media Working Group.

    Science.gov (United States)

    Miron-Shatz, T; Hansen, M M; Grajales, F J; Martin-Sanchez, F; Bamidis, P D

    2013-01-01

    As health information is becoming increasingly accessible, social media offers ample opportunities to track, be informed, share and promote health. These authors explore how social media and holistic care may work together; more specifically however, our objective is to document, from different perspectives, how social networks have impacted, supported and helped sustain holistic self-participatory care. A literature review was performed to investigate the use of social media for promoting health in general and complementary alternative care. We also explore a case study of an intervention for improving the health of Greek senior citizens through digital and other means. The Health Belief Model provides a framework for assessing the benefits of social media interventions in promoting comprehensive participatory self-care. Some interventions are particularly effective when integrating social media with real-world encounters. Yet not all social media tools are evidence-based and efficacious. Interestingly, social media is also used to elicit patient ratings of treatments (e.g., for depression), often demonstrating the effectiveness of complementary treatments, such as yoga and mindfulness meditation. To facilitate the use of social media for the promotion of complementary alternative medicine through self-quantification, social connectedness and sharing of experiences, exploration of concrete and abstract ideas are presented here within. The main mechanisms by which social support may help improve health - emotional support, an ability to share experiences, and non-hierarchal roles, emphasizing reciprocity in giving and receiving support - are integral to social media and provide great hope for its effective use.

  4. Evidence based medical imaging (EBMI)

    International Nuclear Information System (INIS)

    Smith, Tony

    2008-01-01

    Background: The evidence based paradigm was first described about a decade ago. Previous authors have described a framework for the application of evidence based medicine which can be readily adapted to medical imaging practice. Purpose: This paper promotes the application of the evidence based framework in both the justification of the choice of examination type and the optimisation of the imaging technique used. Methods: The framework includes five integrated steps: framing a concise clinical question; searching for evidence to answer that question; critically appraising the evidence; applying the evidence in clinical practice; and, evaluating the use of revised practices. Results: This paper illustrates the use of the evidence based framework in medical imaging (that is, evidence based medical imaging) using the examples of two clinically relevant case studies. In doing so, a range of information technology and other resources available to medical imaging practitioners are identified with the intention of encouraging the application of the evidence based paradigm in radiography and radiology. Conclusion: There is a perceived need for radiographers and radiologists to make greater use of valid research evidence from the literature to inform their clinical practice and thus provide better quality services

  5. Barriers and outcomes of an evidence-based approach to diagnosis and management of chronic obstructive pulmonary disease (COPD) in Australia: a qualitative study.

    Science.gov (United States)

    Dennis, Sarah; Reddel, Helen K; Middleton, Sandy; Hasan, Iqbal; Hermiz, Oshana; Phillips, Rosemary; Crockett, Alan J; Vagholkar, Sanjyot; Marks, Guy B; Zwar, Nicholas

    2017-08-01

    Chronic obstructive pulmonary disease (COPD) is commonly managed in primary care but there is poor awareness of evidence-based guidelines and the quality and interpretation of spirometry is suboptimal. The aims of this qualitative study were to explore how an intervention involving case finding and management of COPD was implemented, and the extent to which the GPs and practice nurses (PNs) worked in partnership to diagnose and manage COPD. Semi-structured interviews with PNs (n = 7), GPs (n = 4) and patients (n = 26) who had participated in the Primary care EarLy Intervention for Copd mANagement (PELICAN) study. The Theoretical Domains Framework was used to guide the coding and analysis of the interviews with PN and GPs. The patient interviews were analysed thematically. PNs developed technical skills and understood the requirements for good-quality spirometry. However, many lacked confidence in its interpretation and felt this was not part of their professional role. This was reflected in responses from the GPs. Once COPD was diagnosed, the GPs tended to manage the patients with the PNs less involved. This was in contrast with PNs' active role in managing patients with other chronic diseases such as diabetes. The extent to which the GPs and PNs worked in partnership to manage COPD varied. PNs improved their skills and confidence in performing spirometry. Beliefs about their professional role, identity and confidence influenced the extent to which PNs were involved in interpretation of the spirometry results and managing the patient in partnership with the GP. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Art or Science? An Evidence-Based Approach to Human Facial Beauty a Quantitative Analysis Towards an Informed Clinical Aesthetic Practice.

    Science.gov (United States)

    Harrar, Harpal; Myers, Simon; Ghanem, Ali M

    2018-02-01

    Patients often seek guidance from the aesthetic practitioners regarding treatments to enhance their 'beauty'. Is there a science behind the art of assessment and if so is it measurable? Through the centuries, this question has challenged scholars, artists and surgeons. This study aims to undertake a review of the evidence behind quantitative facial measurements in assessing beauty to help the practitioner in everyday aesthetic practice. A Medline, Embase search for beauty, facial features and quantitative analysis was undertaken. Inclusion criteria were studies on adults, and exclusions included studies undertaken for dental, cleft lip, oncology, burns or reconstructive surgeries. The abstracts and papers were appraised, and further studies excluded that were considered inappropriate. The data were extracted using a standardised table. The final dataset was appraised in accordance with the PRISMA checklist and Holland and Rees' critique tools. Of the 1253 studies screened, 1139 were excluded from abstracts and a further 70 excluded from full text articles. The remaining 44 were assessed qualitatively and quantitatively. It became evident that the datasets were not comparable. Nevertheless, common themes were obvious, and these were summarised. Despite measures of the beauty of individual components to the sum of all the parts, such as symmetry and the golden ratio, we are yet far from establishing what truly constitutes quantitative beauty. Perhaps beauty is truly in the 'eyes of the beholder' (and perhaps in the eyes of the subject too). This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  7. Transition in governance of river basin management in The Netherlands through multi-level social learning

    NARCIS (Netherlands)

    Van Herk, S.; Rijke, J.S.; Zevenbergen, C.; Ashley, R.

    2012-01-01

    This paper presents a case study of a new adaptive, multi-level governance approach that supported a transition in river basin management in the Netherlands. The floods of 1993 and 1995 in the Netherlands triggered a paradigm shift in flood management. The 2.3 billion Euro flood safety programme

  8. Due date assignment procedures with dynamically updated coefficients for multi-level assembly job shops

    NARCIS (Netherlands)

    Adam, N.R.; Bertrand, J.W.M.; Morehead, D.C.; Surkis, J.

    1993-01-01

    This paper presents a study of due date assignment procedures in job shop environments where multi-level assembly jobs are processed and due dates are internally assigned. Most of the reported studies in the literature have focused on string type jobs. We propose a dynamic update approach (which

  9. The metabolic response of P. putida KT2442 producing high levels of polyhydroxyalkanoate under single- and multiple-nutrient-limited growth: Highlights from a multi-level omics approach

    Directory of Open Access Journals (Sweden)

    Poblete-Castro Ignacio

    2012-03-01

    Full Text Available Abstract Background Pseudomonas putida KT2442 is a natural producer of polyhydroxyalkanoates (PHAs, which can substitute petroleum-based non-renewable plastics and form the basis for the production of tailor-made biopolymers. However, despite the substantial body of work on PHA production by P. putida strains, it is not yet clear how the bacterium re-arranges its whole metabolism when it senses the limitation of nitrogen and the excess of fatty acids as carbon source, to result in a large accumulation of PHAs within the cell. In the present study we investigated the metabolic response of KT2442 using a systems biology approach to highlight the differences between single- and multiple-nutrient-limited growth in chemostat cultures. Results We found that 26, 62, and 81% of the cell dry weight consist of PHA under conditions of carbon, dual, and nitrogen limitation, respectively. Under nitrogen limitation a specific PHA production rate of 0.43 (g·(g·h-1 was obtained. The residual biomass was not constant for dual- and strict nitrogen-limiting growth, showing a different feature in comparison to other P. putida strains. Dual limitation resulted in patterns of gene expression, protein level, and metabolite concentrations that substantially differ from those observed under exclusive carbon or nitrogen limitation. The most pronounced differences were found in the energy metabolism, fatty acid metabolism, as well as stress proteins and enzymes belonging to the transport system. Conclusion This is the first study where the interrelationship between nutrient limitations and PHA synthesis has been investigated under well-controlled conditions using a system level approach. The knowledge generated will be of great assistance for the development of bioprocesses and further metabolic engineering work in this versatile organism to both enhance and diversify the industrial production of PHAs.

  10. Canadian Helicobacter Study Group Consensus Conference: Update on the Approach to Helicobacter Pylori Infection in Children and Adolescents – an Evidence-Based Evaluation

    Directory of Open Access Journals (Sweden)

    Nicola L Jones

    2005-01-01

    Full Text Available As an update to previously published recommendations for the management of Helicobacter pylori infection, an evidence-based appraisal of 14 topics was undertaken in a consensus conference sponsored by the Canadian Helicobacter Study Group. The goal was to update guidelines based on the best available evidence using an established and uniform methodology to address and formulate recommendations for each topic. The degree of consensus for each recommendation is also presented. The clinical issues addressed and recommendations made were: population-based screening for H pylori in asymptomatic children to prevent gastric cancer is not warranted; testing for H pylori in children should be considered if there is a family history of gastric cancer; the goal of diagnostic interventions should be to determine the cause of presenting gastrointestinal symptoms and not the presence of H pylori infection; recurrent abdominal pain of childhood is not an indication to test for H pylori infection; H pylori testing is not required in patients with newly diagnosed gastroesophageal reflux disease; H pylori testing may be considered before the use of long-term proton pump inhibitor therapy; testing for H pylori infection should be considered in children with refractory iron deficiency anemia when no other cause has been found; when investigation of pediatric patients with persistent or severe upper abdominal symptoms is indicated, upper endoscopy with biopsy is the investigation of choice; the 13C-urea breath test is currently the best noninvasive diagnostic test for H pylori infection in children; there is currently insufficient evidence to recommend stool antigen tests as acceptable diagnostic tools for H pylori infection; serological antibody tests are not recommended as diagnostic tools for H pylori infection in children; first-line therapy for H pylori infection in children is a twice-daily, triple-drug regimen comprised of a proton pump inhibitor plus two

  11. Canadian Helicobacter Study Group Consensus Conference: Update on the approach to Helicobacter pylori infection in children and adolescents--an evidence-based evaluation.

    Science.gov (United States)

    Bourke, Billy; Ceponis, Peter; Chiba, Naoki; Czinn, Steve; Ferraro, Richard; Fischbach, Lori; Gold, Ben; Hyunh, Hien; Jacobson, Kevan; Jones, Nicola L; Koletzko, Sibylle; Lebel, Sylvie; Moayyedi, Paul; Ridell, Robert; Sherman, Philip; van Zanten, Sander; Beck, Ivan; Best, Linda; Boland, Margaret; Bursey, Ford; Chaun, Hugh; Cooper, Geraldine; Craig, Brian; Creuzenet, Carole; Critch, Jeffrey; Govender, Krishnasamy; Hassall, Eric; Kaplan, Alan; Keelan, Monica; Noad, Garth; Robertson, Marli; Smith, Lesley; Stein, Markus; Taylor, Diane; Walters, Thomas; Persaud, Robin; Whitaker, Scott; Woodland, Robert

    2005-07-01

    As an update to previously published recommendations for the management of Helicobacter pylori infection, an evidence-based appraisal of 14 topics was undertaken in a consensus conference sponsored by the Canadian Helicobacter Study Group. The goal was to update guidelines based on the best available evidence using an established and uniform methodology to address and formulate recommendations for each topic. The degree of consensus for each recommendation is also presented. The clinical issues addressed and recommendations made were: population-based screening for H. pylori in asymptomatic children to prevent gastric cancer is not warranted; testing for H. pylori in children should be considered if there is a family history of gastric cancer; the goal of diagnostic interventions should be to determine the cause of presenting gastrointestinal symptoms and not the presence of H. pylori infection; recurrent abdominal pain of childhood is not an indication to test for H. pylori infection; H. pylori testing is not required in patients with newly diagnosed gastroesophageal reflux disease; H. pylori testing may be considered before the use of long-term proton pump inhibitor therapy; testing for H. pylori infection should be considered in children with refractory iron deficiency anemia when no other cause has been found; when investigation of pediatric patients with persistent or severe upper abdominal symptoms is indicated, upper endoscopy with biopsy is the investigation of choice; the 13C-urea breath test is currently the best noninvasive diagnostic test for H. pylori infection in children; there is currently insufficient evidence to recommend stool antigen tests as acceptable diagnostic tools for H. pylori infection; serological antibody tests are not recommended as diagnostic tools for H. pylori infection in children; first-line therapy for H. pylori infection in children is a twice-daily, triple-drug regimen comprised of a proton pump inhibitor plus two antibiotics

  12. Multi-level governance in EU climate law

    NARCIS (Netherlands)

    Vedder, Hans; Woerdman, Edwin; Roggenkamp, Martha; Holwerda, Marijn

    2015-01-01

    This chapter analyses the multi-level governance in EU climate law; it connects the international arena, with EU and national decision-making and relates climate change considerations to competitiveness concerns.

  13. Optimal Multi-Level Lot Sizing for Requirements Planning Systems

    OpenAIRE

    Earle Steinberg; H. Albert Napier

    1980-01-01

    The wide spread use of advanced information systems such as Material Requirements Planning (MRP) has significantly altered the practice of dependent demand inventory management. Recent research has focused on development of multi-level lot sizing heuristics for such systems. In this paper, we develop an optimal procedure for the multi-period, multi-product, multi-level lot sizing problem by modeling the system as a constrained generalized network with fixed charge arcs and side constraints. T...

  14. Evidence-based clinical practice

    DEFF Research Database (Denmark)

    Gluud, Christian

    2002-01-01

    , and single clinics. Accordingly, there is an urgent need to improve this situation. Guidelines for Good Clinical (Research) Practice, conduct of more trials as multicentre trials, The Consort Statement, and The Cochrane Collaboration may all help in the application of the best research evidence in clinical......Evidence-based medicine combines the patient's preferences with clinical experience and the best research evidence. Randomized clinical trials are considered the most valid research design for evaluating health-care interventions. However, empirical research shows that intervention effects may...... practice. By investments in education, applied research, and The Cochrane Collaboration, evidence-based medicine may form a stronger basis for clinical practice....

  15. COLLABORATIVE MULTI-LEVEL PLAN MONITORING

    Directory of Open Access Journals (Sweden)

    Mohamad K. ALLOUCHE

    2011-01-01

    Full Text Available The recent worldwide connectivity and the net-centricity of military operations (coalition-based operations are witnessing an increasing need for the monitoring of plan execution for enhanced resource management and decision making. Monitoring of ongoing operations is the process of continuous observation recording and reporting. In this process the plan becomes a resource that needs to be managed effi ciently. The centralized approach to plan monitoring soon reaches its limits when plan execution is distributed across different organizations/countries. We propose a new framework that would allow different monitoring nodes distributed across the network. An effi cient propagation mechanism that allows information exchange between the different nodes would also be needed. The main purpose of this mechanism is to present the right information, to the right person, at the right time. To cope with a rapid increase of information fl ow through the network, an effi cient alarm management mechanism allows the presentation of the information with an appropriate level of details.

  16. Evidence-based dentistry: Future aspects

    Directory of Open Access Journals (Sweden)

    Kanika Mohindra

    2017-01-01

    Full Text Available Traditionally, clinical decisions in dentistry have been based on the experience of the dentist. If the given treatment works, it was utilized again, but if the results were disappointing, the procedure was deserted. Evaluating clinical treatment in this fashion is difficult because it is hard to know which factors are important for success and which contribute to failure. This came with the concept of evidence-based approach which facilitates conclusions for clinical practice based on sound research studies.

  17. Developing Multi-Level Institutions from Top-Down Ancestors

    Directory of Open Access Journals (Sweden)

    Martha Dowsley

    2007-11-01

    Full Text Available The academic literature contains numerous examples of the failures of both top-down and bottom-up common pool resource management frameworks. Many authors agree that management regimes instead need to utilize a multi-level governance approach to meet diverse objectives in management. However, many currently operating systems do not have that history. This paper explores the conversion of ancestral top-down regimes to complex systems involving multiple scales, levels and objectives through the management of the polar bear (Ursus maritimus in its five range countries. The less successful polar bear management systems continue to struggle with the challenges of developing institutions with the capacity to learn and change, addressing multiple objectives while recognizing the conservation backbone to management, and matching the institutional scale with biophysical, economic and social scales. The comparatively successful institutions incorporate these features, but reveal on-going problems with vertical links that are partially dealt with through the creation of links to other groups.

  18. Multi-level restricted maximum likelihood covariance estimation and kriging for large non-gridded spatial datasets

    KAUST Repository

    Castrillon, Julio

    2015-11-10

    We develop a multi-level restricted Gaussian maximum likelihood method for estimating the covariance function parameters and computing the best unbiased predictor. Our approach produces a new set of multi-level contrasts where the deterministic parameters of the model are filtered out thus enabling the estimation of the covariance parameters to be decoupled from the deterministic component. Moreover, the multi-level covariance matrix of the contrasts exhibit fast decay that is dependent on the smoothness of the covariance function. Due to the fast decay of the multi-level covariance matrix coefficients only a small set is computed with a level dependent criterion. We demonstrate our approach on problems of up to 512,000 observations with a Matérn covariance function and highly irregular placements of the observations. In addition, these problems are numerically unstable and hard to solve with traditional methods.

  19. Evidence-based playground design

    DEFF Research Database (Denmark)

    Refshauge, Anne Dahl; Stigsdotter, Ulrika K.; Lamm, Bettina

    2015-01-01

    , best practice, and the theories of Affordances and Behaviour Settings. A post-occupancy evaluation was carried out through a questionnaire survey and observation studies, which revealed that a majority of the potential evidence-based affordances were actualised, and that the application of the theories...

  20. Evidence-Based IT Development

    DEFF Research Database (Denmark)

    Simonsen, Jesper; Hertzum, Morten

    2005-01-01

    Evidence-based IT development aims at developing a new commercial contract model for IT projects where the cus-tomers payment is dependent on measurable effects of using the vendors system. The idea is to establish a strategic part-nership in which customer and IT vendor share the responsi-bility...

  1. Anatomy of an Evidence Base

    Science.gov (United States)

    Malouf, David B.; Taymans, Juliana M.

    2016-01-01

    An analysis was conducted of the What Works Clearinghouse (WWC) research evidence base on the effectiveness of replicable education interventions. Most interventions were found to have little or no support from technically adequate research studies, and intervention effect sizes were of questionable magnitude to meet education policy goals. These…

  2. Evidence-Based Psychological Assessment.

    Science.gov (United States)

    Bornstein, Robert F

    2017-01-01

    In recent years there has been increasing emphasis on evidence-based practice in psychology (EBPP), and as is true in most health care professions, the primary focus of EBPP has been on treatment. Comparatively little attention has been devoted to applying the principles of EBPP to psychological assessment, despite the fact that assessment plays a central role in myriad domains of empirical and applied psychology (e.g., research, forensics, behavioral health, risk management, diagnosis and classification in mental health settings, documentation of neuropsychological impairment and recovery, personnel selection and placement in organizational contexts). This article outlines the central elements of evidence-based psychological assessment (EBPA), using the American Psychological Association's tripartite definition of EBPP as integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. After discussing strategies for conceptualizing and operationalizing evidence-based testing and evidence-based assessment, 6 core skills and 3 meta-skills that underlie proficiency in psychological assessment are described. The integration of patient characteristics, culture, and preferences is discussed in terms of the complex interaction of patient and assessor identities and values throughout the assessment process. A preliminary framework for implementing EBPA is offered, and avenues for continued refinement and growth are described.

  3. Multi-level deep supervised networks for retinal vessel segmentation.

    Science.gov (United States)

    Mo, Juan; Zhang, Lei

    2017-12-01

    Changes in the appearance of retinal blood vessels are an important indicator for various ophthalmologic and cardiovascular diseases, including diabetes, hypertension, arteriosclerosis, and choroidal neovascularization. Vessel segmentation from retinal images is very challenging because of low blood vessel contrast, intricate vessel topology, and the presence of pathologies such as microaneurysms and hemorrhages. To overcome these challenges, we propose a neural network-based method for vessel segmentation. A deep supervised fully convolutional network is developed by leveraging multi-level hierarchical features of the deep networks. To improve the discriminative capability of features in lower layers of the deep network and guide the gradient back propagation to overcome gradient vanishing, deep supervision with auxiliary classifiers is incorporated in some intermediate layers of the network. Moreover, the transferred knowledge learned from other domains is used to alleviate the issue of insufficient medical training data. The proposed approach does not rely on hand-crafted features and needs no problem-specific preprocessing or postprocessing, which reduces the impact of subjective factors. We evaluate the proposed method on three publicly available databases, the DRIVE, STARE, and CHASE_DB1 databases. Extensive experiments demonstrate that our approach achieves better or comparable performance to state-of-the-art methods with a much faster processing speed, making it suitable for real-world clinical applications. The results of cross-training experiments demonstrate its robustness with respect to the training set. The proposed approach segments retinal vessels accurately with a much faster processing speed and can be easily applied to other biomedical segmentation tasks.

  4. Just how multi-level is leadership research? A document co-citation analysis 1980–2013 on leadership constructs and outcomes

    OpenAIRE

    Batistic, S.; Cerne, M.; Vogel, Bernd

    2017-01-01

    The use of multi-level theories and methodologies in leadership has gained momentum in recent years. However, the leadership field still suffers from a fragmented and unclear evolution and practice of multi-level approaches. The questions of how and to what extent multi-level research has evolved in both leadership phenomena and leadership outcomes, and which informal research networks drove this evolution, remain vastly unexplored. In this study, the extent of literature published between 19...

  5. The Evidence-Based Manifesto for School Librarians

    Science.gov (United States)

    Todd, Ross

    2008-01-01

    School Library Journal's 2007 Leadership Summit, "Where's the Evidence? Understanding the Impact of School Libraries," focused on the topic of evidence-based practice. Evidence-based school librarianship is a systematic approach that engages research-derived evidence, school librarian-observed evidence, and user-reported evidence in the processes…

  6. Android Multi-Level System Permission Management Approach

    OpenAIRE

    Luo, Yang; Zhang, Qixun; Shen, Qingni; Liu, Hongzhi; Wu, Zhonghai

    2017-01-01

    With the expansion of the market share occupied by the Android platform, security issues (especially application security) have become attention focus of researchers. In fact, the existing methods lack the capabilities to manage application permissions without root privilege. This study proposes a dynamic management mechanism of Android application permissions based on security policies. The paper first describes the permissions by security policies, then implementes permission checking code ...

  7. Practitioner review: schizophrenia spectrum disorders and the at-risk mental state for psychosis in children and adolescents--evidence-based management approaches.

    Science.gov (United States)

    Tiffin, Paul A; Welsh, Patrick

    2013-11-01

    Schizophrenia spectrum disorders are severe mental illnesses which often result in significant distress and disability. Attempts have been made to prospectively identify and treat young people viewed as at high risk of impending nonaffective psychosis. Once a schizophrenia spectrum disorder has developed, prompt identification and management is required. This article reviews the literature relating to the assessment and management of 'at-risk mental states' (ARMS) and the treatment of schizophrenia spectrum disorders in children and adolescents. A systematic search of the literature was undertaken using EMBASE, MEDLINE, PsycINFO databases for the period January 1970-December 2012. Evidence suggests that young people fulfilling the ARMS criteria are at high risk of adverse mental health outcomes but that the majority do not develop nonaffective psychosis over the medium term. Although clinical trial findings have been inconsistent, psychosocial approaches, such as cognitive behaviour therapy, may reduce the risk of transition to psychosis and improve some symptoms, at least over the short term. The effectiveness of psychotropic medication for the ARMS is uncertain although there is accumulating evidence for potential adverse effects of antipsychotic medication, even at low dose, in this population. For the schizophrenias, clinical trial findings suggest that, as in adults, antipsychotics should be selected on the basis of side-effect profile although clozapine may be helpful in treatment refractory illness. There are almost no studies of psychosocial treatments for schizophrenia in young people under 18, and some caution must be exercised when extrapolating the findings of adult studies to younger individuals. A stepped care approach to the ARMS in young people represents a plausible potential management approach for those at high risk of serious mental health problems. However, predictive models currently lack precision and should focus on accurately identifying

  8. Evidence based herbal drug standardization approach in coping with challenges of holistic management of diabetes: a dreadful lifestyle disorder of 21st century.

    Science.gov (United States)

    Chawla, Raman; Thakur, Pallavi; Chowdhry, Ayush; Jaiswal, Sarita; Sharma, Anamika; Goel, Rajeev; Sharma, Jyoti; Priyadarshi, Smruti Sagar; Kumar, Vinod; Sharma, Rakesh Kumar; Arora, Rajesh

    2013-07-04

    Plants by virtue of its composition of containing multiple constituents developed during its growth under various environmental stresses providing a plethora of chemical families with medicinal utility. Researchers are exploring this wealth and trying to decode its utility for enhancing health standards of human beings. Diabetes is dreadful lifestyle disorder of 21st century caused due to lack of insulin production or insulin physiological unresponsiveness. The chronic impact of untreated diabetes significantly affects vital organs. The allopathic medicines have five classes of drugs, or otherwise insulin in Type I diabetes, targeting insulin secretion, decreasing effect of glucagon, sensitization of receptors for enhanced glucose uptake etc. In addition, diet management, increased food fiber intake, Resistant Starch intake and routine exercise aid in managing such dangerous metabolic disorder. One of the key factors that limit commercial utility of herbal drugs is standardization. Standardization poses numerous challenges related to marker identification, active principle(s), lack of defined regulations, non-availability of universally acceptable technical standards for testing and implementation of quality control/safety standard (toxicological testing). The present study proposed an integrated herbal drug development & standardization model which is an amalgamation of Classical Approach of Ayurvedic Therapeutics, Reverse Pharmacological Approach based on Observational Therapeutics, Technical Standards for complete product cycle, Chemi-informatics, Herbal Qualitative Structure Activity Relationship and Pharmacophore modeling and, Post-Launch Market Analysis. Further studies are warranted to ensure that an effective herbal drug standardization methodology will be developed, backed by a regulatory standard guide the future research endeavors in more focused manner.

  9. Constructing a Theory- and Evidence-Based Treatment Rationale for Complex eHealth Interventions: Development of an Online Alcohol Intervention Using an Intervention Mapping Approach.

    Science.gov (United States)

    Brendryen, Håvar; Johansen, Ayna; Nesvåg, Sverre; Kok, Gerjo; Duckert, Fanny

    2013-01-23

    Due to limited reporting of intervention rationale, little is known about what distinguishes a good intervention from a poor one. To support improved design, there is a need for comprehensive reports on novel and complex theory-based interventions. Specifically, the emerging trend of just-in-time tailoring of content in response to change in target behavior or emotional state is promising. The objective of this study was to give a systematic and comprehensive description of the treatment rationale of an online alcohol intervention called Balance. We used the intervention mapping protocol to describe the treatment rationale of Balance. The intervention targets at-risk drinking, and it is delivered by email, mobile phone text messaging, and tailored interactive webpages combining text, pictures, and prerecorded audio. The rationale of the current treatment was derived from a self-regulation perspective, and the overarching idea was to support continued self-regulation throughout the behavior change process. Maintaining the change efforts over time and coping adaptively during critical moments (eg, immediately before and after a lapse) are key factors to successful behavior change. Important elements of the treatment rationale to achieving these elements were: (1) emotion regulation as an inoculation strategy against self-regulation failure, (2) avoiding lapses by adaptive coping, and (3) avoiding relapse by resuming the change efforts after a lapse. Two distinct and complementary delivery strategies were used, including a day-to-day tunnel approach in combination with just-in-time therapy. The tunnel strategy was in accordance with the need for continuous self-regulation and it functions as a platform from which just-in-time therapy was launched. Just-in-time therapy was used to support coping during critical moments, and started when the client reports either low self-efficacy or that they were drinking above target levels. The descriptions of the treatment

  10. On multi-level thinking and scientific understanding

    Science.gov (United States)

    McIntyre, Michael Edgeworth

    2017-10-01

    Professor Duzheng YE's name has been familiar to me ever since my postdoctoral years at MIT with Professors Jule CHARNEY and Norman PHILLIPS, back in the late 1960s. I had the enormous pleasure of meeting Professor YE personally in 1992 in Beijing. His concern to promote the very best science and to use it well, and his thinking on multi-level orderly human activities, reminds me not only of the communication skills we need as scientists but also of the multi-level nature of science itself. Here I want to say something (a) about what science is; (b) about why multi-level thinking—and taking more than one viewpoint—is so important for scientific as well as for other forms of understanding; and (c) about what is meant, at a deep level, by "scientific understanding" and trying to communicate it, not only with lay persons but also across professional disciplines. I hope that Professor YE would approve.

  11. Three decades after Gjönnaess's laparoscopic ovarian drilling for treatment of PCOS; what do we know? An evidence-based approach.

    Science.gov (United States)

    Abu Hashim, Hatem; Al-Inany, Hesham; De Vos, Michel; Tournaye, Herman

    2013-08-01

    The introduction of laparoscopic ovarian drilling (LOD) by Gjönnaess in 1984 as a substitute for ovarian wedge resection created opportunities for extensive research given its worldwide application for ovulation induction in women with polycystic ovary syndrome (PCOS). To critically evaluate and summarize the current body of literature regarding the role of LOD for the management of PCOS entailing its different preoperative, operative and postoperative aspects. In addition, long-term efficacy, cost-effectiveness, patient preference and health-related quality of life issues will be evaluated together with other available alternatives of ovulation induction treatments. A PubMed search was conducted looking for the different trials, reviews and various guidelines relating to the role of LOD in the management of PCOS. LOD whether unilateral or bilateral is a beneficial second-line treatment in infertile women with clomiphene citrate (CC)-resistant PCOS. It is as effective as gonadotrophin treatment but without the risk of multiple pregnancy or ovarian hyperstimulation and does not require intensive monitoring. Increased responsiveness of the ovary to CC especially in patients who remain anovulatory following LOD is another advantage. Recent evidence suggests that relatively novel oral methods of ovulation induction, e.g. CC plus metformin, CC plus tamoxifen, rosiglitazone plus CC and aromatase inhibitors represent a successful alternative to LOD in CC-resistant PCOS. Meanwhile current evidence does not support LOD as a first-line approach in PCOS-related anovulation or before IVF. LOD is currently recommended as a successful and economical second-line treatment for ovulation induction in women with CC-resistant PCOS.

  12. Pracovní motivace v multi-level marketingu

    OpenAIRE

    Mrázková, Tereza

    2015-01-01

    The purpose of this work is to analyse the motivation in multi-level marketing company. The thesis introduces basic general marketing tools, but also multi-level marketing and the theory of motivation. The research in practical part was done in the form of electronical survey, which was completed by 71 responders. The responders were employees of specific company. The thesis does not only focus on the motivation in work in general, but also on the difference in motivation between male and fem...

  13. Disentangling multi-level systems: averaging, correlations and memory

    International Nuclear Information System (INIS)

    Wouters, Jeroen; Lucarini, Valerio

    2012-01-01

    We consider two weakly coupled systems and adopt a perturbative approach based on the Ruelle response theory to study their interaction. We propose a systematic way of parameterizing the effect of the coupling as a function of only the variables of a system of interest. Our focus is on describing the impacts of the coupling on the long term statistics rather than on the finite-time behavior. By direct calculation, we find that, at first order, the coupling can be surrogated by adding a deterministic perturbation to the autonomous dynamics of the system of interest. At second order, there are additionally two separate and very different contributions. One is a term taking into account the second-order contributions of the fluctuations in the coupling, which can be parameterized as a stochastic forcing with given spectral properties. The other one is a memory term, coupling the system of interest to its previous history, through the correlations of the second system. If these correlations are known, this effect can be implemented as a perturbation with memory on the single system. In order to treat this case, we present an extension to Ruelle's response theory able to deal with integral operators. We discuss our results in the context of other methods previously proposed for disentangling the dynamics of two coupled systems. We emphasize that our results do not rely on assuming a time scale separation, and, if such a separation exists, can be used equally well to study the statistics of the slow variables and that of the fast variables. By recursively applying the technique proposed here, we can treat the general case of multi-level systems

  14. The evidence base for diabetes care

    National Research Council Canada - National Science Library

    Williams, D. R. R. (David Robert Rhys)

    2002-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix 1. The Evidence Base for Diabetes Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rhys Williams, William Herman, Ann-Louise Kinmonth...

  15. Multi-Level Security Cannot Realise NEC Objectives

    NARCIS (Netherlands)

    Schotanus, H.A.; Hartog, T.; Verkoelen, C.A.A.

    2012-01-01

    Multi-Level Security (MLS) is often viewed as the holy grail of information security, especially in those environments where information of different classifications is being processed. In this paper we argue that MLS cannot facilitate the right balance between need-to-protect and duty-to-share as

  16. Governance and the Commons in a Multi-Level World

    Directory of Open Access Journals (Sweden)

    Derek Armitage

    2007-11-01

    Full Text Available Multi-level governance may facilitate learning and adaptation in complex social-ecological circumstances. Such arrangements should connect community-based management with regional/national government-level management, link scientific management and traditional management systems, encourage the sharing of knowledge and information, and promote collaboration and dialogue around goals and outcomes. Governance innovations of this type can thus build capacity to adapt to change and manage for resilience. However, critical reflection on the emergence of adaptive, multi-level governance for the commons is warranted. Drawing on examples from the North and South, the purpose of this review is to connect three complementary bodies of scholarship with insights for commons governance in a multi-level world: common property theory, resilience thinking and political ecology. From the commons and resilience literature, normative principles of adaptive, multi-level governance are synthesized (e.g., participation, accountability, leadership, knowledge pluralism, learning and trust. Political ecological interpretations, however, help to reveal the challenge of actualizing these principles and the contextual forces that make entrenched, top-down management systems resilient to change. These forces include the role of power, scale and levels of organization, knowledge valuation, the positioning of social actors and social constructions of nature. Also addressed are the policy narratives that shape governance, and the dialectic relationship among ecological systems and social change. tekst

  17. A collision dynamics model of a multi-level train

    Science.gov (United States)

    2006-11-05

    In train collisions, multi-level rail passenger vehicles can deform in modes that are different from the behavior of single level cars. The deformation in single level cars usually occurs at the front end during a collision. In one particular inciden...

  18. Extending the enterprise through multi-level supply control

    NARCIS (Netherlands)

    Vlist, van der P.; Hoppenbrouwers, J.J.E.M.; Hegge, H.M.H.

    1997-01-01

    Demands for flexibility require larger parts of the supply chain to become customer driven. This article describes multi-level supply control (MLSC) as a mechanism to facilitate that; it allows to specify gradually and thus to shift the customer order decoupling point well across the boundary to the

  19. Multi-level Reconfigurable Self-organization in Overlay Services

    NARCIS (Netherlands)

    Pournaras, E.

    2013-01-01

    Large-scale decentralized systems organized in overlay networks are complex to manage. Such systems integrate organizational complexity in the application-level resulting in low abstraction and modularity in their services. This thesis introduces a multi-level conceptual architecture for overlay

  20. Course Redesign: An Evidence-Based Approach

    Science.gov (United States)

    Nomme, Kathy; Birol, Gülnur

    2014-01-01

    A first year non-majors biology course, with an enrollment of around 440 students, has been redesigned from a course of traditional content and teaching style to one that emphasizes biological concepts in current global issues and incorporates active learning strategies. We were informed by the education literature incorporating many aspects of…

  1. Rotator cuff tears: An evidence based approach

    Science.gov (United States)

    Sambandam, Senthil Nathan; Khanna, Vishesh; Gul, Arif; Mounasamy, Varatharaj

    2015-01-01

    Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, cost-effective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality. PMID:26716086

  2. Efficacy of a modern neuroscience approach versus usual care evidence-based physiotherapy on pain, disability and brain characteristics in chronic spinal pain patients: protocol of a randomized clinical trial

    Science.gov (United States)

    2014-01-01

    Background Among the multiple conservative modalities, physiotherapy is a commonly utilized treatment modality in managing chronic non-specific spinal pain. Despite the scientific progresses with regard to pain and motor control neuroscience, treatment of chronic spinal pain (CSP) often tends to stick to a peripheral biomechanical model, without targeting brain mechanisms. With a view to enhance clinical efficacy of existing physiotherapeutic treatments for CSP, the development of clinical strategies targeted at ‘training the brain’ is to be pursued. Promising proof-of-principle results have been reported for the effectiveness of a modern neuroscience approach to CSP when compared to usual care, but confirmation is required in a larger, multi-center trial with appropriate evidence-based control intervention and long-term follow-up. The aim of this study is to assess the effectiveness of a modern neuroscience approach, compared to usual care evidence-based physiotherapy, for reducing pain and improving functioning in patients with CSP. A secondary objective entails examining the effectiveness of the modern neuroscience approach versus usual care physiotherapy for normalizing brain gray matter in patients with CSP. Methods/Design The study is a multi-center, triple-blind, two-arm (1:1) randomized clinical trial with 1-year follow-up. 120 CSP patients will be randomly allocated to either the experimental (receiving pain neuroscience education followed by cognition-targeted motor control training) or the control group (receiving usual care physiotherapy), each comprising of 3 months treatment. The main outcome measures are pain (including symptoms and indices of central sensitization) and self-reported disability. Secondary outcome measures include brain gray matter structure, motor control, muscle properties, and psychosocial correlates. Clinical assessment and brain imaging will be performed at baseline, post-treatment and at 1-year follow-up. Web

  3. Consumer engagement and the development, evaluation and dissemination of evidence-based parenting programs

    Science.gov (United States)

    Sanders, Matthew R.; Kirby, James N.

    2013-01-01

    A consumer perspective can contribute much to enhancing the “ecological fit” of population level parenting interventions so they meet the needs of parents. This approach involves building relationships with consumer groups and soliciting consumer input into the relevance and acceptability of interventions, clarifying the enablers and barriers to engagement and involvement of parents, and clarifying variables that influence a parent’s program completion. The adoption of a more collaborative approach to working with consumers is important if meaningful population level change in the prevalence of serious social, emotional and behavioral problems in children and young people is to be achieved. Parents seeking assistance for their children’s behavior come from a diverse range of socioeconomic backgrounds, educational levels, cultures and languages. This paper examines consumer engagement strategies that can be employed throughout the process of program development, evaluation, training and dissemination and in “scaling up” the intervention. We argue that a multi-level public health approach to parenting intervention requires a strong consumer perspective to enable interventions to be more responsive to the preferences and needs of families and to ensure improved population reach of interventions. Examples from large scale dissemination trials are used to illustrate how consumer input can result in an increasingly differentiated suite of evidence-based parenting programs. PMID:22440062

  4. Can Scholarly Communication be Evidence Based? (Editorial

    Directory of Open Access Journals (Sweden)

    Denise Koufogiannakis

    2010-12-01

    disseminate their work, the role of research funding bodies that use public funds, the added value brought to the work by publishers, the role of peer reviewers, the economics of various models, and simply what works best.Research has been done on many of these issuesii and much of that work has then been critically appraised and debated post-publication on mailing listsiii and social networking media such as blogs.ivThe BMJ is one scholarly publication that has committed itself to becoming an “evidence based publisher” and is carrying out research on aspects of scholarly publishing to help guide their processes (Schroter, n.d.. Research on scholarly communication is a hot topic indeed; and for librarians, an area of information overload if there ever was one. How to sort out the good from the bad; the research that is high quality from that which is biased?At this point in time, it is my view that the research does not yet provide a definitive answer for how libraries should approach new models of scholarly communication. We are in the middle of a debate, in the middle of a surge of research, and an ever-changing lens in which we view and approach this topic. But evidence based practice has always been about more than just research – it considers what is needed by our users, and is guided by our professional judgement. Putting those elements together allows us to sort through the research and make informed decisions about our approach to collections, and how we do liaison work. For anyone looking for a research idea, there are certainly a couple of systematic reviews possible on these issues that would benefit practitioners immensely.The decision to start EBLIP was not an evidence based one. It was based in a desire to give the topic a home for discussion, and that in order to facilitate discussion, the widest audience possible must be reached. Hence, barriers such as cost needed to be reduced, and the decision to be open access was made. This was a decision based on

  5. Predicting multi-level drug response with gene expression profile in multiple myeloma using hierarchical ordinal regression.

    Science.gov (United States)

    Zhang, Xinyan; Li, Bingzong; Han, Huiying; Song, Sha; Xu, Hongxia; Hong, Yating; Yi, Nengjun; Zhuang, Wenzhuo

    2018-05-10

    Multiple myeloma (MM), like other cancers, is caused by the accumulation of genetic abnormalities. Heterogeneity exists in the patients' response to treatments, for example, bortezomib. This urges efforts to identify biomarkers from numerous molecular features and build predictive models for identifying patients that can benefit from a certain treatment scheme. However, previous studies treated the multi-level ordinal drug response as a binary response where only responsive and non-responsive groups are considered. It is desirable to directly analyze the multi-level drug response, rather than combining the response to two groups. In this study, we present a novel method to identify significantly associated biomarkers and then develop ordinal genomic classifier using the hierarchical ordinal logistic model. The proposed hierarchical ordinal logistic model employs the heavy-tailed Cauchy prior on the coefficients and is fitted by an efficient quasi-Newton algorithm. We apply our hierarchical ordinal regression approach to analyze two publicly available datasets for MM with five-level drug response and numerous gene expression measures. Our results show that our method is able to identify genes associated with the multi-level drug response and to generate powerful predictive models for predicting the multi-level response. The proposed method allows us to jointly fit numerous correlated predictors and thus build efficient models for predicting the multi-level drug response. The predictive model for the multi-level drug response can be more informative than the previous approaches. Thus, the proposed approach provides a powerful tool for predicting multi-level drug response and has important impact on cancer studies.

  6. Answering medical questions at the point of care: a cross-sectional study comparing rapid decisions based on PubMed and Epistemonikos searches with evidence-based recommendations developed with the GRADE approach.

    Science.gov (United States)

    Izcovich, Ariel; Criniti, Juan Martín; Popoff, Federico; Ragusa, Martín Alberto; Gigler, Cristel; Gonzalez Malla, Carlos; Clavijo, Manuela; Manzotti, Matias; Diaz, Martín; Catalano, Hugo Norberto; Neumann, Ignacio; Guyatt, Gordon

    2017-08-07

    Using the best current evidence to inform clinical decisions remains a challenge for clinicians. Given the scarcity of trustworthy clinical practice guidelines providing recommendations to answer clinicians' daily questions, clinical decision support systems (ie, assistance in question identification and answering) emerge as an attractive alternative. The trustworthiness of the recommendations achieved by such systems is unknown. To evaluate the trustworthiness of a question identification and answering system that delivers timely recommendations. Cross-sectional study. We compared the responses to 100 clinical questions related to inpatient management provided by two rapid response methods with 'Gold Standard' recommendations. One of the rapid methods was based on PubMed and the other on Epistemonikos database. We defined our 'Gold Standard' as trustworthy published evidence-based recommendations or, when unavailable, recommendations developed locally by a panel of six clinicians following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Recommendations provided by the rapid strategies were classified as potentially misleading or reasonable. We also determined if the potentially misleading recommendations could have been avoided with the appropriate implementation of searching and evidence summary tools. We were able to answer all of the 100 questions with both rapid methods. Of the 200 recommendations obtained, 6.5% (95% CI 3% to 9.9%) were classified as potentially misleading and 93.5% (95% CI 90% to 96.9%) as reasonable. 6 of the 13 potentially misleading recommendations could have been avoided by the appropriate usage of the Epistemonikos matrix tool or by constructing summary of findings tables. No significant differences were observed between the evaluated rapid response methods. A question answering service based on the GRADE approach proved feasible to implement and provided appropriate guidance for most identified

  7. Leading change: evidence-based transition.

    Science.gov (United States)

    Lewis, Brennan; Allen, Stephanie

    2015-01-01

    The purpose of this article was to provide a framework for evidence-based transition of patient populations within an acute care pediatric institution. Transition within a hospital is foreseeable, given the ever-changing needs of the patients within an evolving healthcare system. These changes include moving patient populations because of expansion, renovation, or cohorting similar patient diagnoses to provide care across a continuum. Over the past 1 to 2 years, Children's Health Children's Medical Center Dallas has experienced a wide variety of transition. To provide a smooth transition for patients and families into new care areas resulting in a healthy work environment for all team members. The planning phase for patient population moves, and transition should address key aspects to include physical location and care flow, supplies and equipment, staffing model and human resources (HR), education and orientation, change process and integrating teams, and family preparation. It is imperative to consider these aspects in order for transitions within a healthcare system to be successful. During a time of such transitions, the clinical nurse specialist (CNS) is a highly valuable team member offering a unique perspective and methodological approach, which is central to the new initiative's overall success. The themes addressed in this article on evidence-based transition are organized according to the CNS spheres of influence: system/organization, patient/family, and nursing. An evidence-based transition plan was developed and implemented successfully with the support from the CNS for 3 patient populations. Organizational leadership gained an increased awareness of the CNS role at the conclusion of each successful transition. The CNS plays a pivotal role as clinical experts and proponents of evidence-based practice and effects change in the system/organization, nursing, and patient/family spheres of influence. While transitions can be a source of stress for leaders

  8. Multi-stage decoding of multi-level modulation codes

    Science.gov (United States)

    Lin, Shu; Kasami, Tadao; Costello, Daniel J., Jr.

    1991-01-01

    Various types of multi-stage decoding for multi-level modulation codes are investigated. It is shown that if the component codes of a multi-level modulation code and types of decoding at various stages are chosen properly, high spectral efficiency and large coding gain can be achieved with reduced decoding complexity. Particularly, it is shown that the difference in performance between the suboptimum multi-stage soft-decision maximum likelihood decoding of a modulation code and the single-stage optimum soft-decision decoding of the code is very small, only a fraction of dB loss in signal to noise ratio at a bit error rate (BER) of 10(exp -6).

  9. Multi-Level Formation of Complex Software Systems

    Directory of Open Access Journals (Sweden)

    Hui Li

    2016-05-01

    Full Text Available We present a multi-level formation model for complex software systems. The previous works extract the software systems to software networks for further studies, but usually investigate the software networks at the class level. In contrast to these works, our treatment of software systems as multi-level networks is more realistic. In particular, the software networks are organized by three levels of granularity, which represents the modularity and hierarchy in the formation process of real-world software systems. More importantly, simulations based on this model have generated more realistic structural properties of software networks, such as power-law, clustering and modularization. On the basis of this model, how the structure of software systems effects software design principles is then explored, and it could be helpful for understanding software evolution and software engineering practices.

  10. Quantum state preparation using multi-level-atom optics

    International Nuclear Information System (INIS)

    Busch, Th; Deasy, K; Chormaic, S Nic

    2007-01-01

    One of the most important characteristics for controlling processes on the quantum scale is the fidelity or robustness of the techniques being used. In the case of single atoms localized in micro-traps, it was recently shown that the use of time-dependent tunnelling interactions in a multi-trap setup can be viewed as analogous to the area of multi-level optics. The atom's centre-of-mass can then be controlled with a high fidelity, using a STIRAP-type process. Here, we review previous work that led to the development of multi-level atom optics and present two examples of our most recent work on quantum state preparation

  11. On the multi-level solution algorithm for Markov chains

    Energy Technology Data Exchange (ETDEWEB)

    Horton, G. [Univ. of Erlangen, Nuernberg (Germany)

    1996-12-31

    We discuss the recently introduced multi-level algorithm for the steady-state solution of Markov chains. The method is based on the aggregation principle, which is well established in the literature. Recursive application of the aggregation yields a multi-level method which has been shown experimentally to give results significantly faster than the methods currently in use. The algorithm can be reformulated as an algebraic multigrid scheme of Galerkin-full approximation type. The uniqueness of the scheme stems from its solution-dependent prolongation operator which permits significant computational savings in the evaluation of certain terms. This paper describes the modeling of computer systems to derive information on performance, measured typically as job throughput or component utilization, and availability, defined as the proportion of time a system is able to perform a certain function in the presence of component failures and possibly also repairs.

  12. Regulatory networks, legal federalism, and multi-level regulatory systems

    OpenAIRE

    Kerber, Wolfgang; Wendel, Julia

    2016-01-01

    Transnational regulatory networks play important roles in multi-level regulatory regimes, as e.g, the European Union. In this paper we analyze the role of regulatory networks from the perspective of the economic theory of legal federalism. Often sophisticated intermediate institutional solutions between pure centralisation and pure decentralisation can help to solve complex tradeoff problems between the benefits and problems of centralised and decentralised solutions. Drawing upon the insight...

  13. A fast photo-counter with multi-level buffers

    International Nuclear Information System (INIS)

    Peng Hu; Zhou Peiling; Yao Kun; Guo Guangcan

    1992-01-01

    Digital Photon Correlator (DPC) is composed of a Photo-counter and a data processing unit. The performance of Photo-counter in data acquisition system has a direct influence on data processing. The Photo-counter with fast carry designed here has multi-level buffers. Photon pulses can be correctly and dynamically recorded by the Photo-counter and processed by a single chip computer

  14. Multi-Level Marketing as a business model

    Directory of Open Access Journals (Sweden)

    Bogdan Gregor

    2013-03-01

    Full Text Available Multi Level Marketing is a very popular business model in the Western countries. It is a kind of hybrid of the method of distribution of goods and the method of building a sales network. It is one of the safest (carries a very low risk ways of conducting a business activity. The knowledge about functioning of this business model, both among theoreticians (scanty literature on the subject and practitioners, is still insufficient in Poland. Thus, the presented paper has been prepared as — in the Authors' opinion — it, at least infinitesimally, bridges the gap in the recognition of Multi Level Marketing issues. The aim of the study was, first of all, to describe Multi Level Marketing, to indicate practical benefits of this business model as well as to present basic systems of calculating a commission, which are used in marketing plans of companies. The discussion was based on the study of literature and the knowledge gained in the course of free-form interviews with the leaders of the sector.

  15. Multi-level decision making models, methods and applications

    CERN Document Server

    Zhang, Guangquan; Gao, Ya

    2015-01-01

    This monograph presents new developments in multi-level decision-making theory, technique and method in both modeling and solution issues. It especially presents how a decision support system can support managers in reaching a solution to a multi-level decision problem in practice. This monograph combines decision theories, methods, algorithms and applications effectively. It discusses in detail the models and solution algorithms of each issue of bi-level and tri-level decision-making, such as multi-leaders, multi-followers, multi-objectives, rule-set-based, and fuzzy parameters. Potential readers include organizational managers and practicing professionals, who can use the methods and software provided to solve their real decision problems; PhD students and researchers in the areas of bi-level and multi-level decision-making and decision support systems; students at an advanced undergraduate, master’s level in information systems, business administration, or the application of computer science.  

  16. Multi-level methods and approximating distribution functions

    International Nuclear Information System (INIS)

    Wilson, D.; Baker, R. E.

    2016-01-01

    Biochemical reaction networks are often modelled using discrete-state, continuous-time Markov chains. System statistics of these Markov chains usually cannot be calculated analytically and therefore estimates must be generated via simulation techniques. There is a well documented class of simulation techniques known as exact stochastic simulation algorithms, an example of which is Gillespie’s direct method. These algorithms often come with high computational costs, therefore approximate stochastic simulation algorithms such as the tau-leap method are used. However, in order to minimise the bias in the estimates generated using them, a relatively small value of tau is needed, rendering the computational costs comparable to Gillespie’s direct method. The multi-level Monte Carlo method (Anderson and Higham, Multiscale Model. Simul. 10:146–179, 2012) provides a reduction in computational costs whilst minimising or even eliminating the bias in the estimates of system statistics. This is achieved by first crudely approximating required statistics with many sample paths of low accuracy. Then correction terms are added until a required level of accuracy is reached. Recent literature has primarily focussed on implementing the multi-level method efficiently to estimate a single system statistic. However, it is clearly also of interest to be able to approximate entire probability distributions of species counts. We present two novel methods that combine known techniques for distribution reconstruction with the multi-level method. We demonstrate the potential of our methods using a number of examples.

  17. Multi-level methods and approximating distribution functions

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, D., E-mail: daniel.wilson@dtc.ox.ac.uk; Baker, R. E. [Mathematical Institute, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG (United Kingdom)

    2016-07-15

    Biochemical reaction networks are often modelled using discrete-state, continuous-time Markov chains. System statistics of these Markov chains usually cannot be calculated analytically and therefore estimates must be generated via simulation techniques. There is a well documented class of simulation techniques known as exact stochastic simulation algorithms, an example of which is Gillespie’s direct method. These algorithms often come with high computational costs, therefore approximate stochastic simulation algorithms such as the tau-leap method are used. However, in order to minimise the bias in the estimates generated using them, a relatively small value of tau is needed, rendering the computational costs comparable to Gillespie’s direct method. The multi-level Monte Carlo method (Anderson and Higham, Multiscale Model. Simul. 10:146–179, 2012) provides a reduction in computational costs whilst minimising or even eliminating the bias in the estimates of system statistics. This is achieved by first crudely approximating required statistics with many sample paths of low accuracy. Then correction terms are added until a required level of accuracy is reached. Recent literature has primarily focussed on implementing the multi-level method efficiently to estimate a single system statistic. However, it is clearly also of interest to be able to approximate entire probability distributions of species counts. We present two novel methods that combine known techniques for distribution reconstruction with the multi-level method. We demonstrate the potential of our methods using a number of examples.

  18. Queer challenges to evidence-based practice.

    Science.gov (United States)

    Zeeman, Laetitia; Aranda, Kay; Grant, Alec

    2014-06-01

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

  19. [What else is Evidence-based Medicine?].

    Science.gov (United States)

    Hauswaldt, Johannes

    2010-01-01

    The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence. Strange enough, scientific discussion focuses on external evidence from systematic research, but neglects its counterpart, i.e., individual clinical expertise. Apart from a lack of appropriate intellectual tools for approaching the latter, this might be due to the mutual concealment of thought and action, of sensor and motor activity (Viktor von Weizsaecker's principle of the revolving door). Behind this, and incommensurably different from each other, lie the world of physics and the world of biology with an ego animal, that is, the dilemma of the self-conscious subject in a world of objects. When practicing medicine, this dilemma of self-reference is being resolved but only through a holistic approach combining rational and external evidence with biographical, spiritual, emotional and pre-rational elements represented in the physician's individual clinical expertise. Copyright © 2010. Published by Elsevier GmbH.

  20. An evidence-based approach to the creation of normative data: base rates of impaired scores within a brief neuropsychological battery argue for age corrections, but against corrections for medical conditions.

    Science.gov (United States)

    O'Connell, Megan E; Tuokko, Holly; Voll, Stacey; Simard, Martine; Griffith, Lauren E; Taler, Vanessa; Wolfson, Christina; Kirkland, Susan; Raina, Parminder

    We detail a new approach to the creation of normative data for neuropsychological tests. The traditional approach to normative data creation is to make demographic adjustments based on observations of correlations between single neuropsychological tests and selected demographic variables. We argue, however, that this does not describe the implications for clinical practice, such as increased likelihood of misclassification of cognitive impairment, nor does it elucidate the impact on decision-making with a neuropsychological battery. We propose base rate analyses; specifically, differential base rates of impaired scores between theoretical and actual base rates as the basis for decisions to create demographic adjustments within normative data. Differential base rates empirically describe the potential clinical implications of failing to create an appropriate normative group. We demonstrate this approach with data from a short telephone-administered neuropsychological battery given to a large, neurologically healthy sample aged 45-85 years old. We explored whether adjustments for age and medical conditions were warranted based on differential base rates of spuriously impaired scores. Theoretical base rates underestimated the frequency of impaired scores in older adults and overestimated the frequency of impaired scores in younger adults, providing an evidence base for the creation of age-corrected normative data. In contrast, the number of medical conditions (numerous cardiovascular, hormonal, and metabolic conditions) was not related to differential base rates of impaired scores. Despite a small correlation between number of medical conditions and each neuropsychological variable, normative adjustments for number of medical conditions does not appear warranted. Implications for creation of normative data are discussed.

  1. Multi-level governance of forest resources (Editorial to the special feature

    Directory of Open Access Journals (Sweden)

    Esther Mwangi

    2012-08-01

    Full Text Available A major challenge for many researchers and practitioners relates to how to recognize and address cross-scale dynamics in space and over time in order to design and implement effective governance arrangements. This editorial provides an overview of the concept of multi-level governance (MLG. In particular we highlight definitional issues, why the concept matters as well as more practical concerns related to the processes and structure of multi-level governance. It is increasingly clear that multi-level governance of forest resources involves complex interactions of state, private and civil society actors at various levels, and institutions linking higher levels of social and political organization. Local communities are increasingly connected to global networks and influences. This creates new opportunities to learn and address problems but may also introduce new pressures and risks. We conclude by stressing the need for a much complex approach to the varieties of MLG to better understand how policies work as instruments of governance and to organize communities within systems of power and authority.

  2. Evidence-based Practice of Radiology.

    Science.gov (United States)

    Lavelle, Lisa P; Dunne, Ruth M; Carroll, Anne G; Malone, Dermot E

    2015-10-01

    Current health care reform in the United States is producing a shift in radiology practice from the traditional volume-based role of performing and interpreting a large number of examinations to providing a more affordable and higher-quality service centered on patient outcomes, which is described as a value-based approach to the provision of health care services. In the 1990 s, evidence-based medicine was defined as the integration of current best evidence with clinical expertise and patient values. When these methods are applied outside internal medicine, the process is called evidence-based practice (EBP). EBP facilitates understanding, interpretation, and application of the best current evidence into radiology practice, which optimizes patient care. It has been incorporated into "Practice-based Learning and Improvement" and "Systems-based Practice," which are two of the six core resident competencies of the Accreditation Council for Graduate Medical Education and two of the 12 American Board of Radiology milestones for diagnostic radiology. Noninterpretive skills, such as systems-based practice, are also formally assessed in the "Quality and Safety" section of the American Board of Radiology Core and Certifying examinations. This article describes (a) the EBP framework, with particular focus on its relevance to the American Board of Radiology certification and maintenance of certification curricula; (b) how EBP can be integrated into a residency program; and (c) the current value and likely place of EBP in the radiology information technology infrastructure. Online supplemental material is available for this article. © RSNA, 2015.

  3. Barriers to implementing evidence-based practices in addiction treatment programs: comparing staff reports on Motivational Interviewing, Adolescent Community Reinforcement Approach, Assertive Community Treatment, and Cognitive-behavioral Therapy.

    Science.gov (United States)

    Amodeo, M; Lundgren, L; Cohen, A; Rose, D; Chassler, D; Beltrame, C; D'Ippolito, M

    2011-11-01

    This qualitative study explored barriers to implementing evidence-based practices (EBPs) in community-based addiction treatment organizations (CBOs) by comparing staff descriptions of barriers for four EBPs: Motivational Interviewing (MI), Adolescent Community Reinforcement Approach (A-CRA), Assertive Community Treatment (ACT), and Cognitive-behavioral Therapy (CBT). The CBOs received CSAT/SAMHSA funding from 2003 to 2008 to deliver services using EBPs. Phone interview responses from 172 CBO staff directly involved in EBP implementation were analyzed using content analysis, a method for making inferences and developing themes from the systematic review of participant narratives (Berelson, 1952). Staff described different types of barriers to implementing each EBP. For MI, the majority of barriers involved staff resistance or organizational setting. For A-CRA, the majority of barriers involved specific characteristics of the EBP or client resistance. For CBT, the majority of barriers were associated with client resistance, and for ACT, the majority of barriers were associated with resources. EBP designers, policy makers who support EBP dissemination and funders should include explicit strategies to address such barriers. Addiction programs proposing to use specific EBPs must consider whether their programs have the organizational capacity and community capacity to meet the demands of the EBP selected. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Development of a theory and evidence-based program to promote community treatment of fevers in children under five in a rural district in Southern Ghana: An intervention mapping approach

    Directory of Open Access Journals (Sweden)

    Mercy Abbey

    2017-01-01

    Full Text Available Abstract Background This paper describes the development and implementation of a program to promote prompt and appropriate care seeking for fever in children under the age of five. Designed as a multicomponent program, the intervention comprises elements to influence the behavior of caregivers of children, Community Health Workers, professional health care providers and the wider community. Methods Following the six fundamental steps of the Intervention Mapping protocol, we involved relevant stakeholders from the commencement of planning to program end. The IM protocol also recommends various behavior change methods to guide intervention development. Results The intervention components implemented were successful in achieving program goals. For example, the intervention resulted in the primary outcome of reductions in all-cause mortality of 30% and 44%, among children treated with an antimalarial and those treated with the antimalarial plus an antibiotic respectively. Most Community Health Workers were retained on the program, with an attrition rate of 21.2% over a period of 30 months and the Community Health Workers rate of adherence to performance guidelines was high at 94.6%. Conclusion We were able to systematically develop a theory- and evidence-based health promotion program based on the Intervention Mapping protocol. This article contributes to the response to recent calls for a more detailed description of the development of interventions and trials. The intervention mapping approach can serve as a guide for others interested in developing community- based health interventions in similar settings.

  5. Development of a theory and evidence-based program to promote community treatment of fevers in children under five in a rural district in Southern Ghana: An intervention mapping approach.

    Science.gov (United States)

    Abbey, Mercy; Bartholomew, L Kay; Chinbuah, Margaret A; Gyapong, Margaret; Gyapong, John O; van den Borne, Bart

    2017-01-25

    This paper describes the development and implementation of a program to promote prompt and appropriate care seeking for fever in children under the age of five. Designed as a multicomponent program, the intervention comprises elements to influence the behavior of caregivers of children, Community Health Workers, professional health care providers and the wider community. Following the six fundamental steps of the Intervention Mapping protocol, we involved relevant stakeholders from the commencement of planning to program end. The IM protocol also recommends various behavior change methods to guide intervention development. The intervention components implemented were successful in achieving program goals. For example, the intervention resulted in the primary outcome of reductions in all-cause mortality of 30% and 44%, among children treated with an antimalarial and those treated with the antimalarial plus an antibiotic respectively. Most Community Health Workers were retained on the program, with an attrition rate of 21.2% over a period of 30 months and the Community Health Workers rate of adherence to performance guidelines was high at 94.6%. We were able to systematically develop a theory- and evidence-based health promotion program based on the Intervention Mapping protocol. This article contributes to the response to recent calls for a more detailed description of the development of interventions and trials. The intervention mapping approach can serve as a guide for others interested in developing community- based health interventions in similar settings.

  6. Evidence based practice readiness: A concept analysis.

    Science.gov (United States)

    Schaefer, Jessica D; Welton, John M

    2018-01-15

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

  7. Multi level governance framework for sustainable urban mobility

    DEFF Research Database (Denmark)

    Gudmundsson, Henrik

    2013-01-01

    Cities constitute the backbone of European historic development and provide the basis of its economic future. The near neglect of cities in existing European policies for sustainable growth and development such as the Europe 2020 strategy is untenable. The 2011 White Paper has sought to face...... seem essential to move cities beyond business as usual. Research-wise we need to understand in more detail the political and contextual background for successes - and failures - of European cities. This could help build an effective multi level governance framework for sustainable urban mobility...

  8. Multi-level Strategy for Identifying Proteasome-Catalyzed Spliced Epitopes Targeted by CD8(+) T Cells during Bacterial Infection

    NARCIS (Netherlands)

    Platteel, Anouk C M|info:eu-repo/dai/nl/375805613; Liepe, Juliane; Textoris-Taube, Kathrin; Keller, Christin; Henklein, Petra; Schalkwijk, Hanna H; Cardoso, Rebeca; Kloetzel, Peter M; Mishto, Michele; Sijts, Alice J A M|info:eu-repo/dai/nl/115553843

    2017-01-01

    Proteasome-catalyzed peptide splicing (PCPS) generates peptides that are presented by MHC class I molecules, but because their identification is challenging, the immunological relevance of spliced peptides remains unclear. Here, we developed a reverse immunology-based multi-level approach to

  9. Percutaneous vertebroplasty for multi-level osteoporotic vertebral compression fractures

    International Nuclear Information System (INIS)

    Wang Gefang; Cheng Yongde; Wu Chungen; Zhang Ji; Gu Yifeng; Li Minghua

    2008-01-01

    Objective: To prospectively evaluate the clinical efficiency and safety of patients receiving percutaneous vertebroplasty due to multi-level osteoporotic vertebral compression fractures. Methods: A retrospective study was conducted to review eighty-six osteoporotic vertebral compression fracture patients including 23 with three and more levels of vertebroplasty. The outcome was considered carefully by pre and postoperatively the Visual Analogue Scale (VAS)for pain relief, the Oswestry Disability Index (ODI)for the improvement activity of daily life and also the accompanied imaging information. Results: All procedures were performed successfully. Three patients had a transient high blood pressure and dyspnea, and recovered after sublingual nitroglycerin. The VAS and ODI improved from a mean preoperative score of 8.58±1.12 and 81.43 ±12.54 to a mean postoperative score of 3.03±0.98 and 31.04±11.11 one day afterward. Asymptomatic cement leakage rate was 17.8% with no major complications occurred during operation or post-operation. Five patients had new symptomatic vertebral fracture (s) during follow-up in one year. Conclusions: Vertebroplasty with cement to treat multi-level osteoporotic vertebral compression fractures in the elderly is safe and effective, providing immediate and long-term pain relief with improvement in quality of life. Due to the risk of fat embolism, the limitation of three per session must be kept strictly. (authors)

  10. On decoding of multi-level MPSK modulation codes

    Science.gov (United States)

    Lin, Shu; Gupta, Alok Kumar

    1990-01-01

    The decoding problem of multi-level block modulation codes is investigated. The hardware design of soft-decision Viterbi decoder for some short length 8-PSK block modulation codes is presented. An effective way to reduce the hardware complexity of the decoder by reducing the branch metric and path metric, using a non-uniform floating-point to integer mapping scheme, is proposed and discussed. The simulation results of the design are presented. The multi-stage decoding (MSD) of multi-level modulation codes is also investigated. The cases of soft-decision and hard-decision MSD are considered and their performance are evaluated for several codes of different lengths and different minimum squared Euclidean distances. It is shown that the soft-decision MSD reduces the decoding complexity drastically and it is suboptimum. The hard-decision MSD further simplifies the decoding while still maintaining a reasonable coding gain over the uncoded system, if the component codes are chosen properly. Finally, some basic 3-level 8-PSK modulation codes using BCH codes as component codes are constructed and their coding gains are found for hard decision multistage decoding.

  11. Multi-level programming paradigm for extreme computing

    International Nuclear Information System (INIS)

    Petiton, S.; Sato, M.; Emad, N.; Calvin, C.; Tsuji, M.; Dandouna, M.

    2013-01-01

    In order to propose a framework and programming paradigms for post peta-scale computing, on the road to exa-scale computing and beyond, we introduced new languages, associated with a hierarchical multi-level programming paradigm, allowing scientific end-users and developers to program highly hierarchical architectures designed for extreme computing. In this paper, we explain the interest of such hierarchical multi-level programming paradigm for extreme computing and its well adaptation to several large computational science applications, such as for linear algebra solvers used for reactor core physic. We describe the YML language and framework allowing describing graphs of parallel components, which may be developed using PGAS-like language such as XMP, scheduled and computed on supercomputers. Then, we propose experimentations on supercomputers (such as the 'K' and 'Hooper' ones) of the hybrid method MERAM (Multiple Explicitly Restarted Arnoldi Method) as a case study for iterative methods manipulating sparse matrices, and the block Gauss-Jordan method as a case study for direct method manipulating dense matrices. We conclude proposing evolutions for this programming paradigm. (authors)

  12. Multi-Level Bitmap Indexes for Flash Memory Storage

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Kesheng; Madduri, Kamesh; Canon, Shane

    2010-07-23

    Due to their low access latency, high read speed, and power-efficient operation, flash memory storage devices are rapidly emerging as an attractive alternative to traditional magnetic storage devices. However, tests show that the most efficient indexing methods are not able to take advantage of the flash memory storage devices. In this paper, we present a set of multi-level bitmap indexes that can effectively take advantage of flash storage devices. These indexing methods use coarsely binned indexes to answer queries approximately, and then use finely binned indexes to refine the answers. Our new methods read significantly lower volumes of data at the expense of an increased disk access count, thus taking full advantage of the improved read speed and low access latency of flash devices. To demonstrate the advantage of these new indexes, we measure their performance on a number of storage systems using a standard data warehousing benchmark called the Set Query Benchmark. We observe that multi-level strategies on flash drives are up to 3 times faster than traditional indexing strategies on magnetic disk drives.

  13. Modular Multi-level converter based HVDC System for Grid Connection of Offshore Wind Power Plant

    DEFF Research Database (Denmark)

    Gnanarathna, U.N.; Chaudhary, Sanjay Kumar; Gole, A.M.

    2010-01-01

    This paper explores the application of modular multi-level converters (MMC) as a means for harnessing the power from off-shore wind power plants. The MMC consists of a large number of simple voltage sourced converter (VSC) submodules that can be easily assembled into a converter for high......-voltage and high power. The paper shows that the MMC converter has a fast response and low harmonic content in comparison with a two-level VSC option. The paper discusses the modeling approach used, including a solution to the modeling challenge imposed by the very large number of switching devices in the MMC....

  14. Multi-level governance-perspective on management of nuclear waste disposal. A comparative analysis

    Energy Technology Data Exchange (ETDEWEB)

    Brunnengraeber, Achim; Haefner, Daniel

    2015-07-01

    The primary aim of the project is to conduct a detailed social and political analysis of the preconditions for the development of an acceptable strategy for nuclear waste disposal in Germany. This includes the identification of stakeholders and their interests, responsibilities, value systems, views and expectations as well as paths for a constructive approach to dialogue and problem-solving. A focus of the research project will be an international comparative multi-level governance analysis of acceptance patterns and steering mechanisms for conflict resolution.

  15. Multi-level governance-perspective on management of nuclear waste disposal. A comparative analysis

    International Nuclear Information System (INIS)

    Brunnengraeber, Achim; Haefner, Daniel

    2015-01-01

    The primary aim of the project is to conduct a detailed social and political analysis of the preconditions for the development of an acceptable strategy for nuclear waste disposal in Germany. This includes the identification of stakeholders and their interests, responsibilities, value systems, views and expectations as well as paths for a constructive approach to dialogue and problem-solving. A focus of the research project will be an international comparative multi-level governance analysis of acceptance patterns and steering mechanisms for conflict resolution.

  16. Assessment of Material Solutions of Multi-level Garage Structure Within Integrated Life Cycle Design Process

    Science.gov (United States)

    Wałach, Daniel; Sagan, Joanna; Gicala, Magdalena

    2017-10-01

    The paper presents an environmental and economic analysis of the material solutions of multi-level garage. The construction project approach considered reinforced concrete structure under conditions of use of ordinary concrete and high-performance concrete (HPC). Using of HPC allowed to significant reduction of reinforcement steel, mainly in compression elements (columns) in the construction of the object. The analysis includes elements of the methodology of integrated lice cycle design (ILCD). By making multi-criteria analysis based on established weight of the economic and environmental parameters, three solutions have been evaluated and compared within phase of material production (information modules A1-A3).

  17. Proposing an Evidence-Based Strategy for Software Requirements Engineering.

    Science.gov (United States)

    Lindoerfer, Doris; Mansmann, Ulrich

    2016-01-01

    This paper discusses an evidence-based approach to software requirements engineering. The approach is called evidence-based, since it uses publications on the specific problem as a surrogate for stakeholder interests, to formulate risks and testing experiences. This complements the idea that agile software development models are more relevant, in which requirements and solutions evolve through collaboration between self-organizing cross-functional teams. The strategy is exemplified and applied to the development of a Software Requirements list used to develop software systems for patient registries.

  18. Keabsahan Dan Kekuatan Hukum Layanan Multi Level Marketing Di Kota Manado

    OpenAIRE

    Mandang, Christian Leonardo

    2016-01-01

    Tujuan dilakukannya penelitian ini adalah untuk mengetahui apa landasan hukum yang mendasari keabsahan layanan Multi Level Marketing dan bagaimana sebuah Perusahaan dapat memenuhi syarat untuk menjalankan sistem Multi Level Marketing. Dengan menggunakan metode penelitian yuridis normatif, maka dapat disimpulkan: 1. Kehadiran Perusahaan dan kegiatan USAha Multi Level Marketing baik secara global maupun secara nasional, khususnya kehadirannya di negara Indonesia berperan untuk membantu berbagai...

  19. PENERAPAN HIRARKI DATA SQL DALAM MULTI LEVEL MARKETING

    Directory of Open Access Journals (Sweden)

    Sendi Novianto

    2012-05-01

    Full Text Available Sebagian besar pengguna pada satu waktu pasti pernah berurusan dengan hirarki data dalam database SQL dan tidak diragukan lagi belajar bahwa pengelolaan data hirarkis bukanlah apa yang dimaksudkan oleh database relasional. Tabel database relasional tidaklah hirarkis (seperti XML, tetapi hanya sebuah daftar. Data hirarkis memiliki hubungan parents-child yang tidak biasanya direpresentasikan dalam tabel database relasional. Multi Level Marketing (MLM merupakan suatu strategi pemasaran di mana tenaga penjualan mendapatkan kompensasi tidak hanya untuk penjualan tapi, tetapi juga untuk penjualan orang lain yang mereka rekrut, menciptakan suatu downline distributor dan hirarki dari berbagai tingkat kompensasi. Istilah lainnya untuk MLM termasuk jaringan pemasaran, penjualan dan pemasaran piramida rujukan. Data Hirarki penting di MLM untuk melacak catatan aktivitas penjualan, sehingga mereka dapat termotivasi setiap saat. Kata kunci : MLM, hirarki data, SQL, marketing.

  20. Multi-level barriers to LTBI treatment: a research note.

    Science.gov (United States)

    Hill, Linda; Blumberg, Elaine; Sipan, Carol; Schmitz, Katharine; West, Joshua; Kelley, Norma; Hovell, Melbourne

    2010-08-01

    This study describes the barriers to effective and timely LTBI treatment encountered in a research study on INH adherence in Latino adolescents. Participant study logs were reviewed, results of continuing medical education pretests for medical providers were examined, and participating medical facilities were contacted in order to construct a profile of multi-level barriers to LTBI treatment. A total of 285 TST positive Latino (96%) high school students were recruited into the trial. We encountered a lack of understanding of the gravity of tuberculosis infection among both the public and providers of health care. Parents and adolescents cited competing priorities, transportation problems and financial constraints as reasons for non-compliance. Improved education of the public and physicians is needed regarding the gravity of the disease and the value of treatment, as well as public and financial support for LTBI treatment by both the government and the medical community.

  1. Multi-Level Marketing - a Tool of Relationship Marketing

    Directory of Open Access Journals (Sweden)

    Constantin C.

    2009-12-01

    Full Text Available This paper aims to analyse the opportunity of using multi-level marketing (MLM as a tool of relationship marketing. The research is firstly based on an analysis regarding the issues about the legality of MLM techniques in the context of EU and US regulation systems. The outcomes of this research stress the main characteristics of legal network marketing and how a person which wants to become independent distributor could avoid the cooperation with an illegal pyramid scheme. The second research is based on a case study at the level of an insurance broker, which emphasizes the benefits that all parties involved in a transaction (broker, distributor and customer could obtain by using an MLM scheme.

  2. Towards Evidence Based Usability in Health Informatics?

    NARCIS (Netherlands)

    Marcilly, Romaric; Peute, Linda W.; Beuscart-Zephir, Marie-Catherine; Jaspers, Monique W.

    2015-01-01

    In a Health Information Technology (HIT) regulatory context in which the usability of this technology is more and more a critical issue, there is an increasing need for evidence based usability practice. However, a clear definition of evidence based usability practice and how to achieve it is still

  3. Quality of evidence-based pediatric guidelines

    NARCIS (Netherlands)

    Boluyt, Nicole; Lincke, Carsten R.; Offringa, Martin

    2005-01-01

    Objective. To identify evidence-based pediatric guidelines and to assess their quality. Methods. We searched Medline, Embase, and relevant Web sites of guideline development programs and national pediatric societies to identify evidence-based pediatric guidelines. A list with titles of identified

  4. Multi-level damage identification with response reconstruction

    Science.gov (United States)

    Zhang, Chao-Dong; Xu, You-Lin

    2017-10-01

    Damage identification through finite element (FE) model updating usually forms an inverse problem. Solving the inverse identification problem for complex civil structures is very challenging since the dimension of potential damage parameters in a complex civil structure is often very large. Aside from enormous computation efforts needed in iterative updating, the ill-condition and non-global identifiability features of the inverse problem probably hinder the realization of model updating based damage identification for large civil structures. Following a divide-and-conquer strategy, a multi-level damage identification method is proposed in this paper. The entire structure is decomposed into several manageable substructures and each substructure is further condensed as a macro element using the component mode synthesis (CMS) technique. The damage identification is performed at two levels: the first is at macro element level to locate the potentially damaged region and the second is over the suspicious substructures to further locate as well as quantify the damage severity. In each level's identification, the damage searching space over which model updating is performed is notably narrowed down, not only reducing the computation amount but also increasing the damage identifiability. Besides, the Kalman filter-based response reconstruction is performed at the second level to reconstruct the response of the suspicious substructure for exact damage quantification. Numerical studies and laboratory tests are both conducted on a simply supported overhanging steel beam for conceptual verification. The results demonstrate that the proposed multi-level damage identification via response reconstruction does improve the identification accuracy of damage localization and quantization considerably.

  5. Multi-level predictive maintenance for multi-component systems

    International Nuclear Information System (INIS)

    Nguyen, Kim-Anh; Do, Phuc; Grall, Antoine

    2015-01-01

    In this paper, a novel predictive maintenance policy with multi-level decision-making is proposed for multi-component system with complex structure. The main idea is to propose a decision-making process considered on two levels: system level and component one. The goal of the decision rules at the system level is to address if preventive maintenance actions are needed regarding the predictive reliability of the system. At component level the decision rules aim at identifying optimally a group of several components to be preventively maintained when preventive maintenance is trigged due to the system level decision. Selecting optimal components is based on a cost-based group improvement factor taking into account the predictive reliability of the components, the economic dependencies as well as the location of the components in the system. Moreover, a cost model is developed to find the optimal maintenance decision variables. A 14-component system is finally introduced to illustrate the use and the performance of the proposed predictive maintenance policy. Different sensitivity analysis are also investigated and discussed. Indeed, the proposed policy provides more flexibility in maintenance decision-making for complex structure systems, hence leading to significant profits in terms of maintenance cost when compared with existing policies. - Highlights: • A predictive maintenance policy for complex structure systems is proposed. • Multi-level decision process based on prognostic results is proposed. • A cost-based group importance measure is introduced for decision-making. • Both positive and negative dependencies between components are investigated. • A cost model and Monte Carlo simulation are developed for optimization process.

  6. Introduction: evidence-based action in humanitarian crises

    NARCIS (Netherlands)

    Dijkzeul, D.; Hilhorst, D.; Walker, P.

    2013-01-01

    This introductory paper sets the stage for this special issue of Disasters on evidence-based action in humanitarian crises. It reviews definition(s) of evidence and it examines the different disciplinary and methodological approaches to collecting and analysing evidence. In humanitarian action, the

  7. Beyond Evidence-Based Interventions for Teen Pregnancy Prevention

    OpenAIRE

    Emily Scribner-O'Pray

    2017-01-01

    This article examines how the field of adolescent sexual health came to embrace evidence-based interventions (EBIs); whether or not this approach is effective in meeting the needs of adolescents, especially those at high risk for teen pregnancy; concerns related to the scaling up of EBIs; and identifies issues which must be resolved as we move forward.

  8. Evidence-based Paradigm In Orthodontics | Ajayi | Nigerian ...

    African Journals Online (AJOL)

    The need to integrate the accrued scientific evidence into clinical orthodontic practice is amongst the challenges facing orthodontists in the 21st century. The evidence-based health care approach aims to improve patient care based upon informed decision-making. This article therefore highlights the importance and ...

  9. Beyond Evidence-Based Interventions for Teen Pregnancy Prevention

    Directory of Open Access Journals (Sweden)

    Emily Scribner-O'Pray

    2017-04-01

    Full Text Available This article examines how the field of adolescent sexual health came to embrace evidence-based interventions (EBIs; whether or not this approach is effective in meeting the needs of adolescents, especially those at high risk for teen pregnancy; concerns related to the scaling up of EBIs; and identifies issues which must be resolved as we move forward.

  10. No evidence-based restoration without a sound evidence base: a reply to Guldemond et al.

    CSIR Research Space (South Africa)

    Ntshotsho, P

    2012-03-01

    Full Text Available Evidence-based practice is not possible without an evidence base. Guldemond et al. confuse our attempt at assessing the status of the evidence base of restoration programs in South Africa with attempting to assess whether restoration is evidence...

  11. Sicily statement on evidence-based practice

    Directory of Open Access Journals (Sweden)

    Hopayian Kevork

    2005-01-01

    Full Text Available Abstract Background A variety of definitions of evidence-based practice (EBP exist. However, definitions are in themselves insufficient to explain the underlying processes of EBP and to differentiate between an evidence-based process and evidence-based outcome. There is a need for a clear statement of what Evidence-Based Practice (EBP means, a description of the skills required to practise in an evidence-based manner and a curriculum that outlines the minimum requirements for training health professionals in EBP. This consensus statement is based on current literature and incorporating the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers ("Signposting the future of EBHC". Discussion Evidence-Based Practice has evolved in both scope and definition. Evidence-Based Practice (EBP requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources. Health care professionals must be able to gain, assess, apply and integrate new knowledge and have the ability to adapt to changing circumstances throughout their professional life. Curricula to deliver these aptitudes need to be grounded in the five-step model of EBP, and informed by ongoing research. Core assessment tools for each of the steps should continue to be developed, validated, and made freely available. Summary All health care professionals need to understand the principles of EBP, recognise EBP in action, implement evidence-based policies, and have a critical attitude to their own practice and to evidence. Without these skills, professionals and organisations will find it difficult to provide 'best practice'.

  12. Bridging the gap to evidence-based eye care

    Directory of Open Access Journals (Sweden)

    Richard Wormald

    2004-10-01

    Full Text Available In the first article in this series, I touched on the enormous challenge to make access to information equal for those who need it at the time and place when they need it. Only if this is achieved can we successfully promote an evidence-based approach to health care. The move towards open access publishing is taking us some way to achieving this. However, there are further gaps to be bridged if we are to turn eye care workers into evidence-based practitioners. We can define an evidence-based practitioner as one who combines their individual knowledge and expertise with the best available external clinical evidence from systematic research.

  13. Evidence-based policy: implications for nursing and policy involvement.

    Science.gov (United States)

    Hewison, Alistair

    2008-11-01

    Evidence-based policy making is espoused as a central feature of government in the United Kingdom. However, an expectation that this will improve the quality of policy produced and provide a path to increased involvement of nurses in the policy process is misplaced. The purpose of this article is to demonstrate that the emphasis on evidence-based policy is problematic and cannot be regarded as a "new model" of policy making. Also, it could deflect attention from more practical approaches to policy involvement on the part of nurses. Policy development activities, acquisition of skills in policy analysis, and other forms of involvement are needed if nurses are to move along the continuum from policy literacy, through policy acumen, to policy competence. This involves taking a critical stance on the notion of evidence-based policy.

  14. Evidence Based Cataloguing: Moving Beyond the Rules

    Directory of Open Access Journals (Sweden)

    Kathy Carter

    2010-12-01

    Full Text Available Cataloguing is sometimes regarded as a rule-bound, production-based activity that offers little scope for professional judgement and decision-making. In reality, cataloguing involves challenging decisions that can have significant service and financial impacts. The current environment for cataloguing is a maelstrom of changing demands and competing visions for the future. With information-seekers turning en masse to Google and their behaviour receiving greater attention, library vendors are offering “discovery layer” products to replace traditional OPACs, and cataloguers are examining and debating a transformed version of their descriptive cataloguing rules (Resource Description and Access or RDA. In his “Perceptions of the future of cataloging: Is the sky really falling?” (2009, Ivey provides a good summary of this environment. At the same time, myriad new metadata formats and schema are being developed and applied for digital collections in libraries and other institutions. In today’s libraries, cataloguing is no longer limited to management of traditional AACR and MARC-based metadata for traditional library collections. And like their parent institutions, libraries cannot ignore growing pressures to demonstrate accountability and tangible value provided by their services. More than ever, research and an evidence based approach can help guide cataloguing decision-making.

  15. Evidence-based recommendations to facilitate professional ...

    African Journals Online (AJOL)

    Rachel Magdalena (Dalena) van Rooyen

    Purpose of the research: To develop evidence-based recommendations ... attitudes by not referring patients to traditional practitioners based on lack of knowledge ...... Longman Dictionary of Contemporary English. ... A case study from Chile.

  16. The evidence base for diabetes care

    National Research Council Canada - National Science Library

    Williams, D. R. R. (David Robert Rhys)

    2002-01-01

    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3. Evidence-Based Definition and Classification: A Commentary . . . . . . Steve O'Rahilly 37 PART II: PREVENTION OF DIABETES 4. Prevention of Type 1 Diabetes...

  17. Stakeholder conceptualisation of multi-level HIV and AIDS determinants in a Black epicentre.

    Science.gov (United States)

    Brawner, Bridgette M; Reason, Janaiya L; Hanlon, Kelsey; Guthrie, Barbara; Schensul, Jean J

    2017-09-01

    HIV has reached epidemic proportions among African Americans in the USA but certain urban contexts appear to experience a disproportionate disease burden. Geographic information systems mapping in Philadelphia indicates increased HIV incidence and prevalence in predominantly Black census tracts, with major differences across adjacent communities. What factors shape these geographic HIV disparities among Black Philadelphians? This descriptive study was designed to refine and validate a conceptual model developed to better understand multi-level determinants of HIV-related risk among Black Philadelphians. We used an expanded ecological approach to elicit reflective perceptions from administrators, direct service providers and community members about individual, social and structural factors that interact to protect against or increase the risk for acquiring HIV within their community. Gender equity, social capital and positive cultural mores (e.g., monogamy, abstinence) were seen as the main protective factors. Historical negative contributory influences of racial residential segregation, poverty and incarceration were among the most salient risk factors. This study was a critical next step toward initiating theory-based, multi-level community-based HIV prevention initiatives.

  18. Is multi-level marketing of nutrition supplements a legal and an ethical practice?

    Science.gov (United States)

    Cardenas, Diana; Fuchs-Tarlovsky, Vanessa

    2018-06-01

    Multi-level marketing (MLM) of nutrition products has experienced dramatic growth in recent decades. 'Wellness' is the second most popular niche in the MLM industry and represents 35% of sales among all the products in 2016. This category includes dietary supplements, weight management and sports nutrition products. The aim of this paper is to analyse whether this practice is legal and ethical. An analysis of available documentary information about the legal aspects of Multi-level marketing business was performed. Ethical reflexion was based on the "principlism" approach. We argue that, while being a controversial business model, MLM is not fraudulent from a legal point of view. However, it is an unethical strategy obviating all the principles of beneficence, nonmaleficence and autonomy. What is at stake is the possible economic scam and the potential harm those products could cause due to unproven efficacy, exceeding daily nutrient requirements and potential toxicity. The sale of dietary and nutrition supplements products by physicians and dieticians presents a conflict of interests that can undermine the primary obligation of physicians to serve the interests of their patients before their own. While considering that MLM of dietary supplements and other nutrition products are a legal business strategy, we affirm that it is an unethical practice. MLM products that have nutritional value or promoted as remedies may be unnecessary and intended for conditions that are unsuitable for self-prescription as well. Copyright © 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

  19. Multi-level discriminative dictionary learning with application to large scale image classification.

    Science.gov (United States)

    Shen, Li; Sun, Gang; Huang, Qingming; Wang, Shuhui; Lin, Zhouchen; Wu, Enhua

    2015-10-01

    The sparse coding technique has shown flexibility and capability in image representation and analysis. It is a powerful tool in many visual applications. Some recent work has shown that incorporating the properties of task (such as discrimination for classification task) into dictionary learning is effective for improving the accuracy. However, the traditional supervised dictionary learning methods suffer from high computation complexity when dealing with large number of categories, making them less satisfactory in large scale applications. In this paper, we propose a novel multi-level discriminative dictionary learning method and apply it to large scale image classification. Our method takes advantage of hierarchical category correlation to encode multi-level discriminative information. Each internal node of the category hierarchy is associated with a discriminative dictionary and a classification model. The dictionaries at different layers are learnt to capture the information of different scales. Moreover, each node at lower layers also inherits the dictionary of its parent, so that the categories at lower layers can be described with multi-scale information. The learning of dictionaries and associated classification models is jointly conducted by minimizing an overall tree loss. The experimental results on challenging data sets demonstrate that our approach achieves excellent accuracy and competitive computation cost compared with other sparse coding methods for large scale image classification.

  20. Individual relocation decisions after tornadoes: a multi-level analysis.

    Science.gov (United States)

    Cong, Zhen; Nejat, Ali; Liang, Daan; Pei, Yaolin; Javid, Roxana J

    2018-04-01

    This study examines how multi-level factors affected individuals' relocation decisions after EF4 and EF5 (Enhanced Fujita Tornado Intensity Scale) tornadoes struck the United States in 2013. A telephone survey was conducted with 536 respondents, including oversampled older adults, one year after these two disaster events. Respondents' addresses were used to associate individual information with block group-level variables recorded by the American Community Survey. Logistic regression revealed that residential damage and homeownership are important predictors of relocation. There was also significant interaction between these two variables, indicating less difference between homeowners and renters at higher damage levels. Homeownership diminished the likelihood of relocation among younger respondents. Random effects logistic regression found that the percentage of homeownership and of higher income households in the community buffered the effect of damage on relocation; the percentage of older adults reduced the likelihood of this group relocating. The findings are assessed from the standpoint of age difference, policy implications, and social capital and vulnerability. © 2018 The Author(s). Disasters © Overseas Development Institute, 2018.

  1. PHYSICS OF POLARIZED SCATTERING AT MULTI-LEVEL ATOMIC SYSTEMS

    Energy Technology Data Exchange (ETDEWEB)

    Stenflo, J. O., E-mail: stenflo@astro.phys.ethz.ch [Institute of Astronomy, ETH Zurich, CH-8093 Zurich, SwitzerlandAND (Switzerland); Istituto Ricerche Solari Locarno, Via Patocchi, CH-6605 Locarno-Monti (Switzerland)

    2015-03-01

    The symmetric peak observed in linear polarization in the core of the solar sodium D{sub 1} line at 5896 Å has remained enigmatic since its discovery nearly two decades ago. One reason is that the theory of polarized scattering has not been experimentally tested for multi-level atomic systems in the relevant parameter domains, although the theory is continually being used for the interpretation of astrophysical observations. A laboratory experiment that was set up a decade ago to find out whether the D{sub 1} enigma is a problem of solar physics or quantum physics revealed that the D{sub 1} system has a rich polarization structure in situations where standard scattering theory predicts zero polarization, even when optical pumping of the m state populations of the hyperfine-split ground state is accounted for. Here we show that the laboratory results can be modeled in great quantitative detail if the theory is extended to include the coherences in both the initial and final states of the scattering process. Radiative couplings between the allowed dipole transitions generate coherences in the initial state. Corresponding coherences in the final state are then demanded by a phase closure selection rule. The experimental results for the well understood D{sub 2} line are used to constrain the two free parameters of the experiment, collision rate and optical depth, to suppress the need for free parameters when fitting the D{sub 1} results.

  2. Multi-level iteration optimization for diffusive critical calculation

    International Nuclear Information System (INIS)

    Li Yunzhao; Wu Hongchun; Cao Liangzhi; Zheng Youqi

    2013-01-01

    In nuclear reactor core neutron diffusion calculation, there are usually at least three levels of iterations, namely the fission source iteration, the multi-group scattering source iteration and the within-group iteration. Unnecessary calculations occur if the inner iterations are converged extremely tight. But the convergence of the outer iteration may be affected if the inner ones are converged insufficiently tight. Thus, a common scheme suit for most of the problems was proposed in this work to automatically find the optimized settings. The basic idea is to optimize the relative error tolerance of the inner iteration based on the corresponding convergence rate of the outer iteration. Numerical results of a typical thermal neutron reactor core problem and a fast neutron reactor core problem demonstrate the effectiveness of this algorithm in the variational nodal method code NODAL with the Gauss-Seidel left preconditioned multi-group GMRES algorithm. The multi-level iteration optimization scheme reduces the number of multi-group and within-group iterations respectively by a factor of about 1-2 and 5-21. (authors)

  3. Evidence-Based Dentistry in Everyday Practice.

    Science.gov (United States)

    Gudray, Kiran; Walmsley, Anthony Damien

    2016-12-01

    This article informs readers of a method of implementing evidence-based dentistry in practice. Following these steps, practitioners should be able to use this skill in an efficient manner. The importance of evidence-based dentistry and its relevance to situations encountered in everyday practice is also highlighted. Clinical relevance: This article highlights a series of steps to be followed by practitioners to ensure that treatment provided is supported by the most recent, good quality evidence.

  4. Evidence-Based Practice: Management of Vertigo

    Science.gov (United States)

    Nguyen-Huynh, Anh T.

    2012-01-01

    Synopsis The article focuses on the evidence basis for the management of benign paroxysmal positional vertigo (BPPV), the most common diagnosis of vertigo in both primary care and subspecialty settings. Like all articles in this compilation of evidence-based practice, an overview is presented along with evidence based clinical assessment, diagnosis, and management. Summaries of differential diagnosis of vertigo and outcomes are presented. PMID:22980676

  5. Can Scholarly Communication be Evidence Based? (Editorial)

    OpenAIRE

    Denise Koufogiannakis

    2010-01-01

    This issue of Evidence Based Library and Information Practice includes three papers from the Evidence Based Scholarly Communication Conference (EBSCC) that took place in March 2010i. Kroth, Philips and Eldredge have written a commentary that gives an overview of the conference, and introduces us to the research papers that were presented. As well, two research presentations from the conference appear in this issue, an article by Donahue about a potential new method of communicating between sc...

  6. Mapping and navigating transitions - The multi-level perspective compared with arenas of development

    DEFF Research Database (Denmark)

    Jørgensen, Ulrik

    2012-01-01

    actors to navigate. The second concern builds on the observation that actors engage at all levels in society including visions, institutions, and innovations. The third concern addresses the role of academic theories and advice regarding governance of transition processes in which they function......Transitions of socio-technical systems imply the reconfiguration of institutions and politics making made evident the need to understand and intervene in existing patterns of growth and socio-technical practices in more sustainable directions. In recent decades, theories of transitions have been...... introduced, which include the multi-level approach indicating ways to govern transitions through understanding the interactions between niches, regimes and landscapes. An alternative approach is suggested, which takes its outset in arenas of development and increased awareness of actors and their way...

  7. A longitudinal, multi-level comparative study of quality and safety in European hospitals: the QUASER study protocol

    Directory of Open Access Journals (Sweden)

    Weggelaar Anne-Marie

    2011-10-01

    Full Text Available Abstract Background although there is a wealth of information available about quality improvement tools and techniques in healthcare there is little understanding about overcoming the challenges of day-to-day implementation in complex organisations like hospitals. The 'Quality and Safety in Europe by Research' (QUASER study will investigate how hospitals implement, spread and sustain quality improvement, including the difficulties they face and how they overcome them. The overall aim of the study is to explore relationships between the organisational and cultural characteristics of hospitals and how these impact on the quality of health care; the findings will be designed to help policy makers, payers and hospital managers understand the factors and processes that enable hospitals in Europe to achieve-and sustain-high quality services for their patients. Methods/design in-depth multi-level (macro, meso and micro-system analysis of healthcare quality policies and practices in 5 European countries, including longitudinal case studies in a purposive sample of 10 hospitals. The project design has three major features: • a working definition of quality comprising three components: clinical effectiveness, patient safety and patient experience • a conceptualisation of quality as a human, social, technical and organisational accomplishment • an emphasis on translational research that is evidence-based and seeks to provide strategic and practical guidance for hospital practitioners and health care policy makers in the European Union. Throughout the study we will adopt a mixed methods approach, including qualitative (in-depth, narrative-based, ethnographic case studies using interviews, and direct non-participant observation of organisational processes and quantitative research (secondary analysis of safety and quality data, for example: adverse incident reporting; patient complaints and claims. Discussion the protocol is based on the premise that

  8. PELAKSANAAN JUAL BELI MELALUI SISTEM MULTI LEVEL MARKETING PERSPEKTIF HUKUM ISLAM

    Directory of Open Access Journals (Sweden)

    Ayu Dewi Utami

    2016-03-01

    Full Text Available Bisnis Multi Level Marketing (MLM cukup berperan dalam menggerakkan roda perekonomian masyarakat. Dalam sejumlah kasus, Multi Level Marketing (MLM kerap dijadikan kedok dari bisnis money game dan mendewakan passive income. Bertolak dari kasus kasus seperti itulah, Majelis Ulama Indonesia (MUI telah menggodok prinsip-prinsip bisnis ini secara syariah termasuk marketing plannya. Tujuannya untuk melindungi pengusaha dan mitra bisnisnya (masyarakat dari praktik bisnis yang haram atau syubhat. Dari prinsip-prinsip yang ditentukan oleh Majelis Ulama Indonesia (MUI, peneliti mengadakan penelitian ini dengan tujuan untuk mengetahui bagaimana mekanisme bisnis Multi Level Marketing (MLM, serta untuk mengetahui bagaimana bisnis Multi Level Marketing (MLM menurut hukum Islam. Metode yang digunakan dalam penelitian ini adalah menggunakan metode pendekatan yuridis normatif, spesifikasi penelitian yang digunakan adalah deskriptif analitis, sedangkan penentuan sampel menggunakan metode Non Random sampling. Alat penelitian meliputi studi kepustakaan dan wawancara. Metode analisis data dilakukan dengan analisis kualitatif. Ada dua aspek untuk menilai apakah bisnis Multi Level Marketing (MLM itu sesuai dengan syariah atau tidak, yaitu aspek produk atau jasa yang dijual dan sistem dari Multi Level Marketing (MLM itu sendiri. Bagaimana sistem pemberian bonus yang terdapat dalam perusahaan Multi Level Marketing (MLM apakah terbebas dari unsus garar maupun maisir. Penelitian ini bertujuan untuk mengkaji lebih dalam tentang Multi Level Marketing (MLM khususnya dalam Hukum Islam. Sisi negatif yang terdapat pada sistem Multi Level Marketing (MLM tidak mewakili keharaman secara keseluruhan terhadap bisnis yang berbasis Multi Level Marketing (MLM lainnya.

  9. Health decision making: lynchpin of evidence-based practice.

    Science.gov (United States)

    Spring, Bonnie

    2008-01-01

    Health decision making is both the lynchpin and the least developed aspect of evidence-based practice. The evidence-based practice process requires integrating the evidence with consideration of practical resources and patient preferences and doing so via a process that is genuinely collaborative. Yet, the literature is largely silent about how to accomplish integrative, shared decision making. for evidence-based practice are discussed for 2 theories of clinician decision making (expected utility and fuzzy trace) and 2 theories of patient health decision making (transtheoretical model and reasoned action). Three suggestions are offered. First, it would be advantageous to have theory-based algorithms that weight and integrate the 3 data strands (evidence, resources, preferences) in different decisional contexts. Second, patients, not providers, make the decisions of greatest impact on public health, and those decisions are behavioral. Consequently, theory explicating how provider-patient collaboration can influence patient lifestyle decisions made miles from the provider's office is greatly needed. Third, although the preponderance of data on complex decisions supports a computational approach, such an approach to evidence-based practice is too impractical to be widely applied at present. More troublesomely, until patients come to trust decisions made computationally more than they trust their providers' intuitions, patient adherence will remain problematic. A good theory of integrative, collaborative health decision making remains needed.

  10. Reduction of inequalities in health: assessing evidence-based tools

    Directory of Open Access Journals (Sweden)

    Shea Beverley

    2006-09-01

    Full Text Available Abstract Background The reduction of health inequalities is a focus of many national and international health organisations. The need for pragmatic evidence-based approaches has led to the development of a number of evidence-based equity initiatives. This paper describes a new program that focuses upon evidence- based tools, which are useful for policy initiatives that reduce inequities. Methods This paper is based on a presentation that was given at the "Regional Consultation on Policy Tools: Equity in Population Health Reports," held in Toronto, Canada in June 2002. Results Five assessment tools were presented. 1. A database of systematic reviews on the effects of educational, legal, social, and health interventions to reduce unfair inequalities is being established through the Cochrane and Campbell Collaborations. 2 Decision aids and shared decision making can be facilitated in disadvantaged groups by 'health coaches' to help people become better decision makers, negotiators, and navigators of the health system; a pilot study in Chile has provided proof of this concept. 3. The CIET Cycle: Combining adapted cluster survey techniques with qualitative methods, CIET's population based applications support evidence-based decision making at local and national levels. The CIET map generates maps directly from survey or routine institutional data, to be used as evidence-based decisions aids. Complex data can be displayed attractively, providing an important tool for studying and comparing health indicators among and between different populations. 4. The Ottawa Equity Gauge is applying the Global Equity Gauge Alliance framework to an industrialised country setting. 5 The Needs-Based Health Assessment Toolkit, established to assemble information on which clinical and health policy decisions can be based, is being expanded to ensure a focus on distribution and average health indicators. Conclusion Evidence-based planning tools have much to offer the

  11. Antibiotic resistance shaping multi-level population biology of bacteria.

    Science.gov (United States)

    Baquero, Fernando; Tedim, Ana P; Coque, Teresa M

    2013-01-01

    Antibiotics have natural functions, mostly involving cell-to-cell signaling networks. The anthropogenic production of antibiotics, and its release in the microbiosphere results in a disturbance of these networks, antibiotic resistance tending to preserve its integrity. The cost of such adaptation is the emergence and dissemination of antibiotic resistance genes, and of all genetic and cellular vehicles in which these genes are located. Selection of the combinations of the different evolutionary units (genes, integrons, transposons, plasmids, cells, communities and microbiomes, hosts) is highly asymmetrical. Each unit of selection is a self-interested entity, exploiting the higher hierarchical unit for its own benefit, but in doing so the higher hierarchical unit might acquire critical traits for its spread because of the exploitation of the lower hierarchical unit. This interactive trade-off shapes the population biology of antibiotic resistance, a composed-complex array of the independent "population biologies." Antibiotics modify the abundance and the interactive field of each of these units. Antibiotics increase the number and evolvability of "clinical" antibiotic resistance genes, but probably also many other genes with different primary functions but with a resistance phenotype present in the environmental resistome. Antibiotics influence the abundance, modularity, and spread of integrons, transposons, and plasmids, mostly acting on structures present before the antibiotic era. Antibiotics enrich particular bacterial lineages and clones and contribute to local clonalization processes. Antibiotics amplify particular genetic exchange communities sharing antibiotic resistance genes and platforms within microbiomes. In particular human or animal hosts, the microbiomic composition might facilitate the interactions between evolutionary units involved in antibiotic resistance. The understanding of antibiotic resistance implies expanding our knowledge on multi-level

  12. Developing the skills required for evidence-based practice.

    Science.gov (United States)

    French, B

    1998-01-01

    The current health care environment requires practitioners with the skills to find and apply the best currently available evidence for effective health care, to contribute to the development of evidence-based practice protocols, and to evaluate the impact of utilizing validated research findings in practice. Current approaches to teaching research are based mainly on gaining skills by participation in the research process. Emphasis on the requirement for rigour in the process of creating new knowledge is assumed to lead to skill in the process of using research information created by others. This article reflects upon the requirements for evidence-based practice, and the degree to which current approaches to teaching research prepare practitioners who are able to find, evaluate and best use currently available research information. The potential for using the principles of systematic review as a teaching and learning strategy for research is explored, and some of the possible strengths and weakness of this approach are highlighted.

  13. Multi-level Governance as an Alternative: The Municipality of Barcelona and the Ciutat Refugi Plan

    Directory of Open Access Journals (Sweden)

    Ezgi Irgil

    2016-12-01

    Full Text Available This paper analyses the response of the Municipality of Barcelona to the Syrian refugee crisis in Europe as an alternative solution that challenges the national government’s restrictive approach. This response introduces the Ciutat Refugi Plan with a city-to-city network at the municipal level that involves other European cities in creating safe routes for refugees at the local government level. In line with multi-level governance theory, I argue that central governments’ inaction has pressured local governments to take action during the Syrian refugee influx. Relying on the influence of local government networks, the Municipality of Barcelona uses discourse as a tool of action in opening discursive spaces for humanitarian political responses to the refugee crisis. Using critical discourse analysis, I test this argument by examining in-depth interviews, speeches of people in power that have appeared in news articles, and statements on official websites.

  14. Automatic Multi-Level Thresholding Segmentation Based on Multi-Objective Optimization

    Directory of Open Access Journals (Sweden)

    L. DJEROU,

    2012-01-01

    Full Text Available In this paper, we present a new multi-level image thresholding technique, called Automatic Threshold based on Multi-objective Optimization "ATMO" that combines the flexibility of multi-objective fitness functions with the power of a Binary Particle Swarm Optimization algorithm "BPSO", for searching the "optimum" number of the thresholds and simultaneously the optimal thresholds of three criteria: the between-class variances criterion, the minimum error criterion and the entropy criterion. Some examples of test images are presented to compare our segmentation method, based on the multi-objective optimization approach with Otsu’s, Kapur’s and Kittler’s methods. Our experimental results show that the thresholding method based on multi-objective optimization is more efficient than the classical Otsu’s, Kapur’s and Kittler’s methods.

  15. Multi-Level Determinants of Parasitic Fly Infection in Forest Passerines

    Science.gov (United States)

    Manzoli, Darío Ezequiel; Antoniazzi, Leandro Raúl; Saravia, María José; Silvestri, Leonardo; Rorhmann, David; Beldomenico, Pablo Martín

    2013-01-01

    The study of myiasis is important because they may cause problems to the livestock industry, public health, or wildlife conservation. The ecology of parasitic dipterans that cause myiasis is singular, as they actively seek their hosts over relatively long distances. However, studies that address the determinants of myiasis dynamics are very scarce. The genus Philornis include species that may be excellent models to study myiasis ecology, as they exclusively parasitize bird nestlings, which stay in their nests until they are fully fledged, and larvae remain at the point of entry until the parasitic stage is over, thus allowing the collection of sequential individual-level infection data from virtually all the hosts present at a particular area. Here we offer a stratified multi-level analysis of longitudinal data of Philornis torquans parasitism in replicated forest bird communities of central Argentina. Using Generalized Linear Models and Generalized Linear Mixed Models and an information theory approach for model selection, we conducted four groups of analyses, each with a different study unit, the individual, the brood, the community at a given week, and the community at a given year. The response variable was larval abundance per nestling or mean abundance per nestling. At each level, models included the variables of interest of that particular level, and also potential confounders and effect modifiers of higher levels. We found associations of large magnitude at all levels, but only few variables truly governed the dynamics of this parasite. At the individual level, the infection was determined by the species and the age of the host. The main driver of parasite abundance at the microhabitat level was the average height of the forest, and at the community level, the density of hosts and prior rainfall. This multi-level approach contributed to a better understanding of the ecology of myiasis. PMID:23874408

  16. The religion of evidence-based practice

    DEFF Research Database (Denmark)

    Wigram, Tony; Gold, Christian

    2012-01-01

    This chapter begins by outlining the challenges of preparing a chapter on evidence-based practice (EBP) to underpin the use of music as a therapeutic tool in treatment, in the overall frame of music, health, and wellbeing. It then reviews the terminology of EBP and evidence-based medicine...... practice as health, education, and social services tighten their belts and the demand on their resources grows, there is increasing interest in the value of music for health and wellbeing, despite even less ‘hard’ evidence that it is effective against illness and disability....

  17. ML-Space: Hybrid Spatial Gillespie and Particle Simulation of Multi-Level Rule-Based Models in Cell Biology.

    Science.gov (United States)

    Bittig, Arne T; Uhrmacher, Adelinde M

    2017-01-01

    Spatio-temporal dynamics of cellular processes can be simulated at different levels of detail, from (deterministic) partial differential equations via the spatial Stochastic Simulation algorithm to tracking Brownian trajectories of individual particles. We present a spatial simulation approach for multi-level rule-based models, which includes dynamically hierarchically nested cellular compartments and entities. Our approach ML-Space combines discrete compartmental dynamics, stochastic spatial approaches in discrete space, and particles moving in continuous space. The rule-based specification language of ML-Space supports concise and compact descriptions of models and to adapt the spatial resolution of models easily.

  18. Evidence-based medicine Training: Kazakhstan experience.

    Science.gov (United States)

    Kamalbekova, G; Kalieva, M

    2015-01-01

    Understanding principles of evidence-based medicine is of vital importance for improving quality of care, promoting public health and health system development. Understanding principles of evidence-based medicine allows using the most powerful information source, which have ever existed in medicine. To evaluate the effectiveness of teaching Evidence-Based Medicine, including long-term outcomes of training. The study was conducted at the Medical University of Astana, where the Scientific and Educational Center of Evidence-Based Medicine was established in 2010 with the help of the corresponding project of the World Bank. The participants of the study were the faculty trained in Evidence-Based Medicine at the workshop "Introduction to Evidence-Based Medicine" for the period of 2010-2015 years. There were a total of 16 workshops during the period, and 323 employees were trained. All participants were asked to complete our questionnaire two times: before the training - pre-training (to determine the initial level of a listener) and after the training - post-training (to determine the acquired level and get the feedback). Questionnaires were prepared in such a way, that the majority of questions before and after training were identical. Thus, it provided a clear picture of the effectiveness of training. Questions in the survey were open-ended so that the respondents had the opportunity to freely and fully express their views. The main part of the questionnaires included the following questions: "Do you understand what evidence-based medicine is", "how do you understand what the study design means", "what is randomization", "how research is classified", "do you know the steps of decision-making according to Evidence-Based Medicine, list them", "what literature do you prefer to use when searching for information (print, electronic, etc.)", "what resources on the Internet do you prefer to use". Only 30-35% of respondents gave correct answers to the questions on

  19. Evidence-based practice within nutrition

    DEFF Research Database (Denmark)

    Laville, Martine; Segrestin, Berenice; Alligier, Maud

    2017-01-01

    BACKGROUND: Evidence-based clinical research poses special barriers in the field of nutrition. The present review summarises the main barriers to research in the field of nutrition that are not common to all randomised clinical trials or trials on rare diseases and highlights opportunities for im...

  20. Multi-level Governance in Environmental Risk Management

    Directory of Open Access Journals (Sweden)

    Petra Hiller

    2013-04-01

    Full Text Available The article examines regulatory strategies in the field of ecological disaster management with reference to the sociology of risk. The risk perspective draws attention to the fact that political strategies of regulation are to be understood as processes of risk transformation. The behavior of regulatory agencies is related to their perception of risks and opportunities. From this point of view, efforts in the field of disaster management appear as processes that turn perceived environmental threats into risks and opportunities for the agencies involved. The article shows the course of such a governance process which transforms environmental disasters into organizational risks and opportunities. This leads to the following research question: Which types of organizations favor strategies of risk avoidance and which organizations rather allow active pursuit of opportunities? The empirical part of this study is based on data obtained by field research in a multi-level negotiation system set up for managing hazardous wastes. Empirical findings support the assumption that organizational stability is a central condition for active pursuit of opportunities whereas organizational instability supports an orientation towards the avoidance of organizational risk. El artículo examina las estrategias reguladoras en el ámbito de la gestión de los desastres ecológicos, haciendo referencia a la sociología del riesgo. La perspectiva de riesgo pone su atención sobre el hecho de que las estrategias políticas de regulación se deben entender como procesos de transformación de riesgos. El comportamiento de las agencias reguladoras se relaciona con su percepción de los riesgos y oportunidades. Desde este punto de vista, los esfuerzos en el campo de la gestión de catástrofes se convierten en procesos que transforman las amenazas medioambientales (percibidas en riesgos y oportunidades para las agencias involucradas. El artículo muestra el desarrollo de este

  1. First 3D Cadastral Registration of Multi-level Ownerships Rights in the Netherlands

    NARCIS (Netherlands)

    Ploeger, H.D.; Stoter, J.E.; Roes, R; Van der Riet, E.; Biljecki, F.; Ledoux, H.

    2016-01-01

    This paper reports on the first 3D cadastral registration of multi-level ownerships rights in the Netherlands, which was accomplished in March 2016. It is the result of a study that was undertaken from 2013 to 2015 to determine how insight about multi-level ownership can be provided in 3D by the

  2. Cities, Europeanization and Multi-level Governance: Governing Climate Change through Transnational Municipal Networks

    NARCIS (Netherlands)

    Kern, K.; Bulkeley, H.

    2009-01-01

    This article focuses on a variant of multi-level governance and Europeanization, i.e. the transnational networking of local authorities. Focusing on local climate change policy, the article examines how transnational municipal networks (TMNs) govern in the context of multi-level European governance.

  3. Quantification of mold contamination in multi-level buildings using the Environmental Relative Moldiness Index

    Science.gov (United States)

    The goal of this study was to evaluate the possible use of the Environmental Relative Moldiness Index (ERMI) to quantify mold contamination in multi-level, office buildings. Settled-dust samples were collected in multi-level, office buildings and the ERMI value for each sample de...

  4. Multi-level Bayesian analyses for single- and multi-vehicle freeway crashes.

    Science.gov (United States)

    Yu, Rongjie; Abdel-Aty, Mohamed

    2013-09-01

    This study presents multi-level analyses for single- and multi-vehicle crashes on a mountainous freeway. Data from a 15-mile mountainous freeway section on I-70 were investigated. Both aggregate and disaggregate models for the two crash conditions were developed. Five years of crash data were used in the aggregate investigation, while the disaggregate models utilized one year of crash data along with real-time traffic and weather data. For the aggregate analyses, safety performance functions were developed for the purpose of revealing the contributing factors for each crash type. Two methodologies, a Bayesian bivariate Poisson-lognormal model and a Bayesian hierarchical Poisson model with correlated random effects, were estimated to simultaneously analyze the two crash conditions with consideration of possible correlations. Except for the factors related to geometric characteristics, two exposure parameters (annual average daily traffic and segment length) were included. Two different sets of significant explanatory and exposure variables were identified for the single-vehicle (SV) and multi-vehicle (MV) crashes. It was found that the Bayesian bivariate Poisson-lognormal model is superior to the Bayesian hierarchical Poisson model, the former with a substantially lower DIC and more significant variables. In addition to the aggregate analyses, microscopic real-time crash risk evaluation models were developed for the two crash conditions. Multi-level Bayesian logistic regression models were estimated with the random parameters accounting for seasonal variations, crash-unit-level diversity and segment-level random effects capturing unobserved heterogeneity caused by the geometric characteristics. The model results indicate that the effects of the selected variables on crash occurrence vary across seasons and crash units; and that geometric characteristic variables contribute to the segment variations: the more unobserved heterogeneity have been accounted, the better

  5. A Multi-Level Model of Information Seeking in the Clinical Domain

    Science.gov (United States)

    Hung, Peter W.; Johnson, Stephen B.; Kaufman, David R.; Mendonça, Eneida A.

    2008-01-01

    Objective: Clinicians often have difficulty translating information needs into effective search strategies to find appropriate answers. Information retrieval systems employing an intelligent search agent that generates adaptive search strategies based on human search expertise could be helpful in meeting clinician information needs. A prerequisite for creating such systems is an information seeking model that facilitates the representation of human search expertise. The purpose of developing such a model is to provide guidance to information seeking system development and to shape an empirical research program. Design: The information seeking process was modeled as a complex problem-solving activity. After considering how similarly complex activities had been modeled in other domains, we determined that modeling context-initiated information seeking across multiple problem spaces allows the abstraction of search knowledge into functionally consistent layers. The knowledge layers were identified in the information science literature and validated through our observations of searches performed by health science librarians. Results: A hierarchical multi-level model of context-initiated information seeking is proposed. Each level represents (1) a problem space that is traversed during the online search process, and (2) a distinct layer of knowledge that is required to execute a successful search. Grand strategy determines what information resources will be searched, for what purpose, and in what order. The strategy level represents an overall approach for searching a single resource. Tactics are individual moves made to further a strategy. Operations are mappings of abstract intentions to information resource-specific concrete input. Assessment is the basis of interaction within the strategic hierarchy, influencing the direction of the search. Conclusion: The described multi-level model provides a framework for future research and the foundation for development of an

  6. A community of learners in the evidence-based dental clinic

    NARCIS (Netherlands)

    Schoonheim-Klein, M.; Wesselink, P.R.; Vervoorn, J.M.

    2012-01-01

    An increasing emphasis has been placed on the need for an evidence-based approach in dentistry. This calls for effort in dental education to develop and implement tools for the application of evidence in clinical decision-making (evidence-based decision-making, EBDM). Aim:  To evaluate whether the

  7. Multi-level gene/MiRNA feature selection using deep belief nets and active learning.

    Science.gov (United States)

    Ibrahim, Rania; Yousri, Noha A; Ismail, Mohamed A; El-Makky, Nagwa M

    2014-01-01

    Selecting the most discriminative genes/miRNAs has been raised as an important task in bioinformatics to enhance disease classifiers and to mitigate the dimensionality curse problem. Original feature selection methods choose genes/miRNAs based on their individual features regardless of how they perform together. Considering group features instead of individual ones provides a better view for selecting the most informative genes/miRNAs. Recently, deep learning has proven its ability in representing the data in multiple levels of abstraction, allowing for better discrimination between different classes. However, the idea of using deep learning for feature selection is not widely used in the bioinformatics field yet. In this paper, a novel multi-level feature selection approach named MLFS is proposed for selecting genes/miRNAs based on expression profiles. The approach is based on both deep and active learning. Moreover, an extension to use the technique for miRNAs is presented by considering the biological relation between miRNAs and genes. Experimental results show that the approach was able to outperform classical feature selection methods in hepatocellular carcinoma (HCC) by 9%, lung cancer by 6% and breast cancer by around 10% in F1-measure. Results also show the enhancement in F1-measure of our approach over recently related work in [1] and [2].

  8. Authoritative knowledge, evidence-based medicine, and behavioral pediatrics.

    Science.gov (United States)

    Kennell, J H

    1999-12-01

    Evidence-based medicine is the conscientious and judicious use of current best knowledge in making decisions about the care of individual patients, often from well-designed, randomized, controlled trials. Authoritative medicine is the traditional approach to learning and practicing medicine, but no one authority has comprehensive scientific knowledge. Archie Cochrane proposed that every medical specialty should compile a list of all of the randomized, controlled trials within its field to be available for those who wish to know what treatments are effective. This was done first for obstetrics by a group collecting and critically analyzing all of the randomized trials and then indicating procedures every mother should have and those that no mother should have. Support during labor was used as an example. Similar groups are now active in almost all specialties, with information available on the Internet in the Cochrane Database of Systematic Reviews. Developmental-behavioral pediatrics should be part of this movement to evidence-based medicine.

  9. Evidence-Based Advances in Reptile Medicine.

    Science.gov (United States)

    Mitchell, Mark A; Perry, Sean M

    2017-09-01

    Evidence-based medicine allows veterinarians to practice high-quality medicine, because the basis for all decision making is quantitative, objective, and reproducible. Case reports and case series are limited in their scope and application. Cross-sectional studies, likewise, cannot provide answers to specific variable testing with a temporal application. It is essential for the reptile specialty to expand into case-control studies, cohort studies, and experimental/intervention studies. Unfortunately, much of the reptile literature remains limited to descriptive studies. This article reviews current evidence-based topics in reptile medicine and shares how everyone practicing in the field can contribute to improving this specialty. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Professionalism and evidence-based practice

    DEFF Research Database (Denmark)

    Rasmussen, Palle

    2015-01-01

    of evidence- based methods in Danish pre-school education and care. The management sees the use of these methods as strengthening pre- school teacher professionalism, but the actual practices in the day-careinstitutions are ambiguous. In some cases, using the methods becomes an end in itself and tends......The idea of evidence- based practice is influential in public welfare services, including education. The idea is controversial, however, not least because it involves a poten tial redefinition of the relation ship between knowledge, authority and professionalism. This is discussed based on a study...... to displace important educational objectives. In other cases, the methods are reflectively adjusted to a given context. Used in this way only, evid ence-based practice and methodology is a valuable resource for professional practice in education. From such a perspective, at least some types of research based...

  11. [Looking for evidence-based medical informatics].

    Science.gov (United States)

    Coiera, Enrico

    2016-03-01

    e-Health is experiencing a difficult time. On the one side, the forecast is for a bright digital health future created by precision medicine and smart devices. On the other hand, most large scale e-health projects struggle to make a difference and are often controversial. Both futures fail because they are not evidence-based. Medical informatics should follow the example of evidence-based medicine, i.e. conduct rigorous research that gives us evidence to solve real world problems, synthesise that evidence and then apply it strictly. We already have the tools for creating a different universe. What we need is evidence, will, a culture of learning, and hard work.

  12. Validity evidence based on test content.

    Science.gov (United States)

    Sireci, Stephen; Faulkner-Bond, Molly

    2014-01-01

    Validity evidence based on test content is one of the five forms of validity evidence stipulated in the Standards for Educational and Psychological Testing developed by the American Educational Research Association, American Psychological Association, and National Council on Measurement in Education. In this paper, we describe the logic and theory underlying such evidence and describe traditional and modern methods for gathering and analyzing content validity data. A comprehensive review of the literature and of the aforementioned Standards is presented. For educational tests and other assessments targeting knowledge and skill possessed by examinees, validity evidence based on test content is necessary for building a validity argument to support the use of a test for a particular purpose. By following the methods described in this article, practitioners have a wide arsenal of tools available for determining how well the content of an assessment is congruent with and appropriate for the specific testing purposes.

  13. Evidence-based hypnotherapy for depression.

    Science.gov (United States)

    Alladin, Assen

    2010-04-01

    Cognitive hypnotherapy (CH) is a comprehensive evidence-based hypnotherapy for clinical depression. This article describes the major components of CH, which integrate hypnosis with cognitive-behavior therapy as the latter provides an effective host theory for the assimilation of empirically supported treatment techniques derived from various theoretical models of psychotherapy and psychopathology. CH meets criteria for an assimilative model of psychotherapy, which is considered to be an efficacious model of psychotherapy integration. The major components of CH for depression are described in sufficient detail to allow replication, verification, and validation of the techniques delineated. CH for depression provides a template that clinicians and investigators can utilize to study the additive effects of hypnosis in the management of other psychological or medical disorders. Evidence-based hypnotherapy and research are encouraged; such a movement is necessary if clinical hypnosis is to integrate into mainstream psychotherapy.

  14. Evidence Based Education: un quadro storico

    Directory of Open Access Journals (Sweden)

    Giuliano Vivanet

    2013-08-01

    Full Text Available Nel corso dell’ultimo decennio, nel pensiero pedagogico anglosassone, si è affermata una cultura dell’evidenza cui ci si riferisce con l’espressione “evidence based education” (EBE. Secondo tale prospettiva, le decisioni in ambito educativo dovrebbero essere assunte sulla base delle conoscenze che la ricerca empirica offre in merito alla minore o maggiore efficacia delle differenti opzioni didattiche. Si tratta di un approccio (denominato “evidence based practice” che ha origine in ambito medico e che in seguito ha trovato applicazione in differenti domini delle scienze sociali. L’autore presenta un quadro introduttivo all’EBE, dando conto delle sue origini e dei differenti significati di cui è portatrice.

  15. Evidence-based practice of periodontics.

    Science.gov (United States)

    Cobb, Charles M; MacNeill, Simon R; Satheesh, Keerthana

    2010-01-01

    Evidence-based practice involves complex and conscientious decision making based not only on the available evidence but also on patient characteristics, situations, and preferences. It recognizes that care is individualized and ever-changing and involves uncertainties and probabilities. The specialty of periodontics has abundant high-level evidence upon which treatment decisions can be determined. This paper offers a brief commentary and overview of the available evidence commonly used in the private practice of periodontics.

  16. Morphea: Evidence-based recommendations for treatment

    OpenAIRE

    Nicole M Fett

    2012-01-01

    Morphea is a rare fibrosing disorder of the skin. Evidence-based treatment strategies in morphea are lacking. This review summarizes the available data on morphea treatment and provides therapeutic strategies based on morphea subtypes. The Cochrane Library, Medline and Embase from inception until May of 2011 were searched using the key words "morphea" and "morphea treatment." Reference lists of the resultant articles, as well as relevant reviews, were also searched. This review focuses on ran...

  17. Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy?

    Science.gov (United States)

    Cairney, Paul; Oliver, Kathryn

    2017-04-26

    There is extensive health and public health literature on the 'evidence-policy gap', exploring the frustrating experiences of scientists trying to secure a response to the problems and solutions they raise and identifying the need for better evidence to reduce policymaker uncertainty. We offer a new perspective by using policy theory to propose research with greater impact, identifying the need to use persuasion to reduce ambiguity, and to adapt to multi-level policymaking systems.We identify insights from secondary data, namely systematic reviews, critical analysis and policy theories relevant to evidence-based policymaking. The studies are drawn primarily from countries such as the United States, United Kingdom, Canada, Australia and New Zealand. We combine empirical and normative elements to identify the ways in which scientists can, do and could influence policy.We identify two important dilemmas, for scientists and researchers, that arise from our initial advice. First, effective actors combine evidence with manipulative emotional appeals to influence the policy agenda - should scientists do the same, or would the reputational costs outweigh the policy benefits? Second, when adapting to multi-level policymaking, should scientists prioritise 'evidence-based' policymaking above other factors? The latter includes governance principles such the 'co-production' of policy between local public bodies, interest groups and service users. This process may be based primarily on values and involve actors with no commitment to a hierarchy of evidence.We conclude that successful engagement in 'evidence-based policymaking' requires pragmatism, combining scientific evidence with governance principles, and persuasion to translate complex evidence into simple stories. To maximise the use of scientific evidence in health and public health policy, researchers should recognise the tendency of policymakers to base judgements on their beliefs, and shortcuts based on their emotions

  18. Evidence-based pathology: umbilical cord coiling.

    Science.gov (United States)

    Khong, T Y

    2010-12-01

    The generation of a pathology test result must be based on criteria that are proven to be acceptably reproducible and clinically relevant to be evidence-based. This review de-constructs the umbilical cord coiling index to illustrate how it can stray from being evidence-based. Publications related to umbilical cord coiling were retrieved and analysed with regard to how the umbilical coiling index was calculated, abnormal coiling was defined and reference ranges were constructed. Errors and other influences that can occur with the measurement of the length of the umbilical cord or of the number of coils can compromise the generation of the coiling index. Definitions of abnormal coiling are not consistent in the literature. Reference ranges defining hypocoiling or hypercoiling have not taken those potential errors or the possible effect of gestational age into account. Even the way numerical test results in anatomical pathology are generated, as illustrated by the umbilical coiling index, warrants a critical analysis into its evidence base to ensure that they are reproducible or free from errors.

  19. Evidence-based librarianship: an overview.

    Science.gov (United States)

    Eldredge, J D

    2000-10-01

    To demonstrate how the core characteristics of both evidence-based medicine (EBM) and evidence-based health care (EBHC) can be adapted to health sciences librarianship. Narrative review essay involving development of a conceptual framework. The author describes the central features of EBM and EBHC. Following each description of a central feature, the author then suggests ways that this feature applies to health sciences librarianship. First, the decision-making processes of EBM and EBHC are compatible with health sciences librarianship. Second, the EBM and EBHC values of favoring rigorously produced scientific evidence in decision making are congruent with the core values of librarianship. Third, the hierarchical levels of evidence can be applied to librarianship with some modifications. Library researchers currently favor descriptive-survey and case-study methods over systematic reviews, randomized controlled trials, or other higher levels of evidence. The library literature nevertheless contains diverse examples of randomized controlled trials, controlled-comparison studies, and cohort studies conducted by health sciences librarians. Health sciences librarians are confronted with making many practical decisions. Evidence-based librarianship offers a decision-making framework, which integrates the best available research evidence. By employing this framework and the higher levels of research evidence it promotes, health sciences librarians can lay the foundation for more collaborative and scientific endeavors.

  20. An Evidence-Based Framework for Evidence-Based Management in ...

    African Journals Online (AJOL)

    2018-05-01

    May 1, 2018 ... BACKGROUND: Evidence-based management (EBMgt) is a growing literature ... organization and management, especially in the last decade (1-6). One of these models is ..... Organizational Behavior. 2017;4(1):235-61.

  1. An Evidence-Based Framework for Evidence-Based Management in ...

    African Journals Online (AJOL)

    2018-05-01

    May 1, 2018 ... BACKGROUND: Evidence-based management (EBMgt) is a growing literature concept in ... principles are developing across disciplines such as education, criminology ..... Australian Health Review. 2012;36(3):284-90. 17.

  2. A Multi-Level Model of Moral Functioning Revisited

    Science.gov (United States)

    Reed, Don Collins

    2009-01-01

    The model of moral functioning scaffolded in the 2008 "JME" Special Issue is here revisited in response to three papers criticising that volume. As guest editor of that Special Issue I have formulated the main body of this response, concerning the dynamic systems approach to moral development, the problem of moral relativism and the role of…

  3. Multi-level trellis coded modulation and multi-stage decoding

    Science.gov (United States)

    Costello, Daniel J., Jr.; Wu, Jiantian; Lin, Shu

    1990-01-01

    Several constructions for multi-level trellis codes are presented and many codes with better performance than previously known codes are found. These codes provide a flexible trade-off between coding gain, decoding complexity, and decoding delay. New multi-level trellis coded modulation schemes using generalized set partitioning methods are developed for Quadrature Amplitude Modulation (QAM) and Phase Shift Keying (PSK) signal sets. New rotationally invariant multi-level trellis codes which can be combined with differential encoding to resolve phase ambiguity are presented.

  4. Apprehensions of nurse managers on evidence-based practice

    Directory of Open Access Journals (Sweden)

    Fernanda Carolina Camargo

    2017-12-01

    Full Text Available Abstract Objective: To analyze the apprehensions of nurse managers in the implementation of the Evidence Based Practice in a Teaching Hospital of Triângulo Mineiro. Method: Qualitative research guided by the Theory of the Diffusion of Innovations. Five workshops were conducted per focal group (n = 18 participants, conducted by hermeneutic-dialectic interactions between August and September/2016. Textual records resulting from each workshop were analyzed by semantic categories. Results: Aspects conditioning to the implementation of the Evidence Based Practice permeate from elements related to the fragmentation of the care network to the necessary expansion of the governability of the nurse managers to put changes into practice in their sectors. Most importantly, timely access to the results of research conducted at the teaching hospital was mentioned as crucial to guide better practices. Final considerations: The approach allowed the recognition of contextual conditions for the implementation of the Evidence-Based Practice, which may coincide with similar scenarios, as well as increase the national scientific production on the subject, which is still scarce.

  5. Deterministic versus evidence-based attitude towards clinical diagnosis.

    Science.gov (United States)

    Soltani, Akbar; Moayyeri, Alireza

    2007-08-01

    Generally, two basic classes have been proposed for scientific explanation of events. Deductive reasoning emphasizes on reaching conclusions about a hypothesis based on verification of universal laws pertinent to that hypothesis, while inductive or probabilistic reasoning explains an event by calculation of some probabilities for that event to be related to a given hypothesis. Although both types of reasoning are used in clinical practice, evidence-based medicine stresses on the advantages of the second approach for most instances in medical decision making. While 'probabilistic or evidence-based' reasoning seems to involve more mathematical formulas at the first look, this attitude is more dynamic and less imprisoned by the rigidity of mathematics comparing with 'deterministic or mathematical attitude'. In the field of medical diagnosis, appreciation of uncertainty in clinical encounters and utilization of likelihood ratio as measure of accuracy seem to be the most important characteristics of evidence-based doctors. Other characteristics include use of series of tests for refining probability, changing diagnostic thresholds considering external evidences and nature of the disease, and attention to confidence intervals to estimate uncertainty of research-derived parameters.

  6. Multi-level risk factors for suicidal ideation among at-risk adolescent females : The role of hypothalamic-pituitary-adrenal axis responses to stress

    NARCIS (Netherlands)

    Giletta, M.; Calhoun, C.D.; Hastings, P.D.; Rudolph, K.D.; Nock, M.K.; Prinstein, M.J.

    2015-01-01

    Adopting a multi-level approach, this study examined risk factors for adolescent suicidal ideation, with specific attention to (a) hypothalamic-pituitary-adrenal (HPA) axis stress responses and (b) the interplay between HPA-axis and other risk factors from multiple domains (i.e., psychological,

  7. An Evidence-based Approach to Developing a Management Strategy for Medical Contingencies on the Lunar Surface: The NASA/Haughton-Mars Project (HMP) 2006 Lunar Medical Contingency Simulation at Devon Island

    Science.gov (United States)

    Scheuring, R. A.; Jones, J. A.; Lee, P.; Comtois, J. M.; Chappell, S.; Rafiq, A.; Braham, S.; Hodgson, E.; Sullivan, P.; Wilkinson, N.; hide

    2007-01-01

    The lunar architecture for future sortie and outpost missions will require humans to serve on the lunar surface considerably longer than the Apollo moon missions. Although the Apollo crewmembers sustained few injuries during their brief lunar surface activity, injuries did occur and are a concern for the longer lunar stays. Interestingly, lunar medical contingency plans were not developed during Apollo. In order to develop an evidence-base for handling a medical contingency on the lunar surface, a simulation using the moon-Mars analog environment at Devon Island, Nunavut, high Canadian Arctic was conducted. Objectives of this study included developing an effective management strategy for dealing with an incapacitated crewmember on the lunar surface, establishing audio/visual and biomedical data connectivity to multiple centers, testing rescue/extraction hardware and procedures, and evaluating in suit increased oxygen consumption. Methods: A review of the Apollo lunar surface activities and personal communications with Apollo lunar crewmembers provided the knowledge base of plausible scenarios that could potentially injure an astronaut during a lunar extravehicular activity (EVA). Objectives were established to demonstrate stabilization and transfer of an injured crewmember and communication with ground controllers at multiple mission control centers. Results: The project objectives were successfully achieved during the simulation. Among these objectives were extraction from a sloped terrain by a two-member crew in a 1 g analog environment, establishing real-time communication to multiple centers, providing biomedical data to flight controllers and crewmembers, and establishing a medical diagnosis and treatment plan from a remote site. Discussion: The simulation provided evidence for the types of equipment and methods for performing extraction of an injured crewmember from a sloped terrain. Additionally, the necessary communications infrastructure to connect

  8. MKEM: a Multi-level Knowledge Emergence Model for mining undiscovered public knowledge

    Directory of Open Access Journals (Sweden)

    Song Min

    2010-04-01

    Full Text Available Abstract Background Since Swanson proposed the Undiscovered Public Knowledge (UPK model, there have been many approaches to uncover UPK by mining the biomedical literature. These earlier works, however, required substantial manual intervention to reduce the number of possible connections and are mainly applied to disease-effect relation. With the advancement in biomedical science, it has become imperative to extract and combine information from multiple disjoint researches, studies and articles to infer new hypotheses and expand knowledge. Methods We propose MKEM, a Multi-level Knowledge Emergence Model, to discover implicit relationships using Natural Language Processing techniques such as Link Grammar and Ontologies such as Unified Medical Language System (UMLS MetaMap. The contribution of MKEM is as follows: First, we propose a flexible knowledge emergence model to extract implicit relationships across different levels such as molecular level for gene and protein and Phenomic level for disease and treatment. Second, we employ MetaMap for tagging biological concepts. Third, we provide an empirical and systematic approach to discover novel relationships. Results We applied our system on 5000 abstracts downloaded from PubMed database. We performed the performance evaluation as a gold standard is not yet available. Our system performed with a good precision and recall and we generated 24 hypotheses. Conclusions Our experiments show that MKEM is a powerful tool to discover hidden relationships residing in extracted entities that were represented by our Substance-Effect-Process-Disease-Body Part (SEPDB model.

  9. DESTINY: A Comprehensive Tool with 3D and Multi-Level Cell Memory Modeling Capability

    Directory of Open Access Journals (Sweden)

    Sparsh Mittal

    2017-09-01

    Full Text Available To enable the design of large capacity memory structures, novel memory technologies such as non-volatile memory (NVM and novel fabrication approaches, e.g., 3D stacking and multi-level cell (MLC design have been explored. The existing modeling tools, however, cover only a few memory technologies, technology nodes and fabrication approaches. We present DESTINY, a tool for modeling 2D/3D memories designed using SRAM, resistive RAM (ReRAM, spin transfer torque RAM (STT-RAM, phase change RAM (PCM and embedded DRAM (eDRAM and 2D memories designed using spin orbit torque RAM (SOT-RAM, domain wall memory (DWM and Flash memory. In addition to single-level cell (SLC designs for all of these memories, DESTINY also supports modeling MLC designs for NVMs. We have extensively validated DESTINY against commercial and research prototypes of these memories. DESTINY is very useful for performing design-space exploration across several dimensions, such as optimizing for a target (e.g., latency, area or energy-delay product for a given memory technology, choosing the suitable memory technology or fabrication method (i.e., 2D v/s 3D for a given optimization target, etc. We believe that DESTINY will boost studies of next-generation memory architectures used in systems ranging from mobile devices to extreme-scale supercomputers. The latest source-code of DESTINY is available from the following git repository: https://bitbucket.org/sparshmittal/destinyv2.

  10. Evidence-Based Advances in Rabbit Medicine.

    Science.gov (United States)

    Summa, Noémie M; Brandão, João

    2017-09-01

    Rabbit medicine has been continuously evolving over time with increasing popularity and demand. Tremendous advances have been made in rabbit medicine over the past 5 years, including the use of imaging tools for otitis and dental disease management, the development of laboratory testing for encephalitozoonosis, or determination of prognosis in rabbits. Recent pharmacokinetic studies have been published, providing additional information on commonly used antibiotics and motility-enhancer drugs, as well as benzimidazole toxicosis. This article presents a review of evidence-based advances for liver lobe torsions, thymoma, and dental disease in rabbits and controversial and new future promising areas in rabbit medicine. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Evidence-Based Advances in Avian Medicine.

    Science.gov (United States)

    Summa, Noémie M; Guzman, David Sanchez-Migallon

    2017-09-01

    This article presents relevant advances in avian medicine and surgery over the past 5 years. New information has been published to improve clinical diagnosis in avian diseases. This article also describes new pharmacokinetic studies. Advances in the understanding and treatment of common avian disorders are presented in this article, as well. Although important progress has been made over the past years, there is still much research that needs to be done regarding the etiology, pathophysiology, diagnosis, and treatment of avian diseases and evidence-based information is still sparse in the literature. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Evidence-Based Advances in Ferret Medicine.

    Science.gov (United States)

    Huynh, Minh; Chassang, Lucile; Zoller, Graham

    2017-09-01

    This literature review covers approximately 35 years of veterinary medicine. This article develops the current state of knowledge in pet ferret medicine regarding the most common diseases according to evidence-based data and gives insight into further axis of research. Literature review was conducted through identification of keywords (title + ferret) with Web-based database searching. To appreciate the methodological quality and the level of evidence of each article included in the review, full-text versions were reviewed and questions addressed in the articles were formulated. Analysis of the articles' content was performed by the authors, and relevant clinical information was extracted. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Observation, Sherlock Holmes, and Evidence Based Medicine.

    Science.gov (United States)

    Osborn, John

    2002-01-01

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

  14. Morphea: Evidence-based recommendations for treatment

    Directory of Open Access Journals (Sweden)

    Nicole M Fett

    2012-01-01

    Full Text Available Morphea is a rare fibrosing disorder of the skin. Evidence-based treatment strategies in morphea are lacking. This review summarizes the available data on morphea treatment and provides therapeutic strategies based on morphea subtypes. The Cochrane Library, Medline and Embase from inception until May of 2011 were searched using the key words "morphea" and "morphea treatment." Reference lists of the resultant articles, as well as relevant reviews, were also searched. This review focuses on randomized controlled trials, prospective interventional trials without controls and retrospective reviews with greater than five subjects.

  15. Integration of multi-level marketing management systems geographically industry development

    OpenAIRE

    Aleksandr Lavrov; Lada Polikarpova; Alla Handramai

    2015-01-01

    In the article the authors attempt to develop a multi-level management system territorially industry development in market conditions, built in the widespread use of various types of marketing and their horizontal and vertical integration.

  16. space vector pulse width modulation of a multi-level diode clamped

    African Journals Online (AJOL)

    ES Obe

    step by step development of MATLAB /SIMULINK modeling of the space vector ..... Pulse Width Mod. of Multi-Level Diode Clamped Converter 119 powergui. Discrete, .... Load. Figure 22: Block diagram of the three level DCC design. 3 LEVEL ...

  17. Space Vector Pulse Width Modulation of a Multi-Level Diode ...

    African Journals Online (AJOL)

    Space Vector Pulse Width Modulation of a Multi-Level Diode Clamped ... of MATLAB /SIMULINK modeling of the space vector pulse-width modulation and the ... two adjacent active vectors in determining the switching process of the multilevel ...

  18. Energy mesh optimization for multi-level calculation schemes

    International Nuclear Information System (INIS)

    Mosca, P.; Taofiki, A.; Bellier, P.; Prevost, A.

    2011-01-01

    The industrial calculations of third generation nuclear reactors are based on sophisticated strategies of homogenization and collapsing at different spatial and energetic levels. An important issue to ensure the quality of these calculation models is the choice of the collapsing energy mesh. In this work, we show a new approach to generate optimized energy meshes starting from the SHEM 281-group library. The optimization model is applied on 1D cylindrical cells and consists of finding an energy mesh which minimizes the errors between two successive collision probability calculations. The former is realized over the fine SHEM mesh with Livolant-Jeanpierre self-shielded cross sections and the latter is performed with collapsed cross sections over the energy mesh being optimized. The optimization is done by the particle swarm algorithm implemented in the code AEMC and multigroup flux solutions are obtained from standard APOLLO2 solvers. By this new approach, a set of new optimized meshes which encompass from 10 to 50 groups has been defined for PWR and BWR calculations. This set will allow users to adapt the energy detail of the solution to the complexity of the calculation (assembly, multi-assembly, two-dimensional whole core). Some preliminary verifications, in which the accuracy of the new meshes is measured compared to a direct 281-group calculation, show that the 30-group optimized mesh offers a good compromise between simulation time and accuracy for a standard 17 x 17 UO 2 assembly with and without control rods. (author)

  19. Adjusting to Social Change - A Multi-Level Analysis in Three Cultures

    Science.gov (United States)

    2013-08-01

    example, coping may be more collective in collectivist , compared to individualist , societies (Chang & Sivam, 2004). Some cultures have a greater sense...AFRL-AFOSR-UK-TR-2013-0041 Adjusting to Social Change - A multi-level Analysis in three cultures Prof Robin Goodwin...COVERED (From – To) 23 May 2012 – 22 May 2013 4. TITLE AND SUBTITLE Adjusting to Social Change - A multi-level Analysis in three cultures

  20. The Analysis of Product Traits and Innovation Process of Multi Level Marketing Business at Talk Fusion

    OpenAIRE

    Suwarno, Sutrisno

    2013-01-01

    Multi Level Marketing Business nowadays is rapidly growing. In recent years, there have been so many new Multi Level Marketing Business coming out with their own specific offers and products. One of the advantages of MLM Business is the contribution it makes to economic growth. It makes it possible for the national income to continuously grow. The objectives can be achieved from this research are to examine product traits and innovation process of Talk Fusion. Theories supporting research are...

  1. Expanding the domains of attitudes towards evidence-based practice: the evidence based practice attitude scale-50.

    Science.gov (United States)

    Aarons, Gregory A; Cafri, Guy; Lugo, Lindsay; Sawitzky, Angelina

    2012-09-01

    Mental health and social service provider attitudes toward evidence-based practice have been measured through the development and validation of the Evidence-Based Practice Attitude Scale (EBPAS; Aarons, Ment Health Serv Res 6(2):61-74, 2004). Scores on the EBPAS scales are related to provider demographic characteristics, organizational characteristics, and leadership. However, the EBPAS assesses only four domains of attitudes toward EBP. The current study expands and further identifies additional domains of attitudes towards evidence-based practice. A qualitative and quantitative mixed-methods approach was used to: (1) generate items from multiples sources (researcher, mental health program manager, clinician/therapist), (2) identify potential content domains, and (3) examine the preliminary domains and factor structure through exploratory factor analysis. Participants for item generation included the investigative team, a group of mental health program managers (n = 6), and a group of clinicians/therapists (n = 8). For quantitative analyses a sample of 422 mental health service providers from 65 outpatient programs in San Diego County completed a survey that included the new items. Eight new EBPAS factors comprised of 35 items were identified. Factor loadings were moderate to large and internal consistency reliabilities were fair to excellent. We found that the convergence of these factors with the four previously identified evidence-based practice attitude factors (15 items) was small to moderate suggesting that the newly identified factors represent distinct dimensions of mental health and social service provider attitudes toward adopting EBP. Combining the original 15 items with the 35 new items comprises the EBPAS 50-item version (EBPAS-50) that adds to our understanding of provider attitudes toward adopting EBPs. Directions for future research are discussed.

  2. Multi-Level iterative methods in computational plasma physics

    International Nuclear Information System (INIS)

    Knoll, D.A.; Barnes, D.C.; Brackbill, J.U.; Chacon, L.; Lapenta, G.

    1999-01-01

    Plasma physics phenomena occur on a wide range of spatial scales and on a wide range of time scales. When attempting to model plasma physics problems numerically the authors are inevitably faced with the need for both fine spatial resolution (fine grids) and implicit time integration methods. Fine grids can tax the efficiency of iterative methods and large time steps can challenge the robustness of iterative methods. To meet these challenges they are developing a hybrid approach where multigrid methods are used as preconditioners to Krylov subspace based iterative methods such as conjugate gradients or GMRES. For nonlinear problems they apply multigrid preconditioning to a matrix-few Newton-GMRES method. Results are presented for application of these multilevel iterative methods to the field solves in implicit moment method PIC, multidimensional nonlinear Fokker-Planck problems, and their initial efforts in particle MHD

  3. Radiographers' preconditions for evidence-based radiography

    International Nuclear Information System (INIS)

    Ahonen, Sanna-Mari; Liikanen, Eeva

    2010-01-01

    Evidence-based practice (EBP) is essential in today's health care, but its establishment requires several preconditions from individuals and organizations (e.g. knowledge, understanding, attitudes, abilities, self-confidence, support, and resources). Previous studies suggest that radiographers do generate and use evidence in their work, but evidence-based radiography (EBR) is not yet used routinely as established practice, especially in terms of research utilization. This paper aims to describe radiographers' preconditions for EBR, and their participation in research activities. Main focus is on research utilization. Using an electronic questionnaire developed for this study, a survey was conducted: data collected from Finnish radiographers and radiotherapists (N = 438) were analysed both statistically and qualitatively. The final response rate was 39%. The results suggest radiographers' preconditions for EBR to consist of knowledge of research, significance of research activities, research-orientated way of working, and support. In addition, adequate resourcing is essential. Reading scientific journals, participation in research activities, a higher degree of education, and senior post seem to be significant promoters of EBR and research utilization. The results support the notion that EBR, and especially research utilization, are not yet well-established in Finland, and radiographers' viewpoints concerning the role and significance of research evidence and research activities still seem to vary.

  4. Multi-Level Wavelet Shannon Entropy-Based Method for Single-Sensor Fault Location

    Directory of Open Access Journals (Sweden)

    Qiaoning Yang

    2015-10-01

    Full Text Available In actual application, sensors are prone to failure because of harsh environments, battery drain, and sensor aging. Sensor fault location is an important step for follow-up sensor fault detection. In this paper, two new multi-level wavelet Shannon entropies (multi-level wavelet time Shannon entropy and multi-level wavelet time-energy Shannon entropy are defined. They take full advantage of sensor fault frequency distribution and energy distribution across multi-subband in wavelet domain. Based on the multi-level wavelet Shannon entropy, a method is proposed for single sensor fault location. The method firstly uses a criterion of maximum energy-to-Shannon entropy ratio to select the appropriate wavelet base for signal analysis. Then multi-level wavelet time Shannon entropy and multi-level wavelet time-energy Shannon entropy are used to locate the fault. The method is validated using practical chemical gas concentration data from a gas sensor array. Compared with wavelet time Shannon entropy and wavelet energy Shannon entropy, the experimental results demonstrate that the proposed method can achieve accurate location of a single sensor fault and has good anti-noise ability. The proposed method is feasible and effective for single-sensor fault location.

  5. Informed Systems: Enabling Collaborative Evidence Based Organizational Learning

    Directory of Open Access Journals (Sweden)

    Mary M. Somerville

    2015-12-01

    Full Text Available Objective – In response to unrelenting disruptions in academic publishing and higher education ecosystems, the Informed Systems approach supports evidence based professional activities to make decisions and take actions. This conceptual paper presents two core models, Informed Systems Leadership Model and Collaborative Evidence-Based Information Process Model, whereby co-workers learn to make informed decisions by identifying the decisions to be made and the information required for those decisions. This is accomplished through collaborative design and iterative evaluation of workplace systems, relationships, and practices. Over time, increasingly effective and efficient structures and processes for using information to learn further organizational renewal and advance nimble responsiveness amidst dynamically changing circumstances. Methods – The integrated Informed Systems approach to fostering persistent workplace inquiry has its genesis in three theories that together activate and enable robust information usage and organizational learning. The information- and learning-intensive theories of Peter Checkland in England, which advance systems design, stimulate participants’ appreciation during the design process of the potential for using information to learn. Within a co-designed environment, intentional social practices continue workplace learning, described by Christine Bruce in Australia as informed learning enacted through information experiences. In addition, in Japan, Ikujiro Nonaka’s theories foster information exchange processes and knowledge creation activities within and across organizational units. In combination, these theories promote the kind of learning made possible through evolving and transferable capacity to use information to learn through design and usage of collaborative communication systems with associated professional practices. Informed Systems therein draws from three antecedent theories to create an original

  6. Sustainability and evidence-based design in the healthcare estate

    CERN Document Server

    Phiri, Michael

    2014-01-01

    This work aims to deepen our understanding of the role played by technical guidelines and tools for the design, construction and operation of healthcare facilities, ultimately establishing the impact of the physical environment on staff and patient outcomes. Using case studies largely drawn from the UK, Europe, China and Australasia, design approaches such as sustainability (e.g. targets for energy efficiency, carbon neutrality, reduction of waste), evidence-based design (EBD), and Post-Project Evaluation (PPE) are examined in order to identify policies, mechanisms and strategies that can promote an integrated learning environment that in turn supports innovation in healthcare.

  7. Role of calibration, validation, and relevance in multi-level uncertainty integration

    International Nuclear Information System (INIS)

    Li, Chenzhao; Mahadevan, Sankaran

    2016-01-01

    Calibration of model parameters is an essential step in predicting the response of a complicated system, but the lack of data at the system level makes it impossible to conduct this quantification directly. In such a situation, system model parameters are estimated using tests at lower levels of complexity which share the same model parameters with the system. For such a multi-level problem, this paper proposes a methodology to quantify the uncertainty in the system level prediction by integrating calibration, validation and sensitivity analysis at different levels. The proposed approach considers the validity of the models used for parameter estimation at lower levels, as well as the relevance at the lower level to the prediction at the system level. The model validity is evaluated using a model reliability metric, and models with multivariate output are considered. The relevance is quantified by comparing Sobol indices at the lower level and system level, thus measuring the extent to which a lower level test represents the characteristics of the system so that the calibration results can be reliably used in the system level. Finally the results of calibration, validation and relevance analysis are integrated in a roll-up method to predict the system output. - Highlights: • Relevance analysis to quantify the closeness of two models. • Stochastic model reliability metric to integrate multiple validation experiments. • Extend the model reliability metric to deal with multivariate output. • Roll-up formula to integrate calibration, validation, and relevance.

  8. DReAM: Demand Response Architecture for Multi-level District Heating and Cooling Networks

    Energy Technology Data Exchange (ETDEWEB)

    Bhattacharya, Saptarshi; Chandan, Vikas; Arya, Vijay; Kar, Koushik

    2017-05-19

    In this paper, we exploit the inherent hierarchy of heat exchangers in District Heating and Cooling (DHC) networks and propose DReAM, a novel Demand Response (DR) architecture for Multi-level DHC networks. DReAM serves to economize system operation while still respecting comfort requirements of individual consumers. Contrary to many present day DR schemes that work on a consumer level granularity, DReAM works at a level of hierarchy above buildings, i.e. substations that supply heat to a group of buildings. This improves the overall DR scalability and reduce the computational complexity. In the first step of the proposed approach, mathematical models of individual substations and their downstream networks are abstracted into appropriately constructed low-complexity structural forms. In the second step, this abstracted information is employed by the utility to perform DR optimization that determines the optimal heat inflow to individual substations rather than buildings, in order to achieve the targeted objectives across the network. We validate the proposed DReAM framework through experimental results under different scenarios on a test network.

  9. Interevent time distributions of human multi-level activity in a virtual world

    Science.gov (United States)

    Mryglod, O.; Fuchs, B.; Szell, M.; Holovatch, Yu.; Thurner, S.

    2015-02-01

    Studying human behavior in virtual environments provides extraordinary opportunities for a quantitative analysis of social phenomena with levels of accuracy that approach those of the natural sciences. In this paper we use records of player activities in the massive multiplayer online game Pardus over 1238 consecutive days, and analyze dynamical features of sequences of actions of players. We build on previous work where temporal structures of human actions of the same type were quantified, and provide an empirical understanding of human actions of different types. This study of multi-level human activity can be seen as a dynamic counterpart of static multiplex network analysis. We show that the interevent time distributions of actions in the Pardus universe follow highly non-trivial distribution functions, from which we extract action-type specific characteristic 'decay constants'. We discuss characteristic features of interevent time distributions, including periodic patterns on different time scales, bursty dynamics, and various functional forms on different time scales. We comment on gender differences of players in emotional actions, and find that while males and females act similarly when performing some positive actions, females are slightly faster for negative actions. We also observe effects on the age of players: more experienced players are generally faster in making decisions about engaging in and terminating enmity and friendship, respectively.

  10. Evidence-based policymaking: A review

    Directory of Open Access Journals (Sweden)

    Karen Nortje

    2010-05-01

    Full Text Available The process of facilitating the uptake of evidence, for example, scientific research findings, into the policymaking process is multifaceted and thus complex. It is therefore important for scientists to understand this process in order to influence it more effectively. Similarly, policymakers need to understand the complexities of the scientific process to improve their interaction with the scientific sphere. This literature review addresses those factors that influence the uptake of scientific evidence into policymaking, the barriers to using science in policymaking, as well as recommendations for improved science–policymaking interaction. A visual diagram of the gears of a car is used to convey the message of the complexities around the engagement between science and policymaking. It is concluded that the issue of evidence-based policymaking remains unresolved and questions for future research on the science–policy interface are raised.

  11. EVIDENCE-BASED USE OF EPLERENONE

    Directory of Open Access Journals (Sweden)

    S. R. Gilyarevski

    2012-01-01

    Full Text Available Data of the negative effect of high concentrations of aldosterone in the blood for cardiovascular disease, which served as the theoretical basis for wider use in clinical practice of the drugs belonging to the class of aldosterone receptor blockers is presented. Evidence-based data on efficacy and safety of aldosterone receptor blockers, which were obtained in the course of several randomized clinical trials is performed. Particular attention is paid to aspects of the clinical use of selective aldosterone receptor blocker eplerenone, including current data, which makes reasonable extension of indications for its use in treating patients with chronic heart failure. Data on indications of eplerenone use in patients with hypertension, especially in the case of associated target organ damage is presented.

  12. EVIDENCE-BASED USE OF EPLERENONE

    Directory of Open Access Journals (Sweden)

    S. R. Gilyarevski

    2014-07-01

    Full Text Available Data of the negative effect of high concentrations of aldosterone in the blood for cardiovascular disease, which served as the theoretical basis for wider use in clinical practice of the drugs belonging to the class of aldosterone receptor blockers is presented. Evidence-based data on efficacy and safety of aldosterone receptor blockers, which were obtained in the course of several randomized clinical trials is performed. Particular attention is paid to aspects of the clinical use of selective aldosterone receptor blocker eplerenone, including current data, which makes reasonable extension of indications for its use in treating patients with chronic heart failure. Data on indications of eplerenone use in patients with hypertension, especially in the case of associated target organ damage is presented.

  13. Ethical reflections on Evidence Based Medicine

    Directory of Open Access Journals (Sweden)

    S. Corrao

    2013-05-01

    Full Text Available BACKGROUND According to Potter’s point of view, medical ethics is the science of survival, a bridge between humanistic and scientific culture. The working out of judgements on right or wrong referred to the human being are studied by this science. Methodological quality is fundamental in clinical research, and several technical issues are of paramount importance in trying to answer to the final question “what is the true, the right thing?”. We know they are essential aspects as in medical ethics as in evidence based practice. AIM OF THE STUDY The aim of this paper is to talk about relationships and implications between ethical issues and Evidence Based Medicine (EBM. DISCUSSION EBM represents a new paradigm that introduces new concepts to guide medical-decision making and health-care planning. Its principles are deeply rooted in clinical research methodology since information are derived from sound studies of strong quality. Health-care professionals have to deal with methodological concepts for critical appraisal of literature and implementation of evidences in clinical practice and healthcare planning. The central role of EBM in medical ethics is obvious, but a risk could be possible. The shift from Hippocratic point of view to community-centred one could lose sight of the centrality of the patient. CONCLUSION Both EBM principles and the needs to adequately response to economic restrictions urge a balance between individual and community ethics. All this has to represent an opportunity to place the patient at the centre of medical action considering at the same time community ethics as systemic aim, but without forgetting the risk that economic restrictions push towards veterinary ethics where herd is central and individual needs do not exist.

  14. Development of an evidence-based review with recommendations using an online iterative process.

    Science.gov (United States)

    Rudmik, Luke; Smith, Timothy L

    2011-01-01

    The practice of modern medicine is governed by evidence-based principles. Due to the plethora of medical literature, clinicians often rely on systematic reviews and clinical guidelines to summarize the evidence and provide best practices. Implementation of an evidence-based clinical approach can minimize variation in health care delivery and optimize the quality of patient care. This article reports a method for developing an "Evidence-based Review with Recommendations" using an online iterative process. The manuscript describes the following steps involved in this process: Clinical topic selection, Evidence-hased review assignment, Literature review and initial manuscript preparation, Iterative review process with author selection, and Manuscript finalization. The goal of this article is to improve efficiency and increase the production of evidence-based reviews while maintaining the high quality and transparency associated with the rigorous methodology utilized for clinical guideline development. With the rise of evidence-based medicine, most medical and surgical specialties have an abundance of clinical topics which would benefit from a formal evidence-based review. Although clinical guideline development is an important methodology, the associated challenges limit development to only the absolute highest priority clinical topics. As outlined in this article, the online iterative approach to the development of an Evidence-based Review with Recommendations may improve productivity without compromising the quality associated with formal guideline development methodology. Copyright © 2011 American Rhinologic Society-American Academy of Otolaryngic Allergy, LLC.

  15. Evidence-based toxicology for the 21st century: opportunities and challenges.

    Science.gov (United States)

    Stephens, Martin L; Andersen, Melvin; Becker, Richard A; Betts, Kellyn; Boekelheide, Kim; Carney, Ed; Chapin, Robert; Devlin, Dennis; Fitzpatrick, Suzanne; Fowle, John R; Harlow, Patricia; Hartung, Thomas; Hoffmann, Sebastian; Holsapple, Michael; Jacobs, Abigail; Judson, Richard; Naidenko, Olga; Pastoor, Tim; Patlewicz, Grace; Rowan, Andrew; Scherer, Roberta; Shaikh, Rashid; Simon, Ted; Wolf, Douglas; Zurlo, Joanne

    2013-01-01

    The Evidence-based Toxicology Collaboration (EBTC) was established recently to translate evidence-based approaches from medicine and health care to toxicology in an organized and sustained effort. The EBTC held a workshop on "Evidence-based Toxicology for the 21st Century: Opportunities and Challenges" in Research Triangle Park, North Carolina, USA on January 24-25, 2012. The presentations largely reflected two EBTC priorities: to apply evidence-based methods to assessing the performance of emerging pathway-based testing methods consistent with the 2007 National Research Council report on "Toxicity Testing in the 21st Century" as well as to adopt a governance structure and work processes to move that effort forward. The workshop served to clarify evidence-based approaches and to provide food for thought on substantive and administrative activities for the EBTC. Priority activities include conducting pilot studies to demonstrate the value of evidence-based approaches to toxicology, as well as conducting educational outreach on these approaches.

  16. A longitudinal, multi-level comparative study of quality and safety in European hospitals

    DEFF Research Database (Denmark)

    Robert, Glenn B; Anderson, Janet E; Burnett, Susan J

    2011-01-01

    makers in the European Union. Throughout the study we will adopt a mixed methods approach, including qualitative (in-depth, narrative-based, ethnographic case studies using interviews, and direct non-participant observation of organisational processes) and quantitative research (secondary analysis......, patient safety and patient experience • a conceptualisation of quality as a human, social, technical and organisational accomplishment • an emphasis on translational research that is evidence-based and seeks to provide strategic and practical guidance for hospital practitioners and health care policy...... by Research' (QUASER) study will investigate how hospitals implement, spread and sustain quality improvement, including the difficulties they face and how they overcome them. The overall aim of the study is to explore relationships between the organisational and cultural characteristics of hospitals and how...

  17. History and development of evidence-based medicine.

    Science.gov (United States)

    Claridge, Jeffrey A; Fabian, Timothy C

    2005-05-01

    This article illustrates the timeline of the development of evidence-based medicine (EBM). The term "evidence-based medicine" is relatively new. In fact, as far as we can tell, investigators from McMaster's University began using the term during the 1990s. EBM was defined as "a systemic approach to analyze published research as the basis of clinical decision making." Then in 1996, the term was more formally defined by Sacket et al., who stated that EBM was "the conscientious and judicious use of current best evidence from clinical care research in the management of individual patients." Ancient era EBM consists of ancient historical or anecdotal accounts of what may be loosely termed EBM. This was followed by the development of the renaissance era of EBM, which began roughly during the seventeenth century. During this era personal journals were kept and textbooks began to become more prominent. This was followed by the 1900s, during an era we term the transitional era of EBM (1900-1970s). Knowledge during this era could be shared more easily in textbooks and eventually peer-reviewed journals. Finally, during the 1970s we enter the modern era of EBM. Technology has had a large role in the advancement of EBM. Computers and database software have allowed compilation of large amounts of data. The Index Medicus has become a medical dinosaur of the past that students of today likely do not recognize. The Internet has also allowed incredible access to masses of data and information. However, we must be careful with an overabundance of "unfiltered" data. As history, as clearly shown us, evidence and data do not immediately translate into evidence based practice.

  18. Multi-level analysis in information systems research: the case of enterprise resource planning system usage in China

    Science.gov (United States)

    Sun, Yuan; Bhattacherjee, Anol

    2011-11-01

    Information technology (IT) usage within organisations is a multi-level phenomenon that is influenced by individual-level and organisational-level variables. Yet, current theories, such as the unified theory of acceptance and use of technology, describe IT usage as solely an individual-level phenomenon. This article postulates a model of organisational IT usage that integrates salient organisational-level variables such as user training, top management support and technical support within an individual-level model to postulate a multi-level model of IT usage. The multi-level model was then empirically validated using multi-level data collected from 128 end users and 26 managers in 26 firms in China regarding their use of enterprise resource planning systems and analysed using the multi-level structural equation modelling (MSEM) technique. We demonstrate the utility of MSEM analysis of multi-level data relative to the more common structural equation modelling analysis of single-level data and show how single-level data can be aggregated to approximate multi-level analysis when multi-level data collection is not possible. We hope that this article will motivate future scholars to employ multi-level data and multi-level analysis for understanding organisational phenomena that are truly multi-level in nature.

  19. Evidence-based treatment of metabolic myopathy

    Directory of Open Access Journals (Sweden)

    Yan LIN

    2014-05-01

    Full Text Available Objective To evaluate the current treatments and possible adverse reactions of metabolic myopathy, and to develop the best solution for evidence-based treatment.  Methods Taking metabolic myopathy, mitochondrial myopathy, lipid storage myopathy, glycogen storage diseases, endocrine myopathy, drug toxicity myopathy and treatment as search terms, retrieve in databases such as PubMed, Cochrane Library, ClinicalKey database, National Science and Technology Library (NSTL, in order to collect the relevant literature database including clinical guidelines, systematic reviews (SR, randomized controlled trials (RCT, controlled clinical trials, retrospective case analysis and case study. Jadad Scale was used to evaluate the quality of literature.  Results Twenty-eight related articles were selected, including 6 clinical guidelines, 5 systematic reviews, 10 randomized controlled trials and 7 clinical controlled trials. According to Jadad Scale, 23 articles were evaluated as high-quality literature (≥ 4, and the remaining 5 were evaluated as low-quality literature (< 4. Treatment principles of these clinical trials, efficacy of different therapies and drug safety evaluation suggest that: 1 Acid α-glycosidase (GAA enzyme replacement therapy (ERT is the main treatment for glycogen storage diseases, with taking a high-protein diet, exercising before taking a small amount of fructose orally and reducing the patient's physical activity gradually. 2 Carnitine supplementation is used in the treatment of lipid storage myopathy, with carbohydrate and low fat diet provided before exercise or sports. 3 Patients with mitochondrial myopathy can take coenzyme Q10, vitamin B, vitamin K, vitamin C, etc. Proper aerobic exercise combined with strength training is safe, and it can also enhance the exercise tolerance of patients effectively. 4 The first choice to treat the endocrine myopathy is treating primary affection. 5 Myopathies due to drugs and toxins should

  20. Epistemologic inquiries in evidence-based medicine.

    Science.gov (United States)

    Djulbegovic, Benjamin; Guyatt, Gordon H; Ashcroft, Richard E

    2009-04-01

    Since the term "evidence-based medicine" (EBM) first appeared in the scientific literature in 1991, the concept has had considerable influence in many parts of the world. Most professional societies, the public,and funding agencies have accepted EBM with remarkable enthusiasm. The concept of evidence-based practice is now applied in management, education, criminology, and social work. Yet, EBM has attracted controversy: its critics allege that EBM uses a narrow concept of evidence and a naive conception of the relationships between evidence, theory, and practice. They also contend that EBM presents itself as a radical restructuring of medical knowledge that discredits more traditional ways of knowing in medicine, largely in the interests of people with a particular investment in the enterprise of large-scale clinical trials. Because EBM proposes aspecific relationship between theory, evidence, and knowledge, its theoretical basis can be understood as an epistemological system. Undertaking epistemological inquiry is important because the adoption of a particular epistemological view defines how science is conducted. In this paper, we challenge this critical view of EBM by examining how EBM fits into broad epistemological debates within the philosophy of science. We consider how EBM relates to some classical debates regarding the nature of science and knowledge. We investigate EBM from the perspective of major epistemological theories (logical-positivism/inductivism, deductivism/falsificationism/theory-ladeness of observations, explanationism/holism, instrumentalism, underdetermination theory by evidence). We first explore the relationship between evidence and knowledge and discuss philosophical support for the main way that evidence is used in medicine: (1) in the philosophical tradition that "rational thinkers respect their evidence," we show that EBM refers to making medical decisions that are consistent with evidence, (2) as a reliable sign, symptom, or mark to

  1. Multi-level learning: improving the prediction of protein, domain and residue interactions by allowing information flow between levels

    Directory of Open Access Journals (Sweden)

    McDermott Drew

    2009-08-01

    Full Text Available Abstract Background Proteins interact through specific binding interfaces that contain many residues in domains. Protein interactions thus occur on three different levels of a concept hierarchy: whole-proteins, domains, and residues. Each level offers a distinct and complementary set of features for computationally predicting interactions, including functional genomic features of whole proteins, evolutionary features of domain families and physical-chemical features of individual residues. The predictions at each level could benefit from using the features at all three levels. However, it is not trivial as the features are provided at different granularity. Results To link up the predictions at the three levels, we propose a multi-level machine-learning framework that allows for explicit information flow between the levels. We demonstrate, using representative yeast interaction networks, that our algorithm is able to utilize complementary feature sets to make more accurate predictions at the three levels than when the three problems are approached independently. To facilitate application of our multi-level learning framework, we discuss three key aspects of multi-level learning and the corresponding design choices that we have made in the implementation of a concrete learning algorithm. 1 Architecture of information flow: we show the greater flexibility of bidirectional flow over independent levels and unidirectional flow; 2 Coupling mechanism of the different levels: We show how this can be accomplished via augmenting the training sets at each level, and discuss the prevention of error propagation between different levels by means of soft coupling; 3 Sparseness of data: We show that the multi-level framework compounds data sparsity issues, and discuss how this can be dealt with by building local models in information-rich parts of the data. Our proof-of-concept learning algorithm demonstrates the advantage of combining levels, and opens up

  2. Empirical methods for systematic reviews and evidence-based medicine

    NARCIS (Netherlands)

    van Enst, W.A.

    2014-01-01

    Evidence-Based Medicine is the integration of best research evidence with clinical expertise and patient values. Systematic reviews have become the cornerstone of evidence-based medicine, which is reflected in the position systematic reviews have in the pyramid of evidence-based medicine. Systematic

  3. E-Learning and Evidence Based Practice in Schools

    Science.gov (United States)

    Quong, Terrence

    2016-01-01

    JCTIC has used open source software to develop a unique school online environment that has made evidence based practice viable in their school. In this paper the proposition is made that eLearning enables evidence based practice which in turn leads to improved student outcomes. Much has been written about evidence based practice in schools, but…

  4. Information provision in medical libraries: An evidence based ...

    African Journals Online (AJOL)

    The paper examined information provision in special libraries such as medical libraries. It provides an overview of evidence based practice as a concept for information provision by librarians. It specifically proffers meaning to the term evidence as used in evidence based practice and to evidence based medicine from where ...

  5. The multi-level perspective analysis: Indonesia geothermal energy transition study

    Science.gov (United States)

    Wisaksono, A.; Murphy, J.; Sharp, J. H.; Younger, P. L.

    2018-01-01

    The study adopts a multi-level perspective in technology transition to analyse how the transition process in the development of geothermal energy in Indonesia is able to compete against the incumbent fossil-fuelled energy sources. Three levels of multi-level perspective are socio-technical landscape (ST-landscape), socio-technical regime (ST-regime) and niche innovations in Indonesia geothermal development. The identification, mapping and analysis of the dynamic relationship between each level are the important pillars of the multi-level perspective framework. The analysis considers the set of rules, actors and controversies that may arise in the technological transition process. The identified geothermal resource risks are the basis of the emerging geothermal technological innovations in Indonesian geothermal. The analysis of this study reveals the transition pathway, which yields a forecast for the Indonesian geothermal technology transition in the form of scenarios and probable impacts.

  6. Design of shared unit-dose drug distribution network using multi-level particle swarm optimization.

    Science.gov (United States)

    Chen, Linjie; Monteiro, Thibaud; Wang, Tao; Marcon, Eric

    2018-03-01

    Unit-dose drug distribution systems provide optimal choices in terms of medication security and efficiency for organizing the drug-use process in large hospitals. As small hospitals have to share such automatic systems for economic reasons, the structure of their logistic organization becomes a very sensitive issue. In the research reported here, we develop a generalized multi-level optimization method - multi-level particle swarm optimization (MLPSO) - to design a shared unit-dose drug distribution network. Structurally, the problem studied can be considered as a type of capacitated location-routing problem (CLRP) with new constraints related to specific production planning. This kind of problem implies that a multi-level optimization should be performed in order to minimize logistic operating costs. Our results show that with the proposed algorithm, a more suitable modeling framework, as well as computational time savings and better optimization performance are obtained than that reported in the literature on this subject.

  7. Integration of Evidence Base into a Probabilistic Risk Assessment

    Science.gov (United States)

    Saile, Lyn; Lopez, Vilma; Bickham, Grandin; Kerstman, Eric; FreiredeCarvalho, Mary; Byrne, Vicky; Butler, Douglas; Myers, Jerry; Walton, Marlei

    2011-01-01

    INTRODUCTION: A probabilistic decision support model such as the Integrated Medical Model (IMM) utilizes an immense amount of input data that necessitates a systematic, integrated approach for data collection, and management. As a result of this approach, IMM is able to forecasts medical events, resource utilization and crew health during space flight. METHODS: Inflight data is the most desirable input for the Integrated Medical Model. Non-attributable inflight data is collected from the Lifetime Surveillance for Astronaut Health study as well as the engineers, flight surgeons, and astronauts themselves. When inflight data is unavailable cohort studies, other models and Bayesian analyses are used, in addition to subject matters experts input on occasion. To determine the quality of evidence of a medical condition, the data source is categorized and assigned a level of evidence from 1-5; the highest level is one. The collected data reside and are managed in a relational SQL database with a web-based interface for data entry and review. The database is also capable of interfacing with outside applications which expands capabilities within the database itself. Via the public interface, customers can access a formatted Clinical Findings Form (CLiFF) that outlines the model input and evidence base for each medical condition. Changes to the database are tracked using a documented Configuration Management process. DISSCUSSION: This strategic approach provides a comprehensive data management plan for IMM. The IMM Database s structure and architecture has proven to support additional usages. As seen by the resources utilization across medical conditions analysis. In addition, the IMM Database s web-based interface provides a user-friendly format for customers to browse and download the clinical information for medical conditions. It is this type of functionality that will provide Exploratory Medicine Capabilities the evidence base for their medical condition list

  8. Psychiatric mental health evidence-based practice.

    Science.gov (United States)

    Rice, Michael J

    2008-05-01

    This article is the first in a new column focusing on evidence-based practice (EBP) in psychiatric mental health nursing. The EBP movement was strongly influenced by a British epidemiologist, Dr. Cochrane, who advocated care based on randomized clinical controlled trials in the late 1900s. Although the majority of the EBP movement is directed toward developing clinical guidelines, the critical element focuses on the therapeutic relationship and clinical judgment associated with providing care. This column will address a clinical problem, define PICO questions, report knowledge base searches, and present existing evidence. Recommendations will be offered for potential interventions and suggestions for evaluating clinical outcomes. Nurses can no longer view clinical studies as academic exercises discarded on graduation and not applied to the clinical setting. Conscientiously applying what is known about treatments and interventions of ethical, if not legal, value is consistent with the professional definition of care. J Am Psychiatr Nurses Assoc, 2008; 14(2), 107-111. DOI: 10.1177/1078390308315798.

  9. Teaching evidence-based medicine more effectively.

    Science.gov (United States)

    Hatmi, Zinat Nadia; Tahvildari, Sousan; Dabiran, Soheila; Soheili, Suraya; Sabouri Kashani, Ahmad; Raznahan, Maedeh

    2010-01-01

    Evidence-based Medicine (EBM) is becoming an integral component of graduate medical education competency and a requirement for grad medical education practice-based learning core competency. This study tries to compare the efficacy of conferences utilizing small-group discussions with the traditional conference method in enhancing EBM competency. The participants in this randomized controlled trial (RCT) were 170 members of the medical faculty who were divided into two groups of 86 (intervention) and 84 (control). Following the intervention, EBM competency was assessed by a written examination. statistical analysis made use of chi-square test, independent sample t-test and relative risks for univariate analysis. Mantel-Hanszel was used for bivariate analysis. Cox proportional hazard models were used to evaluate multivariate-adjusted associations between EBM educational intervention and EBM knowledge, attitude and skills. A new indicator of number needed to intervention (NNI) was defined and computed. The results proved conference along with small-group discussion to be a more effective teaching method with P=0.001 on knowledge, P<0.001 for attitude and skills P<0.001 in an EBM exam when compared with medical faculty members who did not participate in EBM educational intervention (n=84). Moreover, they had also increased confidence with critical appraisal skills, and searching EBM resources. Conferences followed by small-group discussions significantly enhance EBM knowledge, attitude, critical appraisal skills and literature review skills.

  10. Teaching Evidence-Based Medicine More Effectively

    Directory of Open Access Journals (Sweden)

    Zinat Nadia Hatmi

    2010-09-01

    Full Text Available "nEvidence-based Medicine (EBM is becoming an integral component of graduate medical education competency and a requirement for grad medical education practice-based learning core competency. This study tries to compare the efficacy of conferences utilizing small-group discussions with the traditional conference method in enhancing EBM competency. The participants in this randomized controlled trial (RCT were 170 members of the medical faculty who were divided into two groups of 86 (intervention and 84 (control. Following the intervention, EBM competency was assessed by a written examination. statistical analysis made use of chi-square test, independent sample t-test and relative risks for univariate analysis. Mantel-Hanszel was used for bivariate analysis. Cox proportional hazard models were used to evaluate multivariate-adjusted associations between EBM educational intervention and EBM knowledge, attitude and skills. A new indicator of number needed to intervention (NNI was defined and computed. Results: The results proved conference along with small-group discussion to be a more effective teaching method with P=0.001 on knowledge, P<0.001 for attitude and skills P<0.001 in an EBM exam when compared with medical faculty members who did not participate in EBM educational intervention (n=84. Moreover, they had also increased confidence with critical appraisal skills, and searching EBM resources. Conclusions: Conferences followed by small-group discussions significantly enhance EBM knowledge, attitude, critical appraisal skills and literature review skills.

  11. Teaching Evidence-Based Medicine More Effectively

    Directory of Open Access Journals (Sweden)

    Zinat Nadia Hatmi

    2010-10-01

    Full Text Available Evidence-based Medicine (EBM is becoming an integral component of graduate medical education competency and a requirement for grad medical education practice-based learning core competency. This study tries to compare the efficacy of conferences utilizing small-group discussions with the traditional conference method in enhancing EBM competency. The participants in this randomized controlled trial (RCT were 170 members of the medical faculty who were divided into two groups of 86 (intervention and 84 (control. Following the intervention, EBM competency was assessed by a written examination. statistical analysis made use of chi-square test, independent sample t-test and relative risks for univariate analysis. Mantel-Hanszel was used for bivariate analysis. Cox proportional hazard models were used to evaluate multivariate-adjusted associations between EBM educational intervention and EBM knowledge, attitude and skills. A new indicator of number needed to intervention (NNI was defined and computed. Results: The results proved conference along with small-group discussion to be a more effective teaching method with P=0.001 on knowledge, P

  12. Effectiveness of Evidence-Based Asthma Interventions.

    Science.gov (United States)

    Kennedy, Suzanne; Bailey, Ryan; Jaffee, Katy; Markus, Anne; Gerstein, Maya; Stevens, David M; Lesch, Julie Kennedy; Malveaux, Floyd J; Mitchell, Herman

    2017-06-01

    Researchers often struggle with the gap between efficacy and effectiveness in clinical research. To bridge this gap, the Community Healthcare for Asthma Management and Prevention of Symptoms (CHAMPS) study adapted an efficacious, randomized controlled trial that resulted in evidence-based asthma interventions in community health centers. Children (aged 5-12 years; N = 590) with moderate to severe asthma were enrolled from 3 intervention and 3 geographically/capacity-matched control sites in high-risk, low-income communities located in Arizona, Michigan, and Puerto Rico. The asthma intervention was tailored to the participant's allergen sensitivity and exposure, and it comprised 4 visits over the course of 1 year. Study visits were documented and monitored prospectively via electronic data capture. Asthma symptoms and health care utilization were evaluated at baseline, and at 6 and 12 months. A total of 314 intervention children and 276 control children were enrolled in the study. Allergen sensitivity testing (96%) and home environmental assessments (89%) were performed on the majority of intervention children. Overall study activity completion (eg, intervention visits, clinical assessments) was 70%. Overall and individual site participant symptom days in the previous 4 weeks were significantly reduced compared with control findings (control, change of -2.28; intervention, change of -3.27; difference, -0.99; P asthma in these high-need populations. Copyright © 2017 by the American Academy of Pediatrics.

  13. Evidence Based Practice Outside the Box (Editorial

    Directory of Open Access Journals (Sweden)

    Lindsay Glynn

    2008-09-01

    Full Text Available I love food. I love cooking, baking, testing, and eating. I read about food preparation, food facts, and food service. Over the years I’ve developed my fair share of knowledge about cooking and I’m a decent cook, but I’m no chef. I guess I’m what you’d call a “foodie”. However, I have the good fortune to have a friend who is a chef and owns one of the best, and certainly the most innovative, restaurants in town. During this summer I hosted a cooking class in my home for my family with my chef friend as instructor. The Tex-Mex barbecue theme was a big hit (you can contact me for recipes, if you like, but much more fascinating was the explanation of the science behind the cooking. It turns out that there is a term for this: molecular gastronomy. Another term, and hence the genesis of my “Eureka!” moment of the summer, is evidence based cooking. Good cooking is not just following a recipe (not all of which are evidence based but at its best is the culmination of heaps of tested information regarding why and how chemical and environmental factors work together to result in a gastronomical delight. For example, will brining or marinating a pork chop make it moister? And, if brining, what temperature should the water be, how long should it soak, and how much salt is needed? Why does pounding meat increase its tenderness? What will keep guacamole from browning better – the pit or lime juice? What does baking soda do in a chocolate cake? Eggs or no eggs in fresh pasta? Like most librarians, I tend not to take information at face value. I want to know where information comes from and whether or not it is valid, based on specific factors. I’ve come to notice that evidence based, or evidence informed, practice is everywhere and has a tremendous impact on our lives. Why do you rotate the tires on your car? Evidence shows that the front tires wear more quickly (think about all those 3-pointturns, the braking, etc and therefore

  14. Evidence-Based Management of Anticoagulant Therapy

    Science.gov (United States)

    Schulman, Sam; Witt, Daniel M.; Vandvik, Per Olav; Fish, Jason; Kovacs, Michael J.; Svensson, Peter J.; Veenstra, David L.; Crowther, Mark; Guyatt, Gordon H.

    2012-01-01

    Background: High-quality anticoagulation management is required to keep these narrow therapeutic index medications as effective and safe as possible. This article focuses on the common important management questions for which, at a minimum, low-quality published evidence is available to guide best practices. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: Most practical clinical questions regarding the management of anticoagulation, both oral and parenteral, have not been adequately addressed by randomized trials. We found sufficient evidence for summaries of recommendations for 23 questions, of which only two are strong rather than weak recommendations. Strong recommendations include targeting an international normalized ratio of 2.0 to 3.0 for patients on vitamin K antagonist therapy (Grade 1B) and not routinely using pharmacogenetic testing for guiding doses of vitamin K antagonist (Grade 1B). Weak recommendations deal with such issues as loading doses, initiation overlap, monitoring frequency, vitamin K supplementation, patient self-management, weight and renal function adjustment of doses, dosing decision support, drug interactions to avoid, and prevention and management of bleeding complications. We also address anticoagulation management services and intensive patient education. Conclusions: We offer guidance for many common anticoagulation-related management problems. Most anticoagulation management questions have not been adequately studied. PMID:22315259

  15. Promoting evidence-based practice in pharmacies.

    Science.gov (United States)

    Toklu, Hale Zerrin

    2015-01-01

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

  16. Promoting evidence-based practice in pharmacies

    Directory of Open Access Journals (Sweden)

    Toklu HZ

    2015-09-01

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

  17. Evidence-Based Interactive Management of Change

    Directory of Open Access Journals (Sweden)

    Albert Fleischmann

    2011-06-01

    Full Text Available Evidence-based interactive management of change means hands-on experience of modified work processes, given evidence of change. For this kind of pro-active organizational development support we use an organisational process memory and a communication-based representation technique for role-specific and task-oriented process execution. Both are effective means for organizations becoming agile through interactively modelling the business at the process level and re-constructing or re-arranging process representations according to various needs. The tool allows experiencing role-specific workflows, as the communication-based refinement of work models allows for executable process specifications. When presenting the interactive processes to individuals involved in the business processes, changes can be explored interactively in a context-sensitive way before re-implementing business processes and information systems. The tool is based on a service-oriented architecture and a flexible representation scheme comprising the exchange of message between actors, business objects and actors (roles. The interactive execution of workflows does not only enable the individual reorganization of work but also changes at the level of the entire organization due to the represented interactions.

  18. [A new vision of nursing: the evolution and development of evidence-based nursing].

    Science.gov (United States)

    Chiang, Li-Chi

    2014-08-01

    The concept and principles of evidence-based medicine (EBM), first introduced in 1996 in the UK and Canada, have greatly impacted healthcare worldwide. Evidence-based care is a new approach to healthcare that works to reduce the gap between evidence and practice in order to further the scientific credentials and practices of the nursing profession. The revolution in healthcare has perhaps most noticeably impacted the nursing sciences. Today, new methodologies are increasingly synthesizing knowledge, while expanded access to publication resources is creating a new era in evidence-based nursing. Therefore, we expect to see in Taiwan the increased sharing of innovative implementations of evidence-based nursing practice and promotion campaigns and the exploration of a new evidence-based nursing paradigm for incorporating evidence-based concepts into the policymaking process, nursing practice, and nursing education. All scientists in clinical care, education, and research are responsible to establish scientific nursing knowledge in support of the evidence-based nursing practice.

  19. "They just know": the epistemological politics of "evidence-based" non-formal education.

    Science.gov (United States)

    Archibald, Thomas

    2015-02-01

    Community education and outreach programs should be evidence-based. This dictum seems at once warranted, welcome, and slightly platitudinous. However, the "evidence-based" movement's more narrow definition of evidence--privileging randomized controlled trials as the "gold standard"--has fomented much debate. Such debate, though insightful, often lacks grounding in actual practice. To address that lack, the purpose of the study presented in this paper was to examine what actually happens, in practice, when people support the implementation of evidence-based programs (EBPs) or engage in related efforts to make non-formal education more "evidence-based." Focusing on three cases--two adolescent sexual health projects (one in the United States and one in Kenya) and one more general youth development organization--I used qualitative methods to address the questions: (1) How is evidence-based program and evidence-based practice work actually practiced? (2) What perspectives and assumptions about what non-formal education is are manifested through that work? and (3) What conflicts and tensions emerge through that work related to those perspectives and assumptions? Informed by theoretical perspectives on the intersection of science, expertise, and democracy, I conclude that the current dominant approach to making non-formal education more evidence-based by way of EBPs is seriously flawed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. The meaning of evidence-based management to Brazilian senior nurse leaders.

    Science.gov (United States)

    Spiri, Wilza Carla; MacPhee, Maura

    2013-09-01

    The study objective was to understand the meaning of evidence-based management for senior nurse leaders in accredited, public hospitals in the State of Sao Paulo, Brazil. A phenomenological approach was used to analyze interviews conducted with 10 senior nurse leaders between August 2011 and March 2012. The analytic method was developed by the Brazilian phenomenologist, Martins. Senior nurse leaders described how they critically appraise many sources of evidence when making managerial decisions. They emphasized the importance of working with their teams to locally adapt and evaluate best evidence associated with managerial decision making and organizational innovations. Their statements also demonstrated how they use evidence-based management to support the adoption of evidence-based practices. They did not, however, provide specific strategies for seeking out and obtaining evidence. Notable challenges were traditional cultures and rigid bureaucracies, while major facilitators included accreditation, teamwork, and shared decision making. Evidence-based management necessitates a continuous process of locating, implementing, and evaluating evidence. In this study leaders provided multiple, concrete examples of all these processes except seeking out and locating evidence. They also gave examples of other leadership skills associated with successful adoption of evidence-based practice and management, particularly interdisciplinary teamwork and shared decision making. This study demonstrates senior nurse leaders' awareness and utilization of evidence-based management. The study also suggests what aspects of evidence-based management need further development, such as more active identification of potential, new organizational innovations. © 2013 Sigma Theta Tau International.

  1. Epilepsy, Antiepileptic Drugs, and Aggression: An Evidence-Based Review

    Science.gov (United States)

    Besag, Frank; Ettinger, Alan B.; Mula, Marco; Gobbi, Gabriella; Comai, Stefano; Aldenkamp, Albert P.; Steinhoff, Bernhard J.

    2016-01-01

    Antiepileptic drugs (AEDs) have many benefits but also many side effects, including aggression, agitation, and irritability, in some patients with epilepsy. This article offers a comprehensive summary of current understanding of aggressive behaviors in patients with epilepsy, including an evidence-based review of aggression during AED treatment. Aggression is seen in a minority of people with epilepsy. It is rarely seizure related but is interictal, sometimes occurring as part of complex psychiatric and behavioral comorbidities, and it is sometimes associated with AED treatment. We review the common neurotransmitter systems and brain regions implicated in both epilepsy and aggression, including the GABA, glutamate, serotonin, dopamine, and noradrenaline systems and the hippocampus, amygdala, prefrontal cortex, anterior cingulate cortex, and temporal lobes. Few controlled clinical studies have used behavioral measures to specifically examine aggression with AEDs, and most evidence comes from adverse event reporting from clinical and observational studies. A systematic approach was used to identify relevant publications, and we present a comprehensive, evidence-based summary of available data surrounding aggression-related behaviors with each of the currently available AEDs in both adults and in children/adolescents with epilepsy. A psychiatric history and history of a propensity toward aggression/anger should routinely be sought from patients, family members, and carers; its presence does not preclude the use of any specific AEDs, but those most likely to be implicated in these behaviors should be used with caution in such cases. PMID:27255267

  2. Evidence-based rehabilitation of athletes with glenohumeral instability.

    Science.gov (United States)

    Cools, Ann M; Borms, Dorien; Castelein, Birgit; Vanderstukken, Fran; Johansson, Fredrik R

    2016-02-01

    To give an overview of current knowledge and guidelines with respect to evidence-based rehabilitation of athletes with glenohumeral instability. This narrative review combines scientific evidence with clinical guidelines based on the current literature to highlight the different components of the rehabilitation of glenohumeral instability. Depending on the specific characteristics of the instability pattern, the severity, recurrence, and direction, the therapeutic approach may be adapted to the needs and demands of the athlete. In general, attention should go to (1) restoration of rotator cuff strength and inter-muscular balance, focusing on the eccentric capacity of the external rotators, (2) normalization of rotational range of motion with special attention to the internal rotation ROM, (3) optimization of the flexibility and muscle performance of the scapular muscles, and (4) gradually increasing the functional sport-specific load on the shoulder girdle. The functional kinetic chain should be implemented throughout all stages of the rehabilitation program. Return to play should be based on subjective assessment as well as objective measurements of ROM, strength, and function. This paper summarizes evidence-based guidelines for treatment of glenohumeral instability. These guidelines may assist the clinician in the prevention and rehabilitation of the overhead athlete. Expert opinion, Level V.

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

    Science.gov (United States)

    Oh, Eui Geum

    2016-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Eui Geum Oh, PhD, RN

    2016-06-01

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

  5. The development of evidence-based guidelines in dentistry.

    Science.gov (United States)

    Faggion, C M

    2013-02-01

    Use of guidelines is an important means of reducing the gap between research and clinical practice. Sound and unbiased information should be available to enable dental professionals to provide better clinical treatment for their patients. The development of clinical guidelines in dentistry should follow standard and transparent methodology. The purpose of this article is to propose important steps for developing evidence-based clinical recommendations in dentistry. Initially, dental guidelines should be extensively sought and assessed to answer focused clinical questions. If there is a paucity of guidelines or if existing guidelines are not of good methodological quality, systematic reviews should be searched or conducted to serve as a basis for the development of evidence-based guidelines. When systematic reviews are produced, they should be rigorous in order to provide the best evidence possible. In the last phase of the process, the overall quality of evidence should be scrutinized and assessed, together with other factors (balance between treatment effects and side effects, patients' values, and cost-effectiveness of therapy) to determine the strength of recommendations. It is expected this approach will result in the development of sound clinical guidelines and consequent improvement of dental treatment.

  6. Management of the infertile couple: an evidence-based protocol

    Directory of Open Access Journals (Sweden)

    Kamel Remah M

    2010-03-01

    Full Text Available Abstract Background Infertility is defined as inability of a couple to conceive naturally after one year of regular unprotected sexual intercourse. It remains a major clinical and social problem, affecting perhaps one couple in six. Evaluation usually starts after 12 months; however it may be indicated earlier. The most common causes of infertility are: male factor such as sperm abnormalities, female factor such as ovulation dysfunction and tubal pathology, combined male and female factors and unexplained infertility. Objectives The aim of this study is to provide the healthcare professionals an evidence-based management protocol for infertile couples away from medical information overload. Methods A comprehensive review where the literature was searched for "Management of infertility and/or infertile couples" at library website of University of Bristol (MetaLib by using a cross-search of different medical databases besides the relevant printed medical journals and periodicals. Guidelines and recommendations were retrieved from the best evidence reviews such as that from the American College of Obstetricians and Gynaecologists (ACOG, American Society for Reproductive Medicine (ASRM, Canadian Fertility and Andrology Society (CFAS, and Royal College of Obstetricians and Gynaecologists (RCOG. Results A simple guide for the clinicians to manage the infertile couples. Conclusions The study deploys a new strategy to translate the research findings and evidence-base recommendations into a simplified focused guide to be applied on routine daily practice. It is an approach to disseminate the recommended medical care for infertile couple to the practicing clinicians.

  7. Definition of drug-resistant epilepsy: is it evidence based?

    Science.gov (United States)

    Wiebe, Samuel

    2013-05-01

    Clinical case definitions are the cornerstone of clinical communication and of clinical and epidemiologic research. The ramifications of establishing a case definition are extensive, including potentially large changes in epidemiologic estimates of frequency, and decisions for clinical management. Yet, defining a condition entails numerous challenges such as defining the scope and purpose, incorporating the strongest evidence base with clinical expertise, accounting for patients' values, and considering impact on care. The clinical case definition of drug-resistant epilepsy, in addition, must address what constitutes an adequate intervention for an individual drug, what are the outcomes of relevance, what period of observation is sufficient to determine success or failure, how many medications should be tried, whether seizure frequency should play a role, and what is the role of side effects and tolerability. On the other hand, the principles of evidence-based medicine (EBM) aim at providing a systematic approach to incorporating the best available evidence into the process of clinical decision for individual patients. The case definition of drug-resistant epilepsy proposed by the the International League Against Epilepsy (ILAE) in 2009 is evaluated in terms of the principles of EBM as well as the stated goals of the authors of the definition. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

  8. Simulation and Analysis of a Grid Connected Multi-level Converter Topologies and their Comparison

    Directory of Open Access Journals (Sweden)

    Mohammad Shadab Mirza

    2014-09-01

    Full Text Available This paper presents simulation and analysis of a grid connected multi-level converter topologies. In this paper, converter circuit works as an inverter by controlling the switching angle (α. This paper, presents a MATLAB/SIMULINK model of multi-level converter topologies (topology1 & topology2. Topology1 is without transformer while topology2 with transformer. Both the topologies are simulated and analyzed for three level converters in order to reduce the total harmonic distortion (THD. A comparative study of topology1 and topology2 is also presented in this paper for different switching angles (α and battery voltages. The results have been tabulated and discussed.

  9. Multi-level Strategy for Identifying Proteasome-Catalyzed Spliced Epitopes Targeted by CD8+ T Cells during Bacterial Infection

    Directory of Open Access Journals (Sweden)

    Anouk C.M. Platteel

    2017-08-01

    Full Text Available Proteasome-catalyzed peptide splicing (PCPS generates peptides that are presented by MHC class I molecules, but because their identification is challenging, the immunological relevance of spliced peptides remains unclear. Here, we developed a reverse immunology-based multi-level approach to identify proteasome-generated spliced epitopes. Applying this strategy to a murine Listeria monocytogenes infection model, we identified two spliced epitopes within the secreted bacterial phospholipase PlcB that primed antigen-specific CD8+ T cells in L. monocytogenes-infected mice. While reacting to the spliced epitopes, these CD8+ T cells failed to recognize the non-spliced peptide parts in the context of their natural flanking sequences. Thus, we here show that PCPS expands the CD8+ T cell response against L. monocytogenes by exposing spliced epitopes on the cell surface. Moreover, our multi-level strategy opens up opportunities to systematically investigate proteins for spliced epitope candidates and thus strategies for immunotherapies or vaccine design.

  10. Pictorial AR Tag with Hidden Multi-Level Bar-Code and Its Potential Applications

    Directory of Open Access Journals (Sweden)

    Huy Le

    2017-09-01

    Full Text Available For decades, researchers have been trying to create intuitive virtual environments by blending reality and virtual reality, thus enabling general users to interact with the digital domain as easily as with the real world. The result is “augmented reality” (AR. AR seamlessly superimposes virtual objects on to a real environment in three dimensions (3D and in real time. One of the most important parts that helps close the gap between virtuality and reality is the marker used in the AR system. While pictorial marker and bar-code marker are the two most commonly used marker types in the market, they have some disadvantages in visual and processing performance. In this paper, we present a novelty method that combines the bar-code with the original feature of a colour picture (e.g., photos, trading cards, advertisement’s figure. Our method decorates on top of the original pictorial images additional features with a single stereogram image that optically conceals a multi-level (3D bar-code. Thus, it has a larger capability of storing data compared to the general 1D barcode. This new type of marker has the potential of addressing the issues that the current types of marker are facing. It not only keeps the original information of the picture but also contains encoded numeric information. In our limited evaluation, this pictorial bar-code shows a relatively robust performance under various conditions and scaling; thus, it provides a promising AR approach to be used in many applications such as trading card games, educations, and advertisements.

  11. Multi-level virtual prototyping of electromechanical actuation system for more electric aircraft

    Directory of Open Access Journals (Sweden)

    Jian FU

    2018-05-01

    Full Text Available Electromechanical actuators (EMAs are becoming increasingly attractive in the field of more electric aircraft because of their outstanding benefits, which include reduced fuel burn and maintenance cost, enhanced system flexibility, and improved management of fault detection and isolation. However, electromechanical actuation raises specific issues when being used for safety-critical aerospace applications like flight controls: huge reflected inertia to load, jamming-type failure, and increase of backlash with service due to wear and local dissipation of heat losses for thermal balance. This study proposes an incremental approach for virtual prototyping of EMAs. It is driven by a model-based system engineering process in order to enable simulation-aided design. Best practices supported by Bond graph formalism are suggested to develop a model’s structure efficiently and to make the model ready for use (or extension by addressing the above mentioned issues. Physical effects are progressively introduced, and the realism of lumped-parameter models is increased step-by-step. In particular, multi-level component models are architected to ensure continuity between engineering activities. The models are implemented in the AMESim simulation environment, and simulation responses are given to illustrate how they can be used for preliminary sizing, control design, thermal balance verification, and faults to failure analysis. The proposed best practices intend to provide engineers with fast, reusable, and efficient means to assess performance virtually and enhance maturity, performance, and robustness. Keywords: Bond graph, Electromechanical actuator, Flight control, Model-based system engineering, More electric aircraft, Power-by-wire

  12. Multi-level Discourse Analysis in a Physics Teaching Methods Course from the Psychological Perspective of Activity Theory

    Science.gov (United States)

    Vieira, Rodrigo Drumond; Kelly, Gregory J.

    2014-11-01

    In this paper, we present and apply a multi-level method for discourse analysis in science classrooms. This method is based on the structure of human activity (activity, actions, and operations) and it was applied to study a pre-service physics teacher methods course. We argue that such an approach, based on a cultural psychological perspective, affords opportunities for analysts to perform a theoretically based detailed analysis of discourse events. Along with the presentation of analysis, we show and discuss how the articulation of different levels offers interpretative criteria for analyzing instructional conversations. We synthesize the results into a model for a teacher's practice and discuss the implications and possibilities of this approach for the field of discourse analysis in science classrooms. Finally, we reflect on how the development of teachers' understanding of their activity structures can contribute to forms of progressive discourse of science education.

  13. Teaching evidence based medicine in family medicine

    Directory of Open Access Journals (Sweden)

    Davorka Vrdoljak

    2012-05-01

    Full Text Available The concept of evidence based medicine (EBM as the integrationof clinical expertise, patient values and the best evidence was introduced by David Sackett in the 1980’s. Scientific literature in medicine is often marked by expansion, acummulation and quick expiration. Reading all important articles to keep in touch with relevant information is impossible. Finding the best evidence that answers a clinical question in general practice (GP in a short time is not easy. Five useful steps are described –represented by the acronym “5A+E”: assess, ask, acquire, appraise, apply and evaluate.The habit of conducting an evidence search “on the spot’’ is proposed. Although students of medicine at University of Split School of Medicine are taught EBM from the first day of their study and in all courses, their experience of evidence-searching and critical appraisal of the evidence, in real time with real patient is inadequate. Teaching the final-year students the practical use of EBM in a GP’s office is different and can have an important role in their professional development. It can positively impact on quality of their future work in family practice (or some other medical specialty by acquiring this habit of constant evidence-checking to ensure that best practice becomes a mechanism for life-long learning. Conclusion. EBM is a foundation stone of every branch of medicine and important part of Family Medicine as scientific and professional discipline. To have an EB answer resulting from GP’s everyday work is becoming a part of everyday practice.

  14. The evidence-based practice ideologies.

    Science.gov (United States)

    Mantzoukas, Stefanos

    2007-10-01

    This paper puts forward the argument that there are various, competing, and antithetical evidence-based practice (EBP) definitions and acknowledges that the different EBP definitions are based on different epistemological perspectives. However, this is not enough to understand the way in which nurse professionals choose between the various EBP formations and consequently facilitate them in choosing the most appropriate for their needs. Therefore, the current article goes beyond and behind the various EBP epistemologies to identify how individuals choose an epistemology, which consequently will assist our understanding as to how an individual chooses a specific EBP formation. Individuals choose an epistemology on the mere belief that the specific epistemology offers the ideals or ideas of best explaining or interpreting daily reality. These ideals or ideas are termed by science, history, and politics as ideology. Similarly, individual practitioners choose or should choose between the different EBP formations based on their own personal ideology. Consequently, this article proceeds to analyse the various ideologies behind different EBP definitions as to conclude that there are two broad ideologies that inform the various EBP formations, namely the ideology of truth and the ideology of individual emancipation. These two ideologies are analysed and their connections to the various EBP formations are depicted. Eventually, the article concludes that the in-depth, critical, and intentional analysis by individual nurses of their own ideology will allow them to choose the EBP formation that is most appropriate and fitting for them, and their specific situation. Hence, the conscious analysis of individual ideology becomes the criterion for choosing between competing EBP formations and allows for best evidence to be implemented in practice. Therefore, the best way to teach EBP courses is by facilitating students to analyse their own ideology.

  15. An evidence-based review: distracted driver.

    Science.gov (United States)

    Llerena, Luis E; Aronow, Kathy V; Macleod, Jana; Bard, Michael; Salzman, Steven; Greene, Wendy; Haider, Adil; Schupper, Alex

    2015-01-01

    Cell phone use and texting are prevalent within society and have thus pervaded the driving population. This technology is a growing concern within the confines of distracted driving, as all diversions from attention to the road have been shown to increase the risk of crashes. Adolescent, inexperienced drivers, who have the greatest prevalence of texting while driving, are at a particularly higher risk of crashes because of distraction. Members of the Injury Control Violence Prevention Committee of the Eastern Association for the Surgery of Trauma performed a PubMed search of articles related to distracted driving and cell phone use as a distractor of driving between 2000 and 2013. A total of 19 articles were found to merit inclusion as evidence in the evidence-based review. These articles provided evidence regarding the relationship between distracted driving and crashes, cell phone use contributing to automobile accidents, and/or the relationship between driver experience and automobile accidents. (Adjust methods/results sections to the number of articles that correctly corresponds to the number of references, as well as the methodology for reference inclusion.) Based on the evidence reviewed, we can recommend the following. All drivers should minimize all in-vehicle distractions while on the road. All drivers should not text or use any touch messaging system (including the use of social media sites such as Facebook and Twitter) while driving. Younger, inexperienced drivers should especially not use cell phones, texting, or any touch messaging system while driving because they pose an increased risk for death and injury caused by distractions while driving.

  16. A single-phase multi-level D-STATCOM inverter using modular multi-level converter (MMC) topology for renewable energy sources

    Science.gov (United States)

    Sotoodeh, Pedram

    This dissertation presents the design of a novel multi-level inverter with FACTS capability for small to mid-size (10-20kW) permanent-magnet wind installations using modular multi-level converter (MMC) topology. The aim of the work is to design a new type of inverter with D-STATCOM option to provide utilities with more control on active and reactive power transfer of distribution lines. The inverter is placed between the renewable energy source, specifically a wind turbine, and the distribution grid in order to fix the power factor of the grid at a target value, regardless of wind speed, by regulating active and reactive power required by the grid. The inverter is capable of controlling active and reactive power by controlling the phase angle and modulation index, respectively. The unique contribution of the proposed work is to combine the two concepts of inverter and D-STATCOM using a novel voltage source converter (VSC) multi-level topology in a single unit without additional cost. Simulations of the proposed inverter, with 5 and 11 levels, have been conducted in MATLAB/Simulink for two systems including 20 kW/kVAR and 250 W/VAR. To validate the simulation results, a scaled version (250 kW/kVAR) of the proposed inverter with 5 and 11 levels has been built and tested in the laboratory. Experimental results show that the reduced-scale 5- and 11-level inverter is able to fix PF of the grid as well as being compatible with IEEE standards. Furthermore, total cost of the prototype models, which is one of the major objectives of this research, is comparable with market prices.

  17. Measuring Costs to Community-Based Agencies for Implementation of an Evidence-Based Practice.

    Science.gov (United States)

    Lang, Jason M; Connell, Christian M

    2017-01-01

    Healthcare reform has led to an increase in dissemination of evidence-based practices. Cost is frequently cited as a significant yet rarely studied barrier to dissemination of evidence-based practices and the associated improvements in quality of care. This study describes an approach to measuring the incremental, unreimbursed costs in staff time and direct costs to community-based clinics implementing an evidence-based practice through participating in a learning collaborative. Initial implementation costs exceeding those for providing "treatment as usual" were collected for ten clinics implementing trauma-focused cognitive behavioral therapy through participation in 10-month learning collaboratives. Incremental implementation costs of these ten community-based clinic teams averaged the equivalent of US$89,575 (US$ 2012). The most costly activities were training, supervision, preparation time, and implementation team meetings. Recommendations are made for further research on implementation costs, dissemination of evidence-based practices, and implications for researchers and policy makers.

  18. Evidence-Based Approaches to Improving Chemical Equilibrium Instruction

    Science.gov (United States)

    Davenport, Jodi L.; Leinhardt, Gaea; Greeno, James; Koedinger, Kenneth; Klahr, David; Karabinos, Michael; Yaron, David J.

    2014-01-01

    Two suggestions for instruction in chemical equilibrium are presented, along with the evidence that supports these suggestions. The first is to use diagrams to connect chemical reactions to the effects of reactions on concentrations. The second is the use of the majority and minority species (M&M) strategy to analyze chemical equilibrium…

  19. Exercise and chronic disease: an evidence-based approach

    National Research Council Canada - National Science Library

    Saxton, John, Prof

    2011-01-01

    ..., and written by a team of leading international researchers and medical and health practitioners, the book explores the evidence across a wide range of chronic diseases, including: * * * * cancer diabetes stroke Parkinson disease * * * heart disease multiple sclerosis asthma Each chapter addresses the frequency, intensity, duration and modality of ...

  20. An evidence-based approach to recurrent pregnancy loss

    African Journals Online (AJOL)

    be part of the work-up for all patients with RPL: (i) genetic counselling and karyotyping of the abortus; ... everyday management in hospital clinics as well as private practice. Definition ... as the spontaneous loss of a pregnancy before the fetus has reached ... gestation is often uncertain, a birth weight of 500 g should be used.

  1. Evidence-based approach to using CT in spinal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Mann, F.A. E-mail: famann@u.washington.edu; Cohen, Wendy A.; Linnau, Ken F.; Hallam, Danial K.; Blackmore, C. Craig

    2003-10-01

    Computed tomography has revolutionized the diagnosis and treatment planning of the acutely injured spine. In the cervical spine, its appropriate use can improve outcome and save money. Although there are no clinical prediction rules validated outside of the cervical spine, these proven capabilities have been extrapolated to the thoracolumbar spine.

  2. An Evidence-Based Approach To Exercise Prescriptions on ISS

    Science.gov (United States)

    Ploutz-Snyder, Lori

    2009-01-01

    This presentation describes current exercise countermeasures and exercise equipment for astronauts onboard the ISS. Additionally, a strategy for evaluating evidence supporting spaceflight exercise is described and a new exercise prescription is proposed. The current exercise regimen is not fully effective as the ISS exercise hardware does not allow for sufficient exercise intensity, the exercise prescription is adequate and crew members are noncompliant with the prescription. New ISS hardware is proposed, Advanced Resistance Exercise Device (ARED), which allows additional exercises, is instrumented for data acquisition and offers improved loading. The new T2 hardware offers a better harness and subject loading system, is instrumented to allow ground reaction force data, and offers improved speed. A strategy for developing a spaceflight exercise prescription is described and involves identifying exercise training programs that have been shown to maximize adaptive benefits of people exercising in both 0 and 1 g environments. Exercise intensity emerged as an important factor in maintaining physiologic adaptations in the spaceflight environment and interval training is suggested. New ISS exercise hardware should allow for exercise at intensities high enough to elicit adaptive responses. Additionally, new exercise prescriptions should incorporate higher intensity exercises and seek to optimize intensity, duration and frequency for greater efficiency.

  3. Rabies: an evidence-based approach to management

    African Journals Online (AJOL)

    tral nervous system (CNS) leading to an ... A 10-year-old child presented with pain in the arm, fever and headache ... A newly-qualified game guide is going to work in Zambia, doing surveillance ..... virus (genotype 1), with the yellow mon-.

  4. A mixed-methods study of system-level sustainability of evidence-based practices in 12 large-scale implementation initiatives.

    Science.gov (United States)

    Scudder, Ashley T; Taber-Thomas, Sarah M; Schaffner, Kristen; Pemberton, Joy R; Hunter, Leah; Herschell, Amy D

    2017-12-07

    In recent decades, evidence-based practices (EBPs) have been broadly promoted in community behavioural health systems in the United States of America, yet reported EBP penetration rates remain low. Determining how to systematically sustain EBPs in complex, multi-level service systems has important implications for public health. This study examined factors impacting the sustainability of parent-child interaction therapy (PCIT) in large-scale initiatives in order to identify potential predictors of sustainment. A mixed-methods approach to data collection was used. Qualitative interviews and quantitative surveys examining sustainability processes and outcomes were completed by participants from 12 large-scale initiatives. Sustainment strategies fell into nine categories, including infrastructure, training, marketing, integration and building partnerships. Strategies involving integration of PCIT into existing practices and quality monitoring predicted sustainment, while financing also emerged as a key factor. The reported factors and strategies impacting sustainability varied across initiatives; however, integration into existing practices, monitoring quality and financing appear central to high levels of sustainability of PCIT in community-based systems. More detailed examination of the progression of specific activities related to these strategies may aide in identifying priorities to include in strategic planning of future large-scale initiatives. ClinicalTrials.gov ID NCT02543359 ; Protocol number PRO12060529.

  5. Graduate Attribute Attainment in a Multi-Level Undergraduate Geography Course

    Science.gov (United States)

    Mager, Sarah; Spronken-Smith, Rachel

    2014-01-01

    We investigated students' perceptions of graduate attributes in a multi-level (second and third year) geography course. A case study with mixed methodology was employed, with data collected through focus groups and a survey. We found that undergraduate geography students can identify the skills, knowledge and attributes that are developed through…

  6. A Dynamic Multi-Level Factor Model with Long-Range Dependence

    DEFF Research Database (Denmark)

    Ergemen, Yunus Emre; Rodríguez-Caballero, Carlos Vladimir

    A dynamic multi-level factor model with stationary or nonstationary global and regional factors is proposed. In the model, persistence in global and regional common factors as well as innovations allows for the study of fractional cointegrating relationships. Estimation of global and regional...

  7. Developing the multi-level functioning interface framework for DER models

    DEFF Research Database (Denmark)

    Han, Xue; Bindner, Henrik W.; You, Shi

    2013-01-01

    The paper summarises several modelling applications of distributed energy resources (DERs) for various purposes, and describes the related operational issues regarding the complexity of the future distribution grid. Furthermore, a multi-level functioning interface framework is proposed for DER mo....... The information mapping for photovoltaic panel (PV) modelling is also provided as an example....

  8. Analysis of Harmonic Injection to the Modulation of Multi-Level ...

    African Journals Online (AJOL)

    This paper explores the analysis of third and ninth harmonic injection to the modulation of a multilevel diode clamped converter (DCC) at a varying modulation index. The spectral distributions of the various multi-level waveforms obtained under normal modulation index of 0.8 and over modulation index of 1.15 were ...

  9. Governing the energy challenge : Canada and Germany in a multi-level regional and global context

    International Nuclear Information System (INIS)

    Eberlein, B.; Doern, G.B.; Exeter Univ.,

    2009-01-01

    This book features essays by leading energy and public policy specialists from Canada and Germany. It originated in the Transatlantic Energy Conference which was hosted by the Canadian Centre for German and European Studies at Toronto's York University in September 2005. The conference was attended by leading energy scholars and experts from Canadian and European universities, research institutes and governmental and non-governmental organizations. The purpose of this book was to compare the dynamics of multi-level energy regulatory governance in Germany and Canada, notably the energy policy challenges that include energy security, environmental sustainability and a competitive resource economy. Many strategies to produce more efficient and sustainable energy are presented in the book. Part 1 of the book focuses on the energy industry, with particular emphasise on electricity, nuclear energy and natural gas. Part 2 of the book focuses on domestic patterns of multi-level energy governance and regulation in the two countries. As a member of the European Union, Germany is more advanced in dealing with multi-level governmental and sustainability constraints than Canada is as a member of the North American Free Trade Agreement (NAFTA). The book focuses on the influence that the energy sector and multi-level institutional arrangements have on energy governance, with particular attention to the link between environmental study, climate change issues and economic market reforms. The growing differences between NAFTA and European Union member countries were highlighted. refs., tabs., figs.

  10. A Bayesian Multi-Level Factor Analytic Model of Consumer Price Sensitivities across Categories

    Science.gov (United States)

    Duvvuri, Sri Devi; Gruca, Thomas S.

    2010-01-01

    Identifying price sensitive consumers is an important problem in marketing. We develop a Bayesian multi-level factor analytic model of the covariation among household-level price sensitivities across product categories that are substitutes. Based on a multivariate probit model of category incidence, this framework also allows the researcher to…

  11. Fabrication and characterization of injection molded multi level nano and microfluidic systems

    DEFF Research Database (Denmark)

    Matteucci, Marco; Christiansen, Thomas Lehrmann; Tanzi, Simone

    2013-01-01

    We here present a method for fabrication of multi-level all-polymer chips by means of silicon dry etching, electroplating and injection molding. This method was used for successful fabrication of microfluidic chips for applications in the fields of electrochemistry, cell trapping and DNA elongati...

  12. PENGEMBANGAN MEDIA LUBANG MULTI LEVEL UNTUK PEMBELAJARAN LEMPAR TANGKAP BOLA KECIL

    Directory of Open Access Journals (Sweden)

    Tri Aryo Trubus Anom

    2017-02-01

    Full Text Available This research aims to develop a media Hole Multi Level to capture the small ball throwing learning grade IV elementary school level that can increase students roll control. The model of the research is the development of research and data analysis in the form of a percentage of data types with a description of the qualitative and quantitative. Procedure development include; 1 Potential problems, 2 Data collection, 3 Early media product design Multi Level Hole, 4 Design Validation by expert penjas and learning experts, 5 Revision products I, 6 Trials I in MI Ma’arif NU Darmakradenan, 7 Product revision II, 8 Trial II at four elementary school in the village of Darmakradenan, 9 Product revision III, 10 And products. The results of expert validation against the media Pit Multi Level was 80%, I Test of 83,23%, and II trials of 85.97%. Those results can be concluded that the development of the media Pit Multi Level can be used to capture the small ball throwing learning grade IV elementary school level.

  13. Replantation of multi-level fingertip amputation using the pocket principle (palmar pocket method).

    Science.gov (United States)

    Arata, J; Ishikawa, K; Soeda, H; Kitayama, T

    2003-07-01

    Two cases of multi-level fingertip amputation are presented. In each case, replantation was achieved in a two-stage procedure, involving reattachment, de-epithelialisation and insertion into a palmar pocket in stage 1, followed by removal from the palmar pocket 16 days later. The cases are described and the technique is discussed.

  14. Achieving strategic renewal: the multi-level influences of top and middle managers’ boundary-spanning

    NARCIS (Netherlands)

    Glaser, L.; Fourne, S.P.L.; Elfring, T.

    2015-01-01

    Drawing on corporate entrepreneurship (CE) and social network research, this study focuses on strategic renewal as a form of CE and examines the impact of boundary-spanning at top and middle management levels on business units’ exploratory innovation. Analyses of multi-source and multi-level data,

  15. The Integrated Multi-Level Bilingual Teaching of "Social Research Methods"

    Science.gov (United States)

    Zhu, Yanhan; Ye, Jian

    2012-01-01

    "Social Research Methods," as a methodology course, combines theories and practices closely. Based on the synergy theory, this paper tries to establish an integrated multi-level bilingual teaching mode. Starting from the transformation of teaching concepts, we should integrate interactions, experiences, and researches together and focus…

  16. Multi-Level Risk Assessment of a Power Plant Gas Turbine Applying ...

    African Journals Online (AJOL)

    Multi-Level Risk Assessment of a Power Plant Gas Turbine Applying the Criticality Index Model. ... Journal of the Nigerian Association of Mathematical Physics ... This study has carefully shown and expressed a step by step computation of the severity level of the Turbine component parts, using the Criticality Index model.

  17. Implementation of evidence-based practice by nurses working in community settings and their strategies to mentor student nurses to develop evidence-based practice: A qualitative study.

    Science.gov (United States)

    Brooke, Joanne Mary; Mallion, Jaimee

    2016-08-01

    The aim of the study was to explore how community nurses apply the best available evidence to their practice, and how they mentor student nurses to conceptualize and implement evidence-based practice in community settings. In the UK, the expansion of health-care provision in the community has supported the development of highly skilled community nurses. However, there is limited literature regarding the strategies used by community nurses to implement evidence-based practice and mentor student nurses to conceptualize evidence-based practice in community placements. An exploratory qualitative approach applying inductive reasoning to focus group data was used. As a result, nurses working for a community NHS Foundation Trust in South England with a mentor qualification were invited to participate in one of the seven focus groups, 33 nurses participated. Data were analyzed with thematic analysis. The themes discussed in this paper are: 'our practice is evidence-based' as guidelines and policies provided structure, but occasionally stifled autonomous clinical decision-making, and 'time' as a barrier and facilitator to mentoring student nurses in community settings. In conclusion, nurses need to develop the ability to incorporate patients' needs and wishes within evidence-based care. Time was a facilitator for some community mentors, but protected time is required to complete the necessary practice documentation of student nurses. © 2016 John Wiley & Sons Australia, Ltd.

  18. Evidence Based Management as a Tool for Special Libraries

    Directory of Open Access Journals (Sweden)

    Bill Fisher

    2007-12-01

    Full Text Available Objective ‐ To examine the evidence based management literature, as an example of evidence based practice, and determine how applicable evidence based management might be in the special library environment. Methods ‐ Recent general management literature and the subject‐focused literature of evidence based management were reviewed; likewise recent library/information science management literature and the subject‐focused literature of evidence based librarianshipwere reviewed to identify relevant examples of the introduction and use of evidence based practice in organizations. Searches were conducted in major business/management databases, major library/information science databases, and relevant Web sites, blogs and wikis. Citation searches on key articles and follow‐up searches on cited references were also conducted. Analysis of the retrieved literature was conducted to find similarities and/or differences between the management literature and the library/information scienceliterature, especially as it related to special libraries.Results ‐ The barriers to introducing evidence based management into most organizations were found to apply to many special libraries and are similar to issues involved with evidence based practice in librarianship in general. Despite these barriers, a set of resources to assist special librarians in accessing research‐based information to help them use principles of evidence based management is identified.Conclusion ‐ While most special librarians are faced with a number of barriers to using evidence based management, resources do exist to help overcome these obstacles.

  19. Enabling multi-level relevance feedback on PubMed by integrating rank learning into DBMS.

    Science.gov (United States)

    Yu, Hwanjo; Kim, Taehoon; Oh, Jinoh; Ko, Ilhwan; Kim, Sungchul; Han, Wook-Shin

    2010-04-16

    Finding relevant articles from PubMed is challenging because it is hard to express the user's specific intention in the given query interface, and a keyword query typically retrieves a large number of results. Researchers have applied machine learning techniques to find relevant articles by ranking the articles according to the learned relevance function. However, the process of learning and ranking is usually done offline without integrated with the keyword queries, and the users have to provide a large amount of training documents to get a reasonable learning accuracy. This paper proposes a novel multi-level relevance feedback system for PubMed, called RefMed, which supports both ad-hoc keyword queries and a multi-level relevance feedback in real time on PubMed. RefMed supports a multi-level relevance feedback by using the RankSVM as the learning method, and thus it achieves higher accuracy with less feedback. RefMed "tightly" integrates the RankSVM into RDBMS to support both keyword queries and the multi-level relevance feedback in real time; the tight coupling of the RankSVM and DBMS substantially improves the processing time. An efficient parameter selection method for the RankSVM is also proposed, which tunes the RankSVM parameter without performing validation. Thereby, RefMed achieves a high learning accuracy in real time without performing a validation process. RefMed is accessible at http://dm.postech.ac.kr/refmed. RefMed is the first multi-level relevance feedback system for PubMed, which achieves a high accuracy with less feedback. It effectively learns an accurate relevance function from the user's feedback and efficiently processes the function to return relevant articles in real time.

  20. Evidence-based monitoring and evaluation of the faith-based ...

    African Journals Online (AJOL)

    Background: The Islamic Medical Association of Uganda, has been implementing the faith-based approach to HIV prevention without baseline data on expected positive outcomes. Objectives: To establish evidence-based baseline data on expected positive outcomes of the faith-based approach to HIV prevention. Methods: ...

  1. Concluding the Series on Evidence-Based Practice: The Spread of Excellence in Child and Adolescent Psychiatry

    Science.gov (United States)

    Hamilton, John D.

    2008-01-01

    The child and adolescent psychiatry community has been using large systems of information and new technologies to improve its performance.Evidence-based approach is used by practitioners to find and implement feasible therapies and medication. The different procedures involved of evidence-based practice, as used in child and adolescent psychology,…

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

    Science.gov (United States)

    Stanga, I. C.; Grozavu, A.

    2012-04-01

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

  3. Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials.

    Science.gov (United States)

    Brookman-Frazee, Lauren; Stahmer, Aubyn C

    2018-05-09

    The Centers for Disease Control (2018) estimates that 1 in 59 children has autism spectrum disorder, and the annual cost of ASD in the U.S. is estimated to be $236 billion. Evidence-based interventions have been developed and demonstrate effectiveness in improving child outcomes. However, research on generalizable methods to scale up these practices in the multiple service systems caring for these children has been limited and is critical to meet this growing public health need. This project includes two, coordinated studies testing the effectiveness of the Translating Evidence-based Interventions (EBI) for ASD: Multi-Level Implementation Strategy (TEAMS) model. TEAMS focuses on improving implementation leadership, organizational climate, and provider attitudes and motivation in order to improve two key implementation outcomes-provider training completion and intervention fidelity and subsequent child outcomes. The TEAMS Leadership Institute applies implementation leadership strategies and TEAMS Individualized Provider Strategies for training applies motivational interviewing strategies to facilitate provider and organizational behavior change. A cluster randomized implementation/effectiveness Hybrid, type 3, trial with a dismantling design will be used to understand the effectiveness of TEAMS and the mechanisms of change across settings and participants. Study #1 will test the TEAMS model with AIM HI (An Individualized Mental Health Intervention for ASD) in publicly funded mental health services. Study #2 will test TEAMS with CPRT (Classroom Pivotal Response Teaching) in education settings. Thirty-seven mental health programs and 37 school districts will be randomized, stratified by county and study, to one of four groups (Standard Provider Training Only, Standard Provider Training + Leader Training, Enhanced Provider Training, Enhanced Provider Training + Leader Training) to test the effectiveness of combining standard, EBI-specific training with the two TEAMS

  4. Loading Analysis of Modular Multi-level Converter for Offshore High-voltage DC Application under Various Grid Faults

    DEFF Research Database (Denmark)

    Liu, Hui; Ma, Ke; Loh, Poh Chiang

    2016-01-01

    challenges but may also result in overstressed components for the modular multi-level converter. However, the thermal loading of the modular multi-level converter under various grid faults has not yet been clarified. In this article, the power loss and thermal performance of the modular multi-level converter...... low-voltage ride-through strongly depend on the types and severity values of grid voltage dips. The thermal distribution among the three phases of the modular multi-level converter may be quite uneven, and some devices are much more stressed than the normal operating condition, which may...

  5. Evidence-Based Laboratory Medicine: Is It Working in Practice?

    OpenAIRE

    Price, Christopher P

    2012-01-01

    The principles of Evidence-Based Medicine have been established for about two decades, with the need for evidence-based clinical practice now being accepted in most health systems around the world. These principles can be employed in laboratory medicine. The key steps in evidence-based practice, namely (i) formulating the question; (ii) searching for evidence; (iii) appraising evidence; (iv) applying evidence; and (v) assessing the experience are all accepted but, as yet, translation into dai...

  6. Embedding evidence-based practice among nursing undergraduates: Results from a pilot study.

    Science.gov (United States)

    André, Beate; Aune, Anne G; Brænd, Jorunn A

    2016-05-01

    Evidence-based practice is currently one of the most important developments in health care. Research in nursing science is rapidly growing; however, translating the knowledge based on this research into clinical practice is often hampered, and may be dependent on reflective skills. The aim of this study was to see how undergraduate nursing students in nursing should increase their skills and knowledge related to evidence-based practice through participation in clinical research projects. A qualitative approach was used in collecting and analyzing the data. Students participated in a pilot clinical research project and a received guidance related to their bachelor thesis. After the project was completed, all students filled in a questionnaire. The students' motivation to participate in this study was reported to be high, but they reported low knowledge related to evidence-based practice. All students reported that their attitude towards evidence-based practice changed in a positive direction during their participation in the project. Evidence-based practice influenced nursing practices by putting more focus on critical thinking, increasing pride and giving a sense of ownership in the clinical field. The curricula and the pedagogical perspectives in nursing education can influence the attitude towards evidence-based practice and skills among nursing bachelor students. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Evidence-based intervention in physical activity

    DEFF Research Database (Denmark)

    Heath, Gregory W; Parra, Diana C; Sarmiento, Olga L

    2012-01-01

    Promotion of physical activity is a priority for health agencies. We searched for reviews of physical activity interventions, published between 2000 and 2011, and identified effective, promising, or emerging interventions from around the world. The informational approaches of community......-wide and mass media campaigns, and short physical activity messages targeting key community sites are recommended. Behavioural and social approaches are effective, introducing social support for physical activity within communities and worksites, and school-based strategies that encompass physical education......, classroom activities, after-school sports, and active transport. Recommended environmental and policy approaches include creation and improvement of access to places for physical activity with informational outreach activities, community-scale and street-scale urban design and land use, active transport...

  8. How evidence-based are the recommendations in evidence-based guidelines?

    Directory of Open Access Journals (Sweden)

    Finlay A McAlister

    2007-08-01

    Full Text Available BACKGROUND: Treatment recommendations for the same condition from different guideline bodies often disagree, even when the same randomized controlled trial (RCT evidence is cited. Guideline appraisal tools focus on methodology and quality of reporting, but not on the nature of the supporting evidence. This study was done to evaluate the quality of the evidence (based on consideration of its internal validity, clinical relevance, and applicability underlying therapy recommendations in evidence-based clinical practice guidelines. METHODS AND FINDINGS: A cross-sectional analysis of cardiovascular risk management recommendations was performed for three different conditions (diabetes mellitus, dyslipidemia, and hypertension from three pan-national guideline panels (from the United States, Canada, and Europe. Of the 338 treatment recommendations in these nine guidelines, 231 (68% cited RCT evidence but only 105 (45% of these RCT-based recommendations were based on high-quality evidence. RCT-based evidence was downgraded most often because of reservations about the applicability of the RCT to the populations specified in the guideline recommendation (64/126 cases, 51% or because the RCT reported surrogate outcomes (59/126 cases, 47%. CONCLUSIONS: The results of internally valid RCTs may not be applicable to the populations, interventions, or outcomes specified in a guideline recommendation and therefore should not always be assumed to provide high-quality evidence for therapy recommendations.

  9. The Use of Biosimulation in the Design of a Novel Multi-level Weight Loss Maintenance Program for Overweight Children

    Science.gov (United States)

    Wilfley, Denise E.; Van Buren, Dorothy J.; Theim, Kelly R.; Stein, Richard I.; Saelens, Brian E.; Ezzet, Farkad; Russian, Angela C.; Perri, Michael G.; Epstein, Leonard H.

    2011-01-01

    Objective Weight loss outcomes achieved through conventional behavior change interventions are prone to deterioration over time. Basic learning laboratory studies in the area of behavioral extinction and renewal and multi-level models of weight control offer clues as to why newly acquired weight loss skills are prone to relapse. According to these models, current clinic-based interventions may not be of sufficient duration or scope to allow for the practice of new skills across the multiple community contexts necessary to promote sustainable weight loss. Although longer, more intensive interventions with greater reach may hold the key to improving weight loss outcomes, it is difficult to test these assumptions in a time efficient and cost-effective manner. A research design tool that has been increasingly utilized in other fields (e.g., pharmaceuticals) is the use of biosimulation analyses. The present paper describes our research team's use of computer simulation models to assist in designing a study to test a novel, comprehensive socio-environmental treatment approach to weight loss maintenance in children ages 7 to 12 years. Methods Weight outcome data from the weight loss, weight maintenance, and follow-up phases of a recently completed randomized controlled trial (RCT) were used to describe the time course of a proposed, extended multi-level treatment program. Simulations were then conducted to project the expected changes in child percent overweight trajectories in the proposed study. Results A 12.9% decrease in percent overweight at 30 months was estimated based upon the midway point between models of “best-case” and “worst-case” weight maintenance scenarios. Conclusions Preliminary data and further analyses, including biosimulation projections, suggest that our socio-environmental approach to weight loss maintenance treatment is promising and warrants evaluation in a large-scale RCT. Biosimulation techniques may have utility in the design of future

  10. Occupational segregation and gender inequality in job quality: a multi-level approach

    NARCIS (Netherlands)

    Stier, H.; Yaish, M.

    2012-01-01

    We examine gender differences in perceived quality of employment (achievement, content, job insecurity, job flexibility, and physical and emotional conditions). We ask whether women’s occupations provide better conditions in areas that facilitate their dual role in society, such as flexible working

  11. Data Model Approach And Markov Chain Based Analysis Of Multi-Level Queue Scheduling

    Directory of Open Access Journals (Sweden)

    Diwakar Shukla

    2010-01-01

    Full Text Available There are many CPU scheduling algorithms inliterature like FIFO, Round Robin, Shortest-Job-First and so on.The Multilevel-Queue-Scheduling is superior to these due to itsbetter management of a variety of processes. In this paper, aMarkov chain model is used for a general setup of Multilevelqueue-scheduling and the scheduler is assumed to performrandom movement on queue over the quantum of time.Performance of scheduling is examined through a rowdependent data model. It is found that with increasing value of αand d, the chance of system going over the waiting state reduces.At some of the interesting combinations of α and d, it diminishesto zero, thereby, provides us some clue regarding better choice ofqueues over others for high priority jobs. It is found that ifqueue priorities are added in the scheduling intelligently thenbetter performance could be obtained. Data model helpschoosing appropriate preferences.

  12. A MINIMALIST APPROACH TO MULTI-LEVEL IT-HUMAN INTEGRATION IN TRANSLATION WORK'

    Directory of Open Access Journals (Sweden)

    Jesus Soria

    2002-06-01

    Full Text Available This article attenlpts to define the intimate relationship that is intended between c1assroon1-based and laboratory-based activities, between private study and language class, between individual and collective effort and between computer-centered and teacher-led learning. We tend to take it as an axiom o€ CALL that the place of IT is beside the teacher, its function complementary or suplementary. Typically. the teacher's role is usually one (occasionally just a couple of these: designer, author, editor, tester, provider, trainer, checker or supervisor. Except when in a supervisory role, the teacher's role is taken over by the computer when the teacher's own activity stops. This is what we tend to call computer-aided instruction. In the vast majority of cases, the role of IT is extrinsic to the teacher's own activity. I shall try to demonstrate here that the aid that the coMputer is able to provide can be effectively brought right into the classroom as an integral, intrinsic part of the teacher's own activity and that, by doing so, it can enhance not only the teacher's activity but also the complementary role which is traditionally assigned to the computer. The processes described here were developed with a specific situation in mind, not atypical in, at least, British Higher Education: increased mixed ability and reduced teaching time. In a pedagogical context that, in spite of mission statement protestations, usually attempts to make the most of the average, they specifically target the lower and higher ability student ranges. New funding has been secured to continue with this research from September 2002.

  13. Development of a multi-level approach to model and optimise the Kalina Split Cycle

    DEFF Research Database (Denmark)

    Larsen, Ulrik; Nguyen, Tuong-Van; Haglind, Fredrik

    2012-01-01

    In the marine sector there is a strong motivation for increasing the propulsion system energy efficiency, mainly because of increasing fuel prices and stricter upcoming emission regulations. The Kalina cycle, based on a mixture of ammonia and water as working fluid, exhibits higher conversion...

  14. A Unified Approach towards Decomposition and Coordination for Multi-level Optimization

    NARCIS (Netherlands)

    De Wit, A.J.

    2009-01-01

    Complex systems, such as those encountered in aerospace engineering, can typically be considered as a hierarchy of individual coupled elements. This hierarchy is reflected in the analysis techniques that are used to analyze the physcial characteristics of the system. Consequently, a hierarchy of

  15. Road pricing mechanisms - A game theoretic and multi-level approach

    NARCIS (Netherlands)

    Ohazulike, Anthony

    2014-01-01

    Road traffic externalities such as congestion, high noise levels, emission, accidents, are increasing due to the rise in vehicle ownership. Owing to financial, geographical and/or feasibility constraints, it could not be practically feasible to combat these externalities by expanding

  16. Assessing the potential of dual-purpose maize in southern Africa: A multi-level approach

    NARCIS (Netherlands)

    Homann-Kee Tui, S.; Blümmel, M.; Valbuena, D.F.; Chirima, A.; Maskati, P.; Rooyen, van A.F.; Kassie, G.T.

    2013-01-01

    This paper explores the potential and challenges of increasing production of food and feed on existing maize fields in mixed crop-livestock systems in the semi-arid areas of southern Africa. It integrates results from different sources of data and analysis: 1. Spatial stratification using secondary

  17. Multi-Level Sensor Fusion Algorithm Approach for BMD Interceptor Applications

    National Research Council Canada - National Science Library

    Allen, Doug

    1998-01-01

    ... through fabrication and testing of advanced sensor hardware concepts and advanced sensor fusion algorithms. Advanced sensor concepts include onboard LADAR in conjunction with a multi-color passive IR sensor...

  18. Housing-related lifestyle and energy saving: A multi-level approach

    International Nuclear Information System (INIS)

    Thøgersen, John

    2017-01-01

    A new instrument for measuring housing-related lifestyle (HRL) is introduced and employed for identifying national and cross-national HRL segments in 10 European countries (N=3190). The identified HRL segments are profiled and the practical importance of HRL for everyday energy-saving efforts in the home and for the energy-consumer's openness to new energy saving opportunities (i.e., energy saving innovativeness) is investigated. The HRL instrument's 71 items load on 16 dimensions within five lifestyle elements. Multi-group confirmatory factor analysis reveals that the instrument possesses metric but not scalar (measurement) invariance across the 10 countries. Multilevel latent class analysis is used to classify participants to HRL segments and the 10 countries into regions with similar segment structure. The optimal solution has seven HRL segments and three country classes, which are profiled in terms of relevant background characteristics. A multivariate GLM analysis reveals that when differences in housing-related lifestyles are controlled, neither country of residence nor the interaction between lifestyle and country of residence influence energy saving innovativeness or everyday energy-saving efforts. However, these two behavioural tendencies vary significantly and substantially between lifestyle segments. The study shows that HRL segmentation is a useful tool for creating more targeted and effective energy-saving campaigns. - Highlights: • 7 housing-related lifestyle segments identified in 10 European countries. • The 10 countries cluster in 3 regions with similar housing-related lifestyle pattern. • Lifestyle segments differ significantly with regard to energy saving efforts. • Lifestyle segments also differ with regard to energy saving innovativeness. • Housing-related lifestyle mediate all effects of country on energy saving.

  19. Responsible Leadership in Global Business: A New Approach to Leadership and Its Multi-Level Outcomes

    OpenAIRE

    Voegtlin Christian; Patzer Moritz; Scherer Andreas Georg

    2012-01-01

    The article advances an understanding of responsible leadership in global business and offers an agenda for future research in this field. Our conceptualization of responsible leadership draws on deliberative practices and discursive conflict resolution combining the macro view of the business firm as a political actor with the micro view of leadership. We discuss the concept in relation to existing research in leadership. Further we propose a new model of responsible leadership that shows ho...

  20. Introducing evidence-based dentistry to dental students using histology.

    Science.gov (United States)

    Lallier, Thomas E

    2014-03-01

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

  1. Evidence-based and data-driven road safety management

    Directory of Open Access Journals (Sweden)

    Fred Wegman

    2015-07-01

    Full Text Available Over the past decades, road safety in highly-motorised countries has made significant progress. Although we have a fair understanding of the reasons for this progress, we don't have conclusive evidence for this. A new generation of road safety management approaches has entered road safety, starting when countries decided to guide themselves by setting quantitative targets (e.g. 50% less casualties in ten years' time. Setting realistic targets, designing strategies and action plans to achieve these targets and monitoring progress have resulted in more scientific research to support decision-making on these topics. Three subjects are key in this new approach of evidence-based and data-driven road safety management: ex-post and ex-ante evaluation of both individual interventions and intervention packages in road safety strategies, and transferability (external validity of the research results. In this article, we explore these subjects based on recent experiences in four jurisdictions (Western Australia, the Netherlands, Sweden and Switzerland. All four apply similar approaches and tools; differences are considered marginal. It is concluded that policy-making and political decisions were influenced to a great extent by the results of analysis and research. Nevertheless, to compensate for a relatively weak theoretical basis and to improve the power of this new approach, a number of issues will need further research. This includes ex-post and ex-ante evaluation, a better understanding of extrapolation of historical trends and the transferability of research results. This new approach cannot be realized without high-quality road safety data. Good data and knowledge are indispensable for this new and very promising approach.

  2. Breast abscess: evidence based management recommendations.

    Science.gov (United States)

    Lam, Elaine; Chan, Tiffany; Wiseman, Sam M

    2014-07-01

    Literature review was carried out and studies reporting on treatment of breast abscesses were critically appraised for quality and their level of evidence using the Strength of Recommendation Taxonomy guidelines, and key recommendations were summarized. Needle aspiration either with or without ultrasound guidance should be employed as first line treatment of breast abscesses. This approach has the potential benefits of: superior cosmesis, shorter healing time, and avoidance of general anaesthesia. Multiple aspiration sessions may be required for cure. Ultrasound-guided percutaneous catheter placement may be considered as an alternative approach for treatment of larger abscesses (>3 cm). Surgical incision and drainage should be considered for first line therapy in large (>5 cm), multiloculated, or long standing abscesses, or if percutaneous drainage is unsuccessful. All patients should be treated concurrently with antibiotics. Patients with recurrent subareolar abscesses and fistulas should be referred for consideration of surgical treatment.

  3. Drift-Implicit Multi-Level Monte Carlo Tau-Leap Methods for Stochastic Reaction Networks

    KAUST Repository

    Ben Hammouda, Chiheb

    2015-05-12

    In biochemical systems, stochastic e↵ects can be caused by the presence of small numbers of certain reactant molecules. In this setting, discrete state-space and stochastic simulation approaches were proved to be more relevant than continuous state-space and deterministic ones. These stochastic models constitute the theory of stochastic reaction networks (SRNs). Furthermore, in some cases, the dynamics of fast and slow time scales can be well separated and this is characterized by what is called sti↵ness. For such problems, the existing discrete space-state stochastic path simulation methods, such as the stochastic simulation algorithm (SSA) and the explicit tau-leap method, can be very slow. Therefore, implicit tau-leap approxima- tions were developed to improve the numerical stability and provide more e cient simulation algorithms for these systems. One of the interesting tasks for SRNs is to approximate the expected values of some observables of the process at a certain fixed time T. This is can be achieved using Monte Carlo (MC) techniques. However, in a recent work, Anderson and Higham in 2013, proposed a more computationally e cient method which combines multi-level Monte Carlo (MLMC) technique with explicit tau-leap schemes. In this MSc thesis, we propose new fast stochastic algorithm, particularly designed 5 to address sti↵ systems, for approximating the expected values of some observables of SRNs. In fact, we take advantage of the idea of MLMC techniques and drift-implicit tau-leap approximation to construct a drift-implicit MLMC tau-leap estimator. In addition to accurately estimating the expected values of a given observable of SRNs at a final time T , our proposed estimator ensures the numerical stability with a lower cost than the MLMC explicit tau-leap algorithm, for systems including simultane- ously fast and slow species. The key contribution of our work is the coupling of two drift-implicit tau-leap paths, which is the basic brick for

  4. Evidence-based medicine: pressure sores.

    Science.gov (United States)

    Cushing, Carolyn A; Phillips, Linda G

    2013-12-01

    After studying this article, the participant should be able to: 1. Cite risk factors for pressure sore development. 2. Detail the pathophysiology of pressure sores. 3. List the types and classification of pressure sores. 4. Consider the various nonsurgical conservative wound management strategies. 5. Describe the appropriate surgical interventions for each pressure sore type. 6. Understand the causes of recurrent pressure sores and methods of avoiding recurrence. Pressure sores are the result of unrelieved pressure, usually over a bony prominence. With an estimated 2.5 million pressure ulcers treated annually in the United States at a cost of $11 billion, pressure sores represent a costly and labor-intensive challenge to the health care system. A comprehensive team approach can address both prevention and treatment of these recalcitrant wounds. Consideration must be given to the patient's medical and socioeconomic condition, as these factors are significantly related to outcomes. Mechanical prophylaxis, nutritional optimization, treatment of underlying infection, and spasm control are essential in management. A variety of pressure sore patterns exist, with surgical approaches directed to maximize future coverage options. A comprehensive approach is detailed in this article to provide the reader with the range of treatment options available.

  5. Innovation in Multi-Level Governance for Energy Efficiency. Sharing experience with multi-level governance to enhance energy efficiency. Information paper

    Energy Technology Data Exchange (ETDEWEB)

    Jollands, Nigel; Gasc, Emilien; Pasquier, Sara Bryan

    2009-12-15

    Despite creating a plethora of national and international regulations and voluntary programmes to improve energy efficiency, countries are far from achieving full energy efficiency potential across all sectors of the economy. One major challenge, among numerous barriers, is policy implementation. One strategy that many national governments and international organisations have used to address the implementation issue is to engage regional and local authorities. To that end, many programmes have been created that foster energy efficiency action and collaboration across levels of government. The aim of this report is to identify trends and detail recent developments in multi-level governance in energy efficiency (MLGEE). By sharing lessons learned from daily practitioners in the field, the IEA hopes energy efficiency policy makers at all levels of government will be able to identify useful multilevel governance (MLG) practices across geographical and political contexts and use these to design robust programmes; modify existing programmes, and connect and share experiences with other policy makers in this field.

  6. Non-linear interactions of multi-level atoms with a near-resonant standing wave

    International Nuclear Information System (INIS)

    O'Kane, T.J.; Scholten, R.E.; Walkiewicz, M.R.; Farrell, P.M.

    1998-01-01

    Using a semiclassical density matrix formalism we have calculated the behavior of multi-level atoms interacting with a standing wave field, and show how complex non-linear phenomena, including multi-photon effects, combine to produce saturation spectra as observed in experiments. We consider both 20-level sodium and 24-level rubidium models, contrasting these with a simple 2-level case. The influence of parameters such as atomic trajectory and the time the atom remains in the beam are shown to have a critical effect on the lineshape of these resonances and the emission/absorption processes. Stable oscillations in the excited state populations for both the two-level and multi-level cases are shown to be limit cycles. These limit cycles undergo period doubling as the system evolves into chaos. Finally, using a Monte Carlo treatment, these processes average to produce saturated absorption spectra complete with power and Doppler broadening effects consistent with experiment. (authors)

  7. Habit, custom, and power: a multi-level theory of population health.

    Science.gov (United States)

    Zimmerman, Frederick J

    2013-03-01

    In multi-level theory, individual behavior flows from cognitive habits, either directly through social referencing, rules of thumb, or automatic behaviors; or indirectly through the shaping of rationality itself by framing or heuristics. Although behavior does not arise from individually rational optimization, it generally appears to be rational, because the cognitive habits that guide behavior evolve toward optimality. However, power imbalances shaped by particular social, political, and economic structures can distort this evolution, leading to individual behavior that fails to maximize individual or social well-being. Replacing the dominant rational-choice paradigm with a multi-level theoretical paradigm involving habit, custom, and power will enable public health to engage in rigorous new areas of research. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Off-resonant transitions in the collective dynamics of multi-level atomic ensembles

    DEFF Research Database (Denmark)

    Miroshnychenko, Yevhen; Mølmer, Klaus

    2013-01-01

    We study the contributions of off-resonant transitions to the dynamics of a system of N multi-level atoms sharing one excitation and interacting with the quantized vector electromagnetic field. The rotating wave approximation significantly simplifies the derivation of the equations of motion...... describing the collective atomic dynamics, but it leads to an incorrect expression for the dispersive part of the atom–atom interaction terms. For the case of two-level atoms and a scalar electromagnetic field, it turns out that the atom–atom interaction can be recovered correctly if integrals over...... the photon mode frequencies are extended to incorporate negative values. We explicitly derive the atom–atom interaction for multi-level atoms, coupled to the full vector electromagnetic field, and we recover also in this general case the validity of the results obtained by the extension to negative...

  9. Jansen-MIDAS: A multi-level photomicrograph segmentation software based on isotropic undecimated wavelets.

    Science.gov (United States)

    de Siqueira, Alexandre Fioravante; Cabrera, Flávio Camargo; Nakasuga, Wagner Massayuki; Pagamisse, Aylton; Job, Aldo Eloizo

    2018-01-01

    Image segmentation, the process of separating the elements within a picture, is frequently used for obtaining information from photomicrographs. Segmentation methods should be used with reservations, since incorrect results can mislead when interpreting regions of interest (ROI). This decreases the success rate of extra procedures. Multi-Level Starlet Segmentation (MLSS) and Multi-Level Starlet Optimal Segmentation (MLSOS) were developed to be an alternative for general segmentation tools. These methods gave rise to Jansen-MIDAS, an open-source software. A scientist can use it to obtain several segmentations of hers/his photomicrographs. It is a reliable alternative to process different types of photomicrographs: previous versions of Jansen-MIDAS were used to segment ROI in photomicrographs of two different materials, with an accuracy superior to 89%. © 2017 Wiley Periodicals, Inc.

  10. New techniques for multi-level cross section calculation and fitting

    International Nuclear Information System (INIS)

    Froehner, F.H.

    1981-01-01

    A number of recent developments in multi-level cross section work are described. A new iteration scheme for the conversion of Reich-Moore resonance parameters to Kapur-Peierls parameters allows application of Turing's method for Gaussian broadening of meromorphic functions directly to multi-level cross section expressions, without recourse to the Voigt profiles psi and chi. This makes calculation of Doppler-broadened Reich-Moore and MLBW cross sections practically as fast as SLBW and Adler-Adler cross section calculations involving the Voigt profiles. A convenient distant-level treatment utilizing average resonance parameters is presented. Apart from effectively dealing with edge effects in resonance fitting work it also leads to a simple prescription for the determination of bound levels which reproduce the thermal cross sections correctly. A brief discussion of improved resonance shape fitting techniques is included, with emphasis on the importance of correlated errors and proper use of prior information by application of Bayes' theorem

  11. Profiling micro-organic contaminants in groundwater using multi-level piezometers

    OpenAIRE

    White, Debbie; Lapworth, Dan; Stuart, Marianne; Williams, Peter

    2015-01-01

    The presence of micro-organic pollutants, including ‘emerging contaminants’ within groundwater is of increasing interest. Robust protocols are required to minimise the introduction of contamination during the sampling process. Below we discuss the sampling protocols used to reduce inputs of plasticisers during the sampling process, as well as the techniques used to characterise the distribution of micro-organic pollutants in the subsurface. In this study multi-level piezometers...

  12. A dedicated database system for handling multi-level data in systems biology

    OpenAIRE

    Pornputtapong, Natapol; Wanichthanarak, Kwanjeera; Nilsson, Avlant; Nookaew, Intawat; Nielsen, Jens

    2014-01-01

    Background Advances in high-throughput technologies have enabled extensive generation of multi-level omics data. These data are crucial for systems biology research, though they are complex, heterogeneous, highly dynamic, incomplete and distributed among public databases. This leads to difficulties in data accessibility and often results in errors when data are merged and integrated from varied resources. Therefore, integration and management of systems biological data remain very challenging...

  13. “Peran Polri Dalam Penyidikan Tindak Pidana Yang Terkait Dengan Multi Level Marketing”.

    OpenAIRE

    Sidabutar, Ronny Nicolas; Syahrin, Alvi; Mulyadi, Mahmud; Marlina, Marlina

    2015-01-01

    Business industry Multi Level Marketing (MLM) is a lucrative market society especially with the promised bonuses obtained upon the sale of its products. However, there are also business masquerading as MLM, low quality products but a bonus for members is very large, so as to make the public flocked to follow the program masquerading as MLM business. The issues raised in this study is whether there is legal provision that can ensnare actors masquerading as MLM business practice is, how do I de...

  14. Critical network effect induces business oscillations in multi-level marketing systems

    OpenAIRE

    Juanico, Dranreb Earl

    2012-01-01

    The "social-networking revolution" of late (e.g., with the advent of social media, Facebook, and the like) has been propelling the crusade to elucidate the embedded networks that underlie economic activity. An unexampled synthesis of network science and economics uncovers how the web of human interactions spurred by familiarity and similarity could potentially induce the ups and downs ever so common to our economy. Zeroing in on the million-strong global industry known as multi-level marketin...

  15. A multi-level qualitative analysis of Telehomecare in Ontario: challenges and opportunities

    OpenAIRE

    Hunting, Gemma; Shahid, Nida; Sahakyan, Yeva; Fan, Iris; Moneypenny, Crystal R.; Stanimirovic, Aleksandra; North, Taylor; Petrosyan, Yelena; Krahn, Murray D.; Rac, Valeria E.

    2015-01-01

    Background Despite research demonstrating the potential effectiveness of Telehomecare for people with Chronic Obstructive Pulmonary Disease and Heart Failure, broad-scale comprehensive evaluations are lacking. This article discusses the qualitative component of a mixed-method program evaluation of Telehomecare in Ontario, Canada. The objective of the qualitative component was to explore the multi-level factors and processes which facilitate or impede the implementation and adoption of the pro...

  16. A Formal Model of Trust Chain based on Multi-level Security Policy

    OpenAIRE

    Kong Xiangying

    2013-01-01

    Trust chain is the core technology of trusted computing. A formal model of trust chain based on finite state automata theory is proposed. We use communicating sequential processes to describe the system state transition in trust chain and by combining with multi-level security strategy give the definition of trust system and trust decision theorem of trust chain transfer which is proved meantime. Finally, a prototype system is given to show the efficiency of the model.

  17. Study of multi-level atomic systems with the application of magnetic field

    Science.gov (United States)

    Hu, Jianping; Roy, Subhankar; Ummal Momeen, M.

    2018-04-01

    The complexity of multiple energy levels associated with each atomic system determines the various processes related to light- matter interactions. It is necessary to understand the influence of different levels in a given atomic system. In this work we focus on multi- level atomic schemes with the application of magnetic field. We analyze the different EIT windows which appears in the presence of moderately high magnetic field (∼ 10 G) strength.

  18. In the teeth of the evidence: the curious case of evidence-based medicine.

    Science.gov (United States)

    Davidoff, F

    1999-03-01

    For a very long time, evidence from research has contributed to clinical decision making. Over the past 50 years, however, the nature of clinical research evidence has drastically changed compared with previous eras: its standards are higher, the tools for assembling and analyzing it are more powerful, and the context in which it is used is less authoritarian. The consequence has been a shift in both the concept and the practice of clinical decision making known as evidence-based medicine. Evidence-based decisions, by definition, use the strongest available evidence, are often more quantitatively informed than decisions made in the traditional fashion; and sometimes run counter to expert opinion. The techniques of evidence-based medicine are also helpful in resolving conflicting opinions. Evidence-based medicine did not simply appear in vacuo; its roots extend back at least as far as the great French Encyclopedia of the 18th century, and the subsequent work of Pierre Louis in Paris in the early 19th century. The power of the evidence-based approach has been enhanced in recent years by the development of the techniques of systematic review and meta-analysis. While this approach has its critics, we would all want the best available evidence used in making decisions about our care if we got sick. It is only fair that the patients under our care receive nothing less.

  19. Evidence-based clinical guidelines for eating disorders : International comparison

    NARCIS (Netherlands)

    Hilbert, Anja; Hoek, Hans W.; Schmidt, Ricarda

    2017-01-01

    Purpose of review: The current systematic review sought to compare available evidence-based clinical treatment guidelines for all specific eating disorders. Recent findings: Nine evidence-based clinical treatment guidelines for eating disorders were located through a systematic search. The

  20. De scientist practitioner en de evidence-based practice

    NARCIS (Netherlands)

    Hutschemaekers, G.J.M.; Nijnatten, C.H.C.J. van

    2008-01-01

    Het principe van evidence-based werken heeft kenmerken gekregen van een paradigma en de scientist practitioner lijkt plaatsgemaakt te hebben voor de louter uitvoerende evidence-based practitioner. Dat werkt eerder passiviteit dan wetenschappelijkheid in de hand. Er zijn zes belangrijke problemen met

  1. Illicit Drugs, Policing and the Evidence-Based Policy Paradigm

    Science.gov (United States)

    Ritter, Alison; Lancaster, Kari

    2013-01-01

    The mantra of evidence-based policy (EBP) suggests that endeavours to implement evidence-based policing will produce better outcomes. However there is dissonance between the rhetoric of EBP and the actuality of policing policy. This disjuncture is critically analysed using the case study of illicit drugs policing. The dissonance may be ameliorated…

  2. Behavioral Activation Is an Evidence-Based Treatment for Depression

    Science.gov (United States)

    Sturmey, Peter

    2009-01-01

    Recent reviews of evidence-based treatment for depression did not identify behavioral activation as an evidence-based practice. Therefore, this article conducted a systematic review of behavioral activation treatment of depression, which identified three meta-analyses, one recent randomized controlled trial and one recent follow-up of an earlier…

  3. Thermo-mechanical analysis for multi-level HLW repository concept

    International Nuclear Information System (INIS)

    Kwon, Sang Ki; Choi, Jong Won

    2004-01-01

    This work aims to investigate the influence of design parameters for the underground high-level nuclear waste repository with multi-level concept. B. Necessity o In order to construct an HLW repository in deep underground, it is required to select a site, which is far from major discontinuities. To dispose the whole spent fuels generated from the Korean nuclear power plants in a repository, the underground area of about 4km 2 is required. This would be a constraints for selecting an adequate repository site. It is recommended to dispose the two different spent fuels, PWR and CANDU, in different areas at the operation efficiency point of view. It is necessary to investigate the influence of parameters, which can affect the stability of multi-level repository. It is also needed to consider the influence of heat generated from the HLW and the high in situ stress in deep location. Therefore, thermo-mechanical coupling analysis should be carried out and the results should be compared with the results from single-level repository concept. Three-dimensional analysis is required to model the disposal tunnel and deposition hole. It is recommended to use the Korean geological condition and actually measured rock properties in Korea in order to achieve reliable modeling results. A FISH routine developed for effective modeling of Thermal-Mechanical coupling was implemented in the modeling using FLAC3D, which is a commercial three-dimensional FDM code. The thermal and mechanical properties of rock and rock mass achieved from Yusung drilling site, were used for the computer modeling. Different parameters such as level distance, waste type disposed on different levels, and time interval between the operation on different levels, were considered in the three-dimensional analysis. From the analysis, it was possible to derive adequate multi-level repository concept. Results and recommendations for application From the thermal-mechanical analysis for the multi-level repository

  4. Multi-stage decoding for multi-level block modulation codes

    Science.gov (United States)

    Lin, Shu

    1991-01-01

    In this paper, we investigate various types of multi-stage decoding for multi-level block modulation codes, in which the decoding of a component code at each stage can be either soft-decision or hard-decision, maximum likelihood or bounded-distance. Error performance of codes is analyzed for a memoryless additive channel based on various types of multi-stage decoding, and upper bounds on the probability of an incorrect decoding are derived. Based on our study and computation results, we find that, if component codes of a multi-level modulation code and types of decoding at various stages are chosen properly, high spectral efficiency and large coding gain can be achieved with reduced decoding complexity. In particular, we find that the difference in performance between the suboptimum multi-stage soft-decision maximum likelihood decoding of a modulation code and the single-stage optimum decoding of the overall code is very small: only a fraction of dB loss in SNR at the probability of an incorrect decoding for a block of 10(exp -6). Multi-stage decoding of multi-level modulation codes really offers a way to achieve the best of three worlds, bandwidth efficiency, coding gain, and decoding complexity.

  5. Serving the army as secretaries: intersectionality, multi-level contract and subjective experience of citizenship.

    Science.gov (United States)

    Lomsky-Feder, Edna; Sasson-Levy, Orna

    2015-03-01

    With the growing elusiveness of the state apparatus in late modernity, military service is one of the last institutions to be clearly identified with the state, its ideologies and its policies. Therefore, negotiations between the military and its recruits produce acting subjects of citizenship with long-lasting consequences. Arguing that these negotiations are regulated by multi-level (civic, group, and individual) contracts, we explore the various meanings that these contracts obtain at the intersectionality of gender, class, and ethnicity; and examine how they shape the subjective experience of soldierhood and citizenship. More particularly, we analyse the meaning of military service in the retrospective life stories of Israeli Jewish women from various ethno-class backgrounds who served as army secretaries - a low-status, feminine gender-typed occupation within a hyper-masculine organization. Findings reveal that for women of the lower class, the organizing cultural schema of the multi-level contract is that of achieving respectability through military service, which means being included in the national collective. Conversely, for middle-class women, it is the sense of entitlement that shapes their contract with the military, which they expect to signify and maintain their privileged status. Thus, while for the lower class, the multi-level contract is about inclusion within the boundaries of the national collective, for the dominant groups, this contract is about reproducing social class hierarchies within national boundaries. © London School of Economics and Political Science 2014.

  6. Multi-level Control Framework for Enhanced Flexibility of Active Distribution Network

    DEFF Research Database (Denmark)

    Nainar, Karthikeyan; Pokhrel, Basanta Raj; Pillai, Jayakrishnan Radhakrishna

    2017-01-01

    In this paper, the control objectives of future active distribution networks with high penetration of renewables and flexible loads are analyzed and reviewed. From a state of the art review, the important control objectives seen from the perspective of a distribution system operator are identifie......-ordination and management of the network assets at different voltage levels and geographical locations. The paper finally shows the applicability of the multi-level control architecture to some of the key challenges in the distribution system operation by relevant scenarios....... to be hosting capacity improvement, high reliable operation and cost effective network management. Based on this review and a state of the art review concerning future distribution network control methods, a multi-level control architecture is constructed for an active distribution network, which satisfies...... the selected control objectives and provides enhanced flexibility. The control architecture is supported by generation/load forecasting and distribution state estimation techniques to improve the controllability of the network. The multi-level control architecture consists of three levels of hierarchical...

  7. Bariatric surgery: an evidence-based analysis.

    Science.gov (United States)

    2005-01-01

    To conduct an evidence-based analysis of the effectiveness and cost-effectiveness of bariatric surgery. Obesity is defined as a body mass index (BMI) of at last 30 kg/m(2).() Morbid obesity is defined as a BMI of at least 40 kg/m(2) or at least 35 kg/m(2) with comorbid conditions. Comorbid conditions associated with obesity include diabetes, hypertension, dyslipidemias, obstructive sleep apnea, weight-related arthropathies, and stress urinary incontinence. It is also associated with depression, and cancers of the breast, uterus, prostate, and colon, and is an independent risk factor for cardiovascular disease. Obesity is also associated with higher all-cause mortality at any age, even after adjusting for potential confounding factors like smoking. A person with a BMI of 30 kg/m(2) has about a 50% higher risk of dying than does someone with a healthy BMI. The risk more than doubles at a BMI of 35 kg/m(2). An expert estimated that about 160,000 people are morbidly obese in Ontario. In the United States, the prevalence of morbid obesity is 4.7% (1999-2000). In Ontario, the 2004 Chief Medical Officer of Health Report said that in 2003, almost one-half of Ontario adults were overweight (BMI 25-29.9 kg/m(2)) or obese (BMI ≥ 30 kg/m(2)). About 57% of Ontario men and 42% of Ontario women were overweight or obese. The proportion of the population that was overweight or obese increased gradually from 44% in 1990 to 49% in 2000, and it appears to have stabilized at 49% in 2003. The report also noted that the tendency to be overweight and obese increases with age up to 64 years. BMI should be used cautiously for people aged 65 years and older, because the "normal" range may begin at slightly above 18.5 kg/m(2) and extend into the "overweight" range. The Chief Medical Officer of Health cautioned that these data may underestimate the true extent of the problem, because they were based on self reports, and people tend to over-report their height and under-report their weight

  8. Evidence Based Validation of Indian Traditional Medicine – Way Forward

    Directory of Open Access Journals (Sweden)

    Pulok K Mukherjee

    2016-01-01

    Full Text Available Evidence based validation of the ethno-pharmacological claims on traditional medicine (TM is the need of the day for its globalization and reinforcement. Combining the unique features of identifying biomarkers that are highly conserved across species, this can offer an innovative approach to biomarker-driven drug discovery and development. TMs are an integral component of alternative health care systems. India has a rich wealth of TMs and the potential to accept the challenge to meet the global demand for them. Ayurveda, Yoga, Unani, Siddha and Homeopathy (AYUSH medicine are the major healthcare systems in Indian Traditional Medicine. The plant species mentioned in the ancient texts of these systems may be explored with the modern scientific approaches for better leads in the healthcare. TM is the best sources of chemical diversity for finding new drugs and leads. Authentication and scientific validation of medicinal plant is a fundamental requirement of industry and other organizations dealing with herbal drugs. Quality control (QC of botanicals, validated processes of manufacturing, customer awareness and post marketing surveillance are the key points, which could ensure the quality, safety and efficacy of TM. For globalization of TM, there is a need for harmonization with respect to its chemical and metabolite profiling, standardization, QC, scientific validation, documentation and regulatory aspects of TM. Therefore, the utmost attention is necessary for the promotion and development of TM through global collaboration and co-ordination by national and international programme.

  9. Vitiligo: concise evidence based guidelines on diagnosis and management.

    Science.gov (United States)

    Gawkrodger, David J; Ormerod, Anthony D; Shaw, Lindsay; Mauri-Sole, Inma; Whitton, Maxine E; Watts, M Jane; Anstey, Alex V; Ingham, Jane; Young, Katharine

    2010-08-01

    Vitiligo is a common disease that causes a great degree of psychological distress. In its classical forms it is easily recognised and diagnosed. This review provides an evidence based outline of the management of vitiligo, particularly with the non-specialist in mind. Treatments for vitiligo are generally unsatisfactory. The initial approach to a patient who is thought to have vitiligo is to make a definite diagnosis, offer psychological support, and suggest supportive treatments such as the use of camouflage cosmetics and sunscreens, or in some cases after discussion the option of no treatment. Active therapies open to the non-specialist, after an explanation of potential side effects, include the topical use of potent or highly potent steroids or calcineurin inhibitors for a defined period of time (usually 2 months), following which an assessment is made to establish whether or not there has been a response. Patients whose condition is difficult to diagnose, unresponsive to straightforward treatments, or is causing psychological distress, are usually referred to a dermatologist. Specialist dermatology units have at their disposal phototherapy, either narrow band ultraviolet B or in some cases photochemotherapy, which is the most effective treatment presently available and can be considered for symmetrical types of vitiligo. Depigmenting treatments and possibly surgical approaches may be appropriate for vitiligo in selected cases. There is no evidence that presently available systemic treatments are helpful and safe in vitiligo. There is a need for further research into the causes of vitiligo, and into discovering better treatments.

  10. Development of Evidence-Based Health Policy Documents in Developing Countries: A Case of Iran

    Science.gov (United States)

    Imani-Nasab, Mohammad Hasan; Seyedin, Hesam; Majdzadeh, Reza; Yazdizadeh, Bahareh; Salehi, Masoud

    2014-01-01

    Background: Evidence-based policy documents that are well developed by senior civil servants and are timely available can reduce the barriers to evidence utilization by health policy makers. This study examined the barriers and facilitators in developing evidence-based health policy documents from the perspective of their producers in a developing country. Methods: In a qualitative study with a framework analysis approach, we conducted semi-structured interviews using purposive and snowball sampling. A qualitative analysis software (MAXQDA-10) was used to apply the codes and manage the data. This study was theory-based and the results were compared to exploratory studies about the factors influencing evidence-based health policymaking. Results: 18 codes and three main themes of behavioral, normative, and control beliefs were identified. Factors that influence the development of evidence-based policy documents were identified by the participants: behavioral beliefs included quality of policy documents, use of resources, knowledge and innovation, being time-consuming and contextualization; normative beliefs included policy authorities, policymakers, policy administrators, and co-workers; and control beliefs included recruitment policy, performance management, empowerment, management stability, physical environment, access to evidence, policy making process, and effect of other factors. Conclusion: Most of the cited barriers to the development of evidence-based policy were related to control beliefs, i.e. barriers at the organizational and health system levels. This study identified the factors that influence the development of evidence-based policy documents based on the components of the theory of planned behavior. But in exploratory studies on evidence utilization by health policymakers, the identified factors were only related to control behaviors. This suggests that the theoretical approach may be preferable to the exploratory approach in identifying the barriers

  11. Development of evidence-based health policy documents in developing countries: a case of Iran.

    Science.gov (United States)

    Imani-Nasab, Mohammad Hasan; Seyedin, Hesam; Majdzadeh, Reza; Yazdizadeh, Bahareh; Salehi, Masoud

    2014-02-07

    Evidence-based policy documents that are well developed by senior civil servants and are timely available can reduce the barriers to evidence utilization by health policy makers. This study examined the barriers and facilitators in developing evidence-based health policy documents from the perspective of their producers in a developing country. In a qualitative study with a framework analysis approach, we conducted semi-structured interviews using purposive and snowball sampling. A qualitative analysis software (MAXQDA-10) was used to apply the codes and manage the data. This study was theory-based and the results were compared to exploratory studies about the factors influencing evidence-based health policy-making. 18 codes and three main themes of behavioral, normative, and control beliefs were identified. Factors that influence the development of evidence-based policy documents were identified by the participants: behavioral beliefs included quality of policy documents, use of resources, knowledge and innovation, being time-consuming and contextualization; normative beliefs included policy authorities, policymakers, policy administrators, and co-workers; and control beliefs included recruitment policy, performance management, empowerment, management stability, physical environment, access to evidence, policy making process, and effect of other factors. Most of the cited barriers to the development of evidence-based policy were related to control beliefs, i.e. barriers at the organizational and health system levels. This study identified the factors that influence the development of evidence-based policy documents based on the components of the theory of planned behavior. But in exploratory studies on evidence utilization by health policymakers, the identified factors were only related to control behaviors. This suggests that the theoretical approach may be preferable to the exploratory approach in identifying the barriers and facilitators of a behavior.

  12. Single-Case Research Design: An Alternative Strategy for Evidence-Based Practice

    Science.gov (United States)

    Stapleton, Drue; Hawkins, Andrew

    2015-01-01

    Objective: The trend of utilizing evidence-based practice (EBP) in athletic training is now requiring clinicians, researchers, educators, and students to be equipped to both engage in and make judgments about research evidence. Single-case design (SCD) research may provide an alternative approach to develop such skills and inform clinical and…

  13. 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…

  14. Risk and Strategic Decision-Making in Developing Evidence-Based Practice Guidelines

    Science.gov (United States)

    Wilczynski, Susan M.

    2012-01-01

    Evidence-based practice (EBP) represents an important approach to educating and treating individuals diagnosed with disabilities or disorders. Understanding research findings is the cornerstone of EBP. The methodology of systematic reviews, which involves carefully analyzing research findings, can result a practice guideline that recommends…

  15. Handling a challenging context: experiences of facilitating evidence-based elderly care.

    Science.gov (United States)

    Nygårdh, Annette; Ahlström, Gerd; Wann-Hansson, Christine

    2016-03-01

    To explore improvement facilitators' experiences of handling their commission to implement evidence-based practice in elderly care for frail older persons. Improvement facilitators were put in place across Sweden in a time-limited project by the government, with one part of the project being to evaluate the model before establishing this facilitation of evidence-based practice in elderly care. Two focus groups were interviewed twice. Each group comprised three respondents. The interviews were analysed using qualitative content analysis. A main theme, 'Moving forward by adjusting to the circumstances', described how the improvement facilitators handle their commitment. Five subthemes emerged: identifying barriers, keeping focus, maintaining motivation, building bridges and finding balance. The improvement facilitators' commitment is ambiguous because of unclear leadership of, and responsibility for the national investment. They have to handle leaders' different approaches and justify the need for evidence-based practice. The improvement facilitators did not reflect on the impact of programme adaptations on evidence-based practice. The findings emphasise the need for collaboration between the improvement facilitator and the nurse manager. To fully implement evidence-based practice, negotiations with current practitioners for adaptation to local conditions are necessary. Furthermore, the value of improving organisational performance needs to be rigorously communicated throughout the organisation. © 2015 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd.

  16. Complex interventions required to comprehensively educate allied health practitioners on evidence-based practice

    Directory of Open Access Journals (Sweden)

    Dizon JM

    2011-05-01

    Full Text Available Janine Margarita Dizon1,2, Karen Grimmer-Somers11International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia; 2University of Santo Tomas, Manila, PhilippinesAbstract: There is currently no strong evidence regarding the most effective training approach for allied health professionals that will support them to consistently apply the best research evidence in daily practice. Current evidence-based practice training tends to be 'one size fits all', and is unlikely to be appropriate for all allied health disciplines because of the variability in their tasks and scope of practice. The scant body of evidence regarding the effectiveness of evidence-based practice training for allied health practitioners provides some support for improving knowledge and skills, but equivocal evidence about influencing behaviors and attitudes. We propose a new model of evidence-based practice training, based on the concept of complex interventions reported in the literature. We believe that by offering training in evidence-based practice based on complex interventions relevant to the needs of the attendees, using fixed and variable components, there may be greater success in significantly influencing knowledge skills, attitudes, and behaviors.Keywords: complex interventions, evidence-based practice training, allied health

  17. Evidence-based interventions in pediatric psychology: progress over the decades.

    Science.gov (United States)

    Palermo, Tonya M

    2014-09-01

    This introduction to the special issue on Evidence-Based Interventions in Pediatric Psychology provides background on the process used to develop the special issue, a summary of the key findings from the series of reviews, and discussion of the implications for evidence-based practice. Authors followed a three-phase approach to develop their systematic reviews using rigorous systematic review methodology drawn heavily from the Cochrane Collaboration. The strength of the evidence for each pediatric psychology intervention was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The introduction discusses the progress that has been made in the evidence base for pediatric psychology interventions since the first special series published in 1999. Recommendations to stimulate further research and expand and strengthen the quality of the evidence base are described. The introduction concludes with implications from the special issue for pediatric psychology training in evidence-based practice. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Implementing Evidence-Based Practices for People With Schizophrenia

    Science.gov (United States)

    Drake, Robert E.; Bond, Gary R.; Essock, Susan M.

    2009-01-01

    Over the last decade, a consensus has emerged regarding a set of evidence-based practices for schizophrenia that address symptom management and psychosocial functioning. Yet, surveys suggest that the great majority of the population of individuals with schizophrenia do not receive evidence-based care. In this article, we review the empirical literature on implementation of evidence-based practices for schizophrenia patients. We first examine lessons learned from implementation studies in general medicine. We then summarize the implementation literature specific to schizophrenia, including medication practices, psychosocial interventions, information technology, and state- and federal-level interventions. We conclude with recommendations for future directions. PMID:19491315

  19. Organizational change tactics: the evidence base in the literature.

    Science.gov (United States)

    Packard, Thomas; Shih, Amber

    2014-01-01

    Planned organizational change processes can be used to address the many challenges facing human service organizations (HSOs) and improve organizational outcomes. There is massive literature on organizational change, ranging from popular management books to academic research on specific aspects of change. Regarding HSOs, there is a growing literature, including increasing attention to implementation science and evidence-based practices. However, research which offers generalizable, evidence-based guidelines for implementing change is not common. The purpose of the authors was to assess the evidence base in this organizational change literature to lay the groundwork for more systematic knowledge development in this important field.

  20. Fast-track Orthognathic Surgery: An Evidence-based Review

    Science.gov (United States)

    Otero, Joel Joshi; Detriche, Olivier; Mommaerts, Maurice Yves

    2017-01-01

    The aim of this study was to establish a fast-track protocol for bimaxillary orthognathic surgery (OGS). Fast-track surgery (FTS) is a multidisciplinary approach where the pre-, intra-, and postoperative management is focusing maximally on a quick patient recovery and early discharge. To enable this, the patients’ presurgical stress and postsurgical discomfort should be maximally reduced. Both referral patterns and expenses within the health-care system are positively influenced by FTS. University hospital-literature review through Medline, Embase, and the Cochrane Library (January 2000–July 2016) using the following words – “fast track, enhanced recovery, multimodal, and perioperative care” – to define a protocol evidence based for OGS, as well as evidenced-based medicine search of every term added to the protocol during the same period. The process has resulted in an OGS protocol that may improve the outcome of the patient through several nonoperative and operative measures such as preoperative patient education and intra/postoperative measures that should improve overall patient satisfaction, decrease morbidity such as postoperative nausea, headache, dizziness, pain, and intubation discomfort, and shorten hospital stay. A literature review allowed us to fine-tune a fast-track protocol for uncomplicated OGS that can be prospectively studied against currently applied ones. PMID:29264281