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. (United States)

    Hegerl, Ulrich; Wittenburg, Lisa; Arensman, Ella; Van Audenhove, Chantal; Coyne, James C; McDaid, David; van der Feltz-Cornelis, Christina M; Gusmão, Ricardo; Kopp, Mária; Maxwell, Margaret; Meise, Ullrich; Roskar, Saska; Sarchiapone, Marco; Schmidtke, Armin; Värnik, Airi; Bramesfeld, Anke


    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. 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. This multi-centre research seeks to overcome major challenges of field research in suicide

  2. Optimizing Suicide Prevention Programs and Their Implementation in Europe (OSPI Europe: an evidence-based multi-level approach

    Directory of Open Access Journals (Sweden)

    Maxwell Margaret


    Full Text Available 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

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

    LENUS (Irish Health Repository)

    Hegerl, Ulrich


    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

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

    LENUS (Irish Health Repository)

    Hegerl, Ulrich


    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

  5. Model approach brings multi-level success. (United States)

    Howell, Mark


    n an article that first appeared in US magazine, Medical Construction & Design, Mark Howell, senior vice-president of Skanska USA Building, based in Seattle, describes the design and construction of a new nine-storey, 350,000 ft2 extension to the Good Samaritan Hospital in Puyallup, Washington state. He explains how the use of an Integrated Project Delivery (IPD) approach by the key players, and extensive use of building information modelling (BIM), combined to deliver a healthcare facility that he believes should meet the needs of patients, families, and the clinical care team, 'well into the future'.

  6. A multi-level approach to flood frequency regionalisation

    Directory of Open Access Journals (Sweden)

    C. De Michele


    Full Text Available A multi-level approach to flood frequency regionalisation is given. Based on observed flood data, it combines physical and statistical criteria to cluster homogeneous groups in a geographical area. Seasonality analysis helps identify catchments with a common flood generation mechanism. Scale invariance of annual maximum flood, as parameterised by basin area, is used to check the regional homogeneity of flood peaks. Homogeneity tests are used to assess the statistical robustness of the regions. The approach is based on the appropriate use of the index flood method (Dalrymple, 1960 in regions with complex climate and topography controls. An application to north-western Italy is presented. Keywords: homogeneity, multi-level approach, regionalisation, seasonality, scale invariance, similarity, tests

  7. Multi-level approach for parametric roll analysis

    Directory of Open Access Journals (Sweden)

    Taeyoung Kim


    Full Text Available 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.

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

    Directory of Open Access Journals (Sweden)

    Ritu Gupta


    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.

  9. A RE-AIM evaluation of evidence-based multi-level interventions to improve obesity-related behaviours in adults: a systematic review (the SPOTLIGHT project)

    NARCIS (Netherlands)

    Compernolle, S.; De Cocker, K.; Lakerveld, J.; Mackenbach, J.D.; Nijpels, G.; Oppert, J.M.; Rutter, H.; Teixeira, P.J.; Cardon, G.; de Bourdeaudhuij, I.


    This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework. Methods: Electronic databases (PubMed,

  10. Creative teaching an evidence-based approach

    CERN Document Server

    Sale, Dennis


    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...

  11. A Multi-Level Approach to Outreach for Geologic Sequestration Projects (United States)

    Greenberg, S.E.; Leetaru, H.E.; Krapac, I.G.; Hnottavange-Telleen, K.; Finley, R.J.


    Public perception of carbon capture and sequestration (CCS) projects represents a potential barrier to commercialization. Outreach to stakeholders at the local, regional, and national level is needed to create familiarity with and potential acceptance of CCS projects. This paper highlights the Midwest Geological Sequestration Consortium (MGSC) multi-level outreach approach which interacts with multiple stakeholders. The MGSC approach focuses on external and internal communication. External communication has resulted in building regional public understanding of CCS. Internal communication, through a project Risk Assessment process, has resulted in enhanced team communication and preparation of team members for outreach roles. ?? 2009 Elsevier Ltd. All rights reserved.

  12. The ethical approach to evidence-based medicine

    African Journals Online (AJOL)

    Evidence-based medicine has had a major impact on health care in the last 30 years. This approach has lead to the critical appraisal of therapeutic knowledge. Archie Cochrane, an epidemiologist, gave a series of lectures in 1972 regarding his reflections on the effectiveness and efficiency of health services.1 He ...

  13. Multi-level and multi-scale integrative approach to the understanding of human blastocyst implantation. (United States)

    Sengupta, Jayasree; Ghosh, Debabrata


    Implantation is a complex process which results in fixation of zona pellucida free blastocyst to the maternal uterine endometrium. In the human, it involves progesterone mediated preparation of endometrium, age- and stage-matched development of pre-implantation embryo, and interaction between embryo and endometrium. In the present essay, we present the case to explain why there is a necessity of undertaking multi-level, multi-scale integrative approach to deconstruct the succession process of endometrial development to the climax of implantation. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. An evidence-based approach to human dermatomes. (United States)

    Lee, M W L; McPhee, R W; Stringer, M D


    The dermatome is a fundamental concept in human anatomy and of major importance in clinical practice. There are significant variations in current dermatome maps in standard anatomy texts. The aim of this study was to undertake a systematic literature review of the available evidence for the distribution of human dermatomes. Particular emphasis was placed on the technique of ascertainment, the location and extent of each dermatome, the number of subjects studied, and methodologic limitations. Our findings demonstrate that current dermatome maps are inaccurate and based on flawed studies. After selecting the best available evidence, a novel evidence-based dermatome map was constructed. This represents the most consistent tactile dermatomal areas for each spinal dorsal nerve root found in most individuals. In addition to highlighting the orderly arrangement, areas of consistency and clinical usefulness of dermatomes, their overlap and variability deserve greater emphasis. This review demonstrates the validity of an evidence-based approach to an anatomical concept.

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

    DEFF Research Database (Denmark)

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


    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....

  16. Exploring the impact of different multi-level measures of physician communities in patient-centric care networks on healthcare outcomes: A multi-level regression approach

    National Research Council Canada - National Science Library

    Uddin, Shahadat


    .... In order to assess the impact different multi-level attributes of patient-centric care networks on healthcare outcomes, this study first captured patient-centric care networks for 85 hospitals using...


    Directory of Open Access Journals (Sweden)

    J. O. Macaulay


    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.

  18. 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)


    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.


    Directory of Open Access Journals (Sweden)

    Mohd Fo'ad Rohani


    Full Text Available 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. The proposed method has been tested with real Internet traffic simulation dataset. The results demonstrate that normal traces have probability of LoSS detection below the threshold at all sampling levels. Meanwhile, false positive detection can occur where abnormal traces have probability of LoSS that imitates normal behavior at sampling levels below 100ms. However, the LoSS probability exceeds the threshold at sampling levels larger than 100ms. Our results show the possibility of detecting anomaly traffic behavior based on obtaining continuous LoSS detection monitoring

  20. A Learning Object Approach To Evidence based learning

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    Zabin Visram


    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

  1. 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.

  2. Evidence based medicine, an innovative approach to an old practice ...

    African Journals Online (AJOL)

    Evidence-based medicine (EBM) is a rapidly expanding subject. The aim of this editorial is to give an overview and address some of the practical issues relevant to the developing world. EBM may be defined as the conscientious, explicit and judicious use of current best evidence in making decisions about the care of ...

  3. 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...

  4. Partners in Parenting: A Multi-Level Web-Based Approach to Support Parents in Prevention and Early Intervention for Adolescent Depression and Anxiety (United States)

    Lawrence, Katherine A; Rapee, Ronald M; Cardamone-Breen, Mairead C; Green, Jacqueline; Jorm, Anthony F


    Depression and anxiety disorders in young people are a global health concern. Various risk and protective factors for these disorders are potentially modifiable by parents, underscoring the important role parents play in reducing the risk and impact of these disorders in their adolescent children. However, cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. In this paper, we propose a multi-level public health approach involving a Web-based parenting intervention, Partners in Parenting (PIP). We describe the components of the Web-based intervention and how each component was developed. Development of the intervention was guided by principles of the persuasive systems design model to maximize parental engagement and adherence. A consumer-engagement approach was used, including consultation with parents and adolescents about the content and presentation of the intervention. The PIP intervention can be used at varying levels of intensity to tailor to the different needs of parents across the population. Challenges and opportunities for the use of the intervention are discussed. The PIP Web-based intervention was developed to address the dearth of evidence-based resources to support parents in their important role in their adolescents’ mental health. The proposed public health approach utilizes this intervention at varying levels of intensity based on parents’ needs. Evaluation of each separate level of the model is ongoing. Further evaluation of the whole approach is required to assess the utility of the intervention as a public health approach, as well as its broader effects on adolescent functioning and socioeconomic outcomes. PMID:29258974

  5. Considering a multi-level approach to understanding maintenance of global coherence in adults with aphasia. (United States)

    Wright, Heather Harris; Capilouto, Gilson J


    BACKGROUND: Discourse is a naturally occurring, dynamic form of communication. Coherence is one aspect of discourse and is a reflection of the listener's ability to interpret the overall meaning conveyed by the speaker. Adults with aphasia may present with impaired maintenance of global coherence, which, in turn, may contribute to their difficulties in overall communicative competence. AIMS: The aim of the study was to determine if microlinguistic processes contribute to maintenance of global coherence in adults with and without aphasia. METHOD AND PROCEDURES: Participants included 15 adults with aphasia (PWA) and 15 healthy controls (HC). Study participants told stories conveyed in wordless picture books. The discourse samples were transcribed and then analyzed for percent of information units produced, lexical diversity, syntactic complexity, and maintenance of global coherence. OUTCOMES AND RESULTS: Several linear regression models were carried out to investigate the relationship among the microlinguistic and macrolinguistic measures. For the control group, percent of information units conveyed was a significant predictor of maintenance of global coherence for stories told. For the aphasia group, percent of information units conveyed and lexical diversity were significant predictors of maintenance of global coherence for stories told. CONCLUSIONS: Results indicated that microlinguistic processes contribute to the maintenance of global coherence in stories told by adults with aphasia. These findings have important clinical implications for using a multi-level discourse model for analyzing discourse ability in adults with aphasia and measuring individual response to treatment.

  6. 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.

  7. Developing expert medical teams: toward an evidence-based approach. (United States)

    Fernandez, Rosemarie; Vozenilek, John A; Hegarty, Cullen B; Motola, Ivette; Reznek, Martin; Phrampus, Paul E; Kozlowski, Steve W J


    Current health care literature cites communication breakdown and teamwork failures as primary threats to patient safety. The unique, dynamic environment of the emergency department (ED) and the complexity of patient care necessitate the development of strong interdisciplinary team skills among emergency personnel. As part of the 2008 Academic Emergency Medicine Consensus Conference on "The Science of Simulation in Healthcare," our workshop group identified key theory and evidence-based recommendations for the design and implementation of team training programs. The authors then conducted an extensive review of the team training literature within the domains of organizational psychology, aviation, military, management, and health care. This review, in combination with the workshop session, formed the basis for recommendations and need for further research in six key areas: 1) developing and refining core competencies for emergency medicine (EM) teams; 2) leadership training for emergency physicians (EPs); 3) conducting comprehensive needs analyses at the organizational, personnel, and task levels; 4) development of training platforms to maximize knowledge transfer; 5) debriefing and provision of feedback; and 6) proper implementation of simulation technology. The authors believe that these six areas should form an EM team training research platform to advance the EM literature, while leveraging the unique team structures present in EM to expand team training theory and research.

  8. An approach on defining competency in evidence-based dentistry. (United States)

    Marshall, T A; Straub-Morarend, C L; Guzman-Armstrong, S; McKernan, S C; Marchini, L; Handoo, N Q; Cunningham, M A


    Assessment of evidence-based dentistry (EBD) knowledge and behaviour is hampered by lack of explicit competency criteria. This void impedes instructional design and assessment of student growth during the educational process. Knowledge and cognitive domains supporting educational objectives in a pre-doctoral dental programme were identified for each level of the EBD five-step process. We articulated educational objectives with behavioural expectations for each level of skill acquisition at each step of the EBD process. Outcome evaluation criteria identify students' progressive level of skill acquisition from novice to expert. The educational objectives, type of knowledge, and nature of the cognitive process supporting these objectives are presented for each step of the EBD process. For example, educational objectives of the "Ask" step include (i) to construct a question from the patient presentation and knowledge limitations that addresses the clinical problem and (ii) to articulate the Problem, Intervention/Exposure, Comparison, Outcome (PICO) components. Achievement of these objectives requires both factual information regarding the PICO format and the cognitive process of understanding. Educational outcome criteria consistent with a competent clinician include clear articulation of the PICO with identifiable pieces that relate to the clinical situation. Assessment strategies for progression towards EBD competency are limited due to the complexity associated with evaluating EBD knowledge and behaviours. To evaluate performance, the EBD academic community must define competency expectations for entry into unsupervised general dental practice. This framework offers measurable outcome evaluation criteria to initiate a conversation with academic peers regarding current gaps in EBD assessment. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. A marketing perspective on disseminating evidence-based approaches to disease prevention and health promotion. (United States)

    Maibach, Edward W; Van Duyn, Mary Ann S; Bloodgood, Bonny


    Evidence-based disease prevention practice guidelines can provide a rationale for health programming decisions, which should, in turn, lead to improved public health outcomes. This logic has stimulated the creation of a growing number of evidence-based prevention practice guidelines, including the Guide to Community Preventive Services. Few systematic efforts have been made to document the degree of adoption and implementation of these approaches, although the evidence on translation of research into practice in other health fields indicates that the adoption and implementation rate is low. Drawing on the marketing literature, we suggest three approaches to enhance the adoption and implementation of evidence-based approaches: 1) conducting consumer research with prospective adopters to identify their perspectives on how evidence-based prevention programs can advance their organization's mission, 2) building sustainable distribution channels to promote and deliver evidence-based programs to prospective adopters, and 3) improving access to easily implemented programs that are consistent with evidence-based guidelines. Newly emerging paradigms of prevention research (e.g., RE-AIM) that are more attuned to the needs of the marketplace will likely yield a new generation of evidence-based preventive approaches that can be more effectively disseminated. We suggest that the public health community prioritize the dissemination of evidence-based prevention approaches, because doing so is a potent environmental change strategy for enhancing health.

  10. Management of thyroid nodules: a clinicopathological, evidence-based approach

    Energy Technology Data Exchange (ETDEWEB)

    Pacini, Furio; Ciuoli, Cristina; Di Cairano, Giovanni; Guarino, Elisa [University of Siena, Section of Endocrinology and Metabolism, Siena (Italy); Burroni, Luca [University of Siena, Nuclear Medicine Unit, Siena (Italy)


    Management of thyroid nodules is one of the most controversial issues in thyroidology. Different approaches derive from geographical variation in presentation, inadequate or incomplete clinical diagnosis, lack of prospective controlled studies and, frequently, the different cultural backgrounds of physicians. This review aims to offer a practical approach to the management of nodular thyroid disorders, considering the way in which the pathophysiology of the disease provides clues to the correct clinical diagnosis and therapy. (orig.)

  11. Evidence-Based Medicine Approach to Abdominal Pain. (United States)

    Natesan, Sreeja; Lee, Jerry; Volkamer, Heather; Thoureen, Traci


    The chief complaint of abdominal pain accounts for 5% to 10% of all presentations in the emergency department. With such broad differential and diagnostic modalities available, this article focuses on a systematic approach to evaluating abdominal pain, essential to providing patients with efficient and accurate care. Published by Elsevier Inc.

  12. Method in computer ethics: Towards a multi-level interdisciplinary approach

    NARCIS (Netherlands)

    Brey, Philip A.E.


    This essay considers methodological aspects ofcomputer ethics and argues for a multi-levelinterdisciplinary approach with a central role forwhat is called disclosive computer ethics. Disclosivecomputer ethics is concerned with the moraldeciphering of embedded values and norms in computersystems,

  13. Prescribing menopausal hormone therapy: an evidence-based approach

    Directory of Open Access Journals (Sweden)

    Sood R


    within 10 years of onset of natural menopause, MHT for the treatment of bothersome menopausal symptoms poses low risk and is an acceptable option, particularly when nonhormonal management approaches fail. Keywords: hormone therapy, hot flash, flush, menopause

  14. 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.

  15. 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.


    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)

  16. Transport-related lifestyle and environmentally-friendly travel mode choices: A multi-level approach

    DEFF Research Database (Denmark)

    Thøgersen, John


    This paper introduces a deductive cognitive approach to, and a new instrument for measuring, transport-related lifestyle (TRL) and presents a first application of the instrument for identifying national and cross-national transport-related lifestyle segments based on a survey (N = 3216) in 10...... European countries. Principal component analysis is used to reduce the TRL instrument’s 69 items to 18 dimensions within five lifestyle components. Based on multi-group confirmatory factor analysis, it is found that the instrument possesses metric, but not scalar (measurement) invariance across the 10....... Finally, a multivariate GLM analysis reveals that three behavioral tendencies of importance for transport-related environmental impacts vary significantly and substantially between lifestyle segments: vehicle ownership, everyday travel-mode choice and environmentally-friendly transport innovativeness...

  17. Group personality during collective decision-making: a multi-level approach. (United States)

    Planas-Sitjà, Isaac; Deneubourg, Jean-Louis; Gibon, Céline; Sempo, Grégory


    Collective decision-making processes emerge from social feedback networks within a group. Many studies on collective behaviour underestimate the role of individual personality and, as a result, personality is rarely analysed in the context of collective dynamics. Here, we show evidence of sheltering behaviour personality in a gregarious insect (Periplaneta americana), which is characterized by a collective personality at the group level. We also highlight that the individuals within groups exhibited consistent personality traits in their probability of sheltering and total time sheltered during the three trials over one week. Moreover, the group personality, which arises from the synergy between the distribution of behaviour profiles in the group and social amplifications, affected the sheltering dynamics. However, owing to its robustness, personality did not affect the group probability of reaching a consensus. Finally, to prove social interactions, we developed a new statistical method that will be helpful for future research on personality traits and group behaviour. This approach will help to identify the circumstances under which particular group compositions may improve the fitness of individuals in gregarious species. © 2015 The Author(s) Published by the Royal Society. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Alina CIOMOŞ


    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.

  19. A Clinician's Quick Guide of Evidence-Based Approaches Number 2: Depression (United States)

    Moulds, Michelle L.; Werner-Seidler, Aliza; Dalgleish, Tim


    This quick guide presents resources for clinicians on evidence-based approaches for assessing and treating depression. It also briefly describes the mood disorder module of the clinician administered Structured Clinical Interview for DSM-IV Axis I Disorders, treatment approaches, and new and emerging developments demonstrating the effectiveness of…

  20. Quiet in the Library: An Evidence-Based Approach to Improving the Student Experience (United States)

    McCaffrey, Ciara; Breen, Michelle


    This article deals with the management of noise in an academic library by outlining an evidence-based approach taken over seven years by the University of Limerick in the Republic of Ireland. The objective of this study was to measure the impact on library users of noise management interventions implemented from 2007 to 2014 through retrospective…

  1. Guidance for Schools Selecting Antibullying Approaches: Translating Evidence-Based Strategies to Contemporary Implementation Realities (United States)

    Ansary, Nadia S.; Elias, Maurice J.; Greene, Michael B.; Green, Stuart


    This article synthesizes the current research on bullying prevention and intervention in order to provide guidance to schools seeking to select and implement antibullying strategies. Evidence-based best practices that are shared across generally effective antibullying approaches are elucidated, and these strategies are grounded in examples…

  2. State of the science on implant dentistry: a workshop developed using an evidence-based approach. (United States)

    Iacono, Vincent J; Cochran, David L


    This overview was prepared to describe how an evidence-based approach was used to develop an Academy of Osseointegration (AO) Workshop on the State of the Science on Implant Dentistry (SSID). An AO SSID Workshop Planning Committee was appointed in 2001 to follow an evidence-based approach for reviewing published clinical data using strict inclusion and exclusion criteria in order to answer 8 closed-end 4-part clinical questions. A systematic approach was employed to assure coherent data management and analysis. Reviewers, co-reviewers, and a biostatistician were appointed. The workshop agenda was developed to include participants who had the primary responsibility for each of the 8 workshop sections to answer 5 consensus questions for the section's systematic review. The planned outcomes of the SSID Workshop included publication of the 8 consensus reports with their respective systematic reviews in The International Journal of Oral & Maxillofacial Implants (supplemental issue), 2007; the development of clinical guidelines responding to each of the 8 focused questions; and the identification and prioritization of questions or topics requiring further research. The evidence-based approach was utilized successfully in planning and carrying out the AO SSID Workshop held on August 3-6, 2006, in Oak Brook, Illinois, and the subsequent publication of its proceedings. Although successful in its objectives, the outcome of systematic reviews is only as good as the published data. Significant deficiencies in published implant studies were identified, including, but not limited to, a lack of randomized controlled prospective clinical trials, universal acceptance and publication of defined implant survival and success criteria, and clear questions with well-defined research design. The evidence-based approach can be used to systematically review the literature for a workshop on important questions related to implant dentistry. A major limitation is the lack of common outcome

  3. The use of the evidence-based approach in a periodontal therapy contemporary science workshop. (United States)

    Newman, Michael G; Caton, Jack G; Gunsolley, John C


    When appropriately evaluated and carefully managed, the integration of emerging technology into practice can improve health and enhance the quality of life. Since the last American Academy of Periodontology Workshop in 1996, great technological advances in the areas of data access, retrieval, and management have been made. The World Wide Web has "exploded" with great possibilities for gathering data from many sources. Evaluation methods such as meta-analysis and modeling have likewise improved, permitting a more objective and useful assessment of the retrieved information. The purpose of this paper is to demonstrate how the evidence-based (EB) approach was used to plan and implement a consensus conference on periodontal therapy, the Workshop on Contemporary Science in Clinical Periodontics. The methodologies and philosophies associated with the EB approach provided the ideal framework for assessing the applicability of the newest clinical research to patient therapy. Evidence-based systematic reviews on 15 topics associated with contemporary clinical periodontal practice were conducted prior to the Workshop. High standards of scientific rigor and scholarly ideals were stressed throughout the process. At the highly structured conference the reviews served as the basis for development of consensus reports that include implications for practice and research. MATERIAL COVERED: 1. The rationale, design, and implementation of a conference on contemporary clinical periodontics using an evidence-based approach. 2. Data management, clinical versus statistical significance, and the challenges of technology transfer and dissemination. 3. The benefits and limitations of using the EB approach in a consensus conference. The consensus statements resulting from the conference should serve to augment clinical decision-making, research priorities, education, and reimbursement. The evidence-based approach removed much of the subjectivity traditionally associated with classical

  4. An Evidence-Based Medicine Approach to Antihyperglycemic Therapy in Diabetes Mellitus to Overcome Overtreatment. (United States)

    Makam, Anil N; Nguyen, Oanh K


    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.

  5. Testing use of payers to facilitate evidence-based practice adoption: protocol for a cluster-randomized trial

    National Research Council Canada - National Science Library

    Molfenter, Todd; Kim, Jee-Seon; Quanbeck, Andrew; Patel-Porter, Terry; Starr, Sandy; McCarty, Dennis


    .... The Advancing Recovery Framework offers a multi-level approach to evidence-based practice implementation by aligning purchasing and regulatory policies at the payer level with organizational change...

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


    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.

  7. Analysis of narrative functionality: toward evidence-based approaches in managed care settings. (United States)

    Olness, Gloria Streit; Gyger, Jennifer; Thomas, Kathy


    The advent of managed health care has challenged rehabilitation professionals to guide their clients toward functionally meaningful outcomes in the least amount of time possible and to justify the evidence base for their intervention approaches. The ability to relate personal narratives in everyday contexts lies at the core of communicative functionality, but feasible clinical assessment of narrative has proven elusive. The purpose of this article is to offer an evidence-based framework for guiding assessments of the personal narratives of adults with aphasia, within a managed care model of service delivery. A literature-based model of narrative functionality is proposed, and a targeted set of criterion-referenced measures and behavioral observations derived from this model are suggested as potential metrics of narrative functionality. The authors do not intend to prescribe exact methods of narrative evaluation, but rather to suggest possible directions for professionals to develop evidence-based clinical narrative analysis tailored to the functional assessment needs of their clients across a variety of service settings. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. 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]. (United States)


    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.

  9. Using an interdisciplinary approach to identify factors that affect clinicians' compliance with evidence-based guidelines. (United States)

    Gurses, Ayse P; Marsteller, Jill A; Ozok, A Ant; Xiao, Yan; Owens, Sharon; Pronovost, Peter J


    Our objective was to identify factors that affect clinicians' compliance with the evidence-based guidelines using an interdisciplinary approach and develop a conceptual framework that can provide a comprehensive and practical guide for designing effective interventions. A literature review and a brainstorming session with 11 researchers from a variety of scientific disciplines were used to identify theoretical and conceptual models describing clinicians' guideline compliance. MEDLINE, EMBASE, CINAHL, and the bibliographies of the papers identified were used as data sources for identifying the relevant theoretical and conceptual models. Thirteen different models that originated from various disciplines including medicine, rural sociology, psychology, human factors and systems engineering, organizational management, marketing, and health education were identified. Four main categories of factors that affect compliance emerged from our analysis: clinician characteristics, guideline characteristics, system characteristics, and implementation characteristics. Based on these findings, we developed an interdisciplinary conceptual framework that specifies the expected interrelationships among these four categories of factors and their impact on clinicians' compliance. An interdisciplinary approach is needed to improve clinicians' compliance with evidence-based guidelines. The conceptual framework from this research can provide a comprehensive and systematic guide to identify barriers to guideline compliance and design effective interventions to improve patient safety.

  10. An evidence-based approach to clinical questions in the practice of equine neurology. (United States)

    Van Biervliet, Jérôme


    The practice of equine neurology has special challenges posed by the size of the animal being examined. Many diagnostic procedures routinely used in small animal practice are unsafe when applied to the equine patient or unavailable to the equine practitioner. Therefore, astute observation is the mainstay of making a neuroanatomic diagnosis, and detailed evidence on the deficits present may be difficult to obtain. Because clinical observation can sometimes be ambiguous and somewhat subjective, it is even more important to approach equine neurology from an evidence-based point of view. Here, such an approach is outlined for the diagnosis of cervical vertebral compressive myelopathy (CVCM), one of the most common noninfectious causes of equine neurologic disease. This article is an attempt to summarize all aspects of making a diagnosis of CVCM on the basis of signalment, clinical examination, ancillary diagnostic tests, and pathologic examination. Each of these considerations has inherent limitations regarding diagnostic accuracy, which are discussed.

  11. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. (United States)

    Gibson, Peter R; Shepherd, Susan J


    Functional gastrointestinal symptoms are common and their management is often a difficult clinical problem. The link between food intake and symptom induction is recognized. This review aims to describe the evidence base for restricting rapidly fermentable, short-chain carbohydrates (FODMAPs) in controlling such symptoms. The nature of FODMAPs, their mode of action in symptom induction, results of clinical trials and the implementation of the diet are described. FODMAPs are widespread in the diet and comprise a monosaccharide (fructose), a disaccharide (lactose), oligosaccharides (fructans and galactans), and polyols. Their ingestion increases delivery of readily fermentable substrate and water to the distal small intestine and proximal colon, which are likely to induce luminal distension and induction of functional gut symptoms. The restriction of their intake globally (as opposed to individually) reduces functional gut symptoms, an effect that is durable and can be reversed by their reintroduction into the diet (as shown by a randomized placebo-controlled trial). The diet has a high compliance rate. However it requires expert delivery by a dietitian trained in the diet. Breath hydrogen tests are useful to identify individuals who can completely absorb a load of fructose and lactose so that dietary restriction can be less stringent. The low FODMAP diet provides an effective approach to the management of patients with functional gut symptoms. The evidence base is now sufficiently strong to recommend its widespread application.

  12. The diagnosis and management of inhalation injury: An evidence based approach. (United States)

    Deutsch, C J; Tan, A; Smailes, S; Dziewulski, P


    Smoke inhalation injury (II) is an independent risk factor for mortality in burns and its management is inherently complex. We aim to make recommendations for best practice in managing II and its sequelae by reviewing all available current evidence in order to provide an evidence-based approach. We conducted a systematic search of the Cochrane database and Embase using PRISMA guidelines with no patient population exclusion criteria. Published work was reviewed and evidence levels graded. We identified 521 abstracts for inclusion. Of the 84 articles identified for secondary review, 28 papers were excluded leaving 56 papers suitable for final inclusion. We are able to identify a number of strategies in both diagnosis and treatment of II that have support in the published literature, including the role of bronchoscopy, permissive hypercapnia, nebulized heparin and hydroxycobalamin. Other strategies have not been shown to be harmful, but their efficacy is also not firmly established, such as high frequency oscillatory ventilation and exogenous surfactant. Prophylactic antibiotics and corticosteroids are not recommended. In general, published evidence for II is mostly Level 3 or below, due to a noticeable lack of large-scale human studies. This represents a challenge for evidence-based burns practice as a whole. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

  13. Connecting diverse knowledge systems for enhanced ecosystem governance: the multiple evidence base approach. (United States)

    Tengö, Maria; Brondizio, Eduardo S; Elmqvist, Thomas; Malmer, Pernilla; Spierenburg, Marja


    Indigenous and local knowledge systems as well as practitioners' knowledge can provide valid and useful knowledge to enhance our understanding of governance of biodiversity and ecosystems for human well-being. There is, therefore, a great need within emerging global assessment programs, such as the IPBES and other international efforts, to develop functioning mechanisms for legitimate, transparent, and constructive ways of creating synergies across knowledge systems. We present the multiple evidence base (MEB) as an approach that proposes parallels whereby indigenous, local and scientific knowledge systems are viewed to generate different manifestations of knowledge, which can generate new insights and innovations through complementarities. MEB emphasizes that evaluation of knowledge occurs primarily within rather than across knowledge systems. MEB on a particular issue creates an enriched picture of understanding, for triangulation and joint assessment of knowledge, and a starting point for further knowledge generation.

  14. American Society for Microbiology resources in support of an evidence-based approach to teaching microbiology. (United States)

    Merkel, Susan M


    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:

  15. Adopting a blended learning approach to teaching evidence based medicine: a mixed methods study. (United States)

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


    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.

  16. Adopting a blended learning approach to teaching evidence based medicine: a mixed methods study (United States)


    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

  17. Can colonoscopy diagnose transmural ischaemic colitis after abdominal aortic surgery? An evidence-based approach

    DEFF Research Database (Denmark)

    Houe, T; Thorböll, J E; Sigild, U


    to assess the diagnostic value of colonoscopy in ischaemic colitis following abdominal aortic surgery, based on a literature review, and to introduce the concept of evidence-based assess the diagnostic value of colonoscopy in ischaemic colitis following abdominal aortic surgery, based on a literature review, and to introduce the concept of evidence-based medicine....

  18. Evidence-Based Practice for Teachers of Children with Autism: A Dynamic Approach (United States)

    Lubas, Margaret; Mitchell, Jennifer; De Leo, Gianluca


    Evidence-based practice related to autism research is a controversial topic. Governmental entities and national agencies are defining evidence-based practice as a specific set of interventions that educators should implement; however, large-scale efforts to generalize autism research, which are often single-subject case designs, may be a setback…

  19. Multi-Level Semiosis

    DEFF Research Database (Denmark)

    Bruni, Luis Emilio; Giorgi, Franco


    the importance of this fundamental difference in order to explain how levels, domains and orders of magnitude, on one hand, and synchronic and diachronic processes, on the other, contribute to the overall organization of every living being. To account for such multi-level organization, semiotic freedom...... is assumed to be a scalar property that endows living systems at different levels and domains with the capacity to ponder selectively the overall structural coherence and functional compatibility of their heterarchical processing, which is increasingly less conditioned by the underlying molecular determinism....

  20. A supervised approach to quantifying sentence similarity: with application to evidence based medicine.

    Directory of Open Access Journals (Sweden)

    Hamed Hassanzadeh

    Full Text Available Following the Evidence Based Medicine (EBM practice, practitioners make use of the existing evidence to make therapeutic decisions. This evidence, in the form of scientific statements, is usually found in scholarly publications such as randomised control trials and systematic reviews. However, finding such information in the overwhelming amount of published material is particularly challenging. Approaches have been proposed to automatically extract scientific artefacts in EBM using standardised schemas. Our work takes this stream a step forward and looks into consolidating extracted artefacts-i.e., quantifying their degree of similarity based on the assumption that they carry the same rhetorical role. By semantically connecting key statements in the literature of EBM, practitioners are not only able to find available evidence more easily, but also can track the effects of different treatments/outcomes in a number of related studies. We devise a regression model based on a varied set of features and evaluate it both on a general English corpus (the SICK corpus, as well as on an EBM corpus (the NICTA-PIBOSO corpus. Experimental results show that our approach performs on par with the state of the art on the general English and achieves encouraging results on the biomedical text when compared against human judgement.

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

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


    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. Aligning the flow cytometric evaluation with the diagnostic need: an evidence-based approach. (United States)

    Williams-Voorbeijpel, Dawn; Sanchez, Francisco; Roth, Christine G


    Elimination of non-value added testing without compromising high-quality clinical care is an important mandate for laboratories in a value-based reimbursement system. The goal of this study was to determine the optimal combination of flow cytometric markers for a screening approach that balances efficiency and accuracy. An audit over 9 months of flow cytometric testing was performed, including rereview of all dot plots from positive cases. Of the 807 cases in which leukaemia/lymphoma testing was performed, 23 were non-diagnostic and 189 represented bronchoalveolar lavage specimens. Of the remaining 595 cases, 137 (23%) were positive for an abnormal haematolymphoid population. Review of the positive cases identified minimum requirements for a screening tube as well as analysis strategies to overcome the diagnostic pitfalls noted. It is estimated that 38% fewer antibodies would be used in a screening approach, representing an opportunity for significant cost savings. We provide a framework for developing an evidence-based screening combination for cost-effective characterisation of haematolymphoid malignancies, promoting adoption of 'just-in-time' testing systems that tailor the evaluation to the diagnostic need. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  3. New Evidence-Based Treatment Approach in Behçet's Disease

    Directory of Open Access Journals (Sweden)

    Erkan Alpsoy


    Full Text Available Behçet's disease (BD is a chronic, relapsing, and debilitating systemic vasculitis of unknown aetiology with the clinical features of mucocutaneous lesions, ocular, vascular, articular, neurologic, gastrointestinal, urogenital, and pulmonary involvement. The disease is much more frequent along the ancient “Silk Route” extending from Eastern Asia to the Mediterranean basin, compared with Western countries. The disease usually starts around the third or fourth decade of life. Male sex and a younger age of onset are associated with more severe disease. Although the treatment has become much more effective in recent years, BD is still associated with severe morbidity and considerable mortality. The main aim of the treatment should be the prevention of irreversible organ damage. Therefore, close monitoring, early, and appropriate treatment is mandatory to reduce morbidity and mortality. The treatment is mainly based on the suppression of inflammatory attacks of the disease using immunomodulatory and immunosuppressive agents. In this paper, current state of knowledge regarding the therapeutic approaches is outlined. To provide a rational framework for selecting the appropriate therapy along the various treatment choices, a stepwise, symptom-based, evidence-based algorithmic approach was developed.

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

    DEFF Research Database (Denmark)

    Herrmann, Kim Jesper


    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...

  5. 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


    . 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...

  6. Characterization of post-traumatic stress disorder using resting-state fMRI with a multi-level parametric classification approach. (United States)

    Liu, Feng; Xie, Bing; Wang, Yifeng; Guo, Wenbin; Fouche, Jean-Paul; Long, Zhiliang; Wang, Wenqin; Chen, Heng; Li, Meiling; Duan, Xujun; Zhang, Jiang; Qiu, Mingguo; Chen, Huafu


    Functional neuroimaging studies have found intra-regional activity and inter-regional connectivity alterations in patients with post-traumatic stress disorder (PTSD). However, the results of these studies are based on group-level statistics and therefore it is unclear whether PTSD can be discriminated at single-subject level, for instance using the machine learning approach. Here, we proposed a novel framework to identify PTSD using multi-level measures derived from resting-state functional MRI (fMRI). Specifically, three levels of measures were extracted as classification features: (1) regional amplitude of low-frequency fluctuations (univariate feature), which represents local spontaneous synchronous neural activity; (2) temporal functional connectivity (bivariate feature), which represents the extent of similarity of local activity between two regions, and (3) spatial functional connectivity (multivariate feature), which represents the extent of similarity of temporal correlation maps between two regions. Our method was evaluated on 20 PTSD patients and 20 demographically matched healthy controls. The experimental results showed that the features of each level could successfully discriminate PTSD patients from healthy controls. Furthermore, the combination of multi-level features using multi-kernel learning can further improve the classification performance. Specifically, the classification accuracy obtained by the proposed framework was 92.5 %, which was an increase of at least 5 and 17.5 % from the two-level and single-level feature based methods, respectively. Particularly, the limbic structure and prefrontal cortex provided the most discriminant features for classification, consistent with results reported in previous studies. Together, this study demonstrated for the first time that patients with PTSD can be identified at the individual level using resting-state fMRI data. The promising classification results indicated that this method may provide a

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

    NARCIS (Netherlands)

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


    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

  8. Challenging empowerment: AIDS-affected South African children and the need for a multi-level relational approach. (United States)

    Ansell, Nicola


    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.

  9. Optimization of automated external defibrillator deployment outdoors: An evidence-based approach. (United States)

    Dahan, Benjamin; Jabre, Patricia; Karam, Nicole; Misslin, Renaud; Bories, Marie-Cécile; Tafflet, Muriel; Bougouin, Wulfran; Jost, Daniel; Beganton, Frankie; Beal, Guillaume; Pelloux, Patricia; Marijon, Eloi; Jouven, Xavier


    The benefits of available automatic external defibrillators (AEDs) for out-of-hospital cardiac arrests (OHCAs) are well known, but strategies for their deployment outdoors remain somewhat arbitrary. Our study sought to assess different strategies for AED deployment. All OHCAs in Paris between 2000 and 2010 were prospectively recorded and geocoded. A guidelines-based strategy of placing an AED in locations where more than one OHCA had occurred within the past five years was compared to two novel strategies: a grid-based strategy with a regular distance between AEDs and a landmark-based strategy. The expected number of AEDs necessary and their median (IQR) distance to the nearest OHCA were assessed for each strategy. Of 4176 OHCAs, 1372 (33%) occurred in public settings. The first strategy would result in the placement of 170 AEDs, with a distance to OHCA of 416 (180-614) m and a continuous increase in the number of AEDS. In the second strategy, the number of AEDs and their distance to the closest OHCA would change with the grid size, with a number of AEDs between 200 and 400 seeming optimal. In the third strategy, median distances between OHCAs and AEDs would be 324m if placed at post offices (n=195), 239 at subway stations (n=302), 137 at bike-sharing stations (n=957), and 142 at pharmacies (n=1466). This study presents an original evidence-based approach to strategies of AED deployment to optimize their number and location. This rational approach can estimate the optimal number of AEDs for any city. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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

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


    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. A Multi-Level Approach to Modeling Rapidly Growing Mega-Regions as a Coupled Human-Natural System (United States)

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


    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

  12. A practical approach to a multi-level analysis with a sparse binary outcome within a large surgical trial. (United States)

    Fountain, Jayne; Gallagher, James; Brown, Julia


    To assess the potential source of variation that surgeon may add to patient outcome in a clinical trial of surgical procedures. Two large (n = 1380) parallel multicentre randomized surgical trials were undertaken to compare laparoscopically assisted hysterectomy with conventional methods of abdominal and vaginal hysterectomy; involving 43 surgeons. The primary end point of the trial was the occurrence of at least one major complication. Patients were nested within surgeons giving the data set a hierarchical structure. A total of 10% of patients had at least one major complication, that is, a sparse binary outcome variable. A linear mixed logistic regression model (with logit link function) was used to model the probability of a major complication, with surgeon fitted as a random effect. Models were fitted using the method of maximum likelihood in SAS. There were many convergence problems. These were resolved using a variety of approaches including; treating all effects as fixed for the initial model building; modelling the variance of a parameter on a logarithmic scale and centering of continuous covariates. The initial model building process indicated no significant 'type of operation' across surgeon interaction effect in either trial, the 'type of operation' term was highly significant in the abdominal trial, and the 'surgeon' term was not significant in either trial. The analysis did not find a surgeon effect but it is difficult to conclude that there was not a difference between surgeons. The statistical test may have lacked sufficient power, the variance estimates were small with large standard errors, indicating that the precision of the variance estimates may be questionable.

  13. Diagnosing Appendicitis: Evidence-Based Review of the Diagnostic Approach in 2014 (United States)

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


    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

  14. "Clinical approach to fibromyalgia: Synthesis of Evidence-based recommendations, a systematic review". (United States)

    Ángel García, Daniel; Martínez Nicolás, Ismael; Saturno Hernández, Pedro J


    Efforts have been made to standardise evidence-based practice, but clinical practice guidelines do not always follow strict development methods. The objective of this review is to identify the current guidelines, analyse the variability of its recommendations and make a synthesis for clinical practice. A systematic review of clinical practice guidelines was made in electronic databases and guidelines databases; using "fibromyalgia" AND ["guideline" OR "Clinical Practice guideline"] as terms, from January for 2003 to July of 2013. Guidelines were selected according to the following criteria: a) aimed to fibromyalgia treatment in adults; b) based on scientific evidence, systematically searched; c) evidence levels and strength of recommendation included; d) written in English or Spanish. From 249 initial results, six guides fulfilled the inclusion criteria. Clinical practice guidelines analysed in this review show great variability both in the presence and level of evidence and in the strength of recommendation of many treatments. Physical exercise and cognitive-behavioural therapy are first-line treatments, showing high level of evidence. Amitriptyline, used for short periods of time for pain control, is the pharmacologic treatment with the most solid evidence. The multimodal approach reported better results than the isolated application of any treatment. Final recommendations in this review identify optimal treatments, facilitating the translation of evidence into practice and enabling more efficient and effective quality care. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  15. Comparison of residents’ approaches to clinical decisions before and after the implementation of Evidence Based Medicine course

    Directory of Open Access Journals (Sweden)



    Full Text Available Introduction: It has been found that the decision-making process in medicine is affected, to a large extent, by one’s experience, individual mentality, previous models, and common habitual approaches, in addition to scientific principles. Evidence-based medicine is an approach attempting to reinforce scientific, systematic and critical thinking in physicians and provide the ground for optimal decision making. In this connection, the purpose of the present study is to find out to what extent the education of evidence based medicine affects clinical decision making. Methods: The present quasi-experimental study was carried out on 110 clinical residents, who started their education in September, 2012 and finally 62 residents filled out the questionnaires. The instrument used was a researchermade questionnaire containing items on four decision-making approaches. The questionnaire was used both as a pre-test and a post-test to assess the residents’ viewpoints on decision making approaches. The validity of the questionnaire was determined using medical education and clinical professionals’ viewpoints, and the reliability was calculated through Chronbach alpha; it was found to be 0.93. The results were analyzed by paired t-test using SPSS, version 14. Results: The results demonstrated that evidence-based medicine workshop significantly affected the residents’ decision-making approaches (p<0.001. The pre-test showed that principles-based, reference-based and routine model-based approaches were more preferred before the program (p<0.001. However, after the implementation of the program, the dominant approaches used by the residents in their decision making were evidence-based ones. Conclusion: To develop the evidence-based approach, it is necessary for educational programs to continue steadily and goal-orientedly. In addition, the equipment infrastructure such as the Internet, access to data bases, scientific data, and clinical guides should

  16. Why evidence-based medicine is a good approach in physical and rehabilitation medicine. Thesis. (United States)

    Negrini, S


    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.

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

    CERN Document Server

    Suchmacher, Mendel


    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

  18. 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: [Centre Saint-Laurent, Environment Canada, 105 McGill Street, Montreal, QC H2Y 2E7 (Canada); Giraudo, Maeva, E-mail: [Centre Saint-Laurent, Environment Canada, 105 McGill Street, Montreal, QC H2Y 2E7 (Canada); Douville, Mélanie, E-mail: [Centre Saint-Laurent, Environment Canada, 105 McGill Street, Montreal, QC H2Y 2E7 (Canada); Bougas, Bérénice, E-mail: [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: [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: [Canada Centre for Inland Waters, Environment Canada, 867 Lakeshore Road, P.O. Box 5050, Burlington, ON L7R 4A6 (Canada); Spencer, Christine, E-mail: [Canada Centre for Inland Waters, Environment Canada, 867 Lakeshore Road, P.O. Box 5050, Burlington, ON L7R 4A6 (Canada); Lair, Stéphane, E-mail: [Centre québécois sur la santé des animaux sauvages, Université de Montréal, C.P. 5000, St-Hyacinthe, QC J2S 7C6 (Canada); and others


    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

  19. The Delphi Method: An Approach for Facilitating Evidence Based Practice in Athletic Training (United States)

    Sandrey, Michelle A.; Bulger, Sean M.


    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,…

  20. Implementing Evidence-Based Practice Education in Social Work: A Transdisciplinary Approach (United States)

    Bellamy, Jennifer L.; Mullen, Edward J.; Satterfield, Jason M.; Newhouse, Robin P.; Ferguson, Molly; Brownson, Ross C.; Spring, Bonnie


    Evidence based practice (EBP) is reflected in social work publications, accreditation standards, research, and funding opportunities. However, implementing EBP in social work practice and education has proven challenging, highlighting the need for additional resources. This paper describes the Transdisciplinary Model of EBP, a model based on…

  1. Introducing Evidence-Based Principles to Guide Collaborative Approaches to Evaluation: Results of an Empirical Process (United States)

    Shulha, Lyn M.; Whitmore, Elizabeth; Cousins, J. Bradley; Gilbert, Nathalie; al Hudib, Hind


    This article introduces a set of evidence-based principles to guide evaluation practice in contexts where evaluation knowledge is collaboratively produced by evaluators and stakeholders. The data from this study evolved in four phases: two pilot phases exploring the desirability of developing a set of principles; an online questionnaire survey…

  2. Using pedagogical approaches to influence evidence-based practice integration - processes and recommendations: findings from a grounded theory study. (United States)

    Malik, Gulzar; McKenna, Lisa; Griffiths, Debra


    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.

  3. An Evidence-Based Approach to Differentiating the Cause of Shoulder and Cervical Spine Pain. (United States)

    Bokshan, Steven L; DePasse, J Mason; Eltorai, Adam E M; Paxton, E Scott; Green, Andrew; Daniels, Alan H


    Differentiating the cause of pain and dysfunction due to cervical spine and shoulder pathology presents a difficult clinical challenge in many patients. Furthermore, the anatomic region reported to be painful may mislead the practitioner. Successfully treating these patients requires a careful and complete history and physical examination with appropriate provocative maneuvers. An evidence-based selection of clinical testing also is essential and should be tailored to the most likely underlying cause. When advanced imaging does not reveal a conclusive source of pathology, electromyography and selective injections have been shown to be useful adjuncts, although the sensitivity, specificity, and risk-reward ratio of each test must be considered. This review provides an evidence-based review of common causes of shoulder and neck pain and guidelines for assistance in determining the pain generator in ambiguous cases. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Dangerous "spin": the probability myth of evidence-based prescribing - a Merleau-Pontyian approach. (United States)

    Morstyn, Ron


    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.

  5. Expert consensus v. evidence-based approaches in the revision of the DSM. (United States)

    Kendler, K S; Solomon, M


    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.

  6. Focusing on the Fundamentals in Treating PTSD: An Innovative Approach. Evidence Based Care (United States)


    Adequate Performance Reaction • Grief • Betrayal • Second Guessing • Risk Taking • Dominating Symptom(s) • (Moral Injury) Symptoms Plus Others...standards 2011 MHS Conference Current PTSD Treatments ? 7 CBT PET CBSR ACTCPT ADT Medications TMTVRET Evidence-Based? 2011 MHS Conference Innovations...Manualized Treatment Protocols – PET – CPT – VRET 8 2011 MHS Conference Prolonged Exposure Therapy ( PET )  Group or couples based: – PE delivered

  7. Strategy for developing an evidence-based transdisciplinary vision rehabilitation team approach to treating vision impairment. (United States)

    Grover, Lori Latowski


    Many individuals with vision impairment experience significant loss of the ability to perform daily living activities, which often results in a further decline and loss of quality of life. Appropriate rehabilitation of the population with vision impairment has the potential to both improve individual abilities for health and personal management as well as maximize utilization of available health care resources. The case for an evidence-based model for the vision rehabilitation health care team as a medical rehabilitation program is presented. The recommended strategy has 3 main components: development of a consensus team clinical practice guideline leading to a future evidence-based team guideline for vision rehabilitation; evaluation and measurement of the knowledge, attitudes, and practices of the involved vision rehabilitation professionals before and after implementation of the new paradigm; and measurement of outcomes that estimate the effects of the proposed paradigm on patient care by measuring both the improvement in visual ability of the patient and the economic impact of the model on optometric practice. Development of a state-of-the-art evidence-based transdisciplinary team model guideline will facilitate improvement in the quality of life of individuals with diseases that result in chronic vision impairment.

  8. Comparison of residents' approaches to clinical decisions before and after the implementation of Evidence Based Medicine course. (United States)

    Karimian, Zahra; Kojuri, Javad; Sagheb, Mohammad Mahdi; Mahboudi, Ali; Saber, Mahboobeh; Amini, Mitra; Dehghani, Mohammad Reza


    It has been found that the decision-making process in medicine is affected, to a large extent, by one's experience, individual mentality, previous models, and common habitual approaches, in addition to scientific principles. Evidence-based medicine is an approach attempting to reinforce scientific, systematic and critical thinking in physicians and provide the ground for optimal decision making. In this connection, the purpose of the present study is to find out to what extent the education of evidence based medicine affects clinical decision making. The present quasi-experimental study was carried out on 110 clinical residents, who started their education in September, 2012 and finally 62 residents filled out the questionnaires. The instrument used was a researcher-made questionnaire containing items on four decision-making approaches. The questionnaire was used both as a pre-test and a post-test to assess the residents' viewpoints on decision making approaches. The validity of the questionnaire was determined using medical education and clinical professionals' viewpoints, and the reliability was calculated through Chronbach alpha; it was found to be 0.93. The results were analyzed by paired t-test using SPSS, version 14. The results demonstrated that evidence-based medicine workshop significantly affected the residents' decision-making approaches (pbased, reference-based and routine model-based approaches were more preferred before the program (pevidence-based ones.  To develop the evidence-based approach, it is necessary for educational programs to continue steadily and goal-orientedly. In addition, the equipment infrastructure such as the Internet, access to data bases, scientific data, and clinical guides should develop more in the medical departments.

  9. Introducing a Chair-Side Novel Approach to Reach Evidence-based Periodontal Information in the Daily Periodontal Practice (United States)

    Dannan, Aous


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

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

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


    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


    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. The assimilation of problematic experiences sequence: an approach to evidence-based practice in bereavement counseling. (United States)

    Wilson, John


    Current theories of bereavement are available and complex and suggest that for the bereaved there is no single pathway through grief. This challenges ethically motivated bereavement counselors to integrate theory into evidence-based practice. The Assimilation of Problematic Experiences Sequence offers a way forward for evaluating the effectiveness of bereavement counseling. Parallels are drawn between grief as disrupted self-narrative and grief as the dissociated voices of unassimilated experience. This assimilation sequence is proposed as a means of tracking psychological change in bereaved clients.

  13. Child Disaster Mental Health Services: a Review of the System of Care, Assessment Approaches, and Evidence Base for Intervention. (United States)

    Pfefferbaum, Betty; North, Carol S


    Several decades of research have informed our knowledge of children's reactions to disasters and the factors that influence their reactions. This article describes the system of care for child disaster mental health services using population risk to determine needed services and a stepped care approach built on assessment and monitoring to advance children to appropriate services. To assess the evidence base for disaster interventions, recent reviews of numerous child disaster mental health interventions are summarized.

  14. A patient-centered primary care practice approach using evidence-based quality improvement: rationale, methods, and early assessment of implementation. (United States)

    Rubenstein, Lisa V; Stockdale, Susan E; Sapir, Negar; Altman, Lisa; Dresselhaus, Timothy; Salem-Schatz, Susanne; Vivell, Susan; Ovretveit, John; Hamilton, Alison B; Yano, Elizabeth M


    Healthcare systems and their primary care practices are redesigning to achieve goals identified in Patient-Centered Medical Home (PCMH) models such as Veterans Affairs (VA)'s Patient Aligned Care Teams (PACT). Implementation of these models, however, requires major transformation. Evidence-Based Quality Improvement (EBQI) is a multi-level approach for supporting organizational change and innovation spread. To describe EBQI as an approach for promoting VA's PACT and to assess initial implementation of planned EBQI elements. Descriptive. Regional and local interdisciplinary clinical leaders, patient representatives, Quality Council Coordinators, practicing primary care clinicians and staff, and researchers from six demonstration site practices in three local healthcare systems in one VA region. EBQI promotes bottom-up local innovation and spread within top-down organizational priorities. EBQI innovations are supported by a research-clinical partnership, use continuous quality improvement methods, and are developed in regional demonstration sites. We developed a logic model for EBQI for PACT (EBQI-PACT) with inputs, outputs, and expected outcomes. We describe implementation of logic model outputs over 18 months, using qualitative data from 84 key stakeholders (104 interviews from two waves) and review of study documents. Nearly all implementation elements of the EBQI-PACT logic model were fully or partially implemented. Elements not fully achieved included patient engagement in Quality Councils (4/6) and consistent local primary care practice interdisciplinary leadership (4/6). Fourteen of 15 regionally approved innovation projects have been completed, three have undergone initial spread, five are prepared to spread, and two have completed toolkits that have been pretested in two to three sites and are now ready for external spread. EBQI-PACT has been feasible to implement in three participating healthcare systems in one VA region. Further development of methods for

  15. [Reducing the burden of disease caused by alcohol use in Peru: evidence- based approaches]. (United States)

    Fiestas, Fabián


    Alcohol use is one the most important risk factors for illness and early death in Peru. Measures aimed at decreasing or controlling the great impact caused by alcohol in the Peruvian society are urgently needed. This article identifies and promotes the implementation of public health measures supported by sound scientific evidence of effectiveness or, in some cases, cost-effectiveness. The 10 evidence-based public health measures identified and described here represent a set if measures with high probability of success if implemented, as they are supported by scientific evidence. We recommend that governments, at the national or local levels, apply these measures not individually, but in combination, arranging them into a plan or roadmap, where the framework in which they will be applied must be established according to each context. Considering the available resources, some of these measures could be implemented in the short and medium term while the others can be set in the long-term.

  16. Promoting community practitioners' use of evidence-based approaches to increase breast cancer screening. (United States)

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


    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.

  17. Training medical providers in evidence-based approaches to suicide prevention. (United States)

    DeHay, Tamara; Ross, Sarah; McFaul, Mimi


    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.

  18. Strengthening vaccination policies in Latin America: an evidence-based approach. (United States)

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


    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

  19. Shrub growth and expansion in the Arctic tundra: an assessment of controlling factors using an evidence-based approach (United States)

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


    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.

  20. Practitioner opinions on health promotion interventions that work: opening the 'black box' of a linear evidence-based approach. (United States)

    Kok, Maarten O; Vaandrager, Lenneke; Bal, Roland; Schuit, Jantine


    While attempts are being made to improve health promotion by following a linear Evidence-Based (EB) approach, the actors involved are aware that the quality of health promotion is not just a matter of supplying 'evidence-based' interventions to local practitioners, but the result of a situated coproduction process that depends on many factors. This paper explores what constitutes an intervention that works from the perspective of health promotion professionals (HPP), and how, according to them, the development and implementation of interventions should be improved. We interviewed 81 HPPs about the use of 10 health promotion interventions at 30 Municipality Health Services in The Netherlands. The HPPs described an intervention that works as something that produces its intended effects after being realized in a local situation. Interventions are realized by combining elements of a supplied intervention (e.g. a theory, artefacts) with elements that are situated in the local context (e.g. funding, local network). Interventions that are transferred contain implicit assumptions about local contexts, but it is often unclear what precisely constitutes an intervention and what is assumed of local contexts. An intervention that works is a situated configuration of aligned elements. A linear EB approach depends on the realization of the local circumstances in which 'evidence based' interventions can work. Various strategies are possible for approximating such circumstances, but the core assumption that the configuration that is realized in practice is similar to the 'evidence based' intervention seems unrealistic for most health promotion in The Netherlands. Under such circumstances, attention should shift from central quality assurance to the system of actors and the distributed actions and heterogeneous learning processes that together add up to interventions that work. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Medical management of myxomatous mitral valve disease: An evidence-based veterinary medicine approach. (United States)

    Burchell, Richard K; Schoeman, Johan


    Myxomatous mitral valve disease (MMVD) is the most common heart disease of dogs. The current management of MMVD in dogs is mostly pharmacological, and the recommendations for treatment are based on a number of veterinary studies. Notwithstanding the current consensus regarding the medical management of MMVD, there remains active debate as to which drugs are the most effective. In order to understand how recommendations are constructed in the pharmacological management of diseases, the veterinarian needs to understand the concept of evidence-based veterinary medicine, and how the findings of these studies can be applied in their own practices. This review summarises the current veterinary literature and explains how the consensus regarding the management of MMVD has been reached. This review highlights the limitations of veterinary studies in order to provide veterinary practitioners with a sense of the difficulty there is in establishing the benefit of one treatment over the other. Veterinarians should therefore apply treatment recommendations based on the best evidence, integrated with a pathomechanistic understanding of the disease process and clinical experience.

  2. Evidence-based management of otitis media: a 5S model approach. (United States)

    Wasson, J D; Yung, M W


    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.

  3. An evidence-based approach to the evaluation and management of stress incontinence in women. (United States)

    Gilleran, Jason P; Zimmern, Philippe


    The aim of this article is to use evidence-based criteria to review recent publications on the evaluation and management of stress urinary incontinence in women. Longitudinal studies suggest that a familial predisposition towards stress urinary incontinence may exist. There is mounting evidence that cesarean section may play a protective role against pelvic floor damage due to labor, but this continues to be investigated. Objective parameters in the evaluation of stress urinary incontinence, such as questionnaires, pad test, and urodynamic studies, continue to undergo refinements to become more clinically relevant outcome tools. Non-invasive and minimally-invasive therapies for stress urinary incontinence are expanding. The search continues for the optimal non-autologous material in the pubovaginal sling procedure. Despite concerns over the use of synthetic material and better defined early complications, midurethral slings continue to enjoy popularity with short-term and intermediate success. Further research into the cause of stress urinary incontinence is necessary. There is still no unified protocol in the evaluation of the condition and its severity. Mid-urethral slings appear to be as efficacious as more established procedures (bladder neck suspensions, pubovaginal slings), but long-term results on safety and efficacy remain scarce.

  4. An Evidence-Based Approach to the Prescription Opioid Epidemic in Orthopedic Surgery. (United States)

    Soffin, Ellen M; Waldman, Seth A; Stack, Roberta J; Liguori, Gregory A


    Orthopedic surgery is associated with significant perioperative pain. Providing adequate analgesia is a critical component of patient care and opioids play a vital role in the acute postoperative setting. However, opioid prescribing for patients undergoing orthopedic procedures has recently been identified as a major contributor to the current opioid epidemic. As opioid usage and related morbidity and mortality continue to rise nationwide, opioid-prescribing practices are under increased scrutiny. Here, we update the evidence base and recommendations behind a set of interventions developed at the Hospital for Special Surgery to address the national epidemic at the local level. The main components of our program include (1) guidelines for managing patients who are opioid tolerant and/or have a substance abuse disorder; (2) education programs for patients, emphasizing the role of opioids in recovery after elective orthopedic surgery; (3) education programs for prescribers of controlled substances, including clinical and regulatory aspects; (4) the development of surgery-specific prescribing recommendations for opioid-naive patients; and (5) mechanisms to modify prescribing habits to limit unnecessary prescribing of controlled substances.

  5. A novel approach to training students in delivering evidence-based obesity treatment. (United States)

    Brown, Joshua; Lydecker, Janet A; Turner, Tonya; Knackstedt, Rebecca W; O'Neil, Patrick M


    Obesity is a major public health concern because of its prevalence, serious health consequences, and costs. Many health care providers believe they have been inadequately trained to treat obesity and, as a result, often do not address patients' weight. Despite recommendations to improve knowledge and skills so they can more effectively address obesity, health care educational curricula are already overburdened with content and have been slow to respond to these recommendations. Interprofessional health care students voluntarily participated in an extracurricular service-learning opportunity to learn about the evidence-based treatment of obesity. A multidisciplinary team of weight management professionals taught didactic lessons and oversaw the service-learning component of training. An essential element of the training was the students' delivery of a free 10-week weight management intervention to low-income overweight and obese community residents. Patients in both the student-led (n=25) and professional-led (n=21) programs lost a statistically and clinically significant amount of weight. Additionally, there was no significant difference in weight loss between the two programs, even after taking into account differences in attendance between the two programs. An extracurricular service-learning program pairing brief didactic instruction with experiential learning appears to be a viable strategy for accomplishing the important dual objectives of preparing health care students to treat obesity and providing much-needed treatment to those in our community who are least able to afford it.

  6. What sort of bioethical values are the evidence-based medicine and the GRADE approaches willing to deal with? (United States)

    Watine, Joseph


    The concept of evidence-based medicine (EBM) has been invented by physicians mostly from English Canada, mostly from McMaster University, Ontario, Canada. The term EBM first appeared in the biomedical literature in 1991 in an article written by a prominent member of this group-Gordon Guyatt from McMaster University. The inventors of EBM have also created the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group, which is a prominent international organisation whose main purpose is to develop evidence-based clinical practice guidelines (CPGs). CPGs that are based on the GRADE approach are becoming increasingly adopted worldwide, in particular by many professional or governmental organisations. This group of thinkers being thus identified, we have retrieved and read many of their publications in order to try and understand how they intend to incorporate bioethical values into their concept. The author of this little essay did also spend a few years on the internet as an active member of the GRADE group discussion list. The observations thus gathered suggest that although some of the inventors of EBM, at least Gordon Guyatt, wish to incorporate core principles of biomedical ethics into their concept (ie, non-malevolence, beneficence and maybe to a lesser extent respect for autonomy, and justice), some clarifications are still necessary in order to better understand how they intend to more explicitly incorporate bioethical values into their concept and, perhaps more importantly, into evidence-based CPGs.

  7. Incentive systems in multi-level markets for virtual goods


    Schmidt, A.U.


    As an alternative to rigid DRM measures, ways of marketing virtual goods through multi-level or networked marketing have raised some interest. This report is a first approach to multi-level markets for virtual goods from the viewpoint of theoretical economy. A generic, kinematic model for the monetary flow in multi-level markets, which quantitatively describes the incentives that buyers receive through resales revenues, is devised. Building on it, the competition of goods is examined in a dyn...

  8. A social marketing approach to implementing evidence-based practice in VHA QUERI: the TIDES depression collaborative care model (United States)


    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

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

    Directory of Open Access Journals (Sweden)

    Parker Louise E


    Full Text Available 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.

  10. Evaluating a train-the-trainer approach for improving capacity for evidence-based decision making in public health. (United States)

    Yarber, Laura; Brownson, Carol A; Jacob, Rebekah R; Baker, Elizabeth A; Jones, Ellen; Baumann, Carsten; Deshpande, Anjali D; Gillespie, Kathleen N; Scharff, Darcell P; Brownson, Ross C


    Evidence-based public health gives public health practitioners the tools they need to make choices based on the best and most current evidence. An evidence-based public health training course developed in 1997 by the Prevention Research Center in St. Louis has been taught by a transdisciplinary team multiple times with positive results. In order to scale up evidence-based practices, a train-the-trainer initiative was launched in 2010. This study examines the outcomes achieved among participants of courses led by trained state-level faculty. Participants from trainee-led courses in four states (Indiana, Colorado, Nebraska, and Kansas) over three years were asked to complete an online survey. Attempts were made to contact 317 past participants. One-hundred forty-four (50.9 %) reachable participants were included in analysis. Outcomes measured include frequency of use of materials, resources, and other skills or tools from the course; reasons for not using the materials and resources; and benefits from attending the course. Survey responses were tabulated and compared using Chi-square tests. Among the most commonly reported benefits, 88 % of respondents agreed that they acquired knowledge about a new subject, 85 % saw applications for the knowledge to their work, and 78 % agreed the course also improved abilities to make scientifically informed decisions at work. The most commonly reported reasons for not using course content as much as intended included not having enough time to implement evidence-based approaches (42 %); other staff/peers lack training (34 %); and not enough funding for continued training (34 %). The study findings suggest that utilization of course materials and teachings remains relatively high across practitioner groups, whether they were taught by the original trainers or by state-based trainers. The findings of this study suggest that train-the-trainer is an effective method for broadly disseminating evidence-based public health

  11. Diagnosis of upper limb lymphedema: development of an evidence-based approach. (United States)

    Dylke, E S; Schembri, G P; Bailey, D L; Bailey, E; Ward, L C; Refshauge, K; Beith, J; Black, D; Kilbreath, S L


    The diagnosis of secondary upper limb lymphedema (LE) is complicated by the lack of an agreed-upon measurement tool and diagnostic threshold. The aim of this study was to determine which of the many commonly used and normatively determined clinical diagnostic thresholds has the best diagnostic accuracy of secondary upper limb LE, when compared to diagnosis by an appropriate reference standard, lymphoscintigraphy. The arms of women treated for breast cancer with and without a previous diagnosis of LE, as well as healthy controls, were assessed using lymphoscintigraphy, bioimpedance spectroscopy (BIS) and perometry. Dermal backflow score determined from lymphoscintigraphy imaging assessment (reference standard) was compared with diagnosis by both commonly used and normatively determined diagnostic thresholds for volume and circumference measurements as well as BIS. For those with established dermal backflow, all commonly used and normatively determined diagnostic thresholds accurately identified presence of LE compared with lymphoscintigraphy diagnosis. In participants with mild to moderate changes in dermal backflow, only a normatively determined diagnostic threshold, set at two standard deviations above the norm, for arm circumference and full arm BIS were found to have both high sensitivity (81% and 76%, respectively) and specificity (96% and 93%, respectively). For this group, strong, and clinically useful, positive (23 and 10, respectively) and negative likelihood (0.2 and 0.3) ratios were found for both the circumference and bioimpedance diagnostic thresholds. For the first time, evidence-based clinical diagnostic thresholds have been established for secondary LE. With mild LE, normatively determined circumference and BIS thresholds are superior to the commonly used thresholds.

  12. Driving restrictions after implantable cardioverter defibrillator implantation: an evidence-based approach (United States)

    Thijssen, Joep; Borleffs, C. Jan Willem; van Rees, Johannes B.; de Bie, Mihály K.; van der Velde, Enno T.; van Erven, Lieselot; Bax, Jeroen J.; Cannegieter, Suzanne C.; Schalij, Martin J.


    Aims Little evidence is available regarding restrictions from driving following implantable cardioverter defibrillator (ICD) implantation or following first appropriate or inappropriate shock. The purpose of the current analysis was to provide evidence for driving restrictions based on real-world incidences of shocks (appropriate and inappropriate). Methods and results A total of 2786 primary and secondary prevention ICD patients were included. The occurrence of shocks was noted during a median follow-up of 996 days (inter-quartile range, 428–1833 days). With the risk of harm (RH) formula, using the incidence of sudden cardiac incapacitation, the annual RH to others posed by a driver with an ICD was calculated. Based on Canadian data, the annual RH to others of 5 in 100 000 (0.005%) was used as a cut-off value. In both primary and secondary prevention ICD patients with private driving habits, no restrictions to drive directly following implantation, or an inappropriate shock are warranted. However, following an appropriate shock, these patients are at an increased risk to cause harm to other road users and therefore should be restricted to drive for a period of 2 and 4 months, respectively. In addition, all ICD patients with professional driving habits have a substantial elevated risk to cause harm to other road users during the complete follow-up after both implantation and shock and should therefore be restricted to drive permanently. Conclusion The current analysis provides a clinically applicable tool for guideline committees to establish evidence-based driving restrictions. PMID:21646229

  13. Employing a Multi-level Approach to Recruit a Representative Sample of Women with Recent Gestational Diabetes Mellitus into a Randomized Lifestyle Intervention Trial. (United States)

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


    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

  14. A social marketing approach to implementing evidence-based practice in VHA QUERI: the TIDES depression collaborative care model. (United States)

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


    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.

  15. Modeling Multi-Level Systems

    CERN Document Server

    Iordache, Octavian


    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...

  16. Automatic training sample selection for a multi-evidence based crop classification approach

    DEFF Research Database (Denmark)

    Chellasamy, Menaka; Ferre, Ty; Greve, Mogens Humlekrog

    An approach to use the available agricultural parcel information to automatically select training samples for crop classification is investigated. Previous research addressed the multi-evidence crop classification approach using an ensemble classifier. This first produced confidence measures using...... three Multi-Layer Perceptron (MLP) neural networks trained separately with spectral, texture and vegetation indices; classification labels were then assigned based on Endorsement Theory. The present study proposes an approach to feed this ensemble classifier with automatically selected training samples....... The available vector data representing crop boundaries with corresponding crop codes are used as a source for training samples. These vector data are created by farmers to support subsidy claims and are, therefore, prone to errors such as mislabeling of crop codes and boundary digitization errors. The proposed...

  17. Evidence-based and evidence-inspired: an intergenerational approach in the promotion of balance and strength for fall prevention. (United States)

    Granacher, Urs; Muehlbauer, Thomas; Gollhofer, Albert; Kressig, Reto W; Zahner, Lukas


    The risk of sustaining a fall and fall-related injuries is particularly high in children and seniors, which is why there is a need to develop fall-preventive intervention programs. An intergenerational approach in balance and strength promotion appears to have great potential because it is specifically tailored to the physical, social and behavioural needs of children and seniors. Burtscher and Kopp [Gerontology, DOI: 10.1159/000322930] raised the question whether our previously published mini-review is evidence-based or evidence-inspired. These authors postulate that we did not follow a 4-stage conceptual model for the development of injury and/or fall-preventive intervention programs. In response to this criticism, we present information from the mini-review that comply with the 4-stage model incorporating evidence-based and evidence-inspired components. We additionally provide information on how to implement an intergenerational balance and resistance training approach in a school setting based on a study that is being currently conducted. Copyright © 2010 S. Karger AG, Basel.

  18. Implementation of a blended learning approach to teaching evidence based practice: a protocol for a mixed methods study. (United States)

    Ilic, Dragan; Bin Nordin, Rusli; Glasziou, Paul; Tilson, Julie K; Villanueva, Elmer


    Evidence based practice (EBP) requires that health professionals are competent in integrating the best evidence in their decision making. Being 'evidence-based' requires skills and knowledge in epidemiology, biostatistics and information literacy. EBP is commonly taught in medical and health sciences degrees, yet there is little evidence to guide educators as to the best teaching modality to increase learner competency in EBP. This study is mixed methods in design. A randomised controlled trial will examine the effectiveness of blended learning versus didactic approach of teaching EBP to medical students. The primary outcome of the RCT is EBP competency as assessed by the Berlin tool. Focus groups will be conducted to explore student perceptions and attitudes towards implementing a blended learning approach in teaching EBP. A concurrent triangulation design will be implemented, permitting quantitative data to inform the effectiveness of the intervention and qualitative data to contextualise the results. This study will provide novel evidence on the effectiveness of blended learning in teaching EBP to a cohort of undergraduate and graduate-entry medical students.

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


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


    Aim: The aim of this study was to define, decode, and append to the conceptual frame-work of the integrated approach to yoga therapy (IAYT). Materials and Methods: 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 a...

  20. Evidence based orthopaedic manual therapy for patients with nonspecific low back pain: An integrative approach. (United States)

    Hidalgo, Benjamin


    Orthopaedic manual therapy (OMT) should be based not only on the best available evidence but also on patient values and clinician expertise. Low back pain (LBP) is a complex issue as the majority of people who suffer from LBP cannot be given a specific diagnosis based on imaging studies but kinematic analyses appear to be useful to determine dysfunctional patterns. In physical therapy, various forms of OMT are currently used to manage LBP and there is growing evidence for its use. The underlying principles of OMT are to treat neuro-musculo-skeletal disorders, the aim of which is to reduce pain, as well as improve movement and function. Manual physical therapists use a range of treatment approaches including passive techniques (``hands on'') as well as different active techniques (``hands off'') and communication skills. Systems of stratification are available for classification of people with LBP into specific sub-groups (with sub-group specific OMT intervention). This approach has been shown to be more efficient than generic treatment, although subgroups are not mutually exclusive. Various mechanisms of action are reported in the literature concerning OMT effects. These effects may be biomechanical, neurophysiological and psychological. Moreover, it is essential that the treatment, regardless of the concept of OMT, is carried out on the basis of a systematic and valid clinical examination protocol aimed to correctly classify LBP. The use of pain provocative tests during combined movement examination provides confidence that examination findings are valid and can therefore be confidently used in clinical practice to manage patient. The integrative approach presented in this article is a mix of previously developed classification systems (i.e. based on pain mechanisms, prognosis, treatment responsiveness) and new tools, as kinematic analyses for LBP, and a novel validated combined movements examinationCONCLUSION: As LBP is a complex and multidimensional problem, the

  1. Surgical Otoplasty: An Evidence-Based Approach to Prominent Ears Correction. (United States)

    Stewart, Kenneth J; Lancerotto, Luca


    Otoplasty is one of the first procedures learned during residency. A myriad of surgical techniques and nuances exist. Many have merit, some are ineffective, some destructive, and some frankly fanciful. Adopting an effective and safe technique should be based on proven efficacy and effectiveness to avoid early disappointments. We present a review of traditional otoplasty techniques and more recent innovations. Their pros and cons are discussed in view of the relative risks/benefits balance. Recurrence rates are low for most techniques. Some techniques carry a higher risk of significant complications. A ladder approach preferring techniques that minimize cartilage damage appears advisable. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Open knee joint injuries--an evidence-based approach to management. (United States)

    Konda, Sanjit R; Davidovitch, Roy I; Egol, Kenneth A


    Open knee joint injuries are potentially devastating injuries if not properly diagnosed and treated. Current diagnostic techniques, such as the saline load test (SLT), are based on outdated literature. Diagnosis of traumatic arthrotomies via the presence of intra-articular air on computed tomography (CT) scan has recently been shown to be 100% sensitive and specific to detect these injuries. Additionally, open knee joint injuries have a high rate of associated periarticular fractures (51%). The workhorse open surgical approach to the knee is the medial parapatellar approach; however, arthroscopic irrigation and debridement (I&D) should be considered in the setting of small puncture wounds (e.g., gunshot wounds). Antibiotic therapy following I&D of an open knee joint injury includes 24 to 48 hours of intravenous antibiotics. Oral antibiotic therapy can be administered afterwards for 3 to 5 days if the original injury was grossly contaminated. Ultimately, a unified management algorithm for open knee joint injuries based on current literature should be followed to ensure appropriate diagnosis and treatment of this potentially devastating injury.

  3. Parasite vulnerability to climate change: an evidence-based functional trait approach (United States)

    Cizauskas, Carrie A.; Clements, Chris F.; Dougherty, Eric R.; Harris, Nyeema C.; Phillips, Anna J.


    Despite the number of virulent pathogens that are projected to benefit from global change and to spread in the next century, we suggest that a combination of coextinction risk and climate sensitivity could make parasites at least as extinction prone as any other trophic group. However, the existing interdisciplinary toolbox for identifying species threatened by climate change is inadequate or inappropriate when considering parasites as conservation targets. A functional trait approach can be used to connect parasites' ecological role to their risk of disappearance, but this is complicated by the taxonomic and functional diversity of many parasite clades. Here, we propose biological traits that may render parasite species particularly vulnerable to extinction (including high host specificity, complex life cycles and narrow climatic tolerance), and identify critical gaps in our knowledge of parasite biology and ecology. By doing so, we provide criteria to identify vulnerable parasite species and triage parasite conservation efforts. PMID:28280551

  4. Persuasive Interventions for Controversial Cancer Screening Recommendations: Testing a Novel Approach to Help Patients Make Evidence-Based Decisions. (United States)

    Saver, Barry G; Mazor, Kathleen M; Luckmann, Roger; Cutrona, Sarah L; Hayes, Marcela; Gorodetsky, Tatyana; Esparza, Nancy; Bacigalupe, Gonzalo


    We wanted to evaluate novel decision aids designed to help patients trust and accept the controversial, evidence-based, US Preventive Services Task Force recommendations about prostate cancer screening (from 2012) and mammography screening for women aged 40 to 49 years (from 2009). We created recorded vignettes of physician-patient discussions about prostate cancer screening and mammography, accompanied by illustrative slides, based on principles derived from preceding qualitative work and behavioral science literature. We conducted a randomized crossover study with repeated measures with 27 men aged 50 to 74 years and 35 women aged 40 to 49 years. All participants saw a video intervention and a more traditional, paper-based decision aid intervention in random order. At entry and after seeing each intervention, they were surveyed about screening intentions, perceptions of benefits and harm, and decisional conflict. Changes in screening intentions were analyzed without regard to order of intervention after an initial analyses showed no evidence of an order effect. At baseline, 69% of men and 86% of women reported wanting screening, with 31% and 6%, respectively, unsure. Mean change on a 3-point, yes, unsure, no scale was -0.93 (P = persuasive video interventions significantly changed the screening intentions of substantial proportions of viewers. Our approach needs further testing but may provide a model for helping patients to consider and accept evidence-based, counterintuitive recommendations. © 2017 Annals of Family Medicine, Inc.

  5. Decoding the integrated approach to yoga therapy: Qualitative evidence based conceptual framework (United States)

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


    Aim: The aim of this study was to define, decode, and append to the conceptual frame-work of the integrated approach to yoga therapy (IAYT). Materials and Methods: 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. Results: 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”. Conclusion: 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. PMID:25035604

  6. Decoding the integrated approach to yoga therapy: Qualitative evidence based conceptual framework. (United States)

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


    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.

  7. Optimal management of chronic cyclical pelvic pain: an evidence-based and pragmatic approach

    Directory of Open Access Journals (Sweden)

    Ha Ryun Won


    Full Text Available Ha Ryun Won, Jason AbbottDepartment of Endo-Gynecology, Royal Hospital for Women, Sydney, New South Wales, AustraliaAbstract: This article reviews the literature on management of chronic cyclical pelvic pain (CCPP. Electronic resources including Medline, PubMed, CINAHL, The Cochrane Library, Current Contents, and EMBASE were searched using MeSH terms including all ­subheadings and keywords: “cyclical pelvic pain”, “chronic pain”, “dysmenorrheal”, “nonmenstrual ­pelvic pain”, and “endometriosis”. There is a dearth of high-quality evidence for this common ­problem. Chronic pelvic pain affects 4%–25% of women of reproductive age. Dysmenorrhea of varying degree affects 60% of women. Endometriosis is the commonest pathologic cause of CCPP. Other gynecological causes are adenomyosis, uterine fibroids, and pelvic floor myalgia, although other systems disease such as irritable bowel syndrome or interstitial cystitis may be responsible. ­Management options range from simple to invasive, where simple medical ­treatment such as the combined oral contraceptive pill may be used as a first-line treatment prior to invasive ­management. This review outlines an approach to patients with CCPP through history, physical examination, and investigation to identify the cause(s of the pain and its optimal management.Keywords: cyclical pelvic pain, chronic pain, dysmenorrhea, nonmenstrual pelvic pain, endometriosis

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

    Directory of Open Access Journals (Sweden)

    Antonio Olmos


    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.

  9. Evidence-based approaches to childhood stunting in low and middle income countries: a systematic review. (United States)

    Hossain, Muttaquina; Choudhury, Nuzhat; Adib Binte Abdullah, Khaleda; Mondal, Prasenjit; Jackson, Alan A; Walson, Judd; Ahmed, Tahmeed


    We systematically evaluated health and nutrition programmes to identify context-specific interventional packages that might help to prioritise the implementation of programmes for reducing stunting in low and middle income countries (LMICs). Electronic databases were used to systematically review the literature published between 1980 and 2015. Additional articles were identified from the reference lists and grey literature. Programmes were identified in which nutrition-specific and nutrition-sensitive interventions had been implemented for children under 5 years of age in LMICs. The primary outcome was a change in stunting prevalence, estimated as the average annual rate of reduction (AARR). A realist approach was applied to identify mechanisms underpinning programme success in particular contexts and settings. Fourteen programmes, which demonstrated reductions in stunting, were identified from 19 LMICs. The AARR varied from 0.6 to 8.4. The interventions most commonly implemented were nutrition education and counselling, growth monitoring and promotion, immunisation, water, sanitation and hygiene, and social safety nets. A programme was considered to have effectively reduced stunting when AARR≥3%. Successful interventions were characterised by a combination of political commitment, multi-sectoral collaboration, community engagement, community-based service delivery platform, and wider programme coverage and compliance. Even for similar interventions the outcome could be compromised if the context differed. For all settings, a combination of interventions was associated with success when they included health and nutrition outcomes and social safety nets. An effective programme for stunting reduction embraced country-level commitment together with community engagement and programme context, reflecting the complex nature of exposures of relevance. CRD42016043772. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under

  10. A practical and evidence-based approach to common symptoms: a narrative review. (United States)

    Kroenke, Kurt


    Physical symptoms account for more than half of all outpatient visits, yet the predominant disease-focused model of care is inadequate for many of these symptom-prompted encounters. Moreover, the amount of clinician training dedicated to understanding, evaluating, and managing common symptoms is disproportionally small relative to their prevalence, impairment, and health care costs. This narrative review regarding physical symptoms addresses 4 common epidemiologic questions: cause, diagnosis, prognosis, and therapy. Important findings include the following: First, at least one third of common symptoms do not have a clear-cut, disease-based explanation (5 studies in primary care, 1 in specialty clinics, and 2 in the general population). Second, the history and physical examination alone contribute 73% to 94% of the diagnostic information, with costly testing and procedures contributing much less (5 studies of multiple types of symptoms and 4 of specific symptoms). Third, physical and psychological symptoms commonly co-occur, making a dualistic approach impractical. Fourth, because most patients have multiple symptoms rather than a single symptom, focusing on 1 symptom and ignoring the others is unwise. Fifth, symptoms improve in weeks to several months in most patients but become chronic or recur in 20% to 25%. Sixth, serious causes that are not apparent after initial evaluation seldom emerge during long-term follow-up. Seventh, certain pharmacologic and behavioral treatments are effective across multiple types of symptoms. Eighth, measuring treatment response with valid scales can be helpful. Finally, communication has therapeutic value, including providing an explanation and probable prognosis without "normalizing" the symptom.

  11. An evidence based guide to a safe intraoperative approach of avoiding iatrogenic lesions during difficult laparoscopic cholecystectomies

    Directory of Open Access Journals (Sweden)

    Cosmin A. Moldovan


    Full Text Available Introduction: Although there are many sources for iatrogenic lesions during laparoscopic cholecystectomy, only a few stand out as being one of the most difficult to predict due to their nature of being very hard to diagnose before surgery. Materials and Methods: a short guide of cases with an evidence-based approach to avoid laparoscopic iatrogenic lesions. Results: these cases have been classified and presented into 3 main groups: cases with abnormal arterial layout, cases with heavy alteration of the normal anatomy, and cases with anomalies of the main biliary pathway. Conclusions: while not a complete guide covering all aspects of intraoperative traps during laparoscopic cholecystectomy, this series of cases points out some dangerous situations and some simple solutions to avoid those fiercely iatrogenic lesions of the ductal and vascular landmarks associated with an otherwise simple surgical intervention that has become the golden standard of the gallbladder lithiasic pathology.

  12. 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


    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.

  13. Improving risk assessment of violence among military Veterans: An evidence-based approach for clinical decision-making (United States)

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


    Despite increased media attention on violent acts against others committed by military Veterans, few models have been developed to systematically guide violence risk assessment among Veterans. Ideally, a model would identify which Veterans are most at risk for violence and increased attention could then be turned to determining 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 list 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 Veteran Administration settings and in the broader community. It is likely that the use of a systematic, empirical framework could lead to improved clinical decision-making in the area of risk assessment, and help reduce violence among Veterans. PMID:20627387

  14. Identification of water quality management policy of watershed system with multiple uncertain interactions using a multi-level-factorial risk-inference-based possibilistic-probabilistic programming approach. (United States)

    Liu, Jing; Li, Yongping; Huang, Guohe; Fu, Haiyan; Zhang, Junlong; Cheng, Guanhui


    In this study, a multi-level-factorial risk-inference-based possibilistic-probabilistic programming (MRPP) method is proposed for supporting water quality management under multiple uncertainties. The MRPP method can handle uncertainties expressed as fuzzy-random-boundary intervals, probability distributions, and interval numbers, and analyze the effects of uncertainties as well as their interactions on modeling outputs. It is applied to plan water quality management in the Xiangxihe watershed. Results reveal that a lower probability of satisfying the objective function (θ) as well as a higher probability of violating environmental constraints (q i ) would correspond to a higher system benefit with an increased risk of violating system feasibility. Chemical plants are the major contributors to biological oxygen demand (BOD) and total phosphorus (TP) discharges; total nitrogen (TN) would be mainly discharged by crop farming. It is also discovered that optimistic decision makers should pay more attention to the interactions between chemical plant and water supply, while decision makers who possess a risk-averse attitude would focus on the interactive effect of q i and benefit of water supply. The findings can help enhance the model's applicability and identify a suitable water quality management policy for environmental sustainability according to the practical situations.

  15. Disentangling the Relationship between Behavior Problems and Placement Change in Child Welfare: A Multi-Level Cross-Lag Modeling Approach (United States)

    Aarons, Gregory A.; James, Sigrid; Monn, Amy R.; Raghavan, Ramesh; Wells, Rebecca; Leslie, Laurel


    Introduction There is ongoing debate regarding the relative impact of youth behavior problems on placement change in child welfare compared to the impact of placement change on behavior problems. Existing studies provide some support for either perspective. The purpose of this study was to prospectively examine the relationships of behavior problems and placement change in a nationally representative sample of youths in the National Survey of Child and Adolescent Well-Being (NSCAW). Methods The sample for the present study consists of 422 youths having only out-of-home placements over the course of the NSCAW study. We used multi-level path analysis of a cross-lag design to examine reciprocal effects of behavior problems and placement change over time. Results We found that behavior problems predicted placement change consistently for the sample and in analyses by gender and age. In contrast, we found only isolated effects of placement changes on subsequent behavior problems. Conclusions In keeping with recommendations from a number of professional bodies, we suggest that initial and ongoing screening for internalizing and externalizing behavior problems be instituted as part of standard practice for youths entering or transitioning in the child-welfare system. PMID:20215928

  16. Material deprivation and unemployment affect coercive sex among young people in the urban slums of Blantyre, Malawi: A multi-level approach. (United States)

    Kamndaya, Mphatso; Kazembe, Lawrence N; Vearey, Jo; Kabiru, Caroline W; Thomas, Liz


    We explore relations among material deprivation (measured by insufficient housing, food insecurity and poor healthcare access), socio-economic status (employment, income and education) and coercive sex. A binary logistic multi-level model is used in the estimation of data from a survey of 1071 young people aged 18-23 years, undertaken between June and July 2013, in the urban slums of Blantyre, Malawi. For young men, unemployment was associated with coercive sex (odds ratio [OR]=1.77, 95% confidence interval [CI]: 1.09-3.21) while material deprivation (OR=1.34, 95% CI: 0.75-2.39) was not. Young women in materially deprived households were more likely to report coercive sex (OR=1.37, 95% CI: 1.07-2.22) than in non-materially deprived households. Analysis of local indicators of deprivation is critical to inform the development of effective strategies to reduce coercive sex in urban slums in Malawi. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  17. Spectrum Approach to Mentoring: An Evidence-Based Approach to Mentoring for Academics Working in Higher Education (United States)

    Harvey, Marina; Ambler, Trudy; Cahir, Jayde


    Anecdotal and empirical evidence indicates that mentoring can be a successful strategy for supporting professional learning, yet limited literature exists on approaches to mentoring designed specifically for academics working in higher education. The aim of this study was to create an approach to mentoring tailored to the needs of academics and…

  18. Evidence-Based Toxicology. (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.

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

    Directory of Open Access Journals (Sweden)

    Melanie Austin-McCain


    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.

  20. 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


    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.

  1. Validation of the portuguese version of the attitudes to evidence-based practice questionnaire : an exploratory approach


    Pereira, Rui Pedro Gomes; Peixoto, Maria; Martins, Maria Alice Correia dos Santos Cardoso


    Background: The lack of cultural and linguistically sensitive instruments prevents the opportunity of assessing attitudes and barriers of health care staff towards evidence-based practice. The aim of this communication is to report the validation process in the Portuguese context of the Attitudes to Evidence Based Practice Questionnaire. Methods: We developed a cross-sectional, descriptive psychometric validation study. For cultural adaptation, a bidirectional translation was carried out, acc...

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

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


    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

  3. Grounding evidence-based approaches to cancer prevention in the community: a case study of mammography barriers in underserved African American women. (United States)

    Highfield, Linda; Bartholomew, L Kay; Hartman, Marieke A; Ford, M Molly; Balihe, Philomene


    When community health planners select an evidence-based intervention that has been developed and tested in one situation and adapt it for use in a different situation or community, best practice suggests needs assessment and formative research in the new setting. Cancer prevention planners who are interested in adopting and adapting evidence-based approaches need to base their choices on a sound understanding of the health or behavioral risk problem in which they mean to intervene. This requires a balancing act of weighing community information against a broader perspective from the scientific literature and using the combination to identify and adapt an evidence-based intervention program that is likely to be effective in the new setting. This report is a case study of a community and organizational assessment conducted as a foundation for selecting and recommending adaptation of an evidence-based intervention for improving mammography appointment attendance. We used an inductive sequential exploratory mixed-methods design to inform this process. The process provides a model for formative research grounding evidence-based practice for cancer control planners. Future studies that incorporate findings from needs assessment into the adaptation of the selected intervention program may promote the effective dissemination of evidence-based programs. © 2014 Society for Public Health Education.

  4. SEAS (Scientific Exercises Approach to Scoliosis): a modern and effective evidence based approach to physiotherapic specific scoliosis exercises. (United States)

    Romano, Michele; Negrini, Alessandra; Parzini, Silvana; Tavernaro, Marta; Zaina, Fabio; Donzelli, Sabrina; Negrini, Stefano


    SEAS is the acronym for "Scientific Exercise Approach to Scoliosis", a name related to the continuous changes of the approach based on results published in the literature. SEAS is an individualized exercise program adapted to all situations of conservative treatment of scoliosis: stand-alone in low-medium degree curves during growth to reduce the risk of bracing; complimentary to bracing in medium-high degree curves during growth, with the aim to increase correction, prepare weaning, and avoid/reduce side-effects; for adults either progressing or fused, to help stabilising the curve and reduce disability. SEAS is based on a specific active self-correction technique performed without external aid, and incorporated in functional exercises. Evaluation tests guide the choice of the exercises most appropriate to the individual patient. Improvement of the stability of the spine in active self-correction is the primary objective of SEAS. SEAS exercises train neuromotor function so to stimulate by reflex a self-corrected posture during the activities of daily life. SEAS can be performed as an outpatient (two/three times a week 45 for minutes) or as a home program to be performed 20 minutes daily. In the last case, expert physiotherapy sessions of 1.5 hours every three months are proposed. Different papers, including a randomized controlled trial (2014), published over the past several years, documented the efficacy of the SEAS approach applied in the various phases of scoliosis treatment in reducing Cobb angle progression and the need to wear a brace. SEAS is an approach to scoliosis exercise treatment with a strong modern neurophysiological basis, to reduce requirements for patients and possibly the costs for families linked to the frequency and intensity of treatment and evaluations. Therefore, SEAS allows treating a large number of patients coming from far away. Even if SEAS appears simple by requiring less physiotherapist supervision and by using fewer home exercises

  5. An evidence-based approach to an ancient pursuit: systematic review on converting online contact into a first date. (United States)

    Khan, Khalid S; Chaudhry, Sameer


    To determine, for people seeking a date online, what activities and behaviours have an effect on the chances of converting electronic communication into a face-to-face meeting. Literature in psychology, sociology, and computer, behavioural and neurocognitive sciences that informed effective online dating was captured through electronic searching of Psychinfo, Medline and Embase in November 2013. Study selection and meta-narrative synthesis were carried out in duplicate. There were 3938 initial citations and 86 studies were synthesised. Initial interest was best captured through: a desirable screen name starting with a letter in the top half of the alphabet; an attractive still picture; and a fluent headline message. For those attracted to browse into the profile, a description of personal traits increased likeability when it: showed who the dater was and what they were looking for in a 70:30 ratio; stayed close to reality; and employed simple language with humour added. Invitations were most successful in obtaining a response from the potential date when they: were short personalised messages addressing a trait in their profile; rhymed with their screen name or headline message; and extended genuine compliments. Online communication was most effective in leading to an in-person meeting if there were: a genuine interest; a rapid turnaround; reciprocity in self-disclosure; mimicry of body movements on the webcam; avoidance of criticism; humour; uncertainty about whether there was likeability; and an early move from electronic chat to a date. Attraction and persuasion research provides an evidence-based approach to online dating.

  6. Early Incorporation of an Evidence-Based Aquatic-Assisted Approach to Arthroscopic Rotator Cuff Repair Rehabilitation: Prospective Case Study. (United States)

    Burmaster, Chris; Eckenrode, Brian J; Stiebel, Matthew


    Both traditional and progressive rotator cuff repair rehabilitation protocols often delay active motion of the shoulder for 6 weeks or more. The early inclusion of a comprehensive aquatic-assisted exercise program presents a unique approach to postoperative management. The purpose of this case study is to describe a comprehensive evidence-based, aquatic-assisted rehabilitation program following arthroscopic rotator cuff repair. A 73-year-old woman with a nonretracted, medium-size, full-thickness tear (2.5 cm) of the supraspinatus tendon underwent arthroscopic rotator cuff repair and was referred for postoperative physical therapy. The rehabilitation program was initiated at 2 weeks postoperatively and consisted of concurrent land- and aquatic-based interventions over 6 weeks for a total of 18 physical therapy visits. Improvements were made in all 5 patient-reported outcome measures that were recorded weekly over the course of care. Improvements reached or exceeded minimal detectable change levels for the Shoulder Pain and Disability Index and the Penn Shoulder Score. Her numeric pain rating scale score at rest decreased from 4/10 at the initial evaluation to 2/10 at 8 weeks postoperatively and with activity decreased from 9/10 to 6/10. Shoulder strength and range of motion values also exhibited improvement over the course of care. No adverse events occurred during the case study. This case study illustrates the safe inclusion of low-stress aquatic exercises as an early adjunct to traditional land-based rotator cuff repair rehabilitation programs in small- to medium-size repairs. Further studies are needed to determine the long-term effectiveness of adding aquatic therapy to traditional postoperative programs. © 2016 American Physical Therapy Association.

  7. Multi-level spectral graph partitioning method (United States)

    Talu, Muhammed Fatih


    In this article, a new method for multi-level and balanced division of non-directional graphs (MSGP) is introduced. Using the eigenvectors of the Laplacian matrix of graphs, the method has a spectral approach which has superiority over local methods (Kernighan-Lin and Fiduccia-Mattheyses) with a global division ability. Bisection, which is a spectral method, can divide the graph by using the Fiedler vector, while the recursive version of this method can divide into multiple levels. However, the spectral methods have two disadvantages: (1) high processing costs; (2) dividing the sub-graphs independently. With a better understanding of the eigenvectors of the whole graph, and by discovering the confidential information owned, MSGP can divide the graphs into balanced and multi-leveled without recursive processing. Inspired by Haar wavelets, it uses the eigenvectors with a binary heap tree. The comparison results in seven existing methods (some are community detection algorithms) on regular and irregular graphs which clearly demonstrate that MSGP works about 14,4 times faster than the others to produce a proper partitioning result.

  8. 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)


    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

  9. NASA Earth Science Partnerships - A Multi-Level Approach to Effectively Collaborating with Communities and Organizations to Utilize Earth Science Data for Societal Benefit (United States)

    Favors, J.


    NASA's Earth Science Division (ESD) seeks to develop a scientific understanding of the Earth as a dynamic, integrated system of diverse components that interact in complex ways - analogous to the human body. The Division approaches this goal through a coordinated series of satellite and airborne missions, sponsored basic and applied research, technology development, and science education. Integral to this approach are strong collaborations and partnerships with a spectrum of organizations that produce substantive benefit to communities - both locally and globally. This presentation will showcase various ways ESD approaches partnering and will highlight best practices, challenges, and provide case studies related to rapid partnerships, co-location of scientists and end-user communities, capacity building, and ESD's new Partnerships Program which is built around taking an innovative approach to partnering that fosters interdisplinary teaming & co-production of knowledge to broaden the applicability of Earth observations and answer new, big questions for partners and NASA, alike.

  10. The Collaborative Assessment and Management of Suicidality (CAMS): An Evolving Evidence-Based Clinical Approach to Suicidal Risk (United States)

    Jobes, David A.


    The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based clinical intervention that has significantly evolved over 25 years of clinical research. CAMS is best understood as a therapeutic framework that emphasizes a unique collaborative assessment and treatment planning process between the suicidal patient and…

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

    Cairney, Paul


    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. A unified multi-level model approach to assessing patient responsiveness including; return to normal, minimally important differences and minimal clinically important improvement for patient reported outcome measures. (United States)

    Sayers, Adrian; Wylde, Vikki; Lenguerrand, Erik; Gooberman-Hill, Rachael; Dawson, Jill; Beard, David; Price, Andrew; Blom, Ashley W


    This article reviews and compares four commonly used approaches to assess patient responsiveness with a treatment or therapy (return to normal (RTN), minimal important difference (MID), minimal clinically important improvement (MCII), OMERACT-OARSI [Outcome Measures in Rheumatology-Osteoarthris Reseach Society International] (OO)) and demonstrates how each of the methods can be formulated in a multilevel modelling (MLM) framework. Cohort study. A cohort of patients undergoing total hip and knee replacement were recruited from a single UK National Health Service hospital. 400 patients from the Arthroplasty Pain Experience cohort study undergoing total hip (n=210) and knee (n=190) replacement who completed the Intermittent and Constant Osteoarthritis Pain questionnaire prior to surgery and then at 3, 6 and 12 months after surgery. The primary outcome was defined as a response to treatment following total hip or knee replacement. We compared baseline scores, change scores and proportion of individuals defined as 'responders' using traditional and MLM approaches with patient responsiveness. Using existing approaches, baseline and change scores are underestimated, and the variance of baseline and change scores overestimated in comparison with MLM approaches. MLM increases the proportion of individuals defined as responding in RTN, MID and OO criteria compared with existing approaches. Using MLM with the MCII criteria reduces the number of individuals identified as responders. MLM improves the estimation of the SD of baseline and change scores by explicitly incorporating measurement error into the model and avoiding regression to the mean when making individual predictions. Using refined definitions of responsiveness may lead to a reduction in misclassification when attempting to predict who does and does not respond to an intervention and clarifies the similarities between existing methods. © Article author(s) (or their employer(s) unless otherwise stated in the text

  13. [Approaches, knowledge and capabilities of nurses and physicians regarding evidence-based clinical practice in the Imbadura province (Ecuador)]. (United States)

    Molina Mula, Jesús; Muñoz Navarro, Paulina; Vaca Auz, Janeth; Cabascango Cabascango, Carmita; Cabascango Cabascango, Katty


    The research raises the need to increase understanding of organizational and personal factors that influence the attitude and aptitude of each professional, with respect to evidence-based clinical practice. The aim of this study is to describe the transfer of knowledge into clinical practice in hospital units in Imbabura (Ecuador) identifying the obstacles to implementing evidence-based clinical practice validated questionnaire EBPQ-19. A cross-sectional observational study was conducted in hospitals of the Ministry of Public Health of Imbabura of Ecuador took place, including a total of 281 nurses and physicians. Nurses and physicians showed positive attitudes toward evidence-based clinical practice (EBCP) and their use to support clinical decision-making. This research evidences perceptions of professionals on strategies for knowledge transfer and obstacles to carry it out. Significant differences between the perception of the use of EBCP strategies between nurses and physicians are observed. Physicians consider they use them frequently, while nurses acknowledge using them less (chi-square: 105.254, P=.018). In conclusion, we can say that these factors should be considered as necessary to improve the quality of care that is provided to users based on the best available evidence. It is necessary to start developing change interventions in this regard to remedy the current situation of clinical practice based not on evidence, but rather on experience only. Experimental studies demonstrating the effectiveness of strategies to eliminate barriers to scientific evidence-based clinical practice should be conducted. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  14. Cultural Capital during Migration—A Multi-level Approach for the Empirical Analysis of the Labor Market Integration of Highly Skilled Migrants

    Directory of Open Access Journals (Sweden)

    Arnd-Michael Nohl


    Full Text Available The integration of highly qualified migrants into the labor market can be an opportunity for knowledge societies because their prosperity depends on the incorporation and improvement of cultural capital. In this paper we present a qualitative research approach with which we analyze on several levels how migrants make use of their cultural capital during their entry into the labor market: in addition to the biographical experience of migrants we analyze how this experience is embedded in milieus, social networks and self-organizations (meso-level and structured by the macro-level of judicial regulations of immigration and labor market policies. Our empirical analysis is focused by the assumed importance of educational qualification and residence status during entry into the labor market. Four different groups of empirical cases, which differ with respect to the level of education, the place of its acquisition (at home or abroad as well as to their residence status, are compared to each other. In order to study the contingencies of meso and macro-social contexts, labor-market integration will be examined in the context of Germany as well as in Canada, Great Britain and Turkey. URN: urn:nbn:de:0114-fqs0603143

  15. 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


    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

  16. A structured process to develop scenarios for use in evaluation of an evidence-based approach in clinical decision making. (United States)

    Manns, Patricia J; Darrah, Johanna


    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. 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. 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. 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.

  17. A Multi Level Approach to Social Capital

    NARCIS (Netherlands)

    Beugelsdijk, S.


    The concept of social capital serves as a structural hole in the landscape of scholarly disciplines in social science. This article argues that the unifying strength of the concept is based mainly upon the semantics of trust and networks and is, therefore, superficial, and that various levels of

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


    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

  19. Information literacy as the foundation for evidence-based practice in graduate nursing education: a curriculum-integrated approach. (United States)

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


    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: 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.

  20. Mathematical model comparing of the multi-level economics systems (United States)

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


    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.

  1. 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


    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......-based approach was explored for the treatment of HS. The diagnosis of HS should be made by a dermatologist or other healthcare professional with expert knowledge in HS. All patients should be offered adjuvant therapy as needed (pain management, weight loss, tobacco cessation, treatment of super infections...

  2. Meta-analysis as the core of evidence-based behavioral medicine: tools and pitfalls of a statistical approach. (United States)

    Nestoriuc, Yvonne; Kriston, Levente; Rief, Winfried


    Meta-analyses have a significant impact on clinical decision-making. In behavioral medicine, they are regularly used to derive clinical practice guidelines. Owing to an increasing complexity of data integration methods used, their interpretation has become a challenge to clinicians and researchers. This review aims to provide an accessible introduction to recent advances in the methodology and reporting style of quantitative reviews within the field of behavioral medicine. Meta-analytical findings are sensitive to the precise methods used. State-of-the-art criteria for reporting of clinical trials and meta-analyses have been put forward. Further adaptations of these criteria result from recent meta-analyses of the placebo effect in clinical trials. There is a need to carefully develop and evaluate methods to deal with patient dropout and missing data. Useful methods to evaluate diagnostic test accuracy and meta-analytically evaluate direct and indirect treatment comparisons have recently been developed. In the interdisciplinary field of behavioral medicine, meta-analyses are applied to evaluate interventions, diagnostic instruments, and procedures, and to derive evidence-based treatment recommendations. Criteria to improve reporting quality and methods to control for potential biases have been adapted to meet the requirements of research in behavioral medicine today.

  3. NIAAA's Rapid Response to College Drinking Problems Initiative: Reinforcing the Use of Evidence-Based Approaches in College Alcohol Prevention* (United States)

    DeJong, William; Larimer, Mary E.; Wood, Mark D.; Hartman, Roger


    Objective: The National Institute on Alcohol Abuse and Alcoholism (NIAAA) created the Rapid Response to College Drinking Problems initiative so that senior college administrators facing an alcohol-related crisis could get assistance from well-established alcohol researchers and NIAAA staff. Method: Based on a competitive grant process, NIAAA selected five teams of research scientists with expertise in college drinking research. NIAAA then invited college administrators to propose interventions to address a recently experienced alcohol-related problem. Between September 2004 and September 2005, NIAAA selected 15 sites and paired each recipient college with a scientific team. Together, each program development/evaluation team, working closely with NIAAA scientific staff, jointly designed, implemented, and evaluated a Rapid Response project. Results: This supplement reports the results of several Rapid Response projects, plus other findings of interest that emerged from that research. Eight articles present evaluation findings for prevention and treatment interventions, which can be grouped by the individual, group/interpersonal, institutional, and community levels of the social ecological framework. Additional studies provide further insights that can inform prevention and treatment programs designed to reduce alcohol-related problems among college students. This article provides an overview of these findings, placing them in the context of the college drinking intervention literature. Conclusions: College drinking remains a daunting problem on many campuses, but evidence-based strategies—such as those described in this supplement—provide hope that more effective solutions can be found. The Rapid Response initiative has helped solidify the necessary link between research and practice in college alcohol prevention and treatment. PMID:19538907

  4. Distinguishing benign from malignant mesothelial cells in effusions by Glut-1, EMA, and Desmin expression: an evidence-based approach. (United States)

    Kuperman, Michael; Florence, Roxanne R; Pantanowitz, Liron; Visintainer, Paul F; Cibas, Edmund S; Otis, Christopher N


    Distinguishing malignant mesothelioma (MM) from reactive mesothelial hyperplasia (RM) may be difficult in effusions. This study tested the hypothesis that immunocytochemistry (IC) in effusion cell blocks (CB) can distinguish MM from RM and that the results may be applied to individual specimens. External validation of a risk score (RS) model associating sensitivity and specificity was applied to an external set of MM and RM specimens from a separate institution. Forty three effusion cytology CBs of 25 confirmed malignant mesotheliomas were compared to CBs of 23 benign mesothelial effusions without inflammation and 13 reactive mesothelial proliferations associated with inflammation. Glut-1, EMA, and Desmin expression were evaluated by immunocytochemistry on CBs. Each antibody was compared using ROC values, where the area under the curve (AUC) was 0.90, 0.82, and 0.84 for Glut-1, EMA, and Desmin, respectively. Logistic regression (LR) analysis was applied to a combination of Glut-1 and EMA. A combined ROC curve was modeled for Glut-1 and EMA (AUC = 0.93). A RS = 2 × (Glut-1%) + 1 × (EMA%) was created from this ROC curve. When applied to an external set of MM and RM, the RS resulted in an ROC with AUC = 0.91. In conclusion, a RS derived from a LR of Glut-1 and EMA IC greatly improves the distinction between MM from RM cells in individual effusions. The study illustrates principles of evidence-based pathology concerning internal and external test performance in the differential diagnosis of MM versus RM. Copyright © 2011 Wiley Periodicals, Inc.

  5. An introduction to an evidence-based approach to interventional techniques in the management of chronic spinal pain. (United States)

    Manchikanti, Laxmaiah; Singh, Vijay; Helm, Standiford; Schultz, David M; Datta, Sukdeb; Hirsch, Joshua A


    patient expectations reasonably, and form the basis of a therapeutic partnership between the patient, the provider, and payors. The ASIPP guidelines are based on evidence-based medicine (EBM). EBM is in turn based on 4 basic contingencies: the recognition of the patient's problem and the construction of a structured clinical question; the ability to efficiently and effectively search the medical literature to retrieve the best available evidence to answer the clinical question; clinical appraisal of the evidence; and integration of the evidence with all aspects of the individual patient's decision-making to determine the best clinical care of the patient. Evidence synthesis for guidelines includes the review of all relevant systematic reviews and individual articles, grading them for relevance, methodologic quality, consistency, and recommendations.

  6. 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 (United States)

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


    We report here simultaneous experimental observation of Electromagnetically Induced Transparency (EIT) and Electromagnetically Induced Absorption (EIA) in a multi-level V-type system in D2 transition of 87Rb, 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.

  7. Recovery entails bridging the multiple realms of best practice: towards a more integrated approach to evidence-based clinical treatment and psychosocial disability support for mental health recovery. (United States)

    Rosen, A; O'Halloran, P


    While mental health recovery is a very personal process, the approach also offers possibilities as a meta-framework for improving quality of services to support people with severe and enduring mental illness. This paper explores how a recovery paradigm offers opportunities to better understand how efforts within the personal, clinical, and psychosocial disability domains of well-being relate and need bridging and integration with an evidence-based framework of practice to optimise outcomes. Recovery from a severe and persisting mental illness such as schizophrenia is optimised by a holistic approach integrating the domains of clinical treatment and psychosocial rehabilitation with the personal efforts of individuals. For service providers, a monolithic or single paradigm approach with an exclusive or predominant biological, psychological, social, or cultural focus is unable to offer effective guidance on the treatment and rehabilitation support needed to enable community participation and ameliorate the impact which problems associated with mental illness have on individuals, their families, and their wider communities. Moreover, recovery-oriented services need to be effective, embracing evidence-based policy, practice and service delivery by providing treatment and support which actually work to improve outcomes for consumers and families.

  8. Evidence based practice

    DEFF Research Database (Denmark)

    Hjørland, Birger


    Evidence-based practice (EBP) is an influential interdisciplinary movement that originated in medicine as evidence-based medicine (EBM) about 1992. EBP is of considerable interest to library and information science (LIS) because it focuses on a thorough documentation of the basis for the decision...

  9. The ABCs of CBT (Cognitive Behavior Therapy): Evidence-Based Approaches to Child Anxiety in Public School Settings (United States)

    Miller, Lynn D.; Short, Christina; Garland, E. Jane; Clark, Sandra


    This study evaluated a locally developed cognitive behavior therapy (CBT) intervention program in a public elementary school. In the prevention approach, 118 children were randomly assigned either to an 8-week intervention or to a wait-list control. Results of statistical analysis indicated that the manualized CBT intervention did not reduce…

  10. Commons in a Multi-level World

    Directory of Open Access Journals (Sweden)

    Fikret Berkes


    Full Text Available This special issue of the International Journal of the Commons considers a variety of conceptual perspectives and lessons from cases to deal with the problems of a globalized, multi-level world. It aims to contribute to extending and elaborating commons theory; understanding the issue of scale and institutional linkages; and understanding multi-level governance of a commons with state, private and civil society actors. The issue is based largely on papers presented at the 2006 Biennial Conference of IASC in Bali, Indonesia. Papers investigate partnerships, networks, and cross-scale institutional linkages in commons management, using a grassroots perspective, while taking into account multi-level governance. The issue includes both conceptual and case study papers (and those combining the two, providing examples from a range of geographical areas and resource types, and using interdisciplinary perspectives, in keeping with IASC ideals.

  11. Evidence-based dermatology

    Directory of Open Access Journals (Sweden)

    Ching-Chi Chi


    Full Text Available Evidence-based medicine (EBM has become a hot topic in medical practice, education, and research. However, a large number of senior doctors did not have an opportunity to learn EBM in medical schools. Firstly, this article addresses the history of EBM and the principle of practicing EBM, i.e., asking, acquiring, appraisal, application, and auditing. Secondly, this article also provides a brief introduction to evidence-based dermatology and compares the introduction of clinical practice guidelines between Europe, the UK, and the US. Finally, this article addresses the present condition and future perspective of evidence-based dermatology in Taiwan.

  12. Evidence based medicine and surgical approaches for colon cancer: evidences, benefits and limitations of the laparoscopic vs open resection. (United States)

    Lorenzon, Laura; La Torre, Marco; Ziparo, Vincenzo; Montebelli, Francesco; Mercantini, Paolo; Balducci, Genoveffa; Ferri, Mario


    To report a meta-analysis of the studies that compared the laparoscopic with the open approach for colon cancer resection. Forty-seven manuscripts were reviewed, 33 of which employed for meta-analysis according to the PRISMA guidelines. The results were differentiated according to the study design (prospective randomized trials vs case-control series) and according to the tumor's location. Outcome measures included: (1) short-term results (operating times, blood losses, bowel function recovery, post-operative pain, return to the oral intake, complications and hospital stay); (2) oncological adequateness (number of nodes harvested in the surgical specimens); and (3) long-term results (including the survivals' rates and incidence of incisional hernias) and (4) costs. Meta-analysis of trials provided evidences in support of the laparoscopic procedures for a several short-term outcomes including: a lower blood loss, an earlier recovery of the bowel function, an earlier return to the oral intake, a shorter hospital stay and a lower morbidity rate. Opposite the operating time has been confirmed shorter in open surgery. The same trend has been reported investigating case-control series and cancer by sites, even though there are some concerns regarding the power of the studies in this latter field due to the small number of trials and the small sample of patients enrolled. The two approaches were comparable regarding the mean number of nodes harvested and long-term results, even though these variables were documented reviewing the literature but were not computable for meta-analysis. The analysis of the costs documented lower costs for the open surgery, however just few studies investigated the incidence of post-operative hernias. Laparoscopy is superior for the majority of short-term results. Future studies should better differentiate these approaches on the basis of tumors' location and the post-operative hernias.

  13. An intergenerational approach in promoting balance and strength for fall prevention: evidence-based or evidence-inspired? (United States)

    Burtscher, Martin; Kopp, Martin


    Recently, Granacher et al. (2010) proposed an intergenerational approach to promoting balance and strength for fall prevention in children and elderly subjects together. Although this sounds like a stimulating idea, its effectiveness for fall prevention in both groups has yet to be demonstrated. Undoubtedly, fall prevention remains a big challenge to scientists and health professionals. The idea of implementing prevention programs on an intergenerational basis will probably have to undergo a complex and long-lasting evaluation process before a firm conclusion about its effectiveness can be made. Copyright © 2010 S. Karger AG, Basel.

  14. A Unified Framework for Multi-level Processing of Complex Data (United States)


    other than abstracts): 6.00 1 Invited Speaker, two lectures: "Multi-level methods for image inpainting " and "Manifold approach to high-dimensional data...34 University of Messina, Sicily, Italy, July 10, 2012. 3. Invited Speaker, ``Multi-level methods for image inpainting ,’’ Università degli Studi

  15. Alphabet Strategy for diabetes care: A multi-professional, evidence-based, outcome-directed approach to management. (United States)

    Lee, James D; Saravanan, Ponnusamy; Patel, Vinod


    With the rising global prevalence in diabetes, healthcare systems are facing a growing challenge to provide efficient and effective diabetes care management in the face of spiralling treatment costs. Diabetes is a major cause of premature mortality and associated with devastating complications especially if managed poorly. Although diabetes care is improving in England and Wales, recent audit data suggests care remains imperfect with wide geographical variations in quality. Diabetes care is expensive with a sizeable amount of available expenditure used for treating the complications of diabetes. A target driven, long-term, multifactorial intervention in patients with type 2 diabetes has been shown to reduce mortality and morbidity. The alphabet strategy is a novel approach to effective diabetes care provision, aiming to address patient education and empowerment, provide consistent comprehensive care delivered in a timely fashion, and allowing multidisciplinary team work.

  16. Evidence-Based Development

    DEFF Research Database (Denmark)

    Hertzum, Morten; Simonsen, Jesper


    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...... and electronic patient records for diabetes patients, this paper reports research in progress regarding the prospects and pitfalls of evidence-based development....

  17. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue. (United States)

    Schwartz, Joseph; Winters, Jeffrey L; Padmanabhan, Anand; Balogun, Rasheed A; Delaney, Meghan; Linenberger, Michael L; Szczepiorkowski, Zbigniew M; Williams, Mark E; Wu, Yanyun; Shaz, Beth H


    The American Society for Apheresis (ASFA) JCA Special Issue Writing Committee is charged with reviewing, updating and categorizating indications for therapeutic apheresis. Beginning with the 2007 ASFA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approach in the grading and categorization of indications. This Sixth Edition of the ASFA Special Issue has further improved the process of using evidence-based medicine in the recommendations by consistently applying the category and GRADE system definitions, but eliminating the "level of evidence" criteria (from the University HealthCare Consortium) utilized in prior editions given redundancy between GRADE and University HealthCare Consortium systems. The general layout and concept of a fact sheet that was utilized in the Fourth and Fifth Editions, has been largely maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. This article consists of 78 fact sheets (increased from 2010) for therapeutic indications in ASFA categories I through IV, with many diseases categorized having multiple clinical presentations/situations which are individually graded and categorized. Copyright © 2013 Wiley Periodicals, Inc.

  18. Strengthening management and leadership practices to increase health-service delivery in Kenya: an evidence-based approach

    Directory of Open Access Journals (Sweden)

    Seims La Rue K


    Full Text Available Abstract Background The purpose of the study was to test the hypothesis that strengthening health systems, through improved leadership and management skills of health teams, can contribute to an increase in health-service delivery outcomes. The study was conducted in six provinces in the Republic of Kenya. Methods The study used a non-randomized design comparing measures of key service delivery indicators addressed by health teams receiving leadership and management training (the intervention against measures in comparison areas not receiving the intervention. Measurements were taken at three time periods: baseline, endline, and approximately six months post intervention. At the district level, health-service coverage was computed. At the facility level, the percentage change in the number of client visits was computed. The t-test was used to test for significance. Results Results showed significant increases in health-service coverage at the district level (p = P  Conclusions Strengthening the leadership and management skills of health teams, through team-based approaches focused on selected challenges, contributed to improved health service delivery outcomes and these improvements were sustained at least for six months.

  19. A practical approach to evidence-based dentistry: VIII: How to appraise an article based on a qualitative study. (United States)

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


    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.

  20. 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


    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.

  1. Review of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: an evidence-based approach to diagnosis and management by clinicians. (United States)

    Bested, Alison C; Marshall, Lynn M


    This review was written from the viewpoint of the treating clinician to educate health care professionals and the public about Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). It includes: the clinical definition of ME/CFS with emphasis on how to diagnose ME/CFS; the etiology, pathophysiology, management approach, long-term prognosis and economic cost of ME/CFS. After reading this review, you will be better able to diagnose and treat your patients with ME/CFS using the tools and information provided. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, chronic medical condition characterized by symptom clusters that include: pathological fatigue and malaise that is worse after exertion, cognitive dysfunction, immune dysfunction, unrefreshing sleep, pain, autonomic dysfunction, neuroendocrine and immune symptoms. ME/CFS is common, often severely disabling and costly. The Institute of Medicine (IOM) reviewed the ME/CFS literature and estimates that between 836,000 and 2.5 million Americans have ME/CFS at a cost of between 17 and 24 billion dollars annually in the US. The IOM suggested a new name for ME/CFS and called it Systemic Exertion Intolerance Disease (SEID). SEID's diagnostic criteria are less specific and do not exclude psychiatric disorders in the criteria. The 2010 Canadian Community Health Survey discovered that 29% of patients with ME/CFS had unmet health care needs and 20% had food insecurity--lack of access to sufficient healthy foods. ME/CFS can be severely disabling and cause patients to be bedridden. Yet most patients (80%) struggle to get a diagnosis because doctors have not been taught how to diagnose or treat ME/CFS in medical schools or in their post-graduate educational training. Consequently, the patients with ME/CFS suffer. They are not diagnosed with ME/CFS and are not treated accordingly. Instead of compassionate care from their doctors, they are often ridiculed by the very people from whom they seek help

  2. Evidence-based evolution of an integrated nutrition-focused agriculture approach to address the underlying determinants of stunting. (United States)

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


    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.

  3. 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. (United States)

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


    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.

  4. Involving consumers in research and development agenda setting for the NHS: developing an evidence-based approach. (United States)

    Oliver, S; Clarke-Jones, L; Rees, R; Milne, R; Buchanan, P; Gabbay, J; Gyte, G; Oakley, A; Stein, K


    drawn from individual reports and comparative analyses. Productive methods for involving consumers require appropriate skills, resources and time to develop and follow appropriate working practices. The more that consumers are involved in determining how this is to be done, the more research programmes will learn from consumers and about how to work with them. Further success might be expected if research programmes embarking on collaborations approach well-networked consumers and provide them with information, resources and support to empower them in key roles for consulting their peers and prioritising topics. To be worthwhile, consultations should engage consumer groups directly and repeatedly in facilitated debate; when discussing health services research, more resources and time are required if consumers are drawn from groups whose main focus of interest is not health. These barriers can largely be overcome with good leadership, purposeful outreach to consumers, investing time and effort in good communication, training and support and thereby building good working relationships and building on experience. Organised consumer groups capable of identifying research priorities also need to find ways of introducing their ideas into research programmes. Further research is suggested to develop and evaluate different training methods, information and education and other support for consumers and those wishing to involve them; to address the barriers to consumers' ideas influencing research agendas; and to carry out prospective comparative studies of different methods for involving consumers. Research about collective decision-making would also be further advanced by addressing the processes and outcomes of consensus development that involves consumers.

  5. 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


    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.

  6. How to prepare a systematic review of economic evaluations for informing evidence-based healthcare decisions: a five-step approach (part 1/3). (United States)

    van Mastrigt, Ghislaine A P G; Hiligsmann, Mickaël; Arts, Jacobus J C; Broos, Pieter H; Kleijnen, Jos; Evers, Silvia M A A; Majoie, Marian H J M


    Systematic reviews of economic evaluations are useful for synthesizing economic evidence about health interventions and for informing evidence-based decisions. Areas covered: As there is no detailed description of the methods for performing a systematic review of economic evidence, this paper aims to provide an overview of state-of-the-art methodology. This is laid out in a 5-step approach, as follows: step 1) initiating a systematic review; step 2) identifying (full) economic evaluations; step 3) data extraction, risk of bias and transferability assessment; step 4) reporting results; step 5) discussion and interpretation of findings. Expert commentary: The paper aims to help inexperienced reviewers and clinical practice guideline developers, but also to be a resource for experts in the field who want to check on current methodological developments.

  7. New curricular design in biostatistics to prepare residents for an evidence-based practice and lifelong learning education: a pilot approach. (United States)

    Arias, A; Peters, O A; Broyles, I L


    To develop, implement and evaluate an innovative curriculum in biostatistics in response to the need to foster critical thinking in graduate healthcare education for evidence-based practice and lifelong learning education. The curriculum was designed for first-year residents in a postgraduate endodontic programme using a six-step approach to curriculum development to provide sufficient understanding to critically evaluate biomedical publications, to design the best research strategy to address a specific problem and to analyse data by appropriate statistical test selection. Multiple learner-centred instructional methods and formative and summative assessments (written tasks, simulation exercises, portfolios and pre-post knowledge tests) were used to accomplish the learning outcomes. The analysis of the achievement of the group of students and a satisfaction survey for further feedback provided to the residents at the end of the curriculum were used for curriculum evaluation. All residents demonstrated competency at the end of the curriculum. The correct answer rate changed from 36.9% in the pre-test to 79.8% in the post-test. No common errors were detected in the rest of the assessment activities. All participants completed the questionnaire demonstrating high satisfaction for each independent category and with the overall educational programme, instruction and course in general. The curriculum was validated by the assessment of students' performance and a satisfaction survey, offering an example of a practical approach to the teaching of statistics to prepare students for a successful evidence-based endodontic practice and lifelong learning education as practicing clinicians. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  8. Evidence-based Medicine versus the Conventional Approach to Journal Club Sessions: Which One Is More Successful in Teaching Critical Appraisal Skills? (United States)

    Alavi-Moghaddam, Mostafa; Yazdani, Shahram; Mortazavi, Fathie; Chichi, Samira; Hosseini-Zijoud, Seyed-Mostafa


    This study aimed to compare evidence-based medicine (EBM) vs. conventional approaches to journal club sessions in teaching critical appraisal skills in reading papers by emergency medicine residents. This double cut off discontinuation regression quasi-experimental study was conducted among emergency medicine residents. EBM vs. the conventional approach were applied to teach critical appraisal skills for half of the residents as an experimental group and another half as a control group respectively. Both groups participated in one hour monthly journal club sessions for six months. Before and after the study, all participants were examined by two tests: the Fresno Test (FT) [to evaluate their knowledge about EBM] and the Critical Appraisal Skills Test (CAST) [to evaluate their competency with critical appraisal skills]. The allocation of the participants into the experimental or control groups was according to their CAST scores before the study. 50 emergency medicine residents participated. After the study, the scores of both groups in the FT and CAST significantly improved (pevidence-based medicine approach in journal club sessions was comparatively more advantageous compared to the conventional approach in teaching critical appraisal skills for reading papers among the residents of emergency medicine.

  9. Evidence-based radiography

    Energy Technology Data Exchange (ETDEWEB)

    Hafslund, Bjorg [Institute of Radiography, Faculty of Health and Social Sciences, Bergen University College, P.O. Box 7030, N-5020 Bergen (Norway)], E-mail:; Clare, Judith; Graverholt, Birgitte; Wammen Nortvedt, Monica [Centre for Evidence Based Practice, Faculty of Health and Social Sciences, Bergen University College, Bergen (Norway)


    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.

  10. "GIS, Biostatistics, meteo, m-health and e-health approaches for tailored informed evidence-based agricultural, environment and health interventions in Rwanda" (United States)

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


    " 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

  11. "Championing GIS, Biostatistics, meteo, m-health and e-health approaches for tailored informed evidence-based agricultural, environment and health interventions in Rwanda" (United States)

    Karame, P., Sr.


    "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

  12. Evidence-based management reconsidered. (United States)

    Kovner, Anthony R; Rundall, Thomas G


    Reports of medical mistakes have splashed across newspapers and magazines in the United States. At the same time, instances of overuse, underuse, and misuse of management tactics and strategies receive far less attention. The sense of urgency associated with improving the quality of medical care does not exist with respect to improving the quality of management decision making. A more evidence-based approach would improve the competence of the decision-makers and their motivation to use more scientific methods when making a decision. The authors of this article consider a study of 68 U.S. health services managers that found a low level of evidence-based management behaviors. From the findings, four strategies are suggested to increase health systems managers' use of research evidence to improve decision making: focusing evidence-based decision making on strategically important issues, developing committees and other structures to diffuse management research throughout the organization, building a management culture that values research, and training managers in the competencies required to apply research evidence to health services management decisions. To aid the manager in understanding and applying an evidenced-based approach to decision making, the article provides practical tools, techniques, and resources for immediate use.

  13. Evidence-based playground design

    DEFF Research Database (Denmark)

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


    This paper develops, explores and evaluates an evidence-based approach to playground design, with a public park playground (playlab Cph) in Copenhagen as a case study. In the increasingly urbanised world, park playgrounds are valuable places that support healthy child development by providing...... opportunities for play, nature exploration and sensory stimulation. As it is increasingly expected that designers base their decisions on research evidence, there is a need to develop approaches to facilitate this, which also applies to playground design. The design of PlayLab Cph was based on relevant evidence...

  14. A real-world approach to Evidence-Based Medicine in general practice: a competency framework derived from a systematic review and Delphi process. (United States)

    Galbraith, Kevin; Ward, Alison; Heneghan, Carl


    Evidence-Based Medicine (EBM) skills have been included in general practice curricula and competency frameworks. However, GPs experience numerous barriers to developing and maintaining EBM skills, and some GPs feel the EBM movement misunderstands, and threatens their traditional role. We therefore need a new approach that acknowledges the constraints encountered in real-world general practice. The aim of this study was to synthesise from empirical research a real-world EBM competency framework for general practice, which could be applied in training, in the individual pursuit of continuing professional development, and in routine care. We sought to integrate evidence from the literature with evidence derived from the opinions of experts in the fields of general practice and EBM. We synthesised two sets of themes describing the meaning of EBM in general practice. One set of themes was derived from a mixed-methods systematic review of the literature; the other set was derived from the further development of those themes using a Delphi process among a panel of EBM and general practice experts. From these two sets of themes we constructed a real-world EBM competency framework for general practice. A simple competency framework was constructed, that acknowledges the constraints of real-world general practice: (1) mindfulness - in one's approach towards EBM itself, and to the influences on decision-making; (2) pragmatism - in one's approach to finding and evaluating evidence; and (3) knowledge of the patient - as the most useful resource in effective communication of evidence. We present a clinical scenario to illustrate how a GP might demonstrate these competencies in their routine daily work. We have proposed a real-world EBM competency framework for general practice, derived from empirical research, which acknowledges the constraints encountered in modern general practice. Further validation of these competencies is required, both as an educational resource and as a

  15. Frullania knightbridgei, a new liverwort (Frullaniaceae, Marchantiophyta) species from the deep south of Aotearoa-New Zealand based on an integrated evidence-based approach (United States)

    von Konrat, Matt; de Lange, Peter; Greif, Matt; Strozier, Lynika; Hentschel, Jörn; Heinrichs, Jochen


    Abstract Frullania is a large and taxonomically complex genus. A new liverwort species, Frullania knightbridgei sp. nov. from southern New Zealand, is described and illustrated. The new species, and its placement in Frullania subg. Microfrullania, is based on an integrated evidence-based approach derived from morphology, ecology, experimental growth studies of plasticity, as well as sequence data. Diagnostic characters associated with the leaf and lobule cell-wall anatomy, oil bodies, and spore ultra-structure distinguish it from all other New Zealand species of Frullania. A critical comparison is also made between Frullania knightbridgei and morphologically allied species of botanical regions outside the New Zealand region and an artificial key is provided. The new species is similar to some forms of the widespread Australasian species, Frullania rostrata, but has unique characters associated with the lobule and oil bodies. Frullania knightbridgei is remarkably interesting in comparison with the majority of Frullania species, and indeed liverworts in general, in that it is at least partially halotolerant. Maximum parsimony and maximum likelihood analyses of nuclear ribosomal ITS2 and plastidic trnL-trnF sequences from purported related speciesconfirms its independent taxonomic status and corroborates its placement within Frullania subg. Microfrullania. PMID:22287928

  16. An evidence-based approach to the prevention and initial management of skin tears within the aged community setting: a best practice implementation project. (United States)

    Beechey, Rebekah; Priest, Laura; Peters, Micah; Moloney, Clint


    Maintaining skin integrity in a community setting is an ongoing issue, as research suggests that the prevalence of skin tears within the community is greater than that in an institutional setting. While skin tear prevention and management principles in these settings are similar to those in an acute care setting, consideration of the environmental and psychological factors of the client is pivotal to prevention in a community setting. Evidence suggests that home environment assessment, education for clients and care givers, and being proactive in improving activities of daily living in a community setting can significantly reduce the risk of sustaining skin tears. The aim of this implementation project was to assess and review current skin tear prevention and management practices within the community setting, and from this, to implement an evidence-based approach in the education of clients and staff on the prevention of skin tears. As well. the project aims to implement evidence-based principles to guide clinical practice in relation to the initial management of skin tears, and to determine strategies to overcome barriers and non-compliance. The project utilized the Joanna Brigg's Institute Practical Application of Clinical Evidence System audit tool for promoting changes in the community health setting. The implementation of this particular project is based in a region within Anglicare Southern Queensland. A small team was established and a baseline audit carried out. From this, multiple strategies were implemented to address non-compliance which included education resources for clients and caregivers, staff education sessions, and creating skin integrity kits to enable staff members to tend to skin tears, and from this a follow-up audit undertaken. Baseline audit results were slightly varied, from good to low compliance. From this, the need for staff and client education was highlighted. There were many improvements in the audit criteria following client and

  17. Testing Interventions to Motivate and Educate (TIME: A multi-level intervention to improve colorectal cancer screening

    Directory of Open Access Journals (Sweden)

    Jessica L. Krok-Schoen


    Conclusion: The multi-level intervention was not effective in increasing CRC screening among participants who needed a test, perhaps due to low participation of patients in the stepped intervention. Future studies utilizing evidence-based strategies to encourage CRC screening are needed.

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

    Carrie, Rachael; Dixon, Alan


    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.



    Indriani, Ririn Dewanti Dian Samudera; Sari, Merah Purnama


    Employee performance is very influential to the success of a company, especially a company based in the field of multi-level marketing (MLM) in which a person in demand hard to be able to use their emotional intelligence in order to get satisfactory results for their customers.The purpose of this study to determine the relationship of emotional intelligence with performance on the distributor of multi level marketing (MLM). This study used a quantitative approach. The variables of this study ...

  20. Perspectives on Multi-Level Dynamics

    CERN Document Server

    Atay, Fatihcan M; Blanchard, Philippe; Cessac, Bruno; Olbrich, Eckehard; Volchenkov, Dima


    As Physics did in previous centuries, there is currently a common dream of extracting generic laws of nature in economics, sociology, neuroscience, by focalising the description of phenomena to a minimal set of variables and parameters, linked together by causal equations of evolution whose structure may reveal hidden principles. This requires a huge reduction of dimensionality (number of degrees of freedom) and a change in the level of description. Beyond the mere necessity of developing accurate techniques affording this reduction, there is the question of the correspondence between the initial system and the reduced one. In this paper, we offer a perspective towards a common framework for discussing and understanding multi-level systems exhibiting structures at various spatial and temporal levels. We propose a common foundation and illustrate it with examples from different fields. We also point out the difficulties in constructing such a general setting and its limitations.

  1. Multi-level coupled cluster theory

    Energy Technology Data Exchange (ETDEWEB)

    Myhre, Rolf H.; Koch, Henrik, E-mail: [Department of Chemistry, Norwegian University of Science and Technology, 7491 Trondheim (Norway); Department of Chemistry and the PULSE Institute, Stanford University, Stanford, California 94305 (United States); Sánchez de Merás, Alfredo M. J. [Institute of Molecular Science, University of Valencia, ES-46980 Paterna, Valencia (Spain)


    We present a general formalism where different levels of coupled cluster theory can be applied to different parts of the molecular system. The system is partitioned into subsystems by Cholesky decomposition of the one-electron Hartree-Fock density matrix. In this way the system can be divided across chemical bonds without discontinuities arising. The coupled cluster wave function is defined in terms of cluster operators for each part and these are determined from a set of coupled equations. The total wave function fulfills the Pauli-principle across all borders and levels of electron correlation. We develop the associated response theory for this multi-level coupled cluster theory and present proof of principle applications. The formalism is an essential tool in order to obtain size-intensive complexity in the calculation of local molecular properties.

  2. A Knowledge-Modeling Approach to Integrate Multiple Clinical Practice Guidelines to Provide Evidence-Based Clinical Decision Support for Managing Comorbid Conditions. (United States)

    Abidi, Samina


    Clinical management of comorbidities is a challenge, especially in a clinical decision support setting, as it requires the safe and efficient reconciliation of multiple disease-specific clinical procedures to formulate a comorbid therapeutic plan that is both effective and safe for the patient. In this paper we pursue the integration of multiple disease-specific Clinical Practice Guidelines (CPG) in order to manage co-morbidities within a computerized Clinical Decision Support System (CDSS). We present a CPG integration framework-termed as COMET (Comorbidity Ontological Modeling & ExecuTion) that manifests a knowledge management approach to model, computerize and integrate multiple CPG to yield a comorbid CPG knowledge model that upon execution can provide evidence-based recommendations for handling comorbid patients. COMET exploits semantic web technologies to achieve (a) CPG knowledge synthesis to translate a paper-based CPG to disease-specific clinical pathways (CP) that include specialized co-morbidity management procedures based on input from domain experts; (b) CPG knowledge modeling to computerize the disease-specific CP using a Comorbidity CPG ontology; (c) CPG knowledge integration by aligning multiple ontologically-modeled CP to develop a unified comorbid CPG knowledge model; and (e) CPG knowledge execution using reasoning engines to derive CPG-mediated recommendations for managing patients with comorbidities. We present a web-accessible COMET CDSS that provides family physicians with CPG-mediated comorbidity decision support to manage Atrial Fibrillation and Chronic Heart Failure. We present our qualitative and quantitative analysis of the knowledge content and usability of COMET CDSS.

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

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


    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.

  4. There are big gaps in our knowledge, and thus approach, to zoo animal welfare: a case for evidence-based zoo animal management. (United States)

    Melfi, V A


    There are gaps in knowledge that hinder our ability within zoos to provide good animal welfare. This does not mean that zoos cannot or do not provide good welfare, only that currently this goal is hindered. Three reasons for these gaps are identified as: (1) there is an emphasis on the identification and monitoring of indicators that represent poor welfare and it is assumed that an absence of poor welfare equates to good welfare. This assumption is overly simplistic and potentially erroneous; (2) our understanding of how housing and husbandry (H&H) affects animals is limited to a small set of variables determined mostly by our anthropogenic sensitivities. Thus, we place more value on captive environmental variables like space and companionship, ignoring other factors that may have a greater impact on welfare, like climate; (3) finally, whether intentional or not, our knowledge and efforts to improve zoo animal welfare are biased to very few taxa. Most attention has been focused on mammals, notably primates, large cats, bears, and elephants, to the exclusion of the other numerous species about which very little is known. Unfortunately, the extent to which these gaps limit our ability to provide zoo animals with good welfare is exacerbated by our over reliance on using myth and tradition to determine zoo animal management. I suggest that we can fill these gaps in our knowledge and improve our ability to provide zoo animals with good welfare through the adoption of an evidence-based zoo animal management framework. This approach uses evidence gathered from different sources as a basis for making any management decisions, as good quality evidence increases the likelihood that these decisions result in good zoo animal welfare.

  5. 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)


    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.)

  6. Constrained Multi-Level Algorithm for Trajectory Optimization (United States)

    Adimurthy, V.; Tandon, S. R.; Jessy, Antony; Kumar, C. Ravi

    The emphasis on low cost access to space inspired many recent developments in the methodology of trajectory optimization. Ref.1 uses a spectral patching method for optimization, where global orthogonal polynomials are used to describe the dynamical constraints. A two-tier approach of optimization is used in Ref.2 for a missile mid-course trajectory optimization. A hybrid analytical/numerical approach is described in Ref.3, where an initial analytical vacuum solution is taken and gradually atmospheric effects are introduced. Ref.4 emphasizes the fact that the nonlinear constraints which occur in the initial and middle portions of the trajectory behave very nonlinearly with respect the variables making the optimization very difficult to solve in the direct and indirect shooting methods. The problem is further made complex when different phases of the trajectory have different objectives of optimization and also have different path constraints. Such problems can be effectively addressed by multi-level optimization. In the multi-level methods reported so far, optimization is first done in identified sub-level problems, where some coordination variables are kept fixed for global iteration. After all the sub optimizations are completed, higher-level optimization iteration with all the coordination and main variables is done. This is followed by further sub system optimizations with new coordination variables. This process is continued until convergence. In this paper we use a multi-level constrained optimization algorithm which avoids the repeated local sub system optimizations and which also removes the problem of non-linear sensitivity inherent in the single step approaches. Fall-zone constraints, structural load constraints and thermal constraints are considered. In this algorithm, there is only a single multi-level sequence of state and multiplier updates in a framework of an augmented Lagrangian. Han Tapia multiplier updates are used in view of their special role in

  7. 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


    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

  8. History of evidence-based medicine

    Directory of Open Access Journals (Sweden)

    Roger L Sur


    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.

  9. Evidence-based policy as reflexive practice. What can we learn from evidence-based medicine? (United States)

    Bal, Roland


    The call for evidence-based policy is often accompanied by rather uncritical references to the success of evidence-based medicine, leading to often unsuccessful translation attempts. In this paper, I reflect on the practice of evidence-based medicine in an attempt to sketch a more productive approach to translating evidence into the practice of policy making. Discussing three episodes in the history of evidence-based medicine - clinical trials, and the production and use of clinical guidelines - I conclude that the success of evidence-based medicine is based on the creation of reflexive practices in which evidence and practice can be combined productively. In the conclusion, I discuss the prospects of such a practice for evidence-based policy.

  10. 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. (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


    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.

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

    Maliken, Ashley C.; Katz, Lynn Fainsilber


    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…

  12. Sinus tarsi approach versus extensile lateral approach for displaced intra-articular calcaneal fracture: a meta-analysis of current evidence base. (United States)

    Yao, Hui; Liang, Tangzhao; Xu, Yichun; Hou, Gang; Lv, Lulu; Zhang, Junbin


    The extensile lateral approach (ELA) has been widely performed for displaced intra-articular calcaneal fractures (DIACFs), and wound complications remain a significant problem. As a minimal incision technique, the sinus tarsi approach (STA) was designed to overcome this disadvantage. There were already many reports about this approach but the conclusions were not completely consistent. Based on the current evidence, we performed this meta-analysis to compare the STA with ELA in the management of DIACF and expected to draw a certain and meaningful conclusion. All potentially relevant randomized controlled trials (RCTs) and cohort studies (CSs) were searched in the databases of PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and The desirable outcomes including wound complications, excellent and good rate, secondary surgery rate and Böhler's angle were extracted. RCT studies were assessed using the Risk of Bias Tool recommended by the Cochrane Collaboration, and cohort studies were evaluated using the Newcastle-Ottawa Scale. The data of RCTs and cohorts were pooled respectively using the fixed-effect model or random-effect model. Mean differences with 95% confidence intervals (CIs) were calculated for continuous data, and relative risks (RRs) with 95% CIs were calculated for dichotomous data. Statistical heterogeneity was assessed with the Q test and I 2 . Sensitivity analysis was developed to assess the reliability of pooled results. Seven studies including two RCTs and five CSs were eligible for the meta-analysis. No matter RCTs or CSs, the pooled data all showed that STA group had a lower incidence of wound complications than that in the ELA group and no significant difference was found in excellent and good rate and the recovery of Böhler's angle between the two groups. The CSs also showed that the STA group had a lower incidence of secondary surgeries than that in the ELA group. Through a STA, we not only can reduce

  13. Partnership for Healthier Asians: Disseminating Evidence-Based Practices in Asian-American Communities Using a Market-Oriented and Multilevel Approach. (United States)

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


    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

  14. Partnership for Healthier Asians: Disseminating Evidence-Based Practices in Asian-American Communities Using a Market-Oriented and Multilevel Approach (United States)

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


    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

  15. Corroborating evidence-based medicine. (United States)

    Mebius, Alexander


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

  16. Evidence-based care and the curriculum

    NARCIS (Netherlands)

    Winning, T.; Needleman, I.; Rohlin, M.; Carrassi, A.; Chadwick, B.; Eaton, K.; Hardwick, K.; Ivancakova, R.; Jallaludin, R.L.; Johnsen, D.; Kim, J.G.; Lekkas, D.; Li, D.; Onisei, D.; Pissiotis, A.; Reynolds, P.; Tonni, I.; Vanobbergen, J.; Vassileva, R.; Virtanen, J.; Wesselink, P.R.; Wilson, N.


    An evidence-based (EB) approach has been a significant driver in reforming healthcare over the past two decades. This change has extended across a broad range of health professions, including oral healthcare. A key element in achieving an EB approach to oral healthcare is educating our

  17. Considering health equity when moving from evidence-based guideline recommendations to implementation: a case study from an upper-middle income country on the GRADE approach. (United States)

    Eslava-Schmalbach, Javier; Mosquera, Paola; Alzate, Juan Pablo; Pottie, Kevin; Welch, Vivian; Akl, Elie A; Jull, Janet; Lang, Eddy; Katikireddi, Srinivasa Vittal; Morton, Rachel; Thabane, Lehana; Shea, Bev; Stein, Airton T; Singh, Jasvinder; Florez, Ivan D; Guyatt, Gordon; Schünemann, Holger; Tugwell, Peter


    The availability of evidence-based guidelines does not ensure their implementation and use in clinical practice or policy making. Inequities in health have been defined as those inequalities within or between populations that are avoidable, unnecessary and also unjust and unfair. Evidence-based clinical practice and public health guidelines ('guidelines') can be used to target health inequities experienced by disadvantaged populations, although guidelines may unintentionally increase health inequities. For this reason, there is a need for evidence-based clinical practice and public health guidelines to intentionally target health inequities experienced by disadvantaged populations. Current guideline development processes do not include steps for planned implementation of equity-focused guidelines. This article describes nine steps that provide guidance for consideration of equity during guideline implementation. A critical appraisal of the literature followed by a process to build expert consensus was undertaken to define how to include consideration of equity issues during the specific GRADE guideline development process. Using a case study from Colombia we describe nine steps that were used to implement equity-focused GRADE recommendations: (1) identification of disadvantaged groups, (2) quantification of current health inequities, (3) development of equity-sensitive recommendations, (4) identification of key actors for implementation of equity-focused recommendations, (5) identification of barriers and facilitators to the implementation of equity-focused recommendations, (6) development of an equity strategy to be included in the implementation plan, (7) assessment of resources and incentives, (8) development of a communication strategy to support an equity focus and (9) development of monitoring and evaluation strategies. This case study can be used as model for implementing clinical practice guidelines, taking into account equity issues during guideline

  18. Three essays on multi-level optimization models and applications (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

  19. Evidence-based clinical practice

    DEFF Research Database (Denmark)

    Gluud, Christian


    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....

  20. Evidence-based policy

    DEFF Research Database (Denmark)

    Vohnsen, Nina Holm


    A current ambition in welfare states as diverse as Denmark, the UK, and in the USA is to base political decision making on rigorous research (Cartwright et al 2009; Mulgan 2009; Bason 2010). Sound as this might seem the ambition has nevertheless been problematized by both policy-makers and the re......A current ambition in welfare states as diverse as Denmark, the UK, and in the USA is to base political decision making on rigorous research (Cartwright et al 2009; Mulgan 2009; Bason 2010). Sound as this might seem the ambition has nevertheless been problematized by both policy...... a full account, see Vohnsen 2011). These insights will be relevant for the anthropological researcher of legislative processes who wishes to move beyond a merely discursive approach to the study of policy and politics....

  1. Theory- and evidence-based Intervention

    DEFF Research Database (Denmark)

    Nissen, Poul


    In this paper, a model for assessment and intervention is presented. This model explains how to perform theory- and evidence-based as well as practice-based assessment and intervention. The assessment model applies a holistic approach to treatment planning which includes recognition...

  2. Multi-Level Models For Diagnosis Of Complex Electro-Mechanical Systems (United States)

    Smith, John A.; Biswas, Gautam


    This paper discusses a knowledge-based system for diagnostic problem solving based on a multi-level representational structure and associated reasoning methods. The motivation behind this approach is to combine shallow evidential models for fault diagnosis with deep qualitative models that derive behavior from structural descriptions. In addition, the reasoning scheme utilizes historical data based on past experience for diagnosis. Using this integrated framework, we concentrate on the following issues: (i) Multi-level knowledge based system design, and (ii) Reasoning systems that exploit the multi-level representational structure for diagnostic problem solving. This system is applied to the diagnosis of a complex electro-mechanical system, specifically, the upper cargo door of the DC-10 aircraft in use at Federal Express Corporation.

  3. Evidence-based periodontal therapy: An overview (United States)

    Vijayalakshmi, R.; Anitha, V.; Ramakrishnan, T.; Sudhakar, Uma


    Dentists need to make clinical decisions based on limited scientific evidence. In clinical practice, a clinician must weigh a myriad of evidences every day. The goal of evidence-based dentistry is to help practitioners provide their patients with optimal care. This is achieved by integrating sound research evidence with personal clinical expertise and patient values to determine the best course of treatment. Periodontology has a rich background of research and scholarship. Therefore, efficient use of this wealth of research data needs to be a part of periodontal practice. Evidence-based periodontology aims to facilitate such an approach and it offers a bridge from science to clinical practice. The clinician must integrate the evidence with patient preference, scientific knowledge, and personal experience. Most important, it allows us to care for our patients. Therefore, evidence-based periodontology is a tool to support decision-making and integrating the best evidence available with clinical practice. PMID:20142947

  4. Evidence-Based Medicine: Rhinoplasty. (United States)

    Lee, Matthew K; Most, Sam P


    Evidence-based medicine has become increasingly prominent in the climate of modern day healthcare. The practice of evidence-based medicine involves the integration of the best available evidence with clinical experience and expertise to help guide clinical decision-making. The essential tenets of evidence-based medicine can be applied to both functional and aesthetic rhinoplasty. Current outcome measures in functional and aesthetic rhinoplasty, including objective, subjective, and clinician-reported measures, is summarized and the current data is reviewed. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. 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. (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


    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

  6. Rule-based multi-level modeling of cell biological systems

    Directory of Open Access Journals (Sweden)

    Maus Carsten


    Full Text Available Abstract Background Proteins, individual cells, and cell populations denote different levels of an organizational hierarchy, each of which with its own dynamics. Multi-level modeling is concerned with describing a system at these different levels and relating their dynamics. Rule-based modeling has increasingly attracted attention due to enabling a concise and compact description of biochemical systems. In addition, it allows different methods for model analysis, since more than one semantics can be defined for the same syntax. Results Multi-level modeling implies the hierarchical nesting of model entities and explicit support for downward and upward causation between different levels. Concepts to support multi-level modeling in a rule-based language are identified. To those belong rule schemata, hierarchical nesting of species, assigning attributes and solutions to species at each level and preserving content of nested species while applying rules. Further necessities are the ability to apply rules and flexibly define reaction rate kinetics and constraints on nested species as well as species that are nested within others. An example model is presented that analyses the interplay of an intracellular control circuit with states at cell level, its relation to cell division, and connections to intercellular communication within a population of cells. The example is described in ML-Rules - a rule-based multi-level approach that has been realized within the plug-in-based modeling and simulation framework JAMES II. Conclusions Rule-based languages are a suitable starting point for developing a concise and compact language for multi-level modeling of cell biological systems. The combination of nesting species, assigning attributes, and constraining reactions according to these attributes is crucial in achieving the desired expressiveness. Rule schemata allow a concise and compact description of complex models. As a result, the presented approach

  7. Social Media for the Promotion of Holistic Self-Participatory Care: An Evidence Based Approach. Contribution of the IMIA Social Media Working Group. (United States)

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


    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.

  8. Inpatient Trauma-Focused Treatment for Veterans: Implementation and Evaluation of Patient Perceptions and Outcomes of an Integrated Evidence-Based Treatment Approach. (United States)

    Menefee, Deleene S; Leopoulos, Wendy S; Tran, Jana K; Teng, Ellen; Wanner, Jill; Wilde, Elisabeth; McCauley, Stephen; Day, Susan X


    Practice guidelines for post-traumatic stress disorder (PTSD) treatment suggest that inpatient care may be warranted when the severity of the clinical presentation is marred with significant concerns about suicidality and psychiatric comorbidity. Yet, limited guidance exists on conducting trauma-focused treatment in acute hospital settings beyond the traditional medical or stabilization model. The purpose of this current article is to describe and evaluate the integration of evidence-based treatments (EBTs) for PTSD implemented in two gender-specific, Veterans Affairs inpatient programs. The theoretical underpinnings of these trauma-focused programs are elucidated in this article, and program delivery is explained. The concurrent versus sequential delivery of multiple EBTs over the course of a 30-day, cohorted admission is explained. Paired sample t tests were conducted to determine the effectiveness of these programs on PTSD and depressive symptom severity, and clinically significant reductions in symptoms were found. The characteristics of 584 Veterans (men = 290 and women = 284) who were voluntarily admitted for intensive, trauma-focused work are presented. Treatment completion among the men was 74.8% and 92.4% among the women. Participants' perceptions of treatment acceptability were examined and presented. These preliminary results offer promising evidence for interventions that concurrently provide strategies for increasing coping skills, suicidal disruption, and emotion dysregulation while providing EBTs for PTSD. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  9. 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)


    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.

  10. 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 (United States)


    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. PMID:22433058

  11. Evidence based medical imaging (EBMI)

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Tony [Senior Lecturer in Medical Radiation Science, University Department of Rural Health, School of Health Sciences, Faculty of Health, University of Newcastle, Locked Bag 9783 NEMSC, Tamworth, NSW 2348 (Australia)], E-mail:


    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.

  12. The Geography of International Strategy: a multi-level framework

    NARCIS (Netherlands)

    D. van den Berghe (Douglas)


    textabstractThis article introduces a multi-level framework to structure and analyse FDI patterns. It is argued that three internationalisation strategies currently simultaneously shape the globalisation of Foreign Direct Investment (FDI): classical internationalisation, emerging


    National Research Council Canada - National Science Library

    Sendi Novianto


    .... 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...

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

    KAUST Repository

    Castrillon, Julio


    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.

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

    Directory of Open Access Journals (Sweden)

    Martha Dowsley


    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.


    Directory of Open Access Journals (Sweden)

    Mohamad K. ALLOUCHE


    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.

  17. 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


    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

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


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


    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...

  19. Multi-level deep supervised networks for retinal vessel segmentation. (United States)

    Mo, Juan; Zhang, Lei


    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.

  20. Multi-Level Approach for the Discriminative Generalized Hough Transform

    NARCIS (Netherlands)

    Ruppertshofen, H.; Künne, D.; Lorenz, C.; Schmidt, S.; Beyerlein, P.; Salah, Z.; Rose, G.; Schramm, Hauke


    The Discriminative Generalized Hough Transform (DGHT) is a method for object localization, which combines the standard GHT with a discriminative training technique. Thereby the aim of the discriminativetraining is to equip the models used in the GHT with individual model point weights such that the

  1. Placing "Knowledge" in Teacher Education in the English Further Education Sector: An Alternative Approach Based on Collaboration and Evidence-Based Research (United States)

    Loo, Sai Y.


    This paper focuses on teacher education in the English further education sector, where the teaching of disciplinary and pedagogic knowledge is an issue. Using research findings, the paper advocates an approach based on collaboration and informed research to emphasize and integrate knowledge(s) in situated teaching contexts despite working in a…

  2. Cross-Battery Assessment Pattern of Strengths and Weaknesses Approach to the Identification of Specific Learning Disorders: Evidence-Based Practice or Pseudoscience? (United States)

    Kranzler, John H.; Floyd, Randy G.; Benson, Nicholas; Zaboski, Brian; Thibodaux, Lia


    In this rejoinder, the authors describe the aim of the original study as an effort to conduct a critical test of an important postulate underlying the Cross-Battery Assessment PSW approach (XBA PSW; Kranzler, Floyd, Benson, Zaboski, & Thibodaux, this issue). The authors used classification agreement analysis to examine the concordance between…

  3. Introduction to multi-level community based culturally situated interventions. (United States)

    Schensul, Jean J; Trickett, Edison


    This introduction to a special issue of the American Journal of Community Psychiatry is the result of a symposium at the Annual Meeting of the Society for Applied Anthropology, 2006, that brought together anthropologists and psychologists involved in community based collaborative intervention studies to examine critically the assumptions, processes and results of their multilevel interventions in local communities with local partners. The papers were an effort to examine context by offering a theoretical framework for the concept of "level" in intervention science, and advocating for "multi-level" approaches to social/behavioral change. They presented examples of ways in which interventions targeted social "levels" either simultaneously or sequentially by working together with communities across levels, and drawing on and co-constructing elements of local culture as components of the intervention. The papers raised a number of important issues, for example: (1) How are levels defined and how should collaborators be chosen; (2) does it matter at which level multilevel interventions begin; (3) do multilevel interventions have a greater effect on desired outcomes than level-specific interventions; (4) are multilevel interventions more sustainable; (5) are multilevel interventions cost effective to run, and evaluate; (6) how can theories of intervention be generated and adapted to each level of a multilevel intervention; (7) how should intervention activities at each level coordinate to facilitate community resident or target population empowerment? Many of these questions were only partially addressed in the papers presented at that time, and are more fully addressed in the theoretical papers, case studies and approach to evaluation included in this collection.

  4. On multi-level thinking and scientific understanding (United States)

    McIntyre, Michael Edgeworth


    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.

  5. Multi-Level Sequential Pattern Mining Based on Prime Encoding (United States)

    Lianglei, Sun; Yun, Li; Jiang, Yin

    Encoding is not only to express the hierarchical relationship, but also to facilitate the identification of the relationship between different levels, which will directly affect the efficiency of the algorithm in the area of mining the multi-level sequential pattern. In this paper, we prove that one step of division operation can decide the parent-child relationship between different levels by using prime encoding and present PMSM algorithm and CROSS-PMSM algorithm which are based on prime encoding for mining multi-level sequential pattern and cross-level sequential pattern respectively. Experimental results show that the algorithm can effectively extract multi-level and cross-level sequential pattern from the sequence database.

  6. The Evidence-Based Manifesto for School Librarians (United States)

    Todd, Ross


    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…

  7. Evidence-based radiology: why and how?

    Energy Technology Data Exchange (ETDEWEB)

    Sardanelli, Francesco; Di Leo, Giovanni [Universita degli Studi di Milano, Dipartimento di Scienze Medico-Chirurgiche, Unita di Radiologia, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, Milan (Italy); Hunink, Myriam G. [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Erasmus University Medical Center, Department of Epidemiology, Rotterdam (Netherlands); Harvard School of Public Health, Program for Health Decision Science, Boston, MA (United States); Gilbert, Fiona J. [University of Aberdeen, Aberdeen Biomedical Imaging Centre, Aberdeen (United Kingdom); Krestin, Gabriel P. [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands)


    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.)

  8. A multimodal, evidence-based approach to achieve lipid targets in the treatment of antiretroviral-associated dyslipidemia: case report and review of the literature. (United States)

    Bain, Amy M; White, Elizabeth A; Rutherford, William S; Rahman, Anita P; Busti, Anthony J


    Metabolic abnormalities associated with the treatment of human immunodeficiency virus (HIV) infection are well-recognized problems that increase cardiovascular risk. As a result of the complexity of treating both HIV- and antiretroviral-related comorbidities, strategies that improve adverse drug events while maintaining viral control are in critical need. Although guidelines have somewhat helped in the general approach and in first-line strategies for managing dyslipidemia in patients receiving antiretrovirals, a paucity of data exist to guide clinicians in treating patients whose conditions are refractory to first-line options or who are at substantial risk for cardiovascular events. Further complicating the choice of lipid-lowering strategy is the lack of randomized controlled data from the HIV-affected population and a concern about clinically significant drug-drug interactions. We describe an HIV-infected patient with efavirenz-associated dyslipidemia at very high cardiovascular risk who had not achieved his primary or secondary lipid goals despite 2 years of treatment in a lipid specialty clinic. Lipid control was accomplished in 10 weeks with a targeted, stepwise approach of switching efavirenz to nevirapine, followed by rosuvastatin 20 mg/day, which was sustained for at least 10 months. Of most importance, this outcome was achieved without any clinically significant alteration in virologic or immunologic control. This case report highlights the potential for a pharmacist-guided, multistep approach that addresses HIV-related dyslipidemia and incorporates the pharmacokinetic literature to guide lipid-lowering therapy and promote the attainment of goals based on current standards of care.

  9. Unconventional Coding Technique Applied to Multi-Level Polarization Modulation (United States)

    Rutigliano, G. G.; Betti, S.; Perrone, P.


    A new technique is proposed to improve information confidentiality in optical-fiber communications without bandwidth consumption. A pseudorandom vectorial sequence was generated by a dynamic system algorithm and used to codify a multi-level polarization modulation based on the Stokes vector. Optical-fiber birefringence, usually considered as a disturbance, was exploited to obfuscate the signal transmission. At the receiver end, the same pseudorandom sequence was generated and used to decode the multi-level polarization modulated signal. The proposed scheme, working at the physical layer, provides strong information security without introducing complex processing and thus latency.

  10. Pracovní motivace v multi-level marketingu


    Mrázková, Tereza


    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...

  11. Gaussian translation operator for Multi-Level Fast Multipole Method

    DEFF Research Database (Denmark)

    Borries, Oscar Peter; Hansen, Per Christian; Sorensen, Stig B.


    Results using a new translation operator for the Multi-Level Fast Multipole Method are presented. Based on Gaussian beams, the translation operator allows a significant portion of the plane-wave directions to be neglected, resulting in a much faster translation step.......Results using a new translation operator for the Multi-Level Fast Multipole Method are presented. Based on Gaussian beams, the translation operator allows a significant portion of the plane-wave directions to be neglected, resulting in a much faster translation step....

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

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


    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

  13. Evidence-based concepts and procedures for bonded inlays and onlays. Part I. Historical perspectives and clinical rationale for a biosubstitutive approach. (United States)

    Dietschi, Didier; Spreafico, Roberto


    This first article in the series (Part I) aims to present an updated rationale and treatment approach for indirect adhesive posterior restorations based on the best scientific and long-term clinical evidence available. The proposed treatment concept relies on the basic ideas of (1) the placement of an adhesive base/liner (Dual Bonding [DB] and Cavity Design Optimization [CDO]) and, when needed, (2) a simultaneous relocation of deep cervical margins (Cervical Margin Relocation [CMR]), prior to (3) impression taking to ensure a more conservative preparation and easier-to-follow clinical steps, and the use of (4) a highly filled, light-curing restorative material for the cementation (Controlled Adhesive Cementation [CAC]), together with restoration insertion facilitation, the application of sonic/ultrasonic energy, and/or material heating. The suggested clinical protocol will help the practitioner to eliminate the most frequently experienced difficulties relating to the preparation, isolation, impression taking and cementation of tooth-colored inlays and onlays. This protocol can be applied to both ceramics and composites as no material has been proven to be the most feasible or reliable in all clinical indications regarding its physicochemical and handling characteristics. For the time being, however, we have to regard such indirect restorations as a biosubstitution due to the monolithic nature of the restoration, with still very imperfect replication of the specific natural dentin-enamel assemblage.

  14. Evidence-Based Medicine: Breast Augmentation. (United States)

    Schwartz, Michael R


    After reading this article, the participant should be able to: 1. Understand the key decisions in patient evaluation for cosmetic breast augmentation. 2. Cite key decisions in preoperative planning. 3. Discuss the risks and complications, and key patient education points in breast augmentation. Breast augmentation remains one of the most popular procedures in plastic surgery. The integral information necessary for proper patient selection, preoperative assessment, and surgical approaches are discussed. Current data regarding long term safety and complications are presented to guide the plastic surgeon to an evidence-based approach to the patient seeking breast enhancement to obtain optimal results.

  15. Changing the Adverse Event Profile in Metastatic Spine Surgery: An Evidence-Based Approach to Target Wound Complications and Instrumentation Failure. (United States)

    Mesfin, Addisu; Sciubba, Daniel M; Dea, Nicolas; Nater, Anick; Bird, Justin E; Quraishi, Nasir A; Fisher, Charles G; Shin, John H; Fehlings, Michael G; Kumar, Naresh; Clarke, Michelle J


    Systematic review. To identify risk factors and preventive methods for wound complications and instrumentation failure after metastatic spine surgery. We focused on two postoperative complications of metastatic spine tumor surgery: wound complications and instrumentation failure and preventive measures. We performed a systematic review of the literature from 1980 to 2015. The articles were analyzed for the presence of documented infection and/or wound complications and instrumentation failure. Forty articles met our inclusion criteria for wound complications and prevention. There is very low level of evidence that preoperative radiation, preoperative neurological deficit, revision procedures, and posterior approaches can contribute to wound complications (infections, wound dehiscence). There is very low level of evidence that plastic surgery soft tissue reconstruction, intrawound vancomycin powder, and percutaneous pedicle screws may prevent postoperative wound complications. Fourteen articles met our inclusion criteria for instrumentation failure. There is very low level of evidence that constructs greater than six levels, positive sagittal balance, preoperative radiation, and history of chest wall resection can contribute to implant failures. • For patients undergoing revision metastatic spine tumor surgery, plastic surgery should perform the soft tissue reconstruction (strong recommendation/very low quality of evidence).• For patients undergoing metastatic spine tumor surgery, plastic surgery may perform immediate soft tissue reconstruction (weak recommendation/very low quality of evidence).• For patients undergoing metastatic spine tumor surgery, intrawound vancomycin can be applied to decrease the risk of postoperative wound infections (weak recommendation/very low quality of evidence).• For patients undergoing metastatic spine tumor surgery, percutaneous pedicle screws can be placed to decrease the risk of postoperative wound complications (weak

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

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


    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.

  17. Multi-Level Security Cannot Realise NEC Objectives

    NARCIS (Netherlands)

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


    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

  18. Multi-level determinants of inward FDI ownership

    NARCIS (Netherlands)

    Bhupatiraju, S.


    In this paper, we empirically analyse the determinants of FDI ownership into developing countries. We do this by using firm-level data obtained from the Enterprise Surveys data of the World Bank and country level data from various sources. Using a multi-level logit model, we analyse how

  19. Multi-Level Captioning: Alternatives that Match the Viewers' Abilities. (United States)

    Montandon, Betsy


    The Multi-Level Linguistic Captioning Project at public television station WGBH in Boston developed a method of captioning that controls vocabulary and idiomatic expressions, syntax, and inference at each of three captioning levels (simplest language, greater sophistication, and most difficult). Examples are provided along with background…

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

    Directory of Open Access Journals (Sweden)

    Derek Armitage


    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

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

    NARCIS (Netherlands)

    Pournaras, E.


    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

  2. The evidence base for diabetes care

    National Research Council Canada - National Science Library

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


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

  3. Challenges to Learning Evidence-Based Medicine and Educational Approaches to Meet These Challenges: A Qualitative Study of Selected EBM Curricula in U.S. and Canadian Medical Schools. (United States)

    Maggio, Lauren A; ten Cate, Olle; Chen, H Carrie; Irby, David M; O'Brien, Bridget C


    Evidence-based medicine (EBM) is a fixture in many medical school curricula. Yet, little is known about the challenges medical students face in learning EBM or the educational approaches that medical schools use to overcome these challenges. A qualitative multi-institutional case study was conducted between December 2013 and July 2014. On the basis of the Association of American Medical Colleges 2012 Medical School Graduation Questionnaire data, the authors selected 22 U.S. and Canadian Liaison Committee on Medical Education-accredited medical schools with graduates reporting confidence in their EBM skills. Participants were interviewed and asked to submit EBM curricular materials. Interviews were audio-recorded, transcribed, and analyzed using an inductive approach. Thirty-one EBM instructors (17 clinicians, 11 librarians, 2 educationalists, and 1 epidemiologist) were interviewed from 17 medical schools (13 in the United States, 4 in Canada). Four common EBM learning challenges were identified: suboptimal role models, students' lack of willingness to admit uncertainty, a lack of clinical context, and students' difficulty mastering EBM skills. Five educational approaches to these challenges that were common across the participating institutions were identified: integrating EBM with other courses and content, incorporating clinical content into EBM training, EBM faculty development, EBM whole-task exercises, and longitudinal integration of EBM. The identification of these four learner-centered EBM challenges expands on the literature on challenges in teaching and practicing EBM, and the identification of these five educational approaches provides medical educators with potential strategies to inform the design of EBM curricula.

  4. Consumer engagement and the development, evaluation and dissemination of evidence-based parenting programs (United States)

    Sanders, Matthew R.; Kirby, James N.


    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

  5. Rotator cuff tears: An evidence based approach (United States)

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


    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

  6. 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. (United States)

    Dolphens, Mieke; Nijs, Jo; Cagnie, Barbara; Meeus, Mira; Roussel, Nathalie; Kregel, Jeroen; Malfliet, Anneleen; Vanderstraeten, Guy; Danneels, Lieven


    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. 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-based questionnaires will be completed at

  7. 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 (United States)


    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

  8. Merging Evidence-Based Psychosocial Interventions in Schizophrenia

    Directory of Open Access Journals (Sweden)

    Tania Lecomte


    Full Text Available Psychosocial interventions are an essential part of the treatment for people with severe mental illness such as schizophrenia. The criteria regarding what makes an intervention “evidence-based” along with a current list of evidence-based interventions are presented. Although many evidence-based interventions exist, implementation studies reveal that few, if any, are ever implemented in a given setting. Various theories and approaches have been developed to better understand and overcome implementation obstacles. Among these, merging two evidence-based interventions, or offering an evidence-based intervention within an evidence-based service, are increasingly being reported and studied in the literature. Five such merges are presented, along with their empirical support: cognitive behavior therapy (CBT with skills training; CBT and family psychoeducation; supported employment (SE and skills training; SE and cognitive remediation; and SE and CBT.

  9. Evidence-Based Medicine in Facial Trauma. (United States)

    Dougherty, William M; Christophel, John Jared; Park, Stephen S


    This article provides the reader with a comprehensive review of high-level evidence-based medicine in facial trauma and highlights areas devoid of high-level evidence. The article is organized in the order one might approach a clinical problem: starting with the workup, followed by treatment considerations, operative decisions, and postoperative treatments. Individual injuries are discussed within each section, with an overview of the available high-level clinical evidence. This article not only provides a quick reference for the facial traumatologist, but also allows the reader to identify areas that lack high-level evidence, perhaps motivating future endeavors. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Multi-Level Formation of Complex Software Systems

    Directory of Open Access Journals (Sweden)

    Hui Li


    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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


    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. Multi-level Hybrid Cache: Impact and Feasibility

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Zhe [ORNL; Kim, Youngjae [ORNL; Ma, Xiaosong [ORNL; Shipman, Galen M [ORNL; Zhou, Yuanyuan [University of California, San Diego


    Storage class memories, including flash, has been attracting much attention as promising candidates fitting into in today's enterprise storage systems. In particular, since the cost and performance characteristics of flash are in-between those of DRAM and hard disks, it has been considered by many studies as an secondary caching layer underneath main memory cache. However, there has been a lack of studies of correlation and interdependency between DRAM and flash caching. This paper views this problem as a special form of multi-level caching, and tries to understand the benefits of this multi-level hybrid cache hierarchy. We reveal that significant costs could be saved by using Flash to reduce the size of DRAM cache, while maintaing the same performance. We also discuss design challenges of using flash in the caching hierarchy and present potential solutions.

  13. A Study On Direct Selling Through Multi Level Marketing (United States)

    Merlin, F. Mary


    Direct selling is a multi-level marketing in which the sales force is compensated not only for the sales they make but also for the sales done through their recruit. This recruited sales force is referred to as the participants who can provide multiple levels of compensation.A person's job would be to recruit others to sell their product, and in return, receive a percentage of their sales. The next person's job then is to recruit people even more so below them, and receive a percentage of their sales. Other terms for Multi-level marketing include network marketing and referral marketing. Commonly, the salespeople are expected to sell products directly to consumers by means of relationship through referrals marketing. Some people use direct selling as a synonym for MLM, although MLM is only one type of direct selling

  14. Can Scholarly Communication be Evidence Based? (Editorial

    Directory of Open Access Journals (Sweden)

    Denise Koufogiannakis


    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

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


    Constantin C.


    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 resear...

  16. Multi-level methods and approximating distribution functions (United States)

    Wilson, D.; Baker, R. E.


    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 decision making models, methods and applications

    CERN Document Server

    Zhang, Guangquan; Gao, Ya


    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.  

  18. Multi-Level Marketing as a business model

    Directory of Open Access Journals (Sweden)

    Bogdan Gregor


    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.

  19. Flexible Job Shop Scheduling with Multi-level Job Structures (United States)

    Jang, Yang-Ja; Kim, Ki-Dong; Jang, Seong-Yong; Park, Jinwoo

    This paper deals with a scheduling problem in a flexible job shop with multi-level job structures where end products are assembled from sub-assemblies or manufactured components. For such shops MRP (Material Requirement Planning) logic is frequently used to synchronize and pace the production activities for the required parts. However, in MRP, the planning of operational-level activities is left to short term scheduling. So, we need a good scheduling algorithm to generate feasible schedules taking into account shop floor characteristics and multi-level job structures used in MRP. In this paper, we present a GA (Genetic Algorithm) solution for this complex scheduling problem based on a new gene to reflect the machine assignment, operation sequences and the levels of the operations relative to final assembly operation. The relative operation level is the control parameter that paces the completion timing of the components belonging to the same branch in the multi-level job hierarchy. We compare the genetic algorithm with several dispatching rules in terms of total tardiness and the genetic algorithm shows outstanding performance for about forty modified standard job-shop problem instances.

  20. 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. (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


    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

  1. The Case for Diabetes Population Health Improvement: Evidence-Based Programming for Population Outcomes in Diabetes (United States)

    Maruthur, Nisa; Mathioudakis, Nestoras; Spanakis, Elias; Rubin, Daniel; Zilbermint, Mihail; Hill-Briggs, Felicia


    Purpose of Review The goal of this review is to describe diabetes within a population health improvement framework and to review the evidence for a diabetes population health continuum of intervention approaches, including diabetes prevention and chronic and acute diabetes management, to improve clinical and economic outcomes. Recent Findings Recent studies have shown that compared to usual care, lifestyle interventions in prediabetes lower diabetes risk at the population-level and that group-based programs have low incremental medial cost effectiveness ratio for health systems. Effective outpatient interventions that improve diabetes control and process outcomes are multi-level, targeting the patient, provider, and healthcare system simultaneously and integrate community health workers as a liaison between the patient and community-based healthcare resources. A multi-faceted approach to diabetes management is also effective in the inpatient setting. Interventions shown to promote safe and effective glycemic control and use of evidence-based glucose management practices include provider reminder and clinical decision support systems, automated computer order entry, provider education, and organizational change. Summary Future studies should examine the cost-effectiveness of multi-faceted outpatient and inpatient diabetes management programs to determine the best financial models for incorporating them into diabetes population health strategies. PMID:28567711

  2. Evidence-based Science Communication (United States)

    Kahan, D.


    This presentation will describe a concrete strategy for bridging the gap between the *science* of science communication and the practice of it. In recent years, social scientists have made substantial progress in identifying the psychological influences that shape public receptivity to scientific information relating to climate change and other public policy issues. That work, however, has consisted nearly entirely of laboratory experiments and public opinion surveys; these methods identify general mechanisms of information processing but do not yield concrete prescriptions for communication in field settings. In order to integrate the findings of the science of science communication with the practice of it, field communication must now be made into a meaningful site of science communication research. "Evidence-based science communication" will involve collaborative work between social scientists and practitioners aimed at formulating and testing scientifically informed communication strategies in real-world contexts.

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

    Directory of Open Access Journals (Sweden)

    Esther Mwangi


    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.

  4. Leading change: evidence-based transition. (United States)

    Lewis, Brennan; Allen, Stephanie


    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

  5. Queer challenges to evidence-based practice. (United States)

    Zeeman, Laetitia; Aranda, Kay; Grant, Alec


    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

  6. Organizational change strategies for evidence-based practice. (United States)

    Newhouse, Robin P; Dearholt, Sandi; Poe, Stephanie; Pugh, Linda C; White, Kathleen M


    Evidence-based practice, a crucial competency for healthcare providers and a basic force in Magnet hospitals, results in better patient outcomes. The authors describe the strategic approach to support the maturation of The Johns Hopkins Nursing evidence-based practice model through providing leadership, setting expectations, establishing structure, building skills, and allocating human and material resources as well as incorporating the model and tools into undergraduate and graduate education at the affiliated university.

  7. Evidence Based Medicine in Pediatric Practice: Brief Review (United States)

    Kianifar, Hamid-Reza; Akhondian, Javad; Najafi-Sani, Mehri; Sadeghi, Ramin


    Practicing medicine according to the best evidence is gaining popularity in the medical societies. Although this concept, which is usually called Evidence Based Medicine (EBM) has been explained in many resources, it has not been addressed enough in pediatrics. In this review, we briefly explained Evidence Based Medicine approach and its applications in pediatrics in order to help the pediatricians to efficiently integrate EBM into their daily practice. PMID:23056715

  8. Evidence-Based Practice in Psychology (United States)

    American Psychologist, 2006


    The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force's report describes…

  9. 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. (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.

  10. Multi-level Full Virtualization of Power Management (United States)

    Liu, Yongpeng; Chi, Wanqing; Liu, Yongyan

    Virtual machine technique is employed to improve system utilization and energy efficiency. However, isolation effect of virtualization imposes challenges to power management. A multi-level power behavior statistic framework is introduced to support power profiling of virtual device, virtual machine and host. Power management mechanisms are virtualized to map power management operations between virtual device and physical device. The power consumption of a virtual device is virtualized according to its performance share from the physical device. The experiments demonstrated that our power management virtualization solution has negligible decline of system performance.

  11. [Evidence-based TEP technique]. (United States)

    Köckerling, F


    The guidelines of all international hernia societies recommend as procedures of choice the laparoendoscopic techniques total extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) as well as the open Lichtenstein operation for elective inguinal hernia repair. The learning curve associated with the laparoendoscopic techniques, in particular TEP, is longer than that for the open Lichtenstein technique due to the complexity of the procedures. Accordingly, for laparoendoscopic techniques it is particularly important that the operations are conducted in a standardized manner in compliance with the evidence-based recommendations given for the technical details. When procedures are carried out in strict compliance with the guidelines of the international hernia societies, low rates of perioperative complications, complication-related reoperations, recurrences and chronic pain can be expected for TEP. Compliance with the guidelines can also positively impact mastery of the learning curve for TEP. The technical guidelines on TEP are based on study results and on the experiences of numerous experts; therefore, it is imperative that they are implemented in routine surgical practice.

  12. Multi-Level Discourse Analysis in a Physics Teaching Methods Course from the Psychological Perspective of Activity Theory (United States)

    Vieira, Rodrigo Drumond; Kelly, Gregory J.


    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,…

  13. 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. (United States)

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


    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.

  14. 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


    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.

  15. [Acupressure and Evidence-Based Nursing]. (United States)

    Chen, Li-Li; Lin, Jun-Dai


    Acupressure is a traditional Chinese medicine approach to disease prevention and treatment that may be operated by nurses independently. Therefore, acupressure is being increasingly applied in clinical nursing practice and research. Recently, the implementation of evidence-based nursing (EBN) in clinical practice has been encouraged to promote nursing quality. Evidence-based nursing is a method-ology and process of implementation that applies the best-available evidence to clinical practice, which is acquired through the use of empirical nursing research. Therefore, in this paper, we address the topic of acupressure within the context of empirical nursing practice. We first introduce the current status of acupressure research and provide the locations of common acupoints in order to guide future empirical nursing research and to help nurses use these acupoints in clinical practice. Finally, we describe the steps that are necessary to apply the current empirical information on acupressure as well as provide suggestions to promote safety and efficacy in order to guide nurses in the accurate application of acupressure in nursing practice.

  16. Testing use of payers to facilitate evidence-based practice adoption: protocol for a cluster-randomized trial. (United States)

    Molfenter, Todd; Kim, Jee-Seon; Quanbeck, Andrew; Patel-Porter, Terry; Starr, Sandy; McCarty, Dennis


    More effective methods are needed to implement evidence-based findings into practice. The Advancing Recovery Framework offers a multi-level approach to evidence-based practice implementation by aligning purchasing and regulatory policies at the payer level with organizational change strategies at the organizational level. The Advancing Recovery Buprenorphine Implementation Study is a cluster-randomized controlled trial designed to increase use of the evidence-based practice buprenorphine medication to treat opiate addiction. Ohio Alcohol, Drug Addiction, and Mental Health Services Boards (ADAMHS), who are payers, and their addiction treatment organizations were recruited for a trial to assess the effects of payer and treatment organization changes (using the Advancing Recovery Framework) versus treatment organization changes alone on the use of buprenorphine. A matched-pair randomization, based on county characteristics, was applied, resulting in seven county ADAMHS boards and twenty-five treatment organizations in each arm. Opioid dependent patients are nested within cluster (treatment organization), and treatment organization clusters are nested within ADAMHS county board. The primary outcome is the percentage of individuals with an opioid dependence diagnosis who use buprenorphine during the 24-month intervention period and the 12-month sustainability period. The trial is currently in the baseline data collection stage. Although addiction treatment providers are under increasing pressure to implement evidence-based practices that have been proven to improve patient outcomes, adoption of these practices lags, compared to other areas of healthcare. Reasons frequently cited for the slow adoption of EBPs in addiction treatment include, regulatory issues, staff, or client resistance and lack of resources. Yet the way addiction treatment is funded, the payer's role-has not received a lot of attention in research on EBP adoption.This research is unique because it

  17. Evidence based practice readiness: A concept analysis. (United States)

    Schaefer, Jessica D; Welton, John M


    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.

  18. Multi-level selection for hygienic behaviour in honeybees. (United States)

    Pérez-Sato, J A; Châline, N; Martin, S J; Hughes, W O H; Ratnieks, F L W


    Disease is one of the main factors driving both natural and artificial selection. It is a particularly important and increasing threat to the managed honeybee colonies, which are vital in crop pollination. Artificial selection for disease-resistant honeybee genotypes has previously only been carried out at the colony-level, that is, by using queens or males reared from colonies that show resistance. However, honeybee queens mate with many males and so each colony consists of multiple patrilines that will vary in heritable traits, such as disease resistance. Here, we investigate whether response to artificial selection for a key resistance mechanism, hygienic behaviour, can be improved using multi-level selection, that is, by selecting not only among colonies as normal but also among patrilines within colonies. Highly hygienic colonies were identified (between-colony selection), and the specific patrilines within them responsible for most hygienic behaviour were determined using observation hives. Queens reared from these hygienic patrilines (within-colony selection) were identified using DNA microsatellite analysis of a wing-tip tissue sample and then mated to drones from a third highly hygienic colony. The resulting colonies headed by queens from hygienic patrilines showed approximately double the level of hygienic behaviour of colonies headed by sister queens from non-hygienic patrilines. The results show that multi-level selection can significantly improve the success of honeybee breeding programs.

  19. Evidence Searching for Evidence-based Psychology Practice (United States)

    Falzon, Louise; Davidson, Karina W.; Bruns, Daniel


    There is an increased awareness of evidence-based methodology among psychologists, but little exists in the literature about how to access the research. Moreover, the prohibitive cost of this information combined with limited time are barriers to the identification of evidence to answer clinical questions. This article presents an example of a question worked though in an evidence-based way. Methods are highlighted, including distinguishing background and foreground questions, breaking down questions into searchable statements, and adapting statements to suit both the question being asked and the resource being searched. A number of free, evidence-based resources are listed. Knowing how and where to access this information will enable practitioners to more easily use an evidence-based approach to their practice. PMID:21503266

  20. Assessment of Material Solutions of Multi-level Garage Structure Within Integrated Life Cycle Design Process (United States)

    Wałach, Daniel; Sagan, Joanna; Gicala, Magdalena


    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).

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

    Energy Technology Data Exchange (ETDEWEB)

    Brunnengraeber, Achim; Haefner, Daniel


    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.

  2. 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.


    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....

  3. An Intrusion Detection System Based on Multi-Level Clustering for Hierarchical Wireless Sensor Networks (United States)

    Butun, Ismail; Ra, In-Ho; Sankar, Ravi


    In this work, an intrusion detection system (IDS) framework based on multi-level clustering for hierarchical wireless sensor networks is proposed. The framework employs two types of intrusion detection approaches: (1) “downward-IDS (D-IDS)” to detect the abnormal behavior (intrusion) of the subordinate (member) nodes; and (2) “upward-IDS (U-IDS)” to detect the abnormal behavior of the cluster heads. By using analytical calculations, the optimum parameters for the D-IDS (number of maximum hops) and U-IDS (monitoring group size) of the framework are evaluated and presented. PMID:26593915

  4. An Intrusion Detection System Based on Multi-Level Clustering for Hierarchical Wireless Sensor Networks. (United States)

    Butun, Ismail; Ra, In-Ho; Sankar, Ravi


    In this work, an intrusion detection system (IDS) framework based on multi-level clustering for hierarchical wireless sensor networks is proposed. The framework employs two types of intrusion detection approaches: (1) "downward-IDS (D-IDS)" to detect the abnormal behavior (intrusion) of the subordinate (member) nodes; and (2) "upward-IDS (U-IDS)" to detect the abnormal behavior of the cluster heads. By using analytical calculations, the optimum parameters for the D-IDS (number of maximum hops) and U-IDS (monitoring group size) of the framework are evaluated and presented.

  5. An Intrusion Detection System Based on Multi-Level Clustering for Hierarchical Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Ismail Butun


    Full Text Available In this work, an intrusion detection system (IDS framework based on multi-level clustering for hierarchical wireless sensor networks is proposed. The framework employs two types of intrusion detection approaches: (1 “downward-IDS (D-IDS” to detect the abnormal behavior (intrusion of the subordinate (member nodes; and (2 “upward-IDS (U-IDS” to detect the abnormal behavior of the cluster heads. By using analytical calculations, the optimum parameters for the D-IDS (number of maximum hops and U-IDS (monitoring group size of the framework are evaluated and presented.

  6. Underdetermination in evidence-based medicine. (United States)

    Chin-Yee, Benjamin H


    This article explores the philosophical implications of evidence-based medicine's (EBM's) epistemology in terms of the problem of underdetermination of theory by evidence as expounded by the Duhem-Quine thesis. EBM hierarchies of evidence privilege clinical research over basic science, exacerbating the problem of underdetermination. Because of severe underdetermination, EBM is unable to meaningfully test core medical beliefs that form the basis of our understanding of disease and therapeutics. As a result, EBM adopts an epistemic attitude that is sceptical of explanations from the basic biological sciences, and is relegated to a view of disease at a population level. EBM's epistemic attitude provides a limited research heuristic by preventing the development of a theoretical framework required for understanding disease mechanism and integrating knowledge to develop new therapies. Medical epistemology should remain pluralistic and include complementary approaches of basic science and clinical research, thus avoiding the limited epistemic attitude entailed by EBM hierarchies. © 2014 John Wiley & Sons, Ltd.

  7. [Evidence based surgery. A necessary tool]. (United States)

    Duran-Vega, Héctor César


    Evidence-based surgery is a tool that has been adopted worldwide by surgeons. As all decisions must be current and have a scientific basis, the approach for performing it must be standardised. Five important steps are required to perform surgery based on evidence. Convert the need for information into a question that can be answered, finding the best information to answer that question, critical evaluation of the evidence, and its validity, impact and applicability, integrating the evidence with your own experience, and with the evaluation of the patients. This should take into account their biology, values and specific circumstances, as well as to evaluate the effectiveness and efficiency of the execution of steps 1-4 and propose how to improve them. This article presents the main tools to perform surgery properly based on evidence. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Constantin C.


    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.


    Directory of Open Access Journals (Sweden)

    Sendi Novianto


    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.

  10. Development of the Multi-Level Seismic Receiver (MLSR)

    Energy Technology Data Exchange (ETDEWEB)

    Sleefe, G.E.; Engler, B.P.; Drozda, P.M.; Franco, R.J.; Morgan, J.


    The Advanced Geophysical Technology Department (6114) and the Telemetry Technology Development Department (2664) have, in conjunction with the Oil Recovery Technology Partnership, developed a Multi-Level Seismic Receiver (MLSR) for use in crosswell seismic surveys. The MLSR was designed and evaluated with the significant support of many industry partners in the oil exploration industry. The unit was designed to record and process superior quality seismic data operating in severe borehole environments, including high temperature (up to 200{degrees}C) and static pressure (10,000 psi). This development has utilized state-of-the-art technology in transducers, data acquisition, and real-time data communication and data processing. The mechanical design of the receiver has been carefully modeled and evaluated to insure excellent signal coupling into the receiver.

  11. Explicit and implicit emotion regulation: a multi-level framework (United States)

    Braunstein, Laura Martin; Gross, James J


    Abstract The ability to adaptively regulate emotion is essential for mental and physical well-being. How should we organize the myriad ways people attempt to regulate their emotions? We explore the utility of a framework that distinguishes among four fundamental classes of emotion regulation strategies. The framework describes each strategy class in terms their behavioral characteristics, underlying psychological processes and supporting neural systems. A key feature of this multi-level framework is its conceptualization of the psychological processes in terms of two orthogonal dimensions that describe (i) the nature of the emotion regulation goal (ranging from to implicit to explicit) and (ii) the nature of the emotion change process (ranging from more automatic to more controlled). After describing the core elements of the framework, we use it to review human and animal research on the neural bases of emotion regulation and to suggest key directions for future research on emotion regulation. PMID:28981910

  12. Politics of innovation in multi-level water governance systems (United States)

    Daniell, Katherine A.; Coombes, Peter J.; White, Ian


    Innovations are being proposed in many countries in order to support change towards more sustainable and water secure futures. However, the extent to which they can be implemented is subject to complex politics and powerful coalitions across multi-level governance systems and scales of interest. Exactly how innovation uptake can be best facilitated or blocked in these complex systems is thus a matter of important practical and research interest in water cycle management. From intervention research studies in Australia, China and Bulgaria, this paper seeks to describe and analyse the behind-the-scenes struggles and coalition-building that occurs between water utility providers, private companies, experts, communities and all levels of government in an effort to support or block specific innovations. The research findings suggest that in order to ensure successful passage of the proposed innovations, champions for it are required from at least two administrative levels, including one with innovation implementation capacity, as part of a larger supportive coalition. Higher governance levels can play an important enabling role in facilitating the passage of certain types of innovations that may be in competition with currently entrenched systems of water management. Due to a range of natural biases, experts on certain innovations and disciplines may form part of supporting or blocking coalitions but their evaluations of worth for water system sustainability and security are likely to be subject to competing claims based on different values and expertise, so may not necessarily be of use in resolving questions of "best courses of action". This remains a political values-based decision to be negotiated through the receiving multi-level water governance system.

  13. Multi-level damage identification with response reconstruction (United States)

    Zhang, Chao-Dong; Xu, You-Lin


    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.

  14. What is the evidence based public health?


    Hernández F., Luis J.


    Evidence based Public Health is the execution and evaluation of the efficiency of interventions, plans, programs, projects and politics in public health through the application of the scientific principles of reasoning, including the systematic use of information and information systems. Evidence based public health involves the use of methodologies similar to those applied in evidence-based clinical medicine, but differs in its contents. In public health two types of evidence are described. ...

  15. Toward More Evidence-Based Practice


    Hotelling, Barbara A.


    Childbirth educators are responsible for providing expectant parents with evidence-based information. In this column, the author suggests resources where educators can find evidence-based research for best practices. Additionally, the author describes techniques for childbirth educators to use in presenting research-based information in their classes. A sample of Web sites and books that offer evidence-based resources for expectant parents is provided.

  16. Proposing an Evidence-Based Strategy for Software Requirements Engineering. (United States)

    Lindoerfer, Doris; Mansmann, Ulrich


    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.

  17. Evidence-based Nursing in the IED: From Caring to Curing?

    National Research Council Canada - National Science Library

    Jette Ernst


    .... It is illuminated how two opposing approaches to nursing of hhumanisticallyand pluralistically oriented caring, and evidence-based scientifically oriented curing inform nursing in the department...

  18. Evidence-Based Practice and School Nursing (United States)

    Adams, Susan; McCarthy, Ann Marie


    School nurses need to demonstrate that their practice is based on the best evidence available, which is usually data obtained from research. Evidence-based practice involves combining the best evidence available with nursing expertise and patient and family preferences to determine optimum care. Evidence-based practice guidelines are developed by…

  19. Towards Evidence Based Usability in Health Informatics?

    NARCIS (Netherlands)

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


    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

  20. Stakeholder conceptualisation of multi-level HIV and AIDS determinants in a Black epicentre. (United States)

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


    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.

  1. Cross-Ontology Multi-level Association Rule Mining in the Gene Ontology (United States)

    Manda, Prashanti; Ozkan, Seval; Wang, Hui; McCarthy, Fiona; Bridges, Susan M.


    The Gene Ontology (GO) has become the internationally accepted standard for representing function, process, and location aspects of gene products. The wealth of GO annotation data provides a valuable source of implicit knowledge of relationships among these aspects. We describe a new method for association rule mining to discover implicit co-occurrence relationships across the GO sub-ontologies at multiple levels of abstraction. Prior work on association rule mining in the GO has concentrated on mining knowledge at a single level of abstraction and/or between terms from the same sub-ontology. We have developed a bottom-up generalization procedure called Cross-Ontology Data Mining-Level by Level (COLL) that takes into account the structure and semantics of the GO, generates generalized transactions from annotation data and mines interesting multi-level cross-ontology association rules. We applied our method on publicly available chicken and mouse GO annotation datasets and mined 5368 and 3959 multi-level cross ontology rules from the two datasets respectively. We show that our approach discovers more and higher quality association rules from the GO as evaluated by biologists in comparison to previously published methods. Biologically interesting rules discovered by our method reveal unknown and surprising knowledge about co-occurring GO terms. PMID:23071802

  2. Methadone maintenance therapy as evidence based drug abuse ...

    African Journals Online (AJOL)

    Methadone maintenance therapy as evidence based drug abuse planning in developed countries: Can developing countries afford and learn from this experience? ... However, various studies and preventive approaches have been tried in the US on drug abusers in order to prevent the associated adverse health outcomes.

  3. 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 ...

  4. Evidence-Based Medicine: Liposuction. (United States)

    Chia, Christopher T; Neinstein, Ryan M; Theodorou, Spero J


    After studying this article, the participant should be able to: 1. Review the appropriate indications and techniques for suction-assisted lipectomy body contouring surgery. 2. Accurately calculate the patient limits of lidocaine for safe dosing during the tumescent infiltration phase of liposuction. 3. Determine preoperatively possible "red flags" or symptoms and signs in the patient history and physical examination that may indicate a heightened risk profile for a liposuction procedure. 4. Provide an introduction to adjunctive techniques to liposuction such as energy-assisted liposuction and to determine whether or not the reader may decide to add them to his or her practice. With increased focus on one's aesthetic appearance, liposuction has become the most popular cosmetic procedure in the world since its introduction in the 1980s. As it has become more refined with experience, safety, patient selection, preoperative assessment, fluid management, proper technique, and overall care of the patient have been emphasized and improved. For the present article, a systematic review of the relevant literature regarding patient workup, tumescent fluid techniques, medication overview, and operative technique was conducted with a practical approach that the reader will possibly find clinically applicable. Recent trends regarding energy-assisted liposuction and body contouring local anesthesia use are addressed. Deep venous thromboembolism prophylaxis is mentioned, as are other common and less common possible complications. The article provides a literature-supported overview on liposuction techniques with an emphasis on preoperative assessment, medicines used, operative technique, and outcomes.

  5. Multi-level opinion dynamics under bounded confidence. (United States)

    Kou, Gang; Zhao, Yiyi; Peng, Yi; Shi, Yong


    Opinion dynamics focuses on the opinion evolution in a social community. Recently, some models of continuous opinion dynamics under bounded confidence were proposed by Deffuant and Krause, et al. In the literature, agents were generally assumed to have a homogeneous confidence level. This paper proposes an extended model for a group of agents with heterogeneous confidence levels. First, a social differentiation theory is introduced and a social group is divided into opinion subgroups with distinct confidence levels. Second, a multi-level heterogeneous opinion formation model is formulated under the framework of bounded confidence. Finally, computer simulations are conducted to study the collective opinion evolution, focusing on three key factors: the fractions of heterogeneous agents, the initial opinions, and the group size. The simulation results demonstrate that the number of final opinions depends on the fraction of close-minded agents when the group size and the initial opinions are fixed; the final opinions converge more easily when the initial opinions are closer; and the number of final opinions can be approximately modeled by a linear increasing function of the group size and the increasing rate is the fraction of close-minded agents.

  6. Physics of Polarized Scattering at Multi-level Atomic Systems (United States)

    Stenflo, J. O.


    The symmetric peak observed in linear polarization in the core of the solar sodium D1 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 D1 enigma is a problem of solar physics or quantum physics revealed that the D1 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 D2 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 D1 results.


    Directory of Open Access Journals (Sweden)

    Ayu Dewi Utami


    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.

  8. 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


    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

  9. Evidence-based policy as reflexive practice. : What can we learn from evidence-based medicine?

    NARCIS (Netherlands)

    R.A. Bal (Roland)


    textabstractThe call for evidence-based policy is often accompanied by rather uncritical references to the success of evidence-based medicine, leading to often unsuccessful translation attempts. In this paper, I reflect on the practice of evidence-based medicine in an attempt to sketch a more

  10. Sicily statement on evidence-based practice

    Directory of Open Access Journals (Sweden)

    Hopayian Kevork


    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'.

  11. Identifying Challenges to Building an Evidence Base for Restoration Practice

    Directory of Open Access Journals (Sweden)

    Phumza Ntshotsho


    Full Text Available Global acknowledgement of ecological restoration, as an important tool to complement conservation efforts, requires an effort to increase the effectiveness of restoration interventions. Evidence-based practice is purported to promote effectiveness. A central tenet of this approach is decision making that is based on evidence, not intuition. Evidence can be generated experimentally and in practice but needs to be linked to baseline information collection, clear goals and monitoring of impact. In this paper, we report on a survey conducted to assess practitioners’ perceptions of the evidence generated in restoration practice in South Africa, as well as challenges encountered in building this evidence base. Contrary to a recent assessment of this evidence base which found weaknesses, respondents viewed it as adequate and cited few obstacles to its development. Obstacles cited were mostly associated with planning and resource availability. We suggest that the disparity between practitioners’ perceptions and observed weaknesses in the evidence base could be a challenge in advancing evidence-based restoration. We explore opportunities to overcome this disparity as well as the obstacles listed by practitioners. These opportunities involve a shift from practitioners as users of scientific knowledge and evidence, to practitioners involved in the co-production of evidence needed to increase the effectiveness of restoration interventions.

  12. Evidence-Based Practice: Separating Science From Pseudoscience. (United States)

    Lee, Catherine M; Hunsley, John


    Evidence-based practice (EBP) requires that clinicians be guided by the best available evidence. In this article, we address the impact of science and pseudoscience on psychotherapy in psychiatric practice. We describe the key principles of evidence-based intervention. We describe pseudoscience and provide illustrative examples of popular intervention practices that have not been abandoned, despite evidence that they are not efficacious and may be harmful. We distinguish efficacy from effectiveness, and describe modular approaches to treatment. Reasons for the persistence of practices that are not evidence based are examined at both the individual and the professional system level. Finally, we offer suggestions for the promotion of EBP through clinical practice guidelines, modelling of scientific decision making, and training in core skills.

  13. Evidence-Based Practice: Separating Science From Pseudoscience (United States)

    Lee, Catherine M; Hunsley, John


    Evidence-based practice (EBP) requires that clinicians be guided by the best available evidence. In this article, we address the impact of science and pseudoscience on psychotherapy in psychiatric practice. We describe the key principles of evidence-based intervention. We describe pseudoscience and provide illustrative examples of popular intervention practices that have not been abandoned, despite evidence that they are not efficacious and may be harmful. We distinguish efficacy from effectiveness, and describe modular approaches to treatment. Reasons for the persistence of practices that are not evidence based are examined at both the individual and the professional system level. Finally, we offer suggestions for the promotion of EBP through clinical practice guidelines, modelling of scientific decision making, and training in core skills. PMID:26720821

  14. Proportion of third-level variation in multi-level studies: A note on an interval estimation procedure. (United States)

    Raykov, Tenko


    An interval estimation procedure is outlined that can be used for evaluating the proportion of observed variance in a response variable, which is due to the third level of nesting in a hierarchical design. The approach is also useful when it is of concern to address the necessity of including a third level in analyses of data from a multi-level study, relative to an alternative of proceeding with two-level modelling. The proposed method is illustrated with an empirical example.

  15. Multi-level innovation policy in southern EU countries.An additionality evaluation of the Italian and Spanish public interventions


    Alberto Marzucchi


    The present paper aims to analyse the innovation policies implemented in Italy and Spain. It adopts a multi-level perspective to investigate the effects induced by regional and national public supports and a multi-dimensional approach to disentangle the different types of additionality impacts on firms’ innovation process. In particular input, output and behavioural additionality are considered. The results, obtained through a propensity score matching estimation of the average treatment ef...

  16. The evidence base for diabetes care

    National Research Council Canada - National Science Library

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


    ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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. Evidence based policy-making: A review

    CSIR Research Space (South Africa)

    Strydom, FW


    Full Text Available 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....

  18. Evidence-Based Dentistry in Everyday Practice. (United States)

    Gudray, Kiran; Walmsley, Anthony Damien


    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.

  19. Evidence-based history taking under "time constraint"


    Alireza Moayyeri; Akbar Soltani; Hamideh Moosapour; Mohsin Raza


    Physicians all through the world visit patients under time limitations. The most important troubled clinical skill under ?time constraint? is the diagnostic approach. In this situation, clinicians need some diagnostic approaches to reduce both diagnostic time and errors. It seems that highly experienced physicians utilize some special tactics in this regard. Evidence-based medicine (EBM) as a relatively new paradigm for clinical practice stresses on using research evidences in diagnostic eval...

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

    Directory of Open Access Journals (Sweden)

    Ezgi Irgil


    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.

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

    Directory of Open Access Journals (Sweden)

    L. DJEROU,


    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.

  2. Multi-level determinants of parasitic fly infection in forest passerines.

    Directory of Open Access Journals (Sweden)

    Darío Ezequiel Manzoli

    Full Text Available 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.

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

    Directory of Open Access Journals (Sweden)

    Shea Beverley


    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

  4. An automated method for segmenting white matter lesions through multi-level morphometric feature classification with application to lupus

    Directory of Open Access Journals (Sweden)

    Mark Scully


    Full Text Available We demonstrate an automated, multi-level method to segment white matter brain lesions and apply it to lupus. The method makes use of local morphometric features based on multiple MR sequences, including T1-weighted, T2-weighted, and Fluid Attenuated Inversion Recovery. After preprocessing, including co-registration, brain extraction, bias correction, and intensity standardization, 49 features are calculated for each brain voxel based on local morphometry. At each level of segmentation a supervised classifier takes advantage of a different subset of the features to conservatively segment lesion voxels, passing on more difficult voxels to the next classifier. This multi-level approach allows for a fast lesion classification method with tunable trade-offs between sensitivity and specificity producing accuracy comparable to a human rater.

  5. Introduction: evidence-based action in humanitarian crises. (United States)

    Dijkzeul, Dennis; Hilhorst, Dorothea; Walker, Peter


    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 need for evidence-based approaches sometimes is viewed in tension with a principled approach, often unnecessarily. Choosing appropriate research methods depends on the objectives of the researcher, in particular whether the research focuses on the intervention and/or the context and the length and complexity of the causal chains involved. The paper concludes by defining some trends in evidence-based approaches in crises: the move away from inputs and outputs of humanitarian action towards outcomes and impacts; the shift towards a higher degree of partnerships in research, and the participation of users and target groups; and the acceptance of a broad array of approaches to establish evidence. © 2013 The Author(s). Journal compilation © Overseas Development Institute, 2013.

  6. Automatic detection of multi-level acetowhite regions in RGB color images of the uterine cervix (United States)

    Lange, Holger


    Uterine cervical cancer is the second most common cancer among women worldwide. Colposcopy is a diagnostic method used to detect cancer precursors and cancer of the uterine cervix, whereby a physician (colposcopist) visually inspects the metaplastic epithelium on the cervix for certain distinctly abnormal morphologic features. A contrast agent, a 3-5% acetic acid solution, is used, causing abnormal and metaplastic epithelia to turn white. The colposcopist considers diagnostic features such as the acetowhite, blood vessel structure, and lesion margin to derive a clinical diagnosis. STI Medical Systems is developing a Computer-Aided-Diagnosis (CAD) system for colposcopy -- ColpoCAD, a complex image analysis system that at its core assesses the same visual features as used by colposcopists. The acetowhite feature has been identified as one of the most important individual predictors of lesion severity. Here, we present the details and preliminary results of a multi-level acetowhite region detection algorithm for RGB color images of the cervix, including the detection of the anatomic features: cervix, os and columnar region, which are used for the acetowhite region detection. The RGB images are assumed to be glare free, either obtained by cross-polarized image acquisition or glare removal pre-processing. The basic approach of the algorithm is to extract a feature image from the RGB image that provides a good acetowhite to cervix background ratio, to segment the feature image using novel pixel grouping and multi-stage region-growing algorithms that provide region segmentations with different levels of detail, to extract the acetowhite regions from the region segmentations using a novel region selection algorithm, and then finally to extract the multi-levels from the acetowhite regions using multiple thresholds. The performance of the algorithm is demonstrated using human subject data.

  7. Detailed Modeling, Design, and Evaluation of a Scalable Multi-level Checkpointing System

    Energy Technology Data Exchange (ETDEWEB)

    Moody, A T; Bronevetsky, G; Mohror, K M; de Supinski, B R


    High-performance computing (HPC) systems are growing more powerful by utilizing more hardware components. As the system mean-time-before-failure correspondingly drops, applications must checkpoint more frequently to make progress. However, as the system memory sizes grow faster than the bandwidth to the parallel file system, the cost of checkpointing begins to dominate application run times. A potential solution to this problem is to use multi-level checkpointing, which employs multiple types of checkpoints with different costs and different levels of resiliency in a single run. The goal is to design light-weight checkpoints to handle the most common failure modes and rely on more expensive checkpoints for less common, but more severe failures. While this approach is theoretically promising, it has not been fully evaluated in a large-scale, production system context. To this end we have designed a system, called the Scalable Checkpoint/Restart (SCR) library, that writes checkpoints to storage on the compute nodes utilizing RAM, Flash, or disk, in addition to the parallel file system. We present the performance and reliability properties of SCR as well as a probabilistic Markov model that predicts its performance on current and future systems. We show that multi-level checkpointing improves efficiency on existing large-scale systems and that this benefit increases as the system size grows. In particular, we developed low-cost checkpoint schemes that are 100x-1000x faster than the parallel file system and effective against 85% of our system failures. This leads to a gain in machine efficiency of up to 35%, and it reduces the the load on the parallel file system by a factor of two on current and future systems.

  8. Multi-level Governance in Environmental Risk Management

    Directory of Open Access Journals (Sweden)

    Petra Hiller


    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

  9. The religion of evidence-based practice

    DEFF Research Database (Denmark)

    Wigram, Tony; Gold, Christian


    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....

  10. Creating the evidence base for quality improvement collaboratives. (United States)

    Mittman, Brian S


    Intensive efforts are under way to improve health care quality and safety throughout the United States and abroad. Many of these efforts use the quality improvement collaborative method, an approach emphasizing collaborative learning and exchange of insights and support among a set of health care organizations. Unfortunately, the widespread acceptance and reliance on this approach are based not on solid evidence but on shared beliefs and anecdotal affirmations that may overstate the actual effectiveness of the method. More effective use of the collaborative method will require a commitment by users, researchers, and other stakeholders to rigorous, objective evaluation and the creation of a valid, useful knowledge and evidence base. Development of this evidence base will require improved conceptions of the nature of quality problems, quality improvement processes, and the types of research needed to elucidate these processes. Researchers, journal editors, and funding agencies must also cooperate to ensure that published evaluations are relevant, comprehensive, and cumulative.

  11. Advances toward Evidence-Based Practice: Where to From Here?


    Ollendick, Thomas H.


    Evidence-based practice has a long history; however attempts to bridge the gap between science and practice have been only partially effective and much work remains to be done. Part of the problem has been the unilateral approach associated with dissemination of research findings to clinical practitioners. In this special series, Goldfried and colleagues suggest a two-way bridge, in which practitioners are afforded the opportunity to disseminate their rich clinical experiences to researchers ...

  12. Evidence-based medicine Training: Kazakhstan experience. (United States)

    Kamalbekova, G; Kalieva, M


    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

  13. Lessons to be Learned from Evidence-based Medicine: Practice and Promise of Evidence-based Medicine and Evidence-based Education. (United States)

    Wolf, Fredric M.


    Presents statistics of deaths caused by medical errors and argues the effects of misconceptions in diagnosis and treatment. Suggests evidence-based medicine to enhance the quality of practice and minimize error rates. Presents 10 evidence-based lessons and discusses the possible benefits of evidence-based medicine to evidence-based education and…

  14. Competent in evidence-based practice (EBP)

    NARCIS (Netherlands)

    B. Spek; M. Wieringa-de Waard; C. Lucas; N. van Dijk


    BACKGROUND: Worldwide speech-language therapy (SLT) students are educated in evidence-based practice (EBP). For students to use EBP in their future day-to-day clinical practice, they must value EBP as positive and must feel confident in using it. For curricula developers it is therefore important to

  15. Evidence-Based Practices and Autism (United States)

    Mesibov, Gary B.; Shea, Victoria


    Interventions for autism are increasing being held to standards such as "evidence-based practice" in psychology and "scientifically-based research" in education. When these concepts emerged in the context of adult psychotherapy and regular education, they caused considerable controversy. Application of the concepts to autism treatments and special…

  16. Evidence based practice: perspectives of Iranian urologists. (United States)

    Hajebrahimi, Sakineh; Sadeghi-Ghyassi, Fatemeh; Olfati, Nahid; Dastgiri, Saeed; Maghbouli, Leili


    To determine the attitudes and beliefs of Iranian urologists toward Evidence Based Medicine (EBM) and investigation of the barriers of evidence based practice (EBP). A self- administrated, Likert scale questionnaire designed in Persian and filled up by censuses selected urologist from Iranian Urology Association (IUA). Data were entered to Predictive Analytics Soft Ware version 18.0 and descriptive statistics were obtained for all parts of the questionnaire. A total of 111 out of 500 Iranian urologists who attended in IUA annual meeting, responded to the questionnaires. Mean attitude score of respondents was 30.4 (SD: 5.7, range 16-40). Attitude score showed statistically significant association to previous participation in EBM workshops (P = .01). Of participants 96% believed EBP will improve patient care and 76.2% of them appreciated the impact of use of research utilization and application of evidence based guidelines on clinical decision making and the outcome of surgery. The main barriers to EBP stated as lack of time (64.8%), facilities (53.4%), and training in EBM (29.4%). The urologists have positive attitudes towards EBP. However, regarding lack of time, pre-appraised databases or EBP guidelines can be helpful. Evidence based workshops and familiarity with evidence databases is recommended for Iranian urologists. In addition, health care system and policy makers could play a major role to provide a culture of EBP.

  17. Use of Web 2.0 Technologies in K-12 and Higher Education: The Search for Evidence-Based Practice (United States)

    Hew, Khe Foon; Cheung, Wing Sum


    Evidence-based practice in education entails making pedagogical decisions that are informed by relevant empirical research evidence. The main purpose of this paper is to discuss evidence-based pedagogical approaches related to the use of Web 2.0 technologies in both K-12 and higher education settings. The use of such evidence-based practice would…

  18. The crisis intervention team (CIT) model: An evidence-based policing practice? (United States)

    Watson, Amy C; Compton, Michael T; Draine, Jeffrey N


    As academic researchers, we are often asked to opine on whether the Crisis Intervention Team model (CIT) is an evidence-based practice (EBP) or evidence-based policing. Our answer is that it depends on how you define evidence-based practice and what outcome you are interested in. In this commentary, we briefly describe the CIT model, examine definitions of evidence-based practice and evidence-based policing, and then summarize the existing research on what is known about the effectiveness of CIT to date. We conclude that CIT can be designated an EBP for officer-level cognitive and attitudinal outcomes, but more research is needed to determine if CIT can be designated an EBP for other outcomes. Using an evidence-based practice process approach, CIT may also be a justified strategy for many communities. Future directions to inform the field are discussed. Copyright © 2017 John Wiley & Sons, Ltd.

  19. Evidence-based therapy of diabetic retinopathy. (United States)

    Hoerle, S; Kroll, P


    Evidence-based medicine is often misunderstood as 'cookbook medicine with standard recipes' that does not take clinical experience into account. It is, however, supposed to be a basis for decision making in caring for individual patients under consideration of patients' preferences. This seems to be very important, since diabetic retinopathy continues to be the most frequent cause of vision loss in working age adults with negative consequences for patients' quality of life and for health economics. The most important evidence-based therapy for diabetic retinopathy and maculopathy is laser coagulation. Vitrectomy for proliferative stages has also been proven effective by clinical studies. For more recent treatment options like triamcinolone injection and vitrectomy for diabetic macular edema there is a lower level of evidence so far. The Diabetic Retinopathy Study was the first to show the effectiveness of panfundus laser coagulation for a larger group of patients. The Early Treatment Diabetic Retinopathy Study in turn serves as a basis for laser coagulation of retinopathy and maculopathy. The Diabetic Retinopathy Vitrectomy Study could show the advantages of timely vitrectomy. Both the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study could show the value of intensive blood glucose control. Evidence-based medicine on the basis of the studies mentioned above is practiced quite self-evidently in ophthalmo-diabetology. It should be regarded as a helpful tool for special therapeutic situations which still leaves room for one's personal clinical experience to be included. It is somewhat problematic that the term evidence-based medicine seems to be restricted to the results of large randomized studies, because even special problems and very individual, difficult therapeutic questions can be placed on an evidence-based foundation, although at a lower level of evidence, using today's modern means of literature research. Copyright (c

  20. Statistical Reform: Evidence-Based Practice, Meta-Analyses, and Single Subject Designs (United States)

    Jenson, William R.; Clark, Elaine; Kircher, John C.; Kristjansson, Sean D.


    Evidence-based practice approaches to interventions has come of age and promises to provide a new standard of excellence for school psychologists. This article describes several definitions of evidence-based practice and the problems associated with traditional statistical analyses that rely on rejection of the null hypothesis for the…

  1. Goals and actual practice - multi-level analysis of the evolution of Finnish geriatric nursing from the 1930s to the 2000s


    Paasivaara, Leena


    The purpose of this study was to describe and understand the evolution of the content and characteristics of Finnish geriatric nursing from the 1930s to the 2000s. The research approach was based on three underlying assumptions: historicity, multi-level analysis and the dimensions of goals and actual practice. Historicity implied both a long-term analysis of the phenomenon and the use of historical methodology. Multi-level analysis implied that the phenomenon was analyzed at both a macro-leve...

  2. 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.


    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,

  3. Does Multi-Level Intervention Enhance Work Process Knowledge? (United States)

    Leppanen, Anneli; Hopsu, Leila; Klemola, Soili; Kuosma, Eeva


    Purpose: The aim of this study is to find out the impacts of participation in formal training and development of work on the work process knowledge of school kitchen workers. Design/methodology/approach: The article describes a follow-up study on the consequences of intervention. In total, 108 subjects participated both in the interventions and in…

  4. How to teach evidence-based medicine to urologists (United States)

    Hajebrahimi, Sakineh; Mostafaie, Ali


    The goal of this article is to help develop, disseminate, and evaluate resources that can be used to practice and teach EBM for urology residents and continuing education of urologists to reduce the gap between research and clinical practice. Urology departments should build capacity for residents to shape the future of quality and safety in healthcare through translating evidence into practice. Cutting edge approaches require knowing how to teach Evidence-based urology, to make Bio-statistics easy to understanding and how to lead improvement at every level. The authors shared their experience about ‘what works’ in a surgical department to building an Evidence-based environment and high quality of cares. PMID:22279316

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

    Cairney, Paul; Oliver, Kathryn


    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

  6. Delamination detection by Multi-Level Wavelet Processing of Continuous Scanning Laser Doppler Vibrometry data (United States)

    Chiariotti, P.; Martarelli, M.; Revel, G. M.


    A novel non-destructive testing procedure for delamination detection based on the exploitation of the simultaneous time and spatial sampling provided by Continuous Scanning Laser Doppler Vibrometry (CSLDV) and the feature extraction capability of Multi-Level wavelet-based processing is presented in this paper. The processing procedure consists in a multi-step approach. Once the optimal mother-wavelet is selected as the one maximizing the Energy to Shannon Entropy Ratio criterion among the mother-wavelet space, a pruning operation aiming at identifying the best combination of nodes inside the full-binary tree given by Wavelet Packet Decomposition (WPD) is performed. The pruning algorithm exploits, in double step way, a measure of the randomness of the point pattern distribution on the damage map space with an analysis of the energy concentration of the wavelet coefficients on those nodes provided by the first pruning operation. A combination of the point pattern distributions provided by each node of the ensemble node set from the pruning algorithm allows for setting a Damage Reliability Index associated to the final damage map. The effectiveness of the whole approach is proven on both simulated and real test cases. A sensitivity analysis related to the influence of noise on the CSLDV signal provided to the algorithm is also discussed, showing that the processing developed is robust enough to measurement noise. The method is promising: damages are well identified on different materials and for different damage-structure varieties.

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

    Directory of Open Access Journals (Sweden)

    Sparsh Mittal


    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:

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

    Directory of Open Access Journals (Sweden)

    Song Min


    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. How evidence-based medicine biases physicians against nutrition. (United States)

    Thomas, Laurie Endicott


    Medical students in the United States are taught little about nutrition and dietetics. Worse yet, their training biases them against the studies that show the power of dietary approaches to managing disease. The current approach to evidence-based medicine encourages physicians to ignore any information that does not come from a double-blind, randomized controlled trial. Yet human beings cannot be blinded to a dietary intervention. As a result, physicians are biased toward drug treatments and against dietary interventions for the management of chronic disease. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Evidence Based Education: un quadro storico

    Directory of Open Access Journals (Sweden)

    Giuliano Vivanet


    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.

  11. The fallacy of evidence based policy

    CERN Document Server

    Saltelli, Andrea


    The use of science for policy is at the core of a perfect storm generated by the insurgence of several concurrent crises: of science, of trust, of sustainability. The modern positivistic model of science for policy, known as evidence based policy, is based on dramatic simplifications and compressions of available perceptions of the state of affairs and possible explanations (hypocognition). This model can result in flawed prescriptions. The flaws become more evident when dealing with complex issues characterized by concomitant uncertainties in the normative, descriptive and ethical domains. In this situation evidence-based policy may concur to the fragility of the social system. Science plays an important role in reducing the feeling of vulnerability of humans by projecting a promise of protection against uncertainties. In many applications quantitative science is used to remove uncertainty by transforming it into probability, so that mathematical modelling can play the ritual role of haruspices. This epistem...

  12. Organizational readiness for evidence-based practice. (United States)

    Gale, Barbara Van Patter; Schaffer, Marjorie A


    This study explored factors that affect the adoption or rejection of evidence-based practice (EBP) changes and differences in nurse manager and staff nurse perceptions about those factors. Roger's Diffusion of Innovations Theory explains relevant organizational strategies for guiding practice change. The primary author developed the Evidence-Based Practice Changes Survey consisting of 12 items, completed by 92 nurses at a level 1 trauma center. Top barriers to EBP were insufficient time, lack of staff, and not having the right equipment and supplies. Top reasons to adopt EBP were having personal interest in the practice change, avoiding risk of negative consequences to the patient, and personally valuing the evidence. Several statistically significant differences emerged for demographic variables. Planning for EBP change must address barriers and facilitators to practice change and emphasize the benefit for patients and value of the practice change to nurses.

  13. Professionalism and evidence-based practice

    DEFF Research Database (Denmark)

    Rasmussen, Palle


    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...... 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...... 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...

  14. [Looking for evidence-based medical informatics]. (United States)

    Coiera, Enrico


    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.

  15. Evidence-based hypnotherapy for depression. (United States)

    Alladin, Assen


    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.

  16. Object Recognition by Using Multi-level Feature Point Extraction


    Cheng, Yang; Dubois, Timeo


    In this paper, we present a novel approach for object recognition in real-time by employing multilevel feature analysis and demonstrate the practicality of adapting feature extraction into a Naive Bayesian classification framework that enables simple, efficient, and robust performance. We also show the proposed method scales well as the number of level-classes grows. To effectively understand the patches surrounding a keypoint, the trained classifier uses hundreds of simple binary features an...

  17. What's Wrong with Evidence-Based Medicine? (United States)

    Fins, Joseph J


    Medicine in the last decades of the twentieth century was ripe for a data sweep that would bring systematic analysis to treatment strategies that seemingly had stood the test of time but were actually unvalidated. Coalescing under the banner of evidence-based medicine, this process has helped to standardize care, minimize error, and promote patient safety. But with this advancement, something of the art of medicine has been lost. © 2016 The Hastings Center.

  18. Case studies and evidence based nutrition. (United States)

    Wahlqvist, Mark L


    The clinical nutrition case study is a neglected area of activity and publication. This may be in part because it is not regarded as a serious contributor to evidence-based nutrition (EBN). Yet it can play a valuable part in hypothesis formulation and in the cross-checking of evidence. Most of all, it is usually a point at which the operationalisation of nutrition evidence is granted best current practice status.

  19. The Evidence Base of Czech Health Policy


    Jan Klusáček; Marie Klusáčková


    The article deals with the evidence base of health policy in the Czech Republic. It focuses on articles published in peer-reviewed scholarly journals. It builds on a quantitative analysis of articles published between 2005 and 2010 in scholarly journals in the fields of social science, management and administration, public health and other relevant fields. The main finding is that almost half of the 161 articles with potential use for health policy were published in a single journal, Zdravotn...

  20. Evidence-based librarianship: an overview. (United States)

    Eldredge, J D


    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.

  1. Evidence-based pathology: umbilical cord coiling. (United States)

    Khong, T Y


    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.

  2. Multi-level burst power transient suppression using semiconductor optical amplifiers in gigabit access links

    DEFF Research Database (Denmark)

    Gibbon, Timothy Braidwood; Tafur Monroy, Idelfonso


    For 10 Gb/s transmission limited by multi-level burst transients to non error-free performance, including an SOA reduces the penalty to 0.4 dB relative to back-to-back transmission.......For 10 Gb/s transmission limited by multi-level burst transients to non error-free performance, including an SOA reduces the penalty to 0.4 dB relative to back-to-back transmission....

  3. Reconciling evidence-based medicine and patient-centred care: defining evidence-based inputs to patient-centred decisions. (United States)

    Weaver, Robert R


    Evidence-based and patient-centred health care movements have each enhanced the discussion of how health care might best be delivered, yet the two have evolved separately and, in some views, remain at odds with each other. No clear model has emerged to enable practitioners to capitalize on the advantages of each so actual practice often becomes, to varying degrees, an undefined mishmash of each. When faced with clinical uncertainty, it becomes easy for practitioners to rely on formulas for care developed explicitly by expert panels, or on the tacit ones developed from experience or habit. Either way, these tendencies towards 'cookbook' medicine undermine the view of patients as unique particulars, and diminish what might be considered patient-centred care. The sequence in which evidence is applied in the care process, however, is critical for developing a model of care that is both evidence based and patient centred. This notion derives from a paradigm for knowledge delivery and patient care developed over decades by Dr. Lawrence Weed. Weed's vision enables us to view evidence-based and person-centred medicine as wholly complementary, using computer tools to more fully and reliably exploit the vast body of collective knowledge available to define patients' uniqueness and identify the options to guide patients. The transparency of the approach to knowledge delivery facilitates meaningful practitioner-patient dialogue in determining the appropriate course of action. Such a model for knowledge delivery and care is essential for integrating evidence-based and patient-centred approaches. © 2015 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

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

    Directory of Open Access Journals (Sweden)

    Qiaoning Yang


    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. Multi-Level Re-Planning For Reconnaissance Drones (United States)

    Blank, Glenn D.


    The Navy currently uses airborne drones for reconnaisance, controlling them by radio uplink or autopilot technology. Radio contact is not always possible, however, and autopilot control does not monitor non-navigational sensors, such as a CDC camera. We are developing a system that will monitor the autopilot as it follows a pre-planned mission, and re-plans in response to conditions detected by non-navigational sensors. At its heart is a novel approach to real time system control, called Register Vector Grammar. We demonstrate how this modified finite state automaton is able to model both hierarchical decomposition and heterarchical responsiveness--both needed to handle the range and interaction of behaviors susceptible to intelligent control--without calling for inordinate computational complexity.

  6. Multi-level human evolution: ecological patterns in hominin phylogeny. (United States)

    Parravicini, Andrea; Pievani, Telmo


    Evolution is a process that occurs at many different levels, from genes to ecosystems. Genetic variations and ecological pressures are hence two sides of the same coin; but due both to fragmentary evidence and to the influence of a gene-centered and gradualistic approach to evolutionary phenomena, the field of paleoanthropology has been slow to take the role of macro-evolutionary patterns (i.e. ecological and biogeographical at large scale) seriously. However, several very recent findings in paleoanthropology stress both climate instability and ecological disturbance as key factors affecting the highly branching hominin phylogeny, from the earliest hominins to the appearance of cognitively modern humans. Allopatric speciation due to geographic displacement, turnover-pulses of species, adaptive radiation, mosaic evolution of traits in several coeval species, bursts of behavioral innovation, serial dispersals out of Africa, are just some of the macro-evolutionary patterns emerging from the field. The multilevel approach to evolution proposed by paleontologist Niles Eldredge is adopted here as interpretative tool, and has yielded a larger picture of human evolution that integrates different levels of evolutionary change, from local adaptations in limited ecological niches to dispersal phenotypes able to colonize an unprecedented range of ecosystems. Changes in global climate and Earth's surface most greatly affected human evolution. Precisely because it is cognitively hard for us to appreciate the long-term common destiny we share with the whole biosphere, it is particularly valuable to highlight the accumulating evidence that human evolution has been deeply affected by global ecological changes that transformed our African continent of origin.

  7. Apprehensions of nurse managers on evidence-based practice

    Directory of Open Access Journals (Sweden)

    Fernanda Carolina Camargo


    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.

  8. Aeromedical Risk Assessment of Pharmaceuticals Using Evidence-Based Medicine. (United States)

    Prudhomme, Michael B; Ropp, Lincoln G; Sauer, Samual W; LaVan, Joseph T


    Using concepts from evidence-based medicine, systems theory, and risk assessment, a standardized model was developed to accept or reject medications for use in flight. The model calculates the risk scores of medications, which can then be compared to an organization's acceptable risk tolerance. Risk scores for each medication were established by summing the products of incidence rates and severity scores for all published side effects. The incidence of each side effect was obtained in an evidence-based manner and each assigned a severity multiplier. Using statistical analysis of the calculated risk scores of approved medications, an acceptance control chart was generated. Range of calculated risk scores of historically approved medications was 10-9140. Six Sigma Acceptance Control Line was calculated at 1.5 SDs above the mean and was 9822. Risk score range of medications generally felt unsafe was 27,010-41,294. Risk score range of medications under consideration for approval was 986-6863. This novel approach to medication approval is the first in aerospace medicine to attempt to combine evidence-based medicine, risk analysis, and control charts to standardize and streamline the medication approval process within an organization. The model was validated by testing against medications generally accepted to be unsafe for use in flight. These medications fell several deviations above the control line. Other medications not yet authorized fall well below the acceptance line and could be considered for approval.

  9. Reduciendo la carga de enfermedad generada por el consumo de alcohol en el Perú: propuestas basadas en evidencia Reducing the burden of disease caused by alcohol use in Peru: evidence- based approaches

    Directory of Open Access Journals (Sweden)

    Fabián Fiestas


    Full Text Available El consumo de alcohol constituye uno de los más importantes factores de riesgo para mala salud y muerte prematura en el Perú. Son necesarias medidas que disminuyan o controlen el gran impacto que tiene el alcohol en la sociedad peruana. El presente artículo identifica y promueve el uso de medidas de salud pública que cuentan con evidencia científica sólida de efectividad y, en algunos casos, costo-efectividad. Al ser apoyadas por la evidencia científica, las diez medidas aquí identificadas representan un conjunto de medidas con alta probabilidad de éxito. Se recomienda que los gobiernos, nacionales o locales, tomen estas medidas no aisladamente sino en combinación, en un plan u hoja de ruta que establezca en forma contextualizada el engranaje en que se aplicarán. Tomando en cuenta los recursos que se tienen, algunas de estas medidas podrían implementarse a corto o mediano plazo, mientras que las otras lo serían a más largo plazo.Alcohol use is one the most important risk factors for illness and early death in Peru. Measures aimed at decreasing or controlling the great impact caused by alcohol in the Peruvian society are urgently needed. This article identifies and promotes the implementation of public health measures supported by sound scientific evidence of effectiveness or, in some cases, cost-effectiveness. The 10 evidence-based public health measures identified and described here represent a set if measures with high probability of success if implemented, as they are supported by scientific evidence. We recommend that governments, at the national or local levels, apply these measures not individually, but in combination, arranging them into a plan or roadmap, where the framework in which they will be applied must be established according to each context. Considering the available resources, some of these measures could be implemented in the short and medium term while the others can be set in the long-term.

  10. 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 (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


    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

  11. Evidence Based Practice: Science? Or Art? (Editorial

    Directory of Open Access Journals (Sweden)

    Denise Koufogiannakis


    Full Text Available Evidence based library and information practice (EBLIP is a strategy to bridge research and practice. Generally EBLIP is seen as a movement to encourage and give practitioners the means to incorporate research into their practice, where it previously may have been lacking. The widely accepted definition of EBLIP (Booth, 2000 stresses three aspects that contribute to a practice that is evidence based: 1 "the best available evidence;" 2 "moderated by user needs and preferences;" 3 "applied to improve the quality of professional judgements." The area that the EBLIP movement has focused on is how to create and understand the best available research evidence. CE courses, critical appraisal checklists, and many articles have been written to address a need for librarian education in this area, and it seems that strides have been made.But very little in the EBLIP literature talks about how we make professional judgements, or moderate evidence based on our user needs and preferences. Likewise, how do we make good evidence based decisions when our evidence base is weak. These things seem to be elements we just take for granted or can’t translate into words. It is in keeping with tacit knowledge that librarians just seem to have or acquire skills with education and on the job experience. Tacit knowledge is "knowledge that is not easily articulated, and frequently involves knowledge of how to do things. We can infer its existence only by observing behaviour and determining that this sort of knowledge is a precondition for effective performance" (Patel, Arocha, & Kaufman, 1999, p.78. It is something that is difficult to translate into an article or guideline for how we work. I think of this area as the "art" of evidence based practice. And the art is crucial to being an evidence based practitioner.Science = systematized knowledge, explicit research, methodological examination, investigation, dataArt = professional knowledge of your craft, intuition

  12. A multi-level strategy for anticipating future glacier lake formation and associated hazard potentials

    Directory of Open Access Journals (Sweden)

    H. Frey


    Full Text Available In the course of glacier retreat, new glacier lakes can develop. As such lakes can be a source of natural hazards, strategies for predicting future glacier lake formation are important for an early planning of safety measures. In this article, a multi-level strategy for the identification of overdeepened parts of the glacier beds and, hence, sites with potential future lake formation, is presented. At the first two of the four levels of this strategy, glacier bed overdeepenings are estimated qualitatively and over large regions based on a digital elevation model (DEM and digital glacier outlines. On level 3, more detailed and laborious models are applied for modeling the glacier bed topography over smaller regions; and on level 4, special situations must be investigated in-situ with detailed measurements such as geophysical soundings. The approaches of the strategy are validated using historical data from Trift Glacier, where a lake formed over the past decade. Scenarios of future glacier lakes are shown for the two test regions Aletsch and Bernina in the Swiss Alps. In the Bernina region, potential future lake outbursts are modeled, using a GIS-based hydrological flow routing model. As shown by a corresponding test, the ASTER GDEM and the SRTM DEM are both suitable to be used within the proposed strategy. Application of this strategy in other mountain regions of the world is therefore possible as well.

  13. Aircraft Fault Detection and Classification Using Multi-Level Immune Learning Detection (United States)

    Wong, Derek; Poll, Scott; KrishnaKumar, Kalmanje


    This work is an extension of a recently developed software tool called MILD (Multi-level Immune Learning Detection), which implements a negative selection algorithm for anomaly and fault detection that is inspired by the human immune system. The immunity-based approach can detect a broad spectrum of known and unforeseen faults. We extend MILD by applying a neural network classifier to identify the pattern of fault detectors that are activated during fault detection. Consequently, MILD now performs fault detection and identification of the system under investigation. This paper describes the application of MILD to detect and classify faults of a generic transport aircraft augmented with an intelligent flight controller. The intelligent control architecture is designed to accommodate faults without the need to explicitly identify them. Adding knowledge about the existence and type of a fault will improve the handling qualities of a degraded aircraft and impact tactical and strategic maneuvering decisions. In addition, providing fault information to the pilot is important for maintaining situational awareness so that he can avoid performing an action that might lead to unexpected behavior - e.g., an action that exceeds the remaining control authority of the damaged aircraft. We discuss the detection and classification results of simulated failures of the aircraft's control system and show that MILD is effective at determining the problem with low false alarm and misclassification rates.

  14. 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


    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.

  15. Interevent time distributions of human multi-level activity in a virtual world (United States)

    Mryglod, O.; Fuchs, B.; Szell, M.; Holovatch, Yu.; Thurner, S.


    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.

  16. Evidence-based dentistry and esthetics. (United States)

    Small, B W


    Separating hype from the truth in dental marketing can be frustrating and it is difficult at best for the average dentist to evaluate the safety and efficacy of new products and techniques. Keynote clinicians are presenting information and influencing other dentists without the scientific evidence to support their claims. For the benefit of our patients, the system needs to change. It will not come soon, but until more evidence-based testing is commonplace and made readily available to the practicing dentist, most dentists will continue tradition-based practices.

  17. Evidence-Based Advances in Rodent Medicine. (United States)

    Jekl, Vladimir; Hauptman, Karel; Knotek, Zdenek


    The number of exotic companion pet rodents seen in veterinary practices is growing very rapidly. According to the American Veterinary Medical Association's surveys, more than 2,093,000 pet rodents were kept in US households in 2007 and in 2012 it was more than 2,349,000 animals. This article summarizes the most important evidence-based knowledge in exotic pet rodents (diagnostics of the hyperadrenocorticism in guinea pigs, pituitary tumors in rats, urolithiasis in guinea pigs, use of itopride as prokinetics, use of deslorelin acetate in rodents, cause of dental disease, and prevention of mammary gland tumors in rats). Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Observation, Sherlock Holmes, and Evidence Based Medicine. (United States)

    Osborn, John


    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.

  19. Evidence-based practice within nutrition

    DEFF Research Database (Denmark)

    Laville, Martine; Segrestin, Berenice; Alligier, Maud


    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...... as patient-centred outcomes may occur decennia into the future. The methodologies and regulations for drug trials are, however, applicable to nutrition trials. CONCLUSIONS: Research on clinical nutrition should start by collecting clinical data systematically in databases and registries. Measurable patient...

  20. Evidence-Based Advances in Avian Medicine. (United States)

    Summa, Noémie M; Guzman, David Sanchez-Migallon


    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.

  1. Evidence-Based Advances in Rabbit Medicine. (United States)

    Summa, Noémie M; Brandão, João


    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.

  2. Expanding the domains of attitudes towards evidence-based practice: the evidence based practice attitude scale-50. (United States)

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


    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.

  3. Informed Systems: Enabling Collaborative Evidence Based Organizational Learning

    Directory of Open Access Journals (Sweden)

    Mary M. Somerville


    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

  4. Hemodynamic monitoring in the era of evidence-based medicine. (United States)

    Saugel, Bernd; Malbrain, Manu L N G; Perel, Azriel


    Hemodynamic instability frequently occurs in critically ill patients. Pathophysiological rationale suggests that hemodynamic monitoring (HM) may identify the presence and causes of hemodynamic instability and therefore may allow targeting therapeutic approaches. However, there is a discrepancy between this pathophysiological rationale to use HM and a paucity of formal evidence (as defined by the strict criteria of evidence-based medicine (EBM)) for its use. In this editorial, we discuss that this paucity of formal evidence that HM can improve patient outcome may be explained by both the shortcomings of the EBM methodology in the field of intensive care medicine and the shortcomings of HM itself.

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

    CERN Document Server

    Phiri, Michael


    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.

  6. Why we need multi-level health workforce governance: Case studies from nursing and medicine in Germany. (United States)

    Kuhlmann, Ellen; Larsen, Christa


    Health workforce needs have moved up on the reform agendas, but policymaking often remains 'piece-meal work' and does not respond to the complexity of health workforce challenges. This article argues for innovation in healthcare governance as a key to greater sustainability of health human resources. The aim is to develop a multi-level approach that helps to identify gaps in governance and improve policy interventions. Pilot research into nursing and medicine in Germany, carried out between 2013 and 2015 using a qualitative methodology, serves to illustrate systems-based governance weaknesses. Three explorative cases address major responses to health workforce shortages, comprising migration/mobility of nurses, reform of nursing education, and gender-sensitive work management of hospital doctors. The findings illustrate a lack of connections between transnational/EU and organizational governance, between national and local levels, occupational and sector governance, and organizations/hospital management and professional development. Consequently, innovations in the health workforce need a multi-level governance approach to get transformative potential and help closing the existing gaps in governance. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. A use case driven object-oriented design methodology for the design of multi-level workflow schemas (United States)

    Chen, Pei-Hung

    Traditional workflow schema design largely involves manual processes. It begins with business-process models and ends with delivering a workflow schema that can be executed by a workflow management system. However, little effort has been made to develop methodological approaches for workflow design [BARE99]. As a consequence, this thesis develops a design methodology which will enable workflow designers to model complex business processes in a simple and straightforward manner and easily generate workflow schemas. Our methodology is a use case based approach to algorithmic multi-level workflow schema generation. It begins with an initial analysis phase to capture requirement specifications, and incorporates workflow technology to support business process modeling that captures business processes as workflow specifications. In the process, we extend the interaction diagram for modeling workflow applications and for integrating business rules. Consequently, the extended interaction diagrams, named workflow based interaction diagrams, can support process-related concepts, including static and dynamic rules, multiple use case scenarios, event scheduling and delay features. We develop automatic conversion algorithms, which enable designers to generate different levels of workflow schemas automatically based on the workflow-based interaction diagrams generated from the use case analysis. The workflow schemas produced can be specified at different designers can further create a multi-level web interface based on these workflow schemas to support state and process defined data views and decision trees simultaneously.

  8. Multi-level analysis in information systems research: the case of enterprise resource planning system usage in China (United States)

    Sun, Yuan; Bhattacherjee, Anol


    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.

  9. 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


    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

  10. Evidence-Based Medicine: Mandible Fractures. (United States)

    Pickrell, Brent B; Hollier, Larry H


    After reading this article, the participant should be able to: 1. Explain the epidemiology of mandible fractures. 2. Discuss preoperative evaluation of the patient with a mandible fracture. 3. Compare the various modalities of fracture fixation. 4. Identify common complications after fracture repair. In this Maintenance of Certification/Continuing Medical Education article, the reader is provided with a review of the epidemiology, preoperative evaluation, perioperative management, and surgical outcomes of mandible fractures. The objective of this series is to present a review of the literature so that the practicing physician can remain up-to-date on key evidence-based guidelines to enhance management and improve outcomes. The physician can also seek further in-depth study of the topic through the references provided.

  11. Evidence-based policymaking: A review

    Directory of Open Access Journals (Sweden)

    Karen Nortje


    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.

  12. [Communication problems in evidence-based medicine]. (United States)

    Sachs, Lisbeth


    From a humanistic, social scientific perspective, the most complex task in evidence-based medicine lies in the communication of specialized medical knowledge to non-professionals. Information is never simply the neutral transmission of facts, not even when dealing with scientific knowledge and research. It is always interpreted and evaluated from a particular perspective in a specific context. That information can be neutral is thus a myth. In all medical consultations the process of communication is not just a matter of transmitting information from one who knows to one who does not. Knowledge created and formulated in a scientific context is thus recontextualised first in a clinical situation and then as an interpreted version in people's real lives. Furthermore there are difficulties when practice must be based on current research, in a situation in which no prior clinical experience exists and in which results are interpreted and used regardless of the relative certainty of current evidence.

  13. Evidence-based management of recurrent miscarriages

    Directory of Open Access Journals (Sweden)

    Yadava B Jeve


    Full Text Available Recurrent miscarriages are postimplantation failures in natural conception; they are also termed as habitual abortions or recurrent pregnancy losses. Recurrent pregnancy loss is disheartening to the couple and to the treating clinician. There has been a wide range of research from aetiology to management of recurrent pregnancy loss. It is one of the most debated topic among clinicians and academics. The ideal management is unanswered. This review is aimed to produce an evidence-based guidance on clinical management of recurrent miscarriage. The review is structured to be clinically relevant. We have searched electronic databases (PubMed and Embase using different key words. We have combined the searches and arranged them with the hierarchy of evidences. We have critically appraised the evidence to produce a concise answer for clinical practice. We have graded the evidence from level I to V on which these recommendations are based.

  14. Evidence Base Update for Autism Spectrum Disorder. (United States)

    Smith, Tristram; Iadarola, Suzannah


    This evidence base update examines the level of empirical support for interventions for children with autism spectrum disorder (ASD) younger than 5 years old. It focuses on research published since a previous review in this journal (Rogers & Vismara, 2008 ). We identified psychological or behavioral interventions that had been manualized and evaluated in either (a) experimental or quasi-experimental group studies or (b) systematic reviews of single-subject studies. We extracted data from all studies that met these criteria and were published after the previous review. Interventions were categorized across two dimensions. First, primary theoretical principles included applied behavior analysis (ABA), developmental social-pragmatic (DSP), or both. Second, practice elements included scope (comprehensive or focused), modality (individual intervention with the child, parent training, or classrooms), and intervention targets (e.g., spoken language or alternative and augmentative communication). We classified two interventions as well-established (individual, comprehensive ABA and teacher-implemented, focused ABA + DSP), 3 as probably efficacious (individual, focused ABA for augmentative and alternative communication; individual, focused ABA + DSP; and focused DSP parent training), and 5 as possibly efficacious (individual, comprehensive ABA + DSP; comprehensive ABA classrooms; focused ABA for spoken communication; focused ABA parent training; and teacher-implemented, focused DSP). The evidence base for ASD interventions has grown substantially since 2008. An increasing number of interventions have some empirical support; others are emerging as potentially efficacious. Priorities for future research include improving outcome measures, developing interventions for understudied ASD symptoms (e.g., repetitive behaviors), pinpointing mechanisms of action in interventions, and adapting interventions for implementation with fidelity by community providers.

  15. The multi-level perspective analysis: Indonesia geothermal energy transition study (United States)

    Wisaksono, A.; Murphy, J.; Sharp, J. H.; Younger, P. L.


    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.

  16. Modeling of BN Lifetime Prediction of a System Based on Integrated Multi-Level Information. (United States)

    Wang, Jingbin; Wang, Xiaohong; Wang, Lizhi


    Predicting system lifetime is important to ensure safe and reliable operation of products, which requires integrated modeling based on multi-level, multi-sensor information. However, lifetime characteristics of equipment in a system are different and failure mechanisms are inter-coupled, which leads to complex logical correlations and the lack of a uniform lifetime measure. Based on a Bayesian network (BN), a lifetime prediction method for systems that combine multi-level sensor information is proposed. The method considers the correlation between accidental failures and degradation failure mechanisms, and achieves system modeling and lifetime prediction under complex logic correlations. This method is applied in the lifetime prediction of a multi-level solar-powered unmanned system, and the predicted results can provide guidance for the improvement of system reliability and for the maintenance and protection of the system.

  17. Evidence-based ergonomics: a model and conceptual structure proposal. (United States)

    Silveira, Dierci Marcio


    In Human Factors and Ergonomics Science (HFES), it is difficult to identify what is the best approach to tackle the workplace and systems design problems which needs to be solved, and it has been also advocated as transdisciplinary and multidisciplinary the issue of "How to solve the human factors and ergonomics problems that are identified?". The proposition on this study is to combine the theoretical approach for Sustainability Science, the Taxonomy of the Human Factors and Ergonomics (HFE) discipline and the framework for Evidence-Based Medicine in an attempt to be applied in Human Factors and Ergonomics. Applications of ontologies are known in the field of medical research and computer science. By scrutinizing the key requirements for the HFES structuring of knowledge, it was designed a reference model, First, it was identified the important requirements for HFES Concept structuring, as regarded by Meister. Second, it was developed an evidence-based ergonomics framework as a reference model composed of six levels based on these requirements. Third, it was devised a mapping tool using linguistic resources to translate human work, systems environment and the complexities inherent to their hierarchical relationships to support future development at Level 2 of the reference model and for meeting the two major challenges for HFES, namely, identifying what problems should be addressed in HFE as an Autonomous Science itself and proposing solutions by integrating concepts and methods applied in HFES for those problems.

  18. Evidence-based toxicology for the 21st century: opportunities and challenges. (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


    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.

  19. 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


    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.

  20. Simulation and Analysis of a Grid Connected Multi-level Converter Topologies and their Comparison

    Directory of Open Access Journals (Sweden)

    Mohammad Shadab Mirza


    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.

  1. Research on Multi-level Electromagnetic Leakage Protection Strategy of Industrial Control System (United States)

    Li, Yang; Li, Feng; Wang, Xu; Guo, Qingrui


    The structure of industrial control system (ICS) is different from computer architecture, electromagnetic leakage protection of computer system is no longer suitable for industrial control system. In this paper, a method of electromagnetic leakage multi-level protection for industrial control system is presented, which combines software development, system overhaul and repair management as well as maintainers management. Through the application of the comprehensive and multi-level protection structure, the electromagnetic leakage of the industrial control system is effectively reduced. The defects of traditional protection which focus on local structure and lack of overall protection, are improved.

  2. Multi-level Discourse Analysis in a Physics Teaching Methods Course from the Psychological Perspective of Activity Theory (United States)

    Drumond Vieira, Rodrigo; Kelly, Gregory J.


    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.

  3. Pictorial AR Tag with Hidden Multi-Level Bar-Code and Its Potential Applications

    Directory of Open Access Journals (Sweden)

    Huy Le


    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.

  4. Evidence-Based Clinical Decision: Key to Improved Patients Care ...

    African Journals Online (AJOL)

    religious acts of the prehistoric era to empirical-rational decisions of the Egyptian civilization, to modern day evidence-based medicine. Evidence-based medicine requires that clinical decisions and health policies on the prevention, diagnosis and ...

  5. An Evidence-based Guideline for prehospital analgesia in trauma. (United States)

    Gausche-Hill, Marianne; Brown, Kathleen M; Oliver, Zoë J; Sasson, Comilla; Dayan, Peter S; Eschmann, Nicholas M; Weik, Tasmeen S; Lawner, Benjamin J; Sahni, Ritu; Falck-Ytter, Yngve; Wright, Joseph L; Todd, Knox; Lang, Eddy S


    The management of acute traumatic pain is a crucial component of prehospital care and yet the assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based regional protocols. To develop an evidence-based guideline (EBG) for the clinical management of acute traumatic pain in adults and children by advanced life support (ALS) providers in the prehospital setting. Methods. We recruited a multi-stakeholder panel with expertise in acute pain management, guideline development, health informatics, and emergency medical services (EMS) outcomes research. Representatives of the National Highway Traffic Safety Administration (sponsoring agency) and a major children's research center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide the process of question formulation, evidence retrieval, appraisal/synthesis, and formulation of recommendations. The process also adhered to the National Prehospital Evidence-Based Guideline (EBG) model process approved by the Federal Interagency Council for EMS and the National EMS Advisory Council. Four strong and three weak recommendations emerged from the process; two of the strong recommendations were linked to high- and moderate-quality evidence, respectively. The panel recommended that all patients be considered candidates for analgesia, regardless of transport interval, and that opioid medications should be considered for patients in moderate to severe pain. The panel also recommended that all patients should be reassessed at frequent intervals using a standardized pain scale and that patients should be re-dosed if pain persists. The panel suggested the use of specific age-appropriate pain scales. GRADE methodology was used to develop an evidence-based guideline for prehospital analgesia in trauma. The panel issued four strong recommendations regarding patient

  6. The WORD (Wholeness, Oneness, Righteousness, Deliverance): design of a randomized controlled trial testing the effectiveness of an evidence-based weight loss and maintenance intervention translated for a faith-based, rural, African American population using a community-based participatory approach. (United States)

    Yeary, Karen Hye-cheon Kim; Cornell, Carol E; Prewitt, Elaine; Bursac, Zoran; Tilford, J Mick; Turner, Jerome; Eddings, Kenya; Love, ShaRhonda; Whittington, Emily; Harris, Kimberly


    The positive effects of weight loss on obesity-related risk factors diminish unless weight loss is maintained. Yet little work has focused on the translation of evidence-based weight loss interventions with the aim of sustaining weight loss in underserved populations. Using a community-based participatory approach (CBPR) that engages the strong faith-based social infrastructure characteristic of rural African American communities is a promising way to sustain weight loss in African Americans, who bear a disproportionate burden of the obesity epidemic. Led by a collaborative community-academic partnership, The WORD aims to change dietary and physical activity behaviors to produce and maintain weight loss in rural, African American adults of faith. The WORD is a randomized controlled trial with 450 participants nested within 30 churches. All churches will receive a 16-session core weight loss intervention. Half of the churches will be randomized to receive an additional 12-session maintenance component. The WORD is a cultural adaptation of the Diabetes Prevention Program, whereby small groups will be led by trained church members. Participants will be assessed at baseline, 6, 12, and 18 months. A detailed cost-effectiveness and process evaluation will be included. The WORD aims to sustain weight loss in rural African Americans. The utilization of a CBPR approach and the engagement of the faith-based social infrastructure of African American communities will maximize the intervention's sustainability. Unique aspects of this trial include the focus on weight loss maintenance and the use of a faith-based CBPR approach in translating evidence-based obesity interventions. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Functional recovery, oncologic outcomes and postoperative complications 12 months following robot-assisted radical prostatectomy: follow-up of an evidence-based analysis comparing the Retzius-sparing and standard approaches. (United States)

    Menon, Mani; Dalela, Deepansh; Jamil, Marcus; Diaz, Mireya; Tallman, Christopher; Abdollah, Firas; Sood, Akshay; Lehtola, Linda; Miller, David; Jeong, Wooju


    To report 1-year update of functional (urinary and sexual) recovery, oncological outcomes, and postoperative complications in patients who completed a randomized controlled trial comparing posterior (Retzius-sparing) with anterior robot-assisted radical prostatectomy (RARP). One-hundred twenty patients with clinically low-intermediate risk prostate cancer (PCa) were randomized to undergo posterior (n=60) or anterior RARP (n=60) by a single surgical team at an academic institution. An independent third party ascertained urinary and sexual function outcomes preoperatively, and at 3, 6 and 12 months after surgery. Oncologic outcomes consisted of positive surgical margins (PSM) and biochemical recurrence-free survival (BCRFS; BCR defined as two postoperative prostate-specific antigen ≥0.2 ng/mL). The median age of the cohort was 61 years, and median follow-up duration was 12 months. There were no statistically significant differences in rates of urinary continence (0 pad-one security pad/day; 93.3 vs. 98.3% respectively, p=0.09), 24-hour pad weights (median 7.5 vs. 12 gm, p=0.3), erections sufficient for intercourse (69.2% vs. 86.5%) or postoperative Sexual Health Inventory for Men (SHIM) score ≥17 (44.6% vs. 44.1%) between the anterior and posterior RARP groups respectively at 12 months. Non-focal PSM (11.7% vs. 8.3%), BCRFS (0.93 vs. 0.84), and postoperative complications (11.7% vs. 18.3%) in posterior vs. anterior RARP respectively. Amongst patients with clinically low-intermediate risk PCa randomized to anterior ('Menon') or posterior ('Bocciardi') approach RARP, differences in urinary continence seen at 3 months were muted at 12 months follow-up, while sexual function recovery, postoperative complications and biochemical recurrence rates were comparable 1-year postoperatively. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  8. Evidence-based treatment of metabolic myopathy

    Directory of Open Access Journals (Sweden)

    Yan LIN


    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

  9. A single-phase multi-level D-STATCOM inverter using modular multi-level converter (MMC) topology for renewable energy sources (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.

  10. Empirical methods for systematic reviews and evidence-based medicine

    NARCIS (Netherlands)

    van Enst, W.A.


    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

  11. Evidence-Based Health Policy: A Preliminary Systematic Review (United States)

    Morgan, Gareth


    Objective: The development of evidence-based health policy is challenging. This study has attempted to identify some of the underpinning factors that promote the development of evidence based health policy. Methods: A preliminary systematic literature review of published reviews with "evidence based health policy" in their title was conducted…

  12. Evidence-Based Medicine in the Education of Psychiatrists (United States)

    Srihari, Vinod


    Objective: Evidence-based medicine has an important place in the teaching and practice of psychiatry. Attempts to teach evidence-based medicine skills can be weakened by conceptual confusions feeding a false polarization between traditional clinical skills and evidence-based medicine. Methods: The author develops a broader conception of clinical…

  13. E-Learning and Evidence Based Practice in Schools (United States)

    Quong, Terrence


    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…

  14. 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 ...

  15. Evidence-based medicine in general practice specialty training

    NARCIS (Netherlands)

    Zwolsman, S.E.


    Aio’s huisartsgeneeskunde hebben adequate kennis ten aanzien van evidence-based medicine (geneeskunde op basis van bewijs). In de huisartspraktijk is evidence-based gedrag vaak niet direct zichtbaar, maar artsen kunnen wel aangeven op welk aspect van evidence-based medicine de voorgeschreven

  16. Evidence-based Dental Practice: Part I. Formulating Clinical ...

    African Journals Online (AJOL)

    This first of three articles on evidence-based dental practice discusses the historical background of evidence-based medicine/evidence-based dentistry, how to formulate clear clinical questions and how to track down (search) the available evidence in the literature databases. Nigerian Quarterly Journal of Hospital Medicine ...

  17. Groundwater Age in Multi-Level Water Quality Monitor Wells on California Central Valley Dairies (United States)

    Esser, B. K.; Visser, A.; Hillegonds, D. J.; Singleton, M. J.; Moran, J. E.; Harter, T.


    Dairy farming in California's Central Valley is a significant source of nitrate to underlying aquifers. One approach to mitigation is to implement farm-scale management plans that reduce nutrient loading to groundwater while sustaining crop yield. While the effect of different management practices on crop yield is easily measured, their effect on groundwater quality has only infrequently been evaluated. Documenting and predicting the impact of management on water quality requires a quantitative assessment of transport (including timescale and mixing) through the vadose and saturated zones. In this study, we measured tritium, helium isotopic composition, and noble gas concentrations in groundwater drawn from monitor wells on several dairies in the Lower San Joaquin Valley and Tulare Lake Basin of California's Central Valley in order to predict the timescales on which changes in management may produce observable changes in groundwater quality. These dairies differ in age (from 100 years old), thickness of the vadose zone (from irrigation water (surface or groundwater). All of the dairies use manure wastewater for irrigation and fertilization. Three of the dairies have implemented management changes designed to reduce nutrient loading and/or water usage. Monitor wells in the southern Tulare Lake Basin dairies were installed by UC-Davis as multi-level nested wells allowing depth profiling of tritium and noble gases at these sites. Tritium/helium-3 groundwater ages, calculated using a simple piston-flow model, range from 50 years. Initial tritium (the sum of measured tritium and tritiogenic helium-3) is close to or slightly above precipitation in the calculated recharge year for young samples; and significantly above the precipitation curve for older samples. This pattern is consistent with the use of 20-30 year old groundwater recharged before 1980 for irrigation, and illustrates how irrigation with groundwater can complicate the use of tritium alone for age dating


    Pasleau, F


    The fundamentals of Evidence-Based Medicine (EBM) are the clinical experience, the application of best evidences from research and the consideration of patient expectations. It enabled significant progresses in the management of diseases with a low or multifactorial causality. But it has also led to unintended negative consequences, partly related to conflicts of interest. The objective of this article is to bring the attention back to the scientific rigor that must sustain the medical practice, namely in the occurrence : 1) formulating a question that addresses all the elements of an individual clinical situation; 2) exploring the literature systematically; 3) estimating the degree of confidence in the conclusions of clinical trials. EBM provides intuitive tools to address some uncomfortable concepts of biostatistics and to identify the biases and the embellished data that invalidate many studies. However, it is difficult to decide of the care of a single patient from observations issued from the comparison of'heterogeneous groups. Personalized medicine should help to overcome this difficulty and should facilitate clinical decision making by targeting the patients who are most likely to benefit from an intervention without much inconvenience.

  19. Evidence-Based Interactive Management of Change

    Directory of Open Access Journals (Sweden)

    Albert Fleischmann


    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.

  20. Effectiveness of Evidence-Based Asthma Interventions. (United States)

    Kennedy, Suzanne; Bailey, Ryan; Jaffee, Katy; Markus, Anne; Gerstein, Maya; Stevens, David M; Lesch, Julie Kennedy; Malveaux, Floyd J; Mitchell, Herman


    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.

  1. Evidence Based Practice Outside the Box (Editorial

    Directory of Open Access Journals (Sweden)

    Lindsay Glynn


    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

  2. Promoting evidence-based practice in pharmacies

    Directory of Open Access Journals (Sweden)

    Toklu HZ


    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

  3. Knee surgery and its evidence base. (United States)

    Sharma, A; Hasan, K; Carter, A; Zaidi, R; Cro, S; Briggs, T; Goldberg, A


    Evidence driven orthopaedics is gaining prominence. It enables better management decisions and therefore better patient care. The aim of our study was to review a selection of the leading publications pertaining to knee surgery to assess changes in levels of evidence over a decade. Articles from the years 2000 and 2010 in The Knee, the Journal of Arthroplasty, Knee Surgery, Sports Traumatology, Arthroscopy, the Journal of Bone and Joint Surgery (American Volume) and the Bone and Joint Journal were analysed and ranked according to guidelines from the Centre for Evidence-Based Medicine. The intervening years (2003, 2005 and 2007) were also analysed to further define the trend. The percentage of high level evidence (level I and II) studies increased albeit without reaching statistical significance. Following a significant downward trend, the latter part of the decade saw a major rise in levels of published evidence. The most frequent type of study was therapeutic. Although the rise in levels of evidence across the decade was not statistically significant, there was a significant drop and then rise in these levels in the interim. It is therefore important that a further study is performed to assess longer-term trends. Recent developments have made clear that high quality evidence will be having an ever increasing influence on future orthopaedic practice. We suggest that journals implement compulsory declaration of a published study's level of evidence and that authors consider their study designs carefully to enhance the quality of available evidence.

  4. [Searching for evidence-based data]. (United States)

    Dufour, J-C; Mancini, J; Fieschi, M


    The foundation of evidence-based medicine is critical analysis and synthesis of the best data available concerning a given health problem. These factual data are accessible because of the availability on the Internet of web tools specialized in research for scientific publications. A bibliographic database is a collection of bibliographic references describing the documents indexed. Such a reference includes at least the title, summary (or abstract), a set of keywords, and the type of publication. To conduct a strategically effective search, it is necessary to formulate the question - clinical, diagnostic, prognostic, or related to treatment or prevention - in a form understandable by the research engine. Moreover, it is necessary to choose the specific database or databases, which may have particular specificity, and to analyze the results rapidly to refine the strategy. The search for information is facilitated by the knowledge of the standardized terms commonly used to describe the desired information. These come from a specific thesaurus devoted to document indexing. The most frequently used is MeSH (Medical Subject Heading). The principal bibliographic database whose references include a set of describers from the MeSH thesaurus is Medical Literature Analysis and Retrieval System Online (Medline), which has in turn become a subpart of a still more vast bibliography called PubMed, which indexes an additional 1.4 million references. Numerous other databases are maintained by national or international entities. These include the Cochrane Library, Embase, and the PASCAL and FRANCIS databases.

  5. Overview of Methods for Multi-Level and/or Multi-Disciplinary Optimization

    NARCIS (Netherlands)

    De Wit, A.J.; Van Keulen, A.


    Multi-level optimization and multi-disciplinary optimization are areas of research that are concerned with developing efficient analysis and optimization techniques for complex systems that are made up of coupled elements (components). Within the field of multilevel optimization and

  6. Developing the multi-level functioning interface framework for DER models

    DEFF Research Database (Denmark)

    Han, Xue; Bindner, Henrik W.; You, Shi


    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....


    Directory of Open Access Journals (Sweden)

    A. Warsito A. Warsito


    Full Text Available Inverter is a power electronics circuit which is used to convert DC voltage and current to AC voltage andcurrent. In conventional inverter, most commonly used, only has three level voltage, those are +Vdc, -Vdc,and zero. Meanwhile both square inverters and SWPM inverter has big harmonic distortion. In SPWMinverter scheme, high frequency switching must be used to minimize total harmonic distortion (THD. Multilevel inverter is a type of inverter that has more than one level of voltage and current output.The major advantages of multi level inverters are a good voltage waveform, small harmonic dirtortion,switching component operated under low frequency, and it can supply a big power.This paper will discuse the construction of single phase three level multi level inverters, hardware testinginclude output waveform THD, and the comparisson of multilevel inverter with other conventional invertersscheme suc as PWM inverters modulation, and square waveform inverter. Atmel’s AT89S51 microcontrollerused to control switching scheme in this multi level inverter. By this power electronic circuit, it is expected alow cost and reliable multi level inverters prototipe.

  8. Fabrication and characterization of injection molded multi level nano and microfluidic systems

    DEFF Research Database (Denmark)

    Matteucci, Marco; Christiansen, Thomas Lehrmann; Tanzi, Simone


    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 elongation...

  9. 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. ... However, Turbine maintenance in Nigerian power generating Plants is unimaginably low; there are incessant plant shut downs, and up to 95% of both foreign and local manufacturers have either shut down production or have ...

  10. 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 ...

  11. Multi-level ILU-factorizations for eigenvalue computation and continuation

    NARCIS (Netherlands)

    Wubs, F; Tiesinga, G.; Henry, D; Bergeon, A


    In recent years substantial progress has been made in the development of multi-level ILU-factorizations. In some cases, current versions already show (near) grid-independent convergence and therefore are attractive for very large problems. In this paper a variant called MRILU is described and

  12. Multi-Level Model of Contextual Factors and Teachers' Assessment Practices: An Integrative Review of Research (United States)

    Fulmer, Gavin W.; Lee, Iris C. H.; Tan, Kelvin H. K.


    We present a multi-level model of contextual factors that may influence teachers' assessment practices, and use this model in a selected review of existing literature on teachers' assessment knowledge, views and conceptions with respect to these contextual factors. Adapting Kozma's model, we distinguish three levels of influence on teachers'…


    Directory of Open Access Journals (Sweden)

    Tri Aryo Trubus Anom


    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.

  14. A Bayesian Multi-Level Factor Analytic Model of Consumer Price Sensitivities across Categories (United States)

    Duvvuri, Sri Devi; Gruca, Thomas S.


    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…

  15. 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 Converter with Experimental Verification. ... This paper used generic on-time application method to realize the application time for the zero vector and two adjacent active vectors in determining the switching process of the multilevel DCC, quite unlike the ...

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

    African Journals Online (AJOL)

    ES Obe

    Abstract. This paper presents the analysis of a multi-level diode clamped converter (DCC) which is implemented using space-vector pulse width modulation (SVPWM) tech- nique, widely considered as the most efficient and easily applied modulation tech- nique in most industrial drives and control applications.

  17. Achieving strategic renewal: the multi-level influences of top and middle managers’ boundary-spanning

    NARCIS (Netherlands)

    Glaser, L.; Fourne, S.P.L.; Elfring, T.


    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,

  18. Multi-level Control Framework for Enhanced Flexibility of Active Distribution Network

    DEFF Research Database (Denmark)

    Nainar, Karthikeyan; Pokhrel, Basanta Raj; Pillai, Jayakrishnan Radhakrishna


    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...

  19. Managing Scalp Psoriasis: An Evidence-Based Review. (United States)

    Wang, Ting-Shun; Tsai, Tsen-Fang


    Scalp psoriasis is commonly the initial presentation of psoriasis, and almost 80 % of patients with psoriasis will eventually experience it. Although several systematic reviews and guidelines exist, an up-to-date evidence-based review including more recent progress on the use of biologics and new oral small molecules was timely. Of the 475 studies initially retrieved from PubMed and the 845 from Embase (up to May 2016), this review includes 27 clinical trials, four papers reporting pooled analyses of other clinical trials, ten open-label trials, one case series, and two case reports after excluding non-English literature. To our knowledge, few randomized controlled trials (RCTs) are conducted specifically in scalp psoriasis. Topical corticosteroids provide good effects and are usually recommended as first-line treatment. Calcipotriol-betamethasone dipropionate is well tolerated and more effective than either of its individual components. Localized phototherapy is better than generalized phototherapy on hair-bearing areas. Methotrexate, cyclosporine, fumaric acid esters, and acitretin are well-recognized agents in the treatment of psoriasis, but we found no published RCTs evaluating these agents specifically in scalp psoriasis. Biologics and new small-molecule agents show excellent effects on scalp psoriasis, but the high cost of these treatments mean they may be limited to use in extensive scalp psoriasis. More controlled studies are needed for an evidence-based approach to scalp psoriasis.

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

    Directory of Open Access Journals (Sweden)

    Eui Geum Oh, PhD, RN


    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.

  1. Epilepsy, Antiepileptic Drugs, and Aggression: An Evidence-Based Review (United States)

    Besag, Frank; Ettinger, Alan B.; Mula, Marco; Gobbi, Gabriella; Comai, Stefano; Aldenkamp, Albert P.; Steinhoff, Bernhard J.


    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. Reality of evidence-based practice in palliative care. (United States)

    Visser, Claire; Hadley, Gina; Wee, Bee


    There has been a paradigm shift in medicine away from tradition, anecdote and theoretical reasoning from the basic sciences towards evidence-based medicine (EBM). In palliative care however, statistically significant benefits may be marginal and may not be related to clinical meaningfulness. The typical treatment vs. placebo comparison necessitated by 'gold standard' randomised controlled trials (RCTs) is not necessarily applicable. The complex multimorbidity of end of life care involves considerations of the patient's physical, psychological, social and spiritual needs. In addition, the field of palliative care covers a heterogeneous group of chronic and incurable diseases no longer limited to cancer. Adequate sample sizes can be difficult to achieve, reducing the power of studies and high attrition rates can result in inadequate follow up periods. This review uses examples of the management of cancer-related fatigue and death rattle (noisy breathing) to demonstrate the current state of EBM in palliative care. The future of EBM in palliative care needs to be as diverse as the patients who ultimately derive benefit. Non-RCT methodologies of equivalent quality, validity and size conducted by collaborative research networks using a 'mixed methods approach' are likely to pose the correct clinical questions and derive evidence-based yet clinically relevant outcomes.

  3. Management of the infertile couple: an evidence-based protocol

    Directory of Open Access Journals (Sweden)

    Kamel Remah M


    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.

  4. EPO or not-EPO? An evidence based informed consent. (United States)

    Mezza, E; Piccoli, G B; Pacitti, A; Soragna, G; Bermond, F; Burdese, M; Gai, M; Motta, D; Jeantet, A; Merletti, F; Vineis, P; Segoloni, G P


    Informed consent is crucial in therapeutic choices; however, the forms presented to patients are often locally developed and information may not be homogeneous. To prepare an evidence-based model for informed consent, applied in the case of erythropoietin therapy (EPO) as a teaching tool for medical students. Methodological tools of Evidence-Based Medicine (EBM) were developed within the EBM Course in the Medical School of Torino, Italy, as problem solving and patient information tools (5th year students work in small groups under the supervision of statisticians, epidemiologists and experts of internal medicine--nephrology in this case). Methodological and ethical problems were identified: in the pre-dialysis field, evidence from randomized clinical trials (RCT) is scant; how to use evidence gathered in dialysis? How to deal with implementation? How with the mass media? Do we need to discuss the drug choice with the patients? How to deal with rare and severe side effects?). The "evidence" was searched for on Medline/Embase, by using key-words and free terms. About 680 papers were retrieved and screened. Forms available on the Internet were retrieved and a general scheme was drawn: it included 5 areas: title, aim and targets (patients and family physicians); search strategies and updating; pros and cons of therapy; alternative options; open questions. EBM may offer valuable tools for systematically approaching patient information; the inclusion of this kind of exercise in the Medical School EBM courses may help enhance the awareness of future physicians of the correct communication with patients.

  5. Evidence-based medicine: a commentary on common criticisms


    Straus, Sharon E.; McAlister, Finlay A.


    Discussions about evidence-based medicine engender both negative and positive reactions from clinicians and academics. Ways to achieve evidence-based practice are reviewed here and the most common criticisms described. The latter can be classified as ”limitations universal to the practice of medicine,” ”limitations unique to evidence-based medicine” and ”misperceptions of evidence-based medicine.” Potential solutions to the true limitations of evidence-based medicine are discussed and areas f...

  6. Developing evidence-based immunization recommendations and GRADE. (United States)

    Duclos, P; Durrheim, D N; Reingold, A L; Bhutta, Z A; Vannice, K; Rees, H


    The Strategic Group of Advisory Experts (SAGE) on immunization is an independent advisory committee with a mandate to advise the World Health Organization (WHO) on the development of vaccine and immunization related policies. SAGE working groups are established on a time-limited basis to review and provide evidence-based recommendations, together with their implications, for open deliberation and decision-making by SAGE. In making its recommendations, SAGE takes into consideration: the epidemiologic and clinical characteristics of the disease; vaccine and immunization characteristics; economic analysis; health system considerations; the existence of and interaction with other intervention and control strategies; costing and social impacts; and legal and ethical concerns. Since 1998, WHO has produced evidence-based vaccine position papers for use primarily by national public health officials and immunization programme managers. Since April 2006 all new or updated position papers have been based on SAGE recommendations. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach has been adopted by WHO and, since 2008, GRADE tables that rate the quality of evidence have been produced in support of key recommendations. SAGE previously expressed concern that GRADE was not ideally suited to many immunization-specific issues such as the vaccine population level effect and the inclusion of surveillance system data, particularly for vaccine safety. Extensive productive interactions with various advisory groups including the US Advisory Committee on Immunization Practices, the European Centres for Disease Control, the German Standing Committee on Vaccination (STIKO), WHO's Global Advisory Committee on Vaccine Safety and the GRADE working group resulted in key enhancements to accommodate vaccine-relevant evidence. This facilitated integration and acceptability of the GRADE approach in the development of immunization related SAGE and WHO

  7. A mixed-methods study of system-level sustainability of evidence-based practices in 12 large-scale implementation initiatives. (United States)

    Scudder, Ashley T; Taber-Thomas, Sarah M; Schaffner, Kristen; Pemberton, Joy R; Hunter, Leah; Herschell, Amy D


    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. ID NCT02543359 ; Protocol number PRO12060529.

  8. Multi-level significance of vulnerability indicators. Case study: Eastern Romania (United States)

    Stanga, I. C.; Grozavu, A.


    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 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

  9. Trauma-Sensitive Schools: An Evidence-Based Approach (United States)

    Plumb, Jacqui L.; Bush, Kelly A.; Kersevich, Sonia E.


    Adverse childhood experiences (ACEs) are a common and pervasive problem. There is a positive correlation between ACEs and difficulties across the lifespan. Unlike healthy forms of stress, ACEs have a detrimental impact on the developing brain. There are three types of trauma: acute, chronic, and complex. Most ACEs are considered complex trauma,…

  10. An Evidence-Based Approach To Exercise Prescriptions on ISS (United States)

    Ploutz-Snyder, Lori


    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.

  11. Rabies: an evidence-based approach to management | Blumberg ...

    African Journals Online (AJOL)

    Human rabies in South Africa is largely due to infection with the classical rabies virus (genotype 1), with the yellow mongoose the commonest vector except in KwaZulu-Natal, Eastern Cape, Mpumalanga and now Limpopo provinces where the dog is predominantly responsible for most bites. Rabies is always fatal in ...

  12. [Anaesthesia for canine caesarean section - an evidence-based approach]. (United States)

    Alef, Michaele


    In recent years, several new studies on anaesthesia for caesarean section have been published. This paper refers to these and ground-breaking research on risk factors affecting the puppies. Based on the available evidence, a recommendation for an anaesthetic procedure is given and in addition, alternatives are discussed. Induction with propofol or alfaxalone and maintenance by inhalation anaesthesia appears to be the method with the least risk. Intraoperatively, an adequate and low-risk analgesia is achieved by an epidural anaesthesia. Opioids allow an adequate maternal pain management after delivery of the puppies as well as postoperatively. A stabilisation of the dam before induction and an optimised oxygen supply are additional basal requirements.

  13. Nutrition in the ICU: an evidence-based approach. (United States)

    Desai, Svetang V; McClave, Stephen A; Rice, Todd W


    Providing artificial nutrition is an important part of caring for critically ill patients. However, because of a paucity of robust data, the practice has been highly variable and often based more on dogma than evidence. A number of studies have been published investigating many different aspects of critical care nutrition. Although the influx of data has better informed the practice, the results have often been conflicting or counter to prevailing thought, resulting in discordant opinions and different interpretations by experts in the field. In this article, we review and summarize the data from a number of the published studies, including studies investigating enteral vs parenteral nutrition, supplementing enteral with parenteral nutrition, and use of immunonutrition. In addition, published studies informing the practice of how best to provide enteral nutrition will be reviewed, including the use of trophic feedings, gastric residual volumes, and gastric vs postpyloric tube placement.

  14. Avoiding occlusal derangement in facial fractures: An evidence based approach

    Directory of Open Access Journals (Sweden)

    Derick Mendonca


    Full Text Available Facial fractures with occlusal derangement describe any fracture which directly or indirectly affects the occlusal relationship. Such fractures include dento-alveolar fractures in the maxilla and mandible, midface fractures - Le fort I, II, III and mandible fractures of the symphysis, parasymphysis, body, angle, and condyle. In some of these fractures, the fracture line runs through the dento-alveolar component whereas in others the fracture line is remote from the occlusal plane nevertheless altering the occlusion. The complications that could ensue from the management of maxillofacial fractures are predominantly iatrogenic, and therefore can be avoided if adequate care is exercised by the operating surgeon. This paper does not emphasize on complications arising from any particular technique in the management of maxillofacial fractures but rather discusses complications in general, irrespective of the technique used.

  15. Evidence-based approach to using CT in spinal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Mann, F.A. E-mail:; Cohen, Wendy A.; Linnau, Ken F.; Hallam, Danial K.; Blackmore, C. Craig


    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.

  16. Nutraceuticals in prevention of cataract – An evidence based approach

    Directory of Open Access Journals (Sweden)

    Amandeep Kaur


    Full Text Available Cataract is a principal cause of blindness in the world and is characterized by clouding of eye’s natural lens. Surgery is the major therapeutic step taken to cure cataract; however, it is having its own limitations and complications such as iris prolapse, raised IOP, infection, cystoid macular edema and posterior capsular opacification (PCO. So world is looking toward more robust and natural ways to prevent cataract. One of the important factors that can play a role in prevention of any and many diseases is diet of the people. The inclusion of certain naturally occurring food and nutraceuticals is coming up as a best alternative for curing cataract because of their presumed safety, potential nutritional and therapeutic effects. Some nutraceuticals can act as an anticataract agent through some or the other molecular mechanism if consumed by normal population deliberately or inadvertently.

  17. Rabies: an evidence-based approach to management

    African Journals Online (AJOL)

    Human rabies in South Africa is largely due to infection with the classical rabies virus (genotype 1), with the yellow mongoose the commonest vector except in KwaZulu-Natal, Eastern Cape, Mpumalanga and now Limpopo provinces where the dog is predominantly responsible for most bites. Rabies is always fatal in ...

  18. Exploring the Bullying Construct: An Evidence Based Approach


    Dick, Gavin P.M.; Rayner, Charlotte


    Negative interpersonal behaviour at work has been researched as ‘bullying’ in Europe, and explored under wider headings in the USA (e.g. ‘counter-productive’, ‘antisocial’ or ‘deviant’). The first aim of this paper is progress the concept of bullying by identifying and validating the latent variables that constitute bullying. Confirmatory factor analysis and structural equation modelling of two large UK data sets were used to test different construct models (from the literature) against each ...

  19. Evidence-Based Approaches to Improving Chemical Equilibrium Instruction (United States)

    Davenport, Jodi L.; Leinhardt, Gaea; Greeno, James; Koedinger, Kenneth; Klahr, David; Karabinos, Michael; Yaron, David J.


    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…

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

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


    Apr 29, 2016 ... Reducing urban violence: Understanding why some men choose violence – and others don't. What determines whether or not men choose violence? Do childhood experiences play a role? Does having children make a difference? View moreReducing urban violence: Understanding why some men ...

  1. An evidence-based approach to recurrent pregnancy loss

    African Journals Online (AJOL)

    Recurrent pregnancy loss (RPL) can be defined as more than two to three consecutive miscarriages before 24 weeks' gestation. A ... and hysteroscopy; (iv) syphilis testing must be done routinely; and (v) testing of thyroid function and glucose monitoring/glycosylated ... [7] RPL typically occurs at a similar gestational age in.

  2. Evaluation of multi-level social learning for sustainable landscapes: perspective of a development initiative in Bergslagen, Sweden. (United States)

    Axelsson, Robert; Angelstam, Per; Myhrman, Lennart; Sädbom, Stefan; Ivarsson, Milis; Elbakidze, Marine; Andersson, Kenneth; Cupa, Petr; Diry, Christian; Doyon, Frederic; Drotz, Marcus K; Hjorth, Arne; Hermansson, Jan Olof; Kullberg, Thomas; Lickers, F Henry; McTaggart, Johanna; Olsson, Anders; Pautov, Yurij; Svensson, Lennart; Törnblom, Johan


    To implement policies about sustainable landscapes and rural development necessitates social learning about states and trends of sustainability indicators, norms that define sustainability, and adaptive multi-level governance. We evaluate the extent to which social learning at multiple governance levels for sustainable landscapes occur in 18 local development initiatives in the network of Sustainable Bergslagen in Sweden. We mapped activities over time, and interviewed key actors in the network about social learning. While activities resulted in exchange of experiences and some local solutions, a major challenge was to secure systematic social learning and make new knowledge explicit at multiple levels. None of the development initiatives used a systematic approach to secure social learning, and sustainability assessments were not made systematically. We discuss how social learning can be improved, and how a learning network of development initiatives could be realized.

  3. A reliable energy-efficient multi-level routing algorithm for wireless sensor networks using fuzzy Petri nets. (United States)

    Yu, Zhenhua; Fu, Xiao; Cai, Yuanli; Vuran, Mehmet C


    A reliable energy-efficient multi-level routing algorithm in wireless sensor networks is proposed. The proposed algorithm considers the residual energy, number of the neighbors and centrality of each node for cluster formation, which is critical for well-balanced energy dissipation of the network. In the algorithm, a knowledge-based inference approach using fuzzy Petri nets is employed to select cluster heads, and then the fuzzy reasoning mechanism is used to compute the degree of reliability in the route sprouting tree from cluster heads to the base station. Finally, the most reliable route among the cluster heads can be constructed. The algorithm not only balances the energy load of each node but also provides global reliability for the whole network. Simulation results demonstrate that the proposed algorithm effectively prolongs the network lifetime and reduces the energy consumption.

  4. Familial hyperlipidemia: Resolving a case using evidence-based medicine

    Directory of Open Access Journals (Sweden)

    Edison Benavides-Hernández


    Full Text Available Background: familial hypercholesterolemia (FH and familial hyperlipidemia combined (HFC are metabolic disorders of lipids associated with increase of the risk for cerebrovascular disease. Clinical case: 8-years-old Indigenous child with HFC presented right hemiparesis, motor aphasia and right central facial paralysis for a cerebral ischemic accident; in addition, he had altered lipid profile and family history of hypercholesterolemia. Methodology: this article used patient`s therapeutic approach using evidence-based medicine (EBM, started from a structured clinical question and PubMED search. Four systematic reviews were included. Discussion: statins are safe in children with HF and HFC are effective in improving lipid profile. EBM methodology could help to solve similar therapeutic problems.

  5. Evidence-Based Guidelines to Eliminate Repetitive Laboratory Testing. (United States)

    Eaton, Kevin P; Levy, Kathryn; Soong, Christine; Pahwa, Amit K; Petrilli, Christopher; Ziemba, Justin B; Cho, Hyung J; Alban, Rodrigo; Blanck, Jaime F; Parsons, Andrew S


    Routine daily laboratory testing of hospitalized patients reflects a wasteful clinical practice that threatens the value of health care. Choosing Wisely initiatives from numerous professional societies have identified repetitive laboratory testing in the face of clinical stability as low value care. Although laboratory expenditure often represents less than 5% of most hospital budgets, the impact is far-reaching given that laboratory tests influence nearly 60% to 70% of all medical decisions. Excessive phlebotomy can lead to hospital-acquired anemia, increased costs, and unnecessary downstream testing and procedures. Efforts to reduce the frequency of laboratory orders can improve patient satisfaction and reduce cost without negatively affecting patient outcomes. To date, numerous interventions have been deployed across multiple institutions without a standardized approach. Health care professionals and administrative leaders should carefully strategize and optimize efforts to reduce daily laboratory testing. This review presents an evidence-based implementation blueprint to guide teams aimed at improving appropriate routine laboratory testing among hospitalized patients.

  6. Evidence-Based Yoga Interventions for Patients With Cancer. (United States)

    Sisk, Angela; Fonteyn, Marsha


    Introducing patients with cancer to the practice of yoga can be beneficial for coping with the side effects of treatment and the psychological aspects of cancer that are often difficult and distressing for patients. Oncology nurses can learn to use simple yoga techniques for themselves and as interventions with their patients. This article provides details about the development and implementation of a yoga class for patients with cancer and provides details about other ways nurses can integrate yoga into oncology nursing and cancer care. Current research literature was reviewed and synthesized to provide support for the use of yoga as an evidence-based nursing intervention. A detailed approach for implementing yoga into professional practice was delineated. Yoga techniques can be easily integrated into nursing practice and have been shown to be beneficial for patients and nurses.

  7. Evidence-Based Practice: The Psychology of EBP Implementation. (United States)

    Rousseau, Denise M; Gunia, Brian C


    Evidence-based practice (EBP) is an approach used in numerous professions that focuses attention on evidence quality in decision making and action. We review research on EBP implementation, identifying critical underlying psychological factors facilitating and impeding its use. In describing EBP and the forms of evidence it employs, we highlight the challenges individuals face in appraising evidence quality, particularly that of their personal experience. We next describe critical EBP competencies and the challenges underlying their acquisition: foundational competencies of critical thinking and domain knowledge, and functional competencies such as question formulation, evidence search and appraisal, and outcome evaluation. We then review research on EBP implementation across diverse fields from medicine to management and organize findings around three key contributors to EBP: practitioner ability, motivation, and opportunity to practice (AMO). Throughout, important links between psychology and EBP are highlighted, along with the contributions psychological research can make to further EBP development and implementation.

  8. Advances toward evidence-based practice: where to from here? (United States)

    Ollendick, Thomas H


    Evidence-based practice has a long history; however, attempts to bridge the gap between science and practice have been only partially effective and much work remains to be done. Part of the problem has been the unilateral approach associated with dissemination of research findings to clinical practitioners. In this special series, Goldfried and colleagues (2014--this issue) suggest a two-way bridge, in which practitioners are afforded the opportunity to disseminate their rich clinical experiences to researchers as well. In this manner, a more collaborative working relationship is espoused. Surveys of practitioners on the use of CBT procedures in the treatment of panic disorder, social anxiety disorder, and generalized anxiety disorder are described. The findings are reviewed and limitations associated with the surveys are noted. Finally, future directions are suggested for rapprochement, hopefully resulting in a greater synthesis of research and practice. © 2013.

  9. Promoting Inclusion through Evidence-Based Alternatives to Restraint and Seclusion (United States)

    Trader, Barbara; Stonemeier, Jennifer; Berg, Tricia; Knowles, Christen; Massar, Michelle; Monzalve, Manuel; Pinkelman, Sarah; Nese, Rhonda; Ruppert, Traci; Horner, Robert


    The use of restraint and seclusion in schools has been identified repeatedly as an approach that is overused, misused, and potentially dangerous. In this article, we emphasize the importance of an approach to supporting students with significant problem behavior that focuses on prevention, evidence-based intervention procedures, heightened levels…

  10. Future Paradigm or False Idol: A Cautionary Tale of Evidence-Based Practice for Adventure Education and Therapy (United States)

    Harper, Nevin J.


    Evidence-based practice is an approach that narrowly classifies research results by utilising a hierarchy of evidence. This process renders much available knowledge and experience redundant within its value structure. Currently a dominating ideology across medical and health fields, evidence-based practice is now being promoted in adventure…

  11. Concluding the Series on Evidence-Based Practice: The Spread of Excellence in Child and Adolescent Psychiatry (United States)

    Hamilton, John D.


    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,…

  12. 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


    concentrations entering and leaving a first evaporator stage before being mixed at the inlet of a second evaporator stage. It seems that modelling efforts showing the advantages of the Split Cycle have not been presented in the literature yet. Thus, a thermodynamic model of the Split Cycle is introduced...

  13. A multi-level approach to quantify speed-accuracy trade-offs in great tits (

    NARCIS (Netherlands)

    Moirón, M.; Mathot, K.J.; Dingemanse, N.J.


    Animals often face a conflict between the speed and accuracy by which a decision is made. Decisions taken quickly might be relativelyinaccurate, whereas decisions taken more slowly might be more accurate. Such “speed-accuracy trade-offs” receive increasingattention in behavioral and cognitive

  14. Road pricing mechanisms - A game theoretic and multi-level approach

    NARCIS (Netherlands)

    Ohazulike, Anthony


    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

  15. Road pricing mechanisms: a game theoretic and multi-level approach

    NARCIS (Netherlands)

    Ohazulike, Anthony


    By 2050, it is expected that more than 9 billion people will be living on Earth. Development will reach to many places on Earth, demand for a better life will rise, car/vehicle ownership will increase, leading to high demand for road capacities and infrastructures, yet supply for these road

  16. Investigating teaching performance in seminars : a questionnaire study with a multi-level approach

    NARCIS (Netherlands)

    Spruijt, Annemarie; Leppink, Jimmie; Wolfhagen, Ineke; Scherpbier, Albert; van Beukelen, Peter; Jaarsma, Debbie


    Background: Teachers play an important role in seminars as facilitators and content experts. However, contextual factors like students' preparation, group size, group interaction, and content appear to influence their performance. Understanding the impact of these contextual factors on students'

  17. Occupational segregation and gender inequality in job quality: a multi-level approach

    NARCIS (Netherlands)

    Stier, H.; Yaish, M.


    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

  18. Ethnic Competition and Opposition to Ethnic Intermarriage in the Netherlands : A Multi-Level Approach

    NARCIS (Netherlands)

    Tolsma, Jochem; Lubbers, Marcel; Coenders, Marcel


    This study investigates the relationship between characteristics of the living environment and antagonistic attitudes towards ethnic out-groups, with a focus on the explanation of opposition to ethnic intermarriage. Previous studies on the relationship between the living environment and

  19. 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.


    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

  20. Drift-Implicit Multi-Level Monte Carlo Tau-Leap Methods for Stochastic Reaction Networks

    KAUST Repository

    Ben Hammouda, Chiheb


    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