WorldWideScience

Sample records for identify current practices

  1. Obtaining subjects' consent to publish identifying personal information: current practices and identifying potential issues.

    Science.gov (United States)

    Yoshida, Akiko; Dowa, Yuri; Murakami, Hiromi; Kosugi, Shinji

    2013-11-25

    In studies publishing identifying personal information, obtaining consent is regarded as necessary, as it is impossible to ensure complete anonymity. However, current journal practices around specific points to consider when obtaining consent, the contents of consent forms and how consent forms are managed have not yet been fully examined. This study was conducted to identify potential issues surrounding consent to publish identifying personal information. Content analysis was carried out on instructions for authors and consent forms developed by academic journals in four fields (as classified by Journal Citation Reports): medicine general and internal, genetics and heredity, pediatrics, and psychiatry. An online questionnaire survey of editors working for journals that require the submission of consent forms was also conducted. Instructions for authors were reviewed for 491 academic journals (132 for medicine general and internal, 147 for genetics and heredity, 100 for pediatrics, and 112 for psychiatry). Approximately 40% (203: 74 for medicine general and internal, 31 for genetics and heredity, 58 for pediatrics, and 40 for psychiatry) stated that subject consent was necessary. The submission of consent forms was required by 30% (154) of the journals studied, and 10% (50) provided their own consent forms for authors to use. Two journals mentioned that the possible effects of publication on subjects should be considered. Many journal consent forms mentioned the difficulties in ensuring complete anonymity of subjects, but few addressed the study objective, the subjects' right to refuse consent and the withdrawal of consent. The main reason for requiring the submission of consent forms was to confirm that consent had been obtained. Approximately 40% of journals required subject consent to be obtained. However, differences were observed depending on the fields. Specific considerations were not always documented. There is a need to address issues around the study

  2. Obtaining subjects’ consent to publish identifying personal information: current practices and identifying potential issues

    Science.gov (United States)

    2013-01-01

    Background In studies publishing identifying personal information, obtaining consent is regarded as necessary, as it is impossible to ensure complete anonymity. However, current journal practices around specific points to consider when obtaining consent, the contents of consent forms and how consent forms are managed have not yet been fully examined. This study was conducted to identify potential issues surrounding consent to publish identifying personal information. Methods Content analysis was carried out on instructions for authors and consent forms developed by academic journals in four fields (as classified by Journal Citation Reports): medicine general and internal, genetics and heredity, pediatrics, and psychiatry. An online questionnaire survey of editors working for journals that require the submission of consent forms was also conducted. Results Instructions for authors were reviewed for 491 academic journals (132 for medicine general and internal, 147 for genetics and heredity, 100 for pediatrics, and 112 for psychiatry). Approximately 40% (203: 74 for medicine general and internal, 31 for genetics and heredity, 58 for pediatrics, and 40 for psychiatry) stated that subject consent was necessary. The submission of consent forms was required by 30% (154) of the journals studied, and 10% (50) provided their own consent forms for authors to use. Two journals mentioned that the possible effects of publication on subjects should be considered. Many journal consent forms mentioned the difficulties in ensuring complete anonymity of subjects, but few addressed the study objective, the subjects’ right to refuse consent and the withdrawal of consent. The main reason for requiring the submission of consent forms was to confirm that consent had been obtained. Conclusion Approximately 40% of journals required subject consent to be obtained. However, differences were observed depending on the fields. Specific considerations were not always documented. There is a need

  3. Current practice in Europe

    DEFF Research Database (Denmark)

    Proclemer, Alessandro; Dagres, Nikolaos; Marinskis, Germanas

    2013-01-01

    The purpose of the EP wire is to examine the clinical practice in the management of sustained ventricular tachycardia (VT), with special focus on diagnostic and therapeutic strategies. Forty-five European centres, all members of the EHRA-EP Research network completed the questions of the survey...

  4. Identifying enabling management practices for employee engagement

    Directory of Open Access Journals (Sweden)

    Marius Joubert

    2011-12-01

    Full Text Available Orientation: A currently emerging viewpoint is that today's management practices no longer add value to organisations. The focus of this article is to conduct a systematic review of the scholarly literature on management practices that could be related to employee engagement. Research purpose: This study searched for evidence in support of the notion of a management value chain, and enabling management practices within each value chain component that could relate to employee engagement. Motivation for the study: An alternative management value chain model could contribute towards a better understanding of which management practices may potentially impact employee engagement. Research design, approach, and method: This is a non-empirical (theoretical study, based on a systematic, in-depth literature review to identify the key management components and enabling practices within this proposed management value chain. Scholarly research databases were sourced for relevant peer reviewed research conducted since 1990, not excluding important contributions prior to 1990. The literature was systematically searched, selected, studied, and contextualized within this study. Main findings: Support was found for the notion of a management value chain, for enabling management practices within each proposed management value chain component, and it was also established these management practices indeed have an impact on employee engagement. Practical/managerial/implications: The possibility that management work can be presented as a generic management value chain allows managers to approach engaging management practices more systematically. Contribution/value-add: This study highlights the importance of some management practices that have never been seen as part of management work.

  5. Identifying current training provision and future training needs in allergy available for UK general practice trainees: national cross-sectional survey of General Practitioner Specialist Training programme directors.

    Science.gov (United States)

    Ellis, Jayne; Rafi, Imran; Smith, Helen; Sheikh, Aziz

    2013-03-01

    There are ongoing concerns about the quality of care provision for allergy in primary care. To identify current training provision in allergy to GP trainees and to understand how this could be enhanced. A cross-sectional survey of GP Speciality Training (GPST) programme directors was undertaken. Programme directors of the 174 GPST schemes were sent an online questionnaire which was informed by the content of the Royal College of General Practitioners curriculum. Quantitative data were descriptively analysed and a thematic analysis was undertaken of free text responses. We obtained responses from 146 directors representing 106 training programmes. Responses indicated that two-thirds (62%, 95% CI 53.1 to 71.5) of programmes were providing at least some allergy training, with the remaining third stating that they either provided no training or were unsure. Overall, one-third (33%, 95% CI 22.7 to 42.2) of programme directors believed that all the relevant allergy-related curriculum requirements were being met. Where provided, this training was believed to be best for organ-specific allergic disorders but was thought to be poorer for systemic allergic disorders, particularly food allergy where 67% (95% CI 57.5 to 76.5) of respondents indicated that training was poor. There was considerable interest in increasing the allergy training provided, preferably through eLearning modules and problem-based learning materials supported by those with relevant specialist knowledge. This UK-wide survey has identified important gaps in the training of GP trainees in relation to allergy care. Addressing these gaps, particularly in the management of systemic allergic disorders, should help to improve delivery of primary care-based allergy care.

  6. Current economic trends in equine practice.

    Science.gov (United States)

    Clark, Andrew R

    2009-12-01

    Current economic trends in equine practice are trends of weakness. Most practices, after a decade of double-digit growth, have migrated to survival mode within a few months. Understanding that all regions and disciplines are affected differently, using the Porter five forces model, we can identify changes that must be made in our business models first to survive and then to position ourselves to prosper when the recession ends. If we are to avoid long-term damage to our practices, we must use cost control and work efficiency in addition to price concessions.

  7. Identifying emotional intelligence in professional nursing practice.

    Science.gov (United States)

    Kooker, Barbara Molina; Shoultz, Jan; Codier, Estelle E

    2007-01-01

    The National Center for Health Workforce Analysis projects that the shortage of registered nurses in the United States will double by 2010 and will nearly quadruple to 20% by 2015 (Bureau of Health Professionals Health Resources and Services Administration. [2002]. Projected supply, demand, and shortages of registered nurses, 2000-2020 [On-line]. Available: http:bhpr.hrsa.gov/healthworkforce/reports/rnprojects/report.htm). The purpose of this study was to use the conceptual framework of emotional intelligence to analyze nurses' stories about their practice to identify factors that could be related to improved nurse retention and patient/client outcomes. The stories reflected evidence of the competencies and domains of emotional intelligence and were related to nurse retention and improved outcomes. Nurses recognized their own strengths and limitations, displayed empathy and recognized client needs, nurtured relationships, used personal influence, and acted as change agents. Nurses were frustrated when organizational barriers conflicted with their knowledge/intuition about nursing practice, their communications were disregarded, or their attempts to create a shared vision and teamwork were ignored. Elements of professional nursing practice, such as autonomy, nurse satisfaction, respect, and the professional practice environment, were identified in the excerpts of the stories. The shortage of practicing nurses continues to be a national issue. The use of emotional intelligence concepts may provide fresh insights into ways to keep nurses engaged in practice and to improve nurse retention and patient/client outcomes.

  8. Current practices in economic appraisal

    NARCIS (Netherlands)

    Mossink, J.C.M.

    2000-01-01

    By means of economic appraisal, the costs and the benefits of health, environment and safety management can be made clear, both at the national level and at the company level. As such it is a tool in advocating good practices. This paper explores the possibilities of economic appraisal for policy

  9. BENCHMARKING - PRACTICAL TOOLS IDENTIFY KEY SUCCESS FACTORS

    Directory of Open Access Journals (Sweden)

    Olga Ju. Malinina

    2016-01-01

    Full Text Available The article gives a practical example of the application of benchmarking techniques. The object of study selected fashion store Company «HLB & M Hennes & Mauritz», located in the shopping center «Gallery», Krasnodar. Hennes & Mauritz. The purpose of this article is to identify the best ways to develop a fashionable brand clothing store Hennes & Mauritz on the basis of benchmarking techniques. On the basis of conducted market research is a comparative analysis of the data from different perspectives. The result of the author’s study is a generalization of the ndings, the development of the key success factors that will allow to plan a successful trading activities in the future, based on the best experience of competitors.

  10. Overview of current chelation practices

    Directory of Open Access Journals (Sweden)

    Y. Aydinok

    2011-12-01

    , should provide long-term survival and quality of life for patients with iron loading anemias. The goal of this review is to summarize current concepts in iron chelation therapies based on the considerable amount of prospective data obtained by clinical studies. 去铁胺 (DFO)是自20世纪80年以来输血引起铁过载的参考标准疗法。 虽然它是一种高效的铁螯合剂,但是去铁胺皮下给药的遵从性问题依旧是主要问题。 口服螯合剂去铁酮(DFP)在北美没有销售许可证,但是,它在1994年获得印度许可,1999年欧洲联盟(EU)批准授予去铁酮销售许可证,特别是当去铁胺不足、无法忍受或无法接受时,去铁酮可用于重型地中海贫血患者。 还可获得关于在6岁至10岁之间的儿童身上使用去铁酮的有限数据,但是没有关于在6岁以下儿童身上使用去铁酮的数据。 随后美国食品和药品管理局(FDA)和欧洲药品管理局(EMA)分别在2005年和2006年批准口服螯合剂去铁酮作为第一疗法来治疗2岁以上输血引起铁过载的患者。 铁螯合的主要目的是将身体铁维持在安全水平,但一旦铁累积起来,铁螯合的目标是把组织铁降低到安全级别,这是一个缓慢的过程。 确定螯合剂的螯合方案、剂量和频率管理的主要依据是身体铁负担、心肌铁的状态和输血铁负载速率。 适当监控螯合对测量特殊方案的反应速率和提供计量调整来加强螯合效果和避免毒效尤其重要。 由于一些因素,诸如:螯合剂的吸收和代谢,螯合方案的效果可能呈现个别变化。 耐受性和遵从性也是影响螯合反应的个别变量。 了解螯合剂的优点和局限性,准确确定铁过载患者的螯合需求以及设计毒效更小但效果更优的个性化螯合方案,可以向铁过载贫血患者提供长期的生存和生活质量。 此次调研的目的是在临床研究获得的相当数

  11. Survey of Current Best Practices for Diving in Contaminated Water

    National Research Council Canada - National Science Library

    Steigleman, W

    2002-01-01

    .... Navy divers operating in contaminated water. This survey attempted to identify the current best practices and equipment for diving in contaminated water, including personal protective equipment as well as hazard identification, diver training...

  12. Current Practices in the Delivery of Undergraduate Exercise Physiology Content

    Science.gov (United States)

    Fisher, Michele M.

    2013-01-01

    The purpose of this study was to identify current practices for the delivery of exercise physiology content at the undergraduate level. An anonymous 22-item survey was sent to instructors of exercise physiology to collect information concerning the structure of course offerings and instructional practices. One hundred ten instructors responded to…

  13. Identifying and Understanding Effective High School Practices

    Science.gov (United States)

    Rutledge, Stacey A.; Cannata, Marisa

    2016-01-01

    The authors report on a yearlong investigation into similar schools that performed well and less well in the same district. They found that the higher-performing schools engaged in an intentional set of systemic practices that encourage Personalization for Academic and Social Learning (PASL) in one district and integrated structures of academic…

  14. Identifying Best Practices for an Interactive Webinar

    Science.gov (United States)

    Zoumenou, Virginie; Sigman-Grant, Madeleine; Coleman, Gayle; Malekian, Fatemeh; Zee, Julia M. K.; Fountain, Brent J.; Marsh, Akela

    2015-01-01

    A webinar or web-seminar is a presentation, seminar, lecture, or workshop transmitted over the internet. This emerging technology is becoming increasingly popular due to its convenience and affordability. However, little research has been conducted on best practices for an interactive webinar that engages learners in a professional development or…

  15. Current Risk Management Practices in Psychotherapy Supervision.

    Science.gov (United States)

    Mehrtens, Ilayna K; Crapanzano, Kathleen; Tynes, L Lee

    2017-12-01

    Psychotherapy competence is a core skill for psychiatry residents, and psychotherapy supervision is a time-honored approach to teaching this skill. To explore the current supervision practices of psychiatry training programs, a 24-item questionnaire was sent to all program directors of Accreditation Council for Graduate Medical Education (ACGME)-approved adult psychiatry programs. The questionnaire included items regarding adherence to recently proposed therapy supervision practices aimed at reducing potential liability risk. The results suggested that current therapy supervision practices do not include sufficient management of the potential liability involved in therapy supervision. Better protections for patients, residents, supervisors and the institutions would be possible with improved credentialing practices and better documentation of informed consent and supervision policies and procedures. © 2017 American Academy of Psychiatry and the Law.

  16. How Advertising History Helps Explain Current Practices.

    Science.gov (United States)

    Lanfranco, Leonard W.

    Students majoring in advertising can benefit from a study of that field in its historical context because such study helps them to understand current practices and to foresee future developments. One model of teaching advertising history within a required course about advertising and society begins with some basic definitions of the advertising…

  17. Teaching Math Online: Current Practices in Turkey

    Science.gov (United States)

    Akdemir, Omur

    2011-01-01

    Changing nature of student population, developments in technology, and insufficient number of traditional universities have made online courses popular around the globe. This study was designed to investigate the current practices of teaching mathematics online in Turkish Universities through a qualitative inquiry. The snowball sampling method was…

  18. Identifying challenges in project consultants engagement practices

    Science.gov (United States)

    Shariffuddin, Nadia Alina Amir; Abidin, Nazirah Zainul

    2017-10-01

    Construction projects, green or conventional, involve multi-faceted disciplines engaged with the goal of delivering products i.e. building, infrastructure etc. at the best quality within stipulated budgets. For green projects, additional attention is added for environmental quality. Due to the various responsibilities and liabilities involved as well as the complexity of the construction process itself, formal engagement of multi-disciplinary professionals i.e. project consultants is required in any construction project. Poor selection of project consultants will lead to a multitude of complications resulting in delay, cost escalation, conflicts and poor quality. This paper explores the challenges that occur during the engagement of project consultants in a green project. As the engagement decision involves developers and architects, these two groups of respondents with green project backgrounds were approached qualitatively using interview technique. The challenges identified are limited experience and knowledge, consultants' fee vs. quality, green complexity, conflicts of interest, clients' extended expectation and less demand in green projects. The construction shifts to green project demands engagement of project consultants with added skills. It is expected that through the identification of challenges, better management and administration can be created which would give impact to the overall process of engagement in green projects.

  19. Professional courtesy--current practices and attitudes.

    Science.gov (United States)

    Levy, M A; Arnold, R M; Fine, M J; Kapoor, W N

    1993-11-25

    Physicians have long provided care free of charge or at a reduced rate as a professional courtesy to other physicians and their families. We conducted a stratified national mail survey to assess the extent to which this practice has changed in recent years. Using the American Medical Association's 1991 master list of physicians, we selected a random sample of 4800 practicing physicians from 12 direct-care specialties. These physicians were asked about their current policy and opinions regarding professional courtesy. Of the 2224 respondents, 2127 (96 percent) offered professional courtesy, defined as providing free or discounted health care to physicians and their families. Psychiatrists were less likely to offer professional courtesy than physicians in any of the other specialties (80 percent vs. 91 to 99 percent, P courtesy included billing only the insurance company (75 percent), providing care at no charge (49 percent), and giving a partial discount (23 percent). Twenty-three percent of the respondents reported that they had changed their policy regarding professional courtesy since starting to practice. Among those who had changed their policy, the most common changes were to increase the practice of billing only the insurance company (67 percent) and to provide care at no charge less often (58 percent). The majority of physicians responding to the survey thought that professional courtesy solidified bonds between physicians (79 percent) and was sound business practice (62 percent); 12 percent believed that it was too expensive to offer free or discounted care as a professional courtesy, and 14 percent thought that the practice had negative effects on the physician-patient interaction. Our survey of physicians involved in direct patient care indicates that, with the exception of psychiatrists, almost all American physicians offer free or discounted care as a professional courtesy and support the practice.

  20. The Current Practices and Problems of School Based Supervision in ...

    African Journals Online (AJOL)

    The purpose of this study was to identify the current practice and problems of school based supervision in government primary schools of Jile Timuga Woreda of Oromia Zone. A descriptive survey design of research methodology was employed. Regarding sampling, there were 39 primary schools grouped in 10 cluster ...

  1. Thai pediatricians' current practice toward childhood asthma.

    Science.gov (United States)

    Kamalaporn, Harutai; Chawalitdamrong, Pongpan; Preutthipan, Aroonwan

    2018-04-01

    Childhood asthma is a substantial health burden in Thailand. Due to a lack of pediatric respiratory specialists (pediatric pulmonologists and allergists; RS), most Thai children are cared for by general pediatricians (pediatric primary care providers (PCP)). We investigated whether current practices of Thai pediatricians complied with asthma guidelines and compared practices (diagnosis and treatments) provided by PCP and RS. A cross-sectional study was conducted using electronic surveys including four case scenarios of different asthma phenotypes distributed to Thai pediatricians. Asthma diagnosis and management were evaluated for compliance with standard guidelines. The practices of PCP and RS were compared. From 800 surveys distributed, there were 405 respondents (51%). Most respondents (81%) were PCP, who preferred to use clinical diagnosis rather than laboratory investigations to diagnose asthma. For acute asthmatic attacks, 58% of the pediatricians prescribed a systemic corticosteroid. For uncontrolled asthma, 89% of the pediatricians prescribed at least one controller. For exercise-induced bronchospasm, 55% of the pediatricians chose an inhaled bronchodilator, while 38% chose a leukotriene receptor antagonist (LTRA). For virus-induced wheeze, 40% of the respondents chose an LTRA, while 15% chose inhaled corticosteroids (ICS). PCP prescribed more oral bronchodilators (31% vs. 18%, p = 0.02), antibiotics (20% vs. 6%, p attack. Most of the Thai pediatricians' practices toward diagnosis and treatment of acute asthmatic attack and uncontrolled asthma conform to the guidelines. PCP prescribed more oral bronchodilators, antibiotics, and antihistamines than RS.

  2. Current practice in transvenous lead extraction

    DEFF Research Database (Denmark)

    Bongiorni, Maria Grazia; Blomström-Lundqvist, Carina; Kennergren, Charles

    2012-01-01

    AIM: Current practice with regard to transvenous lead extraction among European implanting centres was analysed by this survey. METHODS AND RESULTS: Among all contacted centres, 164, from 30 countries, declared that they perform transvenous lead extraction and answered 58 questions...... with a compliance rate of 99.9%. Data from the survey show that there seems to be an overall increasing experience of managing various techniques of lead extraction and a widespread involvement of cardiac centres in this treatment. Results and complication rates seem comparable with those of main international...... registries. CONCLUSION: This survey gives an interesting snapshot of lead extraction in Europe today and gives some clues for future research and prospective European registries....

  3. Massive transfusion protocols: current best practice

    Directory of Open Access Journals (Sweden)

    Hsu YM

    2016-03-01

    Full Text Available Yen-Michael S Hsu,1 Thorsten Haas,2 Melissa M Cushing1 1Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA; 2Department of Anesthesia, University Children's Hospital Zurich, Zurich, Switzerland Abstract: Massive transfusion protocols (MTPs are established to provide rapid blood replacement in a setting of severe hemorrhage. Early optimal blood transfusion is essential to sustain organ perfusion and oxygenation. There are many variables to consider when establishing an MTP, and studies have prospectively evaluated different scenarios and patient populations to establish the best practices to attain improved patient outcomes. The establishment and utilization of an optimal MTP is challenging given the ever-changing patient status during resuscitation efforts. Much of the MTP literature comes from the trauma population, due to the fact that massive hemorrhage is the leading cause of preventable trauma-related death. As we come to further understand the positive and negative clinical impacts of transfusion-related factors, massive transfusion practice can be further refined. This article will first discuss specific MTPs targeting different patient populations and current relevant international guidelines. Then, we will examine a wide selection of therapeutic products to support MTPs, including newly available products and the most suitable of the traditional products. Lastly, we will discuss the best design for an MTP, including ratio-based MTPs and MTPs based on the use of point-of-care coagulation diagnostic tools. Keywords: hemorrhage, MTP, antifibrinolytics, coagulopathy, trauma, ratio, logistics, guidelines, hemostatic

  4. Current obstetrical practice and umbilical cord prolapse.

    Science.gov (United States)

    Usta, I M; Mercer, B M; Sibai, B M

    1999-01-01

    The aim of this study was to assess the contribution of current obstetrical practice to the occurrence and complications of umbilical cord prolapse. Maternal and neonatal charts of 87 pregnancies complicated by true umbilical cord prolapse during a 5-year period were reviewed. Twin gestation and noncephalic presentations were common features (14 and 41%, respectively). Eighty-nine percent (77) of infants were delivered by cesarean section of which 29% were classical and 88% were primary. The mean gestational age at delivery was 34.0 +/- 6.0 weeks, and the mean birth weight was 2318 +/- 1159 g. Obstetrical intervention preceded 41 (47%) cases (the obstetrical intervention group): amniotomy (9), scalp electrode application (4), intrauterine pressure catheter insertion (6), attempted external cephalic version (7), expectant management of preterm premature rupture of membranes (14), manual rotation of the fetal head (1), and amnioreduction (1). There were 11 perinatal deaths. Thirty-three percent of the infants (32) had a 5-min Apgar score < 7 and 34% had a cord pH < 7.20. Neonatal seizures, intracerebral hemorrhage, necrotizing enterocolitis, hyaline membrane disease, persistent fetal circulation, sepsis, assisted ventilation, and perinatal mortality were comparable in the "obstetrical intervention" and "no-intervention" groups. Most of the neonatal complications occurred in infants < 32 weeks' gestation. We conclude that obstetrical intervention contributes to 47% of umbilical cord prolapse cases; however, it does not increase the associated perinatal morbidity and mortality.

  5. Specialization and the Current Practices of General Surgeons

    Science.gov (United States)

    Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

    2014-01-01

    Background The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons’ operative practices to inform surgical education and workforce planning. Study Design We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project (HCUP) for three US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and the percentage of practice comprised of their most common operation were calculated. Correlation was measured between general surgeons’ case volume and the number of other specialists in a health service area. Results There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure comprised no more than 30% of total practice. The most common operations, ranked by the frequency that they appeared as general surgeons’ top procedure, included: cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice comprised of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (Rho = - 0.50, p = 0.005). Conclusions Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. PMID:24210145

  6. 21 CFR 225.1 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Current good manufacturing practice. 225.1 Section...) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR MEDICATED FEEDS General Provisions § 225.1 Current good manufacturing practice. (a) Section 501(a)(2)(B) of the Federal Food, Drug, and Cosmetic Act...

  7. 21 CFR 110.5 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 110.5 Section...) FOOD FOR HUMAN CONSUMPTION CURRENT GOOD MANUFACTURING PRACTICE IN MANUFACTURING, PACKING, OR HOLDING HUMAN FOOD General Provisions § 110.5 Current good manufacturing practice. (a) The criteria and...

  8. 21 CFR 1271.150 - Current good tissue practice requirements.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Current good tissue practice requirements. 1271... HUMAN CELLS, TISSUES, AND CELLULAR AND TISSUE-BASED PRODUCTS Current Good Tissue Practice § 1271.150 Current good tissue practice requirements. (a) General. This subpart D and subpart C of this part set...

  9. 21 CFR 226.1 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Current good manufacturing practice. 226.1 Section...) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR TYPE A MEDICATED ARTICLES General Provisions § 226.1 Current good manufacturing practice. (a) The criteria in §§ 226.10 through 226.115, inclusive...

  10. Quality of the current low power and shutdown PSA practice

    International Nuclear Information System (INIS)

    Jang, Seung Cheol; Park, Jin Hee; Lim, Ho Gon; Kim, Tae Woon

    2004-01-01

    A probabilistic safety assessment (PSA) for the low-power and shutdown (LPSD) modes in a Korea standard nuclear power plant (KSNP) has been performed for the purpose of estimating the LPSD risk and identifying the vulnerabilities of LPSD operations. Both the operational experience and PSA results indicate that the risks from LPSD operations could be comparable with those from power operations. However, the application of the LPSD risk insights to risk-informed decision making has been slow to be adopted in practice. It is largely due to the question of whether the current LPSD PSA practice is appropriate for application to risk-informed decision making or not. Such a question has to do with the quality of the current LPSD PSA practice. In this paper, we have performed self-assessment of the KSNP LPSD PSA quality based on the ANS Standard (draft as of 13 Sep. 2002). The aims of the work are to find the LPSD PSA technical areas insufficient for application to risk-informed decision making and to efficiently allocate the limited research resources to improve the LPSD PSA model quality. Many useful findings regarding the current LPSD PSA quality are presented in this paper

  11. 21 CFR 120.5 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 120.5 Section... Provisions § 120.5 Current good manufacturing practice. Part 110 of this chapter applies in determining whether the facilities, methods, practices, and controls used to process juice are safe, and whether the...

  12. 21 CFR 129.1 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 129.1 Section... Current good manufacturing practice. The applicable criteria in part 110 of this chapter, as well as the..., methods, practices, and controls used in the processing, bottling, holding, and shipping of bottled...

  13. 21 CFR 113.5 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 113.5 Section... CONTAINERS General Provisions § 113.5 Current good manufacturing practice. The criteria in §§ 113.10, 113.40..., methods, practices, and controls used by the commercial processor in the manufacture, processing, or...

  14. Current operating practices of nuclear insurance pools

    International Nuclear Information System (INIS)

    O'Connell, J.M.

    1993-01-01

    This paper discusses the nuclear pooling system and co-operation between the pools, present practice and capacity, with a breakdown of the limits for third party liability and material damage. The author also describes the relationship between the pools and the nuclear operators (the policyholders), and concludes that the nuclear pools have been successful in serving the interests of their member companies, their policyholders and the governments as they have provided a stable insurance market by making available capacity in amounts that had never before been assembled and placed at risk in a single location. 2 tabs

  15. Clinical exome sequencing reports: current informatics practice and future opportunities.

    Science.gov (United States)

    Swaminathan, Rajeswari; Huang, Yungui; Astbury, Caroline; Fitzgerald-Butt, Sara; Miller, Katherine; Cole, Justin; Bartlett, Christopher; Lin, Simon

    2017-11-01

    The increased adoption of clinical whole exome sequencing (WES) has improved the diagnostic yield for patients with complex genetic conditions. However, the informatics practice for handling information contained in whole exome reports is still in its infancy, as evidenced by the lack of a common vocabulary within clinical sequencing reports generated across genetic laboratories. Genetic testing results are mostly transmitted using portable document format, which can make secondary analysis and data extraction challenging. This paper reviews a sample of clinical exome reports generated by Clinical Laboratory Improvement Amendments-certified genetic testing laboratories at tertiary-care facilities to assess and identify common data elements. Like structured radiology reports, which enable faster information retrieval and reuse, structuring genetic information within clinical WES reports would help facilitate integration of genetic information into electronic health records and enable retrospective research on the clinical utility of WES. We identify elements listed as mandatory according to practice guidelines but are currently missing from some of the clinical reports, which might help to organize the data when stored within structured databases. We also highlight elements, such as patient consent, that, although they do not appear within any of the current reports, may help in interpreting some of the information within the reports. Integrating genetic and clinical information would assist the adoption of personalized medicine for improved patient care and outcomes. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  16. Structural and practical identifiability analysis of S-system.

    Science.gov (United States)

    Zhan, Choujun; Li, Benjamin Yee Shing; Yeung, Lam Fat

    2015-12-01

    In the field of systems biology, biological reaction networks are usually modelled by ordinary differential equations. A sub-class, the S-systems representation, is a widely used form of modelling. Existing S-systems identification techniques assume that the system itself is always structurally identifiable. However, due to practical limitations, biological reaction networks are often only partially measured. In addition, the captured data only covers a limited trajectory, therefore data can only be considered as a local snapshot of the system responses with respect to the complete set of state trajectories over the entire state space. Hence the estimated model can only reflect partial system dynamics and may not be unique. To improve the identification quality, the structural and practical identifiablility of S-system are studied. The S-system is shown to be identifiable under a set of assumptions. Then, an application on yeast fermentation pathway was conducted. Two case studies were chosen; where the first case is based on a larger state trajectories and the second case is based on a smaller one. By expanding the dataset which span a relatively larger state space, the uncertainty of the estimated system can be reduced. The results indicated that initial concentration is related to the practical identifiablity.

  17. Biomedical waste management in Ayurveda hospitals - current practices & future prospectives.

    Science.gov (United States)

    Rajan, Renju; Robin, Delvin T; M, Vandanarani

    2018-03-16

    Biomedical waste management is an integral part of traditional and contemporary system of health care. The paper focuses on the identification and classification of biomedical wastes in Ayurvedic hospitals, current practices of its management in Ayurveda hospitals and its future prospective. Databases like PubMed (1975-2017 Feb), Scopus (1960-2017), AYUSH Portal, DOAJ, DHARA and Google scholar were searched. We used the medical subject headings 'biomedical waste' and 'health care waste' for identification and classification. The terms 'biomedical waste management', 'health care waste management' alone and combined with 'Ayurveda' or 'Ayurvedic' for current practices and recent advances in the treatment of these wastes were used. We made a humble attempt to categorize the biomedical wastes from Ayurvedic hospitals as the available data about its grouping is very scarce. Proper biomedical waste management is the mainstay of hospital cleanliness, hospital hygiene and maintenance activities. Current disposal techniques adopted for Ayurveda biomedical wastes are - sewage/drains, incineration and land fill. But these methods are having some merits as well as demerits. Our review has identified a number of interesting areas for future research such as the logical application of bioremediation techniques in biomedical waste management and the usage of effective micro-organisms and solar energy in waste disposal. Copyright © 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Published by Elsevier B.V. All rights reserved.

  18. [Identifying indicators of good practice in clinical and healthcare management].

    Science.gov (United States)

    Bermúdez Tamayo, C; Olry de Labry Lima, A; García Mochón, L

    2018-03-06

    To identify good practices in order to develop and implement indicators of health outcomes for clinical and healthcare management, as well as the characteristics for an indicator to be considered adequate. A scoping review was performed, with the following phases: 1) Search and identification of bibliography. 2) Selection of relevant documents. Including those studies that discussed issues related to good practices for the use of health indicators in the management field. Those published in a language other than English or Spanish or before 2006 were excluded. 3) Analysis and extraction of information. 4) Consultation with stakeholders, using a qualitative methodology through Concept Mapping, with the participation of 40 experts (decision-makers, scientific societies, and health professionals). The data collection process included an inductive and structured procedure, with prioritisation of ideas grouped into clusters, according to feasibility and importance criteria (0-10 scale). Good practices identified 2 levels: 1) macro-management: Define a framework for the evaluation of indicators and establish a benchmark of indicators. 2) meso-management: Establish indicators according to evidence and expert consensus, taking into account priority areas and topics, testing before final use, and communicate results adequately. The characteristics of a suitable indicator are: 1) Approach of an important issue, 2) Scientific validity, 3) Possibility of measurement with reliable data, 4) Meaning of useful and applicable measurement, and 5) Wide scope. The best practices for the use of indicators in clinical and healthcare management can make it easier to monitor performance and accountability, as well as to support the decision-making addressed at the development of initiatives for quality improvement. Copyright © 2018 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Evaluating Current Practices in Shelf Life Estimation.

    Science.gov (United States)

    Capen, Robert; Christopher, David; Forenzo, Patrick; Huynh-Ba, Kim; LeBlond, David; Liu, Oscar; O'Neill, John; Patterson, Nate; Quinlan, Michelle; Rajagopalan, Radhika; Schwenke, James; Stroup, Walter

    2018-02-01

    The current International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) methods for determining the supported shelf life of a drug product, described in ICH guidance documents Q1A and Q1E, are evaluated in this paper. To support this evaluation, an industry data set is used which is comprised of 26 individual stability batches of a common drug product where most batches are measured over a 24 month storage period. Using randomly sampled sets of 3 or 6 batches from the industry data set, the current ICH methods are assessed from three perspectives. First, the distributional properties of the supported shelf lives are summarized and compared to the distributional properties of the true shelf lives associated with the industry data set, assuming the industry data set represents a finite population of drug product batches for discussion purposes. Second, the results of the ICH "poolability" tests for model selection are summarized and the separate shelf life distributions from the possible alternative models are compared. Finally, the ICH methods are evaluated in terms of their ability to manage risk. Shelf life estimates that are too long result in an unacceptable percentage of nonconforming batches at expiry while those that are too short put the manufacturer at risk of possibly having to prematurely discard safe and efficacious drug product. Based on the analysis of the industry data set, the ICH-recommended approach did not produce supported shelf lives that effectively managed risk. Alternative approaches are required.

  20. Current pharmacotherapies for obesity: A practical perspective.

    Science.gov (United States)

    Golden, Angela

    2017-10-01

    To review the currently available pharmacotherapies for obesity management with a particular focus on the United States. Narrative review based on literature searches and the latest prescribing information (up to July 2017). Obesity pharmacotherapies may assist those individuals who have obesity, or overweight with comorbidities, who have failed to maintain weight loss with lifestyle modifications alone (caloric restriction and increased physical activity). Currently approved options in the United States include phentermine for short-term use and five obesity pharmacotherapies that can be used long-term (orlistat, lorcaserin, phentermine-topiramate, naltrexone-bupropion, and liraglutide 3.0 mg). If the use of an obesity pharmacotherapy is indicated, treatment should be selected to provide the most appropriate option for each individual and their circumstances. Variables such as contraindications, individual comorbidities, patient choice, patient readiness to incorporate additional behavioral changes (e.g., alcohol prohibition), and cost should guide choices. Each of the obesity pharmacotherapies has advantages and disadvantages that can help guide treatment choice. Those receiving treatment may also have individual preferences based on factors such as administration route, frequency of dosing, and/or safety profile. In addition, some options may be particularly appropriate for patients with common obesity-related complications such as depression or diabetes. ©2017 American Association of Nurse Practitioners.

  1. Psychological assessment for bariatric surgery: current practices.

    Science.gov (United States)

    Flores, Carolina Aita

    2014-01-01

    The prevalence of obesity on a global scale has alarmed health institutions, the general population and professionals involved in its treatment. Bariatric surgery has emerged as an effective and lasting alternative for weight reduction and improved general health. In this context and as part of a multidisciplinary team, psychologists are responsible for the preoperative psychological assessment of bariatric candidates. To investigate how psychological assessments are occurring, including the identification of utilized resources; factors that are addressed; the duration of the process; existing protocols; and to evaluate the importance of this practice. A systematic review of national and international literature, through PubMed and Scielo's databases, using "psychological assessment", "obesity" and "surgery", as keywords. There is an agreement about the main factors that should be investigated during the preoperative assessment, as well as the main contraindications for the surgical procedure. The importance of the psychological assessment is well established in the field of bariatric surgery. However, this area needs a standard protocol to guide the mental health professionals that deal with bariatric patients.

  2. Footwear in rock climbing: Current practice.

    Science.gov (United States)

    McHenry, R D; Arnold, G P; Wang, W; Abboud, R J

    2015-09-01

    Many rock climbers wear ill-fitting and excessively tight footwear during activity. However, there is insufficient evidence of the extent or harms of this practice. To investigate footwear use in rock climbers with a focus on issues surrounding fit. A cross-sectional study with active rock climbers of over one year of experience completing a survey on their activity and footwear. Additionally, the authors quantified foot and shoe lengths and sizes alongside demographic data. Ill-fitting and excessively tight footwear was found in 55 out of 56 rock climbers. Foot pain during activity was also commonplace in 91% of the climbers. A mean size reduction of almost 4 UK shoe sizes was found between the climbers' street shoe size and that of their climbing footwear using a calibrated foot/shoe ruler. There is an unfortunate association of climbers of higher abilities seeking a tighter shoe fit (pfootwear use amongst rock climbers, further investigation may aim to quantify its impact and seek a solution balancing climbing performance while mitigating foot injury. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Topical steroids in the current clinical practice

    Directory of Open Access Journals (Sweden)

    T. A. Belousova

    2014-01-01

    Full Text Available The article discusses issues related to current criteria for selection of glucocorticosteroids for external use as the basic therapy for a great number of allergic and inflammatory skin diseases. The authors emphasize that non-fluorinated GCSs having the best efficacy-to-safety ratio must be the drugs of first choice. The article provides data on a positive clinical experience of using a non-halogenated glucocorticosteroid for external use - hydrocortisone 17-butyrate (Laticort - for treatment of steroid-sensitive dermatoses in children and adults. The drug has a high anti-inflammatory action and minimum risk of the development of side effects, which is sufficient for using it in sensitive areas of skin (face, neck, folds, genitals both in children and in adults. The availability of three forms of the drug (solution, cream and ointment ensures the expedience and convenience of its application at any stage of the inflammatory process and for any localization.

  4. Persistent Identifier Practice for Big Data Management at NCI

    Directory of Open Access Journals (Sweden)

    Jingbo Wang

    2017-04-01

    Full Text Available The National Computational Infrastructure (NCI manages over 10 PB research data, which is co-located with the high performance computer (Raijin and an HPC class 3000 core OpenStack cloud system (Tenjin. In support of this integrated High Performance Computing/High Performance Data (HPC/HPD infrastructure, NCI’s data management practices includes building catalogues, DOI minting, data curation, data publishing, and data delivery through a variety of data services. The metadata catalogues, DOIs, THREDDS, and Vocabularies, all use different Uniform Resource Locator (URL styles. A Persistent IDentifier (PID service provides an important utility to manage URLs in a consistent, controlled and monitored manner to support the robustness of our national ‘Big Data’ infrastructure. In this paper we demonstrate NCI’s approach of utilising the NCI’s 'PID Service 'to consistently manage its persistent identifiers with various applications.

  5. 21 CFR 123.5 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 123.5 Section...) FOOD FOR HUMAN CONSUMPTION FISH AND FISHERY PRODUCTS General Provisions § 123.5 Current good manufacturing practice. (a) Part 110 of this chapter applies in determining whether the facilities, methods...

  6. Current practice in paediatric basic life support

    Directory of Open Access Journals (Sweden)

    Heczková Jana

    2017-06-01

    Full Text Available Introduction. Although the incidence of cardiac arrest in children is much lower than in adults, the condition is still considered a major health problem with a very low chance for survival. As in adults, the timely provision of cardiopulmonary resuscitation (CPR in children is crucial. Current guidelines for CPR in children were published along with the guidelines for CPR in adults in 2015. As in previous years, they are based on consensus provided by International Liaison Committee on Resuscitation (ILCOR. Guidelines of particular ILCOR member councils may vary and reflect regional characteristic such as different access to health care, education methods or willingness of population to provide emergency assistance. Moreover, the conditions requiring CPR in children are characterized not only by different incidence, but also by aetiology or techniques used for different age groups. Therefore, emphasis is put on simplicity and feasibility as well as on consistency with adult guidelines to improve retention of the paediatric sequences. Nurses may be first rescuers not only in health care facilities. Better understanding of CPR guidelines might help them to improve their ability to detect conditions requiring CRP and also initiate and provide effective emergency care.

  7. Telehealth: current practices and future directions

    Science.gov (United States)

    David, Yadin B.

    1996-02-01

    When we review the positive impact that the integration of ostensibly independent patient-care services have on the efficient management of quality care, education, and collaborative research, it is not surprising that telehealth deployment is on the rise. The forces that drive this phenomenon include: the need to manage the entire disease episode; the desire for wider geographically-distributed quality health care; the escalation of customer expectations; globalization of healthcare and its support services; an increase in patient and provider convenience; and the acceptance of the present technological community. At the Telehealth Center at the Texas Children's Hospital, current classifications of clinical applications are listed: (1) initial urgent evaluation of patients, (2) triage decisions and pretransfer arrangements, (3) medical and surgical follow-up and medication review, (4) consultation for primary care encounters, (5) real-time subspecialty care consultation and planning, (6) management of chronic diseases and conditions, (7) extended diagnostic work-ups, (8) review of diagnostic images, and (9) preventive medicine and patient education. The delivery of such services is associated with challenges and opportunities. As we move forward from limited data processing to an integrated communication system, from centralized main frame functions to personalized and location-independent workstations, and from hospitals to clinics and homecare, an increase in the minimum features provided by the equipment and the communication systems must accompany the widening variety of clinical applications. Future expansion of telehealth systems stands to revolutionize the delivery of services to the benefits of providers' networks, our economy, and patients through integration.

  8. Aptamer therapeutics: A review of current practice

    International Nuclear Information System (INIS)

    Perkins, A.C.; Missailidis, S.

    2007-01-01

    meet the criteria for robust, generic drug discovery technology and open new horizons for the development of future radiopharmaceuticals. We have shown that aptamers directed against the MUC1 antigen, a tumour marker previously extensively used in tumour imaging and therapy, demonstrated high specificity and uniform penetration in tumour xenografts. The future strategy will be to manipulate the molecular weight of the molecules to achieve an optimum balance between the low immunogenicity and excellent tumour penetration for diagnostic imaging and targeted therapy. In this way, a balance can be achieved between the rapid renal clearance and adequate tumour uptake required for diagnostic imaging and targeted therapy. The current work and future prospects for aptamer therapeutics will be described. (author)

  9. Overview of current and alternative slaughter practices

    Directory of Open Access Journals (Sweden)

    Troeger K.

    2004-01-01

    Full Text Available The conventional cattle slaughtering process includes some critical stages where a dissemination of Specified Risk Material (SRM: brain, spinal cord within or onto the carcass and within the slaughterhouse environment can occur. These processes are captive bolt stunning, removal of the head and first of all carcass splitting (sawing the spine lengthways. Captive bolt (CB stunning results in massive brain tissue damage with bleeding, and in some cases brain tissue also emerges from the CB hole. As the heart is still functioning, there is a risk of brain tissue particles being transferred v i a the blood flow to heart and lungs or even in the whole carcass. This contamination risk is actually assessed to be low, but a continuing leakage of Central Nervous System (CNS material from the captive bolt aperture in the further slaughter process may lead to direct and indirect contamination of carcass, meat and equipment. Therefore alternative stunning methods like electrical stunning or concussion stunning are discussed. A further critical point is the treatment of the head. When the head is removed, the spinal cord is cut with a knife. There is a danger of cross contamination due to spinal protein that may adhere to the knife and because of liquid cerebralis, which leaks from the foramen occipitale magnum. Further head cleaning with hand-held hoses following skinning also includes the danger of cross contamination from cleaning water or aerosol. Therefore measures regarding the safe handling of head and harvesting of head meat are proposed. The most critical point in terms of contamination of the meat surface with SRM is the currently common practise of sawing the spine vertically in the middle with hand-guided belt-type saws. A m i x t u r e of sawing residues and rinsing water (“sawing sludge” collects in the housing of the saw, and if it contains infectious material this leads to contamination of the subsequent carcasses. The most promising

  10. Current practice for diagnosis and management of silent atrial fibrillation

    DEFF Research Database (Denmark)

    Dobreanu, Dan; Svendsen, Jesper Hastrup; Lewalter, Thorsten

    2013-01-01

    for the diagnosis and management of silent AF. This survey is based on an electronic questionnaire sent to the European Heart Rhythm Association Research Network partners. Responses were received from 33 centres in 16 countries. The preferred screening methods for silent AF in patients with rhythm control...... for such patients. Most responders preferred rate control over rhythm control in patients with silent AF, although some favoured pulmonary vein isolation in young patients. However, oral anticoagulant therapy in patients at high thromboembolic risk was considered mandatory by most, provided that at least one......Although it is well known that silent atrial fibrillation (AF) is associated with morbidity and mortality rates similar to those of symptomatic AF, no specific strategy for screening and management of this form of AF has been advocated. The purpose of this survey was to identify current practices...

  11. Identifying Best Practices for Engaging Faculty in International Agricultural Education

    Directory of Open Access Journals (Sweden)

    Alexa J. Lamm

    2013-10-01

    Full Text Available Universities are being called upon to internationalize curriculum as the need for a globally competent workforce increases. Without globally-competent faculty, international integration within higher education cannot occur. Literature indicates that participation in short-term international agricultural education experiences is important to increasing agricultural faculty members’ cultural awareness. However, the best way to design and implement such experiences for faculty is uncharted. The purpose of the study was to identify best practices for facilitating a short-term international education experience for faculty in the agricultural and life sciences that encouraged learning, discussion, and reflection leading faculty to further integrate international perspectives in their agricultural courses in the U.S. Through a qualitative research design, reflective observations and statements from a planning team conducting short-term international agricultural education experience in Ecuador were used to provide a thick, rich description of the successes/challenges faced while designing and implementing the experience. The results provided a list of best practices future planning team members can use to emphasize learning before, during, and after a short-term international agricultural education experience for faculty.

  12. 78 FR 11611 - Current Good Manufacturing Practice and Hazard Analysis and Risk-Based Preventive Controls for...

    Science.gov (United States)

    2013-02-19

    ... related to the proposed rule on ``Current Good Manufacturing Practice and Hazard Analysis and Risk-Based... . All comments should be identified with the title ``Current Good Manufacturing Practice and Hazard... rulemaking to modernize the regulation for ``Current Good Manufacturing Practice In Manufacturing, Packing...

  13. 21 CFR 114.5 - Current good manufacturing practice.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false Current good manufacturing practice. 114.5 Section...) FOOD FOR HUMAN CONSUMPTION ACIDIFIED FOODS General Provisions § 114.5 Current good manufacturing practice. The criteria in §§ 114.10, 114.80, 114.83, 114.89, and 114.100, as well as the criteria in part...

  14. REVIEW OF CURRENT PRACTICE IN CHARACTERIZATION AND MONITORING

    Energy Technology Data Exchange (ETDEWEB)

    M.A.Ebadian, Ph.D.

    2001-01-01

    Characterization and monitoring are important parts of environmental remediation of contaminated sites by the Department of Energy--Office of Environmental Management (DOE-EM). The actual remediation process often cannot begin or even be planned until characterization is complete. Monitoring is essential to verify the progress of remediation and of the waste stream. However, some contaminated sites are difficult, costly, or have a high exposure risk to personnel to characterize or monitor using the baseline technology or current practice. Therefore, development of new characterization and monitoring technologies is time-critical to remediate these sites. The main task of the Characterization, Monitoring, and Sensor Technology Crosscutting Program (CMST-CP) is to develop and deploy innovative characterization and monitoring technologies that improve performance and reduce personnel exposure, cost, and detection limits. However, to evaluate different proposals for new technologies to decide which ones to develop or deploy, it is necessary to compare their cost and performance to the baseline technology. The goal of this project is to facilitate the direct comparison of new technologies to the baseline technology by documenting the current practices for site characterization and monitoring at DOE sites and by presenting the information in an easy-to-use, concise database. The database will assist the CMST-CP and others in evaluating or designing new technologies by identifying the baseline technologies and describing their performance and cost. The purpose of this document is to report on the completion of this project and to describe the database. Section 2.0 describes the data assessment methodology. Section 3.0 presents the database and serves as a user manual. Section 4.0 lists the references used for each baseline technology in the database. The full references can be found in the Appendix.

  15. REVIEW OF CURRENT PRACTICE IN CHARACTERIZATION AND MONITORING

    International Nuclear Information System (INIS)

    Ebadian, M.A.

    2001-01-01

    Characterization and monitoring are important parts of environmental remediation of contaminated sites by the Department of Energy--Office of Environmental Management (DOE-EM). The actual remediation process often cannot begin or even be planned until characterization is complete. Monitoring is essential to verify the progress of remediation and of the waste stream. However, some contaminated sites are difficult, costly, or have a high exposure risk to personnel to characterize or monitor using the baseline technology or current practice. Therefore, development of new characterization and monitoring technologies is time-critical to remediate these sites. The main task of the Characterization, Monitoring, and Sensor Technology Crosscutting Program (CMST-CP) is to develop and deploy innovative characterization and monitoring technologies that improve performance and reduce personnel exposure, cost, and detection limits. However, to evaluate different proposals for new technologies to decide which ones to develop or deploy, it is necessary to compare their cost and performance to the baseline technology. The goal of this project is to facilitate the direct comparison of new technologies to the baseline technology by documenting the current practices for site characterization and monitoring at DOE sites and by presenting the information in an easy-to-use, concise database. The database will assist the CMST-CP and others in evaluating or designing new technologies by identifying the baseline technologies and describing their performance and cost. The purpose of this document is to report on the completion of this project and to describe the database. Section 2.0 describes the data assessment methodology. Section 3.0 presents the database and serves as a user manual. Section 4.0 lists the references used for each baseline technology in the database. The full references can be found in the Appendix

  16. Identifying practice-related factors for high-volume prescribers of antibiotics in Danish general practice

    DEFF Research Database (Denmark)

    Aabenhus, Rune; Siersma, Volkert Dirk; Sandholdt, Håkon

    2017-01-01

    practice-related factors driving high antibiotic prescribing rates. Results: We included 98% of general practices in Denmark (n = 1962) and identified a 10% group of high prescribers who accounted for 15% of total antibiotic prescriptions and 18% of critically important antibiotic prescriptions. Once case...... prescriptions issued over the phone compared with all antibiotic prescriptions; and a high number of consultations per 1000 patients. We also found that a low number of consultations per 1000 patients was associated with a reduced likelihood of being a high prescriber of antibiotics. Conclusions: An apparent...

  17. Standards of practice for forensic mental health nurses--identifying contemporary practice.

    Science.gov (United States)

    Martin, Trish; Maguire, Tessa; Quinn, Chris; Ryan, Jo; Bawden, Louise; Summers, Monica

    2013-01-01

    Forensic mental health nursing is a recognized field of nursing in most countries. Despite a growing body of literature describing aspects of practice, no publication has been found that captures the core knowledge, skills, and attitudes of forensic mental health nurses. One group of nurses in Australia have pooled their knowledge of relevant literature and their own clinical experience and have written standards of practice for forensic mental health nursing. This paper identifies the need for standards, provides a summary of the standards of practice for forensic mental health nurses, and concludes with how these standards can be used and can articulate to others the desired and achievable level of performance in the specialty area.

  18. Colostomy irrigation: current knowledge and practice of WOC nurses.

    Science.gov (United States)

    Cobb, Martha D; Grant, Marcia; Tallman, Nancy J; Wendel, Christopher S; Colwell, Janice; McCorkle, Ruth; Krouse, Robert S

    2015-01-01

    This study builds on the authors' previous studies that demonstrate that persons living with a colostomy who practice colostomy irrigation (CI) experience quality-of-life benefits. Studies also reveal that patients may not be taught about CI. The purpose of this study was to determine current knowledge, attitudes, and practices of WOC nurses on CI. The target population was ostomy nurses who were members of the Wound, Ostomy and Continence Nurse's Society. Nine hundred eighty-five nurses out of a possible pool of 4191 members responded, providing a response rate of 24%. Their average age was 53 years (range, 25-79 years). Respondents averaged 12 years' experience as a WOC nurse (range, 1-40 years) and 90% (n = 875) were certified. Participants practiced in a variety of settings, including acute and long-term care facilities, home health, and ambulatory clinics. They saw an average of 37 ± 60.5 (mean ± SD) ostomy patients per year (range, 0-1100). A 1-time online survey (SurveyMonkey) of members of the Wound, Ostomy and Continence Nurses (WOCN) Society was conducted. In addition to demographic and educational information, questions also included (1) CI advantages and disadvantages; (2) CI content routinely taught; (3) challenges in assisting patients to learn CI; and (4) where preparation was received for teaching this procedure. Nurses were asked whether they believe CI is evidence-based. More than half identified irrigation as an evidence-based practice (59%), but half indicated they do not routinely teach CI. Multiple factors correlated with nurses' decisions to teach CI, including years of experience (P = .03), specific CI education (P < .001), and considering the intervention evidence-based (P < .001). Factors influencing CI instruction are multifactorial; they include nurses' attitudes, experience base, education, medical indications, setting characteristics, and patient interest and physical abilities. Education on this procedure is urgently needed for

  19. Current earthquake engineering practice for Japanese nuclear power plants

    International Nuclear Information System (INIS)

    Hofmayer, C.H.; Park, Y.J.; Costello, J.F.

    1992-01-01

    This paper provides a brief overview of seismic research being conducted in Japan and describes USNRC efforts to understand Japanese seismic practice. Current earthquake engineering practice for Japanese nuclear power plants is descried in JEAG 4601-1987, ''Technical Guidelines for Aseismic Design of Nuclear Power Plants.'' The USNRC has sponsored BNL to translate this document into English. Efforts are underway to study and understand JEAG 4601-1987 and make the translation more readily available in the United States

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

    CSIR Research Space (South Africa)

    Ntshotsho, P

    2015-11-01

    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...

  1. Gender relations and health research: a review of current practices

    Directory of Open Access Journals (Sweden)

    Bottorff Joan L

    2011-12-01

    Full Text Available Abstract Introduction The importance of gender in understanding health practices and illness experiences is increasingly recognized, and key to this work is a better understanding of the application of gender relations. The influence of masculinities and femininities, and the interplay within and between them manifests within relations and interactions among couples, family members and peers to influence health behaviours and outcomes. Methods To explore how conceptualizations of gender relations have been integrated in health research a scoping review of the existing literature was conducted. The key terms gender relations, gender interactions, relations gender, partner communication, femininities and masculinities were used to search online databases. Results Through analysis of this literature we identified two main ways gender relations were integrated in health research: a as emergent findings; and b as a basis for research design. In the latter, gender relations are included in conceptual frameworks, guide data collection and are used to direct data analysis. Conclusions Current uses of gender relations are typically positioned within intimate heterosexual couples whereby single narratives (i.e., either men or women are used to explore the influence and/or impact of intimate partner gender relations on health and illness issues. Recommendations for advancing gender relations and health research are discussed. This research has the potential to reduce gender inequities in health.

  2. Ecological models and pesticide risk assessment: current modeling practice.

    Science.gov (United States)

    Schmolke, Amelie; Thorbek, Pernille; Chapman, Peter; Grimm, Volker

    2010-04-01

    Ecological risk assessments of pesticides usually focus on risk at the level of individuals, and are carried out by comparing exposure and toxicological endpoints. However, in most cases the protection goal is populations rather than individuals. On the population level, effects of pesticides depend not only on exposure and toxicity, but also on factors such as life history characteristics, population structure, timing of application, presence of refuges in time and space, and landscape structure. Ecological models can integrate such factors and have the potential to become important tools for the prediction of population-level effects of exposure to pesticides, thus allowing extrapolations, for example, from laboratory to field. Indeed, a broad range of ecological models have been applied to chemical risk assessment in the scientific literature, but so far such models have only rarely been used to support regulatory risk assessments of pesticides. To better understand the reasons for this situation, the current modeling practice in this field was assessed in the present study. The scientific literature was searched for relevant models and assessed according to nine characteristics: model type, model complexity, toxicity measure, exposure pattern, other factors, taxonomic group, risk assessment endpoint, parameterization, and model evaluation. The present study found that, although most models were of a high scientific standard, many of them would need modification before they are suitable for regulatory risk assessments. The main shortcomings of currently available models in the context of regulatory pesticide risk assessments were identified. When ecological models are applied to regulatory risk assessments, we recommend reviewing these models according to the nine characteristics evaluated here. (c) 2010 SETAC.

  3. A Profile of Current Employee Training Practices in Selected Businesses and Industries in Southwest Virginia

    OpenAIRE

    Hundley, Katrina M.

    2003-01-01

    The purposes of this study were to (a) establish a profile of the current training practices of selected businesses and industries in Southwest Virginia; (b) identify the type of training methods these companies are choosing -- such as traditional classroom training or web-based training programs, and (c) identify how the training methods are selected. This profile established baseline data for current business and industry employee training programs. The population of this study include...

  4. Continuous infusion in haemophilia: current practice in Europe

    NARCIS (Netherlands)

    Batorova, A.; Holme, P.; Gringeri, A.; Richards, M.; Hermans, C.; Altisent, C.; Lopez-Fernández, M.; Fijnvandraat, K.

    2012-01-01

    . Continuous infusion (CI) of factor VIII (FVIII) is an effective method for replacement therapy in haemophilia. Recently, concerns have been raised regarding association of CI with the development of inhibitors. The aim of this study was to gain information on the current practices in Europe

  5. Clinical Supervision of Substance Abuse Counselors: Current and Preferred Practices.

    Science.gov (United States)

    Culbreth, John R.

    1999-01-01

    Reports on a national survey of substance abuse counselors (N=134) to learn their current and preferred supervision practices. Results suggests that substance abuse counselor are receiving supervision similar to other counselors. No preference was indicated for the sex of the supervisor, nor for the 12-step recovery experience. Counselors did…

  6. The Current Teacher Education Programs in Ethiopia: Reflection on Practice

    Science.gov (United States)

    Mekonnen, Geberew Tulu

    2017-01-01

    This study threw light on the current practice of Postgraduate Diploma in Teaching Program at Addis Ababa University, Ethiopia. The study focused on the enrolment, graduation and attrition proportion of Postgraduate Diploma in Teaching candidates in the year 2011 and 2015. The 2011 and 2015 academic years have been purposively selected because the…

  7. Human Factors Engineering: Current Practices and Development Needs in Finland

    Energy Technology Data Exchange (ETDEWEB)

    Savioja, Paula; Norros, Leena; Liinasuo, Marja; Laarni, Jari [VTT Technical Research Centre of Finland, Finland (Finland)

    2011-08-15

    This paper describes initial findings from a study concerning the practices and development needs of Human Factors Engineering (HFE) in Finland. HFE is increasing in importance as the Radiation and Nuclear Safety Authority Finland (STUK) is renewing the regulatory guidelines and the intention is to include requirements concerning HFE. The motivation for the paper is to discover how HFE is conducted currently in order to envision what should be aimed at when modifying requirements for design practices. In an interview with STUK it was discovered that current HFE practices encompass mainly activities related to control room modifications and as such namely verification and validation of new designs. The adoption of the entire HFE process in design and modification projects requires changes that include better integration of technical and Human Factors Engineering approaches. Boundary objects that mediate between different design disciplines are needed in order to enforce the stronger integration. Concept of operations (CONOPS) is suggested as a such boundary object.

  8. Curating research data a handbook of current practice

    CERN Document Server

    Johnston, Lisa R

    2017-01-01

    Curating Research Data, Volume Two: A Handbook of Current Practice guides you across the data lifecycle through the practical strategies and techniques for curating research data in a digital repository setting. The data curation steps for receiving, appraising, selecting, ingesting, transforming, describing, contextualizing, disseminating, and preserving digital research data are each explored, and then supplemented with detailed case studies written by more than forty international practitioners from national, disciplinary, and institutional data repositories. The steps in this volume detail the sequential actions that you might take to curate a data set from receiving the data (Step 1) to eventual reuse (Step 8). Data curators, archivists, research data management specialists, subject librarians, institutional repository managers, and digital library staff will benefit from these current and practical approaches to data curation.

  9. Practical Approaches for Identifying and Managing Abused and Neglected Children.

    Science.gov (United States)

    Radford, Nola T.

    1998-01-01

    Discusses the exceptional challenges that abused and neglected children may pose for early-intervention providers, particularly speech-language pathologists. It focuses on practical strategies regarding reporting child abuse, effectively assessing the children who have been abused, and managing the bizarre behavior they may exhibit. (Author/CR)

  10. Identifying family television practices to reduce children's television time

    NARCIS (Netherlands)

    Piotrowski, J.; Jordan, A.B.; Bleakley, A.; Hennessy, M.

    2015-01-01

    The family system plays an important role in shaping children’s television use. The American Academy of Pediatrics has recommended that parents limit screen time, given the risks associated with children’s heavy television viewing. Researchers have highlighted family television practices that may be

  11. Forensic Occupational Therapy in Canada: The Current State of Practice.

    Science.gov (United States)

    Chui, Adora L Y; Wong, Chantal Isabelle; Maraj, Sara A; Fry, Danielle; Jecker, Justine; Jung, Bonny

    2016-09-01

    Although occupational therapists have been practicing in forensic settings for many years, there is a paucity of literature regarding the nature of this practice in Canada. The purpose of this study was to describe the practices of Canadian occupational therapists in forensic mental health. An online survey was designed based on the Canadian Practice Process Framework. Following purposive and snowball sampling, responses were analysed with descriptive statistics and content analysis. Twenty-seven clinicians responded (56% response rate). Respondents indicated commonalities in workplaces, client caseloads and practice challenges. The outstanding need in Canada to demonstrate client outcomes through the use of evaluation instruments reflects those practice gaps identified internationally. Education, advocacy and research are critical areas for the development of Canadian forensic occupational therapy. Although findings heavily reflect one provincial context and may not be generalizable to nonhospital settings, a number of priority areas were identified. Future efforts should clarify the role of forensic occupational therapy to stakeholders, and validate their contributions through research that evaluates intervention efficacy and meaningful outcomes. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  12. EIA systems in Nigeria: evolution, current practice and shortcomings

    International Nuclear Information System (INIS)

    Ogunba, Olusegun A.

    2004-01-01

    Amidst mounting criticism of Environmental Impact Assessments (EIAs) carried out in Nigeria under the three independent EIA systems--the EIA Decree 86 (1992), the Town and Country Planning Decree 88 (1992) and the Petroleum Act (1969)--the paper traces the evolution of Nigeria's systems and appraises current practice and shortcomings. The path of development of the systems was traced within the framework of Gibson's model of EIA evolution [Impact Assess. Proj. Apprais., 20 (3) 2002, 151-159], while current practice and shortcomings were explored in random interview surveys of consultant firms, approval authorities and the academia. It was seen that Gibson's four-stage model is not exactly representative of the Nigerian situation, and a more appropriate six-stage model was developed. It was also established that the current practices of the three EIA systems were at different stages of evolution: one of the EIA schemes (the Town and Country Planning Decree) has not evolved satisfactorily, while the other two EIA systems have produced intricate legislations and guidelines, but fall short of first-rate practice. The other discovery was that the simultaneous use of three independent systems creates unnecessary duplication of EIA preparation with considerable time and money costs. The paper advises that Nigeria can make substantial progress along the evolutionary path through a correction of observed system shortcomings and a merger of the three systems

  13. Current nuclear industry practices with regard to the integration of surveillances

    International Nuclear Information System (INIS)

    Stewart, M.; Smith, C.

    1992-04-01

    Commercial nuclear industry practices regarding the integration of technical specification (TS) surveillance and maintenance activities are identified in this report. A questionnaire was developed and used to obtain current industry practices from NRC Regional personnel and INEL engineers with utility experience. Some of these practices indicate that the scheduling of TS surveillance and maintenance items could be more effectively coordinated. Also, must utilities do not formally consider risk implications when they are scheduling maintenance. Methodologies and approaches for proposing and evaluating changes to improve the integration of TS surveillance and maintenance activities have been identified for planned future work

  14. Australian survey on current practices for breast radiotherapy.

    Science.gov (United States)

    Dundas, Kylie L; Pogson, Elise M; Batumalai, Vikneswary; Boxer, Miriam M; Yap, Mei Ling; Delaney, Geoff P; Metcalfe, Peter; Holloway, Lois

    2015-12-01

    Detailed, published surveys specific to Australian breast radiotherapy practice were last conducted in 2002. More recent international surveys specific to breast radiotherapy practice include a European survey conducted in 2008/2009 and a Spanish survey conducted in 2009. Radiotherapy techniques continue to evolve, and the utilisation of new techniques, such as intensity-modulated radiation therapy (IMRT), is increasing. This survey aimed to determine current breast radiotherapy practices across Australia. An online survey was completed by 50 of the 69 Australian radiation therapy treatment centres. Supine tangential beam whole breast irradiation remains the standard of care for breast radiotherapy in Australia. A growing number of institutions are exploring prone positioning and IMRT utilisation. This survey demonstrated a wide variation in the benchmarks used to limit and report organ at risk doses, prescribed dose regimen, and post-mastectomy bolus practices. This survey also indicated, when compared with international literature, that there may be less interest in or uptake of external beam partial breast irradiation, prone positioning, simultaneous integrated boost and breath hold techniques. These are areas where further review and research may be warranted to ensure Australian patients are receiving the best care possible based on the best evidence available. This survey provides insight into the current radiotherapy practice for breast cancer in Australia. © 2015 The Royal Australian and New Zealand College of Radiologists.

  15. Current trends in endodontic practice: emergency treatments and technological armamentarium.

    Science.gov (United States)

    Lee, Michelle; Winkler, Johnathon; Hartwell, Gary; Stewart, Jeffrey; Caine, Rufus

    2009-01-01

    The current clinical practice of endodontics includes the utilization of a variety of new technological advances and materials. The last comprehensive survey that compared treatment modalities used in endodontic practices was conducted in 1990. The purpose of the current survey was to determine the frequency with which these new endodontic technologies and materials are being used in endodontic practices today. An e-mail questionnaire was sent to the 636 active diplomates of the American Board of Endodontics with current e-mail addresses. Two hundred thirty-two diplomates responded for a response rate of 35%. Calcium hydroxide was found to be the most frequently used intracanal medicament for all cases diagnosed with necrotic pulps. Ibuprofen was the most frequently prescribed medication for pain, and penicillin was the most frequently prescribed antibiotic when an active infection was present. Eighty-two percent of the respondents are still incorporating hand files in some fashion during the cleansing and shaping phase of treatment. Lateral condensation and continuous wave were the most common methods used for obturation. Digital radiography was reported as being used by 72.5% of the respondents, whereas 45.3% reported using the microscope greater than 75% of the patient treatment. Ultrasonics was used by 97.8% of the respondents. It appears from the results that new endodontic technology is currently being used in the endodontic offices of those who responded to the survey.

  16. Shifting currents: Progress, setbacks, and shifts in policy and practice

    Science.gov (United States)

    ,; Dunning, Charles; Robertson, Dale M.

    2016-01-01

    clean water future. More than a decade has passed since our first statewide WOW conversation and the report that captured recommendations from its participants: Waters of Wisconsin: The Future of Our Aquatic Ecosystems and Resources. Drawing from a diverse and growing set of stakeholders from across the state, the Wisconsin Academy initiated a new conversation in 2012 (known as WOW II) to assess progress in regard to our 2003 recommendations. We also sought to review the status of waters in Wisconsin today. The result of this renewed conversation is Shifting Currents: Progress, Setbacks, and Shifts in Policy and Practice. The new report assesses progress in brief, and explores in greater depth the continuing and emerging challenges to water quality, supply, and aquatic ecosystems in Wisconsin.In this report, we first review the context and frameworks for public decision-making about water and then examine some of the root causes—or “drivers”—and ecological stressors that underlie many of the symptoms we see in the form of pollution or ecosystem degradation in Wisconsin. This is followed by a summary of current water issues, many of which had been identified in the 2003 report and remain relevant today. We examine progress since 2003 but also setbacks, and discuss issues that we are likely to continue to face in the coming decades, including controlling agricultural runoff, mitigating climate change and grappling with its effects on the state’s waters, protecting groundwater from bacterial contamination and other pollutants, and preventing groundwater depletion. We also attempt to anticipate issues on the horizon. We offer a deeper look at some particular challenges, such as phosphorus pollution and groundwater contamination. We then consider the current decision-making framework and how it is shaping our capacity to respond to water challenges in Wisconsin. Finally, we offer recommendations and identify opportunities to safeguard Wisconsin’s waters in the

  17. Concierge and Second-Opinion Radiology: Review of Current Practices.

    Science.gov (United States)

    Shaikh, Shehbaz; Bafana, Rounak; Halabi, Safwan S

    2016-01-01

    Radiology's core assets include the production, interpretation, and distribution of quality imaging studies. Second-opinion services and concierge practices in radiology aim to augment traditional services by providing patient-centered and physician-centered care, respectively. Patient centeredness enhances patients' understanding and comfort with their radiology tests and procedures and allows them to make better decisions about their health care. As the fee-for-service paradigm shifts to value-based care models, radiology practices have begun to diversify imaging service delivery and communication to coincide with the American College of Radiology Imaging 3.0 campaign. Physician-centered consultation allows for communication of evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. There are disparate practice models and payment schema for the various second-opinion and concierge practices. This review article explores the current state and payment models of second-opinion and concierge practices in radiology. This review also includes a discussion on the benefits, roadblocks, and ethical issues that surround these novel types of practices. Copyright © 2015 Mosby, Inc. All rights reserved.

  18. Nanocuration workflows: Establishing best practices for identifying, inputting, and sharing data to inform decisions on nanomaterials

    Directory of Open Access Journals (Sweden)

    Christina M. Powers

    2015-09-01

    Full Text Available There is a critical opportunity in the field of nanoscience to compare and integrate information across diverse fields of study through informatics (i.e., nanoinformatics. This paper is one in a series of articles on the data curation process in nanoinformatics (nanocuration. Other articles in this series discuss key aspects of nanocuration (temporal metadata, data completeness, database integration, while the focus of this article is on the nanocuration workflow, or the process of identifying, inputting, and reviewing nanomaterial data in a data repository. In particular, the article discusses: 1 the rationale and importance of a defined workflow in nanocuration, 2 the influence of organizational goals or purpose on the workflow, 3 established workflow practices in other fields, 4 current workflow practices in nanocuration, 5 key challenges for workflows in emerging fields like nanomaterials, 6 examples to make these challenges more tangible, and 7 recommendations to address the identified challenges. Throughout the article, there is an emphasis on illustrating key concepts and current practices in the field. Data on current practices in the field are from a group of stakeholders active in nanocuration. In general, the development of workflows for nanocuration is nascent, with few individuals formally trained in data curation or utilizing available nanocuration resources (e.g., ISA-TAB-Nano. Additional emphasis on the potential benefits of cultivating nanomaterial data via nanocuration processes (e.g., capability to analyze data from across research groups and providing nanocuration resources (e.g., training will likely prove crucial for the wider application of nanocuration workflows in the scientific community.

  19. Gender Perspective to Vedic Education: Current Practices in Nepal

    Directory of Open Access Journals (Sweden)

    Rajendra Raj Timilsina

    2016-10-01

    Full Text Available Vedic civilization has seen changes in its history- from Satya Yug to current Kali Yug. There were equal rights and duties of both men and women at the beginning. Interpretations of Veda, brought out of the Puranas and externalities made the status unequal. Sanatan Dharma, which is still mainstream of Hinduism, has been challenged by reformist Arya Samaj. As a result, there are interpretive differences as well as practices. Such differences can be seen in contemporary Nepal for the last 130 years. Continuing the differences, classicism has been reviving in the education. This revival also commenced with the same dualism. In this qualitative approach of exploration, two different gurukuls of girls have been observed and analyzed from the field for the purpose of exploring the recent practices. The observation was based on respective scriptures as well as experts' interviews. These data have analyzed the confronting practices on gender in Veda and rooted ideas in contemporary Nepal.

  20. Analysis of Current Supplier Relationship Management Practices: A Solution Proposal

    OpenAIRE

    Gomes Campelo Filho, Eulalio

    2009-01-01

    The work contributes with the existing literature by investigating current SRM practices. Based on the research, the author has designed an information system framework, which provides companies with an innovative SRM solution to manage their indirect material purchasing process through an environment that supports companies entire plan-to-order activities, including functionalities such as central data management, spend data management, e-sourcing and the usual e-procurement features.

  1. Remediation in Practicing Physicians: Current and Alternative Conceptualizations.

    Science.gov (United States)

    Bourgeois-Law, Gisèle; Teunissen, Pim W; Regehr, Glenn

    2018-04-24

    Suboptimal performance in practicing physicians is a decades-old problem. The lack of a universally accepted definition of remediation, the paucity of research on best remediation practices, and the ongoing controversy regarding the institutional responsibility for enacting and overseeing this activity suggests that the remediation of physicians is not merely a difficult problem to solve, but a problem that the community does not grapple with meaningfully. Undoubtedly, logistical and political considerations contribute to this state of affairs; however, other underlying conceptual issues may also play a role in the medical profession's difficulties in engaging with the challenges around remediation.Through a review of the medical education and other literatures, the authors examined current conceptualizations of both remediation itself and the individual being remediated, as well as how the culture of medicine influences these conceptions. The authors explored how conceptualizations of remediation and the surrounding culture might affect not only the medical community's ability to support, but also its willingness to engage with physicians in need of remediation.Viewing remediation as a means of supporting practice change-rather than as a means of redressing gaps in knowledge and skill-might be a useful alternative conceptualization, providing a good place to start exploring new avenues of research. However, moving forward will require more than simply a reconceptualizion of remediation; it will also necessitate a change in how the community views its struggling members and a change in the medical culture that currently positions professional autonomy as the foundational premise for individual practice improvement.

  2. Current practice in airway management: A descriptive evaluation.

    Science.gov (United States)

    Kjonegaard, Rebecca; Fields, Willa; King, Major L

    2010-03-01

    Ventilator-associated pneumonia, a common complication of mechanical ventilation, could be reduced if health care workers implemented evidence-based practices that decrease the risk for this complication. To determine current practice and differences in practices between registered nurses and respiratory therapists in managing patients receiving mechanical ventilation. A descriptive comparative design was used. A convenience sample of 41 registered nurses and 25 respiratory therapists who manage critical care patients treated with mechanical ventilation at Sharp Grossmont Hospital, La Mesa, California, completed a survey on suctioning techniques and airway management practices. Descriptive and inferential statistics were used to analyze the data. Significant differences existed between nurses and respiratory therapists for hyperoxygenation before suctioning (P =.03). In the 2 groups, nurses used the ventilator for hyper-oxygenation more often, and respiratory therapists used a bag-valve device more often (P =.03). Respiratory therapists instilled saline (P <.001) and rinsed the closed system with saline after suctioning (P =.003) more often than nurses did. Nurses suctioned oral secretions (P <.001) and the nose of orally intubated patients (P =.01), brushed patients' teeth with a toothbrush (P<.001), and used oral swabs to clean the mouth (P <.001) more frequently than respiratory therapists did. Nurses and respiratory therapists differed significantly in the management of patients receiving mechanical ventilation. To reduce the risk of ventilator-associated pneumonia, both nurses and respiratory therapists must be consistent in using best practices when managing patients treated with mechanical ventilation.

  3. Challenges of implementing fibromyalgia treatment guidelines in current clinical practice.

    Science.gov (United States)

    Arnold, Lesley M; Clauw, Daniel J

    2017-09-01

    The current diagnostic and treatment pathway for patients with fibromyalgia (FM) is lengthy, complex, and characterized by multiple physician visits with an average 2-year wait until diagnosis. It is clear that effective identification and appropriate treatment of FM remain a challenge in current clinical practice. Ideally, FM management involves a multidisciplinary approach with the preferable patient pathway originating in primary care but supported by a range of health care providers, including referral to specialist care when necessary. After the publication of individual clinical studies, high-quality reviews, and meta-analyses, recently published FM treatment guidelines have transitioned from an expert consensus to an evidence-based approach. Evidence-based guidelines provide a framework for ensuring early diagnosis and timely adoption of appropriate treatment. However, for successful outcomes, FM treatments must adopt a more holistic approach, which addresses more than just pain. Impact on the associated symptoms of fatigue and cognitive problems, sleep and mood disturbances, and lowered functional status are also important in judging the success of FM therapy. Recently published guidelines recommend the adoption of a symptom-based approach to guide pharmacologic treatment. Emerging treatment options for FM may be best differentiated on the basis of their effect on comorbid symptoms that are often associated with pain (e.g. sleep disturbance, mood, fatigue). The current review discusses the most recently published Canadian guidelines and the implications of the recent European League Against Rheumatism (EULAR) recommendations, with a focus on the challenges of implementing these guidelines in current clinical practice.

  4. Mentoring and New Teacher Induction in the United States: A Review and Analysis of Current Practices

    Science.gov (United States)

    Bullough, Robert V., Jr.

    2012-01-01

    In this article, current practices were reviewed in mentoring and induction across three large states--New York, Texas, and California--and one small state, Utah. Patterns and trends are described in the United States, program results and evolving views of mentoring are discussed, gaps in the research literature are identified, and the future of…

  5. Regulatory Monitoring of Fortified Foods: Identifying Barriers and Good Practices

    Science.gov (United States)

    Rowe, Laura A; Vossenaar, Marieke; Garrett, Greg S

    2015-01-01

    While fortification of staple foods and condiments has gained enormous global traction, poor performance persists throughout many aspects of implementation, most notably around the critical element of regulatory monitoring, which is essential for ensuring foods meet national fortification standards. Where coverage of fortified foods is high, limited nutritional impact of fortification programs largely exists due to regulatory monitoring that insufficiently identifies and holds producers accountable for underfortified products. Based on quality assurance data from 20 national fortification programs in 12 countries, we estimate that less than half of the samples are adequately fortified against relevant national standards. In this paper, we outline key findings from a literature review, key informant interviews with 11 fortification experts, and semi-quantitative surveys with 39 individuals from regulatory agencies and the food fortification industry in 17 countries on the perceived effectiveness of regulatory monitoring systems and barriers to compliance against national fortification standards. Findings highlight that regulatory agencies and industry disagree on the value that enforcement mechanisms have in ensuring compliance against standards. Perceived political risk of enforcement and poorly resourced inspectorate capacity appear to adversely reinforce each other within an environment of unclear legislation to create a major hurdle for improving overall compliance of fortification programs against national standards. Budget constraints affect the ability of regulatory agencies to create a well-trained inspector cadre and improve the detection and enforcement of non-compliant and underfortified products. Recommendations to improve fortification compliance include improving technical capacity; ensuring sustained leadership, accountability, and funding in both the private and the public sectors; and removing political barriers to ensure consistent detection of

  6. Current Administrative court practice in the procedure of Public Procurement

    Directory of Open Access Journals (Sweden)

    Silvio Čović

    2017-01-01

    Full Text Available Under the current conditions of complex and difficult economic and social circumstances and given the comparative possibilities and economic effects, the system of public procurement which is firstly at a legal level regulated by the Public Procurement Act 8 (Zakon o javnoj nabavi of 2011 (further referred to as: PPA (ZN, is of particular importance for the entire legal, political and economic system of the Republic of Croatia. Public procurement in essence represents contracting the procurement of goods, works or services. The specifities of that system are comprised, above all, of regulation of entering contractual relations between the public and private sector. Therefore, this system in principle must be formal in order to protect equality of competitors in the public procurement procedure and also in the general interest. Appreciating the legal tradition and indigenous particularities, the author’s fundamental aims consisted of providing and analysing administrative court practice in the context of international legal acquis communautaire showing some legal regulation in practice of disputable aspects of the system of public procurement in Croatia and the doubts emerging from current administrative court practice.

  7. 78 FR 24691 - Current Good Manufacturing Practice and Hazard Analysis and Risk-Based Preventive Controls for...

    Science.gov (United States)

    2013-04-26

    ... comments should be identified with the title ``Current Good Manufacturing Practice and Hazard Analysis and..., 114, 117, 120, 123, 129, 179, and 211 [Docket No. FDA-2011-N-0920] RIN 0910-AG36 Current Good Manufacturing Practice and Hazard Analysis and Risk- Based Preventive Controls for Human Food; Extension of...

  8. Bimodal Programming: A Survey of Current Clinical Practice.

    Science.gov (United States)

    Siburt, Hannah W; Holmes, Alice E

    2015-06-01

    The purpose of this study was to determine the current clinical practice in approaches to bimodal programming in the United States. To be specific, if clinicians are recommending bimodal stimulation, who programs the hearing aid in the bimodal condition, and what method is used for programming the hearing aid? An 11-question online survey was created and sent via email to a comprehensive list of cochlear implant programming centers in the United States. The survey was sent to 360 recipients. Respondents in this study represented a diverse group of clinical settings (response rate: 26%). Results indicate little agreement about who programs the hearing aids, when they are programmed, and how they are programmed in the bimodal condition. Analysis of small versus large implant centers indicated small centers are less likely to add a device to the contralateral ear. Although a growing number of cochlear implant recipients choose to wear a hearing aid on the contralateral ear, there is inconsistency in the current clinical approach to bimodal programming. These survey results provide evidence of large variability in the current bimodal programming practices and indicate a need for more structured clinical recommendations and programming approaches.

  9. Cardioversion for atrial fibrillation in current European practice

    DEFF Research Database (Denmark)

    Hernández-Madrid, Antonio; Svendsen, Jesper Hastrup; Lip, Gregory Y.H.

    2013-01-01

    This survey was conducted to provide an insight into the current clinical practice regarding the use of cardioversion for atrial fibrillation (AF) in Europe. Responses were received from 57 centres across Europe, 71.9% of which were university hospitals. For electrical cardioversion, general...... anaesthesia was managed by an anaesthesiologist in 73.9% of centres and by a cardiologist in 37%. In the majority of centres, electrical cardioversion was performed using a biphasic defibrillator (85.1%). Antiarrhythmic drugs were routinely prescribed prior to electrical cardioversion by 54.3% of hospitals...

  10. Individual Performance Management: A Review of Current Practices

    Directory of Open Access Journals (Sweden)

    Ian O’ Boyle

    2013-05-01

    Full Text Available This paper provides a review of current practice in relation to individual performance management systems and process within the traditional business environment. There is a consensus that the role of the individual is central to the overall performance of any organization and how individual performances are managed and evaluated can have significant impacts on overall organizational success. Many organizations employ the traditional performance appraisal in order to monitor and assess individual employee performances. However, new approaches, such as 360-degree feedback have also become commonplace within the business environment. An analysis of each approach including benefits and challenges associated with each process is presented within this paper.

  11. Neuroimaging in refractory epilepsy. Current practice and evolving trends

    International Nuclear Information System (INIS)

    Ramli, N.; Rahmat, K.; Lim, K.S.; Tan, C.T.

    2015-01-01

    Highlights: • Neuroimaging is imperative in diagnostic work up and therapeutic assessment of refractory epilepsy. • Identification of epileptogenic zone on EEG, MRI and functional imaging improves the success of surgery. • High performance MRI greatly enhanced metabolic information and elucidate brain functions. • Optimisation of epilepsy protocols in structural and functional MRI are presented in this article. - Abstract: Identification of the epileptogenic zone is of paramount importance in refractory epilepsy as the success of surgical treatment depends on complete resection of the epileptogenic zone. Imaging plays an important role in the locating and defining anatomic epileptogenic abnormalities in patients with medically refractory epilepsy. The aim of this article is to present an overview of the current MRI sequences used in epilepsy imaging with special emphasis of lesion seen in our practices. Optimisation of epilepsy imaging protocols are addressed and current trends in functional MRI sequences including MR spectroscopy, diffusion tensor imaging and fusion MR with PET and SPECT are discussed

  12. Neuroimaging in refractory epilepsy. Current practice and evolving trends

    Energy Technology Data Exchange (ETDEWEB)

    Ramli, N. [Department of Biomedical Imaging, University Malaya Research Imaging Centre (Malaysia); Rahmat, K., E-mail: katt_xr2000@yahoo.com [Department of Biomedical Imaging, University Malaya Research Imaging Centre (Malaysia); Lim, K.S.; Tan, C.T. [Neurology Unit, Department of Medicine, University Malaya, Kuala Lumpur (Malaysia)

    2015-09-15

    Highlights: • Neuroimaging is imperative in diagnostic work up and therapeutic assessment of refractory epilepsy. • Identification of epileptogenic zone on EEG, MRI and functional imaging improves the success of surgery. • High performance MRI greatly enhanced metabolic information and elucidate brain functions. • Optimisation of epilepsy protocols in structural and functional MRI are presented in this article. - Abstract: Identification of the epileptogenic zone is of paramount importance in refractory epilepsy as the success of surgical treatment depends on complete resection of the epileptogenic zone. Imaging plays an important role in the locating and defining anatomic epileptogenic abnormalities in patients with medically refractory epilepsy. The aim of this article is to present an overview of the current MRI sequences used in epilepsy imaging with special emphasis of lesion seen in our practices. Optimisation of epilepsy imaging protocols are addressed and current trends in functional MRI sequences including MR spectroscopy, diffusion tensor imaging and fusion MR with PET and SPECT are discussed.

  13. Autopsy in Islam and current practice in Arab Muslim countries.

    Science.gov (United States)

    Mohammed, Madadin; Kharoshah, Magdy A

    2014-03-01

    Autopsy, or post-mortem examination, is the dissection of a dead body. It is performed for many reasons. Attitudes toward dead bodies vary with religious beliefs and cultural and geographical backgrounds. We have carried out an extensive literature review to determine the Islamic view and current practice of Autopsy, in at least four Arab countries which published their experiences. Several research articles have studied the history of Islamic Autopsy as well as the current situation and legal debates about it. The overwhelming conclusion is that data is lacking. More must be published from Arabic Muslim countries and more research done to correct misconceptions. We also recommend more application of non-invasive Autopsy. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  14. Extracorporeal membrane oxygenation: current clinical practice, coding, and reimbursement.

    Science.gov (United States)

    Schuerer, Douglas J E; Kolovos, Nikoleta S; Boyd, Kayla V; Coopersmith, Craig M

    2008-07-01

    Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support for patients experiencing both pulmonary and cardiac failure by maintaining oxygenation and perfusion until native organ function is restored. ECMO is used routinely at many specialized hospitals for infants and less commonly for children with respiratory or cardiac failure from a variety of causes. Its usage is more controversial in adults, but select medical centers have reported favorable findings in patients with ARDS and other causes of severe pulmonary failure. ECMO is also rarely used as a rescue therapy in a small subset of adult patients with cardiac failure. This article will review the current uses and techniques of ECMO in the critical care setting as well as the evidence supporting its usage. In addition, current practice management related to coding and reimbursement for this intensive therapy will be discussed.

  15. Pediatric hospitalists: training, current practice, and career goals.

    Science.gov (United States)

    Freed, Gary L; Dunham, Kelly M

    2009-03-01

    To determine the range and frequency of experiences, clinical and nonclinical roles, training, work expectations, and career plans of practicing pediatric hospitalists. Mail survey study of a national sample of 530 pediatric hospitalists of whom 67% (N = 338) were from teaching hospitals, 71% (N = 374) were from children's hospitals, 43% (N = 230) were from freestanding children's hospitals, and 69% (N = 354) were from hospitals with >or=250 beds. The response rate was 84%. The majority (54%; N = 211) had been practicing as hospitalists for at least 3 years. Most reported that the pediatric inpatient unit (94%) and inpatient consultation service (51%) were a part of their regular clinical assignment. Most did not provide service in the normal newborn nursery (58%), subspecialty inpatient service (52%), transports (85%), outpatient clinics (66%), or as part of an emergency response team (53%). Many participated in quality improvement (QI) initiatives (84%) and practice guideline development (81%). This study provides the most comprehensive information available regarding the clinical and nonclinical roles, training, work expectations, and career plans of pediatric hospitalists. However, the field is currently a moving target; there is significant flux in the hospitalist workforce and variation in the roles of these professionals in their clinical and nonclinical work environment. (c) 2009 Society of Hospital Medicine.

  16. Figures in clinical trial reports: current practice & scope for improvement.

    Science.gov (United States)

    Pocock, Stuart J; Travison, Thomas G; Wruck, Lisa M

    2007-11-19

    Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses) and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used.

  17. Figures in clinical trial reports: current practice & scope for improvement

    Directory of Open Access Journals (Sweden)

    Travison Thomas G

    2007-11-01

    Full Text Available Abstract Background Most clinical trial publications include figures, but there is little guidance on what results should be displayed as figures and how. Purpose To evaluate the current use of figures in Trial reports, and to make constructive suggestions for future practice. Methods We surveyed all 77 reports of randomised controlled trials in five general medical journals during November 2006 to January 2007. The numbers and types of figures were determined, and then each Figure was assessed for its style, content, clarity and suitability. As a consequence, guidelines are developed for presenting figures, both in general and for each specific common type of Figure. Results Most trial reports contained one to three figures, mean 2.3 per article. The four main types were flow diagram, Kaplan Meier plot, Forest plot (for subgroup analyses and repeated measures over time: these accounted for 92% of all figures published. For each type of figure there is a considerable diversity of practice in both style and content which we illustrate with selected examples of both good and bad practice. Some pointers on what to do, and what to avoid, are derived from our critical evaluation of these articles' use of figures. Conclusion There is considerable scope for authors to improve their use of figures in clinical trial reports, as regards which figures to choose, their style of presentation and labelling, and their specific content. Particular improvements are needed for the four main types of figures commonly used.

  18. International online survey to assess current practice in equine anaesthesia.

    Science.gov (United States)

    Wohlfender, F D; Doherr, M G; Driessen, B; Hartnack, S; Johnston, G M; Bettschart-Wolfensberger, R

    2015-01-01

    Multicentre Confidential Enquiries into Perioperative Equine Fatalities (CEPEF) have not been conducted since the initial CEPEF Phases 1-3, 20 years ago. To collect data on current practice in equine anaesthesia and to recruit participants for CEPEF-4. Online questionnaire survey. An online questionnaire was prepared and the link distributed internationally to veterinarians possibly performing equine anaesthesia, using emails, posters, flyers and an editorial. The questionnaire included 52 closed, semiclosed and open questions divided into 8 subgroups: demographic data, anaesthetist, anaesthesia management (preoperative, technical equipment, monitoring, drugs, recovery), areas of improvements and risks and motivation for participation in CEPEF-4. Descriptive statistics and Chi-squared tests for comparison of categorical variables were performed. A total of 199 questionnaires were completed by veterinarians from 14 different countries. Of the respondents, 43% worked in private hospitals, 36% in private practices and 21% in university teaching hospitals. In 40 institutions (23%) there was at least one diplomate of the European or American colleges of veterinary anaesthesia and analgesia on staff. Individual respondents reported routinely employ the following anaesthesia monitoring modalities: electrocardiography (80%), invasive arterial blood pressures (70%), pulse oximetry (60%), capnography (55%), arterial blood gases (47%), composition of inspired and expired gases (45%) and body temperature (35%). Drugs administered frequently or routinely as part of a standard protocol were: acepromazine (44%), xylazine (68%), butorphanol (59%), ketamine (96%), diazepam (83%), isoflurane (76%), dobutamine (46%), and, as a nonsteroidal anti-inflammatory drug, phenylbutazone (73%) or flunixin meglumine (66%). Recovery was routinely assisted by 40%. The main factors perceived by the respondents to affect outcome of equine anaesthesia were the preoperative health status of the

  19. Current neurotrauma treatment practice in secondary medical service centers

    International Nuclear Information System (INIS)

    Suehiro, Eiichi; Yoshino, Hiroko; Koizumi, Hiroyasu; Yoneda, Hiroshi; Suzuki, Michiyasu

    2011-01-01

    Despite neurotrauma treatment practices comprising a significant amount of neurosurgical work for secondary medical service centers, little attention has been placed on neurotrauma cases and evaluation of current neurotrauma treatment practices is limited. Therefore we investigated current neurotrauma practices in our hospital located in a Japanese suburban city. We analyzed 439 patients with traumatic brain injury (TBI) admitted to our hospital between April 2004 and October 2010. Patients were divided into three groups based on the Glasgow Coma Scale (GCS) score on admission: mild TBI (GCS 14-15) in 252 patients (57.4%), moderate TBI (GCS 9-13) in 116 patients (26.4%), and severe TBI (GCS 3-8) in 71 patients (16.2%). Age, gender, alcohol consumption, cause of injury, cranial CT findings, neurosurgical procedure, length of hospital stay, and clinical outcome were analyzed. The average age of the patients was 59.2 years old. Male patients comprised 65%. Alcohol consumption was reported in 81 cases (18.5%), most of them with moderate TBI. Fall (208 cases, 47.4%) was the most frequent cause of injury, followed by traffic accident (115 cases, 26.2%) and high fall (73 cases, 16.6%). Acute subdural hematoma (174 cases, 39.6%) was most frequently seen in cranial CT findings on admission, which significantly increased with severity. A neurosurgical procedure was performed for 70 cases (15.9%), of which 15 (6.0%) were mild TBI and 18 (15.5%) were moderate TBI. The average hospital stay was 20.8 days, which significantly increased with severity. The overall rate of favorable outcome was 82.7%, and mortality was 8.2%; outcome deteriorated with severity. Some mild and moderate TBI cases had deteriorated and required surgery or resulted in death. These findings suggest that cautious treatment is necessary even in mild to moderate TBI cases which are often encountered in secondary medical service centers. (author)

  20. Self-Assessment in Librarianship: Current Practices and Future Possibilities

    Directory of Open Access Journals (Sweden)

    Ania Dymarz

    2015-07-01

    Full Text Available The authors of this qualitative study set out to investigate self-assessment practices within the library profession. The researchers conducted semi-structured interviews with a purposeful sample of nine librarians coming from a range of library settings and possessing a diversity of library experience. Interviews were then transcribed and coded in NVIVO to identify emergent themes. This paper details some of the results of that study, highlighting motivations, limitations, and strategies with regard to self-assessment. The findings present a summary of a range of approaches to the practice of assessment as reported by the interviewees. One area of possible growth for our profession, as highlighted by the findings, is in the development of peer networks as a support for the individual practice of self-assessment. While the results of this small case study cannot be generalized, the authors hope these preliminary findings can open up the conversation around self-assessment both for individual librarians and for those librarians and managers working to shape their workplace culture.

  1. Soil Quality Impacts of Current South American Agricultural Practices

    Directory of Open Access Journals (Sweden)

    Ana B. Wingeyer

    2015-02-01

    Full Text Available Increasing global demand for oil seeds and cereals during the past 50 years has caused an expansion in the cultivated areas and resulted in major soil management and crop production changes throughout Bolivia, Paraguay, Uruguay, Argentina and southern Brazil. Unprecedented adoption of no-tillage as well as improved soil fertility and plant genetics have increased yields, but the use of purchased inputs, monocropping i.e., continuous soybean (Glycine max (L. Merr., and marginal land cultivation have also increased. These changes have significantly altered the global food and feed supply role of these countries, but they have also resulted in various levels of soil degradation through wind and water erosion, soil compaction, soil organic matter (SOM depletion, and nutrient losses. Sustainability is dependent upon local interactions between soil, climate, landscape characteristics, and production systems. This review examines the region’s current soil and crop conditions and summarizes several research studies designed to reduce or prevent soil degradation. Although the region has both environmental and soil resources that can sustain current agricultural production levels, increasing population, greater urbanization, and more available income will continue to increase the pressure on South American croplands. A better understanding of regional soil differences and quantifying potential consequences of current production practices on various soil resources is needed to ensure that scientific, educational, and regulatory programs result in land management recommendations that support intensification of agriculture without additional soil degradation or other unintended environmental consequences.

  2. Identifying Student Competencies in Macro Practice: Articulating the Practice Wisdom of Field Instructors

    Science.gov (United States)

    Regehr, Cheryl; Bogo, Marion; Donovan, Kirsten; Lim, April; Anstice, Susan

    2012-01-01

    Although a growing literature examines competencies in clinical practice, competencies of students in macro social work practice have received comparatively little attention. A grounded-theory methodology was used to elicit field instructor views of student competencies in community, organization, and policy contexts. Competencies described by…

  3. Current Practices in Defining Seismic Input for Nuclear Facilities

    International Nuclear Information System (INIS)

    2015-05-01

    This report has been written in the framework of seismic subgroup of the OECD/NEA CSNI Working Group on Integrity and Ageing of Components and Structures (WGIAGE) to provide a brief review of current practices regarding the definition of the seismic input for design and reevaluation of nuclear power plants. It is taken for granted that, prior to conducting the seismic design of a nuclear facility, a seismic hazard analysis (SHA) has been conducted for the site where the facility is located. This provides some reference motions for defining those that will later be used as input for the dynamic analyses of the facility. The objective of the report is to clarify the current practices in various OECD Member States for defining the seismic input to be used in the dynamic calculations of NPPs, once the SHA results are already at hand. Current practices have been summarized for Canada, Czech Republic, Finland, France, Germany, Japan, Slovenia, South Korea, Spain, Sweden, The Netherlands, United Kingdom and United States. The main findings of the report are: a) The approaches followed by the regulatory bodies of OECD Member States differ substantially, certainly in relation with the consideration of site effects, but also in the probability level of the event that a nuclear facility should be required to withstand. b) In many countries a probabilistic approach is adopted for the design, in some cases combined with a deterministic one; in other cases, like France, Japan or South Korea, a deterministic approach is followed. c) The US and Japan have the more complete guidelines in relation with site effects. The former provide specific approaches for definition of the seismic input. The latter clearly recognizes the need to propagate the bedrock motion to foundation level, thereby introducing the site effect in some way. d) The definition of bedrock is very heterogeneous in the various countries, although this should not constitute a serious problem if the starting

  4. Trends in Mediation Analysis in Nursing Research: Improving Current Practice.

    Science.gov (United States)

    Hertzog, Melody

    2018-06-01

    The purpose of this study was to describe common approaches used by nursing researchers to test mediation models and evaluate them within the context of current methodological advances. MEDLINE was used to locate studies testing a mediation model and published from 2004 to 2015 in nursing journals. Design (experimental/correlation, cross-sectional/longitudinal, model complexity) and analysis (method, inclusion of test of mediated effect, violations/discussion of assumptions, sample size/power) characteristics were coded for 456 studies. General trends were identified using descriptive statistics. Consistent with findings of reviews in other disciplines, evidence was found that nursing researchers may not be aware of the strong assumptions and serious limitations of their analyses. Suggestions for strengthening the rigor of such studies and an overview of current methods for testing more complex models, including longitudinal mediation processes, are presented.

  5. Identifying and preparing the next generation of part-time clinical teachers from dental practice.

    Science.gov (United States)

    Radford, D R; Hellyer, P; Meakin, N; Jones, K A

    2015-10-09

    Part-time general dental practitioners (GDPs) and dental care professionals (DCPs) working in practice are being increasingly utilised to deliver undergraduate clinical dental education to both dental and hygiene/therapy students. As such, there is a need for appropriate recruitment processes and ongoing staff development in the different and complex role of the clinical teacher. Recently a group of experienced dental practitioners, making a journey from GDP to part-time clinical teacher, identified common themes, experiences, challenges and realisations. These were: 'what is clinical dental education?'; 'me as a clinical teacher'; and 'specific teaching issues'. The themes highlighted the complexity of dental education and the different environment of the teaching clinic from general practice. Some of the themes identified could be a starting point for the induction process to facilitate an easier transition from experienced GDP to clinical teacher. With the current demands from both students and patients alike, the 'three way dynamic of patient, student and teacher' needs to be supported if dental schools are to attract and develop the highest quality clinical teachers. It is of critical importance to give an exceptional experience to students in their clinical education as well as to patients in terms of excellent and appropriate treatment. The challenge for deans and directors of education is to find the resources to properly fund teacher recruitment, induction and the development of part-time GDPs in order to produce the expert teachers of tomorrow.

  6. Typography and layout of technical reports - Survey of current practices

    Science.gov (United States)

    Pinelli, T. E.; Cordle, V. M.; Mccullough, R.

    1985-01-01

    As part of a review of the NASA Langley Research Center scientific and technical information program, 50 technical reports from industry, research institutions, and government agencies were systematically examined and analyzed to determine current usage and practice in regard to (1) typography, including composition method, type style, type size, and margin treatment; (2) graphic design, including layout and imposition of material on the page; and (3) physical media, including paper, ink, and binding methods. The results indicate that approximately 50 percent of the reports were typeset, 70 percent used Roman (serif) type, 80 percent used 10- or 11-point type for text, 60 percent used a ragged right-hand margin, slightly more than half used paragraph indentation, 75 percent used a single-column layout, 65 percent had one or more figures or tables placed perpendicular to (not aligned with) the text, and perfect binding was the most frequently used binding method.

  7. Local air quality management: some evidence of current practices

    Energy Technology Data Exchange (ETDEWEB)

    Beattie, Clare; Newton, Alex; Longhurst, Jim [University of the West of England, Air Quality Research Group, Bristol (United Kingdom)

    1998-12-01

    The recent legislative changes, notably the Environment Act 1995 and resultant National Air Quality Strategy have brought new powers and obligations to local authorities to reach specified air quality standards and objectives. Initially this will involve local authorities carrying out a review and assessment of air quality in their locality by December 1999. This paper will outline a project currently being undertaken within the University of the West of England investigating how this legislation is being put into practice and present the results from a nation-wide questionnaire survey of environmental health officers. The study found that local authorities are still at an early stage of the process. It seems probable that one possible barrier to the implementation of Air Quality Management will be communication and cooperation within local authorities. (Author)

  8. Current best practice in the management of Turner syndrome

    Science.gov (United States)

    Shankar, Roopa Kanakatti; Backeljauw, Philippe F.

    2017-01-01

    Turner syndrome (TS) is characterized by partial or complete loss of the second X-chromosome in phenotypic females resulting in a constellation of clinical findings that may include lymphedema, cardiac anomalies, short stature, primary ovarian failure and neurocognitive difficulties. Optimizing health care delivery is important to enable these individuals achieve their full potential. We review the current best practice management recommendations for individuals with TS focusing on the latest consensus opinion in regard to genetic diagnosis, treatment of short stature, estrogen supplementation, addressing psychosocial issues, as well screening for other comorbidities. A multidisciplinary approach and a well-planned transition to adult follow-up care will improve health care delivery significantly for this population. PMID:29344338

  9. Healthcare waste management: current practices in selected healthcare facilities, Botswana.

    Science.gov (United States)

    Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

    2008-01-01

    Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

  10. Baby walkers--health visitors' current practice, attitudes and knowledge.

    Science.gov (United States)

    Kendrick, Denise; Illingworth, Rachel; Hapgood, Rhydian; Woods, Amanda J; Collier, Jacqueline

    2003-09-01

    Baby walkers are a commonly used item of nursery equipment. Between 12% and 50% of parents whose infant uses a walker report that their child has suffered a walker-related injury. Health visitors' knowledge, attitudes and practice with regard to walkers and related health education has not been explored so far. The aim of the study was to describe health visitors' knowledge of walkers and walker-related injuries, their attitudes towards walkers and current practice with regard to walker health education, and to examine the relationship between knowledge and attitudes and knowledge and practice. A survey was carried out with 64 health visitors prior to participation in a randomized controlled trial assessing the effectiveness of an educational package in reducing baby walker use. The response rate was 95%. Half of the health visitors always discussed walkers postnatally, most frequently at the 6-9 month check. Most did not usually discuss the frequency of walker-related injuries. Most had negative attitudes towards walkers, but believed that parents hold positive attitudes to them and that it is hard to persuade parents not to use them. Health visitors had a limited knowledge of walker use and walker-related injuries. Those giving advice on walkers most often had higher knowledge scores than those giving advice less often (P = 0.03). Those with higher knowledge scores held more negative attitudes towards walkers (rs = 0.29, P = 0.023) and believed parents to have more positive attitudes towards walkers (rs = -0.49, P negotiating alternatives to their use. The provision of audio-visual aids for discussing walkers might also be helpful.

  11. Emergency room management of ureteral calculi: current practices.

    Science.gov (United States)

    Phillips, Elizabeth; Kieley, Sam; Johnson, Elizabeth B; Monga, Manoj

    2009-06-01

    To evaluate current practice patterns in U.S. emergency departments (EDs) for the diagnosis, treatment, and counseling of patients with ureteral calculi. Hospital-based ED physicians were invited by e-mail to participate in a Survey-Monkey survey. E-mails were delivered in March 2008 by Direct Medical Data using a listserv provided by the American Medical Association. Of the e-mails sent, 173 e-mails were opened, and 135 physicians responded. Physicians were compensated with a $10 Amazon.com gift card. Ninety percent of ED physicians use noncontrast CT as their initial imaging modality, and 63% use alpha-blockers for medical expulsive therapy. Only 13% of evaluated EDs have guidelines for the management of renal colic, and only 58% of these guidelines that recommend the use of an alpha-blocker. Alpha-blocker use was more common with physicians who have been practicing fewer than 5 years (81%) compared with those with more than 10 years of experience (56%). The majority of physicians used ketorolac and morphine to achieve effective analgesia. Although the average responses concerning the chance of spontaneous stone passage for stones 4 mm (44%) were close to evidence-based values, great variation in the answers was noted (standard deviations: 12% and 22%, respectively). Indeed, 38% of respondents stated that stones 95% chance of passage. Twenty-eight percent of ED physicians would arrange follow-up with a primary care physician, while the remainder would arrange follow-up with a urologist. This study establishes a need for educational opportunities for ED physicians in the management of renal colic. The development of collaborative practice guidelines between urology and emergency medicine associations may be warranted.

  12. Renal biopsies in children: current practice and audit of outcomes.

    Science.gov (United States)

    Hussain, Farida; Mallik, Meeta; Marks, Stephen D; Watson, Alan R

    2010-02-01

    There is considerable variation in the way that children are prepared for and the techniques employed in a renal biopsy. There was national agreement between UK paediatric renal centres to review current practice and audit outcomes An initial questionnaire survey was undertaken and a 12-month prospective audit performed of renal biopsies against agreed standards for the number of needle passes, adequacy of biopsy material and complication rates. Eleven of 13 centres participated. Information leaflets are sent pre-biopsy in five centres with only one using play preparation. Six of 11 routinely perform biopsies as day-case (DC) procedures and 6 use general anaesthesia (GA). Real-time ultrasound is the favoured method in eight centres. Biopsies are performed by nephrologists only in four centres, nephrologists with radiologists in five and radiology alone in two. Of 531 biopsies (352 native), 31% were performed as a DC with 49% being done under GA. The standard for the number of passes of native kidneys (95%). The major complication rate was higher than the standard of practice with limited use of preparation materials and DC procedures. The results have stimulated constructive debate about preparation and indications for biopsy and training issues. The audit enables centres and individuals to monitor performance.

  13. Current nursing practice by hospital-based stoma specialist nurses.

    Science.gov (United States)

    Burch, Jennie

    Nurses frequently care for patients who have stomas. A common complication is sore peristomal skin (skin around the stoma). The study aim was to answer the research question: what is the current nursing practice for peristomal skin problems among UK stoma specialist nurses? The question was explored through investigation of descriptions, treatments and opinions of peristomal skin problems. Results were examined to ascertain if practice reflects the literature and if care was evidence-based. A questionnaire was posted in September 2009 to the stoma care nurses in all UK NHS hospitals (n=596). The proportion of completed or partially completed questionnaires was 15% (89 of 596). Most of the responding nurses held a stoma-related qualification (86%), a degree (55%) and had specialised in stoma care for over 5 years (67%). Respondents used erythema to describe sore skin (80%). Stoma powder (98%) and convex appliances (98%) were the most commonly used treatments. The most common cause of sore skin was appliance leakage (61%). The study population was deemed suitably qualified and experienced to answer the research question. Many responses were reflected in the literature (predominantly opinion articles), reflecting a degree of reliability and validity. It could be concluded that stoma specialist nurses can accurately assess and use stoma accessories to treat sore skin, but due to the paucity of research, the care cannot be defined as evidence-based. More research is needed to determine universally accepted definitions and treatments for sore peristomal skin.

  14. Current practices and options for confinement of uranium mill tailings

    International Nuclear Information System (INIS)

    1981-01-01

    At the United Nations Conference on the Human Environment, which took place in Stockholm from 4 to 6 June 1972, national governments were asked to explore, with the International Atomic Energy Agency and other appropriate international organizations, international co-operation on radioactive waste matters including those of mining and tailings disposal. Since that time the IAEA has been active in the field of uranium and thorium mill tailings management. As part of this activity, the present report describes current practices and options for confinement of uranium mill tailings. It is addressed to technical and administrative personnel who are involved in planning and implementing national and industrial programmes on the management of such tailings. In 1974 and 1975 the IAEA convened meetings of experts to review matters of interest and importance in the management of uranium and thorium mine and mill tailings. These activities led to the publication in 1976 of Management of Wastes from the Mining and Milling of Uranium and Thorium Ores, a Code of Practice and Guide to the Code, IAEA Safety Series No. 44. As a continuation of this activity, the IAEA is here dealing more specifically with the design and siting considerations for the management of uranium mill tailings

  15. Cost estimation for decommissioning: a review of current practice

    International Nuclear Information System (INIS)

    O'Sullivan, P.; Pescatore, C.

    2009-01-01

    inventory, decontamination and waste disposal. Several countries look for cost reduction possibilities through waste minimization processes. Consideration should be given to developing upgraded decommissioning management systems to deal with latest developments, data quality, completeness and safety, while offering flexibility in data processing and cost calculations. Regular interaction between system developers and users is necessary to develop the inventory and maintain user friendliness. Current good practices include the use of a standardised list of decommissioning activities, a strong quality-assurance programme, use of a dedicated decommissioning core group during the planning phase of decommissioning, and involvement of regulators and stakeholders in the drafting of decommissioning plans

  16. Postoperative electrolyte management: Current practice patterns of surgeons and residents.

    Science.gov (United States)

    Angarita, Fernando A; Dueck, Andrew D; Azouz, Solomon M

    2015-07-01

    Managing postoperative electrolyte imbalances often is driven by dogma. To identify areas of improvement, we assessed the practice pattern of postoperative electrolyte management among surgeons and residents. An online survey was distributed among attending surgeons and surgical residents at the University of Toronto. The survey was designed according to a systematic approach for formulating self-administered questionnaires. Questions addressed workload, decision making in hypothetical clinical scenarios, and improvement strategies. Of 232 surveys distributed, 156 were completed (response rate: 67%). The majority stated that junior residents were responsible for managing electrolytes at 13 University of Toronto-affiliated hospitals. Supervision was carried out predominately by senior residents (75%). Thirteen percent reported management went unsupervised. Approximately 59% of residents were unaware how often attending surgeons assessed patients' electrolytes. Despite the majority of residents (53.7%) reporting they were never given tools or trained in electrolyte replacement, they considered themselves moderately or extremely confident. The management of hypothetical clinical scenarios differed between residents and attending surgeons. The majority (50.5%) of respondents considered that an electrolyte replacement protocol is the most appropriate improvement strategy. Electrolyte replacement represents an important component of surgeons' workload. Despite reporting that formal training in electrolyte management is limited, residents consider themselves competent; however, their practice is highly variable and often differs from pharmacologic-directed recommendations. Optimizing how postoperative electrolytes are managed in surgical wards requires building a framework that improves knowledge, training, and limits unnecessary interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Is dosimetry still a necessity in current dental practice?

    International Nuclear Information System (INIS)

    Reddy, S S; Rakesh, N; Clint, Joseph Ben; Sharma, Shivani; Chauhan, Pallavi

    2015-01-01

    Today, dentists have a wide range of imaging modalities to choose from, the film based techniques, digital techniques, and the recent introduction of 3D volumetric or cone beam computed tomography (CBCT). The inherent design features of the new generation dental x-ray equipment has significantly improved over the years with no evidence of substandard x-ray units in operation. In dental facilities radiological workload is comparatively low, newer radiation equipments and accessories follow safety guidelines and employ better radiation protection measures for the patient and the operator. Dentists’ knowledge and expertise in radiation protection measures is good, enabling them to carry out riskfree radiation procedures in their practice. Therefore, the present study is aimed at assessing the need for dosimeters in current dental scenario.‘Is there currently a significant risk from dental radiography to merit the use of personal dosimetery in dental practice.’Dental health professionals (Oral radiologists) and radiographic assistants of fourteen dental colleges in Karnataka state participated in this questionnaire study. The questionnaire consisted of the following questions—the make, type, year of manufacture of radiographic machines used in their setup, number of radiographs made per day in the institution, type of receptors used, number of personnel at risk for radiation exposure, radiation protection measures used, regular monitoring by personal dosimeters, equivalent dosage readings for the past 12 months and whether the reading of thermoluminescent dosimeters (TLD) for any personnel had exceeded the recommended exposure value in the last 3 years.Dosimetry records of the radiology staff in the last three years shows doses no more than 1.50 mSv per year. The various institutions’ dose (person mSv) was in the range of 3.70 mSv–3.90 mSv.Personal monitoring for Dentists can be omitted in the dental colleges since the estimated dose of oral radiologists

  18. Prevention of healthcare-associated infections in general practice: Current practice and drivers for change in a French study

    Directory of Open Access Journals (Sweden)

    M Gignon

    2012-01-01

    Full Text Available Purpose: The fight against Healthcare-associated infections is a public health priority and a major challenge for the safety and quality of care. The objective was to assess hygiene in general practitioners′ (GPs′ office and identify barriers to and drivers for better practice. Materials and Methods: We performed a cross-sectional study in which a questionnaire was sent to a randomly selected, representative sample of 800 GPs. We used a self-administered questionnaire. The first part assessed current practice and the second part focused on barriers and motivating factors for better practice. We performed a descriptive statistical analysis of the responses to closed questions and a qualitative analysis of the responses to open-ended questions. Results: Only a third of the GPs were aware of the current guidelines. Disposable equipment was used by 31% of the GPs. For the remainder, only 38% complied with the recommended procedures for sterilisation or disinfection. Seventy-two percent of the GPs washed their hands between consultations in the office. A significant minority of physicians disregarded the guidelines by never wearing gloves to perform sutures (11%, treat wounds (10%, fit intrauterine devices (18% or perform injections (18%. The main barriers to good practice were the high cost of modifications and lack of time/space. Two third of the GPs did not intend to change their practices. The drivers for change were pressure from patients (4.8 on a scale of 1 to 7, inspection by the health authorities (4.8 and the fear of legal action (4.4. Conclusions: Our results show that there are significant differences between current practice and laid-down professional guidelines. Policies for improvement of hygiene must take into account barriers and motivating factors.

  19. Power Testing in Basketball: Current Practice and Future Recommendations.

    Science.gov (United States)

    Wen, Neal; Dalbo, Vincent J; Burgos, Bill; Pyne, David B; Scanlan, Aaron T

    2018-02-01

    Numerous foundational movements performed during basketball are predicated on underlying power-related attributes, including speed, change-of-direction, and jumping. Accordingly, fitness testing batteries for basketball have incorporated an assortment of linear speed tests, change-of-direction tests, and jump tests. However, due to the wide variety of testing options it is difficult for basketball practitioners to select appropriate testing protocols for the assessment of power-related attributes. As a result, there is a need to review the relevant literature to identify game-specific, power-related attributes important in basketball and the most appropriate tests available to assess power-related attributes for basketball practitioners. Therefore, the aims of this review were to: (1) identify essential power-related attributes important in basketball; (2) discuss the suitability of common and novel power-related tests; and (3) provide recommendations for future research and best practice approaches for basketball coaching staff. In this review, we propose a series of novel tests that are more targeted and specific to basketball movements including: (1) 5-m and 10-m linear sprints, (2) Modified Agility T-Test, (3) Change-of-Direction Deficit, (4) lateral bound, (5) Sargent jump, (6) one-step jump, and (7) isometric midthigh pull test. Improved testing of power-related attributes should enable basketball practitioners to develop targeted training plans for enhancing player performance.

  20. Child obesity prevention in primary health care: investigating practice nurse roles, attitudes and current practices.

    Science.gov (United States)

    Robinson, Alison; Denney-Wilson, Elizabeth; Laws, Rachel; Harris, Mark

    2013-04-01

    Overweight and obesity affects approximately 20% of Australian pre-schoolers. The general practice nurse (PN) workforce has increased in recent years; however, little is known of PN capacity and potential to provide routine advice for the prevention of child obesity. This mixed methods pilot study aims to explore the current practices, attitudes, confidence and training needs of Australian PNs surrounding child obesity prevention in the general practice setting. PNs from three Divisions of General Practice in New South Wales were invited to complete a questionnaire investigating PN roles, attitudes and practices in preventive care with a focus on child obesity. A total of 59 questionnaires were returned (response rate 22%). Semi-structured qualitative interviews were also conducted with a subsample of PNs (n = 10). Questionnaire respondent demographics were similar to that of national PN data. PNs described preventive work as enjoyable despite some perceived barriers including lack of confidence. Number of years working in general practice did not appear to strongly influence nurses' perceived barriers. Seventy per cent of PNs were interested in being more involved in conducting child health checks in practice, and 85% expressed an interest in taking part in child obesity prevention training. Findings from this pilot study suggest that PNs are interested in prevention of child obesity despite barriers to practice and low confidence levels. More research is needed to determine the effect of training on PN confidence and behaviours in providing routine healthy life-style messages for the prevention of child obesity. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  1. Reporting Multiple Individual Injuries in Studies of Team Ball Sports: A Systematic Review of Current Practice

    OpenAIRE

    Fortington, Lauren V; van der Worp, Henk; van den Akker-Scheek, Inge; Finch, Caroline F

    2017-01-01

    Background To identify and prioritise targets for injury prevention efforts, injury incidence studies are widely reported. The accuracy and consistency in calculation and reporting of injury incidence is crucial. Many individuals experience more than one injury but multiple injuries are not consistently reported in sport injury incidence studies. Objective The aim of this systematic review was to evaluate current practice of how multiple injuries within individuals have been defined and repor...

  2. Identifying the factors influencing practice variation in thrombosis medicine: A qualitative content analysis of published practice-pattern surveys.

    Science.gov (United States)

    Skeith, Leslie; Gonsalves, Carol

    2017-11-01

    Practice variation, the differences in clinical management between physicians, is one reason why patient outcomes may differ. Identifying factors that contribute to practice variation in areas of clinical uncertainty or equipoise may have implications for understanding and improving patient care. To discern what factors may influence practice variation, we completed a qualitative content analysis of all practice-pattern surveys in thrombosis medicine in the last 10years. Out of 2117 articles screened using a systematic search strategy, 33 practice-pattern surveys met eligibility criteria. Themes were identified using constant comparative analysis of qualitative data. Practice variation was noted in all 33 practice-pattern surveys. Contributing factors to variation included lack of available evidence, lack of clear and specific guideline recommendations, past experience, patient context, institutional culture and the perceived risk and benefit of a particular treatment. Additional themes highlight the value placed on expertise in challenging clinical scenarios, the complexity of practice variation and the value placed on minimizing practice variation. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Pharmacovigilance in oncology: evaluation of current practice and future perspectives.

    Science.gov (United States)

    Baldo, Paolo; De Paoli, Paolo

    2014-10-01

    Pharmacovigilance (PV), or drug safety monitoring, aims to improve patient safety through the detection and management of drug-related adverse reactions. It is implemented both by spontaneous reporting of adverse drug reactions (ADRs) and by careful detection of signals suggestive of drug toxicity. PV is an important clinical topic in clinical practice and pharmacotherapy, assuring the maintenance of a safe risk/benefit ratio throughout the commercial life cycle of a drug. We conducted a structured literature search on PubMed, Scopus, Cinahl and the Cochrane Library. We also performed manual searches in international databases of ADR individual reports to outline a structured profile on the topic. Our goal was to review key elements that affect safety monitoring of cancer drugs and their appropriate use, highlighting the strengths and weaknesses of PV in oncology. This paper provides an understanding of the methodologies used by PV in current clinical practice and particularly in cancer drug therapy; a focus upon reporting of ADRs by health professionals and patients; and a focus upon methods used by PV to detect new signals of risk/harm related to medicines utilization. To our knowledge, few articles focus upon the importance of PV and post-marketing surveillance of cancer drug therapies. Structured management of spontaneous reports of ADRs and data collection is essential to monitoring the safe use of drugs in this field in which pharmacotherapy is affected by high incidence of drug-related complications and by a narrow benefit/risk ratio. © 2014 John Wiley & Sons, Ltd.

  4. Survey on current practices for neurological prognostication after cardiac arrest.

    Science.gov (United States)

    Friberg, Hans; Cronberg, Tobias; Dünser, Martin W; Duranteau, Jacques; Horn, Janneke; Oddo, Mauro

    2015-05-01

    To investigate current practices and timing of neurological prognostication in comatose cardiac arrest patients. An anonymous questionnaire was distributed to the 8000 members of the European Society of Intensive Care Medicine during September and October 2012. The survey had 27 questions divided into three categories: background data, clinical data, decision-making and consequences. A total of 1025 respondents (13%) answered the survey with complete forms in more than 90%. Twenty per cent of respondents practiced outside of Europe. Overall, 22% answered that they had national recommendations, with the highest percentage in the Netherlands (>80%). Eighty-nine per cent used induced hypothermia (32-34 °C) for comatose cardiac arrest patients, while 11% did not. Twenty per cent had separate prognostication protocols for hypothermia patients. Seventy-nine per cent recognized that neurological examination alone is not enough to predict outcome and a similar number (76%) used additional methods. Intermittent electroencephalography (EEG), brain computed tomography (CT) scan and evoked potentials (EP) were considered most useful. Poor prognosis was defined as cerebral performance category (CPC) 3-5 (58%) or CPC 4-5 (39%) or other (3%). When prognosis was considered poor, 73% would actively withdraw intensive care while 20% would not and 7% were uncertain. National recommendations for neurological prognostication after cardiac arrest are uncommon and only one physician out of five uses a separate protocol for hypothermia treated patients. A neurological examination alone was considered insufficient to predict outcome in comatose patients and most respondents advocated a multimodal approach: EEG, brain CT and EP were considered most useful. Uncertainty regarding neurological prognostication and decisions on level of care was substantial. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Current UK practices in the management of subacromial impingement

    Science.gov (United States)

    Drury, Colin; Tait, Gavin R

    2015-01-01

    Background Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. Methods BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Results Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Conclusions Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections. PMID:27582972

  6. Postoperative delirium in elderly citizens and current practice

    Directory of Open Access Journals (Sweden)

    Siddareddygari Velayudha Reddy

    2017-01-01

    Full Text Available Postoperative delirium (POD represents an acute brain dysfunction in the postsurgical period. Perioperative physicians caring for the older adults are familiar with the care of dysfunction of organs such as lungs, heart, liver, or kidney in the perioperative setting, but they are less familiar with management of brain dysfunction. As early detection and prompt treatment of inciting factors are utmost important to prevent or minimize the deleterious outcomes of delirium. The purpose of this review is to prepare perioperative physicians with a set of current clinical practice recommendations to provide optimal perioperative care of older adults, with a special focus on specific perioperative interventions that have been shown to prevent POD. On literature search in EMBASE, CINAHL, and PUBMED between January 2000 and September 2015 using search words delirium, POD, acute postoperative confusion, and brain dysfunction resulted in 9710 articles. Among them, 73 articles were chosen for review, in addition, National Institute for Health and Clinical Excellence guidelines, American Geriatric Society guidelines, hospital elderly life program-confusion assessment method training manual, New York geriatric nursing protocols, World Health Organization's International Classification of Diseases, 10th Revision classification of mental disorders, Food and Drug Administration requests boxed warnings on older class of antipsychotic drugs 2008 and delirium in Miller's text book of anesthesia were reviewed and relevant information presented in this article.

  7. Current safety practices in nano-research laboratories in China.

    Science.gov (United States)

    Zhang, Can; Zhang, Jing; Wang, Guoyu

    2014-06-01

    China has become a key player in the global nanotechnology field, however, no surveys have specifically examined safety practices in the Chinese nano-laboratories in depth. This study reports results of a survey of 300 professionals who work in research laboratories that handle nanomaterials in China. We recruited participants at three major nano-research laboratories (which carry out research in diverse fields such as chemistry, material science, and biology) and the nano-chemistry session of the national meeting of the Chinese Chemical Society. Results show that almost all nano-research laboratories surveyed had general safety regulations, whereas less than one third of respondents reported having nanospecific safety rules. General safety measures were in place in most surveyed nano-research laboratories, while nanospecific protective measures existed or were implemented less frequently. Several factors reported from the scientific literature including nanotoxicology knowledge gaps, technical limitations on estimating nano-exposure, and the lack of nano-occupational safety legislation may contribute to the current state of affairs. With these factors in mind and embracing the precautionary principle, we suggest strengthening or providing nanosafety training (including raising risk awareness) and establishing nanosafety guidelines in China, to better protect personnel in the nano-workplace.

  8. Current Continuing Professional Education Practice among Malaysian Nurses

    Directory of Open Access Journals (Sweden)

    Mei Chan Chong

    2014-01-01

    Full Text Available Nurses need to participate in CPE to update their knowledge and increase their competencies. This research was carried out to explore their current practice and the future general needs for CPE. This cross-sectional descriptive study involved registered nurses from government hospitals and health clinics from Peninsular Malaysia. Multistage cluster sampling was used to recruit 1000 nurses from four states of Malaysia. Self-explanatory questionnaires were used to collect the data, which were analyzed using SPSS version 16. Seven hundred and ninety-two nurses participated in this survey. Only 80% (562 of the nurses had engaged in CPE activities during the past 12 months. All attendance for the various activities was below 50%. Workshops were the most popular CPE activity (345, 43.6% and tertiary education was the most unpopular activity (10, 1.3%. The respondents did perceive the importance of future CPE activities for career development. Mandatory continuing professional education (MCPE is a key measure to ensure that nurses upgrade their knowledge and skills; however, it is recommended that policy makers and nurse leaders in the continuing professional development unit of health service facilities plan CPE activities to meet registered nurses’ (RNs needs and not simply organizational requirements.

  9. Current UK practices in the management of subacromial impingement.

    Science.gov (United States)

    Bryceland, James K; Drury, Colin; Tait, Gavin R

    2015-07-01

    Controversy presently exists surrounding the management of patients with subacromial impingement. This study aims to highlight current UK practices in the management of these patients. BESS members were invited to complete a questionnaire and responses were received from 157 consultant shoulder surgeons. Physiotherapy is an integral part of management for 93% of surgeons with a minimum period of 12 weeks being most popular prior to consideration of arthroscopic subacromial decompression. Subacromial steroid injection is used by 95% and 86% repeat this if the patient has failed to respond to a previous injection by the general practioner. From initial presentation, 77% felt there should be at least 3 months of conservative management before proceeding to surgery. Good but transient response to subacromial injection was considered the best predictor of good surgical outcome by 77%. The coracoacromial ligament is fully released by 78%, although there was greater variation in how aggressive surgeons were with acromioplasty. Most (59%) do not include the nontender acromioclavicular joint to any extent in routine acromioplasty. Hospital physiotherapy protocols are used by 63% for postoperative rehabilitation. Variation exists in the management regimes offered to patients with subacromial impingement, but most employ a minimum period of 12 weeks of conservative management incorporating physiotherapy and at least 2 subacromial steriod injections.

  10. Mind the Gap. A systematic review to identify usability and safety challenges and practices during electronic health record implementation.

    Science.gov (United States)

    Ratwani, Raj; Fairbanks, Terry; Savage, Erica; Adams, Katie; Wittie, Michael; Boone, Edna; Hayden, Andrew; Barnes, Janey; Hettinger, Zach; Gettinger, Andrew

    2016-11-16

    Decisions made during electronic health record (EHR) implementations profoundly affect usability and safety. This study aims to identify gaps between the current literature and key stakeholders' perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs. Two approaches were used: a literature review and interviews with key stakeholders. We performed a systematic review of the literature to identify usability and safety challenges and best practices during implementation. A total of 55 articles were reviewed through searches of PubMed, Web of Science and Scopus. We used a qualitative approach to identify key stakeholders' perceptions; semi-structured interviews were conducted with a diverse set of health IT stakeholders to understand their current practices and challenges related to usability during implementation. We used a grounded theory approach: data were coded, sorted, and emerging themes were identified. Conclusions from both sources of data were compared to identify areas of misalignment. We identified six emerging themes from the literature and stakeholder interviews: cost and resources, risk assessment, governance and consensus building, customization, clinical workflow and usability testing, and training. Across these themes, there were misalignments between the literature and stakeholder perspectives, indicating major gaps. Major gaps identified from each of six emerging themes are discussed as critical areas for future research, opportunities for new stakeholder initiatives, and opportunities to better disseminate resources to improve the implementation of EHRs. Our analysis identified practices and challenges across six different emerging themes, illustrated important gaps, and results suggest critical areas for future research and dissemination to improve EHR implementation.

  11. 78 FR 4307 - Current Good Manufacturing Practice Requirements for Combination Products

    Science.gov (United States)

    2013-01-22

    ...-2009-N-0435] Current Good Manufacturing Practice Requirements for Combination Products AGENCY: Food and...) is issuing this regulation on the current good manufacturing practice (CGMP) requirements applicable... this subpart? (Sec. 4.2) D. What current good manufacturing practice requirements apply to my...

  12. 21 CFR 212.2 - What is current good manufacturing practice for PET drugs?

    Science.gov (United States)

    2010-04-01

    ..., holding, or distribution of PET drugs intended for human use. Current good manufacturing practice is... 21 Food and Drugs 4 2010-04-01 2010-04-01 false What is current good manufacturing practice for... HUMAN SERVICES (CONTINUED) DRUGS: GENERAL CURRENT GOOD MANUFACTURING PRACTICE FOR POSITRON EMISSION...

  13. Grading of direct laryngoscopy. A survey of current practice.

    Science.gov (United States)

    Cohen, A M; Fleming, B G; Wace, J R

    1994-06-01

    One hundred and twenty anaesthetists (30 of each grade), from three separate regions, were interviewed as to how they recorded the appearance of laryngeal structures at direct laryngoscopy and about their knowledge of the commonly used numerical grading system. About two-thirds of anaesthetists surveyed (69.2%) used the numerical grading system, but of these, over half could not identify a 'grade 2' laryngoscopic appearance correctly. Of anaesthetists who did not use the numerical method, over half could not correctly state the difference between a 'grade 2' and a 'grade 3' laryngoscopic appearance. Over 40% of anaesthetists stated incorrectly that the grading should be made on the initial view, even when laryngeal pressure had been needed. Junior anaesthetists were more likely to use the numerical method of recording. The results show that there is unacceptable uncertainty and inaccuracy in the use of the numerical grading system by users as well as non-users, which makes the current routine clinical use of the numerical grading system unsatisfactory.

  14. Provision of genetic services in Europe: current practices and issues.

    Science.gov (United States)

    Godard, Béatrice; Kääriäinen, Helena; Kristoffersson, Ulf; Tranebjaerg, Lisbeth; Coviello, Domenico; Aymé, Ségolène

    2003-12-01

    This paper examines the professional and scientific views on the social, ethical and legal issues that impact on the provision of genetic services in Europe. Many aspects have been considered, such as the definition and the aims of genetic services, their organization, the quality assessment, public education, as well as the partnership with patients support groups and the multicultural aspects. The methods was primarily the analysis of professional guidelines, legal frameworks and other documents related to the organization of genetic services, mainly from Europe, but also from USA and international organizations. Then, the method was to examine the background data emerging from an updated report produced by the Concerted Action on Genetic Services in Europe, as well as the issues debated by 43 experts from 17 European countries invited to an international workshop organized by the European Society of Human Genetics Public and Professional Policy Committee in Helsinki, Finland, 8 and 9 September 2000. Some conclusions were identified from the ESHG workshop to arrive at outlines for optimal genetic services. Participants were concerned about equal accessibility and effectiveness of clinical genetic services, quality assessment of services, professional education, multidisciplinarity and division of tasks as well as networking. Within European countries, adherence to the organizational principles of prioritization, regionalization and integration into related health services would maximize equal accessibility and effectiveness of genetic actions. There is a need for harmonization of the rules involved in financial coverage of DNA tests in order to make these available to all Europeans. Clear guidelines for the best practice will ensure that the provision of genetic services develops in a way that is beneficial to its customers, be they health professionals or the public, especially since the coordination of clinical, laboratory and research perspectives within a

  15. Best practice in English Local Air Quality Management: principles illustrated by some examples of current practice

    Energy Technology Data Exchange (ETDEWEB)

    Beattie, C.I.; Ling, K.; Longhurst, J.W.S. [Univ. of the West of England, Faculty of Applied Sciences, Bristol (GB)] [and others

    1999-07-01

    The Local Air Quality Management (LAQM) process, a holistic approach to management, is well underway in England. The process aims to tackle air pollution problems from a variety of diverse sources, operating over different time scales and spatial areas. Although technical guidance from the Government has been published over the last two years, little guidance has been available for the management aspects of the process. Arguably, the management of air quality will be the crucial test of the LAQM process. Only by collaboration can technologies and policy actions, such as traffic management schemes, be put into effective action. The authors present an overview of the process, including a model of current LAQM procedures in the UK. Current practice is illustrated by way of results from a questionnaire survey of local authorities, health authorities and the Environment Agency and also by reference to specific examples from local authorities. (Author)

  16. Preparedness for physiotherapy in private practice: Novices identify key factors in an interpretive description study.

    Science.gov (United States)

    Atkinson, Robyn; McElroy, Theresa

    2016-04-01

    Physiotherapists in Australia deliver services to a diverse range of clients, across many settings, however little research exists examining graduate preparedness for practice, even in the populous field of private practice. To explore novice physiotherapist perspectives on preparedness for work in private practice. The qualitative approach of interpretive description was used to guide in-depth interviews with 8 novice physiotherapists from 3 universities working in 5 private practices in Melbourne. All interviews were digitally recorded, transcribed verbatim and analyzed thematically. Four main themes influencing graduate preparedness for work in private practice were identified: 1) non-curricular experiences (e.g. sports training) 2) elective curricular: practicum experiences; 3) curricular: attainment of skills specific to private practice; and 4) the private practice setting: supportive colleagues. This combination of non-curricular, curricular, and practice setting factors offered the necessary scaffolding for the graduates to report feeling prepared for work in private practice. Non-curricular activities, radiological instruction, clinical placements, building supportive colleague relations and professional development in private practice are recommended as potential means of building preparedness in novice therapists. Findings have implications for physiotherapy students, educators and private practice clinics looking to recruit new graduates. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. An algorithm for identifying the best current friend in a social network

    Directory of Open Access Journals (Sweden)

    Francisco Javier Moreno

    2015-05-01

    Full Text Available A research field in the area of social networks (SNs is the identification of some types of users and groups. To facilitate this process, a SN is usually represented by a graph. The centrality measures, which identify the most important vertices in a graph according to some criterion, are usual tools to analyze a graph. One of these measures is the PageRank (a measure originally designed to classify web pages. Informally, in the context of a SN, the PageRank of a user i represents the probability that another user of the SN is seeing the page of i after a considerable time of navigation in the SN. In this paper, we define a new type of user in a SN: the best current friend. The idea is to identify, among the friends of a user i, who is the friend k that would generate the highest decrease in the PageRank of i if k stops being his/her friend. This may be useful to identify the users/customers whose friendship/relationship should be a priority to keep. We provide formal definitions, algorithms and some experiments for this subject. Our experiments showed that the best current friend of a user is not necessarily the one who has the highest PageRank in the SN nor the one who has more friends.

  18. How to identify, assess and utilise mobile medical applications in clinical practice.

    Science.gov (United States)

    Aungst, T D; Clauson, K A; Misra, S; Lewis, T L; Husain, I

    2014-02-01

    There are thousands of medical applications for mobile devices targeting use by healthcare professionals. However, several factors related to the structure of the existing market for medical applications create significant barriers preventing practitioners from effectively identifying mobile medical applications for individual professional use. To define existing market factors relevant to selection of medical applications and describe a framework to empower clinicians to identify, assess and utilise mobile medical applications in their own practice. Resources available on the Internet regarding mobile medical applications, guidelines and published research on mobile medical applications. Mobile application stores (e.g. iTunes, Google Play) are not effective means of identifying mobile medical applications. Users of mobile devices that desire to implement mobile medical applications into practice need to carefully assess individual applications prior to utilisation. Searching and identifying mobile medical applications requires clinicians to utilise multiple references to determine what application is best for their individual practice methods. This can be done with a cursory exploration of mobile application stores and then moving onto other available resources published in the literature or through Internet resources (e.g. blogs, medical websites, social media). Clinicians must also take steps to ensure that an identified mobile application can be integrated into practice after carefully reviewing it themselves. Clinicians seeking to identify mobile medical application for use in their individual practice should use a combination of app stores, published literature, web-based resources, and personal review to ensure safe and appropriate use. © 2014 John Wiley & Sons Ltd.

  19. On the Current Measurement Practices in Agile Software Development

    OpenAIRE

    Javdani, Taghi; Zulzalil, Hazura; Ghani, Abdul Azim Abd; Sultan, Abu Bakar Md; Parizi, Reza Meimandi

    2013-01-01

    Agile software development (ASD) methods were introduced as a reaction to traditional software development methods. Principles of these methods are different from traditional methods and so there are some different processes and activities in agile methods comparing to traditional methods. Thus ASD methods require different measurement practices comparing to traditional methods. Agile teams often do their projects in the simplest and most effective way so, measurement practices in agile metho...

  20. Identifying Practical Solutions to Meet America’s Fiber Needs: Proceedings from the Food & Fiber Summit

    Directory of Open Access Journals (Sweden)

    Amy R. Mobley

    2014-07-01

    Full Text Available Fiber continues to be singled out as a nutrient of public health concern. Adequate intakes of fiber are associated with reduced risk for cardiovascular disease, cancer, diabetes, certain gastrointestinal disorders and obesity. Despite ongoing efforts to promote adequate fiber through increased vegetable, fruit and whole-grain intakes, average fiber consumption has remained flat at approximately half of the recommended daily amounts. Research indicates that consumers report increasingly attempting to add fiber-containing foods, but there is confusion around fiber in whole grains. The persistent and alarmingly low intakes of fiber prompted the “Food & Fiber Summit,” which assembled nutrition researchers, educators and communicators to explore fiber’s role in public health, current fiber consumption trends and consumer awareness data with the objective of generating opportunities and solutions to help close the fiber gap. The summit outcomes highlight the need to address consumer confusion and improve the understanding of sources of fiber, to recognize the benefits of various types of fibers and to influence future dietary guidance to provide prominence and clarity around meeting daily fiber recommendations through a variety of foods and fiber types. Potential opportunities to increase fiber intake were identified, with emphasis on meal occasions and food categories that offer practical solutions for closing the fiber gap.

  1. Identifying Practical Solutions to Meet America’s Fiber Needs: Proceedings from the Food & Fiber Summit

    Science.gov (United States)

    Mobley, Amy R.; Jones, Julie Miller; Rodriguez, Judith; Slavin, Joanne; Zelman, Kathleen M.

    2014-01-01

    Fiber continues to be singled out as a nutrient of public health concern. Adequate intakes of fiber are associated with reduced risk for cardiovascular disease, cancer, diabetes, certain gastrointestinal disorders and obesity. Despite ongoing efforts to promote adequate fiber through increased vegetable, fruit and whole-grain intakes, average fiber consumption has remained flat at approximately half of the recommended daily amounts. Research indicates that consumers report increasingly attempting to add fiber-containing foods, but there is confusion around fiber in whole grains. The persistent and alarmingly low intakes of fiber prompted the “Food & Fiber Summit,” which assembled nutrition researchers, educators and communicators to explore fiber’s role in public health, current fiber consumption trends and consumer awareness data with the objective of generating opportunities and solutions to help close the fiber gap. The summit outcomes highlight the need to address consumer confusion and improve the understanding of sources of fiber, to recognize the benefits of various types of fibers and to influence future dietary guidance to provide prominence and clarity around meeting daily fiber recommendations through a variety of foods and fiber types. Potential opportunities to increase fiber intake were identified, with emphasis on meal occasions and food categories that offer practical solutions for closing the fiber gap. PMID:25006857

  2. Test result communication in primary care: a survey of current practice.

    Science.gov (United States)

    Litchfield, Ian; Bentham, Louise; Lilford, Richard; McManus, Richard J; Hill, Ann; Greenfield, Sheila

    2015-11-01

    The number of blood tests ordered in primary care continues to increase and the timely and appropriate communication of results remains essential. However, the testing and result communication process includes a number of participants in a variety of settings and is both complicated to manage and vulnerable to human error. In the UK, guidelines for the process are absent and research in this area is surprisingly scarce; so before we can begin to address potential areas of weakness there is a need to more precisely understand the strengths and weaknesses of current systems used by general practices and testing facilities. We conducted a telephone survey of practices across England to determine the methods of managing the testing and result communication process. In order to gain insight into the perspectives from staff at a large hospital laboratory we conducted paired interviews with senior managers, which we used to inform a service blueprint demonstrating the interaction between practices and laboratories and identifying potential sources of delay and failure. Staff at 80% of practices reported that the default method for communicating normal results required patients to telephone the practice and 40% of practices required that patients also call for abnormal results. Over 80% had no fail-safe system for ensuring that results had been returned to the practice from laboratories; practices would otherwise only be aware that results were missing or delayed when patients requested results. Persistent sources of missing results were identified by laboratory staff and included sample handling, misidentification of samples and the inefficient system for collating and resending misdirected results. The success of the current system relies on patients both to retrieve results and in so doing alert staff to missing and delayed results. Practices appear slow to adopt available technological solutions despite their potential for reducing the impact of recurring errors in the

  3. [Description of current hypnosis practice in French university hospitals].

    Science.gov (United States)

    Chabridon, G; Nekrouf, N; Bioy, A

    2017-10-01

    Hypnosis is very fashionable as an entertainment through TV shows searching for new sensational experiences. What about its practice in the medical world? The aim of this article is to answer to this question. Therefore, we contacted every French University Hospital of each region to find out if hypnosis was practiced for the care of pain (hypnoanalgesia), for chirurgical procedures (hypnosedation) and in adult psychiatry care units (hypnotherapy). For this last practice, we also questioned the type of indications. All 30 of the French University Hospitals had replied by November 2015. Hypnoanalgesia is practiced by all and two-thirds offer hypnosedation. Hypnotherapy is practiced by 40 % of the University Hospitals, 91,7 % for anxiety disorders, 66,7 % for psychotraumatic care and 25 % for mood disorders. Therefore, hypnosis seems to have found its place in the care of pain and as an anesthetic to replace standard procedures. However, the use of hypnotherapy in psychiatry is less frequent, indications for its use being variable and not very consensual. Copyright © 2016 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  4. Pediatric endocrine society survey of diabetes practices in the United States: What is the current state?

    Science.gov (United States)

    Guttmann-Bauman, I; Thornton, P; Adhikari, S; Reifschneider, K; Wood, M A; Hamby, T; Rubin, K

    2018-03-26

    The Practice Management Committee (PMC) of the Pediatric Endocrine Society (PES) conducted a survey of its membership in February/March, 2016 to assess the current state of pediatric diabetes care delivery across multiple practice types in the United States. The PES distributed an anonymous electronic survey (Survey Monkey) via email to its membership and requested that only one survey be completed for each practice. Ninety-three unique entries from the US were entered into analysis. Care is predominantly delivered by multidisciplinary teams, based at academic institutions (65.6%), with >85% of the provider types being physicians. Each 1.0 full time equivalent certified diabetes educators serves on average 367 diabetic youth. Fee-for-service remains the standard method of reimbursement with 57% of practices reporting financial loss. Survey respondents identified under-reimbursement as a major barrier to improving patient outcomes and lack of behavioral health (BH) providers as a key gap in services provided. Our survey reveals wide variation in all aspects of pediatric diabetes care delivery in the United States. Pediatric Endocrinologists responding to the survey identified a lack of resources and the current fee for service payment model as a major impediment to practice and the lack of integrated BH staff as a key gap in service. The respondents strongly support its organizations' involvement in the dissemination of standards for care delivery and advocacy for a national payment model aligned with chronic diabetes care in the context of our emerging value-based healthcare system. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Identifying industrial best practices for the waste minimization of low-level radioactive materials

    Energy Technology Data Exchange (ETDEWEB)

    Levin, V.

    1996-04-01

    In US DOE, changing circumstances are affecting the management and disposal of solid, low-level radioactive waste (LLW). From 1977 to 1991, the nuclear power industry achieved major reductions in solid waste disposal, and DOE is interested in applying those practices to reduce solid waste at DOE facilities. Project focus was to identify and document commercial nuclear industry best practices for radiological control programs supporting routine operations, outages, and decontamination and decommissioning activities. The project team (DOE facility and nuclear power industry representatives) defined a Work Control Process Model, collected nuclear power industry Best Practices, and made recommendations to minimize LLW at DOE facilities.

  6. Acute care patient portals: a qualitative study of stakeholder perspectives on current practices.

    Science.gov (United States)

    Collins, Sarah A; Rozenblum, Ronen; Leung, Wai Yin; Morrison, Constance Rc; Stade, Diana L; McNally, Kelly; Bourie, Patricia Q; Massaro, Anthony; Bokser, Seth; Dwyer, Cindy; Greysen, Ryan S; Agarwal, Priyanka; Thornton, Kevin; Dalal, Anuj K

    2017-04-01

    To describe current practices and stakeholder perspectives of patient portals in the acute care setting. We aimed to: (1) identify key features, (2) recognize challenges, (3) understand current practices for design, configuration, and use, and (4) propose new directions for investigation and innovation. Mixed methods including surveys, interviews, focus groups, and site visits with stakeholders at leading academic medical centers. Thematic analyses to inform development of an explanatory model and recommendations. Site surveys were administered to 5 institutions. Thirty interviews/focus groups were conducted at 4 site visits that included a total of 84 participants. Ten themes regarding content and functionality, engagement and culture, and access and security were identified, from which an explanatory model of current practices was developed. Key features included clinical data, messaging, glossary, patient education, patient personalization and family engagement tools, and tiered displays. Four actionable recommendations were identified by group consensus. Design, development, and implementation of acute care patient portals should consider: (1) providing a single integrated experience across care settings, (2) humanizing the patient-clinician relationship via personalization tools, (3) providing equitable access, and (4) creating a clear organizational mission and strategy to achieve outcomes of interest. Portals should provide a single integrated experience across the inpatient and ambulatory settings. Core functionality includes tools that facilitate communication, personalize the patient, and deliver education to advance safe, coordinated, and dignified patient-centered care. Our findings can be used to inform a "road map" for future work related to acute care patient portals. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  7. 77 FR 16158 - Current Good Manufacturing Practice in Manufacturing, Processing, Packing, or Holding of Drugs...

    Science.gov (United States)

    2012-03-20

    .... FDA-1997-N-0518] (formerly 97N-0300) Current Good Manufacturing Practice in Manufacturing, Processing... labeling control provisions of the current good manufacturing practice (CGMP) regulations for human and... GOOD MANUFACTURING PRACTICE FOR FINISHED PHARMACEUTICALS 0 1. The authority citation for 21 CFR part...

  8. Current Rehabilitation Practices for Children with Cerebral Palsy: Focus and Gaps.

    Science.gov (United States)

    Anaby, Dana; Korner-Bitensky, Nicol; Steven, Emma; Tremblay, Stephanie; Snider, Laurie; Avery, Lisa; Law, Mary

    2017-02-01

    To describe the focus of therapy practices in occupational and physical therapy for school-aged children with cerebral palsy, and better understand whether it is congruent with recommended practices. A Canada-wide Web-based survey was completed by 62 occupational and 61 physical therapists to identify problems, assessments, and treatment interventions for two case-based scenarios. Data were coded using the International Classification of Functioning, Disability and Health (ICF) definitions for "body functions and structure," "activity and participation," and "environment." Physical therapists, in comparison to occupational therapists, were more likely to select interventions classed in the "body functions and structure" category (34-42% and 18-20%, respectively). Both professions focused on "activity and participation" (34-61%) when identifying problems, assessing, and intervening; attention, however, was mainly directed towards task-oriented activities such as activities of daily living and mobility. Participation in leisure or community-based activities received less attention (2-15%). The environment received limited attention for problems and assessments (4-25%), though it was an important focus of intervention (19-37%). While body functions and structure are well-addressed, other ICF elements, specifically participation, are poorly integrated into practice. The emerging focus on the environment in therapy intervention, by modifying the context rather than changing aspects of the child, is consistent with current approaches and evidence. Knowledge translation implementation initiatives are recommended to bridge identified gaps.

  9. Assessment of current practices in creating and using passwords as a control mechanism for information access

    Directory of Open Access Journals (Sweden)

    P. L. Wessels

    2007-11-01

    Full Text Available One of the critical issues in managing information within an organization is to ensure that proper controls exist and are applied in allowing people access to information. Passwords are used extensively as the main control mechanism to identify users wanting access to systems, applications, data files, network servers or personal information. In this article, the issues involved in selecting and using passwords are discussed and the current practices employed by users in creating and storing passwords to gain access to sensitive information are assessed. The results of this survey conclude that information managers cannot rely only on users to employ proper password control in order to protect sensitive information.

  10. Current Practices In Infant Nutrition In Benin City, Nigeria ...

    African Journals Online (AJOL)

    Of the 780 mothers 432 (55.6%) had children who were less than 6 months while 348(44.6%) had older infants. About 98.0% of the mothers were practicing one form of breast-feeding or the other. The exclusive breastfeeding rate (EBR), predominant breastfeeding rate (PBR) and bottle-feed rates (BOTFR) were respectively ...

  11. Feedback matters current feedback practices in the EFL classroom

    CERN Document Server

    Reitbauer, Margit; Mercer, Sarah; Schumm-Fauster, Jennifer

    2013-01-01

    This varied collection of papers is concerned with feedback in the language learning context. With its blend of theoretical overviews, action research-based empirical studies and practical implications, this will be a valuable resource for all academics and practitioners concerned with generating feedback that matters.

  12. Teacher's current practices of teaching reading and grade four ...

    African Journals Online (AJOL)

    This study examined the practices and challenges of teaching reading strategies and ... Twelve grade 4 students were selected using simple random sampling ... The quantitative data disclosed lower student scores, while the qualitative data ... By Country · List All Titles · Free To Read Titles This Journal is Open Access.

  13. Equity crowdfunding in China : Current practice and important legal issues

    NARCIS (Netherlands)

    Li, Jing

    2017-01-01

    By studying two leading Chinese equity crowdfunding portals, namely, Renrentou and Zhongou8, this paper provides the very first empirical evidence on the practice and regulation of equity crowdfunding in China. In the case of Renrentou, I examine a hand-collected sample consisting of the investment

  14. Psychotherapy: a profile of current occupational therapy practice in Ontario.

    Science.gov (United States)

    Moll, Sandra E; Tryssenaar, Joyce; Good, Colleen R; Detwiler, Lisa M

    2013-12-01

    Psychotherapy can be an important part of psychosocial occupational therapy practice; however, it requires specialized training to achieve and maintain competence. Regulation varies by province, and in Ontario, occupational therapists were recently authorized to perform psychotherapy. The purpose of this study was to explore the psychotherapy practice, training, and support needs of Ontario occupational therapists. An online survey was sent to occupational therapists who had clients with mental health or chronic pain issues, asking about their expertise and support needs in relation to nine psychotherapy approaches. Of the 331 therapists who responded, there were variations in the nature and frequency of psychotherapy practice. Experienced therapists in outpatient settings were more likely to practice psychotherapy, and cognitive-behaviour therapy, motivational interviewing, and mindfulness were the most common approaches. Supervision and training varied, with many therapists interested in occupational therapy-specific training. Recommendations for a framework of support include education about the nature of psychotherapy, training and supervision guidelines, and advocacy for occupational therapy and psychotherapy.

  15. Current marketing practices in the nursing home sector.

    Science.gov (United States)

    Calhoun, Judith G; Banaszak-Holl, Jane; Hearld, Larry R

    2006-01-01

    Marketing is widely recognized as an essential business function across all industries, including healthcare. While many long-term care facilities adopted basic healthcare marketing practices and hired marketing staff by the early 1990s, a paucity of research on nursing home marketing exists in the literature. This study examines the extent to which nursing homes have developed more formulated marketing and related communication and promotional strategies as market competition has increased in this sector during the past two decades. In addition, we explored managers' perceptions of their control over marketing decision making, the impact of competition on the use of marketing practices, and areas for enhanced competitive positioning. Administrators from 230 nursing homes in 18 Southeastern Michigan counties were surveyed regarding (1) the adoption level of approximately 40 literature-based, best-practice marketing strategies; (2) the types of staff involved with the marketing function; and (3) their perception of their level of control over marketing functions and of local competition. Results from 101 (44 percent) survey participants revealed that although respondents viewed their markets as highly competitive, their marketing practices remained focused on traditional and relatively constrained practices. In relation to the importance of customer relationship management, the majority of the administrators reported intensive efforts being focused on residents and their families, referrers, and staff, with minimal efforts being extended to insurers and other types of payers. A significant positive relation was found between the intensity of marketing initiatives and the size of the facility (number of beds), whereas significant negative correlations were revealed in relation to occupancy and the perceived level of control over the function.

  16. Personal trainer demographics, current practice trends and common trainee injuries

    Directory of Open Access Journals (Sweden)

    Gregory R. Waryasz

    2016-10-01

    Full Text Available Increasing emphasis on maintaining a healthy lifestyle has led many individuals to seek advice on exercise from personal trainers. There are few studies to date that evaluate personal trainer education, practice trends, and injuries they have seen while training clients. A survey was distributed to personal trainers using Survey Monkey® (Palo Alto, CA, USA with 605 personal trainers accessing the survey. An exercise related bachelor’s degree was held by 64.2% of survey participants and a certification in personal training by 89.0%. The most common personal trainer certifications were from American College of Sports Medicine (59.2% and National Strength and Conditioning Association (28.9%. Only 2.9% of all personal trainers surveyed had no exercise-related bachelor’s degree and no personal trainer certification. The most common injuries seen by personal trainers during sessions were lumbar muscle strain (10.7%, rotator cuff tear/tendonitis (8.9%, shin splints (8.1%, ankle sprain (7.5%, and cervical muscle strain (7.4%. There is variability in the practices between different personal trainers when analyzing differences in collegiate education, personal trainer certifications, and strength and conditioning certifications. The clinical implication of the differences in practices is unknown as to the impact on injuries or exercise prescription effectiveness.

  17. Personal Trainer Demographics, Current Practice Trends and Common Trainee Injuries

    Science.gov (United States)

    Waryasz, Gregory R.; Daniels, Alan H.; Gil, Joseph A.; Suric, Vladimir; Eberson, Craig P.

    2016-01-01

    Increasing emphasis on maintaining a healthy lifestyle has led many individuals to seek advice on exercise from personal trainers. There are few studies to date that evaluate personal trainer education, practice trends, and injuries they have seen while training clients. A survey was distributed to personal trainers using Survey Monkey® (Palo Alto, CA, USA) with 605 personal trainers accessing the survey. An exercise related bachelor’s degree was held by 64.2% of survey participants and a certification in personal training by 89.0%. The most common personal trainer certifications were from American College of Sports Medicine (59.2%) and National Strength and Conditioning Association (28.9%). Only 2.9% of all personal trainers surveyed had no exercise-related bachelor’s degree and no personal trainer certification. The most common injuries seen by personal trainers during sessions were lumbar muscle strain (10.7%), rotator cuff tear/tendonitis (8.9%), shin splints (8.1%), ankle sprain (7.5%), and cervical muscle strain (7.4%). There is variability in the practices between different personal trainers when analyzing differences in collegiate education, personal trainer certifications, and strength and conditioning certifications. The clinical implication of the differences in practices is unknown as to the impact on injuries or exercise prescription effectiveness. PMID:27761219

  18. Online Learning Integrity Approaches: Current Practices and Future Solutions

    Science.gov (United States)

    Lee-Post, Anita; Hapke, Holly

    2017-01-01

    The primary objective of this paper is to help institutions respond to the stipulation of the Higher Education Opportunity Act of 2008 by adopting cost-effective academic integrity solutions without compromising the convenience and flexibility of online learning. Current user authentication solutions such as user ID and password, security…

  19. Factors influencing the current practice of self-medication consultations in Eastern Indonesian community pharmacies: a qualitative study.

    Science.gov (United States)

    Brata, Cecilia; Fisher, Colleen; Marjadi, Brahmaputra; Schneider, Carl R; Clifford, Rhonda M

    2016-05-13

    Research has shown that the current practice of pharmacy staff when providing self-medication consultations in Indonesia is suboptimal. To improve the performance of pharmacy staff when providing self-medication consultations in community pharmacies, the factors that influence current practice need to be understood. The aim of this study is to identify the factors that influence current practice of pharmacy staff when handling self-medication consultations in Eastern Indonesian community pharmacies. Fifteen in-depth interviews were conducted with pharmacists, pharmacy technicians, pharmacy owners, and counter attendants. Thematic analysis was used to generate findings. The current practice of pharmacy staff when handling self-medication consultations is directly influenced by the professionalism of pharmacy staff and patient responses to the consultations. These factors are in turn affected by the organisational context of the pharmacy and the external pharmacy environment. The organisational context of the pharmacy includes staffing, staff affordability, and the availability of time and facilities in which to provide consultations. The external pharmacy environment includes the number of trained pharmacy staff in the research setting, the relevance of pharmacy education to the needs of pharmacy practice, the support offered by the Indonesian Pharmacists Association, a competitive business environment, and the policy environment. Complex and inter-related factors influence the current practice of pharmacy staff when providing self-medication consultations in community pharmacies in this research setting. Multiple strategies will be required to improve consultation practices.

  20. Current problems of foreign practice-related educational psychology

    Directory of Open Access Journals (Sweden)

    A.D. Andreeva

    2012-09-01

    Full Text Available The article regards the questions of scientific-methodological provision of psychologist’s activity in an educational settlement which are urgent for the activity of practical educational psychologist in Russia as well. The presented information concerns the psychologist’s particular strands of work which can be both developing (development of ABM and psycho-correcting (reasons and forms of school phobias, bullying displays, lying. The ethical problems of psychologist’s work with families namely in case of the parent-child conflicts is also reviewed in the article.

  1. Sealed radionuclide sources - new technical specifications and current practice

    Energy Technology Data Exchange (ETDEWEB)

    Brabec, D

    1987-03-01

    Basic technical specifications are discussed valid in Czechoslovakia for sealed radionuclide sources, based on international ISO and CMEA standards. Described are the standardization of terminology, relationships of tests, testing methods, types of sealed sources and their applications, relations to Czechoslovak regulations on radiation protection and to IAEA specifications for radioactive material shipment, etc. Practical impact is shown of the introduction of the new standards governing sealed sources on the national economy, and the purpose is explained of various documents issued with sealed sources. (author). 2 figs., 45 refs.

  2. Revisiting reflexology: Concept, evidence, current practice, and practitioner training

    OpenAIRE

    Embong, Nurul Haswani; Soh, Yee Chang; Ming, Long Chiau; Wong, Tin Wui

    2015-01-01

    Reflexology is basically a study of how one part of the human body relates to another part of the body. Reflexology practitioners rely on the reflexes map of the feet and hands to all the internal organs and other human body parts. They believe that by applying the appropriate pressure and massage certain spots on the feet and hands, all other body parts could be energized and rejuvenated. This review aimed to revisit the concept of reflexology and examine its effectiveness, practices, and th...

  3. The Context of Enterprise Education: Insights into Current Practices

    Science.gov (United States)

    Penaluna, Kathryn; Penaluna, Andy; Jones, Colin

    2012-01-01

    This paper presents the results of an investigation into contextual differences in the development and delivery of enterprise education in higher education globally. Using information gathered from an online survey distributed to enterprise educators, distinct differences in the provision of enterprise education are identified, as are differences…

  4. Quantitative health impact assessment: current practice and future directions

    NARCIS (Netherlands)

    J.L. Veerman (Lennert); J.J.M. Barendregt (Jan); J.P. Mackenbach (Johan)

    2005-01-01

    textabstractSTUDY OBJECTIVE: To assess what methods are used in quantitative health impact assessment (HIA), and to identify areas for future research and development. DESIGN: HIA reports were assessed for (1) methods used to quantify effects of policy on determinants of health

  5. Newborn Hearing Screening: An Analysis of Current Practices

    Science.gov (United States)

    Houston, K. Todd; Bradham, Tamala S.; Munoz, Karen F.; Guignard, Gayla Hutsell

    2011-01-01

    State coordinators of early hearing detection and intervention (EHDI) programs completed a strengths, weaknesses, opportunities, and threats, or SWOT, analysis that consisted of 12 evaluative areas of EHDI programs. For the newborn hearing screening area, a total of 293 items were listed by 49 EHDI coordinators, and themes were identified within…

  6. Feeding practices of low-income mothers: how do they compare to current recommendations?

    Science.gov (United States)

    Power, Thomas G; Hughes, Sheryl O; Goodell, L Suzanne; Johnson, Susan L; Duran, J Andrea Jaramillo; Williams, Kimberly; Beck, Ashley D; Frankel, Leslie A

    2015-03-07

    Despite a growing consensus on the feeding practices associated with healthy eating patterns, few observational studies of maternal feeding practices with young children have been conducted, especially in low-income populations. The aim of this study was to provide such data on a low income sample to determine the degree to which observed maternal feeding practices compare with current recommendations. Eighty low-income mothers and their preschool children were videotaped at dinner in their homes. Mothers were chosen from a larger study to create a 2 X 2 X 2 design: maternal ethnicity (African American vs. Latina) by child gender by child weight status (healthy weight vs. overweight/obese). Observers coded videotapes for a range of maternal feeding strategies and other behaviors. Many mothers spent considerable time encouraging eating--often in spite of the child's insistence that he or she was finished. Mothers talked little about food characteristics, rarely referred to feelings of hunger and fullness, and made more attempts to enforce table manners than to teach eating skills. Latina mothers showed higher levels of teaching eating skills and encouraging their children to eat; African American mothers showed higher levels of enforcing table manners and getting children to clear their plates. Mothers of boys used more unelaborated commands and less questions/suggestions than mothers of girls. Finally, compared to mothers of overweight/obese children, mothers of healthy weight children showed higher levels of encouraging eating and lower levels of discouraging eating. Most of the mothers in this study did not engage in feeding practices that are consistent with current recommendations. They did this, despite the fact that they knew they were being observed. These results should be used to inform future research about the motivations behind mothers' feeding practices and the development of interventions by helping identify areas in greatest need of change.

  7. Investigating influences on current community pharmacy practice at micro, meso, and macro levels.

    Science.gov (United States)

    Hermansyah, Andi; Sainsbury, Erica; Krass, Ines

    The nature of Australian community pharmacy is continually evolving, raising the need to explore the current situation in order to understand the potential impact of any changes. Although community pharmacy has the potential to play a greater role in health care, it is currently not meeting this potential. To investigate the nature of the contemporary practice of community pharmacy in Australia and examine the potential missed opportunities for role expansion in health care. In-depth semi-structured interviews with a wide-range of key stakeholders within and beyond community pharmacy circles were conducted. Interviews were audio-recorded, transcribed verbatim and analyzed for emerging themes. Twenty-seven key informants across Eastern half of Australia were interviewed between December 2014 and August 2015. Several key elements of the current situation representing the social, economic and policy context of community pharmacy have been identified. These elements operate interdependently, influence micro, meso and macro levels of community pharmacy operation and are changing in the current climate. Community pharmacy has untapped potential in primary health care, but it has been slow to change to meet opportunities available in the current situation. As the current situation is complex, interrelated and dynamic with often unintended and unpredictable consequences, this paper suggests that policy makers to consider the micro, meso and macro levels of community pharmacy operation when making significant policy changes. The framework proposed in this study can be a helpful tool to analyze the processes operating at these three levels and their influences on practice. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. What is current practice in soft tissue sarcoma grading?

    International Nuclear Information System (INIS)

    Golouh, R.; Bracko, M.

    2001-01-01

    Purpose. Most published grading systems of soft tissue sarcomas (STS) are somewhat subjective and it seems that there is no definite consensus among experts which of them is the most effective. The aim of this study was to collect data from practicing pathologists and to get some insight in the practice of STS grading. Subjects. A questionnaire was sent to 135 pathologists chosen randomly. Results. There were 88 responders from 30 countries from 5 continents. Most responders (85%) grade STS, more frequently in Europe than in non-European countries. Three-grade system is preferred by both European and non-European pathologists, who use it in almost 77% and 67%, respectively. They apply the criteria set by FNCLCC in 37.3%, by NCI in 24%, by Broders in 12% and by Markhede in 1.4%. In Europe, FNCLCC system is the most widely used. Beside classical histological criteria, other modern methods are applied by more than one half of the responders. Immunohistochemical evaluation of proliferation markers is the method most widely used, followed by molecular markers and DNA flow cytometry. Conclusion. The results of our study indicate that most pathologists consider histologic grade of STS as a valuable, however not completely satisfactory predictor of a patient's survival. (author)

  9. Practical Application of Eddy Currents Generated by Wind

    International Nuclear Information System (INIS)

    Dirba, I; Kleperis, J

    2011-01-01

    When a conductive material is subjected to time-varying magnetic fluxes, eddy (Foucault) currents are generated in it and magnetic field of opposite polarity as the applied one arises. Due to the internal resistance of the conductive material, the eddy currents will be dissipated into heat (Joule heating). Conventional domestic water heaters utilize gas burners or electric resistance heating elements to heat the water in the tank and substantial part of the energy to use for it is wasted. In this paper the origin of electromagnetic induction heat generated by wind turbine in special heat exchange camera connected to water boiler is discussed and material evaluation performed using mathematical modelling (comparing the 2D finite element model with analytical and numerical calculation results).

  10. Practical Application of Eddy Currents Generated by Wind

    Science.gov (United States)

    Dirba, I.; Kleperis, J.

    2011-06-01

    When a conductive material is subjected to time-varying magnetic fluxes, eddy (Foucault) currents are generated in it and magnetic field of opposite polarity as the applied one arises. Due to the internal resistance of the conductive material, the eddy currents will be dissipated into heat (Joule heating). Conventional domestic water heaters utilize gas burners or electric resistance heating elements to heat the water in the tank and substantial part of the energy to use for it is wasted. In this paper the origin of electromagnetic induction heat generated by wind turbine in special heat exchange camera connected to water boiler is discussed and material evaluation performed using mathematical modelling (comparing the 2D finite element model with analytical and numerical calculation results).

  11. Practical Application of Eddy Currents Generated by Wind

    Energy Technology Data Exchange (ETDEWEB)

    Dirba, I; Kleperis, J, E-mail: imants.dirba@gmail.com [Institute of Solid State Physics of University of Latvia, 8 Kengaraga Street, Riga, LV-1063 (Latvia)

    2011-06-23

    When a conductive material is subjected to time-varying magnetic fluxes, eddy (Foucault) currents are generated in it and magnetic field of opposite polarity as the applied one arises. Due to the internal resistance of the conductive material, the eddy currents will be dissipated into heat (Joule heating). Conventional domestic water heaters utilize gas burners or electric resistance heating elements to heat the water in the tank and substantial part of the energy to use for it is wasted. In this paper the origin of electromagnetic induction heat generated by wind turbine in special heat exchange camera connected to water boiler is discussed and material evaluation performed using mathematical modelling (comparing the 2D finite element model with analytical and numerical calculation results).

  12. Is current clinical practice modified about intraoperative breast irradiation?

    Science.gov (United States)

    Massa, Michela; Franchelli, Simonetta; Panizza, Renzo; Massa, Tiberio

    2016-04-01

    After the results obtained in the two randomized clinical trial, the ELIOT trial and the TARGIT-A trial, a heated debate is going on concerning the question of applying intraoperative radiotherapy (IORT) instead of postoperative whole breast irradiation (WBI) after breast conservative treatment. Currently, many centers are applying the IORT following the strict selection criteria dictated by the working groups American Society for Radiation Oncology (ASTRO) and Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) and monitoring the oncological outcome together with radiation toxicity on breast tissue. The clinical experience of the Geneva University Hospital regarding the use of the Intrabeam system is evaluated and compared with current evidences.

  13. Current Status and Challenges in Identifying Disease Resistance Genes in Brassica napus

    Science.gov (United States)

    Neik, Ting Xiang; Barbetti, Martin J.; Batley, Jacqueline

    2017-01-01

    Brassica napus is an economically important crop across different continents including temperate and subtropical regions in Europe, Canada, South Asia, China and Australia. Its widespread cultivation also brings setbacks as it plays host to fungal, oomycete and chytrid pathogens that can lead to serious yield loss. For sustainable crop production, identification of resistance (R) genes in B. napus has become of critical importance. In this review, we discuss four key pathogens affecting Brassica crops: Clubroot (Plasmodiophora brassicae), Blackleg (Leptosphaeria maculans and L. biglobosa), Sclerotinia Stem Rot (Sclerotinia sclerotiorum), and Downy Mildew (Hyaloperonospora parasitica). We first review current studies covering prevalence of these pathogens on Brassica crops and highlight the R genes and QTL that have been identified from Brassica species against these pathogens. Insights into the relationships between the pathogen and its Brassica host, the unique host resistance mechanisms and how these affect resistance outcomes is also presented. We discuss challenges in identification and deployment of R genes in B. napus in relation to highly specific genetic interactions between host subpopulations and pathogen pathotypes and emphasize the need for common or shared techniques and research materials or tighter collaboration between researchers to reconcile the inconsistencies in the research outcomes. Using current genomics tools, we provide examples of how characterization and cloning of R genes in B. napus can be carried out more effectively. Lastly, we put forward strategies to breed resistant cultivars through introgressions supported by genomic approaches and suggest prospects that can be implemented in the future for a better, pathogen-resistant B. napus. PMID:29163558

  14. Current Status and Challenges in Identifying Disease Resistance Genes in Brassica napus

    Directory of Open Access Journals (Sweden)

    Ting Xiang Neik

    2017-11-01

    Full Text Available Brassica napus is an economically important crop across different continents including temperate and subtropical regions in Europe, Canada, South Asia, China and Australia. Its widespread cultivation also brings setbacks as it plays host to fungal, oomycete and chytrid pathogens that can lead to serious yield loss. For sustainable crop production, identification of resistance (R genes in B. napus has become of critical importance. In this review, we discuss four key pathogens affecting Brassica crops: Clubroot (Plasmodiophora brassicae, Blackleg (Leptosphaeria maculans and L. biglobosa, Sclerotinia Stem Rot (Sclerotinia sclerotiorum, and Downy Mildew (Hyaloperonospora parasitica. We first review current studies covering prevalence of these pathogens on Brassica crops and highlight the R genes and QTL that have been identified from Brassica species against these pathogens. Insights into the relationships between the pathogen and its Brassica host, the unique host resistance mechanisms and how these affect resistance outcomes is also presented. We discuss challenges in identification and deployment of R genes in B. napus in relation to highly specific genetic interactions between host subpopulations and pathogen pathotypes and emphasize the need for common or shared techniques and research materials or tighter collaboration between researchers to reconcile the inconsistencies in the research outcomes. Using current genomics tools, we provide examples of how characterization and cloning of R genes in B. napus can be carried out more effectively. Lastly, we put forward strategies to breed resistant cultivars through introgressions supported by genomic approaches and suggest prospects that can be implemented in the future for a better, pathogen-resistant B. napus.

  15. A revisit on the current practice of dispute resolution and ADR in the Malaysian construction industry

    Directory of Open Access Journals (Sweden)

    Mohd Suhaimi Mohd Danuri

    2012-06-01

    Full Text Available The current dispute resolution procedures available in the Malaysian construction industry are mainly litigation and arbitration. In addition, the alternative dispute resolutions (ADR, namely mediation and adjudication, have also been introduced as the other methods for resolving disputes. The objective of this study is to examine the current practice of dispute resolution and ADR available in the Malaysian construction industry. The aim of this paper is two-fold: to report the current practice of dispute resolution and ADR, and identify the attributes of successful implementation of both mechanisms based on the perceptions of the Malaysian construction industry players. From the jurisprudence point of view, this study looks into the law as it is, in relation to the current practice of dispute resolution and ADR, by showing how those findings can be used to explain why improvement is needed to promote a successful and well received dispute resolution and ADR, and what lessons can be learnt, towards the formulation of a more viable methods for the Malaysian construction industry. NVivo software has been used to manage and organise the complete interview transcripts and facilitate the data analysis process for this study. Literature review reveals a continuous development of dispute resolution and ADR in the Malaysian construction industry, while, globally the industry has not only embraced ADR but also spearheaded the development of innovative forms of dispute avoidance mechanism. The findings of interviews show that locally, apart from litigation, the common types of ADR are arbitration, mediation and ad hoc mechanism. The findings also lead to the discovery of the following attributes: faster, less procedural, cost effective and enforceable; regulation and government's support; professionalism and ethic; training; and facility, that may promote a successful implementation of dispute resolution and ADR in Malaysia.

  16. Identifying and acting on potentially inappropriate care? Inadequacy of current hospital coding for this task.

    Science.gov (United States)

    Cooper, P David; Smart, David R

    2017-06-01

    Recent Australian attempts to facilitate disinvestment in healthcare, by identifying instances of 'inappropriate' care from large Government datasets, are subject to significant methodological flaws. Amongst other criticisms has been the fact that the Government datasets utilized for this purpose correlate poorly with datasets collected by relevant professional bodies. Government data derive from official hospital coding, collected retrospectively by clerical personnel, whilst professional body data derive from unit-specific databases, collected contemporaneously with care by clinical personnel. Assessment of accuracy of official hospital coding data for hyperbaric services in a tertiary referral hospital. All official hyperbaric-relevant coding data submitted to the relevant Australian Government agencies by the Royal Hobart Hospital, Tasmania, Australia for financial year 2010-2011 were reviewed and compared against actual hyperbaric unit activity as determined by reference to original source documents. Hospital coding data contained one or more errors in diagnoses and/or procedures in 70% of patients treated with hyperbaric oxygen that year. Multiple discrete error types were identified, including (but not limited to): missing patients; missing treatments; 'additional' treatments; 'additional' patients; incorrect procedure codes and incorrect diagnostic codes. Incidental observations of errors in surgical, anaesthetic and intensive care coding within this cohort suggest that the problems are not restricted to the specialty of hyperbaric medicine alone. Publications from other centres indicate that these problems are not unique to this institution or State. Current Government datasets are irretrievably compromised and not fit for purpose. Attempting to inform the healthcare policy debate by reference to these datasets is inappropriate. Urgent clinical engagement with hospital coding departments is warranted.

  17. A survey of current clinical practice in permanent and temporary prostate brachytherapy: 2010 update.

    Science.gov (United States)

    Buyyounouski, Mark K; Davis, Brian J; Prestidge, Bradley R; Shanahan, Thomas G; Stock, Richard G; Grimm, Peter D; Demanes, D Jeffrey; Zaider, Marco; Horwitz, Eric M

    2012-01-01

    To help establish patterns of care and standards of care of interstitial permanent low-dose-rate (LDR) and temporary high-dose-rate brachytherapy for prostate cancer and to compare the results with a similar 1998 American Brachytherapy Society (ABS) survey. A comprehensive questionnaire intended to survey specific details of current clinical brachytherapy practice was provided to the participants of the seventh ABS Prostate Brachytherapy School. Responses were tabulated and descriptive statistics are reported. Sixty-five brachytherapy practitioners responded to the survey. Eighty-nine percent (89%) of respondents performed LDR and 49% perform high-dose-rate brachytherapy. The median number of years of experience for LDR brachytherapists increased from 5 to 10 years over the course of the 12 years since the preceding survey. Compared with the first ABS, a smaller proportion of respondents received formal brachytherapy residency training (43% vs. 56%) or formal "hands-on" brachytherapy training (15% vs. 63%). There has been a marked decline in the utilization of the Mick applicator (Mick Radio-Nuclear Instruments, Inc., Mount Vernon, NY, USA) (60% vs. 28%) and an increase in the use of stranded seeds (40% vs. 11%). Compliance with postimplant dosimetry was higher in the 2010 survey. This survey does suggest an evolution in the practice of LDR brachytherapy since 1998 and aids in identifying aspects that require further progress or investigation. ABS guidelines and other practice recommendations appear to impact the practice of brachytherapy. Copyright © 2012 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  18. Current practice in out-of-hospital cardiac arrest management

    DEFF Research Database (Denmark)

    Proclemer, Alessandro; Dobreanu, Dan; Pison, Laurent

    2012-01-01

    AIMS: The purpose of this EP wire is to examine clinical practice in the field of out-of-hospital cardiac arrest (OHCA) management, with special focus on in-hospital diagnostic and therapeutic strategies. METHODS AND RESULTS: Fifty-three European centres, all members of the EHRA-EP Research network......, completed the questions of the survey. A dedicated strategy for OHCA management is active in 85% of the centres. Shockable tachyarrhythmias such as initial OHCA rhythm are reported in >70% of the patients in 64% of the centres. In-hospital therapeutic hypothermia was applied in >50% of the patients in 53...... management strategy, including coronary angiography/PCI and implantable cardioverter defibrillator therapy, while therapeutic hypothermia appears to be underused....

  19. The Current State of Rural Neurosurgical Practice: An International Perspective.

    Science.gov (United States)

    Upadhyayula, Pavan S; Yue, John K; Yang, Jason; Birk, Harjus S; Ciacci, Joseph D

    2018-01-01

    Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. A comprehensive literature search was performed for English language manuscripts with keywords "rural" and "neurosurgery" using the National Library of Medicine PubMed database (01/1971-06/2017). Twenty-four articles focusing on rural non-neurosurgical practice were included. Time to care and/or surgery and shortage of trained personnel remain the strongest risk factors for mortality and poor outcome. Telemedicine consults to regional centers with neurosurgery housestaff have potential for increased timeliness of diagnosis/triage, improved time to surgery, and reductions in unnecessary transfers in remote areas. Mobile neurosurgery teams have been deployed with success in nations with large transport distances precluding initial transfers. Common neurosurgical procedures involve trauma mechanisms; accordingly, training programs for nonneurosurgery medical personnel on basic assessment and operative techniques have been successful in resource-deficient settings where neurosurgeons are unavailable. Protracted transport times, lack of resources/training, and difficulty retaining specialists are barriers to successful outcomes. Advances in telemedicine, mobile neurosurgery, and training programs for urgent operative techniques have been implemented efficaciously. Development of guidelines for paired partnerships between rural centers and academic hospitals, supplying surplus technology to rural areas, and rapid training of qualified local surgical personnel can create sustainable feed-forward programs for trainees and infrastructural solutions to address challenges in rural neurosurgery.

  20. Gastroesophageal reflux disease in pediatric practice: current topical issues

    Directory of Open Access Journals (Sweden)

    O.Yu. Bielousova

    2017-03-01

    Full Text Available In recent years, much attention has been paid to the upper digestive tract diseases in children, particularly gastroesophageal reflux disease, as a cause that has an impact on the quality of life, even in children of school age, and thereafter in young adults. Consequently, there are searches for optimization of early detection, new me-thods of non-invasive diagnosis, screening of this pathology in children’s population in order to determine persons with risk factors and to control disease development and complicated course, as well as searches for the formation of preventive activities algorithm. Scientists came to a consensus that all examinations, which are used in pediatric practice, must be maximally available, simple and non-invasive to the extent of child’s condition. The question about advisability of performing esophagogastroduodenoscopy for all patients with complaints of heartburn and with other symptoms of gastroesophageal reflux disease, the question relative to performing ultrasonography of the esophagus in children as an additional method of examination, usage of questionnaire in pediatric practice, formation of disease course prediction algorithm, and identification of preventive measures specific to every patient remain open. In order to explain their application, the developmental mechanisms of this pathology must be well-understood, and individual risk factors that may influence disease severity and disease course prediction, which occur in children in different periods of life, must be taken into account. Therefore, the goal of this research is to provide an overview of modern literature with reference to topical issues of clinical evidence, risk factors, diagnosis, prediction of gastroesophageal reflux disease course in children of different ages (regarding main causative and pathogenic factors, clinical evidence (esophageal and extra-esophageal, diagnostic methods and modern approaches to gastroesophageal reflux disease

  1. The current state of rural neurosurgical practice: An international perspective

    Directory of Open Access Journals (Sweden)

    Pavan S Upadhyayula

    2018-01-01

    Full Text Available Introduction: Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. Methods: A comprehensive literature search was performed for English language manuscripts with keywords “rural” and “neurosurgery” using the National Library of Medicine PubMed database (01/1971–06/2017. Twenty-four articles focusing on rural non-neurosurgical practice were included. Results: Time to care and/or surgery and shortage of trained personnel remain the strongest risk factors for mortality and poor outcome. Telemedicine consults to regional centers with neurosurgery housestaff have potential for increased timeliness of diagnosis/triage, improved time to surgery, and reductions in unnecessary transfers in remote areas. Mobile neurosurgery teams have been deployed with success in nations with large transport distances precluding initial transfers. Common neurosurgical procedures involve trauma mechanisms; accordingly, training programs for nonneurosurgery medical personnel on basic assessment and operative techniques have been successful in resource-deficient settings where neurosurgeons are unavailable. Conclusions: Protracted transport times, lack of resources/training, and difficulty retaining specialists are barriers to successful outcomes. Advances in telemedicine, mobile neurosurgery, and training programs for urgent operative techniques have been implemented efficaciously. Development of guidelines for paired partnerships between rural centers and academic hospitals, supplying surplus technology to rural areas, and rapid training of qualified local surgical personnel can create sustainable feed-forward programs for trainees and

  2. The Current State of Rural Neurosurgical Practice: An International Perspective

    Science.gov (United States)

    Upadhyayula, Pavan S.; Yue, John K.; Yang, Jason; Birk, Harjus S.; Ciacci, Joseph D.

    2018-01-01

    Introduction: Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. Methods: A comprehensive literature search was performed for English language manuscripts with keywords “rural” and “neurosurgery” using the National Library of Medicine PubMed database (01/1971–06/2017). Twenty-four articles focusing on rural non-neurosurgical practice were included. Results: Time to care and/or surgery and shortage of trained personnel remain the strongest risk factors for mortality and poor outcome. Telemedicine consults to regional centers with neurosurgery housestaff have potential for increased timeliness of diagnosis/triage, improved time to surgery, and reductions in unnecessary transfers in remote areas. Mobile neurosurgery teams have been deployed with success in nations with large transport distances precluding initial transfers. Common neurosurgical procedures involve trauma mechanisms; accordingly, training programs for nonneurosurgery medical personnel on basic assessment and operative techniques have been successful in resource-deficient settings where neurosurgeons are unavailable. Conclusions: Protracted transport times, lack of resources/training, and difficulty retaining specialists are barriers to successful outcomes. Advances in telemedicine, mobile neurosurgery, and training programs for urgent operative techniques have been implemented efficaciously. Development of guidelines for paired partnerships between rural centers and academic hospitals, supplying surplus technology to rural areas, and rapid training of qualified local surgical personnel can create sustainable feed-forward programs for trainees and infrastructural solutions to

  3. Teacher feedback during active learning: current practices in primary schools.

    Science.gov (United States)

    van den Bergh, Linda; Ros, Anje; Beijaard, Douwe

    2013-06-01

    Feedback is one of the most powerful tools, which teachers can use to enhance student learning. It appears difficult for teachers to give qualitatively good feedback, especially during active learning. In this context, teachers should provide facilitative feedback that is focused on the development of meta-cognition and social learning. The purpose of the present study is to contribute to the existing knowledge about feedback and to give directions to improve teacher feedback in the context of active learning. The participants comprised 32 teachers who practiced active learning in the domain of environmental studies in the sixth, seventh, or eighth grade of 13 Dutch primary schools. A total of 1,465 teacher-student interactions were examined. Video observations were made of active learning lessons in the domain of environmental studies. A category system was developed based on the literature and empirical data. Teacher-student interactions were assessed using this system. Results. About half of the teacher-student interactions contained feedback. This feedback was usually focused on the tasks that were being performed by the students and on the ways in which these tasks were processed. Only 5% of the feedback was explicitly related to a learning goal. In their feedback, the teachers were directing (rather than facilitating) the learning processes. During active learning, feedback on meta-cognition and social learning is important. Feedback should be explicitly related to learning goals. In practice, these kinds of feedback appear to be scarce. Therefore, giving feedback during active learning seems to be an important topic for teachers' professional development. © 2012 The British Psychological Society.

  4. Are the physical activity parenting practices reported by U.S. and Canadian parents captured in currently published instruments?

    Science.gov (United States)

    The purpose of this study was to compare the physical activity parenting practices (PAPPs) parents report using with the PAPPs incorporated in the published literature. PAPPs in the literature were identified by reviewing the content of 74 published PAPPs measures obtained from current systematic re...

  5. Sensitivity analysis of the STICS-MACRO model to identify cropping practices reducing pesticides losses.

    Science.gov (United States)

    Lammoglia, Sabine-Karen; Makowski, David; Moeys, Julien; Justes, Eric; Barriuso, Enrique; Mamy, Laure

    2017-02-15

    STICS-MACRO is a process-based model simulating the fate of pesticides in the soil-plant system as a function of agricultural practices and pedoclimatic conditions. The objective of this work was to evaluate the influence of crop management practices on water and pesticide flows in contrasted environmental conditions. We used the Morris screening sensitivity analysis method to identify the most influential cropping practices. Crop residues management and tillage practices were shown to have strong effects on water percolation and pesticide leaching. In particular, the amount of organic residues added to soil was found to be the most influential input. The presence of a mulch could increase soil water content so water percolation and pesticide leaching. Conventional tillage was also found to decrease pesticide leaching, compared to no-till, which is consistent with many field observations. The effects of the soil, crop and climate conditions tested in this work were less important than those of cropping practices. STICS-MACRO allows an ex ante evaluation of cropping systems and agricultural practices, and of the related pesticides environmental impacts. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. Small Wind Turbine Applications: Current Practice in Colorado

    International Nuclear Information System (INIS)

    Green, Jim

    1999-01-01

    Numerous small wind turbines are being used by homeowners in Colorado. Some of these installations are quite recent while others date back to the federal tax-credit era of the early 1980s. Through visits with small wind turbine owners in Colorado, I have developed case studies of six small wind energy applications focusing on the wind turbine technology, wind turbine siting, the power systems and electric loads, regulatory issues, and motivations about wind energy. These case studies offer a glimpse into the current state-of-the-art of small-scale wind energy and provide some insight into issues affecting development of a wider market

  7. Robotic general surgery: current practice, evidence, and perspective.

    Science.gov (United States)

    Jung, M; Morel, P; Buehler, L; Buchs, N C; Hagen, M E

    2015-04-01

    Robotic technology commenced to be adopted for the field of general surgery in the 1990s. Since then, the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, CA, USA) has remained by far the most commonly used system in this domain. The da Vinci surgical system is a master-slave machine that offers three-dimensional vision, articulated instruments with seven degrees of freedom, and additional software features such as motion scaling and tremor filtration. The specific design allows hand-eye alignment with intuitive control of the minimally invasive instruments. As such, robotic surgery appears technologically superior when compared with laparoscopy by overcoming some of the technical limitations that are imposed on the surgeon by the conventional approach. This article reviews the current literature and the perspective of robotic general surgery. While robotics has been applied to a wide range of general surgery procedures, its precise role in this field remains a subject of further research. Until now, only limited clinical evidence that could establish the use of robotics as the gold standard for procedures of general surgery has been created. While surgical robotics is still in its infancy with multiple novel systems currently under development and clinical trials in progress, the opportunities for this technology appear endless, and robotics should have a lasting impact to the field of general surgery.

  8. Gas Hydrate Investigations Using Pressure Core Analysis: Current Practice

    Science.gov (United States)

    Schultheiss, P.; Holland, M.; Roberts, J.; Druce, M.

    2006-12-01

    Recently there have been a number of major gas hydrate expeditions, both academic and commercially oriented, that have benefited from advances in the practice of pressure coring and pressure core analysis, especially using the HYACINTH pressure coring systems. We report on the now mature process of pressure core acquisition, pressure core handling and pressure core analysis and the results from the analysis of pressure cores, which have revealed important in situ properties along with some remarkable views of gas hydrate morphologies. Pressure coring success rates have improved as the tools have been modified and adapted for use on different drilling platforms. To ensure that pressure cores remain within the hydrate stability zone, tool deployment, recovery and on-deck handling procedures now mitigate against unwanted temperature rises. Core analysis has been integrated into the core transfer protocol and automated nondestructive measurements, including P-wave velocity, gamma density, and X-ray imaging, are routinely made on cores. Pressure cores can be subjected to controlled depressurization experiments while nondestructive measurements are being made, or cores can be stored at in situ conditions for further analysis and subsampling.

  9. Somatic cell nuclear transfer cloning: practical applications and current legislation.

    Science.gov (United States)

    Niemann, H; Lucas-Hahn, A

    2012-08-01

    Somatic cloning is emerging as a new biotechnology by which the opportunities arising from the advances in molecular genetics and genome analysis can be implemented in animal breeding. Significant improvements have been made in SCNT protocols in the past years which now allow to embarking on practical applications. The main areas of application of SCNT are: Reproductive cloning, therapeutic cloning and basic research. A great application potential of SCNT based cloning is the production of genetically modified (transgenic) animals. Somatic cell nuclear transfer based transgenic animal production has significant advances over the previously employed microinjection of foreign DNA into pronuclei of zygotes. This cell based transgenesis is compatible with gene targeting and allows both, the addition of a specific gene and the deletion of an endogenous gene. Efficient transgenic animal production provides numerous opportunities for agriculture and biomedicine. Regulatory agencies around the world have agreed that food derived from cloned animals and their offspring is safe and there is no scientific basis for questioning this. Commercial application of somatic cloning within the EU is via the Novel Food regulation EC No. 258/97. Somatic cloning raises novel questions regarding the ethical and moral status of animals and their welfare which has prompted a controversial discussion in Europe which has not yet been resolved. © 2012 Blackwell Verlag GmbH.

  10. Brachytherapy in Europe: philosophies, current practice and future directions

    International Nuclear Information System (INIS)

    Haworth, A.

    2000-01-01

    Full text: Five months sabbatical leave provided an opportunity to visit six radiotherapy centres in France, Holland and England. While brachytherapy philosophies and practices within each country were similar, there were considerable differences in attitudes between countries. The Institute Gustave Roussy, home of the Paris System and host for the French sector confirmed that the Paris System is still very much the preferred dosimetry method in this part of the world. Though their preference for low dose rate brachytherapy is still evident, high dose rate brachytherapy has found some applications but the rules of the Paris System are never far away and the words 'what about the hyperdose sleeve' are firmly implanted into this visitor's brain. The use of real time dosimetry for I-125 prostate brachytherapy at the Institute Curie (Paris) provided an interesting contrast to the standard pre and post implant dosimetry techniques commonly employed elsewhere. The two Dutch centres on the itinerary, in stark contrast to the traditional techniques seen in France, have applied the power of computers to investigate optimisation of the classic dosimetry systems and called on the analysis techniques (DVH, NTCP, TCP etc) now familiar to us all in external beam therapy. The Cookridge Hospital in England fitted somewhere between the French and Dutch centres. This centre showed how both modern and traditional techniques could be applied in an efficient way for a large variety of treatment sites. Copyright (2000) Australasian College of Physical Scientists and Engineers in Medicine

  11. Current Developments and Best Practice in Open and Distance Learning

    Directory of Open Access Journals (Sweden)

    Armando Rocha Trinidade

    2000-06-01

    Full Text Available Through the many documents regularly emitted by those dedicated to this activity, it is comparatively easy to describe factual developments in the field of open and distance education in different places in the world. However, it is much more difficult to produce judgements of value about their quality. Quality is a subjective rather than an absolute concept and may be examined from different analytical perspectives: consumers' satisfaction level, intrinsic value of scientific and technical content of learning materials, soundness of learning strategies, efficiency of organisation and procedures, adequate use of advanced technologies, reliability of student support mechanisms, etc.These parameters should be put into the context of specific objectives, nature of target populations and availability of different kinds of resources. In a specific geographic, social, economic and cultural situation a given set of solutions might be judged as adequate and deserving the qualification of "good practice," while in a different context it could be considered of rather poor quality.The selection of examples in this article is the sole responsibility of the authors: neither should the chosen cases be considered as clearly better than any other one, nor missing cases be interpreted as lack of appreciation or a negative judgement.Finally, the authors are aware of the risks of interpreting trends and trying to extrapolate them into the near future: readers should use their own judgement in accepting (or forcefully rejecting these projections.

  12. Revisiting reflexology: Concept, evidence, current practice, and practitioner training.

    Science.gov (United States)

    Embong, Nurul Haswani; Soh, Yee Chang; Ming, Long Chiau; Wong, Tin Wui

    2015-10-01

    Reflexology is basically a study of how one part of the human body relates to another part of the body. Reflexology practitioners rely on the reflexes map of the feet and hands to all the internal organs and other human body parts. They believe that by applying the appropriate pressure and massage certain spots on the feet and hands, all other body parts could be energized and rejuvenated. This review aimed to revisit the concept of reflexology and examine its effectiveness, practices, and the training for reflexology practitioners. PubMed, SCOPUS, Google Scholar, and SpringerLink databases were utilized to search the following medical subject headings or keywords: foot massage, reflexology, foot reflexotherapy, reflexological treatment, and zone therapy. The articles published for the last 10 years were included. Previous systematic reviews failed to show concrete evidence for any specific effect of reflexology in any conditions. Due to its non-invasive, non-pharmacological complementary nature, reflexology is widely accepted and anecdotal evidence of positive effect reflexology in a variety of health conditions are available. Adequate training for practitioners is necessary to ensure the consistency of service provided.

  13. Revisiting reflexology: Concept, evidence, current practice, and practitioner training

    Directory of Open Access Journals (Sweden)

    Nurul Haswani Embong

    2015-10-01

    Full Text Available Reflexology is basically a study of how one part of the human body relates to another part of the body. Reflexology practitioners rely on the reflexes map of the feet and hands to all the internal organs and other human body parts. They believe that by applying the appropriate pressure and massage certain spots on the feet and hands, all other body parts could be energized and rejuvenated. This review aimed to revisit the concept of reflexology and examine its effectiveness, practices, and the training for reflexology practitioners. PubMed, SCOPUS, Google Scholar, and SpringerLink databases were utilized to search the following medical subject headings or keywords: foot massage, reflexology, foot reflexotherapy, reflexological treatment, and zone therapy. The articles published for the last 10 years were included. Previous systematic reviews failed to show concrete evidence for any specific effect of reflexology in any conditions. Due to its non-invasive, non-pharmacological complementary nature, reflexology is widely accepted and anecdotal evidence of positive effect reflexology in a variety of health conditions are available. Adequate training for practitioners is necessary to ensure the consistency of service provided.

  14. Overview of robotic colorectal surgery: Current and future practical developments

    Science.gov (United States)

    Roy, Sudipta; Evans, Charles

    2016-01-01

    Minimal access surgery has revolutionised colorectal surgery by offering reduced morbidity and mortality over open surgery, while maintaining oncological and functional outcomes with the disadvantage of additional practical challenges. Robotic surgery aids the surgeon in overcoming these challenges. Uptake of robotic assistance has been relatively slow, mainly because of the high initial and ongoing costs of equipment but also because of limited evidence of improved patient outcomes. Advances in robotic colorectal surgery will aim to widen the scope of minimal access surgery to allow larger and more complex surgery through smaller access and natural orifices and also to make the technology more economical, allowing wider dispersal and uptake of robotic technology. Advances in robotic endoscopy will yield self-advancing endoscopes and a widening role for capsule endoscopy including the development of motile and steerable capsules able to deliver localised drug therapy and insufflation as well as being recharged from an extracorporeal power source to allow great longevity. Ultimately robotic technology may advance to the point where many conventional surgical interventions are no longer required. With respect to nanotechnology, surgery may eventually become obsolete. PMID:26981188

  15. Labelling of electronic cigarettes: regulations and current practice.

    Science.gov (United States)

    Buonocore, Federico; Marques Gomes, Ana C N; Nabhani-Gebara, Shereen; Barton, Stephen J; Calabrese, Gianpiero

    2017-01-01

    Over the past decade e-cigarettes have established themselves in the global market. E-cigarettes triggered much interest in relation to their content and efficacy as smoking cessation tools, but less attention has been paid to users and environmental safety warnings and guidance. Several regulations have been introduced to promote their safe handling and disposal. From May 2016, liquids and cartridges will be regulated by European Community Directives (ECDs) 2001/83/EC and 93/42/EEC, or 2014/40/EU if marketed as tobacco-related products. Currently, manufacturers and distributors must abide by the Chemical (Hazard Information and Packaging for Supply) Regulations 2009 (CHIP) or Classification, Labelling and Packaging Regulations (CLP), the latter replacing CHIP in June 2015. In this work, the compliance of marketed e-liquids and e-cigarettes with current European Union and UK legislations is assessed. E-liquids and e-cigarettes (21 and 9 brands, respectively) were evaluated. Evidence of non-compliance was found in relation to the CHIP/CLP toxic (13%) and environmental (37%) pictograms, tactile warning (23%), nominal amount of solution (30%), supplier contact telephone number and address (40%). None of the evaluated e-cigarettes displayed information on the correct disposal/recycling of batteries in line with the ECD 2006/66/EC. More stringent enforcement of regulations is needed to ensure not only the user's safety and awareness, but also the safeguarding of the environment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  16. China's spent nuclear fuel management: Current practices and future strategies

    International Nuclear Information System (INIS)

    Zhou Yun

    2011-01-01

    Although China's nuclear power industry is relatively young and the management of its spent nuclear fuel is not yet a concern, China's commitment to nuclear energy and its rapid pace of development require detailed analyses of its future spent fuel management policies. The purpose of this study is to provide an overview of China's fuel cycle program and its reprocessing policy, and to suggest strategies for managing its future fuel cycle program. The study is broken into four sections. The first reviews China's current nuclear fuel cycle program and facilities. The second discusses China's current spent fuel management methods and the storage capability of China's 13 operational nuclear power plants. The third estimates China's total accumulated spent fuel, its required spent fuel storage from present day until 2035, when China expects its first commercialized fast neutron reactors to be operational, and its likely demand for uranium resources. The fourth examines several spent fuel management scenarios for the present period up until 2035; the financial cost and proliferation risk of each scenario is evaluated. The study concludes that China can and should maintain a reprocessing operation to meet its R and D activities before its fast reactor program is further developed. - Highlights: → This study provides an overview of China's fuel cycle program and its reprocessing policy.→ This study suggests strategies for managing its future fuel cycle program.→ China will experience no pressure to lessen the burden of spent fuel storage in the next 30 years.→ China should maintain sufficient reprocessing operations to meet its demands for R and D activities.→ China should actively invest on R and D activities of both fuel cycling and fast reactor programs.

  17. Eliciting, Identifying, Interpreting, and Responding to Students' Ideas: Teacher Candidates' Growth in Formative Assessment Practices

    Science.gov (United States)

    Gotwals, Amelia Wenk; Birmingham, Daniel

    2016-06-01

    With the goal of helping teacher candidates become well-started beginners, it is important that methods courses in teacher education programs focus on high-leverage practices. Using responsive teaching practices, specifically eliciting, identifying, interpreting, and responding to students' science ideas (i.e., formative assessment), can be used to support all students in learning science successfully. This study follows seven secondary science teacher candidates in a yearlong practice-based methods course. Course assignments (i.e., plans for and reflections on teaching) as well as teaching videos were analyzed using a recursive qualitative approach. In this paper, we present themes and patterns in teacher candidates' abilities to elicit, identify, interpret, and respond to students' ideas. Specifically, we found that those teacher candidates who grew in the ways in which they elicited students' ideas from fall to spring were also those who were able to adopt a more balanced reflection approach (considering both teacher and student moves). However, we found that even the teacher candidates who grew in these practices did not move toward seeing students' ideas as nuanced; rather, they saw students' ideas in a dichotomous fashion: right or wrong. We discuss implications for teacher preparation, specifically for how to promote productive reflection and tools for better understanding students' ideas.

  18. 76 FR 38399 - Assessing the Current Research, Policy, and Practice Environment in Public Health Genomics

    Science.gov (United States)

    2011-06-30

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention [Docket Number CDC-2011-0008] Assessing the Current Research, Policy, and Practice Environment in Public Health... information helpful to assess the current research, policy, and practice environment in public health genomics...

  19. Recently Identified Changes to the Demographics of the Current and Future Geoscience Workforce

    Science.gov (United States)

    Wilson, C. E.; Keane, C. M.; Houlton, H. R.

    2014-12-01

    The American Geosciences Institute's (AGI) Geoscience Workforce Program collects and analyzes data pertaining to the changes in the supply, demand, and training of the geoscience workforce. Much of these trends are displayed in detail in AGI's Status of the Geoscience Workforce reports. In May, AGI released the Status of the Geoscience Workforce 2014, which updates these trends since the 2011 edition of this report. These updates highlight areas of change in the education of future geoscientists from K-12 through graduate school, the transition of geoscience graduates into early-career geoscientists, the dynamics of the current geoscience workforce, and the future predictions of the changes in the availability of geoscience jobs. Some examples of these changes include the increase in the number of states that will allow a high school course of earth sciences as a credit for graduation and the increasing importance of two-year college students as a talent pool for the geosciences, with over 25% of geoscience bachelor's graduates attending a two-year college for at least a semester. The continued increase in field camp hinted that these programs are at or reaching capacity. The overall number of faculty and research staff at four-year institutions increased slightly, but the percentages of academics in tenure-track positions continued to slowly decrease since 2009. However, the percentage of female faculty rose in 2013 for all tenure-track positions. Major geoscience industries, such as petroleum and mining, have seen an influx of early-career geoscientists. Demographic trends in the various industries in the geoscience workforce forecasted a shortage of approximately 135,000 geoscientists in the next decade—a decrease from the previously predicted shortage of 150,000 geoscientists. These changes and other changes identified in the Status of the Geoscience Workforce will be addressed in this talk.

  20. The mining sector of Liberia: current practices and environmental challenges.

    Science.gov (United States)

    Wilson, Samuel T K; Wang, Hongtao; Kabenge, Martin; Qi, Xuejiao

    2017-08-01

    Liberia is endowed with an impressive stock of mineral reserves and has traditionally relied on mining, namely iron ore, gold, and diamonds, as a major source of income. The recent growth in the mining sector has the potential to contribute significantly to employment, income generation, and infrastructure development. However, the development of these mineral resources has significant environmental impacts that often go unnoticed. This paper presents an overview of the Liberian mining sector from historical, current development, and economic perspectives. The efforts made by government to address issues of environmental management and sustainable development expressed in national and international frameworks, as well as some of the environmental challenges in the mining sector are analyzed. A case study was conducted on one of the iron ore mines (China Union Bong Mines Investment) to analyze the effects of the water quality on the local water environment. The results show that the analyzed water sample concentrations were all above the WHO and Liberia water standard Class I guidelines for drinking water. Finally the paper examines the application of water footprint from a life cycle perspective in the Liberian mining sector and suggests some policy options for water resources management.

  1. Current practices in generation of small molecule new leads.

    Science.gov (United States)

    Goodnow, R A

    2001-01-01

    The current drug discovery processes in many pharmaceutical companies require large and growing collections of high quality lead structures for use in high throughput screening assays. Collections of small molecules with diverse structures and "drug-like" properties have, in the past, been acquired by several means: by archive of previous internal lead optimization efforts, by purchase from compound vendors, and by union of separate collections following company mergers. More recently, many drug discovery companies have established dedicated efforts to effect synthesis by internal and/or outsourcing efforts of targeted compound libraries for new lead generation. Although high throughput/combinatorial chemistry is an important component in the process of new lead generation, the selection of library designs for synthesis and the subsequent design of library members has evolved to a new level of challenge and importance. The potential benefits of screening multiple small molecule compound library designs against multiple biological targets offers substantial opportunity to discover new lead structures. Subsequent optimization of such compounds is often accelerated because of the structure-activity relationship (SAR) information encoded in these lead generation libraries. Lead optimization is often facilitated due to the ready applicability of high-throughput chemistry (HTC) methods for follow-up synthesis. Some of the strategies, trends, and critical issues central to the success of lead generation processes are discussed below. Copyright 2002 Wiley-Liss, Inc.

  2. Turbine Engine Clearance Control Systems: Current Practices and Future Directions

    Science.gov (United States)

    Lattime, Scott B.; Steinetz, Bruce M.

    2002-01-01

    Improved blade tip sealing in the high pressure compressor (HPC) and high pressure turbine (HPT) can provide dramatic reductions in specific fuel consumption (SFC), time-on-wing, compressor stall margin, and engine efficiency as well as increased payload and mission range capabilities. Maintenance costs to overhaul large commercial gas turbine engines can easily exceed $1M. Engine removal from service is primarily due to spent exhaust gas temperature (EGT) margin caused mainly by the deterioration of HPT components. Increased blade tip clearance is a major factor in hot section component degradation. As engine designs continue to push the performance envelope with fewer parts and the market drives manufacturers to increase service life, the need for advanced sealing continues to grow. A review of aero gas turbine engine HPT performance degradation and the mechanisms that promote these losses are discussed. Benefits to the HPT due to improved clearance management are identified. Past and present sealing technologies are presented along with specifications for next generation engine clearance control systems.

  3. Radioactive waste disposal in Slovakia: Current practice and development

    International Nuclear Information System (INIS)

    Salzer, P.; Hanusik, V.; Ehn, L.

    2002-01-01

    The paper describes activities concerning the disposal of radioactive waste in the Slovak Republic. For disposal of the low and intermediate short-lived radioactive waste, the National radioactive waste repository Mochovce (near surface type) was put into operation in 1999. History and approaches to repository development, siting and construction are briefly described. Recent activities regarding the repository are concerning on the safety re-assessment and re-derivation of coherent waste acceptance criteria, studies of repository covering and possible enlargement. In the second part, attention is given to the Slovak deep geological repository development programme, which has been under way since 1996. Most of the results were obtained from the siting part of the programme, where four localities (six sites) were identified as prospective for next investigation. The paper also gives an overview on next two routes of deep repository development programme: studies resulted later in performance assessment and general activities, i.e. design studies, analysis of legislative and infrastructure conditions, planning and evaluation of works. (author)

  4. Identifying best practice in relation to Iodine-131 ablation discharges to sewers in Ireland

    International Nuclear Information System (INIS)

    Ryan, Thomas P.; Fennell, Stepehn; McGarry, Ann; Punt, Adrian

    2008-01-01

    Full text: In line with a commitment in Ireland's strategy on the implementation of the Oslo-Paris Convention (OSPAR) as well as recent developments in the provision of national oncology services, best practice in relation to Iodine-131 (I-131) ablation discharges to sewers in Ireland is under review. Preparatory to this review the Radiological Protection Institute of Ireland (RPII) commissioned a study of current practices in Ireland and associated doses as well as a review of international best practice and advice. Currently, there are three hospitals in Ireland at which thyroid ablation therapy procedures (large therapeutic administrations of I-131 for thyroid cancer treatment) are carried out. Only one facility has a limited capacity for delay and decay storage prior to discharge. Based on current administrations and discharges, the potentially most exposed workers comprises hospital plumbers dealing with specific incidents with estimated doses in the order of 50 to 70 μSv per incident. Doses to sewage workers and fishing communities are estimated at less than 4 μSv y -1 and 0.4 μSv y -1 respectively. Based on anticipated future service requirements in Ireland, a marginal increase in doses to some of these groups is estimated. Iodine-131 discharges to the environment and associated doses to workers and members of the public may be significantly reduced by the introduction of state-of-the-art delay and decay tanks using multi-tank vacuum systems. The justification for the introduction of a regulatory requirement to install such systems is examined taking account of: discharges to the environment, concentrations in the environment, doses to workers and members of the public, best available techniques (BAT), international best practice and advice as well as the financial implications for medical facilities. The case for retrofitting delay and decay tanks to existing medical facilities is also examined as well as the option of including such tanks in the

  5. Prenatal screening: current practice, new developments, ethical challenges.

    Science.gov (United States)

    de Jong, Antina; Maya, Idit; van Lith, Jan M M

    2015-01-01

    Prenatal screening pathways, as nowadays offered in most Western countries consist of similar tests. First, a risk-assessment test for major aneuploides is offered to pregnant women. In case of an increased risk, invasive diagnostic tests, entailing a miscarriage risk, are offered. For decades, only conventional karyotyping was used for final diagnosis. Moreover, several foetal ultrasound scans are offered to detect major congenital anomalies, but the same scans also provide relevant information for optimal support of the pregnancy and the delivery. Recent developments in prenatal screening include the application of microarrays that allow for identifying a much broader range of abnomalities than karyotyping, and non-invasive prenatal testing (NIPT) that enables reducing the number of invasive tests for aneuploidies considerably. In the future, broad NIPT may become possible and affordable. This article will briefly address the ethical issues raised by these technological developments. First, a safe NIPT may lead to routinisation and as such challenge the central issue of informed consent and the aim of prenatal screening: to offer opportunity for autonomous reproductive choice. Widening the scope of prenatal screening also raises the question to what extent 'reproductive autonomy' is meant to expand. Finally, if the same test is used for two different aims, namely detection of foetal anomalies and pregnancy-related problems, non-directive counselling can no longer be taken as a standard. Our broad outline of the ethical issues is meant as an introduction into the more detailed ethical discussions about prenatal screening in the other articles of this special issue. © 2014 John Wiley & Sons Ltd.

  6. Serratia Infections: from Military Experiments to Current Practice

    Science.gov (United States)

    Mahlen, Steven D.

    2011-01-01

    Summary: Serratia species, in particular Serratia marcescens, are significant human pathogens. S. marcescens has a long and interesting taxonomic, medical experimentation, military experimentation, and human clinical infection history. The organisms in this genus, particularly S. marcescens, were long thought to be nonpathogenic. Because S. marcescens was thought to be a nonpathogen and is usually red pigmented, the U.S. military conducted experiments that attempted to ascertain the spread of this organism released over large areas. In the process, members of both the public and the military were exposed to S. marcescens, and this was uncovered by the press in the 1970s, leading to U.S. congressional hearings. S. marcescens was found to be a certain human pathogen by the mid-1960s. S. marcescens and S. liquefaciens have been isolated as causative agents of numerous outbreaks and opportunistic infections, and the association of these organisms with point sources such as medical devices and various solutions given to hospitalized patients is striking. Serratia species appear to be common environmental organisms, and this helps to explain the large number of nosocomial infections due to these bacteria. Since many nosocomial infections are caused by multiply antibiotic-resistant strains of S. marcescens, this increases the danger to hospitalized patients, and hospital personnel should be vigilant in preventing nosocomial outbreaks due to this organism. S. marcescens, and probably other species in the genus, carries several antibiotic resistance determinants and is also capable of acquiring resistance genes. S. marcescens and S. liquefaciens are usually identified well in the clinical laboratory, but the other species are rare enough that laboratory technologists may not recognize them. 16S rRNA gene sequencing may enable better identification of some of the less common Serratia species. PMID:21976608

  7. Protocol for audit of current Filipino practice in rehabilitation of stroke inpatients.

    Science.gov (United States)

    Gonzalez-Suarez, Consuelo B; Dizon, Janine Margarita R; Grimmer, Karen; Estrada, Myrna S; Liao, Lauren Anne S; Malleta, Anne-Rochelle D; Tan, Ma Elena R; Marfil, Vero; Versales, Cristina S; Suarez, Jimah L; So, Kleon C; Uyehara, Edgardo D

    2015-01-01

    Stroke is one of the leading medical conditions in the Philippines. Over 500,000 Filipinos suffer from stroke annually. Provision of evidence-based medical and rehabilitation management for stroke patients has been a challenge due to existing environmental, social, and local health system issues. Thus, existing western guidelines on stroke rehabilitation were contextualized to draft recommendations relevant to the local Philippine setting. Prior to fully implementing the guidelines, an audit of current practice needs to be undertaken, thus the purpose of this audit protocol. A clinical audit of current practices in stroke rehabilitation in the Philippines will be undertaken. A consensus list of data items to be captured was identified by the audit team during a 2-day meeting in 2012. These items, including patient demographics, type of stroke, time to referral for rehabilitation management, length of hospital stay, and other relevant descriptors of stroke management were included as part of the audit. Hospitals in the Philippines will be recruited to take part in the audit activity. Recruitment will be via the registry of the Philippine Academy of Rehabilitation Medicine, where 90% of physiatrists (medical doctors specialized in rehabilitation medicine) are active members and are affiliated with various hospitals in the Philippines. Data collectors will be identified and trained in the audit process. A pilot audit will be conducted to test the feasibility of the audit protocol, and refinements to the protocol will be undertaken as necessary. The comprehensive audit process will take place for a period of 3 months. Data will be encoded using MS Excel(®). Data will be reported as means and percentages as appropriate. Subgroup analysis will be undertaken to look into differences and variability of stroke patient descriptors and rehabilitation activities. This audit study is an ambitious project, but given the "need" to conduct the audit to identify "gaps" in current

  8. Current practice in software development for computational neuroscience and how to improve it.

    Science.gov (United States)

    Gewaltig, Marc-Oliver; Cannon, Robert

    2014-01-01

    Almost all research work in computational neuroscience involves software. As researchers try to understand ever more complex systems, there is a continual need for software with new capabilities. Because of the wide range of questions being investigated, new software is often developed rapidly by individuals or small groups. In these cases, it can be hard to demonstrate that the software gives the right results. Software developers are often open about the code they produce and willing to share it, but there is little appreciation among potential users of the great diversity of software development practices and end results, and how this affects the suitability of software tools for use in research projects. To help clarify these issues, we have reviewed a range of software tools and asked how the culture and practice of software development affects their validity and trustworthiness. We identified four key questions that can be used to categorize software projects and correlate them with the type of product that results. The first question addresses what is being produced. The other three concern why, how, and by whom the work is done. The answers to these questions show strong correlations with the nature of the software being produced, and its suitability for particular purposes. Based on our findings, we suggest ways in which current software development practice in computational neuroscience can be improved and propose checklists to help developers, reviewers, and scientists to assess the quality of software and whether particular pieces of software are ready for use in research.

  9. Current practice in software development for computational neuroscience and how to improve it.

    Directory of Open Access Journals (Sweden)

    Marc-Oliver Gewaltig

    2014-01-01

    Full Text Available Almost all research work in computational neuroscience involves software. As researchers try to understand ever more complex systems, there is a continual need for software with new capabilities. Because of the wide range of questions being investigated, new software is often developed rapidly by individuals or small groups. In these cases, it can be hard to demonstrate that the software gives the right results. Software developers are often open about the code they produce and willing to share it, but there is little appreciation among potential users of the great diversity of software development practices and end results, and how this affects the suitability of software tools for use in research projects. To help clarify these issues, we have reviewed a range of software tools and asked how the culture and practice of software development affects their validity and trustworthiness. We identified four key questions that can be used to categorize software projects and correlate them with the type of product that results. The first question addresses what is being produced. The other three concern why, how, and by whom the work is done. The answers to these questions show strong correlations with the nature of the software being produced, and its suitability for particular purposes. Based on our findings, we suggest ways in which current software development practice in computational neuroscience can be improved and propose checklists to help developers, reviewers, and scientists to assess the quality of software and whether particular pieces of software are ready for use in research.

  10. Identifying critical thinking indicators and critical thinker attributes in nursing practice.

    Science.gov (United States)

    Chao, Shu-Yuan; Liu, Hsing-Yuan; Wu, Ming-Chang; Clark, Mary Jo; Tan, Jung-Ying

    2013-09-01

    Critical thinking is an essential skill in the nursing process. Although several studies have evaluated the critical thinking skills of nurses, there is limited information related to the indicators of critical thinking or evaluation of critical thinking in the context of the nursing process. This study investigated the potential indicators of critical thinking and the attributes of critical thinkers in clinical nursing practice. Knowledge of these indicators can aid the development of tools to assess nursing students' critical thinking skills. The study was conducted between September 2009 and August 2010. In phase 1, a literature review and four focus groups were conducted to identify the indicators of critical thinking in the context of nursing and the attributes of critical thinkers. In phase 2, 30 nursing professionals participated in a modified Delphi research survey to establish consensus and the appropriateness of each indicator and attribute identified in phase 1. We identified 37 indicators of critical thinking and 10 attributes of critical thinkers. The indicators were categorized into five subscales within the context of the nursing process toreflect nursing clinical practice: assessment, 16 indicators of ability to apply professional knowledge and skills to analyze and interpret patient problems; diagnosis, five indicators of ability to propose preliminary suppositions; planning, five indicators of ability to develop problem-solving strategies; implementation, five indicators of ability to implement planning; and evaluation, six indicators of ability to self-assess and reflect. The study operationalized critical thinking into a practical indicator suitable for nursing contexts in which critical thinking is required for clinical problem solving. Identified indicators and attributes can assist clinical instructors to evaluate student critical thought skills and development-related teaching strategies.

  11. Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening

    DEFF Research Database (Denmark)

    Buckley, B S; Harreiter, J; Damm, P

    2012-01-01

    Background: Gestational diabetes mellitus is a potentially serious condition that affects many pregnancies and its prevalence is increasing. Evidence suggests early detection and treatment improves outcomes, but this is hampered by continued disagreement and inconsistency regarding many aspects...... of its diagnosis. Methods: The Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus Prevention (DALI) research programme aims to promote pan-European standards in the detection and diagnosis of gestational diabetes and to develop effective preventive interventions. To provide...... an overview of the context within which the programme will be conducted and its findings interpreted, systematic searching and narrative synthesis have been used to identify and review the best available European evidence relating to the prevalence of gestational diabetes, current screening practices...

  12. Screening for developmental dysplasia of the hip: current practices in Ireland.

    LENUS (Irish Health Repository)

    O'Grady, M J

    2012-01-31

    OBJECTIVE: To ascertain the current approach to screen for developmental dysplasia of the hip in the Republic of Ireland. METHODS: Two-pronged prospective and retrospective study. (1) Postal questionnaire to consultant paediatricians responsible for the routine neonatal care of infants in the Irish Republic in June 2006. (2) Retrospective database review to identify infants undergoing radiological follow-up and their outcome. RESULTS: All maternity units surveyed responded. Most units (84%) were dependent on radiographs at 4-6 months for imaging hips, only two units primarily used ultrasound (10.5%). We estimate that neonatal hip examination is performed by an experienced examiner in less than 30% of routine newborn examinations. On retrospective analysis, 94% of radiographs performed were normal. CONCLUSIONS: The most effective interventions, selective ultrasound and examination by an experienced clinician are not widely practiced. There is a need for the development of national guidelines based on available resources.

  13. Identifying Natural syNergist from Pongamia pinnata Using High-Speed Counter-Current Chromatography Combined with Isobolographic Analysis

    Directory of Open Access Journals (Sweden)

    Hao Yin

    2017-03-01

    Full Text Available For identifying the synergistic compounds from Pongamia pinnata, an approach based on high-speed counter-current chromatography (HSCCC combined with isobolographic analysis was designed to detect the synergistic effects in the complex mixture [...

  14. Health impact assessment in Latin American countries: Current practice and prospects

    International Nuclear Information System (INIS)

    Pereira, Carlos A.R.; Périssé, André R.S.; Knoblauch, Astrid M.; Utzinger, Jürg; Hacon, Sandra de Souza

    2017-01-01

    Background: With the objective to avoid and mitigate potential adverse health impacts of projects, programmes and policies, health impact assessment (HIA) offers an opportunity for disease prevention and health promotion. Although HIA has gained importance over the past two decades, it is unclear whether and to what extent HIA practice has been established and institutionalised in Latin America. To address this issue, the current practice and prospects of HIA in Latin America was assessed in the peer-reviewed literature and existing guidelines. Methodology: The peer-reviewed literature was systematically searched using five electronic databases until February 2016. Studies were included on a set of pre-defined criteria. The search was carried out in English, French, Portuguese and Spanish. Additionally, a search for HIA guidelines used in Latin American countries and territories was performed by means of a Google search and on websites of government departments and institutions that may promote HIA. Results: The search yielded 167 hits in the peer-reviewed literature of which 17 articles met inclusion criteria. Only four peer-reviewed articles described prospective HIAs and four featured a discussion of the HIA approach. The remaining nine articles presented health impact evaluations. Most studies were published only recently, after 2012 (88%). Seven HIA guideline documents were identified, two of which were country-specific (i.e. Brazil and Mexico) and the remaining five addressed HIA at the regional level. Conclusions: This study confirmed the paucity of literature pertaining to HIA implementation, as well as HIA guidelines in Latin America. Mexico, Brazil and Cuba have the longest track record in scientific literature and guidelines on HIA. In order to better understand current barriers and limitations to practice and institutionalisation of HIA in Latin American countries, a broad discussion among policy makers, academic institutions and HIA practitioners is

  15. The Outwardly Rectifying Current of Layer 5 Neocortical Neurons that was Originally Identified as "Non-Specific Cationic" Is Essentially a Potassium Current.

    Directory of Open Access Journals (Sweden)

    Omer Revah

    Full Text Available In whole-cell patch clamp recordings from layer 5 neocortical neurons, blockade of voltage gated sodium and calcium channels leaves a cesium current that is outward rectifying. This current was originally identified as a "non-specific cationic current", and subsequently it was hypothesized that it is mediated by TRP channels. In order to test this hypothesis, we used fluorescence imaging of intracellular sodium and calcium indicators, and found no evidence to suggest that it is associated with influx of either of these ions to the cell body or dendrites. Moreover, the current is still prominent in neurons from TRPC1-/- and TRPC5-/- mice. The effects on the current of various blocking agents, and especially its sensitivity to intracellular tetraethylammonium, suggest that it is not a non-specific cationic current, but rather that it is generated by cesium-permeable delayed rectifier potassium channels.

  16. Assessment of current practice and barriers to antimicrobial prophylaxis in peritoneal dialysis patients.

    Science.gov (United States)

    Campbell, Denise J; Brown, Fiona G; Craig, Jonathan C; Gallagher, Martin P; Johnson, David W; Kirkland, Geoffrey S; Kumar, Subramanian K; Lim, Wai H; Ranganathan, Dwarakanathan; Saweirs, Walaa; Sud, Kamal; Toussaint, Nigel D; Walker, Rowan G; Williams, Lesley A; Yehia, Maha; Mudge, David W

    2016-04-01

    Existing Australasian and international guidelines outline antibiotic and antifungal measures to prevent the development of treatment-related infection in peritoneal dialysis (PD) patients. Practice patterns and rates of PD-related infection vary widely across renal units in Australia and New Zealand and are known to vary significantly from guideline recommendations, resulting in PD technique survival rates that are lower than those achieved in many other countries. The aim of this study was to determine if there is an association between current practice and PD-related infection outcomes and to identify the barriers and enablers to good clinical practice. This is a multicentre network study involving eight PD units in Australia and New Zealand, with a focus on adherence to guideline recommendations on antimicrobial prophylaxis in PD patients. Current practice was established by asking the PD unit heads to respond to a short survey about practice/protocols/policies and a 'process map' was constructed following a face-to-face interview with the primary PD nurse at each unit. The perceived barriers/enablers to adherence to the relevant guideline recommendations were obtained from the completion of 'cause and effect' diagrams by the nephrologist and PD nurse at each unit. Data on PD-related infections were obtained for the period 1 January 2011 to 31 December 2011. Perceived barriers that may result in reduced adherence to guideline recommendations included lack of knowledge, procedural lapses, lack of a centralized patient database, patients with non-English speaking background, professional concern about antibiotic resistance, medication cost and the inability of nephrologists and infectious diseases staff to reach consensus on unit protocols. The definitions of PD-related infections used by some units varied from those recommended by the International Society for Peritoneal Dialysis, particularly with exit-site infection (ESI). Wide variations were observed in the

  17. Measuring Infant and Young Child Complementary Feeding Practices: Indicators, Current Practice, and Research Gaps.

    Science.gov (United States)

    Ruel, Marie T

    2017-01-01

    The publication of the WHO Infant and Young Child Feeding (IYCF) indicators in 2008 equipped the nutrition and broader development community with an invaluable tool for measuring, documenting, and advocating for faster progress in improving these practices in low- and middle-income countries (LMICs). The indicators, with 5 of them focusing on complementary feeding (CF) practices, were originally designed for population level assessment, targeting, monitoring, and evaluation. This chapter takes stock of where we are with the existing CF indicators: it reviews how the indicators have been used, what we have learned, and what their strengths and limitations are, and it suggests a way forward. We find that the indicators have been used extensively for population level assessments and country comparisons, and to track progress. They have also been adopted by researchers in program impact evaluations and in research seeking to understand the determinants and consequences of poor CF practices for child growth and development outcomes. In addition to generating a wealth of knowledge and unveiling the severity of the global problem of poor CF practices in LMICs, the indicators have been an invaluable tool to raise awareness and call for urgent action on improving CF practices at scale. The indicators have strengths and limitations, which are summarized in this chapter. Although enormous progress has been achieved since the indicators were released in 2008, we feel it is time to reflect and revisit the CF indicators, improve them, develop new ones, and promote their appropriate use. Better indicators are critically important to stimulate action and investments in improving CF practices at scale. © 2017 Nestec Ltd., Vevey/S. Karger AG, Basel.

  18. Questioning in Tongan Science Classrooms: A Pilot Study to Identify Current Practice, Barriers and Facilitators

    Science.gov (United States)

    Bay, Jacquie L.; Fohoko, Fehi; La'Akulu, Mumui; Leota, Ofa; Pulotu, Lesieli; Tu'Ipuloto, Sina; Tutoe, Salesi; Tovo, Oliveti; Vekoso, Ana; Pouvalu, Emeli H.

    2016-01-01

    Questioning is central to the development of scientific and health literacies. In exploring this concept, Tongan science teachers hypothesized that their ability to use and encourage questioning presented challenges in the context of Tongan social and cultural norms. This study set out to develop a peer-to-peer protocol to enable teachers to…

  19. Lessons learned from England's Health Checks Programme: using qualitative research to identify and share best practice.

    Science.gov (United States)

    Ismail, Hanif; Kelly, Shona

    2015-10-20

    This study aimed to explore the challenges and barriers faced by staff involved in the delivery of the National Health Service (NHS) Health Check, a systematic cardiovascular disease (CVD) risk assessment and management program in primary care. Data have been derived from three qualitative evaluations that were conducted in 25 General Practices and involved in depth interviews with 58 staff involved all levels of the delivery of the Health Checks. Analysis of the data was undertaken using the framework approach and findings are reported within the context of research and practice considerations. Findings indicated that there is no 'one size fits all' blueprint for maximising uptake although success factors were identified: evolution of the programme over time in response to local needs to suit the particular characteristics of the patient population; individual staff characteristics such as being proactive, enthusiastic and having specific responsibility; a supportive team. Training was clearly identified as an area that needed addressing and practitioners would benefit from CVD specific baseline training and refresher courses to keep them up to date with recent developments in the area. However there were other external factors that impinged on an individual's ability to provide an effective service, some of these were outside the control of individuals and included cutbacks in referral services, insufficient space to run clinics or general awareness of the Health Checks amongst patients. The everyday experiences of practitioners who participated in this study suggest that overall, Health Check is perceived as a worthwhile exercise. But, organisational and structural barriers need to be addressed. We also recommend that clear referral pathways be in place so staff can refer patients to appropriate services (healthy eating sessions, smoking cessation, and exercise referrals). Local authorities need to support initiatives that enable data sharing and linkage so that

  20. Practices for Identifying and Rejecting Hemolyzed Specimens Are Highly Variable in Clinical Laboratories.

    Science.gov (United States)

    Howanitz, Peter J; Lehman, Christopher M; Jones, Bruce A; Meier, Frederick A; Horowitz, Gary L

    2015-08-01

    Hemolysis is an important clinical laboratory quality attribute that influences result reliability. To determine hemolysis identification and rejection practices occurring in clinical laboratories. We used the College of American Pathologists Survey program to distribute a Q-Probes-type questionnaire about hemolysis practices to Chemistry Survey participants. Of 3495 participants sent the questionnaire, 846 (24%) responded. In 71% of 772 laboratories, the hemolysis rate was less than 3.0%, whereas in 5%, it was 6.0% or greater. A visual scale, an instrument scale, and combination of visual and instrument scales were used to identify hemolysis in 48%, 11%, and 41% of laboratories, respectively. A picture of the hemolysis level was used as an aid to technologists' visual interpretation of hemolysis levels in 40% of laboratories. In 7.0% of laboratories, all hemolyzed specimens were rejected; in 4% of laboratories, no hemolyzed specimens were rejected; and in 88% of laboratories, some specimens were rejected depending on hemolysis levels. Participants used 69 different terms to describe hemolysis scales, with 21 terms used in more than 10 laboratories. Slight and moderate were the terms used most commonly. Of 16 different cutoffs used to reject hemolyzed specimens, moderate was the most common, occurring in 30% of laboratories. For whole blood electrolyte measurements performed in 86 laboratories, 57% did not evaluate the presence of hemolysis, but for those that did, the most common practice in 21 laboratories (24%) was centrifuging and visually determining the presence of hemolysis in all specimens. Hemolysis practices vary widely. Standard assessment and consistent reporting are the first steps in reducing interlaboratory variability among results.

  1. Identifying parasitic current pathways in CIGS solar cells by modelling dark J-V response

    NARCIS (Netherlands)

    Williams, B.L.; Smit, S.; Kniknie, B.J.; Bakker, K.; Keuning, W.; Schropp, R.E.I.; Creatore, M.; Kessels, W.M.M.

    2015-01-01

    The non-uniform presence of shunting defects is a significant cause of poor reproducibility across large-area solar cells, or from batch-to-batch for small area cells, but the most commonly used value for shunt parameterisation (the shunt resistance) fails to identify the cause for shunting. Here,

  2. European audit of current practice in diagnosis and treatment of childhood growth hormone deficiency

    DEFF Research Database (Denmark)

    Juul, Anders; Bernasconi, Sergio; Clayton, Peter E

    2002-01-01

    The present survey among members of the ESPE on current practice in diagnosis and treatment of growth hormone (GH) deficiency (GHD) is of great clinical relevance and importance in the light of the recently published guidelines for diagnosis and treatment of GHD by the Growth Hormone Research...... Society. We have found much conformity but also numerous discrepancies between the recommendations of the Growth Hormone Research Society and the current practice in Europe....

  3. Feeding practices of low-income mothers: how do they compare to current recommendations?

    OpenAIRE

    Power, Thomas G; Hughes, Sheryl O; Goodell, L Suzanne; Johnson, Susan L; Duran, J Andrea Jaramillo; Williams, Kimberly; Beck, Ashley D; Frankel, Leslie A

    2015-01-01

    Background Despite a growing consensus on the feeding practices associated with healthy eating patterns, few observational studies of maternal feeding practices with young children have been conducted, especially in low-income populations. The aim of this study was to provide such data on a low income sample to determine the degree to which observed maternal feeding practices compare with current recommendations. Methods Eighty low-income mothers and their preschool children were videotaped a...

  4. Delivering Communication Strategy Training for People with Aphasia: What Is Current Clinical Practice?

    Science.gov (United States)

    Beckley, Firle; Best, Wendy; Beeke, Suzanne

    2017-01-01

    Background: Communication strategy training (CST) is a recognized part of UK speech and language therapists' (SLTs) role when working with a person with aphasia. Multiple CST interventions have been published but, to date, there are no published studies exploring clinical practice in this area. Aims: To investigate UK SLTs' current CST practices.…

  5. Globalization of Gerontology Education: Current Practices and Perceptions for Graduate Gerontology Education in the United States

    Science.gov (United States)

    Mwangi, Samuel M.; Yamashita, Takashi; Ewen, Heidi H.; Manning, Lydia K.; Kunkel, Suzanne R.

    2012-01-01

    The purpose of this study is to document current practices and understandings about globalization of gerontology education in the United States. Better understanding of aging requires international perspectives in global communities. However, little is known about how globalization of gerontology education is practiced in U.S. graduate-level…

  6. Critical Ethical Issues in Online Counseling: Assessing Current Practices with an Ethical Intent Checklist

    Science.gov (United States)

    Shaw, Holly E.; Shaw, Sarah F.

    2006-01-01

    The authors used a 16-item Ethical Intent Checklist, developed from the American Counseling Association's (1999) Ethical Standards for Internet Online Counseling, to assess the current practices of 88 online counseling Web sites. Results showed fewer than half of online counselors were following the accepted practice on 8 of the 16 items. Online…

  7. The Practice of School Psychology in Quebec English Schools: Current Challenges and Opportunities

    Science.gov (United States)

    Finn, Cindy A.

    2016-01-01

    In Quebec, school psychology is alive and well. This article outlines current challenges and opportunities related to the practice of psychology in Quebec English schools. Changes to the practice of psychology in Quebec over the last decade have had an impact on the delivery of psychological services in schools. Modifications of the admission…

  8. Identifying, monitoring and implementing "sustainable" agricultural practices for smallholder farmers over large geographic areas in India and Vietnam

    Science.gov (United States)

    Kritee, K.; Ahuja, R.; Nair, D.; Esteves, T.; Rudek, J.; Thu Ha, T.

    2015-12-01

    Industrial agriculture systems, mostly in developed and some emerging economies, are far different from the small-holder farms (size management variability from farm to farm and also the current inability to ground-truth remote sensing data due to lack of relaible basic parameters (e.g., yields, N use, farm boundaries) which are necessary for calibrating empirical/biogeochemical models. While we continue to learn from new research, we have found that it is crucial to follow some steps if sustainable farming programs are to succeed at small-holder farms Demographic data collection and GPS plot demarcation to establish farm size and ownership Baseline nutrient, water & energy use and crop yield determination via surveys and self-reporting which are verifiable through farmer networks given the importance of peer to peer learning in the dissemination of new techniques in such landscapes "Sustainable" practice determination in consultation with local universities/NGO experts Measurements on representative plots for 3-4 years to help calibrate biogeochemical models and/or empirical equations and establish which practices are truly "sustainable" (e.g., GHG emission reduction varies from 0-7 tCO2e/acre for different sustainable practices). Propagation of sustainable practices across the landscape via local NGOs/governments after analyzing the replicability of identified farming practices in the light of local financial, cultural or socio-political barriers. We will present results from representative plots (including soil and weather parameters, GHG emissions, yields, inputs, economic and environmental savings), farmer surveys and diary data; and discuss our key conclusions based on our approach and the analysis of the collected data which was enabled by use of a commercially available comprehensive agricultural data collection software.

  9. Current practices in corrosion, surface characterization, and nickel leach testing of cardiovascular metallic implants.

    Science.gov (United States)

    Nagaraja, Srinidhi; Di Prima, Matthew; Saylor, David; Takai, Erica

    2017-08-01

    In an effort to better understand current test practices and improve nonclinical testing of cardiovascular metallic implants, the Food and Drug Administration (FDA) held a public workshop on Cardiovascular Metallic Implants: corrosion, surface characterization, and nickel leaching. The following topics were discussed: (1) methods used for corrosion assessments, surface characterization techniques, and nickel leach testing of metallic cardiovascular implant devices, (2) the limitations of each of these in vitro tests in predicting in vivo performance, (3) the need, utility, and circumstances when each test should be considered, and (4) the potential testing paradigms, including acceptance criteria for each test. In addition to the above topics, best practices for these various tests were discussed, and knowledge gaps were identified. Prior to the workshop, discussants had the option to provide feedback and information on issues relating to each of the topics via a voluntary preworkshop assignment. During the workshop, the pooled responses were presented and a panel of experts discussed the results. This article summarizes the proceedings of this workshop and background information provided by workshop participants. Published 2016. This article is a U.S. Government work and is in the public domain in the USA. J Biomed Mater Res Part B: Appl Biomater, 105B: 1330-1341, 2017. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  10. Technical guidelines for maintaining occupational exposures as low as practicable. Phase I. Summary of current practices

    International Nuclear Information System (INIS)

    Gilchrist, R.L.; Selby, J.M.; Wedlick, H.L.

    1978-08-01

    Reducing radiation exposures to as low as practicable is a principle that was first introduced in 1949. However, the recent controversy over the low-level effects of radiation has led the Department of Energy (DOE) to review its programs. One such review was conducted by the Pacific Northwest Laboratory to survey the implementation of the ALAP principle in the DOE laboratories. This report contains the results of that survey, performed in 18 major DOE installations. The DOE contractors were asked questions concerning the following eight major areas: management, operational health physics, design, dosimetry, instrumentation, training, risk/cost-benefit, and impact of the ALAP philosophy. The survey revealed several potential areas of concern, which are described in this report. These areas will be addressed in the forthcoming manual, A Guide to Reducing Radiation Exposures As Low As Practicable

  11. Identifying Measures Used for Assessing Quality of YouTube Videos with Patient Health Information: A Review of Current Literature.

    Science.gov (United States)

    Gabarron, Elia; Fernandez-Luque, Luis; Armayones, Manuel; Lau, Annie Ys

    2013-02-28

    Recent publications on YouTube have advocated its potential for patient education. However, a reliable description of what could be considered quality information for patient education on YouTube is missing. To identify topics associated with the concept of quality information for patient education on YouTube in the scientific literature. A literature review was performed in MEDLINE, ISI Web of Knowledge, Scopus, and PsychINFO. Abstract selection was first conducted by two independent reviewers; discrepancies were discussed in a second abstract review with two additional independent reviewers. Full text of selected papers were analyzed looking for concepts, definitions, and topics used by its authors that focused on the quality of information on YouTube for patient education. In total, 456 abstracts were extracted and 13 papers meeting eligibility criteria were analyzed. Concepts identified related to quality of information for patient education are categorized as expert-driven, popularity-driven, or heuristic-driven measures. These include (in descending order): (1) quality of content in 10/13 (77%), (2) view count in 9/13 (69%), (3) health professional opinion in 8/13 (62%), (4) adequate length or duration in 6/13 (46%), (5) public ratings in 5/13 (39%), (6) adequate title, tags, and description in 5/13 (39%), (7) good description or a comprehensive narrative in 4/13 (31%), (8) evidence-based practices included in video in 4/13 (31%), (9) suitability as a teaching tool in 4/13 (31%), (10) technical quality in 4/13 (31%), (11) credentials provided in video in 4/13 (31%), (12) enough amount of content to identify its objective in 3/13 (23%), and (13) viewership share in 2/13 (15%). Our review confirms that the current topics linked to quality of information for patient education on YouTube are unclear and not standardized. Although expert-driven, popularity-driven, or heuristic-driven measures are used as proxies to estimate the quality of video information

  12. Current Welfare Problems Facing Horses in Great Britain as Identified by Equine Stakeholders.

    Science.gov (United States)

    Horseman, Susan V; Buller, Henry; Mullan, Siobhan; Whay, Helen R

    2016-01-01

    Despite growing concerns about the welfare of horses in Great Britain (GB) there has been little surveillance of the welfare status of the horse population. Consequently we have limited knowledge of the range of welfare problems experienced by horses in GB and the situations in which poor welfare occurs. Thirty-one in-depth interviews were conducted with a cross -section of equine stakeholders, in order to explore their perceptions of the welfare problems faced by horses in GB. Welfare problems relating to health, management and riding and training were identified, including horses being under or over weight, stabling 24 hours a day and the inappropriate use of training aids. The interviewees also discussed broader contexts in which they perceived that welfare was compromised. The most commonly discussed context was where horses are kept in unsuitable environments, for example environments with poor grazing. The racing industry and travellers horses were identified as areas of the industry where horse welfare was particularly vulnerable to compromise. Lack of knowledge and financial constraints were perceived to be the root cause of poor welfare by many interviewees. The findings give insight into the range of welfare problems that may be faced by horses in GB, the contexts in which these may occur and their possible causes. Many of the problems identified by the interviewees have undergone limited scientific investigation pointing to areas where further research is likely to be necessary for welfare improvement. The large number of issues identified suggests that some form of prioritisation may be necessary to target research and resources effectively.

  13. Current Welfare Problems Facing Horses in Great Britain as Identified by Equine Stakeholders

    Science.gov (United States)

    Horseman, Susan V.; Buller, Henry

    2016-01-01

    Despite growing concerns about the welfare of horses in Great Britain (GB) there has been little surveillance of the welfare status of the horse population. Consequently we have limited knowledge of the range of welfare problems experienced by horses in GB and the situations in which poor welfare occurs. Thirty-one in-depth interviews were conducted with a cross -section of equine stakeholders, in order to explore their perceptions of the welfare problems faced by horses in GB. Welfare problems relating to health, management and riding and training were identified, including horses being under or over weight, stabling 24 hours a day and the inappropriate use of training aids. The interviewees also discussed broader contexts in which they perceived that welfare was compromised. The most commonly discussed context was where horses are kept in unsuitable environments, for example environments with poor grazing. The racing industry and travellers horses were identified as areas of the industry where horse welfare was particularly vulnerable to compromise. Lack of knowledge and financial constraints were perceived to be the root cause of poor welfare by many interviewees. The findings give insight into the range of welfare problems that may be faced by horses in GB, the contexts in which these may occur and their possible causes. Many of the problems identified by the interviewees have undergone limited scientific investigation pointing to areas where further research is likely to be necessary for welfare improvement. The large number of issues identified suggests that some form of prioritisation may be necessary to target research and resources effectively. PMID:27501387

  14. Protocol for audit of current Filipino practice in rehabilitation of stroke inpatients

    Directory of Open Access Journals (Sweden)

    Gonzalez-Suarez CB

    2015-03-01

    Full Text Available Consuelo B Gonzalez-Suarez,1–3 Janine Margarita R Dizon,2,3 Karen Grimmer,3 Myrna S Estrada,4 Lauren Anne S Liao,1 Anne-Rochelle D Malleta,5 Ma Elena R Tan,6 Vero Marfil,6 Cristina S Versales,1 Jimah L Suarez,5 Kleon C So,1 Edgardo D Uyehara6 1University of Santo Tomas Hospital, University of Santo Tomas, 2University of Santo Tomas, Manila, Philippines; 3International Centre for Allied Health Evidence, University of South Australia, City East Campus, North Terrace, Adelaide, SA, Australia; 4De La Salle University Hospital, Cavite, Dasmariñas, 5Philippine Orthopedic Center, 6Veterans’ Memorial Medical Center, Quezon City, Philippines Background: Stroke is one of the leading medical conditions in the Philippines. Over 500,000 Filipinos suffer from stroke annually. Provision of evidence-based medical and rehabilitation management for stroke patients has been a challenge due to existing environmental, social, and local health system issues. Thus, existing western guidelines on stroke rehabilitation were contextualized to draft recommendations relevant to the local Philippine setting. Prior to fully implementing the guidelines, an audit of current practice needs to be undertaken, thus the purpose of this audit protocol.Methods: A clinical audit of current practices in stroke rehabilitation in the Philippines will be undertaken. A consensus list of data items to be captured was identified by the audit team during a 2-day meeting in 2012. These items, including patient demographics, type of stroke, time to referral for rehabilitation management, length of hospital stay, and other relevant descriptors of stroke management were included as part of the audit. Hospitals in the Philippines will be recruited to take part in the audit activity. Recruitment will be via the registry of the Philippine Academy of Rehabilitation Medicine, where 90% of physiatrists (medical doctors specialized in rehabilitation medicine are active members and are affiliated

  15. Benchmarking to Identify Practice Variation in Test Ordering: A Potential Tool for Utilization Management.

    Science.gov (United States)

    Signorelli, Heather; Straseski, Joely A; Genzen, Jonathan R; Walker, Brandon S; Jackson, Brian R; Schmidt, Robert L

    2015-01-01

    Appropriate test utilization is usually evaluated by adherence to published guidelines. In many cases, medical guidelines are not available. Benchmarking has been proposed as a method to identify practice variations that may represent inappropriate testing. This study investigated the use of benchmarking to identify sites with inappropriate utilization of testing for a particular analyte. We used a Web-based survey to compare 2 measures of vitamin D utilization: overall testing intensity (ratio of total vitamin D orders to blood-count orders) and relative testing intensity (ratio of 1,25(OH)2D to 25(OH)D test orders). A total of 81 facilities contributed data. The average overall testing intensity index was 0.165, or approximately 1 vitamin D test for every 6 blood-count tests. The average relative testing intensity index was 0.055, or one 1,25(OH)2D test for every 18 of the 25(OH)D tests. Both indexes varied considerably. Benchmarking can be used as a screening tool to identify outliers that may be associated with inappropriate test utilization. Copyright© by the American Society for Clinical Pathology (ASCP).

  16. Current best practice for the health surveillance of enzyme workers in the soap and detergent industry.

    Science.gov (United States)

    Nicholson, P J; Newman Taylor, A J; Oliver, P; Cathcart, M

    2001-03-01

    This study defines current best practice for the health surveillance of workers who are potentially exposed to enzymes in the manufacture of enzymatic detergent products. It is recommended that health surveillance is performed 6-monthly for the first 2 years and annually thereafter. The health surveillance programme should include a respiratory questionnaire to detect symptoms, assessment of lung function to detect pre-symptomatic changes and an immunological test to detect specific immunoglobulin E (IgE) to enzymes. The International Union Against Tuberculosis and Lung Disease respiratory questionnaire should be used since it has been validated extensively for detecting asthma. Operators should observe the American Thoracic Society performance criteria for spirometers and standardized procedures for conducting spirometry. Since current airborne monitoring techniques for enzymes do not detect short-duration peak exposures, the incidence of employee sensitizations remains the most reliable measure of the integrity of environmental control. The Pepys skin prick test has been validated as a sensitive, specific and practical test for detecting specific IgE to many inhalant allergens including enzymes. For newly sensitized workers, a multi-cause investigation should be conducted to identify potential sources of exposure. Group results of immunological test results assist in the evaluation of workplace control measures, and should be used to monitor the effectiveness of hygiene and engineering programmes and to help prioritize areas for improvement. Positive responses to a questionnaire or abnormal spirometry should be assessed further. Occupational asthma should be excluded in any case of adult-onset asthma that starts or deteriorates during working life. This is particularly important because an accurate diagnosis of occupational asthma with early avoidance of exposure to its cause can result in remission of symptoms and restoration of lung function.

  17. Application of radiotherapy for hepatocellular carcinoma in current clinical practice guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Rim, Chai Hong; Seong, Jin Sil [Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-09-15

    In oncologic practice, treatment guidelines provide appropriate treatment strategies based on evidence. Currently, many guidelines are used, including those of the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer (EASL-EORTC), National Comprehensive Cancer Network (NCCN), Asia-Pacific Primary Liver Cancer Expert (APPLE), and Korean Liver Cancer Study Group and National Cancer Centre (KLCSG-NCC). Although radiotherapy is commonly used in clinical practice, some guidelines do not accept it as a standard treatment modality. In this review, we will investigate the clinical practice guidelines currently used, and discuss the application of radiotherapy.

  18. Application of radiotherapy for hepatocellular carcinoma in current clinical practice guidelines

    International Nuclear Information System (INIS)

    Rim, Chai Hong; Seong, Jin Sil

    2016-01-01

    In oncologic practice, treatment guidelines provide appropriate treatment strategies based on evidence. Currently, many guidelines are used, including those of the European Association for the Study of the Liver and European Organization for Research and Treatment of Cancer (EASL-EORTC), National Comprehensive Cancer Network (NCCN), Asia-Pacific Primary Liver Cancer Expert (APPLE), and Korean Liver Cancer Study Group and National Cancer Centre (KLCSG-NCC). Although radiotherapy is commonly used in clinical practice, some guidelines do not accept it as a standard treatment modality. In this review, we will investigate the clinical practice guidelines currently used, and discuss the application of radiotherapy

  19. Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening.

    LENUS (Irish Health Repository)

    Buckley, B S

    2011-12-12

    Background:  Gestational diabetes mellitus is a potentially serious condition that affects many pregnancies and its prevalence is increasing. Evidence suggests early detection and treatment improves outcomes, but this is hampered by continued disagreement and inconsistency regarding many aspects of its diagnosis. Methods:  The Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus Prevention (DALI) research programme aims to promote pan-European standards in the detection and diagnosis of gestational diabetes and to develop effective preventive interventions. To provide an overview of the context within which the programme will be conducted and its findings interpreted, systematic searching and narrative synthesis have been used to identify and review the best available European evidence relating to the prevalence of gestational diabetes, current screening practices and barriers to screening. Results:  Prevalence is most often reported as 2-6% of pregnancies. Prevalence may be lower towards the Northern Atlantic seaboard of Europe and higher in the Southern Mediterranean seaboard. Screening practice and policy is inconsistent across Europe, hampered by lack of consensus on testing methods, diagnostic glycaemic thresholds and the value of routine screening. Poor clinician awareness of gestational diabetes, its diagnosis and local clinical guidelines further undermine detection of gestational diabetes. Conclusions:  Europe-wide agreement on screening approaches and diagnostic standards for gestational diabetes could lead to better detection and treatment, improved outcomes for women and children and a strengthened evidence base. There is an urgent need for well-designed research that can inform decisions on best practice in gestational diabetes mellitus screening and diagnosis. © 2011 The Authors. Diabetic Medicine© 2011 Diabetes UK.

  20. Educating for collaborative practice: an interpretation of current achievements and thoughts for future directions.

    Science.gov (United States)

    Hudson, Judith Nicky; Croker, Anne

    2018-01-01

    The Edinburgh Declaration, developed in 1998 as a pledge to alter the character of medical education to more effectively meet the needs of society, included a recommendation to increase the opportunity for joint learning between health and health-related professions, as part of the training for teamwork. This article acknowledges achievements since the Declaration in relation to this recommendation, using an umbrella term for the phenomenon, 'educating for collaborative practice', and presents a perspective framed as a series of questions to encourage reflection on future directions. A literature interpretation, informed by philosophical hermeneutics, was conducted using text sets comprising reports and reviews from a section of the international literature since 1988. The interpretation involved: engaging with meanings as presented in the chosen texts; making iterative returns to the texts to explore emerging understanding; and ensuring parts of our understanding from particular texts were fused with complete understanding of the texts as a whole. A lens of appreciative inquiry facilitated acknowledgement of what has been achieved, while being curious about how it could be. Interpretation of the selected literature revealed notable achievements. Areas for further consideration were identified in relation to three themes: establishing shared understanding AND purpose behind use of terminology; being a conduit AND sharing responsibility for change; exploring ways of doing things AND ensuring ongoing inclusivity. Interpreting the current literature on 'educating for collaborative practice' has generated questions for reflection on how it may be otherwise. Readers are encouraged to embrace the tensions inherent in unanswered questions, providing space for communication, initiative and diversity of thought. An ongoing dialogue with the literature is proposed, asking whether educating students for a collective identity in settings where they are learning for and with

  1. Current Status and Future Agenda for the Theory, Research, and Practice of Childhood Career Development

    Science.gov (United States)

    Schultheiss, Donna E. Palladino

    2008-01-01

    This article reviews the current status and a future agenda for childhood career development theory, research, and practice. The fragmented nature of the current state of the literature is noted, and a call is made for a reexamination and reconsideration of the childhood developmental pathways of life's work. It is suggested that the study of…

  2. Current practices in treatment of female genital fistula: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Ruminjo Joseph

    2010-11-01

    Full Text Available Abstract Background Maternal outcomes in most countries of the developed world are good. However, in many developing/resource-poor countries, maternal outcomes are bleaker: Every year, more than 500,000 women die in childbirth, mostly in resource-poor countries. Those who survive often suffer from severe and long-term morbidities. One of the most devastating injuries is obstetric fistula, occurring most often in south Asia and sub-Saharan Africa. Fistula treatment and care are available in many countries across Africa and Asia, but there is a lack of reliable data around clinical factors associated with the success of fistula repair surgery. Most published research has been retrospective. While these studies have provided useful information about the care and treatment of fistula, they are limited by the design. This study was designed to identify practices in care that could lead to the design of prospective and randomized controlled trials. Methods Self-administered questionnaires were completed by 40 surgeons known to provide fistula treatment services in Africa and Asia at private and government hospitals. The questionnaire was divided into three parts to address the following issues: prophylactic use of antibiotics before, during, and after fistula surgery; urethral catheter management; and management practices for patients with urinary incontinence following fistula repair. Results The results provide a glimpse into current practices in fistula treatment and care across a wide swath of geographic, economic, and organizational considerations. There is consensus in treatment in some areas (routine use of prophylactic antibiotics, limited bed rest until the catheter is removed, nonsurgical treatment for postsurgical incontinence, while there are wide variations in practice in other areas (duration of catheter use, surgical treatments for postsurgical incontinence. These findings are based on a small sample and do not allow for recommending

  3. Current practices in treatment of female genital fistula: a cross sectional study.

    Science.gov (United States)

    Arrowsmith, Steven D; Ruminjo, Joseph; Landry, Evelyn G

    2010-11-10

    Maternal outcomes in most countries of the developed world are good. However, in many developing/resource-poor countries, maternal outcomes are bleaker: Every year, more than 500,000 women die in childbirth, mostly in resource-poor countries. Those who survive often suffer from severe and long-term morbidities. One of the most devastating injuries is obstetric fistula, occurring most often in south Asia and sub-Saharan Africa. Fistula treatment and care are available in many countries across Africa and Asia, but there is a lack of reliable data around clinical factors associated with the success of fistula repair surgery. Most published research has been retrospective. While these studies have provided useful information about the care and treatment of fistula, they are limited by the design. This study was designed to identify practices in care that could lead to the design of prospective and randomized controlled trials. Self-administered questionnaires were completed by 40 surgeons known to provide fistula treatment services in Africa and Asia at private and government hospitals. The questionnaire was divided into three parts to address the following issues: prophylactic use of antibiotics before, during, and after fistula surgery; urethral catheter management; and management practices for patients with urinary incontinence following fistula repair. The results provide a glimpse into current practices in fistula treatment and care across a wide swath of geographic, economic, and organizational considerations. There is consensus in treatment in some areas (routine use of prophylactic antibiotics, limited bed rest until the catheter is removed, nonsurgical treatment for postsurgical incontinence), while there are wide variations in practice in other areas (duration of catheter use, surgical treatments for postsurgical incontinence). These findings are based on a small sample and do not allow for recommending changes in clinical care, but they point to issues for

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

    Science.gov (United States)

    Mun, Mi Suk

    2010-02-01

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

  5. An information-theoretic approach to assess practical identifiability of parametric dynamical systems.

    Science.gov (United States)

    Pant, Sanjay; Lombardi, Damiano

    2015-10-01

    A new approach for assessing parameter identifiability of dynamical systems in a Bayesian setting is presented. The concept of Shannon entropy is employed to measure the inherent uncertainty in the parameters. The expected reduction in this uncertainty is seen as the amount of information one expects to gain about the parameters due to the availability of noisy measurements of the dynamical system. Such expected information gain is interpreted in terms of the variance of a hypothetical measurement device that can measure the parameters directly, and is related to practical identifiability of the parameters. If the individual parameters are unidentifiable, correlation between parameter combinations is assessed through conditional mutual information to determine which sets of parameters can be identified together. The information theoretic quantities of entropy and information are evaluated numerically through a combination of Monte Carlo and k-nearest neighbour methods in a non-parametric fashion. Unlike many methods to evaluate identifiability proposed in the literature, the proposed approach takes the measurement-noise into account and is not restricted to any particular noise-structure. Whilst computationally intensive for large dynamical systems, it is easily parallelisable and is non-intrusive as it does not necessitate re-writing of the numerical solvers of the dynamical system. The application of such an approach is presented for a variety of dynamical systems--ranging from systems governed by ordinary differential equations to partial differential equations--and, where possible, validated against results previously published in the literature. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Can suitable candidates for levodopa/carbidopa intestinal gel therapy be identified using current evidence?

    Directory of Open Access Journals (Sweden)

    Maria José Catalán

    2017-09-01

    In recent years, strong evidence has supported the use of LCIG in treating motor fluctuations associated with APD, and several clinical studies provide emerging evidence for additional benefits of LCIG treatment in certain patients. This article provides an overview of the published literature on the benefits, limitations, and drawbacks of LCIG in relation to PD symptoms, the psychosocial impact of the disease, and the quality of life of patients, with the aim of determining candidates for whom treatment with LCIG would be beneficial. According to current evidence, patients with APD (defined as inability to achieve optimal control of the disease with conventional oral treatment, a relatively well-preserved cognitive-behavioral status, and good family/caregiver would count as suitable candidates for LCIG treatment. Contraindications in the opinion of the authors are severe dementia and active psychosis.

  7. Identifying therapeutic targets in gastric cancer: the current status and future direction

    Science.gov (United States)

    Yu, Beiqin; Xie, Jingwu

    2016-01-01

    Gastric cancer is the third leading cause of cancer-related death worldwide. Our basic understanding of gastric cancer biology falls behind that of many other cancer types. Current standard treatment options for gastric cancer have not changed for the last 20 years. Thus, there is an urgent need to establish novel strategies to treat this deadly cancer. Successful clinical trials with Gleevec in CML and gastrointestinal stromal tumors have set up an example for targeted therapy of cancer. In this review, we will summarize major progress in classification, therapeutic options of gastric cancer. We will also discuss molecular mechanisms for drug resistance in gastric cancer. In addition, we will attempt to propose potential future directions in gastric cancer biology and drug targets. PMID:26373844

  8. Identifying context factors explaining physician's low performance in communication assessment: an explorative study in general practice.

    Science.gov (United States)

    Essers, Geurt; van Dulmen, Sandra; van Weel, Chris; van der Vleuten, Cees; Kramer, Anneke

    2011-12-13

    Communication is a key competence for health care professionals. Analysis of registrar and GP communication performance in daily practice, however, suggests a suboptimal application of communication skills. The influence of context factors could reveal why communication performance levels, on average, do not appear adequate. The context of daily practice may require different skills or specific ways of handling these skills, whereas communication skills are mostly treated as generic. So far no empirical analysis of the context has been made. Our aim was to identify context factors that could be related to GP communication. A purposive sample of real-life videotaped GP consultations was analyzed (N = 17). As a frame of reference we chose the MAAS-Global, a widely used assessment instrument for medical communication. By inductive reasoning, we analyzed the GP behaviour in the consultation leading to poor item scores on the MAAS-Global. In these cases we looked for the presence of an intervening context factor, and how this might explain the actual GP communication behaviour. We reached saturation after having viewed 17 consultations. We identified 19 context factors that could potentially explain the deviation from generic recommendations on communication skills. These context factors can be categorized into doctor-related, patient-related, and consultation-related factors. Several context factors seem to influence doctor-patient communication, requiring the GP to apply communication skills differently from recommendations on communication. From this study we conclude that there is a need to explicitly account for context factors in the assessment of GP (and GP registrar) communication performance. The next step is to validate our findings.

  9. An international survey to identify the intrinsic and extrinsic factors of research studies most likely to change orthopaedic practice.

    Science.gov (United States)

    Thornley, P; de Sa, D; Evaniew, N; Farrokhyar, F; Bhandari, M; Ghert, M

    2016-04-01

    Evidence -based medicine (EBM) is designed to inform clinical decision-making within all medical specialties, including orthopaedic surgery. We recently published a pilot survey of the Canadian Orthopaedic Association (COA) membership and demonstrated that the adoption of EBM principles is variable among Canadian orthopaedic surgeons. The objective of this study was to conduct a broader international survey of orthopaedic surgeons to identify characteristics of research studies perceived as being most influential in informing clinical decision-making. A 29-question electronic survey was distributed to the readership of an established orthopaedic journal with international readership. The survey aimed to analyse the influence of both extrinsic (journal quality, investigator profiles, etc.) and intrinsic characteristics (study design, sample size, etc.) of research studies in relation to their influence on practice patterns. A total of 353 surgeons completed the survey. Surgeons achieved consensus on the 'importance' of three key designs on their practices: randomised controlled trials (94%), meta-analyses (75%) and systematic reviews (66%). The vast majority of respondents support the use of current evidence over historical clinical training; however subjective factors such as journal reputation (72%) and investigator profile (68%) continue to influence clinical decision-making strongly. Although intrinsic factors such as study design and sample size have some influence on clinical decision-making, surgeon respondents are equally influenced by extrinsic factors such as investigator reputation and perceived journal quality.Cite this article: Dr M. Ghert. An international survey to identify the intrinsic and extrinsic factors of research studies most likely to change orthopaedic practice. Bone Joint Res 2016;5:130-136. DOI: 10.1302/2046-3758.54.2000578. © 2016 Ghert et al.

  10. Australian general practitioners’ current practice for chronic kidney disease (CKD detection and management

    Directory of Open Access Journals (Sweden)

    Marie Ludlow

    2017-06-01

    Full Text Available Background Guidelines for early detection of chronic kidney disease (CKD emphasise regular testing of kidney health in high-risk individuals. However, evidence suggests that CKD is not being adequately detected or appropriately managed in primary care. Aims Assess Australian general practitioners’ (GP current practice in relation to CKD detection and management. Methods This was a cross-sectional study utilising a random sample of GPs identified by interrogation of the national online telephone directory, and stratified by geographical location. Data collection occurred between October 2014 and January 2015. Of 2,815 eligible contacts, the final response rate was 23 per cent. Results Of the 656 respondents, over 90 per cent assessed kidney health at least annually in people with diabetes or high blood pressure, and 71 per cent correctly assessed kidney health every 3–6 months in a patient with Stage 3b CKD. The tests most commonly used to assess kidney health were serum creatinine (with eGFR, blood pressure and urine albumin creatinine ratio. The most commonly reported CKD management strategies were ‘blood pressure reduction using pharmacological agents’ (81 per cent and ‘glycaemic control if diabetes present’ (64 per cent. Knowledge testing highlighted that 32 per cent of respondents were not able to correctly identify how to properly assess absolute cardiovascular risk, and this was significantly more common in more experienced GPs (p=0.003. Conclusion The results indicate that Australian GPs are mainly practising in accordance with current guidelines for detection and management of patients with CKD, but with room for improvement in some areas

  11. Prevention of Backover Fatalities in Highway Work Zones: A Synthesis of Current Practices and Recommendations

    Directory of Open Access Journals (Sweden)

    Wei Fan

    2014-12-01

    Full Text Available The purpose of this paper is to synthesize current practices and procedures on the prevention of backing fatalities in highway work zones. First, general work zone safety hazards are reviewed, particularly blind areas are identified. Second, engineering controls currently in use are examined and explained to help understand what steps can be taken to prevent future backing fatalities. Third, administrative controls (including signalers, drivers, and workers-on-foot training are also discussed. Fourth, existing technology controls are reviewed for use in aiding equipment operators in identifying when pedestrian personnel are in dangerous areas around their equipment (i.e., back-up camera, radar. Fifth, recommendations are made based on the comprehensive review of the backover fatality prevention techniques in construction work zones and the conducted testing results of several commercially available systems. Recommendations on engineering and technology controls are discussed, with detailed information such as improving internal traffic control plans, and integrating technology with traffic control plans. Information and drawings are provided to illustrate how to design work zones, and the internal traffic flow diagrams are created using the integrated technology available, and site specific characteristics. The drawings represent examples of using different types of technology, in different scenarios using the proper legend, as well as using the proper general and technology notes to help explain the traffic control plan, ensuring that full comprehension is made. Recommendations on administrative controls are also given such as how to conduct safety meetings, electing safety officers, how to set regulations and guidelines for workers, and how to handle training. Training should be used as a backover fatality prevention method for pedestrian workers, flaggers, spotters, and equipment operators. Finally, a summary and discussion of future research

  12. Screening mammography among nursing home residents in the United States: Current guidelines and practice.

    Science.gov (United States)

    Mack, Deborah S; Epstein, Mara M; Dubé, Catherine; Clark, Robin E; Lapane, Kate L

    2018-06-04

    United States (US) guidelines regarding when to stop routine breast cancer screening remain unclear. No national studies to-date have evaluated the use of screening mammography among US long-stay nursing home residents. This cross-sectional study was designed to identify prevalence, predictors, and geographic variation of screening mammography among that population in the context of current US guidelines. Screening mammography prevalence, identified with Physician/Supplier Part B claims and stratified by guideline age classification (65-74, ≥75 years), was estimated for all women aged ≥65 years residing in US Medicare- and Medicaid- certified nursing homes (≥1 year) with an annual Minimum Data Set (MDS) 3.0 assessment, continuous Medicare Part B enrollment, and no clinical indication for screening mammography as of 2011 (n = 389,821). The associations between resident- and regional- level factors, and screening mammography, were estimated by crude and adjusted prevalence ratios from robust Poisson regressions clustered by facility. Women on average were 85.4 (standard deviation ±8.1) years old, 77.9% were disabled, and 76.3% cognitively impaired. Screening mammography prevalence was 7.1% among those aged 65-74 years (95% Confidence Interval (CI): 6.8%-7.3%) and 1.7% among those ≥75 years (95% CI, 1.7%-1.8%), with geographic variation observed. Predictors of screening in both age groups included race, cognitive impairment, frailty, hospice, and some comorbidities. These results shed light on the current screening mammography practices in US nursing homes. Thoughtful consideration about individual screening recommendations and the implementation of more clear guidelines for this special population are warranted to prevent overscreening. Copyright © 2018 Elsevier Inc. All rights reserved.

  13. Identifying gaps between current and expected ICT competencies of nurses in Serbia.

    Science.gov (United States)

    Paunic, Sanja; Stojkovic, Ivana

    2014-01-01

    Introducing of ICT in the health care system in Serbia started 19 years ago and systematic training of nurses and technicians has not been realized yet. The primary objective of this paper is to determine the gap between the sets of ICT competencies of nurses and technicians acquiring education and experience and the necessary skill set required for their daily work. The qualitative research included questioning of the focus group of experts and 400 nurses and technicians employed in secondary and tertiary health institutions in Serbia. Based on the analysis of existing literature we choose the Informatics competencies for nurses at four levels of practice (Staggers, Gassert, Curran, 2001), and for the purposes of this study, we used a list of competencies of the first, and partially of the second and third level. At the start, the group of 12 experts had the task to eliminate some of listed competencies to express the subjective expectations of the ICT competencies of nurses. After that nurses and medical technicians were expected to grade, by Likert scale, their level of knowledge and skills for each of the 39 competencies, respectively. The answers were analyzed using measure of central tendency and distribution of results was done by median. Comparison of perceived competence of the nurses and the desired/expected level by managers shows that there is difference in 25 of the 39 offered statements. Managers expect that nurses are great users of administrative applications for staff scheduling and for maintaining employee records, while nurses declared that these programs they use relatively poorly or not at all. The larger gap is also observed when it comes to computer skill for documenting patient care--experts expect that nurses do it well, and nurses, again, estimate that their documentation skills are relatively poor. The same situation is with use of ICT for patient education. It can be concluded that further training is required in the field of ICT, either

  14. Practical In-Depth Analysis of IDS Alerts for Tracing and Identifying Potential Attackers on Darknet

    Directory of Open Access Journals (Sweden)

    Jungsuk Song

    2017-02-01

    Full Text Available The darknet (i.e., a set of unused IP addresses is a very useful solution for observing the global trends of cyber threats and analyzing attack activities on the Internet. Since the darknet is not connected with real systems, in most cases, the incoming packets on the darknet (‘the darknet traffic’ do not contain a payload. This means that we are unable to get real malware from the darknet traffic. This situation makes it difficult for security experts (e.g., academic researchers, engineers, operators, etc. to identify whether the source hosts of the darknet traffic are infected by real malware or not. In this paper, we present the overall procedure of the in-depth analysis between the darknet traffic and IDS alerts using real data collected at the Science and Technology Cyber Security Center (S&T CSC in Korea and provide the detailed in-depth analysis results. The ultimate goal of this paper is to provide practical experience, insight and know-how to security experts so that they are able to identify and trace the root cause of the darknet traffic. The experimental results show that correlation analysis between the darknet traffic and IDS alerts is very useful to discover potential attack hosts, especially internal hosts, and to find out what kinds of malware infected them.

  15. [Identifying gaps between guidelines and clinical practice in Clostridium difficile infection].

    Science.gov (United States)

    Rodríguez-Martín, C; Serrano-Morte, A; Sánchez-Muñoz, L A; de Santos-Castro, P A; Bratos-Pérez, M A; Ortiz de Lejarazu-Leonardo, R

    2016-01-01

    The first aim was to determine whether patients are being treated in accordance with the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (IDSA/SHEA) Clostridium difficile guidelines and whether adherence impacts patient outcomes. The second aim was to identify specific action items in the guidelines that are not being translated into clinical practice, for their subsequent implementation. A retrospective, descriptive study was conducted over a 36 month period, on patients with compatible clinical symptoms and positive test for C. difficile toxins A and/or B in stool samples, in an internal medicine department of a tertiary medical centre. Patient demographic and clinical data (outcomes, comorbidity, risk factors) and compliance with guidelines, were examined A total of 77 patients with C. difficile infection were identified (87 episodes). Stratified by disease severity criteria, 49.3% of patients were mild-moderate, 35.1% severe, and 15.6% severe-complicated. Full adherence with the guidelines was observed in only 40.2% of patients, and was significantly better for mild-moderate (71.0%), than in severe (7.4%) or severe-complicated patients (16.6%) (PClostridium difficile infection was poor, especially in severe and severe-complicated patients, being associated with worse clinical outcomes. Educational interventions aimed at improving guideline adherence are warranted. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  16. Shifting the Focus to Student Learning: Characteristics of Effective Teaching Practice As Identified by Experienced Pre-service Faculty Advisors

    Directory of Open Access Journals (Sweden)

    Nancy Maynes

    2012-11-01

    Full Text Available Cochrane-Smith and Power identify trends in teacher education programs with some relating to heightened teacher accountability for students’ learning. In this paper we provide a model that identifies characteristics believed to be critical elements related to a teacher’s conceptual focus shifting from an emphasis on their teaching to their students’ learning and we have grounded these characteristics in current educational research. Through focus group inquiry, we have identified those teacher characteristics thought to account for effective teaching practice. These characteristics include: a professional growth perspective, passion and enthusiasm for the  content, pedagogical content knowledge, a rich instructional repertoire of strategies, awareness of assessment for, as, and of learning, ability to read the body language  of the learner, caring classroom management strategies, and instructional efforts (e.g., social justice. Our research data provide a conceptual framework for further study.

  17. Developing a Clinician Friendly Tool to Identify Useful Clinical Practice Guidelines: G-TRUST.

    Science.gov (United States)

    Shaughnessy, Allen F; Vaswani, Akansha; Andrews, Bonnie K; Erlich, Deborah R; D'Amico, Frank; Lexchin, Joel; Cosgrove, Lisa

    2017-09-01

    Clinicians are faced with a plethora of guidelines. To rate guidelines, they can select from a number of evaluation tools, most of which are long and difficult to apply. The goal of this project was to develop a simple, easy-to-use checklist for clinicians to use to identify trustworthy, relevant, and useful practice guidelines, the Guideline Trustworthiness, Relevance, and Utility Scoring Tool (G-TRUST). A modified Delphi process was used to obtain consensus of experts and guideline developers regarding a checklist of items and their relative impact on guideline quality. We conducted 4 rounds of sampling to refine wording, add and subtract items, and develop a scoring system. Multiple attribute utility analysis was used to develop a weighted utility score for each item to determine scoring. Twenty-two experts in evidence-based medicine, 17 developers of high-quality guidelines, and 1 consumer representative participated. In rounds 1 and 2, items were rewritten or dropped, and 2 items were added. In round 3, weighted scores were calculated from rankings and relative weights assigned by the expert panel. In the last round, more than 75% of experts indicated 3 of the 8 checklist items to be major indicators of guideline usefulness and, using the AGREE tool as a reference standard, a scoring system was developed to identify guidelines as useful, may not be useful, and not useful. The 8-item G-TRUST is potentially helpful as a tool for clinicians to identify useful guidelines. Further research will focus on its reliability when used by clinicians. © 2017 Annals of Family Medicine, Inc.

  18. Addressing Prediabetes in Childhood Obesity Treatment Programs: Support from Research and Current Practice

    Science.gov (United States)

    Grow, H. Mollie; Fernandez, Cristina; Lukasiewicz, Gloria J.; Rhodes, Erinn T.; Shaffer, Laura A.; Sweeney, Brooke; Woolford, Susan J.; Estrada, Elizabeth

    2014-01-01

    Abstract Background: Type 2 diabetes mellitus (T2DM) and prediabetes have increased in prevalence among overweight and obese children, with significant implications for long-term health. There is little published evidence on the best approaches to care of prediabetes among overweight youth or the current practices used across pediatric weight management programs. Methods: This article reviews the literature and summarizes current practices for screening, diagnosis, and treatment of prediabetes at childhood obesity treatment centers. Findings regarding current practice were based on responses to an online survey from 28 pediatric weight management programs at 25 children's hospitals in 2012. Based on the literature reviewed, and empiric data, consensus support statements on prediabetes care and T2DM prevention were developed among representatives of these 25 children's hospitals' obesity clinics. Results: The evidence reviewed demonstrates that current T2DM and prediabetes diagnostic parameters are derived from adult-based studies with little understanding of clinical outcomes among youth. Very limited evidence exists on preventing progression of prediabetes. Some evidence suggests that a significant proportion of obese youth with prediabetes will revert to normoglycemia without pharmacological management. Evidence supports lifestyle modification for children with prediabetes, but further study of specific lifestyle changes and pharmacological treatments is needed. Conclusion: Evidence to guide management of prediabetes in children is limited. Current practice patterns of pediatric weight management programs show areas of variability in practice, reflecting the limited evidence base. More research is needed to guide clinical care for overweight youth with prediabetes. PMID:25055134

  19. Diagnosed, identified, current and complete depression among patients attending primary care in southern Catalonia: different aspects of the same concept.

    Science.gov (United States)

    Montesó-Curto, Pilar; Ferré-Grau, Carme; Lleixà-Fortuño, Mar; Albacar-Riobóo, Nuria; Lejeune, Marylene

    2014-02-01

    The aims of this study were to explore the prevalence and the conceptualizations of depression detected by the healthcare system, identified by the patient or classified/identified in the validated Goldberg's questionnaire in a community. We conducted a cross-sectional evaluation of 317 patients. The different types of depression diagnosed, identified, current or total were stratified by age and gender groups. The difference in the conceptualization of depression from the medical or ordinary people point of view indicate that depression care requires the understanding of the lifestyle, beliefs, attitudes, family and social networks of the people the physicians and nurses care for. © 2014.

  20. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Preceptor and Student Considerations.

    Science.gov (United States)

    Dornblaser, Emily K; Ratka, Anna; Gleason, Shaun E; Ombengi, David N; Tofade, Toyin; Wigle, Patricia R; Zapantis, Antonia; Ryan, Melody; Connor, Sharon; Jonkman, Lauren J; Ochs, Leslie; Jungnickel, Paul W; Abrons, Jeanine P; Alsharif, Naser Z

    2016-04-25

    The objective of this article is to describe the key areas of consideration for global/international advanced pharmacy practice experience (G/I APPE) preceptors, students and learning objectives. At the 2013 Annual Meeting of the American Association of Colleges of Pharmacy (AACP), the GPE SIG prepared and presented an initial report on the G/IAPPE initiatives. Round table discussions were conducted at the 2014 AACP Annual Meeting to document GPE SIG member input on key areas in the report. Literature search of PubMed, Google Scholar and EMBASE with keywords was conducted to expand this report. In this paper, considerations related to preceptors and students and learning outcomes are described. Preceptors for G/I APPEs may vary based on the learning outcomes of the experience. Student learning outcomes for G/I APPEs may vary based on the type of experiential site. Recommendations and future directions for development of G/IAPPEs are presented. Development of a successful G/I APPE requires significant planning and consideration of appropriate qualifications for preceptors and students.

  1. Current practices of construction waste reduction through 3R practice among contractors in malaysia: Case study in penang

    Science.gov (United States)

    Ng, L. S.; Tan, L. W.; Seow, T. W.

    2017-11-01

    The effectiveness of the implementation of construction waste reduction through 3R reflects the sustainability in construction waste management. Weak implementation of construction waste reduction through 3R among contractors will lead to unsustainable construction waste management. Increase in construction waste on landfills is critical especially on islands where land is very limited for solid waste disposal. This aim of this paper is to investigate current practice of construction waste reduction through 3R practice among contractors in Penang, Malaysia. The findings reported herein is based on feedbacks from 143 construction contractors of grade CIDB G7, G6 and G5 in Penang and experts from Penang Local Authority, CIDB in Penang and its Headquarters, National Solid Waste Management Department, and Headquarters of Solid Waste and Public Cleansing Management Corporation. Interviews and questionnaire surveys have been found that 3R practice is not mandatory in construction waste management in Penang. Only 39.8% construction contractors practiced 3R in managing their waste. Therefore, 3R practices should be emphasized in construction industry. Reducing wastes through 3R practices in construction industry is a way forward towards sustainable construction waste management especially in expanding the lifetime of landfill.

  2. Identifying criteria for multimodel software process improvement solutions : based on a review of current problems and initiatives

    NARCIS (Netherlands)

    Kelemen, Z.D.; Kusters, R.J.; Trienekens, J.J.M.

    2012-01-01

    In this article, we analyze current initiatives in multimodel software process improvement and identify criteria for multimodel solutions. With multimodel, we mean the simultaneous usage of more than one quality approach (e.g. standards, methods, techniques to improve software processes). This paper

  3. Current clinical nutrition practices in critically ill patients in Latin America: a multinational observational study.

    Science.gov (United States)

    Vallejo, Karin Papapietro; Martínez, Carolina Méndez; Matos Adames, Alfredo A; Fuchs-Tarlovsky, Vanessa; Nogales, Guillermo Carlos Contreras; Paz, Roger Enrique Riofrio; Perman, Mario Ignacio; Correia, Maria Isabel Toulson Davisson; Waitzberg, Dan Linetzky

    2017-08-25

    Malnutrition in critically ill adults in the intensive care unit (ICU) is associated with a significantly elevated risk of mortality. Adequate nutrition therapy is crucial to optimise outcomes. Currently, there is a paucity of such data in Latin America. Our aims were to characterise current clinical nutrition practices in the ICU setting in Latin America and evaluate whether current practices meet caloric and protein requirements in critically ill patients receiving nutrition therapy. We conducted a cross-sectional, retrospective, observational study in eight Latin American countries (Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, Panama, and Peru). Eligible patients were critically ill adults hospitalised in the ICU and receiving enteral nutrition (EN) and/or parenteral nutrition (PN) on the Screening Day and the previous day (day -1). Caloric and protein balance on day -1, nutritional status, and prescribed nutrition therapy were recorded. Multivariable logistic regression analysis was performed to identify independent predictors of reaching daily caloric and protein targets. The analysis included 1053 patients from 116 hospitals. Evaluation of nutritional status showed that 74.1% of patients had suspected/moderate or severe malnutrition according to the Subjective Global Assessment. Prescribed nutrition therapy included EN alone (79.9%), PN alone (9.4%), and EN + PN (10.7%). Caloric intake met >90% of the daily target in 59.7% of patients on day -1; a caloric deficit was present in 40.3%, with a mean (±SD) daily caloric deficit of -688.8 ± 455.2 kcal. Multivariable logistic regression analysis showed that combined administration of EN + PN was associated with a statistically significant increase in the probability of meeting >90% of daily caloric and protein targets compared with EN alone (odds ratio, 1.56; 95% confidence interval, 1.02-2.39; p = 0.038). In the ICU setting in Latin America, malnutrition was highly prevalent and caloric

  4. Surveys of Current Teaching and Practice for Impressions for Complete Dentures.

    Science.gov (United States)

    Hussain, N; Jabbar, H; Hayati, M; Wu, J; Hyde, T P

    2018-03-08

    The 3 objectives are to assess current preferences for impressions for complete dentures, audit practice and compare practice to current UK teaching. Three surveys where undertaken; a survey of GDPs preferences, an audit of practice and a survey of teaching in UK dental schools. UK Universities advocate border moulded custom trays. In stated preferences, 99% of practitioners used custom trays for private practice; 67% for NHS work. In actual use, the audit found 91% practitioners in private practice used custom trays; in NHS practice 78% did so. The most widely taught materials were silicone (43%), alginate (29%), & zinc oxide eugenol paste (19%). In practitioners stated preferences, 97% of NHS and 53% of private dentists listed alginate as an option; however the audit showed only 74% (NHS) and 52% (private) actually used alginate, with 20% (NHS) and 48% (private) using silicone. Definitive impressions in custom trays are used by GDPs for both private and NHS work; they are universally taught at UK dental schools. Alginate is popular in NHS practice; however, silicone is more widely taught in UK Universities. The use of silicone materials for definitive impressions has increased since 1999. In UK private practice silicone usage is aligned in popularity with alginate. Copyright© 2018 Dennis Barber Ltd.

  5. Infective endocarditis prophylaxis: current practice trend among paediatric cardiologists: are we following the 2007 guidelines?

    Science.gov (United States)

    Naik, Ronak J; Patel, Neil R; Wang, Ming; Shah, Nishant C

    2016-08-01

    In 2007, the American Heart Association modified the infective endocarditis prophylaxis guidelines by limiting the use of antibiotics in patients with cardiac conditions associated with the highest risk of adverse outcomes after infective endocarditis. Our objective was to evaluate current practice for infective endocarditis prophylaxis among paediatric cardiologists. A web-based survey focussing on current practice, describing the use of antibiotics for infective endocarditis prophylaxis in various congenital and acquired heart diseases, was distributed via e-mail to paediatric cardiologists. The survey was kept anonymous and was distributed twice. Data from 253 participants were analysed. Most paediatric cardiologists discontinued infective endocarditis prophylaxis in patients with simple lesions such as small ventricular septal defect, patent ductus arteriosus, and bicuspid aortic valve without stenosis or regurgitation; however, significant disagreement persists in prescribing infective endocarditis prophylaxis in certain conditions such as rheumatic heart disease, Fontan palliation without fenestration, and the Ross procedure. Use of antibiotic prophylaxis in certain selected conditions for which infective endocarditis prophylaxis has been indicated as per the current guidelines varies from 44 to 83%. Only 44% follow the current guidelines exclusively, and 34% regularly discuss the importance of oral hygiene with their patients at risk for infective endocarditis. Significant heterogeneity still persists in recommending infective endocarditis prophylaxis for several cardiac lesions among paediatric cardiologists. More than half of the participants (56%) do not follow the current guidelines exclusively in their practice. Counselling for optimal oral health in patients at risk for infective endocarditis needs to be optimised in the current practice.

  6. Improving healthcare practice behaviors: an exploratory study identifying effective and ineffective behaviors in healthcare.

    Science.gov (United States)

    Van Fleet, David D; Peterson, Tim O

    2016-01-01

    The purpose of this paper is to present the results of exploratory research designed to develop an awareness of healthcare behaviors, with a view toward improving the customer satisfaction with healthcare services. It examines the relationship between healthcare providers and their consumers/patients/clients. The study uses a critical incident methodology, with both effective and ineffective behavioral specimens examined across different provider groups. The effects of these different behaviors on what Berry (1999) identified as the common core values of service organizations are examined, as those values are required to build a lasting service relationship. Also examined are categories of healthcare practice based on the National Quality Strategy priorities. The most obvious is the retrospective nature of the method used. How accurate are patient or consumer memories? Are they capable of making valid judgments of healthcare experiences (Berry and Bendapudi, 2003)? While an obvious limitation, such recollections are clearly important as they may be paramount in following the healthcare practitioners' instructions, loyalty for repeat business, making recommendations to others and the like. Further, studies have shown retrospective reports to be accurate and useful (Miller et al., 1997). With this information, healthcare educators should be in a better position to improve the training offered in their programs and practitioners to better serve their customers. The findings would indicate that the human values of excellence, innovation, joy, respect and integrity play a significant role in building a strong service relationship between consumer and healthcare provider. Berry (1999) has argued that the overriding importance in building a lasting service business is human values. This exploratory study has shown how critical incident analysis can be used to determine both effective and ineffective practices of different medical providers. It also provides guidelines as

  7. Identifying children who may be cognitively gifted: the gap between practical demands and scientific supply

    Directory of Open Access Journals (Sweden)

    KLAUS D. KUBINGER

    2008-06-01

    Full Text Available When it comes to high cognitive ability assessment, traditional “IQ-diagnosis” has not proven to be particularly helpful. Psychological assessment aimed at promoting the development of gifted individuals requires a scientifically based theoretical model that identifies which cognitive strengths are necessary and which weaknesses can be compensated, and that takes the moderating effects of personality and environment into account when describing the interplay between ability and achievement. While such models – including the one described in the following paper – do exist, they currently lack an adequate theoretical foundation or at least a convincing empirical validation. Science still stands before the challenge of offering appropriate psychodiagnostic instruments to measure model components while fulfilling practitioners’ requirements. The following work describes a prototypic example of how such requirements might be met for ability testing. Yet in terms of personality and environmental variables, particularly caregiving, currently available methods are wholly unsuitable for meeting intended goals. Systematic behavioral observation offers a possible solution. Its validity, objectivity, comprehensiveness and efficiency in terms of high ability testing – as well as that of interview guides – must, however, be further explored.

  8. A Case Study with an Identified Bully: Policy and Practice Implications

    Directory of Open Access Journals (Sweden)

    Huddleston, Lillie

    2011-07-01

    Full Text Available Objective: Bullying is a serious public health problem that may include verbal or physical injury as well as social isolation or exclusion. As a result, research is needed to establish a database for policies and interventions designed to prevent bullying and its negative effects. This paper presented a case study that contributed to the literature by describing an intervention for bullies that has implications for research, practice and related policies regarding bullying.Methods: An individualized intervention for an identified bully was implemented using the Participatory Culture-Specific Intervention Model (PCSIM; Nastasi, Moore, & Varjas, 2004 with a seventh-grade middle school student. Ecological and culture-specific perspectives were used to develop and implement the intervention that included psychoeducational sessions with the student and consultation with the parent and school personnel. A mixed methods intervention design was used with the following informants: the target student, the mother of the student, a teacher and the school counselor. Qualitative data included semi-structured interviews with the parent, teacher and student, narrative classroom observations and evaluation/feedback forms filled out by the student and interventionist. Quantitative data included the following quantitative surveys (i.e., Child Posttraumatic Stress Reaction Index [CPTS-RI] and the Behavior Assessment Scale for Children, 2nd Edition. Both qualitative and quantitative data were used to evaluate the acceptability, integrity and efficacy of this intervention.Results: The process of intervention design, implementation and evaluation are described through an illustrative case study. Qualitative and quantitative findings indicated a decrease in internalizing, externalizing and bullying behaviors as reported by the teacher and the mother, and a high degree of acceptability and treatment integrity as reported by multiple stakeholders.Conclusion: This case

  9. 78 FR 48636 - Current Good Manufacturing Practice and Hazard Analysis and Risk-Based Preventive Controls for...

    Science.gov (United States)

    2013-08-09

    ... collection related to the proposed rule, ``Current Good Manufacturing Practice and Hazard Analysis and Risk... period. These two proposals are related to the proposed rule ``Current Good Manufacturing Practice and... final extension of the comment period for the ``Current Good Manufacturing Practice and Hazard Analysis...

  10. The current state of abortion law and practice in Northern Ireland.

    Science.gov (United States)

    Daniels, Pauline; Campbell, Patricia; Clinton, Alison

    This paper reviews current abortion law and practice in Northern Ireland (NI). It explores the origins of NI's abortion law and its complexity in relation to current practice. It reviews issues relating to women seeking terminations in NI and Great Britain and reviews attempts by the Family Planning Association in NI to require the Department of Health, Social Services and Public Safety NI to clarify the current legal basis for termination of pregnancy and to provide guidance for health professionals engaged in this practice. The paper also discusses some of the issues surrounding abortion in NI and seeks to explain why this subject is causing controversy and debate, especially following a judicial review in February and Marie Stopes opening a termination service in Belfast.

  11. Mesoscale Biotransformations of Uranium: Identifying Sites and Strategies where Reductive Immobilization is Practical

    International Nuclear Information System (INIS)

    Tetsu K. Tokunaga; Jiamin Wan; Terry C. Hazen; Mary K. Firestone; Eoin Brodie; Yongman Kim; Rebecca Daly

    2006-01-01

    Bioreduction of U in contaminated sediments is an attractive strategy because of its low cost, and because of short-term studies supporting its feasibility. However, any in-situ immobilization approach for U will require assurance of either permanent fixation, or of very low release rates into the biosphere. Our previous long-term (2 years) laboratory experiments have shown that organic carbon (OC) based U(VI) bioreduction to UO2 can be transient even under sustained reducing (methanogenic) conditions. The biogeochemical processes underlying this finding urgently need to be understood. The current research is designed to identify mechanisms responsible for anaerobic U oxidation, and identify conditions that will support long-term stability of bioreduced U. We are investigating: (1) effects of OC concentration and supply rate on remobilization of bioreduced U, (2) the roles of Fe- and Mn-oxides as potential U oxidants in sediments, and (3) the role of microorganisms in U reoxidation, and (4) influences of pH on U(IV)/U(VI) redox equilibrium

  12. Goal setting practice in chronic low back pain. What is current practice and is it affected by beliefs and attitudes?

    Science.gov (United States)

    Gardner, Tania; Refshauge, Kathryn; McAuley, James; Hübscher, Markus; Goodall, Stephen; Smith, Lorraine

    2018-01-18

    Goal setting, led by the patient, is promising as an effective treatment for the management of chronic low back pain (CLBP); however, little is known about current practice. The aims of the study were to explore (1) current goal setting practice in CLBP among physiotherapists; (2) perceived barriers to goal setting in CLBP; and (3) relationship between clinician's attitudes and beliefs and goal setting practice. A cross-sectional observational survey. The majority of respondents used goal setting with the main aim of facilitating self-management. The greatest number of goals were set with 50% therapist/50% patient involvement. The most common perceived barriers to goal setting related to time constraints and lack of skill and confidence. A higher biomedical score for treatment orientation of the therapist was associated with a lower patient involvement score. Goal setting is common practice for CLBP and is perceived as a high priority. It is more often a collaboration between therapist and patient rather than patient-led with treatment orientation of the physiotherapist a predictor of patient involvement. Education of healthcare professionals needs to include better understanding of chronic pain to orient them away from a biomedical treatment approach, as well as to enhance skills in facilitating patient involvement in goal setting.

  13. Physiotherapy for plantar fasciitis: a UK-wide survey of current practice.

    Science.gov (United States)

    Grieve, Rob; Palmer, Shea

    2017-06-01

    To identify how United Kingdom (UK) physiotherapists currently diagnose, assess and manage plantar fasciitis in routine practice. Online questionnaire survey. Practising physiotherapists across the UK who treat patients with plantar fasciitis. Physiotherapists were approached via 'interactive Chartered Society of Physiotherapy (CSP)' online networks and an email database of clinical educators in South West England. An online questionnaire was developed by reviewing similar existing physiotherapy surveys and consultation with experienced musculoskeletal researchers/clinicians. Descriptive statistics were used to analyse the data. 285 physiotherapists responded, with 257 complete survey responses. Pain on palpation and early morning pain were the most common diagnostic criteria, with some physiotherapists using no formal test criteria. Advice (237/257, 92%), plantar fasciitis pathology education (207/257, 81%) and general stretching exercises (189/257, 74%) were most routinely used. Prefabricated orthotics, custom made orthotics and night splints were seldom always used. For the manual therapy approach, the most frequently used modalities were massage, myofascial release, specific soft tissue mobilisations and myofascial trigger point therapy. Commonly used outcome measures were pain assessment, functional tests and range of movement. Physiotherapists appeared to follow most of the established diagnostic criteria for PF, but have not followed established outcome measure guidelines. Advice as well as education with an emphasis on self-management including calf/hamstring stretching was the most commonly reported treatment approach. There was uncertainty whether this approach accurately reflected clinical practice used throughout the UK, owing to potential response bias/unknown response rate and the low number of patients with PF treated by the respondents. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  14. Current practices related to family presence during acute deterioration in adult emergency department patients.

    Science.gov (United States)

    Youngson, Megan J; Currey, Judy; Considine, Julie

    2017-11-01

    To explore the characteristics of and interactions between clinicians, patients and family members during management of the deteriorating adult patient in the emergency department. Previous research into family presence during resuscitation has identified many positive outcomes when families are included. However, over the last three decades the epidemiology of acute clinical deterioration has changed, with a decrease in in-hospital cardiac arrests and an increase in acute clinical deterioration. Despite the decrease in cardiac arrests, research related to family presence continues to focus on care during resuscitation rather than care during acute deterioration. Descriptive exploratory study using nonparticipatory observation. Five clinical deterioration episodes were observed within a 50-bed, urban, Australian emergency department. Field notes were taken using a semistructured tool to allow for thematic analysis. Presence, roles and engagement describe the interactions between clinicians, family members and patients while family are present during a patient's episode of deterioration. Presence was classified as no presence, physical presence and therapeutic presence. Clinicians and family members moved through primary, secondary and tertiary roles during patients' deterioration episode. Engagement was observed to be superficial or deep. There was a complex interplay between presence, roles and engagement with each influencing which form the other could take. Current practices of managing family during episodes of acute deterioration are complex and multifaceted. There is fluid interplay between presence, roles and engagement during a patient's episode of deterioration. This study will contribute to best practice, provide a strong foundation for clinician education and present opportunities for future research. © 2017 John Wiley & Sons Ltd.

  15. Assessment of current cybersecurity practices in the public domain : cyber indications and warnings domain.

    Energy Technology Data Exchange (ETDEWEB)

    Hamlet, Jason R.; Keliiaa, Curtis M.

    2010-09-01

    This report assesses current public domain cyber security practices with respect to cyber indications and warnings. It describes cybersecurity industry and government activities, including cybersecurity tools, methods, practices, and international and government-wide initiatives known to be impacting current practice. Of particular note are the U.S. Government's Trusted Internet Connection (TIC) and 'Einstein' programs, which are serving to consolidate the Government's internet access points and to provide some capability to monitor and mitigate cyber attacks. Next, this report catalogs activities undertaken by various industry and government entities. In addition, it assesses the benchmarks of HPC capability and other HPC attributes that may lend themselves to assist in the solution of this problem. This report draws few conclusions, as it is intended to assess current practice in preparation for future work, however, no explicit references to HPC usage for the purpose of analyzing cyber infrastructure in near-real-time were found in the current practice. This report and a related SAND2010-4766 National Cyber Defense High Performance Computing and Analysis: Concepts, Planning and Roadmap report are intended to provoke discussion throughout a broad audience about developing a cohesive HPC centric solution to wide-area cybersecurity problems.

  16. Investigation of the current requirements engineering practices among software developers at the Universiti Utara Malaysia Information Technology (UUMIT) centre

    Science.gov (United States)

    Hussain, Azham; Mkpojiogu, Emmanuel O. C.; Abdullah, Inam

    2016-08-01

    Requirements Engineering (RE) is a systemic and integrated process of eliciting, elaborating, negotiating, validating and managing of the requirements of a system in a software development project. UUM has been supported by various systems developed and maintained by the UUM Information Technology (UUMIT) Centre. The aim of this study was to assess the current requirements engineering practices at UUMIT. The main problem that prompted this research is the lack of studies that support software development activities at the UUMIT. The study is geared at helping UUMIT produce quality but time and cost saving software products by implementing cutting edge and state of the art requirements engineering practices. Also, the study contributes to UUM by identifying the activities needed for software development so that the management will be able to allocate budget to provide adequate and precise training for the software developers. Three variables were investigated: Requirement Description, Requirements Development (comprising: Requirements Elicitation, Requirements Analysis and Negotiation, Requirements Validation), and Requirement Management. The results from the study showed that the current practice of requirement engineering in UUMIT is encouraging, but still need further development and improvement because a few RE practices were seldom practiced.

  17. Globalization of Gerontology Education: Current Practices and Perceptions for Graduate Gerontology Education in the United States

    Science.gov (United States)

    MWANGI, SAMUEL M.; YAMASHITA, TAKASHI; EWEN, HEIDI H.; MANNING, LYDIA K.; KUNKEL, SUZANNE R.

    2013-01-01

    The purpose of this study is to document current practices and understandings about globalization of gerontology education in the United States. Better understanding of aging requires international perspectives in global communities. However, little is known about how globalization of gerontology education is practiced in U.S. graduate-level degree programs. The authors conducted qualitative interviews with representatives of the Association for Gerontology in Higher Education, the major national organization supporting higher education in gerontology, graduate program directors, and students. Although all respondents expressed their interest in globalizing gerontology education, actual practices are diverse. The authors discuss suggested conceptualization and strategies for globalizing gerontology education. PMID:22490075

  18. Globalization of gerontology education: current practices and perceptions for graduate gerontology education in the United States.

    Science.gov (United States)

    Mwangi, Samuel M; Yamashita, Takashi; Ewen, Heidi H; Manning, Lydia K; Kunkel, Suzanne R

    2012-01-01

    The purpose of this study is to document current practices and understandings about globalization of gerontology education in the United States. Better understanding of aging requires international perspectives in global communities. However, little is known about how globalization of gerontology education is practiced in U.S. graduate-level degree programs. The authors conducted qualitative interviews with representatives of the Association for Gerontology in Higher Education, the major national organization supporting higher education in gerontology, graduate program directors, and students. Although all respondents expressed their interest in globalizing gerontology education, actual practices are diverse. The authors discuss suggested conceptualization and strategies for globalizing gerontology education.

  19. General Practice Clinical Data Help Identify Dementia Hotspots: A Novel Geospatial Analysis Approach.

    Science.gov (United States)

    Bagheri, Nasser; Wangdi, Kinley; Cherbuin, Nicolas; Anstey, Kaarin J

    2018-01-01

    We have a poor understanding of whether dementia clusters geographically, how this occurs, and how dementia may relate to socio-demographic factors. To shed light on these important questions, this study aimed to compute a dementia risk score for individuals to assess spatial variation of dementia risk, identify significant clusters (hotspots), and explore their association with socioeconomic status. We used clinical records from 16 general practices (468 Statistical Area level 1 s, N = 14,746) from the city of west Adelaide, Australia for the duration of 1 January 2012 to 31 December 2014. Dementia risk was estimated using The Australian National University-Alzheimer's Disease Risk Index. Hotspot analyses were applied to examine potential clusters in dementia risk at small area level. Significant hotspots were observed in eastern and southern areas while coldspots were observed in the western area within the study perimeter. Additionally, significant hotspots were observed in low socio-economic communities. We found dementia risk scores increased with age, sex (female), high cholesterol, no physical activity, living alone (widow, divorced, separated, or never married), and co-morbidities such as diabetes and depression. Similarly, smoking was associated with a lower dementia risk score. The identification of dementia risk clusters may provide insight into possible geographical variations in risk factors for dementia and quantify these risks at the community level. As such, this research may enable policy makers to tailor early prevention strategies to the correct individuals within their precise locations.

  20. MYC Immunohistochemistry to Identify MYC-Driven B-Cell Lymphomas in Clinical Practice.

    Science.gov (United States)

    Kluk, Michael J; Ho, Caleb; Yu, Hongbo; Chen, Benjamin J; Neuberg, Donna S; Dal Cin, Paola; Woda, Bruce A; Pinkus, Geraldine S; Rodig, Scott J

    2016-02-01

    Immunohistochemistry with anti-MYC antibody (MYC IHC) detects MYC protein in fixed samples of aggressive B-cell lymphomas and, according to the number of positive staining tumor nuclei, facilitates tumor subclassification, predicts underlying MYC rearrangements, and stratifies patient outcome. We aimed to determine the performance of MYC IHC in clinical practice. We reviewed MYC IHC performed on control specimens and 256 aggressive B-cell lymphomas and compared clinically reported IHC scores with experts' review. Control tissues showed less than 5% variation in daily IHC staining. Reported and expert IHC scores were well correlated (r = 0.86) with an SD of 14.2%. Reported IHC scores 30% or less and 70% or more were accurate (94.5%) compared with experts in categorizing tumors as "MYC IHC-Low" and "MYC IHC-High," respectively, but scores 40% to 60% were not (60.3%). The mean IHC score among lymphomas with MYC rearrangements was 80%, but with a large range of scores (20%-100%). There was no statistically significant association between IHC score and MYC copy number. Under optimal conditions, clinically reported MYC IHC scores are concordant with expert scores within 15%. MYC IHC does not capture all B-cell lymphomas with MYC rearrangements, however. MYC IHC and MYC fluorescence in situ hybridization are both recommended to identify MYC-driven B-cell lymphomas. © American Society for Clinical Pathology, 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Current status of information literacy instruction practices in medical libraries of Pakistan.

    Science.gov (United States)

    Ullah, Midrar; Ameen, Kanwal

    2014-10-01

    The research explored the current practices of information literacy (IL) instruction in medical libraries of Pakistan. A semi-structured questionnaire was mailed to the head librarians of all 114 academic medical libraries in Pakistan. It investigated the types of IL instruction provided, topics covered, methods of delivery and assessment, level of integration in the curriculum, and level of collaboration with teaching staff. The study revealed that 74% of the respondents had offered some types of IL instruction in their institutions during the previous year, ranging from library orientation to research-level skills. IL instruction is typically only offered to new students or first-time library users or on demand. A majority of the respondents developed IL instruction programs without faculty involvement. Librarians were primarily responsible for offering IL instruction in medical institutions. Face-to-face instruction in computer labs or lecture halls and individual instruction at reference desks were identified as the most common IL instruction delivery methods. The data indicated that oral feedback, written feedback, and searching in a computer lab were the most popular assessment methods that medical librarians used. IL instruction activities in medical libraries of Pakistan are in their infancy. Medical librarians also lack systematic approaches to IL instruction. Medical librarians need to develop educational partnerships with faculty for integrating IL instruction into the mainstream curriculum.

  2. Reporting Multiple Individual Injuries in Studies of Team Ball Sports: A Systematic Review of Current Practice.

    Science.gov (United States)

    Fortington, Lauren V; van der Worp, Henk; van den Akker-Scheek, Inge; Finch, Caroline F

    2017-06-01

    To identify and prioritise targets for injury prevention efforts, injury incidence studies are widely reported. The accuracy and consistency in calculation and reporting of injury incidence is crucial. Many individuals experience more than one injury but multiple injuries are not consistently reported in sport injury incidence studies. The aim of this systematic review was to evaluate current practice of how multiple injuries within individuals have been defined and reported in prospective, long-term, injury studies in team ball sports. A systematic search of three online databases for articles published before 2016. Publications were included if (1) they collected prospective data on musculoskeletal injuries in individual participants; (2) the study duration was >1 consecutive calendar year/season; and (3) individuals were the unit of analysis. Key study features were summarised, including definitions of injury, how multiple individual injuries were reported and results relating to multiple injuries. Of the 71 publications included, half did not specifically indicate multiple individual injuries; those that did were largely limited to reporting recurrent injuries. Eight studies reported the number/proportion of athletes with more than one injury, and 11 studies presented the mean/number of injuries per athlete. Despite it being relatively common to collect data on individuals across more than one season, the reporting of multiple injuries within individuals is much more limited. Ultimately, better addressing of multiple injuries will improve the accuracy of injury incidence studies and enable more precise targeting and monitoring of the effectiveness of preventive interventions.

  3. Identifying Best Practices in Pavement Design, Materials, Construction, and Maintenance in Wet-Freeze Climates Similar to Michigan

    Science.gov (United States)

    2018-02-28

    The intent of this research is to identify best practices for pavements in wet-freeze climates. For the purposes of this report, a best practice is a procedure that has been shown by research or experience to produce improved results and that is esta...

  4. "Current Good Manufacturing Practices" and the Federal Food, Drug and Cosmetic Act

    OpenAIRE

    Goldstein, Beth F.

    1995-01-01

    The Food and Drug Administration (hereinafter, FDA) regulates food, drugs, and cosmetics in order to ensure that these products are safe and truthfully labelled. As part of its responsibilities under the Federal Food, Drug, and Cosmetic Act (hereinafter, Act), the FDA monitors the manufacturing practices of companies involved in the production of food, drugs, and medical devices. The manufacturing practices used by these companies must comply with certain standards, identified in the Act as "...

  5. Best practices in identifying, reporting and screening operating experience at nuclear power plants

    International Nuclear Information System (INIS)

    2008-03-01

    IAEA Safety Standards Series No. SF-1 entitled Fundamental Safety Principles: Safety Fundamentals states the need for operating organizations to establish a programme for the collection and analysis of operating experience in nuclear power plants. Such a programme ensures that operating experience is analysed, events important to safety are reviewed in depth, lessons learned are disseminated to the staff of the organization and to relevant national and international organizations, and corrective actions are effectively implemented. This publication has been developed to provide advice and assistance to nuclear installations, and related institutions including contractors and support organizations to strengthen and enhance their own feedback process through the implementation of best practices in identifying, reporting and screening processes and to assess the effectiveness of the above areas. To support a proactive safety management approach the nuclear installations are enhancing the operating experience feedback (OEF) processes. For this purpose, the nuclear industry is striving to collect more information on occurrences that are useful to address the early signs of declining performance and improve operational safety performance. In this environment a strong reporting culture that motivates people to identify and report issues is an important attribute. As a consequence, the number and diversity of issues identified increases, and there is a need to set thresholds of screening for further treatment. Thus, the establishment of an effective identification, reporting and screening process is very beneficial to streamline the efforts, and ensure that major incidents and latent weaknesses are being addressed and that operating experience is treated according to its significance. This leads to improved safety and production. This publication was written to complement the publication IAEA Services Series No. 10 - PROSPER Guidelines - Guidelines for Peer Review and for

  6. Biological variation in musculoskeletal injuries: current knowledge, future research and practical implications.

    Science.gov (United States)

    Collins, Malcolm; September, Alison V; Posthumus, Michael

    2015-12-01

    Evidence from familial and genetic association studies have reported that DNA sequence variants play an important role, together with non-genetic factors, in the aetiology of both exercise-associated and occupational-associated acute and chronic musculoskeletal soft tissue injuries. The associated variants, which have been identified to date, may contribute to the interindividual variation in the structure and, by implication, mechanical properties of the collagen fibril and surrounding matrix within musculoskeletal soft tissues, as well as their response to mechanical loading and other stimuli. Future work should focus on the establishment of multidisciplinary international consortia for the identification of biologically relevant variants involved in modulating injury risk. These consortia will improve the limitations of the published hypothesis-driven genetic association studies, since they will allow resources to be pooled in recruiting large well-characterised cohorts required for whole-genome screening. Finally, clinicians and coaches need to be aware that many direct-to-consumer companies are currently marketing genetic tests directly to athletes without it being requested by an appropriately qualified healthcare professional, and without interpretation alongside other clinical indicators or lifestyle factors. These specific genetic tests are premature and are not necessarily required to evaluate susceptibility to musculoskeletal soft tissue injury. Current practice should rather consider susceptibility through known risk factors such as a positive family history of a specific injury, a history of other tendon and/or ligament injuries and participation in activities associated with the specific musculoskeletal injuries. Potential susceptible athletes may then be individually managed to reduce their risk profile. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  7. Identifying and ranking implicit leadership strategies to promote evidence-based practice implementation in addiction health services.

    Science.gov (United States)

    Guerrero, Erick G; Padwa, Howard; Fenwick, Karissa; Harris, Lesley M; Aarons, Gregory A

    2016-05-14

    Despite a solid research base supporting evidence-based practices (EBPs) for addiction treatment such as contingency management and medication-assisted treatment, these services are rarely implemented and delivered in community-based addiction treatment programs in the USA. As a result, many clients do not benefit from the most current and efficacious treatments, resulting in reduced quality of care and compromised treatment outcomes. Previous research indicates that addiction program leaders play a key role in supporting EBP adoption and use. The present study expanded on this previous work to identify strategies that addiction treatment program leaders report using to implement new practices. We relied on a staged and iterative mixed-methods approach to achieve the following four goals: (a) collect data using focus groups and semistructured interviews and conduct analyses to identify implicit managerial strategies for implementation, (b) use surveys to quantitatively rank strategy effectiveness, (c) determine how strategies fit with existing theories of organizational management and change, and (d) use a consensus group to corroborate and expand on the results of the previous three stages. Each goal corresponded to a methodological phase, which included data collection and analytic approaches to identify and evaluate leadership interventions that facilitate EBP implementation in community-based addiction treatment programs. Findings show that the top-ranked strategies involved the recruitment and selection of staff members receptive to change, offering support and requesting feedback during the implementation process, and offering in vivo and hands-on training. Most strategies corresponded to emergent implementation leadership approaches that also utilize principles of transformational and transactional leadership styles. Leadership behaviors represented orientations such as being proactive to respond to implementation needs, supportive to assist staff members

  8. Current practices for the management and confinement of uranium mill tailings

    International Nuclear Information System (INIS)

    1992-01-01

    This report discusses the current practices used in the design siting, construction and closeout of impoundment facilities for uranium mill tailings. The objective is to present an integrated overview of the technological, safety and radiation protection aspects of these topics in order to ensure that the potential radiological and non-radiological risks associated with the management of uranium mill tailings are minimized now and in the future. The report: identifies the nature and source of radioactive and non-radioactive pollutants in uranium mill tailings; identifies the important mechanisms by which pollutants can be released from the tailings impoundment; reviews radiation protection aspects of these mechanisms; describes the pathways by which the pollutants may reach humans; describes some of the site selection and design options and considerations for final stabilization and rehabilitation of tailings impoundments; describes the methods of assessing closure strategies; describes long term responsibilities for tailings management and financial assurance to ensure these responsibilities; and reviews the magnitude and probability of occurrence of the hazards arising, with the aim of ensuring that the risks presented are acceptable. Because of the complexity of the pollutant release mechanisms and the site specific nature of the design and management controls that can be used, it is not possible for a report of this nature to be either exhaustive or detailed in all respects. The methods of confinement employed for any particular tailings impoundment will depend on the country, its climate, demography and its site specific performance criteria which should be defined by the relevant competent authorities. Both operating and post-operating conditions are considered. After shutdown of the mill and stabilization of the tailings, continuing surveillance and maintenance should be considered until the integrity and durability of the tailings impoundment have been

  9. Community-based child health nurses: an exploration of current practice.

    Science.gov (United States)

    Borrow, Stephanie; Munns, Ailsa; Henderson, Saras

    2011-12-01

    The purpose of this research was to define, the practice domain of community-based child health nursing in light of widespread political, economic and social changes in Western Australia. The project was conducted by a group of nurse researchers with experience in child health nursing from the School of Nursing and Midwifery at Curtin University and the Child and Adolescent Community Health Division at the Department of Health, Western Australia. The overall aim of the project was to map the scope of nursing practice in the community child health setting in Western Australia and to identify the decision making framework that underpins this nursing specialty. Given the widespread social, economic and health service management changes, it was important for nurses involved with, or contemplating a career in, community-based child health to have the role accurately defined. In addition, consumer expectations of the service needed to be explored within the current climate. A descriptive qualitative study was used for this project. A purposive sample of 60 participants was drawn from the pool of child health nurses in the South Metropolitan Community Health Service, North Metropolitan Health Service and Western Australian Country Health Service. Following ethical approval data was collected via participants keeping a 2-week work diary. The data was coded and thematic analysis was applied. Several themes emerged from the analysis which were validated by follow up focus group interviews with participants. This clearly demonstrated common, recurring issues. The results identified that the community-based child health nurses are currently undertaking a more complex and expanded child health service role for an increasingly diverse client population, over their traditional practices which are still maintained. Excessive workloads and lack of human and non human resources also presented challenges. There are increasing requirements for child health nurses to engage in

  10. Rehabilitation of the Upper Extremity after Stroke: Current Practice As a Guide for Curriculum

    Directory of Open Access Journals (Sweden)

    Mylene Schriner PhD, OTR/L

    2014-01-01

    Full Text Available Stroke is the leading cause of disability in the United States and a top diagnosis for occupational therapy (OT services among neurological conditions. Academic programs teach OT students neurological frames of reference (FORs to provide a foundation for future practice. To meet accreditation standards, entry-level curricula must reflect current practice and evidence-based interventions. A survey of OT practitioners working in upper extremity stroke rehabilitation was conducted to investigate current clinical practice in a variety of treatment settings. Survey questions probed the use of motor rehabilitation techniques exclusive to one of six neurological FORs: Brunnstrom, Constraint-induced Movement Therapy, Neurodevelopmental Treatment, Proprioceptive Neuromuscular Facilitation, Rood, and Task-Oriented. Responses from 167 OT professionals indicated interventions representing all six FORs are currently being utilized in stroke rehabilitation. Techniques from the Task-Oriented and Neurodevelopmental Treatment approaches were used most frequently; however, the Rood–based techniques were used much less than interventions from the other FORs. No single neurological approach was found to dominate practice regardless of the number of years of experience in stroke rehabilitation or years since graduation from an entry-level program. A majority of participants appear to employ techniques from multiple approaches frequently, suggesting contemporary OT practice in upper extremity stroke rehabilitation is eclectic in nature.

  11. A Focus Group Study of Child Nutrition Professionals' Attitudes about Food Allergies and Current Training Practices

    Science.gov (United States)

    Lee, Yee Ming; Kwon, Junehee; Sauer, Kevin

    2014-01-01

    Purpose/Objectives: The purpose of this study was to explore child nutrition professionals' (CNPs) attitudes about food allergies, current practices of food allergy training, and operational issues related to food allergy training in school foodservice operations. Methods: Three focus groups were conducted with 21 CNPs with managerial…

  12. Assessment of Current Practice for Tank Testing of Small Marine Energy Devices

    DEFF Research Database (Denmark)

    Kofoed, Jens Peter; Frigaard, Peter

    Discussion Report. Equitable Testing and Evaluation of Marine Energy Extraction Devices in terms of Performance, Cost and Environmental Impact. The report is a contribution by Aalborg University (AAU) to the deliverable on Assessment of current practice for tank testing of small marine energy...

  13. Examining Current Beliefs, Practices and Barriers about Technology Integration: A Case Study

    Science.gov (United States)

    Hsu, Pi-Sui

    2016-01-01

    The purpose of this mixed-methods study was to examine the current beliefs, practices and barriers concerning technology integration of Kindergarten through Grade Six teachers in the midwestern United States. The three data collection methods were online surveys with 152 teachers as well as interviews and observations with 8 teachers. The findings…

  14. Cultural landscapes as heritage in Malaysia: Potentials, threats, and current practices

    NARCIS (Netherlands)

    Ahmad, R.

    2013-01-01

    The rural cultural landscape in Malaysia is relatively under-researched. The current heritage practices focus on built heritage as national heritage, which implies the everyday landscapes of the rural areas have been neglected as potential heritage and have received little attention from politicians

  15. Current Trends in Malaysian Higher Education and the Effect on Education Policy and Practice: An Overview

    Science.gov (United States)

    Grapragasem, Selvaraj; Krishnan, Anbalagan; Mansor, Azlin Norhaini

    2014-01-01

    Malaysia has evolved from a production-based to knowledge-based economy in order to stay relevant and compete in the global marketplace. Thus, the purpose of this article is to discuss current trends in Malaysian higher education and how these affect education policies and practices. Four main trends are discussed in this study: Globalization,…

  16. Vitamin D status of dairy cattle: Outcomes of current practices in the dairy industry

    Science.gov (United States)

    The need for vitamin D supplementation of dairy cattle has been known for the better part of the last century and is well-appreciated by dairy producers and nutritionists. Whether current recommendations and practices for supplemental vitamin D are meeting the needs of dairy cattle, however, is not...

  17. Cardioversion for atrial fibrillation in current European practice : results of the European Heart Rhythm Association survey

    NARCIS (Netherlands)

    Hernandez-Madrid, Antonio; Svendsen, Jesper Hastrup; Lip, Gregory Y. H.; Van Gelder, Isabelle C.; Dobreanu, Dan; Blomstrom-Lundqvist, Carina

    This survey was conducted to provide an insight into the current clinical practice regarding the use of cardioversion for atrial fibrillation (AF) in Europe. Responses were received from 57 centres across Europe, 71.9 of which were university hospitals. For electrical cardioversion, general

  18. Educating physicians in evidence based medicine: current practices and curricular strategies

    NARCIS (Netherlands)

    Maggio, L.A.

    2015-01-01

    Evidence based medicine (EBM) is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” The practice of EBM is an expectation of professional healthcare and requisite component in many medical school curricula. Yet, despite

  19. Interpersonal Relationships, Motivation, Engagement, and Achievement: Yields for Theory, Current Issues, and Educational Practice

    Science.gov (United States)

    Martin, Andrew J.; Dowson, Martin

    2009-01-01

    In this review, we scope the role of interpersonal relationships in students' academic motivation, engagement, and achievement. We argue that achievement motivation theory, current issues, and educational practice can be conceptualized in relational terms. Influential theorizing, including attribution theory, expectancy-value theory, goal theory,…

  20. Methane emissions from natural gas pipelines - current estimates, technologies and practices

    International Nuclear Information System (INIS)

    Lang, M.C.; Crook, L.

    1997-01-01

    Methane is the major component of natural gas. World-wide methane emissions from gas systems is estimated to be between 50 and 25 tera grams or about 5 percent of the world-wide total of anthropogenic methane emissions. Technologies and practices are described that are currently being used or are planned to be used in the US to both measure and/or reduce methane emissions from natural gas pipelines. One of the technologies that is described includes a high flow sampling instrument. One of the practices that is described is the current voluntary program conducted by the US Environmental Protection Agency called the Natural Gas Star program. This program supports research into best management practices, information sharing and technology transfer to promote methane emissions reductions profitably. (R.P.)

  1. Detection of previously undiagnosed cases of COPD in a high-risk population identified in general practice

    DEFF Research Database (Denmark)

    Løkke, Anders; Ulrik, Charlotte Suppli; Dahl, Ronald

    2012-01-01

    Background and Aim: Under-diagnosis of COPD is a widespread problem. This study aimed to identify previously undiagnosed cases of COPD in a high-risk population identified through general practice. Methods: Participating GPs (n = 241) recruited subjects with no previous diagnosis of lung disease,...

  2. Standard practice for examination of welds using the alternating current field measurement technique

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2007-01-01

    1.1 This practice describes procedures to be followed during alternating current field measurement examination of welds for baseline and service-induced surface breaking discontinuities. 1.2 This practice is intended for use on welds in any metallic material. 1.3 This practice does not establish weld acceptance criteria. 1.4 The values stated in either inch-pound units or SI units are to be regarded separately as standard. The values stated in each system might not be exact equivalents; therefore, each system shall be used independently of the other. 1.5 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

  3. Current practice and views of neurologists on the transition from pediatric to adult care.

    Science.gov (United States)

    Oskoui, Maryam; Wolfson, Christina

    2012-12-01

    To describe the current practice and views of neurologists on transitioning patients from pediatric to adult care, a cross-sectional study of all pediatric and adult neurologists in the province of Quebec, Canada, was conducted. The response rate was 73% for pediatric and 49% for adult neurologists. Most pediatric neurologists do not have a patient transition program or policy in place. Although a transfer summary is commonly provided, critical information is often lacking. Nearly half of neurologists believed that patients experience a gap in care during the transition process, and most agreed that the transition process is often poorly coordinated, highlighting patient, family, and health care factors. Current practice does not follow existing consensus statements for transition of care with respect to timing, communication, and preparation, and many pediatric neurologists experience difficulty in finding an appropriate adult health care provider for their patients. Neurologists reported many challenges in the current transition of care process.

  4. Occupational Safety and Health: A View of Current Practices in Agricultural Education

    Science.gov (United States)

    Threeton, Mark D.; Ewing, John C.; Evanoski, Danielle C.

    2015-01-01

    Providing safe and secure teaching and learning environments within schools is an ongoing process which requires a significant amount of attention. Therefore, this study sought to: 1) explore safety and health practices within secondary Agricultural Mechanics Education; and 2) identify the perceived obstacles which appear to hinder implementation…

  5. Evidence-Based Practices in Special Education: Current Assumptions and Future Considerations

    Science.gov (United States)

    Russo-Campisi, Jacqueline

    2017-01-01

    Background: The research on evidence-based practices (EBP) in special education has shifted over the last decade from identifying efficacious interventions to exploring issues that impede implementation in the classroom. Common barriers to implementation include absence of training and resources, limited collaboration between researchers and…

  6. Theoretical and practical program in the non-destructive testing by eddy currents - the first level

    International Nuclear Information System (INIS)

    Shaaban, H.I.; Addarwish, J.M.A.

    2014-11-01

    The testing using eddy currents is one of the non-destructive tests that use electromagnetic property as a basis for testing procedures, and there are many other ways to use this principle, including Remote Field Testing and the Magnetic Flux Leakage test. Eddy currents are electrical currents moving in a circular path, and took the name eddy of eddies that form when a liquid or gas is moving in a circular path because of objection obstacles to its track. They are generated in the material using a variable magnetic field. Non-destructive testing by eddy currents is a technique used for the detection of defects and interruptions in a material and it is a process that relies on the generation of small eddy currents in the material of the part to be examined, provided that this part is of an electrically conducting material. This technique and its scientific basis are explained in this book. Also the devices used in this technique and how to use these devices in details are explained. The book contains Twelve chapters: Introduction to non destructive testing - Engineering materials and its mechanical characteristics - Electrical and magnetic characteristics of engineering materials - Introduction to testing by eddy currents - Factors affecting eddy currents - Basis of electrical circuits used in eddy currents testing devices - Probes of eddy currents testing - Eddy currents testing devices (Theoretical) - Analysis of the examination results of testing by eddy currents: techniques and applications - Applications of testing by eddy currents - Eddy currents testing devices (Application) - Practical lessons for the first level in testing by eddy currents.

  7. Articulating current service development practices: a qualitative analysis of eleven mental health projects.

    Science.gov (United States)

    Jun, Gyuchan Thomas; Morrison, Cecily; Clarkson, P John

    2014-01-17

    The utilisation of good design practices in the development of complex health services is essential to improving quality. Healthcare organisations, however, are often seriously out of step with modern design thinking and practice. As a starting point to encourage the uptake of good design practices, it is important to understand the context of their intended use. This study aims to do that by articulating current health service development practices. Eleven service development projects carried out in a large mental health service were investigated through in-depth interviews with six operation managers. The critical decision method in conjunction with diagrammatic elicitation was used to capture descriptions of these projects. Stage-gate design models were then formed to visually articulate, classify and characterise different service development practices. Projects were grouped into three categories according to design process patterns: new service introduction and service integration; service improvement; service closure. Three common design stages: problem exploration, idea generation and solution evaluation - were then compared across the design process patterns. Consistent across projects were a top-down, policy-driven approach to exploration, underexploited idea generation and implementation-based evaluation. This study provides insight into where and how good design practices can contribute to the improvement of current service development practices. Specifically, the following suggestions for future service development practices are made: genuine user needs analysis for exploration; divergent thinking and innovative culture for idea generation; and fail-safe evaluation prior to implementation. Better training for managers through partnership working with design experts and researchers could be beneficial.

  8. ICU nurses' oral-care practices and the current best evidence.

    Science.gov (United States)

    DeKeyser Ganz, Freda; Fink, Naomi Farkash; Raanan, Ofra; Asher, Miriam; Bruttin, Madeline; Nun, Maureen Ben; Benbinishty, Julie

    2009-01-01

    The purpose of this study was to describe the oral-care practices of ICU nurses, to compare those practices with current evidence-based practice, and to determine if the use of evidence-based practice was associated with personal demographic or professional characteristics. A national survey of oral-care practices of ICU nurses was conducted using a convenience sample of 218 practicing ICU nurses in 2004-05. The survey instrument included questions about demographic and professional characteristics and a checklist of oral-care practices. Nurses rated their perceived level of priority concerning oral care on a scale from 0 to 100. A score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the current best evidence. This score was then statistically analyzed using ANOVA to determine differences of EBP based on demographic and professional characteristics. The most commonly used equipment was gauze pads (84%), followed by tongue depressors (55%), and toothbrushes (34%). Chlorhexidine was the most common solution used (75%). Less than half (44%) reported brushing their patients' teeth. The majority performed an oral assessment before beginning oral care (71%); however, none could describe what assessment tool was used. Only 57% of nurses reported documenting their oral care. Nurses rated oral care of intubated patients with a priority of 67+/-27.1. Wide variations were noted within and between units in terms of which techniques, equipment, and solutions were used. No significant relationships were found between the use of an evidence-based protocol and demographic and professional characteristics or with the priority given to oral care. While nurses ranked oral care a high priority, many did not implement the latest evidence into their current practice. The level of research utilization was not related to personal or professional characteristics. Therefore attempts should be made to encourage all

  9. Implications of current resident work-hour guidelines on the future practice of surgery in Canada.

    Science.gov (United States)

    Maruscak, Adam A; VanderBeek, Laura; Ott, Michael C; Kelly, Stephen; Forbes, Thomas L

    2012-01-01

    Work-hour restrictions have had a profound impact on surgical training. However, little is known of how work-hour restrictions may affect the future practice patterns of current surgical residents. The purpose of this study is to compare the anticipated career practice patterns of surgical residents who are training within an environment of work-hour restrictions with the current practice of faculty surgeons. An electronic survey was sent to all surgery residents and faculty at 2 Canadian university-affiliated medical centers. The survey consisted of questions regarding expected (residents) or current (faculty) practice patterns. A total of 149 residents and 125 faculty members completed the survey (50.3% and 52.3% response rates, respectively). A greater proportion of males were in the faculty cohort than in the resident group (77.6% vs 62.4%, p = 0.0003). More faculty than residents believed that work-hour restrictions have a negative impact on both residency education (40.8% vs 20.8%, p = 0.008) and preparation for a surgical career (56.8% vs 19.5%, p implications and might require larger surgical groups and reconsideration of resource allocation. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  10. The effect of recent amblyopia research on current practice in the UK.

    Science.gov (United States)

    Newsham, D

    2010-10-01

    Several studies have recently provided insights into how amblyopia may be most effectively managed. Despite the new evidence, a US study reported that a recent randomised controlled trial had made little influence on clinical practice. The aims of this research are to assess current practice of amblyopia management in the UK and to determine the comparability with the evidence-based recommendations. A questionnaire was constructed to assess current amblyopia management practice, particularly in relation to areas investigated by recent research and emailed to every head orthoptist within the UK. There was a great deal of variability in the amount of occlusion that was prescribed for moderate and severe amblyopia. Sixty per cent of clinicians indicated that the maximum they would prescribe was in excess of the 6 h recommended by research. Atropine was rarely recommended as a first-line treatment, with occlusion generally being considered to be more effective. Despite recommendations regarding education as a means of reducing non-compliance, only 39% of clinicians always gave written information, although various other methods of enhancing compliance were used. A period of refractive adaptation was allowed by most clinicians but often far less than recommended. The uptake of recent research evidence into clinical practice is sporadic and incomplete with one-third of respondents indicating that following the studies, they had made no changes whatsoever to their practice. This is similar to other areas of medicine; the reasons are likely to be varied, and is an area that would benefit from greater attention.

  11. A Snapshot Study of Current Practices among Sellers of Translation Services between Japanese and English

    Directory of Open Access Journals (Sweden)

    Dr. Stephen Crabbe

    2015-11-01

    Full Text Available A two-part study was launched in light of the Japan Translation Federation’s 2012 statement in its guide, 翻訳で失敗しないために翻訳発注の手引き [lit. For not getting it wrong with translation: a guide to ordering translation], that “外国語の文書を母国語に翻訳するのがプロの原則です” [lit. It is a fundamental principle that professional translators work into their native languages] (Japan Translation Federation, 2012, p. 15. The key goal is to gauge the extent to which this 2012 statement is reflected in current practices among the sellers and buyers of translation services between Japanese and English. In this paper, which describes the first part of the study, the focus is on the practices of sellers of translation services between Japanese and English: specifically, professional freelance translators. Twenty-four professional freelance translators completed an online questionnaire. The results of this questionnaire, first, suggest that current practices among sellers of translation services between Japanese and English are consistent with the Japan Translation Federation’s 2012 statement and, second, broadly support secondary literature on L1 translation (translation into the first language and L2 translation (translation into the second language. Whilst this is only a snapshot of current practices among sellers of translation services between Japanese and English, the overall results are informative. In the second, follow-up part of the study the focus will be on the current practices of buyers of translation services between Japanese and English.

  12. Identifying context factors explaining physician's low performance in communication assessment: an explorative study in general practice.

    NARCIS (Netherlands)

    Essers, G.; Dulmen, S. van; Weel, C. van; Vleuten, C. van der; Kramer, A.

    2011-01-01

    BACKGROUND: Communication is a key competence for health care professionals. Analysis of registrar and GP communication performance in daily practice, however, suggests a suboptimal application of communication skills. The influence of context factors could reveal why communication performance

  13. Identifying context factors explaining physician's low performance in communication assessment: an explorative study in general practice.

    NARCIS (Netherlands)

    Essers, G.T.J.M.; Dulmen, A.M. van; Weel, C. van; Vleuten, C.P.M. van der; Kramer, A.W.

    2011-01-01

    ABSTRACT: BACKGROUND: Communication is a key competence for health care professionals. Analysis of registrar and GP communication performance in daily practice, however, suggests a suboptimal application of communication skills. The influence of context factors could reveal why communication

  14. The impact of [corrected] expanded nursing practice on professional identify in Denmark.

    Science.gov (United States)

    Piil, Karin; Kolbæk, Raymond; Ottmann, Goetz; Rasmussen, Bodil

    2012-01-01

    This article explores the concept of professional identity of Danish nurses working in an expanded practice. The case study explores the experiences of a small group of Danish nurses with a new professional category that reaches into a domain that customarily belonged to physicians. The aim of this case study was to explore the impact of "nurse consultations," representing an expanded nursing role, of 5 nurses focusing on their perception of autonomy, self-esteem, and confidence. The case study used semistructured interviews with 5 participants triangulated and validated with participant observations, a focus group interview, and theoretically derived insights. This study indicates that nurses working within a new expanded professional practice see themselves as still engaged in nursing and not as substitute physicians. The study also suggests that the involved nurses gained a higher sense of autonomy, self-esteem, and confidence in their practice. These elements have a positive impact on their professional identity. The research demonstrates that for the nurses involved in expanded professional practice, the boundaries of professional practice have shifted significantly. The research indicates that an expanded practice generates a new domain within the professional identity of nurses.

  15. 78 FR 64425 - Current Good Manufacturing Practice and Hazard Analysis and Risk-Based Preventive Controls for...

    Science.gov (United States)

    2013-10-29

    ..., 507, and 579 [Docket No. FDA-2011-N-0922] Current Good Manufacturing Practice and Hazard Analysis and... requirements for current good manufacturing practice and hazard analysis and risk-based preventive controls for..., packing, or holding of animal food in two ways. First, it would create new current good manufacturing...

  16. 78 FR 69604 - Current Good Manufacturing Practice and Hazard Analysis and Risk-Based Preventive Controls for...

    Science.gov (United States)

    2013-11-20

    ... Federal Register of January 16, 2013 (78 FR 3646), entitled ``Current Good Manufacturing Practice and... a proposed rule entitled ``Current Good Manufacturing Practice and Hazard Analysis and Risk-Based..., 114, 117, 120, 123, 129, 179, and 211 [Docket No. FDA-2011-N-0920] RIN 0910-AG36 Current Good...

  17. Teachers' instructional goals for science practice: Identifying knowledge gaps using cultural-historical activity theory (CHAT)

    Science.gov (United States)

    Farrar, Cynthia Hamen

    In AP Biology, the course goal, with respect to scientific acts and reasoning, has recently shifted toward a reform goal of science practice, where the goal is for students to have a scientific perspective that views science as a practice of a community rather than a body of knowledge. Given this recent shift, this study is interested in the gaps that may exist between an individual teacher's instructional goal and the goals of the AP Biology course. A Cultural-Historical Activity Theory (CHAT) methodology and perspective is used to analyze four teachers' knowledge, practice, and learning. Teachers have content knowledge for teaching, a form of knowledge that is unique for teaching called specialized content knowledge. This specialized content knowledge (SCK) defines their instructional goals, the student outcomes they ultimately aim to achieve with their students. The study employs a cultural-historical continuum of scientific acts and reasoning, which represents the development of the AP Biology goal over time, to study gaps in their instructional goal. The study also analyzes the contradictions within their teaching practice and how teachers address those contradictions to shift their instructional practice and learn. The findings suggest that teachers have different interpretations of the AP Biology goals of science practice, placing their instructional goal at different points along the continuum. Based on the location of their instructional goal, different micro-communities of teachers exist along the continuum, comprised of teachers with a shared goal, language, and culture of their AP Biology teaching. The in-depth study of one teacher's AP Biology teaching, using a CHAT perspective, provides a means for studying the mechanisms that connect SCK to classroom actions and ultimately to instructional practice. CHAT also reveals the nature and importance of contradictions or cognitive dissonance in teacher learning and the types of support teachers need to

  18. Current practice and developmental efforts for leak detection in U.S. reactor primary systems

    International Nuclear Information System (INIS)

    Kupperman, D.S.; Claytor, T.N.

    1986-01-01

    Current leak detection practices in 74 operating nuclear reactors have been reviewed. Existing leak detection systems are adequate to ensure a leak-before-break scenario in most situations, but no currently available, single method combines optimal leakage detection sensitivity, leak-locating ability, and leakage measurement accuracy. Simply tightening current leakage limits may produce an unacceptably large number of unnecessary shutdowns. The use of commercially available acoustic monitoring systems or moisture-sensitive tape may improve leak detection capability at specific sites. However, neither of these methods currently provides source discrimination (e.g., to distinguish between leaks from pipe cracks and valves) or leak-rate information (a small leak may saturate the system). A field-implementable acoustic leak detection system is being developed to address these limitations. 5 refs.

  19. Current practice and developmental efforts for leak detection in US reactor primary systems

    International Nuclear Information System (INIS)

    Kupperman, D.S.; Claytor, T.N.

    1985-07-01

    Current leak detection practices in 74 operating nuclear reactors have been reviewed. Existing leak detection systems are adequate to ensure a leak-before-break scenario in most situations, but no currently available, single method combines optimal leakage detection sensitivity, leak-locating ability, and leakage measurement accuracy. Simply tightening current leakage limits may produce an unacceptably large number of unnecessary shutdowns. The use of commercially available acoustic monitoring systems or moisture-sensitive tape may improve leak detection capability at specific sites. However, neither of these methods currently provides source discrimination (e.g., to distinguish between leaks from pipe cracks and valves) or leak-rate information (a small leak may saturate the system). A field-implementable acoustic leak detection system is being developed to address these limitations. 5 refs., 3 figs

  20. Clinical balance assessment: perceptions of commonly-used standardized measures and current practices among physiotherapists in Ontario, Canada.

    Science.gov (United States)

    Sibley, Kathryn M; Straus, Sharon E; Inness, Elizabeth L; Salbach, Nancy M; Jaglal, Susan B

    2013-03-20

    Balance impairment is common in multiple clinical populations, and comprehensive assessment is important for identifying impairments, planning individualized treatment programs, and evaluating change over time. However, little information is available regarding whether clinicians who treat balance are satisfied with existing assessment tools. In 2010 we conducted a cross-sectional survey of balance assessment practices among physiotherapists in Ontario, Canada, and reported on the use of standardized balance measures (Sibley et al. 2011 Physical Therapy; 91: 1583-91). The purpose of this study was to analyse additional survey data and i) evaluate satisfaction with current balance assessment practices and standardized measures among physiotherapists who treat adult or geriatric populations with balance impairment, and ii) identify factors associated with satisfaction. The questionnaire was distributed to 1000 practicing physiotherapists. This analysis focuses on questions in which respondents were asked to rate their general perceptions about balance assessment, the perceived utility of individual standardized balance measures, whether they wanted to improve balance assessment practices, and why. Data were summarized with descriptive statistics and utility of individual measures was compared across clinical practice areas (orthopaedic, neurological, geriatric or general rehabilitation). The questionnaire was completed by 369 respondents, of which 43.4% of respondents agreed that existing standardized measures of balance meet their needs. In ratings of individual measures, the Single Leg Stance test and Berg Balance Scale were perceived as useful for clinical decision-making and evaluating change over time by over 70% of respondents, and the Timed Up-and-Go test was perceived as useful for decision-making by 56.9% of respondents and useful for evaluating change over time by 62.9% of respondents, but there were significant differences across practice groups. Seventy

  1. Current state of information technology use in a US primary care practice-based research network.

    Science.gov (United States)

    Andrews, James E; Pearce, Kevin A; Sydney, Carey; Ireson, Carol; Love, Margaret

    2004-01-01

    To examine the current levels of information technology (IT) use in a primary care practice-based research network (PBRN) in order to inform future development of its infrastructure. Every primary care practitioner who is a member of the Kentucky Ambulatory Network (KAN),as well as the office managers of each practice. Practitioners included family practitioners, general practitioners, nurse practitioners and physician assistants. A cross-sectional study using two survey instruments: one for office managers and one for practitioners. The office manager survey included questions related to the current state of IT within the practice, plans for enhancement and general IT issues from the perspective of managing a practice. The practitioner survey was designed to measure current IT use and attitudes of primary care practitioners. Response rates for the surveys were 46% (n = 68) for the office managers and 51% (n = 116) for practitioners. All but one practice had internet access; however, 43% had only dial-up service. Only 21% of practitioners use an electronic medical record (EMR), with dollar cost being the barrier reported most frequently (58%). More than half of the office managers were either 'somewhat interested' (45%) or 'very interested' (17%) in a low-cost, standardised EMR that was, at the time, to be sponsored by the American Academy of Family Physicians. For practitioners, 71% were either 'somewhat' or 'very' interested in such a system. Responses to other IT issues are reported. While interest in enabling information technologies was high in KAN, adoption was variable, with use of several key technologies reported as low.The results suggest that research in this network that would be dependent on or enhanced by IT might be impeded and, generally, greater attention should be given to enhancing the IT infrastructure in primary care.

  2. Identifying educational priorities for occupational therapy students to prepare for mental health practice in Australia and New Zealand: Opinions of practising occupational therapists.

    Science.gov (United States)

    Scanlan, Justin Newton; Pépin, Geneviève; Haracz, Kirsti; Ennals, Priscilla; Webster, Jayne S; Meredith, Pamela J; Batten, Rachel; Bowman, Siann; Bonassi, Marianne; Bruce, Rosie

    2015-10-01

    The effective preparation of occupational therapy students for mental health practice is critical to facilitate positive consumer outcomes, underpin optimal practice and support new graduates' professional identity. This project was established to determine a set of 'educational priorities' for occupational therapy students to prepare them for current (and future) entry-level practice in mental health, from the perspective of mental health occupational therapists in Australia and New Zealand. The study included two phases. In Phase One, participants identified what they considered to be important educational priorities for occupational therapy students to prepare them for practice in mental health. For Phase Two, an 'expert panel' was assembled to review and rank these using a Policy Delphi approach. Eighty-five participants provided educational priorities in Phase One. These were grouped into a total of 149 educational themes. In Phase Two, the expert panel (consisting of 37 occupational therapists from diverse locations and practice settings) prioritised these themes across three Delphi rounds. A final priority list was generated dividing educational themes into three prioritised categories: 29 'Essential', 25 'Important' and 44 'Optional' priorities. Highest-ranked priorities were: clinical reasoning, client-centred practice, therapeutic use of self, functional implications of mental illness, therapeutic use of occupation and mental health fieldwork experience. The priority list developed as part of this project provides additional information to support the review of occupational therapy curricula across Australia and New Zealand to ensure that new graduates are optimally prepared for mental health practice. © 2015 Occupational Therapy Australia.

  3. Caring for people with dementia in hospital: findings from a survey to identify barriers and facilitators to implementing best practice dementia care.

    Science.gov (United States)

    Tropea, Joanne; LoGiudice, Dina; Liew, Danny; Roberts, Carol; Brand, Caroline

    2017-03-01

    Best practice dementia care is not always provided in the hospital setting. Knowledge, attitudes and motivation, practitioner behavior, and external factors can influence uptake of best practice and quality care. The aim of this study was to determine hospital staff perceived barriers and enablers to implementing best practice dementia care. A 17-item survey was administered at two Australian hospitals between July and September 2014. Multidisciplinary staff working in the emergency departments and general medical wards were invited to participate in the survey. The survey collected data about the respondents' current role, work area, and years of experience, their perceived level of confidence and knowledge in dementia care and common symptoms of dementia, barriers and enablers to implementing best practice dementia care, job satisfaction in caring for people with dementia, and to rate the hospital's capacity and available resources to support best practice dementia care. A total of 112 survey responses were received. The environment, inadequate staffing levels and workload, time, and staff knowledge and skills were identified as barriers to implementing best practice dementia care. Most respondents rated their knowledge of dementia care and common symptoms of dementia, and confidence in recognizing whether a person has dementia, as moderate or high dementia. Approximately, half the respondents rated access to training and equipment as low or very low. The survey findings highlighted hospital staff perceived barriers to implementing best practice dementia care that can be used to inform locally tailored improvement interventions.

  4. Current practices in vestibular schwannoma management: a survey of American and Canadian neurosurgeons.

    Science.gov (United States)

    Fusco, Matthew R; Fisher, Winfield S; McGrew, Benjamin M; Walters, Beverly C

    2014-12-01

    Comprehensive therapy for vestibular schwannomas has changed dramatically over the past fifty years. Previously, neurosurgeons were most likely to treat these tumors via an independent surgical approach. Currently, many neurosurgeons treat vestibular schwannomas employing an interdisciplinary team approach with neuro-otologists and radiation oncologists. This survey aims to determine the current treatment paradigm for vestibular schwannomas among American and Canadian neurosurgeons, with particular attention to the utilization of a team approach to the surgical resection of these lesions. A seventeen part survey questionnaire was sent by electronic mail to residency trained members of the American Association of Neurological Surgeons currently practicing in Canada or the United States. Questions were divided into groups regarding physician background, overall practice history, recent practice history, opinions on treatment paradigms, and experience with an interdisciplinary team approach. Seven hundred and six responses were received. The vast majority of neurosurgeons surgically resect vestibular schwannomas as part of an interdisciplinary team (85.7%). Regional variations were observed in the use of an interdisciplinary team: 52.3% of responding neurosurgeons who surgically treat vestibular schwannomas without neuro-otologists currently practice in the South (no other region represented more than 15.4% of this group, p=0.02). Surgeons who have treated >50 vestibular schwannomas show a trend towards more frequent utilization of an interdisciplinary approach than less experienced surgeons, but this did not reach statistical significance. The majority of neurosurgeons in the United States and Canada surgically resect vestibular schwannomas via an interdisciplinary approach with the participation of a neuro-otologist. Neurosurgeons in the South appear more likely to surgically treat these tumors alone than neurosurgeons in other regions of the U.S. and Canada

  5. Small Business and Defense Acquisitions: A Review of Policies and Current Practices

    Science.gov (United States)

    2011-01-01

    Office of Management and Budget xviii Small Business and Defense Acquisitions: A Review of Policies and Current Practices PSC Product and Service Code...themselves as minority-owned, women-owned, veteran- owned, or small disadvantaged businesses . The resulting database gives sourcing managers a tool for...REPORT DATE 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE Small Business and Defense Acquisitions: A

  6. Surgical handover in an era of reduced working hours: an audit of current practice.

    Science.gov (United States)

    Shafiq-ur-Rehman; Mehmood, Sajid; Ahmed, Jamil; Razzaq, Muhammad Haroon; Khan, Shakeeb; Perry, Eugene Phillip

    2012-06-01

    To examine the current practice of handover and to record trainees' assessment of handover process. An audit study. Department of General Surgery, Scarborough General Hospital, Scarborough, United Kingdom, from January to April 2010. A paper-based questionnaire containing instruments pertaining to handover guidelines was disseminated to trainees on surgical on-call rota at the hospital. Trainees' responses regarding handover process including information transferred, designated location, duration, structure, senior supervision, awareness of guidelines, formal training, and rating of current handover practice were analysed. A total of 42 questionnaires were returned (response rate = 100%). The trainees included were; registrars 21% (n=9), core surgical trainees 38 % (n=16), and foundation trainees 41% (n=17). Satisfactory compliance (> 80% handover sessions) to RCS guidelines was observed for only five out of nine components. Ninety-five percent of hand over sessions took place at a designated place and two-third lasted less than 20-minutes. Computer generated handover sheet 57% (n=24) was the most commonly practised method of handover. Specialist registrar 69 % (n=29) remained the supervising person in majority of handover sessions. None of the respondents received formal teaching or training in handover, whereas only half of them 48% (n=20) were aware of handover guidelines. Twenty-one percent of the trainees expressed dissatisfaction with the current practice of handover. Current practice of surgical handover lacks structure despite a fair degree of compliance to RCS handover guidelines. A computerised-sheet based structured handover process, subjected to regular audit, would ensure patient safety and continuity of care.

  7. Management of Pediatric Delirium in Pediatric Cardiac Intensive Care Patients: An International Survey of Current Practices.

    Science.gov (United States)

    Staveski, Sandra L; Pickler, Rita H; Lin, Li; Shaw, Richard J; Meinzen-Derr, Jareen; Redington, Andrew; Curley, Martha A Q

    2018-06-01

    The purpose of this study was to describe how pediatric cardiac intensive care clinicians assess and manage delirium in patients following cardiac surgery. Descriptive self-report survey. A web-based survey of pediatric cardiac intensive care clinicians who are members of the Pediatric Cardiac Intensive Care Society. Pediatric cardiac intensive care clinicians (physicians and nurses). None. One-hundred seventy-three clinicians practicing in 71 different institutions located in 13 countries completed the survey. Respondents described their clinical impression of the occurrence of delirium to be approximately 25%. Most respondents (75%) reported that their ICU does not routinely screen for delirium. Over half of the respondents (61%) have never attended a lecture on delirium. The majority of respondents (86%) were not satisfied with current delirium screening, diagnosis, and management practices. Promotion of day/night cycle, exposure to natural light, deintensification of care, sleep hygiene, and reorientation to prevent or manage delirium were among nonpharmacologic interventions reported along with the use of anxiolytic, antipsychotic, and medications for insomnia. Clinicians responding to the survey reported a range of delirium assessment and management practices in postoperative pediatric cardiac surgery patients. Study results highlight the need for improvement in delirium education for pediatric cardiac intensive care clinicians as well as the need for systematic evaluation of current delirium assessment and management practices.

  8. Toward a more materialistic medicine: the value of authentic materialism within current and future medical practice.

    Science.gov (United States)

    Leder, Drew; Krucoff, Mitchell W

    2011-09-01

    Modern medicine is often accused by diverse critics of being "too materialistic" and therefore insufficiently holistic and effective. Yet, this critique can be misleading, dependent upon the ambiguous meanings of "materialism." The term can refer to the prevalence of financial concerns in driving medical practice. Alternatively, it can refer to "mechanistic materialism," the patient viewed as a body-machine. In each case, this article shows that this represents not authentic "materialism" at play, but a focus upon high-level abstractions. "Bottom-line" financial or diagnostic numbers can distract practitioners from the embodied needs of sick patients. In this sense, medical practice is not materialist enough. Through a series of clinical examples, this article explores how an authentic materialism would look in current and future practice. The article examines the use of prayer/comfort shawls at the bedside; hospitals and nursing homes redesigned as enriched healing environments; and a paradigmatic medical device--the implantable cardioverter defibrillator--as it might be presented to patients, in contrast to current practice.

  9. The sensitivity and specificity of four questions (HARK to identify intimate partner violence: a diagnostic accuracy study in general practice

    Directory of Open Access Journals (Sweden)

    Feder Gene

    2007-08-01

    Full Text Available Abstract Background Intimate partner violence (IPV including physical, sexual and emotional violence, causes short and long term ill-health. Brief questions that reliably identify women experiencing IPV who present in clinical settings are a pre-requisite for an appropriate response from health services to this substantial public health problem. We estimated the sensitivity and specificity of four questions (HARK developed from the Abuse Assessment screen, compared to a 30-item abuse questionnaire, the Composite Abuse Scale (CAS. Methods We administered the four HARK questions and the CAS to women approached by two researchers in general practice waiting rooms in Newham, east London. Inclusions: women aged more than 17 years waiting to see a doctor or nurse, who had been in an intimate relationship in the last year. Exclusions: women who were accompanied by children over four years of age or another adult, too unwell to complete the questionnaires, unable to understand English or unable to give informed consent. Results Two hundred and thirty two women were recruited. The response rate was 54%. The prevalence of current intimate partner violence, within the last 12 months, using the CAS cut off score of ≥3, was 23% (95% C.I. 17% to 28% with pre-test odds of 0.3 (95% C.I. 0.2 to 0.4. The receiver operator characteristic curve demonstrated that a HARK cut off score of ≥1 maximises the true positives whilst minimising the false positives. The sensitivity of the optimal HARK cut-off score of ≥1 was 81% (95% C.I. 69% to 90%, specificity 95% (95% C.I. 91% to 98%, positive predictive value 83% (95% C.I. 70% to 91%, negative predictive value 94% (95% C.I. 90% to 97%, likelihood ratio 16 (95% C.I. 8 to 31 and post-test odds 5. Conclusion The four HARK questions accurately identify women experiencing IPV in the past year and may help women disclose abuse in general practice. The HARK questions could be incorporated into the electronic medical record

  10. Smartphone use in dermatology for clinical photography and consultation: Current practice and the law.

    Science.gov (United States)

    Abbott, Lisa M; Magnusson, Roger S; Gibbs, Emma; Smith, Saxon D

    2018-05-01

    Smartphones are rapidly changing the way doctors capture and communicate clinical information, particularly in highly visual specialties such as dermatology. An understanding of how and why smartphones are currently used in clinical practice is critical in order to evaluate professional and legal risks, and to formulate policies that enable safe use of mobile technologies for the maximal benefit of practitioners and patients. Australian dermatologists and dermatology trainees were surveyed on their current practices relating to clinical smartphone use. Of the 105 respondents, 101 provided useable results. The data show clinical smartphone use is common and frequent, with more than 50% of respondents sending and receiving images on their smartphones at least weekly. Clinical photographs were usually sent via multimedia message or email and were commonly stored on smartphones (46%). Security measures adopted to protect data were limited. There was inadequate documentation of consent for transmission of photographs and advice provided. Only 22% of respondents were aware of clear policies in their workplace regarding smartphone use, and a majority desired further education on digital image management. Given the frequency of use and the degree of importance placed on the ability to send and receive clinical images, clinical smartphone use will persist and will likely increase over time. Current practices are insufficient to comply with professional and legal obligations, and increase practitioners' vulnerability to civil and disciplinary proceedings. Further education, realistic policies and adequate software resources are critical to ensure protection of patients, practitioners and the reputation of the dermatological profession. © 2017 The Australasian College of Dermatologists.

  11. A survey of current practice of vascular surgeons in venous disease management.

    Science.gov (United States)

    Bush, Ruth L; Gloviczki, Peter

    2013-01-01

    Acute venous thromboembolism and chronic venous diseases are common conditions that affect a large proportion of the United States population. The diagnosis of venous disease has improved, and the treatment options have rapidly evolved over the past decade. To date, it is unclear to what extent vascular surgeons have become involved in the modern management of venous disorders. This survey was undertaken to explore the current interest and practice of vascular surgeons in the contemporary care of venous disease. A survey was administered via a web-based platform to active and candidate members of the Society for Vascular Surgery (SVS). The survey included 30 questions investigating the characteristics of venous surgeons and scope of venous practice. Open-ended questions were also included for commentary. A total of 1879 surveys were sent to SVS members nationwide, and 385 members participated (response rate of 20.5%). The participants were mostly men (89.6%) with 37.7% practicing in an academic setting and 59.2% in private practice. The respondents treated superficial veins (92.9%) and deep veins (85.8%) in clinical practice, with 89.9% having their own vascular laboratory. A wide spectrum of interventions for superficial (91.9%), deep (85.8%), and perforator veins (52.7% endovenous, 19.4% subfascial endoscopic perforator surgery) are being performed by respondents. Only 26.2% had learned endovenous thermal ablation in their training program; however, over 96% of those performing venous interventions utilized this technique. Overall, the majority (85.5%) devoted 50% or less of practice to venous disorders. Respondents indicated that limitations to expansion of vein practices mainly involved challenges with third party payers, local competition, and existing large volumes of arterial interventions needing to be performed. Despite the widespread incorporation of venous disease into current vascular practices, 66.1% are not members of the American Venous Forum (AVF

  12. Are adverse effects incorporated in economic models? An initial review of current practice.

    Science.gov (United States)

    Craig, D; McDaid, C; Fonseca, T; Stock, C; Duffy, S; Woolacott, N

    2009-12-01

    To identify methodological research on the incorporation of adverse effects in economic models and to review current practice. Major electronic databases (Cochrane Methodology Register, Health Economic Evaluations Database, NHS Economic Evaluation Database, EconLit, EMBASE, Health Management Information Consortium, IDEAS, MEDLINE and Science Citation Index) were searched from inception to September 2007. Health technology assessment (HTA) reports commissioned by the National Institute for Health Research (NIHR) HTA programme and published between 2004 and 2007 were also reviewed. The reviews of methodological research on the inclusion of adverse effects in decision models and of current practice were carried out according to standard methods. Data were summarised in a narrative synthesis. Of the 719 potentially relevant references in the methodological research review, five met the inclusion criteria; however, they contained little information of direct relevance to the incorporation of adverse effects in models. Of the 194 HTA monographs published from 2004 to 2007, 80 were reviewed, covering a range of research and therapeutic areas. In total, 85% of the reports included adverse effects in the clinical effectiveness review and 54% of the decision models included adverse effects in the model; 49% included adverse effects in the clinical review and model. The link between adverse effects in the clinical review and model was generally weak; only 3/80 (manipulation. Of the models including adverse effects, 67% used a clinical adverse effects parameter, 79% used a cost of adverse effects parameter, 86% used one of these and 60% used both. Most models (83%) used utilities, but only two (2.5%) used solely utilities to incorporate adverse effects and were explicit that the utility captured relevant adverse effects; 53% of those models that included utilities derived them from patients on treatment and could therefore be interpreted as capturing adverse effects. In total

  13. Managing the Services Supply Chain in the Department of Defense: An Empirical Study of Current Management Practices

    National Research Council Canada - National Science Library

    Apte, Aruna U; Apte, Uday M; Rendon, Rene G

    2008-01-01

    .... Specifically, we studied the current management practices in such areas as life cycle approach, project management, organization/ management structure, and training provided to services acquisition personnel...

  14. Identifying household television practices to reduce children’s television time

    NARCIS (Netherlands)

    Piotrowski, J.; Jordan, A.B.; Bleakley, A.; Hennessy, M.

    2013-01-01

    The risks associated with children’s heavy television viewing justify television-reduction efforts. Targeting parents and the household environment provides a promising strategy for limiting television. Research has highlighted household television practices to reduce children’s viewing, but more

  15. Mathematics Reform Curricula and Special Education: Identifying Intersections and Implications for Practice

    Science.gov (United States)

    Sayeski, Kristin L.; Paulsen, Kim J.

    2010-01-01

    In many general education classrooms today, teachers are using "reform" mathematics curricula. These curricula emphasize the application of mathematics in real-life contexts and include such practices as collaborative, group problem solving and student-generated algorithms. Students with learning disabilities in the area of mathematics can…

  16. Identifying and Clarifying Values and Reason Statements that Promote Effective Food Parenting Practices, Using Intensive Interviews

    Science.gov (United States)

    Beltran, Alicia; Hingle, Melanie D.; Knesek, Jessica; O'Connor, Teresia; Baranowski, Janice; Thompson, Debbe; Baranowski, Tom

    2011-01-01

    Objective: Generate and test parents' understanding of values and associated reason statements to encourage effective food parenting practices. Methods: This study was cross-sectional. Sixteen parents from different ethnic groups (African American, white, and Hispanic) living with their 3- to 5-year-old child were recruited. Interested parents…

  17. Prevention of supine hypotensive syndrome in pregnant women undergoing computed tomography - A national survey of current practice

    International Nuclear Information System (INIS)

    McMahon, Michelle A.; Fenwick, Alison; Banks, Amelia; Dineen, Robert A.

    2009-01-01

    Aim: Supine hypotensive syndrome (SHS) can occur in women in the second half of pregnancy due to compression of the aorta and inferior vena cava by the gravid uterus. This results in a decrease in cardiac output with effects ranging from transient asymptomatic hypotension to cardiovascular collapse. SHS can be easily avoided by left lateral tilt positioning. We undertook a nationwide survey to assess the awareness amongst senior computed tomography (CT) radiographers of the potential risk of SHS in women in this patient group, and to identify the extent to which preventative practices and protocols are in place. Methods and materials: A questionnaire was sent to superintendent CT radiographers at all acute NHS Trusts in England and Wales examining awareness of the risk of SHS and the preventative practices and protocols currently used. Results: Completed questionnaires were received from 64% institutions. Of respondents who scan women in this patient group, only 44% were aware of the risk of SHS. No institution had a written protocol specifying positioning of women in this patient group. Seventy-five percent of institutions never employed oblique positioning. Eighty-five percent felt that specific guidelines from the Society of Radiographers or Royal College of Radiologists would be helpful. Conclusion: Current awareness and practices for preventing this easily avoidable but potentially harmful condition are inadequate. Central guidance would be welcomed by a large majority of respondents.

  18. Prevention of supine hypotensive syndrome in pregnant women undergoing computed tomography - A national survey of current practice

    Energy Technology Data Exchange (ETDEWEB)

    McMahon, Michelle A.; Fenwick, Alison [Department of Diagnostic Imaging, Queen' s Medical Centre Campus, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH (United Kingdom); Banks, Amelia [Department of Anaesthesia, City Hospital Campus, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB (United Kingdom); Dineen, Robert A. [Department of Diagnostic Imaging, Queen' s Medical Centre Campus, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH (United Kingdom)], E-mail: Robert.dineen@nhs.net

    2009-05-15

    Aim: Supine hypotensive syndrome (SHS) can occur in women in the second half of pregnancy due to compression of the aorta and inferior vena cava by the gravid uterus. This results in a decrease in cardiac output with effects ranging from transient asymptomatic hypotension to cardiovascular collapse. SHS can be easily avoided by left lateral tilt positioning. We undertook a nationwide survey to assess the awareness amongst senior computed tomography (CT) radiographers of the potential risk of SHS in women in this patient group, and to identify the extent to which preventative practices and protocols are in place. Methods and materials: A questionnaire was sent to superintendent CT radiographers at all acute NHS Trusts in England and Wales examining awareness of the risk of SHS and the preventative practices and protocols currently used. Results: Completed questionnaires were received from 64% institutions. Of respondents who scan women in this patient group, only 44% were aware of the risk of SHS. No institution had a written protocol specifying positioning of women in this patient group. Seventy-five percent of institutions never employed oblique positioning. Eighty-five percent felt that specific guidelines from the Society of Radiographers or Royal College of Radiologists would be helpful. Conclusion: Current awareness and practices for preventing this easily avoidable but potentially harmful condition are inadequate. Central guidance would be welcomed by a large majority of respondents.

  19. Noteworthy practices as identified by the US Department of Energy environmental, safety, and health first 31 Tiger Team assessments

    International Nuclear Information System (INIS)

    1992-05-01

    Noteworthy Practices are exceptional ways of accomplishing a performance objective or some aspect of it. Other DOE facilities are encouraged to adopt these practices when they are applicable to their operation. Noteworthy Practices included in this report have been drawn from the first 31 Tiger Team Assessments at DOE sites. This report includes all noteworthy practices listed in an earlier tabulation (June 1990) which the Secretary of the US Department of Energy distributed for information on July 31, 1990. This earlier tabulation included noteworthy practices from the first thirteen Tiger Team Assessments. A brief key-word title has been assigned to each Noteworthy Practice. This title provides a brief description of each Noteworthy Practice. The reader may peruse these titles in the table of contents to identify Noteworthy Practices that may be applicable to their site, facility, or operations. A flexible-disk copy of this compilation is also available in ASCII format on personal-computer, DOS-formatted disks from the Office of Special Projects in the Office of Environment, Safety, and Health at the Headquarters of the US Department of Energy. The ASCII file may be used in combination with word processing software for more detailed word and text-string searches

  20. Current Evaluation of Upper Oesophageal Sphincter Opening in Dysphagia Practice: An International SLT Survey

    Science.gov (United States)

    Regan, Julie; Walshe, Margaret; McMahon, Barry P.

    2012-01-01

    Background: The assessment of adequate upper oesophageal sphincter (UOS) opening during swallowing is an integral component of dysphagia evaluation. Aims: To ascertain speech and language therapists' (SLTs) satisfaction with current methods for assessing UOS function in people with dysphagia and to identify challenges encountered by SLTs with UOS…

  1. What is a pilot or feasibility study? A review of current practice and editorial policy

    OpenAIRE

    Cooper Cindy L; Campbell Michael J; Arain Mubashir; Lancaster Gillian A

    2010-01-01

    Abstract Background In 2004, a review of pilot studies published in seven major medical journals during 2000-01 recommended that the statistical analysis of such studies should be either mainly descriptive or focus on sample size estimation, while results from hypothesis testing must be interpreted with caution. We revisited these journals to see whether the subsequent recommendations have changed the practice of reporting pilot studies. We also conducted a survey to identify the methodologic...

  2. Biomonitoring of intermittent rivers and ephemeral streams in Europe: Current practice and priorities to enhance ecological status assessments.

    Science.gov (United States)

    Stubbington, Rachel; Chadd, Richard; Cid, Núria; Csabai, Zoltán; Miliša, Marko; Morais, Manuela; Munné, Antoni; Pařil, Petr; Pešić, Vladimir; Tziortzis, Iakovos; Verdonschot, Ralf C M; Datry, Thibault

    2018-03-15

    Intermittent rivers and ephemeral streams (IRES) are common across Europe and dominate some Mediterranean river networks. In all climate zones, IRES support high biodiversity and provide ecosystem services. As dynamic ecosystems that transition between flowing, pool, and dry states, IRES are typically poorly represented in biomonitoring programmes implemented to characterize EU Water Framework Directive ecological status. We report the results of a survey completed by representatives from 20 European countries to identify current challenges to IRES status assessment, examples of best practice, and priorities for future research. We identify five major barriers to effective ecological status classification in IRES: 1. the exclusion of IRES from Water Framework Directive biomonitoring based on their small catchment size; 2. the lack of river typologies that distinguish between contrasting IRES; 3. difficulties in defining the 'reference conditions' that represent unimpacted dynamic ecosystems; 4. classification of IRES ecological status based on lotic communities sampled using methods developed for perennial rivers; and 5. a reliance on taxonomic characterization of local communities. Despite these challenges, we recognize examples of innovative practice that can inform modification of current biomonitoring activity to promote effective IRES status classification. Priorities for future research include reconceptualization of the reference condition approach to accommodate spatiotemporal fluctuations in community composition, and modification of indices of ecosystem health to recognize both taxon-specific sensitivities to intermittence and dispersal abilities, within a landscape context. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  3. How current Clinical Practice Guidelines for low back pain reflect Traditional Medicine in East Asian Countries: a systematic review of Clinical Practice Guidelines and systematic reviews.

    Directory of Open Access Journals (Sweden)

    Hyun-Woo Cho

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

  4. Adolescents' physical activity is associated with previous and current physical activity practice by their parents

    Directory of Open Access Journals (Sweden)

    Diego Giulliano Destro Christofaro

    Full Text Available Abstract Objective: The purpose of this study was to determine whether parents' current and previous physical activity practice is associated with adolescents' physical activity. Methods: The sample was composed of 1231 adolescents (14-17 years, and 1202 mothers and 871 fathers were interviewed. Weight and height of the adolescents were measured. Self-reported parents' weight and height were obtained. The current and previous physical activity levels (Baecke's questionnaire of parents (during childhood and adolescence and adolescents' physical activity levels were obtained using a questionnaire. The magnitude of the associations between parent and adolescent physical activity levels was determined by binary logistic regression (adjusted by sex, age, and socioeconomic level of adolescents and education level of parents. Results: The current physical activity practice by parents was associated with adolescents' physical activity (p < 0.001. The physical activities reported by parents in their childhood and adolescence were also associated with higher physical activity levels among adolescents. Adolescents whose parents were both physically active in the past and present were six times (OR = 6.67 [CI = 1.94-22.79] more likely to be physically active compared to adolescents with no parents who were physically active in the past. Conclusions: The current and previous physical activities of parents were associated with higher levels of physical activity in adolescents, even after controlling for confounding factors.

  5. Adolescents' physical activity is associated with previous and current physical activity practice by their parents.

    Science.gov (United States)

    Christofaro, Diego Giulliano Destro; Andersen, Lars Bo; Andrade, Selma Maffei de; Barros, Mauro Virgílio Gomes de; Saraiva, Bruna Thamyres Ciccotti; Fernandes, Rômulo Araújo; Ritti-Dias, Raphael Mendes

    The purpose of this study was to determine whether parents' current and previous physical activity practice is associated with adolescents' physical activity. The sample was composed of 1231 adolescents (14-17 years), and 1202 mothers and 871 fathers were interviewed. Weight and height of the adolescents were measured. Self-reported parents' weight and height were obtained. The current and previous physical activity levels (Baecke's questionnaire) of parents (during childhood and adolescence) and adolescents' physical activity levels were obtained using a questionnaire. The magnitude of the associations between parent and adolescent physical activity levels was determined by binary logistic regression (adjusted by sex, age, and socioeconomic level of adolescents and education level of parents). The current physical activity practice by parents was associated with adolescents' physical activity (p<0.001). The physical activities reported by parents in their childhood and adolescence were also associated with higher physical activity levels among adolescents. Adolescents whose parents were both physically active in the past and present were six times (OR=6.67 [CI=1.94-22.79]) more likely to be physically active compared to adolescents with no parents who were physically active in the past. The current and previous physical activities of parents were associated with higher levels of physical activity in adolescents, even after controlling for confounding factors. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  6. The Current Landscape of Transitions of Care Practice Models: A Scoping Review.

    Science.gov (United States)

    Rochester-Eyeguokan, Charmaine D; Pincus, Kathleen J; Patel, Roshni S; Reitz, Shirley J

    2016-01-01

    Transitions of care (TOC) are a set of actions to ensure patient coordination and continuity of care as patients transfer between different locations or levels. During transitions associated with chronic or acute illness, vulnerable patients may be placed at risk with fragmented systems compromising their health and safety. In addition, poor care transitions also have an enormous impact on health care spending. The primary objective of this scoping review is to summarize the current landscape of practice models that deliver TOC services in the United States. The secondary objective is to use the information to characterize the current state of best practice models. A search of the PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, International Pharmaceutical Abstracts, National Center for Biotechnology Information at the U.S. National Library of Medicine, and Cochrane Library databases (January 1, 2000-April 13, 2015) for articles pertaining to TOC models, limited to U.S. studies published in the English language with human subjects, gleaned 1362 articles. An additional 26 articles were added from the gray literature. Articles meeting inclusion criteria underwent a second review and were categorized into four groups: background information, original TOC research articles not evaluating practice model interventions, original TOC research articles describing practice models, and systematic or Cochrane reviews. The reviewers met weekly to discuss the challenges and resolve disagreements regarding literature reviews with consensus before progressing. A total of 188 articles describing TOC practice models met the inclusion criteria. Despite the strengths of several quality TOC models, none satisfied all the components recommended by leading experts. Multimodal interventions by multidisciplinary teams appear to represent a best practice model for TOC to improve patient outcomes and reduce readmissions, but one size does not fit all

  7. Questioning current practice in brown bear, Ursus arctos, conservation in Europe that undervalues taxonomy

    Energy Technology Data Exchange (ETDEWEB)

    Gippoliti, S.

    2016-07-01

    The present paper highlights problems associated with the currently–accepted taxonomy of brown bear, Ursus arctos, and their consequences for conservation at the European level. The enormous morphological variability within Ursus arctos is not acknowledged in current taxonomy and conservation practice. Seven major clades are recognized in Ursus arctos by molecular researchers, and although Western Europe maintains most of the populations belonging to the relict Clade 1 brown bear lineage, no reference to this is made in current conservation policy. Furthermore, the tiny population of Apennine brown bears, characterized by unique skull morphology, is not even recognized as a distinct ESU (evolutionari significant unit) by current European legislation, nor is it included in the IUCN Red List. This may have serious consequences as brown bear conservation in Western Europe has been mainly based on restocking and reintroduction programs. (Author)

  8. Current Practices in Global/International Advanced Pharmacy Practice Experiences: Home/Host Country or Site/Institution Considerations.

    Science.gov (United States)

    Alsharif, Naser Z; Dakkuri, Adnan; Abrons, Jeanine P; Williams, Dennis; Ombengi, David N; Zheng, HaiAn; Al-Dahir, Sara; Tofade, Toyin; Gim, Suzanna; O'Connell, Mary Beth; Ratka, Anna; Dornblaser, Emily

    2016-04-25

    International outreach by schools and colleges of pharmacy is increasing. In this paper, we provide current practice guidelines to establish and maintain successful global/international advanced pharmacy practice experiences (G/I APPEs) with specific recommendations for home/host country and host site/institution. The paper is based on a literature review (2000-2014) in databases and Internet searches with specific keywords or terms. Educational documents such as syllabi and memoranda of understanding (MoUs) from pharmacy programs were also examined. In addition, a preliminary draft was developed and the findings and recommendations were reviewed in a 90-minute roundtable discussion at the 2014 American Association of Colleges of Pharmacy Annual Meeting. Recommendations for the host country include travel considerations (eg, passport, visa, air travel), safety, housing, transportation, travel alerts and warnings, health issues, and financial considerations. For the home country, considerations for establishment of G/I APPE site (eg, vetting process, MoU, site expectations) are described. The paper is a resource for development of new G/I APPEs and provides guidance for continuous quality improvement of partnerships focusing on G/I pharmacy education.

  9. Determination of significance in Ecological Impact Assessment: Past change, current practice and future improvements

    Energy Technology Data Exchange (ETDEWEB)

    Briggs, Sam; Hudson, Malcolm D., E-mail: mdh@soton.ac.uk

    2013-01-15

    Ecological Impact Assessment (EcIA) is an important tool for conservation and achieving sustainable development. 'Significant' impacts are those which disturb or alter the environment to a measurable degree. Significance is a crucial part of EcIA, our understanding of the concept in practice is vital if it is to be effective as a tool. This study employed three methods to assess how the determination of significance has changed through time, what current practice is, and what would lead to future improvements. Three data streams were collected: interviews with expert stakeholders, a review of 30 Environmental Statements and a broad-scale survey of the United Kingdom Institute of Ecology and Environmental Management (IEEM) members. The approach taken in the determination of significance has become more standardised and subjectivity has become constrained through a transparent framework. This has largely been driven by a set of guidelines produced by IEEM in 2006. The significance of impacts is now more clearly justified and the accuracy with which it is determined has improved. However, there are limitations to accuracy and effectiveness of the determination of significance. These are the quality of baseline survey data, our scientific understanding of ecological processes and the lack of monitoring and feedback of results. These in turn are restricted by the limited resources available in consultancies. The most notable recommendations for future practice are the implementation of monitoring and the publication of feedback, the creation of a central database for baseline survey data and the streamlining of guidance. - Highlights: Black-Right-Pointing-Pointer The assessment of significance has changed markedly through time. Black-Right-Pointing-Pointer The IEEM guidelines have driven a standardisation of practice. Black-Right-Pointing-Pointer Currently limited by quality of baseline data and scientific understanding. Black-Right-Pointing-Pointer Monitoring

  10. A nationwide survey concerning practices in pessary use for pelvic organ prolapse in The Netherlands : identifying needs for further research

    NARCIS (Netherlands)

    Velzel, Joost; Roovers, Jan Paul; van der Vaart, C. H.; Broekman, Bart; Vollebregt, Astrid; Hakvoort, Robert

    2015-01-01

    Introduction and hypothesis: To identify practice variation in management of patients with a vaginal pessary for pelvic organ prolapse (POP). Methods: A nationwide survey was sent to all Dutch gynecologists with a special interest in urogynecology. Results: The response rate was 59 %. Of the

  11. A nationwide survey concerning practices in pessary use for pelvic organ prolapse in The Netherlands: identifying needs for further research

    NARCIS (Netherlands)

    J. Velzel (Joost); J.P. Roovers (Jan Paul); C.H. Van der Vaart; B.M.W. Broekman (Bart); A. Vollebregt (Astrid); R. Hakvoort (Robert)

    2015-01-01

    textabstractIntroduction and hypothesis: To identify practice variation in management of patients with a vaginal pessary for pelvic organ prolapse (POP). Methods: A nationwide survey was sent to all Dutch gynecologists with a special interest in urogynecology. Results: The response rate was 59 %. Of

  12. A nationwide survey concerning practices in pessary use for pelvic organ prolapse in The Netherlands: identifying needs for further research

    NARCIS (Netherlands)

    Velzel, Joost; Roovers, Jan Paul; van der Vaart, C. H.; Broekman, Bart; Vollebregt, Astrid; Hakvoort, Robert

    2015-01-01

    To identify practice variation in management of patients with a vaginal pessary for pelvic organ prolapse (POP). A nationwide survey was sent to all Dutch gynecologists with a special interest in urogynecology. The response rate was 59 %. Of the respondents, 13 % had a written protocol for pessary

  13. How user-innovators can be identified? Evidence collected from the analysis of practices

    Energy Technology Data Exchange (ETDEWEB)

    Fursov, K.; Nefedova, A.; Thurner, T

    2016-07-01

    This paper studies how daily routines around media consumption, internet and technologyusage, product preferences or civic engagement mediate likehood of being a user-innovator. Based on the differences in demographic characteristics of consumers and assimilation by them of certain daily routines we conclude that a deeper analysis of day-to-day activities can help distinguishing user-innovators fron non-innovating peers. It is argued that innovationrelated actions are rooted in learned behaviour, can be observed through the daily routines and tell us more on user-innovation experience. We suggest that no individual practice, but instead sets of practices taken in different economic, social and cultural environments can explain how innovations grow and disseminate through the entire economy. (Author)

  14. Using simulation technology to identify gaps between education and practice among new graduate nurses.

    Science.gov (United States)

    Everett-Thomas, Ruth; Valdes, Beatriz; Valdes, Guillermo R; Shekhter, Ilya; Fitzpatrick, Maureen; Rosen, Lisa F; Arheart, Kristopher L; Birnbach, David J

    2015-01-01

    Applied knowledge was observed among nurse groups from a medical-surgical residency program to measure clinical performance during simulation training. Twenty groups of new graduate nurses were observed during five simulated clinical scenarios, and their performances were scored on a 24-item checklist. Nurse groups showed significant improvement (p new graduate nurses, and standardized training during the residency program may help instructors recognize specific factors to address during the transition from education to practice. Copyright 2015, SLACK Incorporated.

  15. MDO and Cross-Disciplinary Practice in R&D: A Portrait of Principles and Current Practice

    Science.gov (United States)

    Rivas McGowan, Anna-Maria; Papalambros, Panos Y.; Baker, Wayne E.

    2014-01-01

    For several decades, Multidisciplinary Design Optimization (MDO) has served an important role in aerospace engineering by incorporating physics based disciplinary models into integrated system or sub-system models for use in research, development, (R&D) and design. This paper examines MDO's role in facilitating the integration of the researchers from different single disciplines during R&D and early design of large-scale complex engineered systems (LaCES) such as aerospace systems. The findings in this paper are summarized from a larger study on interdisciplinary practices and perspectives that included considerable empirical data from surveys, interviews, and ethnography. The synthesized findings were derived by integrating the data with theories from organization science and engineering. The over-arching finding is that issues related to cognition, organization, and social interrelations mostly dominate interactions across disciplines. Engineering issues, such as the integration of hardware or physics-based models, are not as significant. Correspondingly, the data showed that MDO is not the primary integrator of researchers working across disciplines during R&D and early design of LaCES. Cognitive focus such as analysis versus design, organizational challenges such as incentives, and social opportunities such as personal networks often drove the human interactive practices among researchers from different disciplines. Facilitation of the inherent confusion, argument, and learning in crossdisciplinary research was identified as one of several needed elements of enabling successful research across disciplines.

  16. Improving medical students' knowledge of genetic disease: a review of current and emerging pedagogical practices

    Directory of Open Access Journals (Sweden)

    Wolyniak MJ

    2015-10-01

    Full Text Available Michael J Wolyniak,1 Lynne T Bemis,2 Amy J Prunuske2 1Department of Biology, Hampden-Sydney College, Hampden-Sydney, VA, 2Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, MN, USA Abstract: Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student's critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics. Keywords: genetics education, medical genetics, pedagogical practice, active learning, problem-based learning

  17. Identifying the readiness of patients in implementing telemedicine in northern Louisiana for an oncology practice.

    Science.gov (United States)

    Gurupur, Varadraj; Shettian, Kruparaj; Xu, Peixin; Hines, Scott; Desselles, Mitzi; Dhawan, Manish; Wan, Thomas Th; Raffenaud, Amanda; Anderson, Lindsey

    2017-09-01

    This study identified the readiness factors that may create challenges in the use of telemedicine among patients in northern Louisiana with cancer. To identify these readiness factors, the team of investigators developed 19 survey questions that were provided to the patients or to their caregivers. The team collected responses from 147 respondents from rural and urban residential backgrounds. These responses were used to identify the individuals' readiness for utilising telemedicine through factor analysis, Cronbach's alpha reliability test, analysis of variance and ordinary least squares regression. The analysis results indicated that the favourable factor (positive readiness item) had a mean value of 3.47, whereas the unfavourable factor (negative readiness item) had a mean value of 2.76. Cronbach's alpha reliability test provided an alpha value of 0.79. Overall, our study indicated a positive attitude towards the use of telemedicine in northern Louisiana.

  18. Current Ketamine Practice: Results of the 2016 American Society of Pain Management Nursing Survey on Ketamine.

    Science.gov (United States)

    Klaess, Cynthia C; Jungquist, Carla R

    2018-06-01

    Ketamine is increasingly utilized for a variety of pain management challenges. Audience comments from a ketamine presentation at the 2015 American Society of Pain Management Nursing (ASPMN) Conference reflected wide variation in ketamine practices as well as barriers to use. The goal was to gain a greater understanding of ASPMN member practice patterns and barriers related to ketamine as adjunctive therapy for pain management. A questionnaire survey design was used. Respondents represented 35 states and 2 countries. The participants were 146 respondents from ASPMN membership (1,485 members). The survey was distributed by ASPMN on SurveyMonkey. Practice setting and ketamine administration practices were assessed with areas for comments. Results were reviewed using frequencies to describe responses and formatted into tables. Comments were individually reviewed and grouped into common themes. Administration of ketamine as an analgesic was reported by 63% of respondents. Continuous intravenous ketamine infusions were the most common route of administration (65%); however, wide variability in dosing and length of therapy was reported. A wide variety of practices and challenges related to ketamine utilization were noted. Numerous studies have indicated the analgesic benefits of ketamine in pain management. The lack of practice standardization has created challenges to its consistent use and outcome measurement. Additionally, the off-label use of ketamine for pain management creates its own unique challenges. However, given the current national climate with intense focus on pain management, interdisciplinary practitioners have an ideal opportunity to evaluate ketamine's use in a comprehensive approach to pain management. Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  19. Defining the Undefinable: Operationalization of Methods to Identify Specific Learning Disabilities among Practicing School Psychologists

    Science.gov (United States)

    Cottrell, Joseph M.; Barrett, Courtenay A.

    2016-01-01

    Accurate and consistent identification of students with specific learning disabilities (SLDs) is crucial; however, state and district guidelines regarding identification methods lack operationalization and are inconsistent throughout the United States. In the current study, the authors surveyed 471 school psychologists about "school" SLD…

  20. A Practical Approach To Identify and Solve Problems: Continuous Improvement Strategies.

    Science.gov (United States)

    Burgess, Michael; And Others

    The current pressures of reduced government funding, lower enrollments, and greater scrutiny by governing boards require institutions of higher education to redesign processes and systems to survive. Despite resistance to Total Quality Management (TQM) in academia, it can provide the tools to implement systemic change and quality improvement.…

  1. Modeling of novel diagnostic strategies for active tuberculosis - a systematic review: current practices and recommendations.

    Directory of Open Access Journals (Sweden)

    Alice Zwerling

    Full Text Available The field of diagnostics for active tuberculosis (TB is rapidly developing. TB diagnostic modeling can help to inform policy makers and support complicated decisions on diagnostic strategy, with important budgetary implications. Demand for TB diagnostic modeling is likely to increase, and an evaluation of current practice is important. We aimed to systematically review all studies employing mathematical modeling to evaluate cost-effectiveness or epidemiological impact of novel diagnostic strategies for active TB.Pubmed, personal libraries and reference lists were searched to identify eligible papers. We extracted data on a wide variety of model structure, parameter choices, sensitivity analyses and study conclusions, which were discussed during a meeting of content experts.From 5619 records a total of 36 papers were included in the analysis. Sixteen papers included population impact/transmission modeling, 5 were health systems models, and 24 included estimates of cost-effectiveness. Transmission and health systems models included specific structure to explore the importance of the diagnostic pathway (n = 4, key determinants of diagnostic delay (n = 5, operational context (n = 5, and the pre-diagnostic infectious period (n = 1. The majority of models implemented sensitivity analysis, although only 18 studies described multi-way sensitivity analysis of more than 2 parameters simultaneously. Among the models used to make cost-effectiveness estimates, most frequent diagnostic assays studied included Xpert MTB/RIF (n = 7, and alternative nucleic acid amplification tests (NAATs (n = 4. Most (n = 16 of the cost-effectiveness models compared new assays to an existing baseline and generated an incremental cost-effectiveness ratio (ICER.Although models have addressed a small number of important issues, many decisions regarding implementation of TB diagnostics are being made without the full benefits of insight from mathematical

  2. Refining Current Scientific Priorities and Identifying New Scientific Gaps in HIV-Related Heart, Lung, Blood, and Sleep Research.

    Science.gov (United States)

    Twigg, Homer L; Crystal, Ronald; Currier, Judith; Ridker, Paul; Berliner, Nancy; Kiem, Hans-Peter; Rutherford, George; Zou, Shimian; Glynn, Simone; Wong, Renee; Peprah, Emmanuel; Engelgau, Michael; Creazzo, Tony; Colombini-Hatch, Sandra; Caler, Elisabet

    2017-09-01

    The National Heart, Lung, and Blood Institute (NHLBI) AIDS Program's goal is to provide direction and support for research and training programs in areas of HIV-related heart, lung, blood, and sleep (HLBS) diseases. To better define NHLBI current HIV-related scientific priorities and with the goal of identifying new scientific priorities and gaps in HIV-related HLBS research, a wide group of investigators gathered for a scientific NHLBI HIV Working Group on December 14-15, 2015, in Bethesda, MD. The core objectives of the Working Group included discussions on: (1) HIV-related HLBS comorbidities in the antiretroviral era; (2) HIV cure; (3) HIV prevention; and (4) mechanisms to implement new scientific discoveries in an efficient and timely manner so as to have the most impact on people living with HIV. The 2015 Working Group represented an opportunity for the NHLBI to obtain expert advice on HIV/AIDS scientific priorities and approaches over the next decade.

  3. Current and previous eating practices among women recovered from anorexia nervosa: a qualitative approach

    Directory of Open Access Journals (Sweden)

    Mariana Dimitrov Ulian

    2013-12-01

    Full Text Available OBJECTIVE: The aim of this study was to analyze qualitatively how women, who have recovered from anorexia nervosa, perceive and describe their current eating practices, as well as the ones developed during the eating disorder period. METHODS: Seven women were interviewed individually with the objective of investigating their eating practices, transition phases and all relevant aspects that somewhat contributed to the habit-forming; experiences, feelings and perceptions related to mealtime and the influence that food has had over the present subjects' life. The interviews were analyzed by the discourse of the collective subject method. RESULTS: The results brought up the following topics: a control; b concerns and feelings; c deprivation d beauty dictatorship; e eating competence; f importance of food; g food cacophony. CONCLUSIONS: What stands out is a multiplicity of eating practices, which during the eating disorder were similar to and characterized by restriction; however, after recovery, part of the subjects seem to have developed a higher eating competence, whereas others show a practice similar to the one acquired during the anorexia nervosa, such as the difficulty in realizing when they are satisfied and a feeling of discomfort when facing social interactions.

  4. Gender trends in dental practice patterns. A review of current U.S. literature.

    Science.gov (United States)

    Dolan, T A

    1991-01-01

    This paper reviews three recent reports of national gender trends in dental practice patterns. Although the three independent cross-sectional studies were conducted at different points in time, used different sampling strategies, and used similar but independent survey instruments, findings were consistent across studies. In summary: Women dentists are less likely to be married and have fewer children. Women are more likely to assume child rearing and household responsibilities. Women are less likely to be practice owners. Women worked slightly fewer hours per week and weeks per year, and were more likely to take a leave of absence for illness or child rearing. However, women dentists demonstrate a far greater professional work commitment than was previously reported in the literature. Women earn significantly less income from the practice of dentistry, even after controlling for age, practice ownership, hours worked per week, and other personal characteristics. The most current "Gender Wage Gap" estimates range from 57.7% for specialists to 75.4% for general practitioners (8). delta.

  5. Emergency nurses' current practices and understanding of family presence during CPR.

    LENUS (Irish Health Repository)

    Madden, Eilis

    2012-02-03

    PURPOSE: To examine emergency nurses\\' current practices and understanding of family presence during CPR in the emergency department, Cork University Hospital, Republic of Ireland. METHOD: A quantitative descriptive design was used in the study. A questionnaire developed by ENA was distributed to emergency nurses working in a level I trauma emergency department at Cork University Hospital. The total sample number was 90, including all emergency nurses with at least 6 months\\' emergency nursing experience. RESULTS: Emergency nurses often took families to the bedside during resuscitation efforts (58.9%) or would do so if the opportunity arose (17.8%). A high percentage (74.4%) of respondents would prefer a written policy allowing the option of family presence during CPR. The most significant barrier to family witnessed resuscitation (FWR) was conflicts occurring within the emergency team. The most significant facilitator to FWR was a greater understanding of health care professionals on the benefits of FWR to patients and families, indicating the need for educational development. CONCLUSION: The findings of the study and previously published studies indicate the need for development of written polices and guidelines on the practice to meet the needs of patients, families, and staff by providing consistent, safe, and caring practices for all involved in the resuscitation process. Recommendations of the study include the development of a written policy and an educational programme on the safe implementation and practices of FWR.

  6. Fear of birth in clinical practice: A structured review of current measurement tools.

    Science.gov (United States)

    Richens, Yana; Smith, Debbie M; Lavender, Dame Tina

    2018-06-01

    To identify measurement tools which screen for the presence of fear of birth (FOB) and to determine the most effective tool/s for use in clinical practice. Fear or birth (FOB) is internationally recognised as a cause for increasing concern, despite a lack of consensus on a definition or optimal measure of assessment. There is a wide array of FOB measurement tools, however little clarity on which tool should be used to screen for FOB in clinical practice. This review explores the use of tools that are used to screen for FOB and discusses the perceived effectiveness of such tools. A structured literature review was undertaken. Electronic databases were searched in July 2017 and manuscripts reviewed for quality. The review included 46 papers. The majority of studies were undertaken in Scandinavia (n = 29) and a range of tools were used to measure FOB. The most widely used tool was the Wijma Delivery Expectancy Experience Questionnaire' (W-DEQ). Inconsistencies were found in the way this tool was used, including variations in assessment cut-off points, implementation and use across a range of cultural settings and women of varying gestations. Moreover, the tool may be too lengthy to use in clinical practice. The Fear of Birth Scale (FOBS) has been shown to be as effective as W-DEQ but has the advantage of being short and easy to administer. The inconsistencies in tools reflect the difficulties in defining FOB. A clear consensus definition of FOB would aid comparisons across practice and research. The W-DEQ is not used in clinical practice; this may be due to its length and complexity. The FOBS is likely to be a more versatile tool that can be used in clinical practice. Copyright © 2018 Elsevier B.V. All rights reserved.

  7. Status and current spent fuel storage practices in the United States

    International Nuclear Information System (INIS)

    Lake, W.H.

    1999-01-01

    Brief discussions are presented on the history and state of spent fuel generation by utilities that comprise the United States commercial nuclear power industry, the current situation regarding the Federal government's nuclear waste policy, and evolving spent fuel storage practices. These evolving spent fuel storage practices are the result of private sector initiatives, but appear to be influenced by various external factors. The paper is not intended to provide a comprehensive appraisal of the storage initiatives being conducted by the private sector. The focus, instead, is on the Federal government's role and activities related to spent fuel management. Although the Federal government has adopted a policy calling for deep geological disposal of spent fuel, the US Congress has recently begun to consider expanding that policy to include a centralized interim storage facility. In the absence of such an expanded policy, the Department of Energy has performed some preliminary activities that would expedite development of a centralized interim storage facility, if Congress were to enact such a policy. The Department's current activities with regard to developing a centralized interim storage facility, which are consistent with the current policy, are described in the paper. The paper also describes two important technical development activities that have been conducted by the Department of Energy to support improved efficiency in spent fuel management. The Department's activities regarding development of a burnup credit methodology, and a dry transfer system are summarized. (author)

  8. An international survey of MRI qualification and certification frameworks with an emphasis on identifying elements of good practice

    International Nuclear Information System (INIS)

    Castillo, J.; Caruana, C.J.; Morgan, P.S.; Westbrook, C.; Mizzi, A.

    2017-01-01

    The purpose of the study was to survey MRI qualification and certification frameworks in the major English-speaking countries (Australia, New Zealand, US, Canada, UK, Ireland) with the aim of identifying elements of good practice. The intention is to incorporate these elements in a national framework that could be used in supporting an MRI specialist register. The study was conducted using document analysis of MRI qualification and certification documents from these states with data triangulated through a web-based questionnaire amongst an expert group of MRI radiographers (n = 59) from the same states. Based on the results of the study, recommendations have been put forward for those countries that are in the process of developing such frameworks. The main recommendations include that a professional or regulatory body externally accredits MRI programmes and that learning outcomes be based on an MRI competence profile that addresses current and forecasted needs of the particular country. The MRI competence profile should encompass a novice-to expert continuum and be referenced directly to a national qualification framework. Ideally each level of expertise should be assessed and evidenced by a portfolio of CPD activities, including clinical and management case studies appropriate to that level. - Highlights: • Professional or regulatory bodies should accredit MRI academic programmes. • Competence profiles should reflect and support local MRI services. • MRI competence profiles should be structured in a novice-to-expert continuum format. • Competence profiles should reference national qualification/certification frameworks. • Mandatory certification could lead to registration in an MRI specialist register.

  9. Identifying optimal postmarket surveillance strategies for medical and surgical devices: implications for policy, practice and research.

    Science.gov (United States)

    Gagliardi, Anna R; Umoquit, Muriah; Lehoux, Pascale; Ross, Sue; Ducey, Ariel; Urbach, David R

    2013-03-01

    Non-drug technologies offer many benefits, but have been associated with adverse events, prompting calls for improved postmarket surveillance. There is little empirical research to guide the development of such a system. The purpose of this study was to identify optimal postmarket surveillance strategies for medical and surgical devices. Qualitative methods were used for sampling, data collection and analysis. Stakeholders from Canada and the USA representing different roles and perspectives were first interviewed to identify examples and characteristics of different surveillance strategies. These stakeholders and others they recommended were then assembled at a 1-day nominal group meeting to discuss and prioritise the components of a postmarket device surveillance system, and research needed to achieve such a system. Consultations were held with 37 participants, and 47 participants attended the 1-day meeting. They recommended a multicomponent system including reporting by facilities, clinicians and patients, supported with some external surveillance for validation and real-time trials for high-risk devices. Many considerations were identified that constitute desirable characteristics of, and means by which to implement such a system. An overarching network was envisioned to broker linkages, establish a shared minimum dataset, and support communication and decision making. Numerous research questions were identified, which could be pursued in tandem with phased implementation of the system. These findings provide unique guidance for establishing a device safety network that is based on existing initiatives, and could be expanded and evaluated in a prospective, phased fashion as it was developed.

  10. Practices to identify and preclude adverse Aircraft-and-Rotorcraft-Pilot Couplings - A design perspective

    Science.gov (United States)

    Pavel, Marilena D.; Masarati, Pierangelo; Gennaretti, Massimo; Jump, Michael; Zaichik, Larisa; Dang-Vu, Binh; Lu, Linghai; Yilmaz, Deniz; Quaranta, Giuseppe; Ionita, Achim; Serafini, Jacopo

    2015-07-01

    Understanding, predicting and supressing the inadvertent aircraft oscillations caused by Aircraft/Rotorcraft Pilot Couplings (A/RPC) is a challenging problem for designers. These are potential instabilities that arise from the effort of controlling aircraft with high response actuation systems. The present paper reviews, updates and discusses desirable practices to be used during the design process for unmasking A/RPC phenomena. These practices are stemming from the European Commission project ARISTOTEL Aircraft and Rotorcraft Pilot Couplings - Tools and Techniques for Alleviation and Detection (2010-2013) and are mainly related to aerodynamic and structural modelling of the aircraft/rotorcraft, pilot modelling and A/RPC prediction criteria. The paper proposes new methodologies for precluding adverse A/RPCs events taking into account the aeroelasticity of the structure and pilot biodynamic interaction. It is demonstrated that high-frequency accelerations due to structural elasticity cause negative effects on pilot control, since they lead to involuntary body and limb-manipulator system displacements and interfere with pilot's deliberate control activity (biodynamic interaction) and, finally, worsen handling quality ratings.

  11. Current thinking in qualitative research: evidence-based practice, moral philosophies, and political struggle.

    Science.gov (United States)

    Papadimitriou, Christina; Magasi, Susan; Frank, Gelya

    2012-01-01

    In this introduction to the special issue on current thinking in qualitative research and occupational therapy and science, the authors focus on the importance of rigorous qualitative research to inform occupational therapy practice. The authors chosen for this special issue reflect a "second generation of qualitative researchers" who are critical, theoretically sophisticated, methodologically productive, and politically relevant to show that working with disabled clients is political work. Three themes emerged across the articles included in this special issue: (1) recognizing and addressing social justice issues; (2) learning from clients' experiences; and (3) critically reframing occupational therapy's role. These themes can inform occupational therapy practice, research, and education to reflect a more client-centered and politically engaging approach. Copyright 2012, SLACK Incorporated.

  12. Trends in Dental Practice Sales and Associateships in the Current Economy

    Directory of Open Access Journals (Sweden)

    C. Steven Wolff

    2011-10-01

    Full Text Available Recent experiences would suggest that there is a significant discrepancy in the number of doctors retiring and transitioning their practices and the number of younger practitioners wishing to assume ownership and build a career. Peaks and valleys in dental school enrollment over the last forty years should have produced an abundance of retirement aged doctors wishing to place their practices on the market to a smaller pool of buyers. Such is currently not the case. Doctors in their sixties have experienced recent stock market downturns in 2000 and 2008, the “9-11” tragedy and a drop in both the value and liquidity of the housing market. The ready access to refinance or second mortgage funds may even find some doctors upside down on personal, vacation and investment real estate. All of this combined has had considerable negative impact on their net worth. Health care costs continue to increase and most dentists are personally responsible for their premiums. Combine all of this with the current low level of secure returns on invested capital along with a significant increase in life expectancy over the last two generations and many decide they are simply unable to retire as planned. The fear of running out of money is stronger than their will to pursue retirement. This article examines in some detail the reasons for this imbalance and the effects they are having on practice transitions, practice values and the market for associate employment. We will also explore what the future may hold for both retiring and new career doctors.

  13. An examination of current stroke rehabilitation practice in Peru: Implications for interprofessional education.

    Science.gov (United States)

    McDonald, Cody L; Fuhs, Amy K; Kartin, Deborah

    2018-05-01

    This study aimed to better understand current clinical practice of rehabilitation professionals in Lima, Peru, and to explore the existence of and potential for interprofessional collaboration. A secondary purpose was to assess rehabilitation professionals' agreement with evidence-based stroke rehabilitation statements and confidence performing stroke rehabilitation tasks prior to and following an interprofessional stroke rehabilitation training. Current clinical practice for rehabilitation professionals in Peru differs from high-income counties like the United States, as physical therapists work with dysphagia and feeding, prosthetist orthotists serve a strictly technical role, and nurses have a limited role in rehabilitation. Additionally, while opportunity for future interprofessional collaboration within stroke rehabilitation exists, it appears to be discouraged by current health system policies. Pre- and post-training surveys were conducted with a convenience sample of 107 rehabilitation professionals in Peru. Survey response options included endorsement of professionals for rehabilitation tasks and a Likert scale of agreement and confidence. Training participants largely agreed with evidence-based stroke rehabilitation statements. Differences in opinion remained regarding the prevalence of dysphagia and optimal frequency of therapy post-stroke. Substantially increased agreement post-training was seen in favour of early initiation of stroke rehabilitation and ankle foot orthosis use. Participants were generally confident performing traditional profession-specific interventions and educating patients and families. Substantial increases were seen in respondents' confidence to safely and independently conduct bed to chair transfers and determine physiological stability. Identification of key differences in rehabilitation professionals' clinical practice in Peru is a first step toward strengthening the development of sustainable rehabilitation systems and

  14. Antidepressants during pregnancy: Guideline adherence and current practice amongst Dutch gynaecologists and midwives.

    Science.gov (United States)

    Molenaar, Nina M; Brouwer, Marlies E; Duvekot, Johannes J; Burger, Huibert; Knijff, Esther M; Hoogendijk, Witte J; Bockting, Claudi L H; de Wolf, G S; Lambregtse-van den Berg, Mijke P

    2018-06-01

    prescription rates of antidepressants during pregnancy range from 2-3% in The Netherlands to 6.2% in the USA. Inconclusive evidence about harms and benefits of antidepressants during pregnancy leads to variation in advice given by gynaecologists and midwives. The objective was to investigate familiarity with, and adherence to the Dutch multidisciplinary guideline on Selective Serotonin Reuptake Inhibitor (SSRI) use during pregnancy by gynaecologists and midwives in the Netherlands. an online survey was developed and send to Dutch gynaecologists and midwives. The survey consisted mainly of multiple-choice questions addressing guideline familiarity and current practice of the respondent. Also, caregiver characteristics associated with guideline adherence were investigated. a total of 178 gynaecologists and 139 midwives responded. Overall familiarity with the Dutch guideline was 92.7%. However, current practice and advice given to patients by caregivers differed substantially, both between gynaecologists and midwives as well as within both professions. Overall guideline adherence was 13.9%. Multivariable logistic regression showed that solely caregiver profession was associated with guideline adherence, with gynaecologists having a higher adherence rate (OR 2.10, 95%CI 1.02-4.33) than midwives. although reported familiarity with the guideline is high, adherence to the guideline is low, possibly resulting in advice to patients that is inconsistent with guidelines and unwanted variation in current practice. further implementation of the recommendations as given in the guideline should be stimulated. Additional research is needed to examine how gynaecologists and midwives can be facilitated to follow the recommendations of the clinical guideline on SSRI use during pregnancy. Copyright © 2018 Elsevier Ltd. All rights reserved.

  15. North America Wound, Ostomy, and Continence and Enterostomal Therapy Nurses Current Ostomy Care Practice Related to Peristomal Skin Issues.

    Science.gov (United States)

    Colwell, Janice C; McNichol, Laurie; Boarini, Joy

    The purpose of this study was to describe the practice of 796 ostomy nurses in North America in 2014 related to peristomal skin issues. Descriptive study. Participants were 796 wound, ostomy, and continence (WOC) and enterostomal therapy (ET) nurses currently practicing in the United States or Canada and caring for patients with ostomies. The collection of data occurred in conjunction with an educational program on peristomal skin complications and practice issues and solicited the participant's perception on the incidence and frequency of peristomal skin issues as well as on practice patterns. Participants attended an educational program. They were also asked to anonymously respond to multiple-choice questions on ostomy care management via an audience response system followed by discussion of each item and their responses. This descriptive study reports on the answers to the questions as well as the pertinent discussion points. Participants estimated that approximately 77.70% of their patients developed peristomal skin issues. The most commonly encountered problem was irritant contact dermatitis (peristomal moisture-associated skin damage). Contributing factors were inappropriate use of a pouching system owing to lack of follow-up after hospital discharge. Reported interventions for the prevention and management of peristomal skin issues included preoperative stoma site marking, use of a convex pouching system, and barrier rings. However, subsequent discussion revealed that the frequency of use of these products varied considerably. Participants identified shortened hospital stays, absence of preoperative stoma marking, and limited outpatient follow-up as contributing to development of peristomal skin problems. WOC and ET nurses estimate that more than three-quarters of persons living with an ostomy develop peristomal skin problems. Multiple interventions for managing these problems were identified, but some variability in management approaches emerged.

  16. Educational priorities and current involvement in genetic practice: a survey of midwives in the Netherlands, UK and Sweden.

    Science.gov (United States)

    Benjamin, Caroline M; Anionwu, Elizabeth N; Kristoffersson, Ulf; ten Kate, Leo P; Plass, Anne Marie C; Nippert, Irmgard; Julian-Reynier, Claire; Harris, Hilary J; Schmidtke, Joerg; Challen, Kirsty; Calefato, Jean Marc; Waterman, Christine; Powell, Eileen; Harris, Rodney

    2009-10-01

    to investigate whether practising midwives are adequately prepared to integrate genetic information into their practice. a cross-sectional, postal, structured questionnaire survey was sent to practising midwives. practising midwives from the Netherlands (NL), Sweden (SE) and the United Kingdom (UK). 1021 replies were received, achieving a response rate of 62%. 79% (799/1015) of midwives reported attending courses with some 'genetic content' during their initial training. Sixty-eight per cent (533/784) judged this to have been useful for clinical practice. Variation was seen between countries in the amount of genetic content in post-registration training (SE 87%, NL 44%, UK 17%) and most was considered useful. Questions assessing clinical activity identified a current need for genetic knowledge. Midwives described low levels of self-reported confidence both in overtly genetic procedures and in everyday tasks that were underpinned by genetic knowledge. For eight of the 12 procedures, fewer than 20% of midwives considered themselves to be confident. Differences were apparent between countries. Midwives identified psychosocial, screening and risk assessment aspects of genetic education as being important to them, rather than technical aspects or genetic science. given the low reported confidence with genetic issues in clinical practice, it is essential that this is addressed in terms of the amount, content and targeting of genetic education. This is especially important to ensure the success of national antenatal and baby screening programmes. The results of this study suggest that midwives would welcome further training in genetics, addressing genetic topics most relevant to their clinical practice.

  17. Identifying best existing practice for characterization modeling in life cycle impact assessment

    DEFF Research Database (Denmark)

    Hauschild, Michael Zwicky; Goedkoop, Mark; Guinée, Jeroen

    2013-01-01

    Purpose: Life cycle impact assessment (LCIA) is a field of active development. The last decade has seen prolific publication of new impact assessment methods covering many different impact categories and providing characterization factors that often deviate from each other for the same substance...... and impact. The LCA standard ISO 14044 is rather general and unspecific in its requirements and offers little help to the LCA practitioner who needs to make a choice. With the aim to identify the best among existing characterization models and provide recommendations to the LCA practitioner, a study...... was performed for the Joint Research Centre of the European Commission (JRC). Methods Existing LCIA methods were collected and their individual characterization models identified at both midpoint and endpoint levels and supplemented with other environmental models of potential use for LCIA. No new developments...

  18. Study on practical of eddy current testing of core and core support graphite components in HTTR

    International Nuclear Information System (INIS)

    Ishihara, Masahiro; Iyoku, Tatsuo; Ooka, Norikazu; Shindo, Yoshihisa; Kawae, Hidetoshi; Hayashi, Motomitsu; Kambe, Mamoru; Takahashi, Masaaki; Ide, Akira.

    1994-01-01

    Core and core support graphite components in the HTTR (High Temperature Engineering Test Reactor) are mainly made of nuclear-grade IG-110 and PGX graphites. Nondestructive inspection with Eddy Current Testing (ECT) is planned to be applied to these components. The method of ECT has been already established for metallic components, however, cannot be applied directly to the graphite ones, because the characteristics of graphite are quite different in micro-structure from those of metals. Therefore, ECT method and condition were studied for the application of the ECT to the graphite components. This paper describes the study on practical method and conditions of ECT for above mentioned graphite structures. (author)

  19. Closeout of uranium mines and mills: A review of current practices

    International Nuclear Information System (INIS)

    1997-04-01

    The present report is a first step in gathering information on the assessment and control of the long term (over a few centuries) impact of uranium mining and milling waste. Its intention is to outline several examples of worldwide experience. It contains summaries of current closeout practices which have not previously been presented in a singly publication. It is expected to provide necessary information to Member States to formulate meaningful decisions for adequately controlling impacts resulting from uranium mines and mills waste materials. The information contained herein may also be valuable as background material for developing relevant guidance in this subject area, for example within the IAEA Safety Standards Programme. Refs, figs, tabs

  20. Identifying Best Practices for and Utilities of the Pharmacy Curriculum Outcome Assessment Examination.

    Science.gov (United States)

    Mok, Timothy Y; Romanelli, Frank

    2016-12-25

    Objective. A review was conducted to determine implementation strategies, utilities, score interpretation, and limitations of the Pharmacy Curriculum Outcome Assessment (PCOA) examination. Methods. Articles were identified through the PubMed and American Journal of Pharmaceutical Education , and International Pharmaceutical Abstracts databases using the following terms: "Pharmacy Curriculum Outcomes Assessment," "pharmacy comprehensive examination," and "curricular assessment." Studies containing information regarding implementation, utility, and predictive values for US student pharmacists, curricula, and/or PGY1/PGY2 residents were included. Publications from the Academic Medicine Journal , the Accreditation Council for Pharmacy Education (ACPE), and the American Association of Colleges of Pharmacy (ACCP) were included for background information and comparison of predictive utilities of comprehensive examinations in medicine. Results. Ten PCOA and nine residency-related publications were identified. Based on published information, the PCOA may be best used as an additional tool to identify knowledge gaps for third-year student pharmacists. Conclusion. Administering the PCOA to students after they have completed their didactic coursework may yield scores that reflect student knowledge. Predictive utility regarding the North American Pharmacy Licensure Examination (NAPLEX) and potential applications is limited, and more research is required to determine ways to use the PCOA.

  1. Identifying Depression in South Asian Patients with End-Stage Renal Disease: Considerations for Practice

    Directory of Open Access Journals (Sweden)

    Shivani Sharma

    2011-12-01

    Full Text Available Depression is a prevalent burden for patients with end-stage renal disease (ESRD and one that is under-recognized and consequently under-treated. Although several studies have explored the association between depression symptoms, treatment adherence and outcomes in Euro-American patient groups, quantitative and qualitative exploration of these issues in patients from different cultural and ethnic backgrounds has been lacking. This review discusses the methodological issues associated with measuring depression in patients of South Asian origin who have a 3- to 5-fold greater risk of developing ESRD. There is a need to advance research into the development of accurate screening practices for this patient group, with an emphasis on studies utilizing rigorous approaches to evaluating the use of both emic (culture-specific and etic (universal or culture-general screening instruments.

  2. Current practices of laparoscopic inguinal hernia repair: a population-based analysis.

    Science.gov (United States)

    Trevisonno, M; Kaneva, P; Watanabe, Y; Fried, G M; Feldman, L S; Andalib, A; Vassiliou, M C

    2015-10-01

    The selection of a laparoscopic approach for inguinal hernias varies among surgeons. It is unclear what is being done in actual practice. The purpose of this study was to report practice patterns for treatment of inguinal hernias among Quebec surgeons, and to identify factors that may be associated with the choice of operative approach. We studied a population-based cohort of patients who underwent an inguinal hernia repair between 2007 and 2011 in Quebec, Canada. A generalized linear model was used to identify predictors associated with the selection of a laparoscopic approach. 49,657 inguinal hernias were repaired by 478 surgeons. Laparoscopic inguinal hernia repair (LIHR) was used in 8 % of all cases. LIHR was used to repair 28 % of bilateral hernias, 10 % of recurrent hernias, 6 % of unilateral hernias, and 4 % of incarcerated hernias. 268 (56 %) surgeons did not perform any laparoscopic repairs, and 11 (2 %) surgeons performed more than 100 repairs. These 11 surgeons performed 61 % of all laparoscopic cases. Patient factors significantly associated with having LIHR included younger age, fewer comorbidities, bilateral hernias, and recurrent hernias. An open approach is favored for all clinical scenarios, even for situations where published guidelines recommend a laparoscopic approach. Surgeons remain divided on the best technique for inguinal hernia repair: while more than half never perform LIHR, the small proportion who perform many use the technique for a large proportion of their cases. There appears to be a gap between the best practices put forth in guidelines and what surgeons are doing in actual practice. Identification of barriers to the broader uptake of LIHR may help inform the design of educational programs to train those who have the desire to offer this technique for certain cases, and have the volume to overcome the learning curve.

  3. Current Practices and Barriers to the Integration of Oncoplastic Breast Surgery: A Canadian Perspective.

    Science.gov (United States)

    Maxwell, Jessica; Roberts, Amanda; Cil, Tulin; Somogyi, Ron; Osman, Fahima

    2016-10-01

    Despite the safety and popularity of oncoplastic surgery, there is limited data examining utilization and barriers associated with its incorporation into practice. This study examines the use of oncoplastic techniques in breast conserving surgery and determines the barriers associated with their implementation. A 13-item survey was mailed to all registered general surgeons in Ontario, Canada. The survey assessed surgeon demographics, utilization of specific oncoplastic techniques, and perceived barriers. A total of 234 survey responses were received, representing a response rate of 32.2 % (234 of 725). Of the respondents, 166 surgeons (70.9 %) reported a practice volume of at least 25 % breast surgery. Comparison was made between general surgeons performing oncoplastic breast surgery (N = 79) and those who did not use these techniques (N = 87). Surgeon gender, years in practice, fellowship training, and access to plastic surgery were similar across groups. Both groups rated the importance of breast cosmesis similarly. General surgeons with a practice volume involving >50 % breast surgery were more likely to use oncoplastic techniques (OR 8.82, p < .001) and involve plastic surgeons in breast conserving surgery (OR 2.21, p = .02). For surgeons not performing oncoplastic surgery, a lack of training and access to plastic surgeons were identified as significant barriers. For those using oncoplastic techniques, the absence of specific billing codes was identified as a limiting factor. Lack of training, access to plastic surgeons, and absence of appropriate reimbursement for these cases are significant barriers to the adoption of oncoplastic techniques.

  4. What's down below? Current and potential future applications of geophysical techniques to identify subsurface permafrost conditions (Invited)

    Science.gov (United States)

    Douglas, T. A.; Bjella, K.; Campbell, S. W.

    2013-12-01

    For infrastructure design, operations, and maintenance requirements in the North the ability to accurately and efficiently detect the presence (or absence) of ground ice in permafrost terrains is a serious challenge. Ground ice features including ice wedges, thermokarst cave-ice, and segregation ice are present in a variety of spatial scales and patterns. Currently, most engineering applications use borehole logging and sampling to extrapolate conditions at the point scale. However, there is high risk of over or under estimating the presence of frozen or unfrozen features when relying on borehole information alone. In addition, boreholes are costly, especially for planning linear structures like roads or runways. Predicted climate warming will provide further challenges for infrastructure development and transportation operations where permafrost degradation occurs. Accurately identifying the subsurface character in permafrost terrains will allow engineers and planners to cost effectively create novel infrastructure designs to withstand the changing environment. There is thus a great need for a low cost rapidly deployable, spatially extensive means of 'measuring' subsurface conditions. Geophysical measurements, both terrestrial and airborne, have strong potential to revolutionize our way of mapping subsurface conditions. Many studies in continuous and discontinuous permafrost have used geophysical measurements to identify discrete features and repeatable patterns in the subsurface. The most common measurements include galvanic and capacitive coupled resistivity, ground penetrating radar, and multi frequency electromagnetic induction techniques. Each of these measurements has strengths, weaknesses, and limitations. By combining horizontal geophysical measurements, downhole geophysics, multispectral remote sensing images, LiDAR measurements, and soil and vegetation mapping we can start to assemble a holistic view of how surface conditions and standoff measurements

  5. Public Health Insurance in Vietnam towards Universal Coverage: Identifying the challenges, issues, and problems in its design and organizational practices

    OpenAIRE

    Midori Matsushima; Hiroyuki Yamada

    2013-01-01

    Vietnam is attempting to achieve universal health insurance coverage by 2014. Despite great progress, the country faces some challenges, issues and problems. This paper reviewed official documents, existing reports, and related literature to address: (1) grand design for achieving universal health coverage, (2) current insurance coverage, (3) health insurance premium and subsidies by the government, (4) benefit package and payment rule, and (5) organizational practices. From the review, it be...

  6. Delivery of care consistent with the psychosocial standards in pediatric cancer: Current practices in the United States.

    Science.gov (United States)

    Scialla, Michele A; Canter, Kimberly S; Chen, Fang Fang; Kolb, E Anders; Sandler, Eric; Wiener, Lori; Kazak, Anne E

    2018-03-01

    With published evidence-based Standards for Psychosocial Care for Children with Cancer and their Families, it is important to know the current status of their implementation. This paper presents data on delivery of psychosocial care related to the Standards in the United States. Pediatric oncologists, psychosocial leaders, and administrators in pediatric oncology from 144 programs completed an online survey. Participants reported on the extent to which psychosocial care consistent with the Standards was implemented and was comprehensive and state of the art. They also reported on specific practices and services for each Standard and the extent to which psychosocial care was integrated into broader medical care. Participants indicated that psychosocial care consistent with the Standards was usually or always provided at their center for most of the Standards. However, only half of the oncologists (55.6%) and psychosocial leaders (45.6%) agreed or strongly agreed that their psychosocial care was comprehensive and state of the art. Types of psychosocial care provided included evidence-based and less established approaches but were most often provided when problems were identified, rather than proactively. The perception of state of the art care was associated with practices indicative of integrated psychosocial care and the extent to which the Standards are currently implemented. Many oncologists and psychosocial leaders perceive that the delivery of psychosocial care at their center is consistent with the Standards. However, care is quite variable, with evidence for the value of more integrated models of psychosocial services. © 2017 Wiley Periodicals, Inc.

  7. An audit of current practice and management of metastatic spinal cord compression at a regional cancer centre.

    LENUS (Irish Health Repository)

    Sui, J

    2012-02-01

    Metastatic spinal cord compression (MSCC) is an oncological emergency requiring prompt recognition and management to preserve neurological function and mobility. We performed an audit to assess current practice of MSCC against current best practice as outlined by NICE. Our retrospective audit identified 10 patients from January to December 2009 with confirmed MSCC. The most common primary tumours were prostate 3 (30%), breast 3 (30%) and lung 2 (20%). Pain was the main presenting symptom 9 (90%), followed by weakness 7 (70%) and sensory changes 1 (10%). 5 (50%) had MRI within 24 hours and only 6 (60%) underwent full MRI scan. 8 (80%) had corticosteroids before MRI scan. 6 (60%) received radiotherapy within 24 hours. Only 4 (40%) were referred to orthopaedics and none of these patients had been recommended surgery. Up 14 days following radiological confirmation of MSCC, the number of patients who were unable to walk increased by 20%. Only 5 (50%) were discharged during this period of study. Our audit reported a number of variances in management compared to NICE guideline. These can be improved by following a\\'fast track\\' referral pathway and regular education for junior doctors and primary care doctors.

  8. Getting emotional: historic and current changes in food consumption practices viewed through the lens of cultural theories

    OpenAIRE

    Sahakian, Marlyne

    2015-01-01

    Social practice theory has brought new perspectives to ‘sustainable consumption’ studies in terms of both conceptual developments and rich empirical research. One appealing and shared understanding is that practices change over time, suggesting that shifts away from current unsustainable practices toward more environmentally sound and socially just alternatives are possible. Much work has focused on how to recruit new practitioners to more ‘sustainable’ practices (Jack 2013; Plessz et al. 201...

  9. Psychopharmacological and Other Treatments in Preschool Children with Attention-Deficit/Hyperactivity Disorder: Current Evidence and Practice

    Science.gov (United States)

    Arnold, L. Eugene; Anthony, Bruno J.

    2008-01-01

    Abstract Objective This article reviews rational approaches to treating attention-deficit/hyperactivity disorder (ADHD) in preschool children, including pharmacological and nonpharmacological treatments. Implications for clinical practice are discussed. Data Sources We searched MEDLINE, PsychINFO, Cumulative Index to Nursing & Allied Health, Educational Resources Information Center, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects for relevant literature published in English from 1967 to 2007 on preschool ADHD. We also reviewed the references cited in identified reports. Study Selection Studies were reviewed if the sample included at least some children younger than 6 years of age or attending kindergarten, the study participants had a diagnosis of ADHD or equivalent symptoms, received intervention aimed at ADHD symptoms, and included a relevant outcome measure. Data Extraction Studies were reviewed for type of intervention and outcome relevant to ADHD and were rated for the level of evidence for adequacy of the data to inform clinical practice. Conclusions The current level of evidence for adequacy of empirical data to inform clinical practice for short-term treatment of ADHD in preschool children is Level A for methylphenidate and Level B for parent behavior training, child training, and additive-free elimination diet. PMID:18844482

  10. Identified best environmental management practices to improve the energy performance of the retail trade sector in Europe

    International Nuclear Information System (INIS)

    Galvez-Martos, Jose-Luis; Styles, David; Schoenberger, Harald

    2013-01-01

    The retail trade sector has been identified as a target sector for the development of sectoral reference documents on best environmental management practices under the Eco-Management and Audit Scheme. This paper focuses on the important energy-related needs in retailers' stores such as for food refrigeration and lighting, as well as heating, ventilation and air conditioning of the building. For the definition of best environmental management practices in the European framework, frontrunner retailers have been identified as those retailers integrating energy minimization and saving measures as standard practice systematically across stores. These best performers also integrate a comprehensive monitoring system in the energy management of every store or building belonging to the company, enabling the rapid identification of energy saving opportunities. An integrative approach is needed to define how best practices should be implemented in combination to optimize energy management within stores: building aspects such as insulation of the building envelope or the heating, ventilation and air conditioning system, should be optimized in combination with best options for refrigeration in food retailers. Refrigeration systems are responsible for half of the final energy use in stores and of their carbon footprint. Natural refrigerants, heat recovery from the condensation stage and covering of display cases are measures with high environmental benefits to reduce the impact of refrigeration. Finally, practices for lighting, as optimal lighting strategies, and the integration of renewable energy sources in overall zero energy building concepts can save considerable amounts of fossil energy, reduce the carbon footprint and produce significant cost-savings in the long term. - highlights: • There is a high energy performance improvement potential of the retail trade sector. • We propose techniques with a high performance level and applied by frontrunners. • We identified

  11. Obstructive sleep apnea among commercial motor vehicle drivers: using evidence-based practice to identify risk factors.

    Science.gov (United States)

    Olszewski, Kimberly; Wolf, Debra

    2013-11-01

    Commercial motor vehicle driving is a hazardous occupation, having the third highest fatality rate among common U.S. jobs. Among the estimated 14 million U.S. commercial motor vehicle drivers, the prevalence of obstructive sleep apnea is reported to be 17% to 28%. Despite the identified increased prevalence of obstructive sleep apnea among commercial motor vehicle drivers, federal law does not require that they be screened for obstructive sleep apnea. This article presents an evidence-based practice change project; the authors developed, implemented, and evaluated a screening program to identify commercial motor vehicle drivers' risk for obstructive sleep apnea during commercial driver medical examinations. The results of this practice change indicated screening for obstructive sleep apnea during the commercial driver medical examination led to improved identification of obstructive sleep apnea risk among commercial motor vehicle drivers and should be a clinical standard in occupational health clinics. Copyright 2013, SLACK Incorporated.

  12. Identifying critical success factors for designing selection processes into postgraduate specialty training: the case of UK general practice.

    Science.gov (United States)

    Plint, Simon; Patterson, Fiona

    2010-06-01

    The UK national recruitment process into general practice training has been developed over several years, with incremental introduction of stages which have been piloted and validated. Previously independent processes, which encouraged multiple applications and produced inconsistent outcomes, have been replaced by a robust national process which has high reliability and predictive validity, and is perceived to be fair by candidates and allocates applicants equitably across the country. Best selection practice involves a job analysis which identifies required competencies, then designs reliable assessment methods to measure them, and over the long term ensures that the process has predictive validity against future performance. The general practitioner recruitment process introduced machine markable short listing assessments for the first time in the UK postgraduate recruitment context, and also adopted selection centre workplace simulations. The key success factors have been identified as corporate commitment to the goal of a national process, with gradual convergence maintaining locus of control rather than the imposition of change without perceived legitimate authority.

  13. Identifying organisational principles and management practices important to the quality of health care services for chronic conditions

    DEFF Research Database (Denmark)

    Frølich, Anne

    2012-01-01

    are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisational methods and principles. Kaiser Permanente (KP), an integrated health care delivery system...... in the U.S., is recognized as providing high-quality chronic care; to some extent, this is due to KP's implementation of the chronic care model (CCM). This model recommends a range of evidence-based management practices that support the implementation of evidence-based medicine. However, it is not clear...... which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved....

  14. Practical considerations on the introduction of sacubitril/valsartan in clinical practice: Current evidence and early experience.

    Science.gov (United States)

    Farmakis, Dimitrios; Bistola, Vassiliki; Karavidas, Apostolos; Parissis, John

    2016-11-15

    The combination of neprilysin inhibitor sacubitril with the angiotensin II receptor 1 blocker valsartan is the first agent from the angiotensin receptor neprilysin inhibitors (ARNI) class authorized for clinical use in heart failure (HF) patients with reduced ejection fraction (HFrEF). Sacubitril/valsartan resulted in 20% reduction in the incidence rate of death or HF hospitalization compared to enalapril in symptomatic HFrEF patients in the seminal PARADIGM-HF trial. As a result, the recently updated European and American HF guidelines granted this agent a class IB indication for the treatment of ambulatory/chronic symptomatic HFrEF patients. However, translating the positive results of trials into true clinical benefit is often challenging. This is particularly true in the case of sacubitril/valsartan, as HF is a heterogeneous syndrome including many severely ill patients who are prone to decompensation, while this new agent comes to replace a cornerstone of current evidence-based HF therapy. In the present paper, we address a number of practical issues regarding the introduction of sacubitril/valsartan and propose an algorithm based on available evidence and early clinical experience. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Improving medical students' knowledge of genetic disease: a review of current and emerging pedagogical practices.

    Science.gov (United States)

    Wolyniak, Michael J; Bemis, Lynne T; Prunuske, Amy J

    2015-01-01

    Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student's critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics.

  16. Physicians' current practices and opportunities for DNA banking of dying patients with cancer.

    Science.gov (United States)

    Quillin, John M; Bodurtha, Joann N; Siminoff, Laura A; Smith, Thomas J

    2011-05-01

    The availability of genetic tests for cancer susceptibility is increasing. Current tests, however, have limited clinical sensitivity. Even when clinically valid tests are available, the genetic counseling and informed consent process might not be feasible for dying patients with cancer. DNA banking preserves the opportunity for future research or clinical testing and may provide critical opportunities for surviving relatives. This study explored the current practices and potential for DNA banking for cancer susceptibility among oncologists specializing in palliative care. Palliative care oncologists actively providing clinical care for dying patients with cancer were recruited for an online survey. Descriptive statistics for DNA banking practices, perceived qualification to recommend banking, and potential predictors were assessed. Data were collected from 49 physicians (37% recruitment rate). Eighty percent reported assessing at least some patients for genetic cancer susceptibility in the past 12 months. No participants reported banking DNA for patients in the past 12 months. Only 5% reported feeling at least somewhat qualified to order DNA banking. A Web-based risk assessment tool and genetic counselor on staff were perceived as the most helpful potential resources. Despite its potential, DNA banking is not being used by palliative care oncologists.

  17. Improving medical students’ knowledge of genetic disease: a review of current and emerging pedagogical practices

    Science.gov (United States)

    Wolyniak, Michael J; Bemis, Lynne T; Prunuske, Amy J

    2015-01-01

    Genetics is an essential subject to be mastered by health professional students of all types. However, technological advances in genomics and recent pedagogical research have changed the way in which many medical training programs teach genetics to their students. These advances favor a more experience-based education focused primarily on developing student’s critical thinking skills. In this review, we examine the current state of genetics education at both the preclinical and clinical levels and the ways in which medical and pedagogical research have guided reforms to current and emerging teaching practices in genetics. We discover exciting trends taking place in which genetics is integrated with other scientific disciplines both horizontally and vertically across medical curricula to emphasize training in scientific critical thinking skills among students via the evaluation of clinical evidence and consultation of online databases. These trends will produce future health professionals with the skills and confidence necessary to embrace the new tools of medical practice that have emerged from scientific advances in genetics, genomics, and bioinformatics. PMID:26604852

  18. The current practice of using multiple representations in year 4 science classrooms

    Science.gov (United States)

    Chuenmanee, Chanoknat; Thathong, Kongsak

    2018-01-01

    Multiple representations have been widely used as a reasoning tool for understanding complex scientific concepts. Thus this study attempted to investigate the current practice of using multiple representations on Year 4 science classrooms in terms of modes and levels which appear in curriculum documents, teaching plans, tasks and assessments, teaching practices, and students' behaviors. Indeed, documentary analysis, classroom observation, and interview were used as the data collection methods. First of all, Year 4 science documents were analyzed. Then classroom observation was used as a collecting method to seek what actually happen in the classroom. Finally, in-depth interviews were used to gather more information and obtain meaningful data. The finding reveals that many modes of verbal, visual, and tactile representations within three levels of representations are posed in Year 4 documents. Moreover, according to classroom observations and interviews, there are three main points of applying multiple representations into classrooms. First of all, various modes of representations were used, however, a huge number of them did not come together with the levels. The levels of representations, secondly, macroscopic and cellular levels were introduced into all classrooms while symbolic level was provided only in some classrooms. Finally, the connection of modes and levels pointed out that modes of representations were used without the considerations on the levels of them. So, it seems to be that teaching practice did not meet the aims of curriculum. Therefore, these issues were being considered in order to organize and design the further science lessons.

  19. Field Measurements at River and Tidal Current Sites for Hydrokinetic Energy Development: Best Practices Manual

    Energy Technology Data Exchange (ETDEWEB)

    Neary, Vincent S [ORNL; Gunawan, Budi [Oak Ridge National Laboratory (ORNL)

    2011-09-01

    In this report, existing data collection techniques and protocols for characterizing open channel flows are reviewed and refined to further address the needs of the MHK industry. The report provides an overview of the hydrodynamics of river and tidal channels, and the working principles of modern acoustic instrumentation, including best practices in remote sensing methods that can be applied to hydrokinetic energy site characterization. Emphasis is placed upon acoustic Doppler velocimeter (ADV) and acoustic-Doppler current profiler (ADCP) instruments, as these represent the most practical and economical tools for use in the MHK industry. Incorporating the best practices as found in the literature, including the parameters to be measured, the instruments to be deployed, the instrument deployment strategy, and data post-processing techniques. The data collected from this procedure aims to inform the hydro-mechanical design of MHK systems with respect to energy generation and structural loading, as well as provide reference hydrodynamics for environmental impact studies. The standard metrics and protocols defined herein can be utilized to guide field experiments with MHK systems.

  20. Evaluation and management of patients with peripheral artery disease by interventional radiologists: current practices.

    Science.gov (United States)

    Prince, Ethan A; Murphy, Timothy P; Dhangana, Raj; Soares, Gregory M; Ahn, Sun H; Dubel, Gregory J

    2008-05-01

    Traditionally, surgeons have served as primary consultants for patients with peripheral vascular disease for whom revascularization is considered. An important component of care for patients with peripheral artery disease (PAD) is risk factor management. The present study was undertaken to determine current management practices of interventional radiologists for patients with PAD and compare them to published data for vascular surgeons. If PAD patient management practices are similar, this would support direct referral of PAD patients who are considered for revascularization from primary care doctors to interventional radiologists. An online survey was administered to full members of the Society of Interventional Radiology with e-mail addresses on file. Filtering was done to examine and compare interactions among several responses. The margin of error for the survey was +/-2%, based on 95% CIs for the entire surveyed population (N=2,371). Seventy-five percent of respondents see PAD patients in ambulatory office settings. Only eight percent see themselves as the physician responsible for risk factor management, similar to reported results of vascular surgeons (10%). Other variables examined, such as frequency of inquiring about Framingham risk factors, indicate similar practices to those previously reported for vascular surgeons. For interventional radiologists who accept direct referrals for medical management of patients with PAD, disease management by interventional radiologists is similar to that previously reported for vascular surgeons. This supports the role of interventional radiologists who accept direct referrals of patients with PAD as primary consultants to primary care doctors.

  1. AC impedance behavior of a practical-size single-cell SOFC under DC current

    Energy Technology Data Exchange (ETDEWEB)

    Momma, Akihiko; Kaga, Yasuo; Takano, Kiyonami; Nozaki, Ken; Negishi, Akira; Kato, Ken; Kato, Tohru [Fuel Cell Group, Energy Electronics Institute, National Institute of Advanced Industrial Science and Technology, Umezono Tsukuba-shi, Ibaraki 305-8568 (Japan); Inagaki, Toru; Yoshida, Hiroyuki [Energy Use R and D Center, The Kansai Electric Power Company, Inc., 11-20 Nakoji, 3-Chome, Amagasaki, Hyogo 661-0974 (Japan); Hosoi, Kei; Hoshino, Koji; Akbay, Taner; Akikusa, Jun; Yamada, Masaharu; Chitose, Norihisa [Central Research Institute, Naka Research Center, Mitsubishi Materials Corp. 1002-14 Mukohyama, Naka-machi, Naka-gun, Ibaraki 311-0102 (Japan)

    2004-10-29

    AC impedance measurements were carried out using practical-size planar disc-type SOFC which employs lanthanum gallate as a solid electrolyte. The data were obtained under practical conditions of gas flow rate and DC current. Under these conditions, the gas conversion impedance (GCI), which originates from the change of the electromotive force (EMF) caused by the change in anodic gaseous concentrations along the flow direction, was observed in the low-frequency range of the data obtained. The overlapping impedance together with GCI on the low-frequency arc was also estimated. Experimentally obtained GCI was in good agreement with that calculated. It was concluded that GCI was predominant in the impedance data obtained under practical conditions. The shift of the high-frequency intercept in the complex impedance diagrams was shown to appear as a result of the change in the distribution of gaseous composition in the anode. The dependency of the low-frequency arc on temperature was also shown, and it was assumed that the overlapped impedance varies as the temperature changes. The validity of the impedance measurement, as a diagnostic means to evaluate the gas flow in SOFC stack, was suggested.

  2. IDENTIFYING AND CHANGING STEREOTYPES BETWEEN ROMA AND NON-ROMA: FROM THEORY TO PRACTICE

    Directory of Open Access Journals (Sweden)

    Gregor Maučec

    2013-09-01

    Full Text Available Having shortly delineated and theoretically defined the concept of stereotypes (as collective social constructs and stereotyping as such, the author turns to much more complex issue as to how to identify and change stereotypes about Roma, which are deeply rooted in mainstream European societies where they live and also those stereotypes that are nurtured and strictly followed by the Roma and which relate to non-Roma. The author arrives at a conclusion that today one can note several factors and conditions in European countries which still nurture and further reinforce especially anti-Roma stereotypes. According to him, the specific and carefully elaborated stereotypes-oriented policies and strategies which favour mutual education, knowledge and understanding as well as ongoing contact and dialogue between the two different ethnic, social and cultural identities at both EU and member states levels are conditio sine qua non for the enhanced and overall Roma inclusion and integration.

  3. MANIPULATION, PROFESSIONAL PRACTICES AND DEONTOLOGY IN INFORMATIONAL PHOTOGRAPHY: IDENTIFYING NEW PARAMETERS

    Directory of Open Access Journals (Sweden)

    Paulo Munhoz

    2014-06-01

    Full Text Available This paper investigates impacts of digital technologies on photographic post-production and image manipulation in information photography. An attempt is made to assess the extent to which ethical codes and conventions are being modified concerning the digital treatment of photographic images. We sought to assess whether one can identify, in the rules of photographic competitions, an embryonic process of establishment of new boundaries as to what constitutes content manipulation and what is acceptable as technical adjustments.  We observed that, in a large proportion of cases, competition rules consist of very generic guidelines regarding the acceptable procedures for photo editing, without clear distinctions between technical adjustment and manipulation. Despite such limitations, we conclude that the analysis of photographic competitions can lead to identification of observable regularities that may act as ethical standards in relation to post-production images.

  4. Manipulation, professional practices and deontology in informational photography: identifying new parameters

    Directory of Open Access Journals (Sweden)

    Paulo Munhoz

    2014-06-01

    Full Text Available This paper investigates impacts of digital technologies on photographic post-production and image manipulation in information photography. An attempt is made to assess the extent to which ethical codes and conventions are being modified concerning the digital treatment of photographic images. We sought to assess whether one can identify, in the rules of photographic competitions, an embryonic process of establishment of new boundaries as to what constitutes content manipulation and what is acceptable as technical adjustments.  We observed that, in a large proportion of cases, competition rules consist of very generic guidelines regarding the acceptable procedures for photo editing, without clear distinctions between technical adjustment and manipulation. Despite such limitations, we conclude that the analysis of photographic competitions can lead to identification of observable regularities that may act as ethical standards in relation to post-production images.

  5. Identifying a practice-based implementation framework for sustainable interventions for improving the evolving working environment

    DEFF Research Database (Denmark)

    Højberg, Helene; Nørregaard Rasmussen, Charlotte Diana; Osborne, Richard H.

    2018-01-01

    Our aim was to identify implementation components for sustainable working environment interventions in the nursing assistant sector to generate a framework to optimize the implementation of workplace improvement initiatives. The implementation framework was informed by: 1) an industry advisory...... group, 2) interviews with key stakeholder, 3) concept mapping workshops, and 4) an e-mail survey. Thirty five stakeholders were interviewed and contributed in the concept mapping workshops. Eleven implementation components were derived across four domains: 1) A supportive organizational platform, 2......) An engaged workplace with mutual goals, 3) The intervention is sustainably fitted to the workplace, and 4) the intervention is an attractive choice. The highest rated component was “Engaged and Active Management” (mean 4.1) and the lowest rated was “Delivered in an Attractive Form” (mean 2.8). The framework...

  6. Exploring patient experiences with prescription medicines to identify unmet patient needs: implications for research and practice.

    Science.gov (United States)

    Kucukarslan, Suzan N; Lewis, Nancy J W; Shimp, Leslie A; Gaither, Caroline A; Lane, Daniel C; Baumer, Andrea L

    2012-01-01

    Pharmacy services are offered to patients, and often, they decline participation. Research is needed to better understand patients' unmet needs when taking prescribed medications. To identify and characterize patients' unmet needs related to using prescribed medication for chronic conditions. Focus groups of patients using prescription medication for chronic conditions discussed their experiences with medications, starting from initial diagnosis to ongoing management. Sessions involved 40 patients from 1 Midwestern U.S. state. Major themes were identified using content analysis. Three major themes emerged. First, patients seek information to understand their health condition and treatment rationale. Patients form an illness perception (its consequence, controllability, cause, and duration) that dictates their actions. Second, patients desire to be involved in treatment decisions, and they often feel that decisions are made for them without their understanding of the risk-to-benefit trade-off. Third, patients monitor the impact of treatment decisions to determine if anticipated outcomes are achieved. The results were consistent with Dowell's therapeutic alliance model (TAM) and Leventhal's common sense model (CSM). The TAM can be used to model the consultative services between pharmacists and patients. The impact of the new services (or interventions) can be evaluated using the CSM. Patients expressed a strong desire to be involved in their treatment decisions. The effectiveness of medication therapy management services may be enhanced if pharmacists build on patients' desire to be involved in their treatment decisions and assist them to understand the role of medications and their risks and expected outcomes within the context of the patients' perceptions of illness and desired coping strategies. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Assessment of surgical competence in North American graduate periodontics programs: a survey of current practices.

    Science.gov (United States)

    Ghiabi, Edmond; Taylor, K Lynn

    2010-08-01

    This cross-sectional study was designed to document the methods utilized by North American graduate periodontics programs in assessing their residents' surgical skills. A survey of clinical skills assessment was mailed to directors of all fifty-eight graduate periodontics programs in Canada and the United States. Thirty-four programs (59 percent) responded. The data collected were analyzed using SPSS version 15.0. The results demonstrate that the most common practice for providing feedback and documenting residents' surgical skills in the programs surveyed was daily one-on-one verbal feedback given by an instructor. The next two most commonly reported methods were a standard checklist developed at program level and a combination of a checklist and verbal comments. The majority of the programs reported that the instructors met collectively once per term to evaluate the residents' progress. The results suggest that graduate periodontics programs provide their residents frequent opportunities for daily practice with verbal feedback from instructors. However, assessment strategies identified in other health professions as beneficial in fostering the integration of clinical skills practices are not employed.

  8. Current Practice "Constraints" in the Uptake and Use of Intensive Upper Extremity Training: A Canadian Perspective.

    Science.gov (United States)

    Shikako-Thomas, Keiko; Fehlings, Darcy; Germain, Manon; Gordon, Andrew M; Maynard, Doug; Majnemer, Annette

    2018-05-01

    Intensive upper extremity training (IUET) has demonstrated efficacy in clinical and functioning outcomes in children with hemiplegia. However, implementation in the clinical context requires novel service models and knowledge translation. To map implementation of IUET in Canada, to identify factors associated with the implementation and best practices for implementation. Mixed-methods design; descriptive statistics, chi-square tests. Individual phone interviews and focus groups with purposeful sampling. Thematic analysis; telephone surveys with managers of 31 pediatric rehabilitation centers across Canada. Four focus groups across Canada and one in the Netherlands. Implementation of IUET group interventions is limited in Canada (7/31). Barriers included beliefs and values related to evidence-based practice, opportunities for continuing education, researchers-clinicians partnerships, access to scientific literature, and the presence of a champion. Pressure from parents and media presenting IUET as a novel and effective therapy, support and flexibility of families, having the critical mass of clients and a managerial willingness to accommodate new ideas and restructure service provision were some facilitators. Uptake of the evidence requires many steps described in the knowledge translation cycle. Factors identified in the study could be considered in most clinical settings to facilitate the uptake of research evidence for IUET.

  9. Assessment of Current Inservice Inspection and Leak Monitoring Practices for Detecting Materials Degradation in Light Water Reactors

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, Michael T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Simonen, Fredric A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Muscara, Joseph [US Nuclear Regulatory Commission (NRC), Rockville, MD (United States); Doctor, Steven R. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Kupperman, David S. [Argonne National Lab. (ANL), Argonne, IL (United States)

    2016-09-01

    An assessment was performed to determine the effectiveness of existing inservice inspection (ISI) and leak monitoring techniques, and recommend improvements, as necessary, to the programs as currently performed for light water reactor (LWR) components. Information from nuclear power plant (NPP) aging studies and from the U. S. Nuclear Regulatory Commission’s Generic Aging Lessons Learned (GALL) report (NUREG-1801) was used to identify components that have already experienced, or are expected to experience, degradation. This report provides a discussion of the key aspects and parameters that constitute an effective ISI program and a discussion of the basis and background against which the effectiveness of the ISI and leak monitoring programs for timely detection of degradation was evaluated. Tables based on the GALL components were used to systematically guide the process, and table columns were included that contained the ISI requirements and effectiveness assessment. The information in the tables was analyzed using histograms to reduce the data and help identify any trends. The analysis shows that the overall effectiveness of the ISI programs is very similar for both boiling water reactors (BWRs) and pressurized water reactors (PWRs). The evaluations conducted as part of this research showed that many ISI programs are not effective at detecting degradation before its extent reached 75% of the component wall thickness. This work should be considered as an assessment of NDE practices at this time; however, industry and regulatory activities are currently underway that will impact future effectiveness assessments. A number of actions have been identified to improve the current ISI programs so that degradation can be more reliably detected.

  10. A qualitative study examining methods of accessing and identifying research relevant to clinical practice among rehabilitation clinicians.

    Science.gov (United States)

    Patel, Drasti; Koehmstedt, Christine; Jones, Rebecca; Coffey, Nathan T; Cai, Xinsheng; Garfinkel, Steven; Shaewitz, Dahlia M; Weinstein, Ali A

    2017-01-01

    Research examining the utilization of evidence-based practice (EBP) specifically among rehabilitation clinicians is limited. The objective of this study was to examine how various rehabilitative clinicians including physical therapists, occupational therapists, rehabilitation counselors, and physiatrists are gaining access to literature and whether they are able to implement the available research into practice. A total of 21 total clinicians were interviewed via telephone. Using NVivo, a qualitative analysis of the responses was performed. There were similarities found with respect to the information-seeking behaviors and translation of research across the different clinician types. Lack of time was reported to be a barrier for both access to literature and implementation of research across all clinician types. The majority of clinicians who reported having difficulty with utilizing the published literature indicated that the literature was not applicable to their practice, the research was not specific enough to be put into practice, or the research found was too outdated to be relevant. In addition, having a supportive work environment aided in the search and utilization of research through providing resources central to assisting clinicians in gaining access to health information. Our study identified several barriers that affect EBP for rehabilitation clinicians. The findings suggest the need for researchers to ensure that their work is applicable and specific to clinical practice for implementation to occur.

  11. Relationship Between Current Substance Use and Unhealthy Weight Loss Practices Among Adolescents.

    Science.gov (United States)

    Vidot, Denise C; Messiah, Sarah E; Prado, Guillermo; Hlaing, WayWay M

    2016-04-01

    To determine the relationship between current substance use and unhealthy weight loss practices (UWLP) among 12-to-18 year olds. Participants were 12-to-18 year olds who completed the 2013 Youth Risk Behavior Survey in Florida (N = 5620). Current alcohol, tobacco, and marijuana use was self-reported based on last 30-day use. UWLP was defined based on self-report of at least one of three methods to lose weight in last 30-days: (1) ≥24 h of fasting, (2) diet pill use, and (3) laxative use/purging. The reference group included those with no reported UWLP. Logistic regression models adjusted for age, gender, race/ethnicity, academic performance, age-sex-specific body mass index percentiles, and perceived weight status were fitted to assess relationships between UWLP and current substance use. About 15 and 41 % of adolescents reported ≥1 UWLP and use of ≥1 substance in the last 30-days, respectively. Over half (60.1 %) of adolescents who reported substance use engaged in UWLP (p < 0.0001). The prevalence of current alcohol use (50.6 %) was the highest among those who reported UWLP, followed by marijuana (31.9 %), tobacco (19.7 %), and cocaine (10.5 %) use. Adolescents who reported current tobacco [adjusted odds ratio (AOR) 2.7, 95 % confidence interval (CI) 2.1-3.6], alcohol (AOR 2.2, 95 % CI 1.9-2.6), or marijuana (AOR 2.1, 95 % CI 1.7-2.5) use had significantly higher odds of UWLP compared to their non-user counterparts. This cross-sectional study shows that substance use and UWLP behaviors are likely to co-exist in adolescents. Further studies are necessary to determine the temporal relationship between substance use and UWLP. It is recommended that intervention programs for youth consider targeting these multiple health risk behaviors.

  12. Good practice or positive action? Using Q methodology to identify competing views on improving gender equality in academic medicine.

    Science.gov (United States)

    Bryant, Louise D; Burkinshaw, Paula; House, Allan O; West, Robert M; Ward, Vicky

    2017-08-22

    The number of women entering medicine has increased significantly, yet women are still under-represented at senior levels in academic medicine. To support the gender equality action plan at one School of Medicine, this study sought to (1) identify the range of viewpoints held by staff on how to address gender inequality and (2) identify attitudinal barriers to change. Q methodology. 50 potential interventions representing good practice or positive action, and addressing cultural, organisational and individual barriers to gender equality, were ranked by participants according to their perception of priority. The School of Medicine at the University of Leeds, UK. Fifty-five staff members were purposively sampled to represent gender and academic pay grade. Principal components analysis identified six competing viewpoints on how to address gender inequality. Four viewpoints favoured positive action interventions: (1) support careers of women with childcare commitments, (2) support progression of women into leadership roles rather than focus on women with children, (3) support careers of all women rather than just those aiming for leadership, and (4) drive change via high-level financial and strategic initiatives. Two viewpoints favoured good practice with no specific focus on women by (5) recognising merit irrespective of gender and (6) improving existing career development practice. No viewpoint was strongly associated with gender, pay grade or role; however, latent class analysis identified that female staff were more likely than male to prioritise the setting of equality targets. Attitudinal barriers to the setting of targets and other positive action initiatives were identified, and it was clear that not all staff supported positive action approaches. The findings and the approach have utility for those involved in gender equality work in other medical and academic institutions. However, the impact of such initiatives needs to be evaluated in the longer term.

  13. Control and management of congenital Chagas disease in Europe and other non-endemic countries: current policies and practices.

    Science.gov (United States)

    Soriano-Arandes, Antoni; Angheben, Andrea; Serre-Delcor, Nuria; Treviño-Maruri, Begoña; Gómez I Prat, Jordi; Jackson, Yves

    2016-05-01

    Identifying pregnant women infected with Trypanosoma cruzi is one of the major challenges for preventing and controlling Chagas disease (CD) in non-endemic countries. The aim of this paper was to perform a policy evaluation of the current practices of congenital Chagas disease (CCD) control in non-endemic countries and to propose specific targets for enhanced interventions to tackle this emerging health problem outside the endemic areas of Latin America. We conducted a mixed method review of CCD policy strategies by searching the literature in the PubMed, Google Scholar and the World Health Organization (WHO) databases using the key terms 'CCD', 'paediatric Chagas disease' and 'non-endemic countries'; as free text and combined as one phrase to increase the search sensitivity. Reviews, recommendations, guidelines and control/surveillance programme reports were included. Of 427 CCD papers identified in non-endemic countries, 44 matched the inclusion. Although local programmes were launched in different countries with large numbers of Latin American immigrants, there were considerable disparities in terms of the programmes' distribution, delivery, integration and appropriated CCD control strategies. Moreover, Catalonia, Spain is the only region/country with an established systematic monitoring of CCD in pregnant women from Latin American countries. Given the worldwide dissemination of CD, the nature of its vertical transmission, and the gaps of the current strategies in non-endemic countries, there is an urgent need to standardise, expand and reinforce the control measures against CCD transmission. © 2016 John Wiley & Sons Ltd.

  14. Current Research and Statistical Practices in Sport Science and a Need for Change

    Directory of Open Access Journals (Sweden)

    Jake R. Bernards

    2017-11-01

    Full Text Available Current research ideologies in sport science allow for the possibility of investigators producing statistically significant results to help fit the outcome into a predetermined theory. Additionally, under the current Neyman-Pearson statistical structure, some argue that null hypothesis significant testing (NHST under the frequentist approach is flawed, regardless. For example, a p-value is unable to measure the probability that the studied hypothesis is true, unable to measure the size of an effect or the importance of a result, and unable to provide a good measure of evidence regarding a model or hypothesis. Many of these downfalls are key questions researchers strive to answer following an investigation. Therefore, a shift towards a magnitude-based inference model, and eventually a fully Bayesian framework, is thought to be a better fit from a statistical standpoint and may be an improved way to address biases within the literature. The goal of this article is to shed light on the current research and statistical shortcomings the field of sport science faces today, and offer potential solutions to help guide future research practices.

  15. Human resource aspects of antiretroviral treatment delivery models: current practices and recommendations.

    Science.gov (United States)

    Assefa, Yibeltal; Van Damme, Wim; Hermann, Katharina

    2010-01-01

    PURPOSE OF VIEW: To illustrate and critically assess what is currently being published on the human resources for health dimension of antiretroviral therapy (ART) delivery models. The use of human resources for health can have an effect on two crucial aspects of successful ART programmes, namely the scale-up capacity and the long-term retention in care. Task shifting as the delegation of tasks from higher qualified to lower qualified cadres has become a widespread practice in ART delivery models in low-income countries in recent years. It is increasingly shown to effectively reduce the workload for scarce medical doctors without compromising the quality of care. At the same time, it becomes clear that task shifting can only be successful when accompanied by intensive training, supervision and support from existing health system structures. Although a number of recent publications have focussed on task shifting in ART delivery models, there is a lack of accessible information on the link between task shifting and patient outcomes. Current ART delivery models do not focus sufficiently on retention in care as arguably one of the most important issues for the long-term success of ART programmes. There is a need for context-specific re-designing of current ART delivery models in order to increase access to ART and improve long-term retention.

  16. Improving Hospital Services Based on Patient Experience Data: Current Feedback Practices and Future Opportunities.

    Science.gov (United States)

    Kaipio, Johanna; Stenhammar, Hanna; Immonen, Susanna; Litovuo, Lauri; Axelsson, Minja; Lantto, Minna; Lahdenne, Pekka

    2018-01-01

    Patient feedback is considered important for healthcare organizations. However, measurement and analysis of patient reported data is useful only if gathered insights are transformed into actions. This article focuses on gathering and utilization of patient experience data at hospitals with the aim of supporting the development of patient-centered services. The study was designed to explore both current practices of collecting and utilizing patient feedback at hospitals as well as future feedback-related opportunities. Nine people working at different hierarchical levels of three university hospitals in Finland participated in in-depth interviews. Findings indicate that current feedback processes are poorly planned and inflexible. Some feedback data are gathered, but not systematically utilized. Currently, it is difficult to obtain a comprehensive picture of the situation. One future hope was to increase the amount of patient feedback to be able to better generalize and utilize the data. Based on the findings the following recommendations are given: attention to both patients' and healthcare staff's perspectives when collecting feedback, employing a coordinated approach for collecting and utilizing patient feedback, and organizational transformation towards a patient-centric culture.

  17. [Current Research Activities on Person-Centered Medicine in Academic Institutes of General Practice in Germany and Austria].

    Science.gov (United States)

    Weber, Annemarie; Schelling, Jörg; Kohls, Niko; van Dyck, Marcus; Poggenburg, Stephanie; Vajda, Christian; Hirsch, Jameson; Sirois, Fuschia; Toussaint, Loren; Offenbächer, Martin

    2017-10-11

    Aim of study Person-centered medicine (PCM) with its focus on humanistic-biographical-oriented medicine and integrated, positive-salutogenic health is a central aspect in the patient-physician relationship in general practice. The objective of this analysis is to assess the prevalence and type of research project in academic institutions of general practice in Germany (Ger) and Austria (At) and the thematic priorities of the projects in the areas PCM, health promotion (HP), prevention (PRE) and conventional medicine (CM). Methods A search was conducted (September-December 2015) on the websites of 30 institutes and divisions of general medicine for their current research projects. The retrieved projects were assigned to five categories: PCM, HP, PRE, CM and others. Subsequently, we identified the targeted patient groups of the projects as well as the thematic focus in the categories PCM, HP, PRE and CM with focus on PCM and HP. Results 541 research projects were identified, 452 in Germany and 89 in Austria. Research projects were only included if they were explicitly indicated as research-oriented. Seventy projects addressed PCM aspects, 15 projects HP aspects, 32 projects PRE aspects and 396 projects CM aspects. The most frequently target groups in the categories PCM (24 of 70) and HP (7 of 15) were chronically ill patients. The most common thematic focus in PCM was communication (13 of 70) and in HP, physical activity (6 of 15). Conclusion The vast majority of research projects investigated conventional medical topics. The percentage of research activities in the field of PCM (13%) or PCM including HP (16%) in Ger and At is below the European average of 20%. From our point of view, PCM and HP need to be implemented to a greater extent in general practice. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Current Australian speech-language pathology practice in addressing psychological well-being in people with aphasia after stroke.

    Science.gov (United States)

    Sekhon, Jasvinder K; Douglas, Jacinta; Rose, Miranda L

    2015-06-01

    Psychological well-being is essential to overall health; however, there is a paucity of research on how to address psychological well-being in stroke survivors with aphasia. This study describes the current beliefs, attitudes and practices of Australian speech-language pathologists in addressing psychological well-being in people with aphasia after stroke. A 26-item web-based survey consisting of open and closed questions was distributed to Australian speech-language pathologists through four electronic databases. Australian speech-language pathologists (n = 111) utilized counselling and clinical approaches to address psychological well-being in people with post-stroke aphasia. The majority of speech-language pathologists did not feel comfortable with addressing psychological well-being in people with aphasia and sought support from other health professionals in this practice. Self-perception of being under-skilled was the main barrier identified to adequate practice in this domain, followed by inadequate time, inadequate staffing and people with aphasia declining referral to counselling. The main facilitators reported by speech-language pathologists to address psychological well-being included personal interest, personal and professional experience and availability of counselling health professionals for people with aphasia. There were small-to-medium statistically significant correlations between speech-language pathologists reporting additional training in counselling and perceived knowledge of, confidence in and satisfaction with managing psychological well-being in people with aphasia. This study identifies factors requiring attention in order to enable speech-language pathologists to facilitate improved psychological well-being in people with aphasia.

  19. Cancer pain management in China: current status and practice implications based on the ACHEON survey

    Directory of Open Access Journals (Sweden)

    Xia Z

    2017-08-01

    Full Text Available Zhongjun Xia Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, ChinaPurpose: Cancer pain can seriously impact the quality of life (QoL of patients, and optimal management practices are therefore of paramount importance. The ACHEON survey queried physicians and patients from 10 Asian countries/regions to assess current clinical practices in cancer pain management in Asia. This study presents the data obtained for cancer pain management in mainland China, with an emphasis on practices related to opioid drugs.Materials and methods: In several tertiary hospitals across China, 250 patients experiencing cancer pain and 100 physicians were surveyed on questions designed to assess current cancer pain management practices and cancer pain impact on QoL.Results: The patient survey showed that 88% of patients reported moderate-to-severe cancer pain, with a median duration of 6 months. The physician survey showed that medical school/residency training with regard to cancer pain management was inadequate in ~80% of physicians. A total of 80% of physicians and 67.2% of patients reported that pain scale was used during pain assessment; 84% of physicians expressed that physician-perceived pain severity was not completely consistent with actual pain the patient experienced. Of the 147 patients who recalled the medication received, 83.7% were administered opioid prescriptions. Of the 240 patients who received treatment, 43.8% perceived the inadequacy of controlling pain. The primary barriers from physicians perceived to optimal pain management included patients’ fear of side effects (58%, patients’ fear of addiction (53%, patients’ reluctance to report pain (43%, physicians’ reluctance to prescribe (29%, physicians’ inadequacy of pain assessment (27% and excessive regulation of opioid analgesics (47%.Conclusion: Knowledge of cancer pain management should be strengthened among physicians. Quantitative pain assessment and principle-based pain

  20. Identifying the barriers and enablers in the implementation of the New Zealand and Australian Antenatal Corticosteroid Clinical Practice Guidelines

    Directory of Open Access Journals (Sweden)

    E. L. Mc Goldrick

    2016-10-01

    Full Text Available Abstract Background The ineffective implementation of evidence based practice guidelines can mean that the best health outcomes are not achieved. This study examined the barriers and enablers to the uptake and implementation of the new bi-national (Australia and New Zealand antenatal corticosteroid clinical practice guidelines among health professionals, using the Theoretical Domains Framework. Methods Semi-structured interviews or online questionnaires were conducted across four health professional groups and three district health boards in Auckland, New Zealand. The questions were constructed to reflect the 14 behavioural domains from the Theoretical Domains Framework. Relevant domains were identified by the presence of conflicting beliefs within a domain; the frequency of beliefs; and the likely strength of the impact of a belief on the behaviour using thematic analysis. The influence of health professional group and organisation on the different barriers and enablers identified were explored. Results Seventy-three health professionals completed either a semi-structured interview (n = 35 or on-line questionnaire (n = 38. Seven behavioural domains were identified as overarching enablers: belief about consequences; knowledge; social influences; environmental context and resource; belief about capabilities; social professional role and identity; and behavioural regulation. Five behavioural domains were identified as overarching barriers: environmental context and resources; knowledge; social influences; belief about consequences; and social professional role and identity. Differences in beliefs between individual health professional groups were identified within the domains: belief about consequences; social professional role and identity; and emotion. Organisational differences were identified within the domains: belief about consequences; social influences; and belief about capabilities. Conclusion This study has identified some of the

  1. Role of scanning electron microscopy in identifying drugs used in medical practice.

    Science.gov (United States)

    Fazil Marickar, Y M; Sylaja, N; Koshy, Peter

    2009-10-01

    Several plant preparations are administered for treatment of stone disease without scientific basis. This paper presents the results of in vitro and animal experimental studies using scanning electron microscopy (SEM) in the identification of the therapeutic properties of trial drugs in medicine. In the first set of the study, urinary crystals namely calcium oxalate monohydrate and calcium oxalate dehydrate were grown in six sets of Hane's tubes in silica gel medium. Trial drugs namely scoparia dulcis Lynn, musa sapiens and dolicos biflorus were incorporated in the gel medium to identify the dopant effect of the trial drugs on the size and extent of crystal column growth. The changes in morphology of crystals were studied using SEM. In the second set, six male Wistar rats each were calculogenised by administering sodium oxalate and ethylene glycol and diabetised using streptozotocin. The SEM changes of calculogenisation were studied. The rats were administered trial drugs before calculogenisation or after. The kidneys of the rats studied under the scanning electron microscope showed changes in tissue morphology and crystal deposition produced by calculogenisation and alterations produced by addition of trial drugs. The trial drugs produced changes in the pattern of crystal growth and in the crystal morphology of both calcium oxalate monohydrate and calcium oxalate dihydrate grown in vitro. Elemental distribution analysis showed that the crystal purity was not altered by the trial drugs. Scoparia dulcis Lynn was found to be the most effective anticalculogenic agent. Musa sapiens and dolicos biflorus were found to have no significant effect in inhibiting crystal growth. The kidneys of rats on calculogenisation showed different grades of crystals in the glomerulus and interstitial tissues, extrusion of the crystals into the tubular lumen, collodisation and tissue inflammatory cell infiltration. Scoparia dulcis Lynn exhibited maximum protector effect against the

  2. Current practices in the identification of critical habitat for threatened species.

    Science.gov (United States)

    Camaclang, Abbey E; Maron, Martine; Martin, Tara G; Possingham, Hugh P

    2015-04-01

    The term critical habitat is used to describe the subset of habitat that is essential to the survival and recovery of species. Some countries legally require that critical habitat of listed threatened and endangered species be identified and protected. However, there is little evidence to suggest that the identification of critical habitat has had much impact on species recovery. We hypothesized that this may be due at least partly to a mismatch between the intent of critical habitat identification, which is to protect sufficient habitat for species persistence and recovery, and its practice. We used content analysis to systematically review critical habitat documents from the United States, Canada, and Australia. In particular, we identified the major trends in type of information used to identify critical habitat and in occupancy of habitat identified as critical. Information about population viability was used to identify critical habitat for only 1% of the species reviewed, and for most species, designated critical habitat did not include unoccupied habitat. Without reference to population viability, it is difficult to determine how much of a species' occupied and unoccupied habitat will be required for persistence. We therefore conclude that the identification of critical habitat remains inconsistent with the goal of protecting sufficient habitat to support persistence and recovery of the species. Ensuring that critical habitat identification aligns more closely with its intent will improve the accuracy of the designations and may therefore help improve the benefits to species recovery when combined with adequate implementation and enforcement of legal protections. © 2014 Society for Conservation Biology.

  3. Current Status of Marker Genes of Bacteroides and Related Taxa for Identifying Sewage Pollution in Environmental Waters

    Directory of Open Access Journals (Sweden)

    Warish Ahmed

    2016-05-01

    Full Text Available Microbial source tracking (MST endeavors to determine sources of fecal pollution in environmental waters by capitalizing on the association of certain microorganisms with the gastrointestinal tract and feces of specific animal groups. Several decades of research have shown that bacteria belonging to the gut-associated order Bacteroidales, and particularly the genus Bacteroides, tend to co-evolve with the host, and are, therefore, particularly suitable candidates for MST applications. This review summarizes the current research on MST methods that employ genes belonging to Bacteroidales/Bacteroides as tracers or “markers” of sewage pollution, including known advantages and deficiencies of the many polymerase chain reaction (PCR-based methods that have been published since 2000. Host specificity is a paramount criterion for confidence that detection of a marker is a true indicator of the target host. Host sensitivity, or the prevalence of the marker in feces/waste from the target host, is necessary for confidence that absence of the marker is indicative of the absence of the pollution source. Each of these parameters can vary widely depending on the type of waste assessed and the geographic location. Differential decay characteristics of bacterial targets and their associated DNA contribute to challenges in interpreting MST results in the context of human health risks. The HF183 marker, derived from the 16S rRNA gene of Bacteroides dorei and closely related taxa, has been used for almost two decades in MST studies, and is well characterized regarding host sensitivity and specificity, and in prevalence and concentration in sewage in many countries. Other markers such as HumM2 and HumM3 show promise, but require further performance testing to demonstrate their widespread utility. An important limitation of the one-marker-one-assay approach commonly used for MST is that given the complexities of microbial persistence in environmental waters, and

  4. [Materials/Biomaterials in Clinical Practice - a Short Review and Current Trends].

    Science.gov (United States)

    Bolle, T; Meyer, F; Walcher, F; Lohmann, C; Jockenhövel, S; Gries, T; Hoffmann, W

    2017-04-01

    Biomaterials play a major role in interventional medicine and surgery. However, the development of biomaterials is still in its early phases in spite of the huge progress made within the last decades. On the one hand, this is because our knowledge of the molecular and cellular processes associated with biomaterials is still increasing exponentially. On the other hand, a wide variety of advanced materials with highly interesting properties is being developed currently. This review provides a short introduction into the variety of materials in use as well as their application in interventional medicine and surgery. Also the importance of biomaterials for tissue engineering in the field of regenerative medicine and the functionalisation of biomaterials, including sterilisation methods are discussed. For the future, an even broader interdisciplinary scientific collaboration is necessary in order to develop novel biomaterials and facilitate their translation into clinical practice. Georg Thieme Verlag KG Stuttgart · New York.

  5. Biodiversity in environmental assessment-current practice and tools for prediction

    International Nuclear Information System (INIS)

    Gontier, Mikael; Balfors, Berit; Moertberg, Ulla

    2006-01-01

    Habitat loss and fragmentation are major threats to biodiversity. Environmental impact assessment and strategic environmental assessment are essential instruments used in physical planning to address such problems. Yet there are no well-developed methods for quantifying and predicting impacts of fragmentation on biodiversity. In this study, a literature review was conducted on GIS-based ecological models that have potential as prediction tools for biodiversity assessment. Further, a review of environmental impact statements for road and railway projects from four European countries was performed, to study how impact prediction concerning biodiversity issues was addressed. The results of the study showed the existing gap between research in GIS-based ecological modelling and current practice in biodiversity assessment within environmental assessment

  6. Current Knowledge and Practice of Pediatric Providers in Umbilical Cord Blood Banking.

    Science.gov (United States)

    Armstrong, Amy E; Fonstad, Rachel; Spellman, Stephen; Tullius, Zoe; Chaudhury, Sonali

    2018-02-01

    More than 35 000 umbilical cord blood (UCB) transplants have been performed worldwide, prompting the development of private and public banks to collect and store UCB cells. We hypothesized that pediatricians, who are uniquely poised to discuss UCB banking (UCBB) during prenatal or sibling visits, rarely do so. Through distribution of a 26-question electronic survey to general and subspecialty pediatric providers, we assessed baseline knowledge and conversations about UCBB. A total of 473 providers completed the survey; only 22% of physicians ever discussed UCBB with expectant parents. The majority responded that autologous UCB transplants were indicated in malignant (73%) and nonmalignant (61%) conditions; however, these are rare indications. Providers practicing >10 years were more likely to address UCBB ( P ≤ .001), whereas younger and female general pediatric providers were significantly less likely ( P < .001). Overall, pediatric providers rarely speak to families about UCBB, and we believe that they can be better informed to its current clinical utility.

  7. Myocardial perfusion imaging in Denmark: activity from 1997 to 2001 and current practice

    DEFF Research Database (Denmark)

    Petersen, Claus Leth; Kjaer, Andreas

    2003-01-01

    , and the survey thus covers all MPI performed in Denmark during the period in question. The number of MPI studies (examined patients) was 2,531 in 1997 (0.47 MPI/1,000/year) and 4,961 (0.93 MPI/1,000/year) in 2001, which is a doubling in activity in 5 years. Nineteen (95%) of the Danish departments performed MPI...... in 2001, and 14 (74%) of these reported that activity had increased over the past 5 years. MPI activity was unevenly distributed between hospitals and regions. In 2001, the university hospitals in the central Copenhagen region (capital) accounted for the highest MPI activity (2.00/1,000/year), while......A questionnaire was sent to all departments of nuclear medicine in Denmark (n=20) asking for details of myocardial perfusion imaging (MPI), including the number of patients examined each year from 1997 to 2001 and the current clinical and technical practice. All (100%) departments replied...

  8. Anaesthetic specialist registrars in Ireland: current teaching practices and perceptions of their role as undergraduate teachers.

    LENUS (Irish Health Repository)

    Walsh, K

    2012-02-03

    BACKGROUND AND OBJECTIVES: Teaching is an important responsibility of non-consultant hospital doctors. In Ireland, specialist registrars (SpRs) in anaesthesia are contractually obliged to teach medical students, other doctors and nurses. Both medical students and fellow non-consultant hospital doctors attribute between 30 and 40% of their knowledge gain to non-consultant hospital doctors. METHODS: We carried out a confidential telephone survey of anaesthetic SpRs in Ireland regarding their current teaching practices and the perceptions of their role as undergraduate teachers. All the SpRs currently working in clinical practice in Ireland were eligible. RESULTS: Fifty-five of the 79 (70%) SpRs responded to the questionnaire. Only 7 (12.7%) of the respondents said they had been well trained as a teacher. The majority of the respondents stated that they would attend a learning-to-teach course\\/workshop if one was available, and felt that such a course would improve their ability as a teacher. Only 8 (14.5%) agreed that adequate emphasis is placed on commitment to teaching in the assessment of SpRs, both by individual departments and by the College of Anaesthetists. Anaesthetic SpRs in Ireland spend a considerable amount of time each day teaching undergraduate medical students, the majority (68.9%) stated that they had inadequate time to prepare for teaching. CONCLUSION: The majority of the respondents stated that they enjoy teaching, feel that they play an important role in undergraduate teaching but have inadequate time to prepare for teaching. An adequate emphasis is not placed on their commitment to teaching.

  9. Current Cytology Practices in Korea: A Nationwide Survey by the Korean Society for Cytopathology

    Directory of Open Access Journals (Sweden)

    Eun Ji Oh

    2017-11-01

    Full Text Available Background Limited data are available on the current status of cytology practices in Korea. This nationwide study presents Korean cytology statistics from 2015. Methods A nationwide survey was conducted in 2016 as a part of the mandatory quality-control program by the Korean Society for Cytopathology. The questionnaire was sent to 208 medical institutions performing cytopathologic examinations in Korea. Individual institutions were asked to submit their annual cytology statistical reports and gynecologic cytology-histology correlation data for 2015. Results Responses were obtained from 206 medical institutions including 83 university hospitals, 87 general hospitals, and 36 commercial laboratories. A total of 8,284,952 cytologic examinations were performed in 2015, primarily in commercial laboratories (74.9%. The most common cytology specimens were gynecologic samples (81.3%. Conventional smears and liquid-based cytology were performed in 6,190,526 (74.7% and 2,094,426 (25.3% cases, respectively. The overall diagnostic concordance rate between cytologic and histologic diagnoses of uterine cervical samples was 70.5%. Discordant cases were classified into three categories: category A (minimal clinical impact, 17.4%, category B (moderate clinical impact, 10.2%, and category C (major clinical impact, 1.9%. The ratio of atypical squamous cells of undetermined significance to squamous intraepithelial lesion was 1.6 in university hospitals, 2.9 in general hospitals, and 4.9 in commercial laboratories. Conclusions This survey reveals the current status and trend of cytology practices in Korea. The results of this study can serve as basic data for the establishment of nationwide cytopathology policies and quality improvement guidelines in Korean medical institutions.

  10. A survey of current practices in management of Hirschsprung′s disease in Nigeria

    Directory of Open Access Journals (Sweden)

    Abdulrasheed A. Nasir

    2014-01-01

    Full Text Available Background: Although there are several modalities of treatment for Hirschsprung′s disease (HD, there are presently no clear guidelines on treatment of the condition by paediatric surgeons in Nigeria. This survey determines the current approach to treatment among Nigerian paediatric surgeons and should help in establishing a consensus and guidelines for care in this and similar setting. Materials and Methods: An online questionnaire was designed using survey Monkey ® to determine current clinical and operative management of patients with HD by consultant paediatric surgeons practicing in the Nigeria. The paediatric surgeons were notified by E-mail, which included a link to the survey on survey Monkey ® . The survey was also administered at the 12 th annual meeting of Association of Paediatric Surgeons of Nigeria in September, 2013, to capture those who did not complete the online survey. Thirty-one paediatric surgeons from 21 different tertiary paediatric surgery centres completed the survey. Results: Sixteen (52% respondents see up to 20% of their patients with HD in the neonatal period. Twenty-six (84% respondents do routine barium enema. Twenty six (84% respondents do full thickness rectal biopsy under general anaesthesia (GA. There was no consistency in operative techniques, with transabominal Swenson′s operation being practiced by 17 (57% respondents and 11 (37% transanal endorectal pull through. 14 (45% do pull through at any age. 12 (39% respondents do more than half of their patient as primary pull through. Conclusion: Full thickness rectal biopsy under GA is still the vogue with variations in the surgical technique for management of Hirshsprung′s disease in Nigeria. Primary pull through procedures is becoming increasingly popular. There′s a need for Paediatric Surgeons in Nigeria to come up with a guideline on management of HD, to guide trainees and other surgeons in the care of these patients.

  11. Current practice and recommendations in UK epilepsy monitoring units. Report of a national survey and workshop.

    Science.gov (United States)

    Hamandi, Khalid; Beniczky, Sandor; Diehl, Beate; Kandler, Rosalind H; Pressler, Ronit M; Sen, Arjune; Solomon, Juliet; Walker, Matthew C; Bagary, Manny

    2017-08-01

    Inpatient video-EEG monitoring (VEM) is an important investigation in patients with seizures or blackouts, and in the pre-surgical workup of patients with epilepsy. There has been an expansion in the number of Epilepsy Monitoring Units (EMU) in the UK offering VEM with a necessary increase in attention on quality and safety. Previous surveys have shown variation across centres on issues including consent and patient monitoring. In an effort to bring together healthcare professionals in the UK managing patients on EMU, we conducted an online survey of current VEM practice and held a one-day workshop convened under the auspices of the British Chapter of the ILAE. The survey and workshop aimed to cover all aspects of VEM, including pre-admission, consent procedures, patient safety, drug reduction and reinstatement, seizure management, staffing levels, ictal testing and good data recording practice. This paper reports on the findings of the survey, the workshop presentations and workshop discussions. 32 centres took part in the survey and there were representatives from 22 centres at the workshop. There was variation in protocols, procedures and consent processes between units, and levels of observation of monitored patients. Nevertheless, the workshop discussion found broad areas of agreement on points. A survey and workshop of UK epilepsy monitoring units found that some variability in practice is inevitable due to different local arrangements and patient groups under investigation. However, there were areas of clear consensus particularly in relation to consent and patient safety that can be applied to most units and form a basis for setting minimum standards. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  12. Cervical spine trauma radiographs: Swimmers and supine obliques; an exploration of current practice

    Energy Technology Data Exchange (ETDEWEB)

    Fell, Michael, E-mail: michael.fell@mkgeneral.nhs.u [Milton Keynes General Hospital, Radiology Standing Way, Eaglestone, Milton Keynes, Buckinghamshire MK6 5LD (United Kingdom)

    2011-02-15

    The study objectives were: to investigate current cervical spine radiographic imaging practices in conscious adult patients with suspected neck injury; reasons behind variation and consideration of dose estimates were explored. Comparison with a previous survey has been made. Questionnaires were sent to superintendent radiographers responsible for accident and emergency X-ray departments in English trusts with over 8500 emergency admissions per year, with a response rate of 97% (n = 181/186). Departmental cervical spine imaging protocols were reported by 82% of respondents. None use fewer than the three standard projections; if the cervicothoracic junction (C7/T1), is not adequately demonstrated 87% use swimmers projections, 9% supine obliques, 3% CT alone. Following projectional radiography, 97% perform CT. A significant (p = 0.018) increase was found since 1999 in CT use once the swimmers projection fails; fewer now use obliques at this point, continuing with CT instead. No significant difference (p = 0.644) was found in choice of first supplementary radiographs; despite British Trauma Society's recommendation to undertake supine obliques, swimmers remain the most widespread technique. An 85% response rate (n = 103/121) completed a second questionnaire, exploring reasons behind the various practices. Several reported a perceived difficulty in interpreting oblique radiographs, some a concern over high dose of the swimmers. Numerous issues affect the acquisition of cervical spine radiographs. Patient radiation dose should be a major consideration in selection of technique. A potential need for training in interpretation of obliques is highlighted. Specific guidelines for optimum projections should be researched, and protocols issued to ensure best practice.

  13. A survey of current clinical practice of permanent prostate brachytherapy in the United States

    International Nuclear Information System (INIS)

    Prestidge, Bradley R.; Prete, James J.; Buchholz, Thomas A.; Friedland, Jay L.; Stock, Richard G.; Grimm, Peter D.; Bice, William S.

    1998-01-01

    Purpose: To help establish standards of care for transperineal interstitial permanent prostate brachytherapy (TIPPB) by obtaining data regarding current clinical practice among the most experienced TIPPB brachytherapists in the United States. Methods and Materials: The 70 brachytherapists who performed the greatest number of TIPPB cases in 1995 in the U.S. were surveyed. Each received a comprehensive four page questionnaire that included sections on training and experience, patient and isotope selection criteria, manpower, technique, and follow-up. Thirty-five (50%) surveys were ultimately returned after three mailings and follow-up phone calls. The cumulative experience of the 35 respondents represented approximately 45% of the total TIPPB volume in the U.S. for 1995. Respondents included 29 from the private sector and six from academic programs. Results: The median physician experience with TIPPB was reported as 4.9 years. Each performed an average of 73 TIPPB procedures in 1995 (range 40-300). This represented an increase in volume for most (74%) of the respondents. Sixty-three percent of the respondents attended a formal training course, 54% had TIPPB-specific residency training, and 31% had been proctored (16 had received two or more types of training experience). The most commonly reported selection criteria for implant alone was on Gleason score ≤7, PSA 125 I prescribed to 120 Gy (75%) or 103 Pd to 90 Gy (50%). Sixty percent reported using a Mick applicator, 46% prefer using preloaded needles, and (11%) use both techniques. Real-time imaging was usually performed with ultrasound (94%); most included fluoroscopy (60%). Definitions of PSA control varied widely. Conclusions: TIPPB clinical practice in the U.S. demonstrates similarities in technique, but differences in patient selection and definitions of biochemical control. It is, therefore, incumbent on those beginning TIPPB programs to carefully review the specific practice details of those institutions

  14. Identifying economic hurdles to early adoption of preventative practices: The case of trunk diseases in California winegrape vineyards

    Directory of Open Access Journals (Sweden)

    Jonathan Kaplan

    2016-12-01

    Full Text Available Despite the high likelihood of infection and substantial yield losses from trunk diseases, many California practitioners wait to adopt field-tested, preventative practices (delayed pruning, double pruning, and application of pruning-wound protectants until after disease symptoms appear in the vineyard at around 10 years old. We evaluate net benefits from adoption of these practices before symptoms appear in young Cabernet Sauvignon vineyards and after they become apparent in mature vineyards to identify economic hurdles to early adoption. We simulate winegrape production in select counties of California and find widespread benefits from early adoption, increasing vineyard profitable lifespans, in some cases, by close to 50%. However, hurdles may result from uncertainty about the cost and returns from adoption, labor constraints, long time lags in benefits from early adoption, growers’ perceived probabilities of infection, and their discount rate. Development of extension resources communicating benefits and potential hurdles to growers likely reduces uncertainty, increasing early adoption. Improvements in efficacy of preventative practices, perhaps by detecting when pathogen spores are released into the vineyard, will increase early adoption. Lastly, practice cost reductions will increase early adoption too, especially when the time it takes for adoption to payoff and infection uncertainty are influential in adoption decisions.

  15. Coliform Bacteria Monitoring in Fish Systems: Current Practices in Public Aquaria.

    Science.gov (United States)

    Culpepper, Erin E; Clayton, Leigh A; Hadfield, Catherine A; Arnold, Jill E; Bourbon, Holly M

    2016-06-01

    Public aquaria evaluate coliform indicator bacteria levels in fish systems, but the purpose of testing, testing methods, and management responses are not standardized, unlike with the coliform bacteria testing for marine mammal enclosures required by the U.S. Department of Agriculture. An online survey was sent to selected aquaria to document current testing and management practices in fish systems without marine mammals. The information collected included indicator bacteria species, the size and type of systems monitored, the primary purpose of testing, sampling frequency, test methods, the criteria for interpreting results, corrective actions, and management changes to limit human exposure. Of the 25 institutions to which surveys were sent, 19 (76%) responded. Fourteen reported testing for fecal indicator bacteria in fish systems. The most commonly tested indicator species were total (86%) and fecal (79%) coliform bacteria, which were detected by means of the membrane filtration method (64%). Multiple types and sizes of systems were tested, and the guidelines for testing and corrective actions were highly variable. Only three institutions performed additional tests to confirm the identification of indicator organisms. The results from this study can be used to compare bacterial monitoring practices and protocols in fish systems, as an aid to discussions relating to the accuracy and reliability of test results, and to help implement appropriate management responses. Received August 23, 2015; accepted December 29, 2015.

  16. Current Trends in the Studies of Allelochemicals for Their Application in Practice

    Directory of Open Access Journals (Sweden)

    Arsen V.Viter

    2015-06-01

    Full Text Available The allelochemicals have been largely used in agriculture, forestry, landscape design and ornamental plant growing for many decades. However, there is a lack of the comprehensive studies, where existing publications are analyzed and synthesized with regards to the theoretic aspects for such usage. The objective of this paper was to systemize the advances in the research on allelochemicals’ application in practice. Numerous novel methodological propositions have risen recently. We classified them into the physical, chemical, biological, biotechnological and cropgrowing approaches. The allelochemicals consist of the wide diversity of the substances according to their chemical nature. Among these substances we outlined, firstly, the unidentified plant exudates and the products of green manuring, secondly, the chemically characterized or purified substances, which include alcohols, organic acids, aliphatic compounds, aromatic, alicyclic and nitrogen-contain organic compounds. Several groups of the biotic sources of allelochemicals were described: dicotyledonous and monocotyledonous plants, particularly under their colonization by non-pathogenic strains of Fusarium oxysporum, marine flora and fungi, which exhibit the herbicidal activity. Different targets of the allelochemical application were listed in the paper and they were categorized into several groups: higher flora, animals, unicellular and multi-cellular fungi. We concluded that there is lack of the modern multifaceted knowledge bases for the information about the allelochemical application. Those knowledge bases must be useful in order to choose the appropriate biological method for solving each particular problem of plant cultivation. To that end we systemized the results of current investigation about the usage of allelochemicals in practice.

  17. What is the current practice of therapists in the measurement of somatosensation in children with cerebral palsy and other neurological disorders?

    Science.gov (United States)

    Walmsley, Corrin; Taylor, Susan; Parkins, Timothy; Carey, Leeanne; Girdler, Sonya; Elliott, Catherine

    2018-04-01

    Somatosensation is the ability to detect and recognise body sensations such as touch, vibration, pressure, pain, temperature and proprioception. Cerebral palsy is a neurological disorder that is often accompanied by impairments in somatosensation. Current somatosensory assessments have limited psychometrics established for use with these children. The aim of this study was to identify therapists' current practice and perspectives related to the assessment of somatosensation in children with neurological disorders. A cross-sectional questionnaire was used to identify the somatosensory assessments currently used in clinical practice, time allocated to assessment, and therapists' satisfaction and confidence using the available assessments of somatosensation. The questionnaire was adapted from a previously utilised questionnaire that identified therapists' use of somatosensory assessments with adults post-stroke. A total of 135 therapists responded to the questionnaire. Seventy-nine (92%) occupational therapists and 44 (89.7%) physiotherapists indicated that they currently assessed or treated children with somatosensory deficits. Sixty-four (82.1%) occupational therapists and 38 (86.3%) physiotherapists regarded assessment of somatosensation in children with neurological disorders as important to very important. However, only seven (8.8%) occupational therapists and seven (15.9%) physiotherapists reported confidence in their ability to do so. The methods with which therapists detect and measure somatosensory impairment in children with neurological disorders are variable, with non-standardised and/or informal assessments most frequently used. Despite there being recommendations of best practice for the assessment of specific domains of somatosensation in children with cerebral palsy, current practice does not yet mirror these recommendations. Additionally, therapists have low satisfaction and confidence with what they are currently using, highlighting the need for a

  18. Shared decision making in mental health: the importance for current clinical practice.

    Science.gov (United States)

    Alguera-Lara, Victoria; Dowsey, Michelle M; Ride, Jemimah; Kinder, Skye; Castle, David

    2017-12-01

    We reviewed the literature on shared decision making (regarding treatments in psychiatry), with a view to informing our understanding of the decision making process and the barriers that exist in clinical practice. Narrative review of published English-language articles. After culling, 18 relevant articles were included. Themes identified included models of psychiatric care, benefits for patients, and barriers. There is a paucity of published studies specifically related to antipsychotic medications. Shared decision making is a central part of the recovery paradigm and is of increasing importance in mental health service delivery. The field needs to better understand the basis on which decisions are reached regarding psychiatric treatments. Discrete choice experiments might be useful to inform the development of tools to assist shared decision making in psychiatry.

  19. Unmanned Aerial Aircraft Systems for transportation engineering: Current practice and future challenges

    Directory of Open Access Journals (Sweden)

    Emmanouil N. Barmpounakis

    2016-10-01

    Full Text Available Acquiring and processing video streams from static cameras has been proposed as one of the most efficient tools for visualizing and gathering traffic information. With the latest advances in technology and visual media, combined with the increased needs in dealing with congestion more effectively and directly, the use of Unmanned Aerial Aircraft Systems (UAS has emerged in the field of traffic engineering. In this paper, we review studies and applications that incorporate UAS in transportation research and practice with the aim to set the grounds from the proper understanding and implementation of UAS related surveillance systems in transportation and traffic engineering. The studies reviewed are categorized in different transportation engineering areas. Additional significant applications from other research fields are also referenced to identify other promising applications. Finally, issues and emerging challenges in both a conceptual and methodological level are revealed and discussed.

  20. Early surgery versus optimal current step-up practice for chronic pancreatitis (ESCAPE): design and rationale of a randomized trial

    NARCIS (Netherlands)

    Ahmed Ali, U.; Issa, Y.; Bruno, M.J.; Goor, H. van; Santvoort, H.C. van; Busch, O.R.; Dejong, C.H.; Nieuwenhuijs, V.B.; Eijck, C.H. van; Dullemen, H.M. van; Fockens, P.; Siersema, P.D.; Gouma, D.J.; Hooft, J.E. van; Keulemans, Y.; Poley, J.W.; Timmer, R.; Besselink, M.G.; Vleggaar, F.P.; Wilder-Smith, O.H.G.; Gooszen, H.G.; Dijkgraaf, M.G.; Boermeester, M.A.; et al.,

    2013-01-01

    BACKGROUND: In current practice, patients with chronic pancreatitis undergo surgical intervention in a late stage of the disease, when conservative treatment and endoscopic interventions have failed. Recent evidence suggests that surgical intervention early on in the disease benefits patients in

  1. Early surgery versus optimal current step-up practice for chronic pancreatitis (ESCAPE): Design and rationale of a randomized trial

    NARCIS (Netherlands)

    U. Ahmed Ali (Usama); Y. Issa (Yama); M.J. Bruno (Marco); H. van Goor (Harry); H.C. van Santvoort (Hjalmar); O.R.C. Busch (Olivier); C.H. Dejong (Cees); V.B. Nieuwenhuijs (Vincent); C.H.J. van Eijck (Casper); H.M. van Dullemen (Hendrik); P. Fockens (Paul); P.D. Siersema (Peter); D.J. Gouma (Dirk); J.E. van Hooft (Jeanin); Y. Keulemans (Yolande); J.-W. Poley (Jan-Werner); R. Timmer (Robin); M.G. Besselink (Marc); F.P. Vleggaar (Frank); O.H. Wilder-Smith (O.); H.G. Gooszen (Hein); M.G.W. Dijkgraaf (Marcel); M.A. Boermeester (Marja)

    2013-01-01

    textabstractBackground: In current practice, patients with chronic pancreatitis undergo surgical intervention in a late stage of the disease, when conservative treatment and endoscopic interventions have failed. Recent evidence suggests that surgical intervention early on in the disease benefits

  2. European Communication Monitor: Current developments, issues and tendencies of the professional practice of public relations in Europe

    NARCIS (Netherlands)

    Moreno, A.; Zerfass, A.; Tench, R.; Verčič, D.; Verhoeven, P.

    2009-01-01

    The European Communication Monitor (ECM) research explores the current developments for communications disciplines, practices and instruments. It is an extensive research project to monitor trends in communication management, analyse the changing framework for the profession driven by European

  3. Early surgery versus optimal current step-up practice for chronic pancreatitis (ESCAPE) : design and rationale of a randomized trial

    NARCIS (Netherlands)

    Ali, Usama Ahmed; Issa, Yama; Bruno, Marco J.; van Goor, Harry; van Santvoort, Hjalmar; Busch, Olivier R. C.; Dejong, Cornelis H. C.; Nieuwenhuijs, Vincent B.; van Eijck, Casper H.; van Dullemen, Hendrik M.; Fockens, Paul; Siersema, Peter D.; Gouma, Dirk J.; van Hooft, Jeanin E.; Keulemans, Yolande; Poley, Jan W.; Timmer, Robin; Besselink, Marc G.; Vleggaar, Frank P.; Wilder-Smith, Oliver H.; Gooszen, Hein G.; Dijkgraaf, Marcel G. W.; Boermeester, Marja A.

    2013-01-01

    Background: In current practice, patients with chronic pancreatitis undergo surgical intervention in a late stage of the disease, when conservative treatment and endoscopic interventions have failed. Recent evidence suggests that surgical intervention early on in the disease benefits patients in

  4. Current issues in dental practice management. Part 1. The importance of shared values.

    Science.gov (United States)

    Newsome, Philip R H

    2003-04-01

    There can be few who would argue with the notion that the nature of dental practice in the United Kingdom has changed dramatically over the last couple of decades. A variety of factors, including new clinical techniques, growing consumerism, a much greater awareness of health-related and well-being issues in the public at large, as well as a marked deregulation within the dental profession, the development of vocational training and recently mandatory lifelong learning, the growing number of females working in the profession, and an increasing reluctance of young dentists to finance dental practices have all combined to create an environment which has enabled and encouraged a move away from traditional forms of dental care delivery. Instead, there has been considerable growth in independently-funded practice and a commensurate growth in the number of practices operating under a corporate body umbrella of one form or another. Currently there are 27 corporate bodies registered with the General Dental Council (GDC) with the likelihood of more in the future given the proposed GDC review. This will no doubt take into consideration European law, under which the restriction within the Dentist's Act on the number of corporate bodies is likely to be untenable. Although they still have only a small share of the dental market--with 4% of all dentists in the UK in 1999--they have expanded rapidly from a small base. The data available at the time the paper was written indicate that the global total of fees earned from dentistry in the UK in the financial year 2001/2002 was almost 3 billion Pounds, of which 1.9 billion Pounds (64%) came from NHS fees and 1.1 billion Pounds (36%) from private fees. Of this 1.9 billion Pounds received in NHS fees in 2001/2002, 0.55 billion Pounds were paid by patients who were not exempt from charges, bringing the total amount actually paid out of patients' pockets for dental treatment to 1.65 billion Pounds. Compare these figures with 1996

  5. Black Truffle Harvesting in Spanish Forests: Trends, Current Policies and Practices, and Implications on its Sustainability

    Science.gov (United States)

    Garcia-Barreda, Sergi; Forcadell, Ricardo; Sánchez, Sergio; Martín-Santafé, María; Marco, Pedro; Camarero, J. Julio; Reyna, Santiago

    2018-04-01

    The European black truffle is a mycorrhizal fungus native to Spanish Mediterranean forests. In most Spanish regions it was originally commercially harvested in the second half of the 20th century. Experts agree that wild truffle yields suffered a sharp decline during the 1970s and 1980s. However, official statistics for Spanish harvest are scarce and seemingly conflicting, and little attention has been paid to the regime for the exploitation of truffle-producing forests and its implications on the sustainability of this resource. Trends in harvest from 1969 to 2013 and current harvesting practices were analyzed as a case study, taking into account that Spain is a major truffle producer worldwide, but at the same time truffles have only recently been exploited. The available statistical sources, which include an increasing proportion of cultivated truffles since the mid-1990s, were explored, with estimates from Truffle Harvesters Federation showing higher consistency. Statistical sources were then compared with proxies for wild harvest (rents from truffle leases in public forests) to corroborate time trends in wild harvesting. Results suggest that black truffle production is recovering in recent years thanks to plantations, whereas wild harvest is still declining. The implications of Spanish legal and institutional framework on sustainability of wild truffle use are reviewed. In the current scenario, the decline of wild harvest is likely to continue and eventually make commercial harvesting economically unattractive, thus aggravating sustainability issues. Strengthening of property rights, rationalization of harvesting pressure, forest planning and involvement of public stakeholders are proposed as corrective measures.

  6. Previous management practices for naturally occurring radionuclide wastes: current radiological status

    International Nuclear Information System (INIS)

    Goldsmith, W.A.; Crawford, D.J.; Haywood, F.F.; Leggett, R.Q.

    1979-01-01

    Many installations used during the early days of the United States atomic energy program have been released in recent years for unrestricted private uses. These installations include lands and buildings used for the storage of radioactive wastes resulting from refining and processing of uranium and thorium. Waste management practices at these sites in the 1940's and 1950's were not conducted with today's emphasis on as-low-as-reasonably-achievable (ALARA) principles. Consequently, many of these older waste storage areas are contaminated with naturally occurring radionuclides in concentrations which are orders of magnitude greater than those found ordinarily in the earth's crust. current and potential elevated human exposures at fifteen of these sites are due primarily to radon daughters and external-gamma radiation. A wide variety of exposure conditions may be found at these sites - ranging from slightly above background to more than thirty times the guidelines recommended for the public. Remedial actions are contemplated for a number of these sites where contamination levels or radiaion exposures exceed current guidelines

  7. High- and Low-Load Resistance Training: Interpretation and Practical Application of Current Research Findings.

    Science.gov (United States)

    Fisher, James; Steele, James; Smith, Dave

    2017-03-01

    Our current state of knowledge regarding the load (lighter or heavier) lifted in resistance training programmes that will result in 'optimal' strength and hypertrophic adaptations is unclear. Despite this, position stands and recommendations are made based on, we propose, limited evidence to lift heavier weights. Here we discuss the state of evidence on the impact of load and how it, as a single variable, stimulates adaptations to take place and whether evidence for recommending heavier loads is available, well-defined, currently correctly interpreted or has been overlooked. Areas of discussion include electromyography amplitude, in vivo and in vitro methods of measuring hypertrophy, and motor schema and skill acquisition. The present piece clarifies to trainers and trainees the impact of these variables by discussing interpretation of synchronous and sequential motor unit recruitment and revisiting the size principle, poor agreement between whole-muscle cross-sectional area (CSA) and biopsy-determined changes in myofibril CSA, and neural adaptations around task specificity. Our opinion is that the practical implications of being able to self-select external load include reducing the need for specific facility memberships, motivating older persons or those who might be less confident using heavy loads, and allowing people to undertake home- or field-based resistance training intervention strategies that might ultimately improve exercise adherence.

  8. Inhaled therapies in patients with moderate COPD in clinical practice: current thinking

    Science.gov (United States)

    Ariel, Amnon; Altraja, Alan; Belevskiy, Andrey; Boros, Piotr W; Danila, Edvardas; Fležar, Matjaz; Koblizek, Vladimir; Fridlender, Zvi G; Kostov, Kosta; Krams, Alvils; Milenkovic, Branislava; Somfay, Attila; Tkacova, Ruzena; Tudoric, Neven; Ulmeanu, Ruxandra; Valipour, Arschang

    2018-01-01

    COPD is a complex, heterogeneous condition. Even in the early clinical stages, COPD carries a significant burden, with breathlessness frequently leading to a reduction in exercise capacity and changes that correlate with long-term patient outcomes and mortality. Implementation of an effective management strategy is required to reduce symptoms, preserve lung function, quality of life, and exercise capacity, and prevent exacerbations. However, current clinical practice frequently differs from published guidelines on the management of COPD. This review focuses on the current scientific evidence and expert opinion on the management of moderate COPD: the symptoms arising from moderate airflow obstruction and the burden these symptoms impose, how physical activity can improve disease outcomes, the benefits of dual bronchodilation in COPD, and the limited evidence for the benefits of inhaled corticosteroids in this disease. We emphasize the importance of maximizing bronchodilation in COPD with inhaled dual-bronchodilator treatment, enhancing patient-related outcomes, and enabling the withdrawal of inhaled corticosteroids in COPD in well-defined patient groups. PMID:29317810

  9. Robotic surgery for rectal cancer: A systematic review of current practice

    Science.gov (United States)

    Mak, Tony Wing Chung; Lee, Janet Fung Yee; Futaba, Kaori; Hon, Sophie Sok Fei; Ngo, Dennis Kwok Yu; Ng, Simon Siu Man

    2014-01-01

    AIM: To give a comprehensive review of current literature on robotic rectal cancer surgery. METHODS: A systematic review of current literature via PubMed and Embase search engines was performed to identify relevant articles from january 2007 to november 2013. The keywords used were: “robotic surgery”, “surgical robotics”, “laparoscopic computer-assisted surgery”, “colectomy” and “rectal resection”. RESULTS: After the initial screen of 380 articles, 20 papers were selected for review. A total of 1062 patients (male 64.0%) with a mean age of 61.1 years and body mass index of 24.9 kg/m2 were included in the review. Out of 1062 robotic-assisted operations, 831 (78.2%) anterior and low anterior resections, 132 (12.4%) intersphincteric resection with coloanal anastomosis, 98 (9.3%) abdominoperineal resections and 1 (0.1%) Hartmann’s operation were included in the review. Robotic rectal surgery was associated with longer operative time but with comparable oncological results and anastomotic leak rate when compared with laparoscopic rectal surgery. CONCLUSION: Robotic colorectal surgery has continued to evolve to its current state with promising results; feasible surgical option with low conversion rate and comparable short-term oncological results. The challenges faced with robotic surgery are for more high quality studies to justify its cost. PMID:24936229

  10. Evaluation of the current practices of noise-induced hearing loss (NIHL) awareness training in the South African mining industry

    CSIR Research Space (South Africa)

    Edwards, AL

    2015-01-01

    Full Text Available This study aimed to evaluate the current practices in relation to best practice criteria and make recommendations for improvements to noise-induced hearing loss (NIHL) awareness training in the South African mining industry. A survey tool based...

  11. Continuous improvement in the Netherlands: A survey-based study into the current practices of continuous improvement

    NARCIS (Netherlands)

    Middel, H.G.A.; op de Weegh, S.; Gieskes, J.F.B.; Schuring, R.W.

    2004-01-01

    Continuous Improvement is a well-known and consolidated concept in literature and practice and is considered vital in today¿s business environment. In 2003 a survey, as part of the international CINet survey, has been performed in the Netherlands in order to gain insight into the current practices

  12. A qualitative study examining methods of accessing and identifying research relevant to clinical practice among rehabilitation clinicians

    Directory of Open Access Journals (Sweden)

    Patel D

    2017-12-01

    Full Text Available Drasti Patel,1 Christine Koehmstedt,1 Rebecca Jones,1 Nathan T Coffey,1 Xinsheng Cai,2 Steven Garfinkel,2 Dahlia M Shaewitz,2 Ali A Weinstein1 1Center for Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, VA, 2American Institutes for Research, Washington, DC, USA Purpose: Research examining the utilization of evidence-based practice (EBP specifically among rehabilitation clinicians is limited. The objective of this study was to examine how various rehabilitative clinicians including physical therapists, occupational therapists, rehabilitation counselors, and physiatrists are gaining access to literature and whether they are able to implement the available research into practice.Methods: A total of 21 total clinicians were interviewed via telephone. Using NVivo, a qualitative analysis of the responses was performed.Results: There were similarities found with respect to the information-seeking behaviors and translation of research across the different clinician types. Lack of time was reported to be a barrier for both access to literature and implementation of research across all clinician types. The majority of clinicians who reported having difficulty with utilizing the published literature indicated that the literature was not applicable to their practice, the research was not specific enough to be put into practice, or the research found was too outdated to be relevant. In addition, having a supportive work environment aided in the search and utilization of research through providing resources central to assisting clinicians in gaining access to health information.Conclusion: Our study identified several barriers that affect EBP for rehabilitation clinicians. The findings suggest the need for researchers to ensure that their work is applicable and specific to clinical practice for implementation to occur. Keywords: health information, information behavior, knowledge utilization

  13. Shared Decision-Making in Oncology - A Qualitative Analysis of Healthcare Providers' Views on Current Practice.

    Science.gov (United States)

    Frerichs, Wiebke; Hahlweg, Pola; Müller, Evamaria; Adis, Christine; Scholl, Isabelle

    2016-01-01

    Despite an increased awareness of shared decision-making (SDM) and its prominent position on the health policy agenda, its implementation in routine care remains a challenge in Germany. In order to overcome this challenge, it is important to understand healthcare providers' views regarding SDM and to take their perspectives and opinions into account in the development of an implementation program. The present study aimed at exploring a) the attitudes of different healthcare providers regarding SDM in oncology and b) their experiences with treatment decisions in daily practice. A qualitative study was conducted using focus groups and individual interviews with different healthcare providers at the University Cancer Center Hamburg, Germany. Focus groups and interviews were audio-recorded, transcribed and analyzed using conventional content analysis and descriptive statistics. N = 4 focus groups with a total of N = 25 participants and N = 17 individual interviews were conducted. Attitudes regarding SDM varied greatly between the different participants, especially concerning the definition of SDM, the attitude towards the degree of patient involvement in decision-making and assumptions about when SDM should take place. Experiences on how treatment decisions are currently made varied. Negative experiences included time and structural constraints, and a lack of (multidisciplinary) communication. Positive experiences comprised informed patients, involvement of relatives and a good physician-patient relationship. The results show that German healthcare providers in oncology have a range of attitudes that currently function as barriers towards the implementation of SDM. Also, their experiences on how decision-making is currently done reveal difficulties in actively involving patients in decision-making processes. It will be crucial to take these attitudes and experiences seriously and to subsequently disentangle existing misconceptions in future implementation programs.

  14. Modeling Aerobic Carbon Source Degradation Processes using Titrimetric Data and Combined Respirometric-Titrimetric Data: Structural and Practical Identifiability

    DEFF Research Database (Denmark)

    Gernaey, Krist; Petersen, B.; Dochain, D.

    2002-01-01

    The structural and practical identifiability of a model for description of respirometric-titrimetric data derived from aerobic batch substrate degradation experiments of a CxHyOz carbon source with activated sludge was evaluated. The model processes needed to describe titrimetric data included su...... the initial substrate concentration S-S(O) is known. The values found correspond to values reported in literature, but, interestingly, also seem able to reflect the occurrence of storage processes when pulses of acetate and dextrose are added. (C) 2002 Wiley Periodicals, Inc....

  15. Service Delivery to Children With Mild Hearing Loss: Current Practice Patterns and Parent Perceptions.

    Science.gov (United States)

    Walker, Elizabeth A; Spratford, Meredith; Ambrose, Sophie E; Holte, Lenore; Oleson, Jacob

    2017-03-01

    This study investigates clinical practice patterns and parent perception of intervention for children with mild hearing loss (HL). Ages at and delays between service delivery steps (first diagnostic evaluation, confirmation of HL, hearing aid [HA] fitting, entry into early intervention) were investigated for 113 children with mild HL. Comparisons were made to children with moderate-to-severe HL. Parents of children with mild HL reported reasons for delays and their perceptions of intervention and amplification for their children. Seventy-four percent of children with mild HL were identified through the newborn hearing screen; 26% were identified later due to passing or not receiving a newborn hearing screen. Ninety-four percent of children with mild HL were fit with HAs, albeit at significantly later ages than children with moderate-to-severe HL. Most parents indicated that their children benefited from HA use, but some parents expressed ambivalence toward the amount of benefit. Audiologists appear to be moving toward regularly providing amplification for children with mild HL. However, delays in HA fittings indicate that further educating professionals and parents about the benefits of early amplification and intervention is warranted to encourage timely fitting and consistent use of HAs.

  16. Practical use of registered veterinary medicinal products in Macedonia in identifying the risk of developing of antimicrobial resistance

    Directory of Open Access Journals (Sweden)

    Velev Romel

    2013-07-01

    Full Text Available The use of antimicrobial agents is the key risk factor for the development and spread of antimicrobial resistance. It is therefore generally recognized that data on the usage of antimicrobial agents in food-producing animals are essential for identifying and quantifying the risk of developing and spreading of antimicrobial resistance in the food-chain. According to the WHO guidelines, the Anatomical Therapeutic Chemical system for the classification of veterinary medicines (ATC-vet is widely recognized as a classification tool. The aim of this work is to analyze the list of registered veterinary medicinal products in R. Macedonia and to evaluate the quality and practical use of this list according to the ATC-vet classification in order to identify the risk of developing and spreading of antimicrobial resistance.

  17. Development of the athlete sleep behavior questionnaire: A tool for identifying maladaptive sleep practices in elite athletes

    Science.gov (United States)

    Driller, Matthew W; Mah, Cheri D; Halson, Shona L

    2018-01-01

    Introduction Existing sleep questionnaires to assess sleep behaviors may not be sensitive in determining the unique sleep challenges faced by elite athletes. The purpose of the current study was to develop and validate the Athlete Sleep Behavior Questionnaire (ASBQ) to be used as a practical tool for support staff working with elite athletes. Methods 564 participants (242 athletes, 322 non-athletes) completed the 18-item ASBQ and three previously validated questionnaires; the Sleep Hygiene Index (SHI), the Epworth Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). A cohort of the studied population performed the ASBQ twice in one week to assess test-retest reliability, and also performed sleep monitoring via wrist-actigraphy. Results Comparison of the ASBQ with existing sleep questionnaires resulted in moderate to large correlations (r=0.32 - 0.69). There was a significant difference between athletes and non-athletes for the ASBQ global score (44±6 vs. 41±6, respectively, psleep time (r=-0.42). Conclusion The ASBQ is a valid and reliable tool that can differentiate the sleep practices between athletes and non-athletes, and offers a practical instrument for practitioners and/or researchers wanting to evaluate the sleep behaviors of elite athletes. The ASBQ may provide information on areas where improvements to individual athletes’ sleep habits could be made. PMID:29796200

  18. The U.S. Forest Service's analysis of cumulative effects to wildlife: A study of legal standards, current practice, and ongoing challenges on a National Forest

    International Nuclear Information System (INIS)

    Schultz, Courtney A.

    2012-01-01

    Cumulative effects analysis (CEA) allows natural resource managers to understand the status of resources in historical context, learn from past management actions, and adapt future activities accordingly. U.S. federal agencies are required to complete CEA as part of environmental impact assessment under the National Environmental Policy Act (NEPA). Past research on CEA as part of NEPA has identified significant deficiencies in CEA practice, suggested methodologies for handling difficult aspects of CEA, and analyzed the rise in litigation over CEA in U.S. courts. This article provides a review of the literature and legal standards related to CEA as it is done under NEPA and then examines current practice on a U.S. National Forest, utilizing qualitative methods in order to provide a detailed understanding of current approaches to CEA. Research objectives were to understand current practice, investigate ongoing challenges, and identify impediments to improvement. Methods included a systematic review of a set of NEPA documents and semi-structured interviews with practitioners, scientists, and members of the public. Findings indicate that the primary challenges associated with CEA include: issues of both geographic and temporal scale of analysis, confusion over the purpose of the requirement, the lack of monitoring data, and problems coordinating and disseminating data. Improved monitoring strategies and programmatic analyses could support improved CEA practice.

  19. Paediatric end-of-life care needs in Switzerland: current practices, and perspectives from parents and professionals. A study protocol.

    Science.gov (United States)

    Bergstraesser, Eva; Zimmermann, Karin; Eskola, Katri; Luck, Patricia; Ramelet, Anne-Sylvie; Cignacco, Eva

    2015-08-01

    To present a protocol for a multi-phase study about the current practice of end-of-life care in paediatric settings in Switzerland. In Switzerland, paediatric palliative care is usually provided by teams, who may not necessarily have specific training. There is a lack of systematic data about specific aspects of care at the end of a child's life, such as symptom management, involvement of parents in decision-making and family-centred care and experiences and needs of parents, and perspectives of healthcare professionals. This retrospective nationwide multicentre study, Paediatric End-of-LIfe CAre Needs in Switzerland (PELICAN), combines quantitative and qualitative methods of enquiry. The PELICAN study consists of three observational parts, PELICAN I describes practices of end-of-life care (defined as the last 4 weeks of life) in the hospital and home care setting of children (0-18 years) who died in the years 2011-2012 due to a cardiac, neurological or oncological disease, or who died in the neonatal period. PELICAN II assesses the experiences and needs of parents during the end-of-life phase of their child. PELICAN III focuses on healthcare professionals and explores their perspectives concerning the provision of end-of-life care. This first study across Switzerland will provide comprehensive insight into the current end-of-life care in children with distinct diagnoses and the perspectives of affected parents and health professionals. The results may facilitate the development and implementation of programmes for end-of-life care in children across Switzerland, building on real experiences and needs. ClinicalTrials.gov Identifier: NCT01983852. © 2015 John Wiley & Sons Ltd.

  20. Endoscopic and histological pitfalls in the diagnosis of celiac disease: a multicentre study assessing the current practice

    Directory of Open Access Journals (Sweden)

    Mohammad Rostami-Nejad

    2013-06-01

    Full Text Available Background and aims: the diagnosis of celiac disease requires small bowel biopsies to identify the characteristic mucosal changes. The current biopsy practice among endoscopists for celiac disease is in most part unknown. The aim of this study was to compare the different diagnostic policies in various centers in their current practice. Method: information from a total of 931 confirmed celiac disease patients was retrospectively obtained retrospectively from nine centers in European and Middle Eastern countries. The number of small-bowel biopsies obtained from the duodenal bulb and the second part of the duodenum was compared among different centers. Results: the most frequent stage of mucosal changes amongst Iranian subjects was Marsh IIIa whereas in the rest of the study population was Marsh IIIc. Marsh I and Marsh II were more prevalent in adults (P < 0.05 and Marsh IIIc was significantly higher in pediatric ages between 1 and 15 (P < 0.05. The most common number of biopsy specimens obtained from Romanian subjects was 1 (52% of cases, followed by 2 for Iranian (56%, 3 for Lithuanian (66.7% and British patients (65% and 4 for Italian patients (48.3%. For majority of cases, anemia was the most prevalent symptom (18.7% followed by malabsorption (10.5%, diarrhea (9.3% and dyspepsia (8.2%, respectively. Conclusions: despite the evidence-based recommendations, this study revealed a poor compliance with major guidelines on diagnosis of celiac disease. We emphasize that taking adequate number of duodenal biopsies should be implemented for an accurate diagnosis and also for the exclusion of celiac disease.

  1. Endoscopic and histological pitfalls in the diagnosis of celiac disease: A multicentre study assessing the current practice.

    Science.gov (United States)

    Rostami-Nejad, Mohammad; Villanacci, Vincenzo; Hogg-Kollars, Sabine; Volta, Umberto; Manenti, Stefania; Reza-Zali, Mohammad; Caio, Giacomo; Giovenali, Paolo; Barakauskiene, Ausrine; Kazenaite, Edita; Becheanu, Gabriel; Diculescu, Mircea; Pellegrino, Salvatore; Magazzù, Giuseppe; Casella, Giovanni; Di-Bella, Camillo; Decarli, Nicola; Biancalani, Mauro; Bassotti, Gabrio; Rostami, Kamran

    2013-07-01

    the diagnosis of celiac disease requires small bowel biopsies to identify the characteristic mucosal changes. The current biopsy practice among endoscopists for celiac disease is in most part unknown. The aim of this study was to compare the different diagnostic policies in various centers in their current practice. information from a total of 931 confirmed celiac disease patients was retrospectively obtained retrospectively from nine centers in European and Middle Eastern countries. The number of small-bowel biopsies obtained from the duodenal bulb and the second part of the duodenum was compared among different centers. the most frequent stage of mucosal changes amongst Iranian subjects was Marsh IIIa whereas in the rest of the study population was Marsh IIIc. Marsh I and Marsh II were more prevalent in adults (P < 0.05) and Marsh IIIc was significantly higher in pediatric ages between 1 and 15 (P < 0.05). The most common number of biopsy specimens obtained from Romanian subjects was 1 (52% of cases), followed by 2 for Iranian (56%), 3 for Lithuanian (66.7%) and British patients (65%) and 4 for Italian patients (48.3%). For majority of cases, anemia was the most prevalent symptom (18.7%) followed by malabsorption (10.5%), diarrhea (9.3%) and dyspepsia (8.2%), respectively. despite the evidence-based recommendations, this study revealed a poor compliance with major guidelines on diagnosis of celiac disease. We emphasize that taking adequate number of duodenal biopsies should be implemented for an accurate diagnosis and also for the exclusion of celiac disease.

  2. Review of Manganese Processing for Production of TRIP/TWIP Steels, Part 1: Current Practice and Processing Fundamentals

    Science.gov (United States)

    Elliott, R.; Coley, K.; Mostaghel, S.; Barati, M.

    2018-02-01

    The increasing demand for high-performance steel alloys has led to development of transformation-induced plasticity (TRIP) and twinning-induced plasticity (TWIP) alloys over the past three decades. These alloys offer exceptional combinations of high tensile strength and ductility. Thus, the mechanical behavior of these alloys has been a subject of significant work in recent years. However, the challenge of economically providing Mn in the quantity and purity required by these alloys has received considerably less attention. To enable commercial implementation of ultrahigh-Mn alloys, it is desirable to lower the high material costs associated with their production. Therefore, the present work reviews Mn processing routes in the context of the chemical requirements of these alloys. The aim of this review is to assess the current state of the art regarding reduction of manganese ores and provide a comprehensive reference for researchers working to mitigate material processing costs associated with Mn production. The review is presented in two parts: Part 1 introduces TRIP and TWIP alloys, current industrial practice, and pertinent thermodynamic fundamentals; Part 2 addresses available literature regarding reduction of Mn ores and oxides, and seeks to identify opportunities for future process development.

  3. Current practice patterns and knowledge among gynecologic surgeons of InterStim® programming after implantation.

    Science.gov (United States)

    Hobson, Deslyn T G; Gaskins, Jeremy T; Frazier, LaTisha; Francis, Sean L; Kinman, Casey L; Meriwether, Kate V

    2017-10-03

    The objective of this study was to describe surgeons' current practices in InterStim® programming after initial implantation and their knowledge of programming parameters. We hypothesized that surgeons performing their own reprogramming would have increased knowledge. We administered a written survey to attendees at the Society of Gynecologic Surgeons Scientific Meeting and analyzed those on which surgeons indicated they offer InterStim® care. The survey queried surgeon characteristics, experience with InterStim® implantation and programming, and clinical opinions regarding reprogramming and tested six knowledge-based questions about programming parameters. Correct response to all six questions was the primary outcome. One hundred and thirty-five of 407 (33%) attendees returned the survey, of which 99 met inclusion criteria. Most respondents (88 of 99; 89%) were between 36 and 60 years, 27 (73%) were women, 76 (77%) practiced in a university setting, and 76 (77%) were trained in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). Surgeons who had InterStim® programming training were more likely to perform their own programming [15/46 (32%) vs 6/47 (13%), p = 0.03]. Most answered all knowledge-based questions correctly (62/90, 69%); no surgeon characteristics were significantly associated with this outcome. Most surgeons cited patient comfort (71/80, 89%) and symptom relief (64/80, 80%) as important factors when reprogramming, but no prevalent themes emerged on how and why surgeons change certain programming parameters. Surgeons who had formal InterStim® programming training are more likely to perform programming themselves. No surgeon characteristic was associated with improved programming knowledge. We found that surgeons prioritize patient comfort and symptoms when deciding to reprogram.

  4. Design and analysis of group-randomized trials in cancer: A review of current practices.

    Science.gov (United States)

    Murray, David M; Pals, Sherri L; George, Stephanie M; Kuzmichev, Andrey; Lai, Gabriel Y; Lee, Jocelyn A; Myles, Ranell L; Nelson, Shakira M

    2018-06-01

    The purpose of this paper is to summarize current practices for the design and analysis of group-randomized trials involving cancer-related risk factors or outcomes and to offer recommendations to improve future trials. We searched for group-randomized trials involving cancer-related risk factors or outcomes that were published or online in peer-reviewed journals in 2011-15. During 2016-17, in Bethesda MD, we reviewed 123 articles from 76 journals to characterize their design and their methods for sample size estimation and data analysis. Only 66 (53.7%) of the articles reported appropriate methods for sample size estimation. Only 63 (51.2%) reported exclusively appropriate methods for analysis. These findings suggest that many investigators do not adequately attend to the methodological challenges inherent in group-randomized trials. These practices can lead to underpowered studies, to an inflated type 1 error rate, and to inferences that mislead readers. Investigators should work with biostatisticians or other methodologists familiar with these issues. Funders and editors should ensure careful methodological review of applications and manuscripts. Reviewers should ensure that studies are properly planned and analyzed. These steps are needed to improve the rigor and reproducibility of group-randomized trials. The Office of Disease Prevention (ODP) at the National Institutes of Health (NIH) has taken several steps to address these issues. ODP offers an online course on the design and analysis of group-randomized trials. ODP is working to increase the number of methodologists who serve on grant review panels. ODP has developed standard language for the Application Guide and the Review Criteria to draw investigators' attention to these issues. Finally, ODP has created a new Research Methods Resources website to help investigators, reviewers, and NIH staff better understand these issues. Published by Elsevier Inc.

  5. A discussion of current issues and concepts in the practice of skull-photo/craniofacial superimposition.

    Science.gov (United States)

    Gordon, G M; Steyn, M

    2016-05-01

    A recent review paper on cranio-facial superimposition (CFS) stated that "there have been specific conceptual variances" from the original methods used in the practice of skull-photo superimposition, leading to poor results as far as accuracy is concerned. It was argued that the deviations in the practice of the technique have resulted in the reduced accuracies (for both failure to include and failure to exclude) that are noted in several recent studies. This paper aims to present the results from recent research to highlight the advancement of skull-photo/cranio-facial superimposition, and to discuss some of the issues raised regarding deviations from original techniques. The evolving methodology of CFS is clarified in context with the advancement of technology, forensic science and specifically within the field of forensic anthropology. Developments in the skull-photo/cranio-facial superimposition techniques have largely focused on testing reliability and accuracy objectively. Techniques now being employed by forensic anthropologists must conform to rigorous scientific testing and methodologies. Skull-photo/cranio-facial superimposition is constantly undergoing accuracy and repeatability testing which is in line with the principles of the scientific method and additionally allows for advancement in the field. Much of the research has indicated that CFS is useful in exclusion which is consistent with the concept of Popperian falsifiability - a hypothesis and experimental design which is falsifiable. As the hypothesis is disproved or falsified, another evolves to replace it and explain the new observations. Current and future studies employing different methods to test the accuracy and reliability of skull-photo/cranio-facial superimposition will enable researchers to establish the contribution the technique can have for identification purposes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Evidence-based practice in physical therapy in Austria: current state and factors associated with EBP engagement.

    Science.gov (United States)

    Diermayr, Gudrun; Schachner, Herbert; Eidenberger, Margit; Lohkamp, Monika; Salbach, Nancy M

    2015-12-01

    Research examining the use of evidence-based practice (EBP) in physical therapy in many countries has revealed positive attitudes, varying degrees of EBP use and barriers at practitioner, patient and organizational levels. In contrast to these countries, Austria does not have an academic or research tradition in physical therapy. Engagement in EBP in countries such as Austria is unknown. The objectives of the study were to describe the current state of EBP engagement and identify factors associated with EBP engagement among Austrian physical therapists (PTs). A cross-sectional online survey was conducted. Existing questionnaires and the theory of planned behaviour guided questionnaire development. Face and content validity and ease of use of the questionnaire were evaluated in pilot tests. Item-level response frequencies and percentages were determined. Simple and multiple regressions were used to identify factors associated with EBP engagement. The final sample size was 588 (response rate: 17.5%). Ten percent of participants fully agreed that they regularly use guidelines and standardized assessment tools in clinical practice. While 49.9% reported not using electronic databases for literature searching, 41.9% reported reading research articles 2-5 times per month. Most frequently cited barriers to EBP engagement were lack of scientific skills, lack of time and insufficient organizational support. Research awareness, attitude, behavioural control, involvement in research and degree level were final correlates of EBP engagement. Austrian PTs show a low level of engagement in EBP. Initiatives to advance EBP in Austria and other countries with no academic or research tradition should primarily target practitioner-level factors. © 2015 John Wiley & Sons, Ltd.

  7. Current and Best Practices of Genetic Testing for Maturity Onset Diabetes of the Young: Views of Professional Experts

    NARCIS (Netherlands)

    van der Zwaag, A.M.; Weinreich, S.S.; Bosma, A.R.; Rigter, T.; Losekoot, M.; Henneman, L.; Cornel, M.C.

    2015-01-01

    Aims: Currently, many patients with maturity onset diabetes of the young (MODY) are undiagnosed or misdiagnosed with type 1 or 2 diabetes. This study aims to assess professional experts' views on factors which may influence the current practice of genetic testing for MODY and to explore next steps

  8. The relevance of the early history of probability theory to current risk assessment practices in mental health care.

    Science.gov (United States)

    Large, Matthew

    2013-12-01

    Probability theory is at the base of modern concepts of risk assessment in mental health. The aim of the current paper is to review the key developments in the early history of probability theory in order to enrich our understanding of current risk assessment practices.

  9. U.S. military enlisted accession mental health screening: history and current practice.

    Science.gov (United States)

    Cardona, Robert Andrew; Ritchie, Elspeth Cameron

    2007-01-01

    Through the stimulus of war and concerns about neuropsychiatric disability, the U.S. military developed methods to rapidly screen the mental health of World War I and II draftees. Intelligence testing and brief psychiatric screening expanded the accession physical examination and underwent revision to identify only gross mental health disability. Supplemental psychiatric evaluations and written psychological screening tools were abandoned after postwar assessments; they demonstrated poor predictive power in evaluating recruit service capacity for combat environments. Currently, only three mental health accession tools are used to screen applicants before their entrance into military service, namely, educational achievement, cognitive testing, and a cursory psychiatric evaluation. The Navy and Air Force use a fourth screening measure during entry-level training. Educational attainment with high school graduation has been the strongest predictor of finishing a service term. The purpose of this article is to provide both a historical review and a review of testing efforts.

  10. Designing PV Incentive Programs to Promote Performance: A Reviewof Current Practice

    Energy Technology Data Exchange (ETDEWEB)

    Barbose, Galen; Wiser, Ryan; Bolinger, Mark

    2007-06-01

    Increasing levels of financial support for customer-sited photovoltaic (PV) systems, provided through publicly-funded incentive programs, has heightened concerns about the long-term performance of these systems. Given the barriers that customers face to ensuring that their PV systems perform well, and the responsibility that PV incentive programs bear to ensure that public funds are prudently spent, these programs should, and often do, play a critical role in ensuring that PV systems receiving incentives perform well. To provide a point of reference for assessing the current state of the art, and to inform program design efforts going forward, we examine the approaches to encouraging PV system performance used by 32 prominent PV incentive programs in the U.S. We identify eight general strategies or groups of related strategies that these programs have used to address performance issues, and highlight important differences in the implementation of these strategies among programs.

  11. Perioperative management of haemophilia B: A critical appraisal of the evidence and current practices.

    Science.gov (United States)

    Neufeld, E J; Solimeno, L; Quon, D; Walsh, C; Seremetis, S; Cooper, D; Iyer, N N; Hoxer, C S; Giangrande, P

    2017-11-01

    While there is substantial literature addressing the principles of general management of haemophilia, literature on perioperative management of haemostasis is scarce. The aim of this study was to better understand perioperative management among congenital haemophilia B patients (without inhibitors) and to gain insights into real-world surgical practices. A systematic literature review, with an emphasis on haemophilia B, was conducted using EMBASE ® , Medline ® and the Cochrane Library. Studies from 1974 to June 2015 were accessed, and 132 studies were eligible for the full-study review. An international expert panel with five haematologists and one surgeon reviewed the resulting literature and provided further insights. The literature review revealed that documented experience in the perioperative management of bleeding risk in haemophilia B patients is relatively scarce. Therefore, the review was amended to provide a comprehensive overview of the perioperative management for haemophilia A and B patients; the expert panel applied a particular focus to haemophilia B. Several gaps were identified in the literature including the lack of consensus on defining surgery in terms of bleeding risk, optimal factor levels during surgery and lack of robust evidence on surgical outcomes. The ensuing discussions with the expert panel provided validation of some of the results from the systematic literature review and proposed future directions for perioperative management. Suggestions included collaboration with haemophilia treatment centres (HTCs) to collect real-world data on perioperative management, establishing the need for optimal factor level monitoring practice, and the appropriate adoption of extended half-life products in clinical settings. © 2017 John Wiley & Sons Ltd.

  12. Physician Knowledge and Attitudes About Hepatitis A and Current Practices Regarding Hepatitis A Vaccination Delivery.

    Science.gov (United States)

    Nelson, Noele P; Allison, Mandy A; Lindley, Megan C; Brtnikova, Michaela; Crane, Lori A; Beaty, Brenda L; Hurley, Laura P; Kempe, Allison

    2017-07-01

    To assess physicians': 1) knowledge and attitudes about hepatitis A disease and hepatitis A (HepA) vaccine, 2) child care and school HepA vaccine mandates, 3) practices related to HepA vaccine delivery, 4) factors associated with strongly recommending HepA vaccine to all 1- to 2-year-olds, and 5) feasibility of implementing HepA catch-up vaccination at health maintenance visits. A national survey was conducted among representative networks of pediatricians and family medicine physicians (FMs) from March to June, 2014 via e-mail or mail on the basis of provider preference. Response rates were 81% (356 of 440) among pediatricians and 75% (348 of 464) among FMs. Less than 50% correctly identified that hepatitis A virus (HAV) infection is usually asymptomatic in young children and that morbidity from HAV disease increases with age. Ninety-two percent of pediatricians and 59% of FMs strongly recommend HepA vaccine for all 1- to 2-year-olds. In addition to practice specialty, belief that HepA vaccine is required for kindergarten enrollment was the most robust predictor of strong physician recommendation. Gaps in knowledge regarding HAV infection and hepatitis A recommendations and lack of a strong recommendation for routine HepA vaccination of young children among FMs likely contribute to suboptimal coverage. Closing knowledge gaps and addressing barriers that prevent all physicians from strongly recommending HepA vaccine to 1- to 2-year-olds could help increase HepA vaccine coverage and ultimately improve population protection against HAV infection. Published by Elsevier Inc.

  13. Diagnosing acute and prevalent HIV-1 infection in young African adults seeking care for fever: a systematic review and audit of current practice.

    Science.gov (United States)

    Prins, Henrieke A B; Mugo, Peter; Wahome, Elizabeth; Mwashigadi, Grace; Thiong'o, Alexander; Smith, Adrian; Sanders, Eduard J; Graham, Susan M

    2014-06-01

    Fever is a common complaint in HIV-1 infected adults and may be a presenting sign of acute HIV-1 infection (AHI). We investigated the extent to which HIV-1 infection was considered in the diagnostic evaluation of febrile adults in sub-Saharan Africa (SSA) through a systematic review of published literature and guidelines in the period 2003-2014. We also performed a detailed audit of current practice for the evaluation of febrile young adults in coastal Kenya. Our review identified 43 studies investigating the aetiology of fever in adult outpatients in SSA. While the guidelines identified recommend testing for HIV-1 infection, none mentioned AHI. In our audit of current practice at nine health facilities, only 189 out of 1173 (16.1%) patients, aged 18-29 years, were tested for HIV-1. In a detailed record review, only 2 out of 39 (5.1%) young adults seeking care for fever were tested for HIV-1, and the possibility of AHI was not mentioned. Available literature on adult outpatients presenting with fever is heavily focused on diagnosing malaria and guidelines are poorly defined in terms of evaluating aetiologies other than malaria. Current practice in coastal Kenya shows poor uptake of provider-initiated HIV-1 testing and AHI is not currently considered in the differential diagnosis. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

  14. Identifying organisational principles and management practices important to the quality of health care services for chronic conditions.

    Science.gov (United States)

    Frølich, Anne

    2012-02-01

    The quality of health care services offered to people suffering from chronic diseases often fails to meet standards in Denmark or internationally. The population consisting of people with chronic diseases is large and accounts for about 70% of total health care expenses. Given that resources are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisational methods and principles. Kaiser Permanente (KP), an integrated health care delivery system in the U.S., is recognized as providing high-quality chronic care; to some extent, this is due to KP's implementation of the chronic care model (CCM). This model recommends a range of evidence-based management practices that support the implementation of evidence-based medicine. However, it is not clear which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved. The aim of this dissertation is to describe the effect of determinants, such as organisational structures and management practices including two selected incentives, on the quality of care in chronic diseases. The dissertation is based on four studies with the following purposes: 1) macro- or healthcare system-level identification of organisational structures and principles that affect the quality of health care services, based on a comparison of KP and the Danish health care system; 2) meso- or organisation-level identification of management practices with positive effects on screening rates for hemoglobin A1c and lipid profile in diabetes; 3) evaluation of the effect of the CCM on quality of health care services and continuity of care in a Danish setting; 4) micro- or practice-level evaluation of the

  15. Family medicine practice in Saudi Arabia: The current situation and Proposed Strategic Directions Plan 2020.

    Science.gov (United States)

    Al-Khaldi, Yahia M; Al-Ghamdi, Essam A; Al-Mogbil, Tariq I; Al-Khashan, Hesham I

    2017-01-01

    The objectives of this study were to assess the current situation of the teaching and training of undergraduate and postgraduate programs in family medicine in KSA, assess the current practice of family medicine, and draw a roadmap to achieve Saudi vision 2020. This study was conducted with the support and collaboration of the Primary Health Care Department of the Ministry of Health, Saudi Arabia, and World Health Organization (EMRO) in November 2015. Based on the literature review of previous studies conducted for similar purposes, relevant questionnaires were developed. These consisted of four forms, each of which was directed at a different authority to achieve the above-mentioned objectives. Data of all questionnaires were coded, entered, and analyzed using SPSS version 16. There are 2282 primary health-care centers (PHCCs), 60% of which are in rural areas. More than half of the PHCCs have a laboratory and more than one-third have a Radiology Department. Out of the 6107 physicians, 636 are family physicians (10%). All medical colleges have a family medicine department with a total staff of 170 medical teachers. Thirteen departments run family medicine courses of 4-8 weeks' duration for students. Fourteen colleges have internship programs in family medicine and four colleges have postgraduate centers for family medicine (27%). There are 95 training centers for Saudi Board (Saudi Board of Family Medicine [SBFM]) and 68 centers for Saudi Diploma (Saudi Diploma of Family Medicine [SDFM]). The total number of trainers was 241, while the total trainees were 756 in SBFM and 137 in SDFM. This survey showed that there is a shortage of qualified family physicians in all health sectors in Saudi Arabia as a result of the lack of a strategic plan for the training of family physicians. A national strategic plan with specific objectives and an explicit budget are necessary to deal with this shortage and improve the quality of health-care services at PHCCs.

  16. Current evidence does not support the use of Kinesio Taping in clinical practice: a systematic review

    Directory of Open Access Journals (Sweden)

    Patrícia do Carmo Silva Parreira

    2014-03-01

    Full Text Available Questions: Is Kinesio Taping more effective than a sham taping/placebo, no treatment or other interventions in people with musculoskeletal conditions? Is the addition of Kinesio Taping to other interventions more effective than other interventions alone in people with musculoskeletal conditions? Design: Systematic review of randomised trials. Participants: People with musculoskeletal conditions. Intervention: Kinesio Taping was compared with sham taping/placebo, no treatment, exercises, manual therapy and conventional physiotherapy. Outcome measures: Pain intensity, disability, quality of life, return to work, and global impression of recovery. Results: Twelve randomised trials involving 495 participants were included in the review. The effectiveness of the Kinesio Taping was tested in participants with: shoulder pain in two trials; knee pain in three trials; chronic low back pain in two trials; neck pain in three trials; plantar fasciitis in one trial; and multiple musculoskeletal conditions in one trial. The methodological quality of eligible trials was moderate, with a mean of 6.1 points on the 10-point PEDro Scale score. Overall, Kinesio Taping was no better than sham taping/placebo and active comparison groups. In all comparisons where Kinesio Taping was better than an active or a sham control group, the effect sizes were small and probably not clinically significant or the trials were of low quality. Conclusion: This review provides the most updated evidence on the effectiveness of the Kinesio Taping for musculoskeletal conditions. The current evidence does not support the use of this intervention in these clinical populations. PROSPERO registration: CRD42012003436. [Parreira PdCS, Costa LdCM, Hespanhol Junior LC, Lopes AD, Costa LOP (2014 Current evidence does not support the use of Kinesio Taping in clinical practice: a systematic review. Journal of Physiotherapy 60: 31–39

  17. Current good manufacturing practice production of an oncolytic recombinant vesicular stomatitis viral vector for cancer treatment.

    Science.gov (United States)

    Ausubel, L J; Meseck, M; Derecho, I; Lopez, P; Knoblauch, C; McMahon, R; Anderson, J; Dunphy, N; Quezada, V; Khan, R; Huang, P; Dang, W; Luo, M; Hsu, D; Woo, S L C; Couture, L

    2011-04-01

    Vesicular stomatitis virus (VSV) is an oncolytic virus currently being investigated as a promising tool to treat cancer because of its ability to selectively replicate in cancer cells. To enhance the oncolytic property of the nonpathologic laboratory strain of VSV, we generated a recombinant vector [rVSV(MΔ51)-M3] expressing murine gammaherpesvirus M3, a secreted viral chemokine-binding protein that binds to a broad range of mammalian chemokines with high affinity. As previously reported, when rVSV(MΔ51)-M3 was used in an orthotopic model of hepatocellular carcinoma (HCC) in rats, it suppressed inflammatory cell migration to the virus-infected tumor site, which allowed for enhanced intratumoral virus replication leading to increased tumor necrosis and substantially prolonged survival. These encouraging results led to the development of this vector for clinical translation in patients with HCC. However, a scalable current Good Manufacturing Practice (cGMP)-compliant manufacturing process has not been described for this vector. To produce the quantities of high-titer virus required for clinical trials, a process that is amenable to GMP manufacturing and scale-up was developed. We describe here a large-scale (50-liter) vector production process capable of achieving crude titers on the order of 10(9) plaque-forming units (PFU)/ml under cGMP. This process was used to generate a master virus seed stock and a clinical lot of the clinical trial agent under cGMP with an infectious viral titer of approximately 2 × 10(10) PFU/ml (total yield, 1 × 10(13) PFU). The lot has passed all U.S. Food and Drug Administration-mandated release testing and will be used in a phase 1 clinical translational trial in patients with advanced HCC.

  18. Current strategies in the farm practices and post-harvest pesticidal defence

    Directory of Open Access Journals (Sweden)

    Luciano Suss

    2008-04-01

    Full Text Available Today, people often talk about biologic agriculture and Integrated Production (IP, even if the real meaning of these terms is altered. In both cases, they deal with production methods characterized by a particular attention to the reduction of the environmental impact of all the farm practices used, especially for defence from adversities, being the element of major concern for environment and consumers’ health.Farm practice evolution, especially those about pest defence, is based on important conceptual change, accurate scientific analysis and organization of technical assistance, rationalization of agri-pharmaceutical product use is one of the main objective of Integrated Production Specifications (IPS. The quantitative reduction is the first objective, obtained by various means such as the use of efficient equipment and the qualitative selection based on the priority use of minor impact means, effectiveness being equal. At post-harvest, the anti-parasitary defence is undergoing deep changes in our country. Once, pesticides very toxic and persistent were used; however, in the last years the availability of active principles (a.p. usable on foodstuffs or in productive environments; for instance, methyl bromide use has been progressively reduced till its banishment because it is recognized to damage the ozone layer. Thus, on the whole we can talk about “integrated pest management” even for the post-harvest sector. However, substantial differences exist between agriculture and post-harvest, thus the integrated pest management in food production environment has to be designed in a different way. The fundamental element of this technique is to identify a tolerance threshold to pest attack but for the defence of food industries and stored foodstuffs is very difficult, if not impossible, to fix a limit to insect presence after which intervening is compulsory. Monitoring of pest attacks and the implementation of prevention practices is

  19. Factors in Sustainable Development: Current and Innovative Livestock and Range Management Practices as Perceived by Cattle-Producing Ejidatarios and Private Cattle Ranchers of Sonora, Mexico. A Summary Report of Research. Department Information Bulletin 99-4.

    Science.gov (United States)

    Hamlett, Peggy J.

    A study was conducted to identify and compare livestock production and range management practices currently in use in the Texas/Mexico border corridor, and to determine the acceptance of selected innovative practices among cattle ranchers in the State of Sonora, Mexico. Information was collected from private livestock producers who were members of…

  20. On the Need for Rethinking Current Practice that Highlights Goal Achievement Risk in an Enterprise Context.

    Science.gov (United States)

    Aven, Eyvind; Aven, Terje

    2015-09-01

    This article addresses the issue of how performance and risk management can complement each other in order to enhance the management of an enterprise. Often, we see that risk management focuses on goal achievements and not the enterprise risk related to its activities in the value chain. The statement "no goal, no risk" is a common misconception. The main aim of the article is to present a normative model for describing the links between performance and risk, and to use this model to give recommendations on how to best structure and plan the management of an enterprise in situations involving risk and uncertainties. The model, which has several novel features, is based on the interaction between different types of risk management (enterprise risk management, task risk management, and personal risk management) and a structure where the enterprise risk management overrules both the task and personal risk management. To illustrate the model we use the metaphor of a ship, where the ship is loaded with cash-generating activities and has a direction over time determined by the overall strategic objectives. Compared to the current enterprise risk management practice, the model and related analysis are founded on a new perspective on risk, highlighting knowledge and uncertainties beyond probabilities. © 2015 Society for Risk Analysis.

  1. Current contraceptive management in Australian general practice: an analysis of BEACH data.

    Science.gov (United States)

    Mazza, Danielle; Harrison, Christopher; Taft, Angela; Brijnath, Bianca; Britt, Helena; Hobbs, Melissa; Stewart, Kay; Hussainy, Safeera

    2012-07-16

    To determine current contraceptive management by general practitioners in Australia. Analysis of data from a random sample of 3910 Australian GPs who participated in the Bettering the Evaluation and Care of Health (BEACH) survey, a continuous cross-sectional survey of GP activity, between April 2007 and March 2011. Consultations with female patients aged 12-54 years that involved all forms of contraception were analysed. GP and patient characteristics associated with the management of contraception; types of contraception used; rates of encounters involving emergency contraception. Increased age, ethnicity, Indigenous status and holding a Commonwealth Health Care Card were significantly associated with low rates of encounters involving management of contraception. The combined oral contraceptive pill was the most frequently prescribed method of contraception, with moderate prescription of long-acting reversible contraception (LARC), especially among women aged 34-54 years. Rates of consultations concerned with emergency contraception were low, but involved high rates of counselling, advice or education (48%) compared with encounters for general contraception (> 20%). A shift towards prescribing LARC, as recommended in clinical guidelines, has yet to occur in Australian general practice. Better understanding of patient and GP perspectives on contraceptive choices could lead to more effective contraceptive use.

  2. Current End-of-Life Care Needs and Care Practices in Acute Care Hospitals

    Directory of Open Access Journals (Sweden)

    Amy J. Thurston

    2011-01-01

    Full Text Available A descriptive-comparative study was undertaken to examine current end-of-life care needs and practices in hospital. A chart review for all 1,018 persons who died from August 1, 2008 through July 31, 2009 in two full-service Canadian hospitals was conducted. Most decedents were elderly (73.8% and urbanite (79.5%, and cancer was the most common diagnosis (36.2%. Only 13.8% had CPR performed at some point during this hospitalization and 8.8% had CPR immediately preceding death, with 87.5% having a DNR order and 30.8% providing an advance directive. Most (97.3% had one or more life-sustaining technologies in use at the time of death. These figures indicate, when compared to those in a similar mid-1990s Canadian study, that impending death is more often openly recognized and addressed. Technologies continue to be routinely but controversially used. The increased rate of end-stage CPR from 2.9% to 8.8% could reflect a 1994+ shift of expected deaths out of hospital.

  3. Current practices for maintaining occupational exposures ALARA at low-level waste disposal sites

    International Nuclear Information System (INIS)

    Hadlock, D.E.; Herrington, W.N.; Hooker, C.D.; Murphy, D.W.; Gilchrist, R.L.

    1983-12-01

    The United States Nuclear Regulatory Commission contracted with Pacific Northwest Laboratory (PNL) to provide technical assistance in establishing operational guidelines, with respect to radiation control programs and methods of minimizing occupational radiation exposure, at Low-Level Waste (LLW) disposal sites. The PNL, through site visits, evaluated operations at LLW disposal sites to determine the adequacy of current practices in maintaining occupational exposures as low as is reasonably achievable (ALARA). The data sought included th