Sample records for patients analytic reasoning
-
Analytical reasoning task reveals limits of social learning in networks.
Rahwan, Iyad; Krasnoshtan, Dmytro; Shariff, Azim; Bonnefon, Jean-François
2014-04-06
Social learning-by observing and copying others-is a highly successful cultural mechanism for adaptation, outperforming individual information acquisition and experience. Here, we investigate social learning in the context of the uniquely human capacity for reflective, analytical reasoning. A hallmark of the human mind is its ability to engage analytical reasoning, and suppress false associative intuitions. Through a set of laboratory-based network experiments, we find that social learning fails to propagate this cognitive strategy. When people make false intuitive conclusions and are exposed to the analytic output of their peers, they recognize and adopt this correct output. But they fail to engage analytical reasoning in similar subsequent tasks. Thus, humans exhibit an 'unreflective copying bias', which limits their social learning to the output, rather than the process, of their peers' reasoning-even when doing so requires minimal effort and no technical skill. In contrast to much recent work on observation-based social learning, which emphasizes the propagation of successful behaviour through copying, our findings identify a limit on the power of social networks in situations that require analytical reasoning.
-
The heuristic-analytic theory of reasoning: extension and evaluation.
Evans, Jonathan St B T
2006-06-01
An extensively revised heuristic-analytic theory of reasoning is presented incorporating three principles of hypothetical thinking. The theory assumes that reasoning and judgment are facilitated by the formation of epistemic mental models that are generated one at a time (singularity principle) by preconscious heuristic processes that contextualize problems in such a way as to maximize relevance to current goals (relevance principle). Analytic processes evaluate these models but tend to accept them unless there is good reason to reject them (satisficing principle). At a minimum, analytic processing of models is required so as to generate inferences or judgments relevant to the task instructions, but more active intervention may result in modification or replacement of default models generated by the heuristic system. Evidence for this theory is provided by a review of a wide range of literature on thinking and reasoning.
-
Semantic Interaction for Sensemaking: Inferring Analytical Reasoning for Model Steering.
Endert, A; Fiaux, P; North, C
2012-12-01
Visual analytic tools aim to support the cognitively demanding task of sensemaking. Their success often depends on the ability to leverage capabilities of mathematical models, visualization, and human intuition through flexible, usable, and expressive interactions. Spatially clustering data is one effective metaphor for users to explore similarity and relationships between information, adjusting the weighting of dimensions or characteristics of the dataset to observe the change in the spatial layout. Semantic interaction is an approach to user interaction in such spatializations that couples these parametric modifications of the clustering model with users' analytic operations on the data (e.g., direct document movement in the spatialization, highlighting text, search, etc.). In this paper, we present results of a user study exploring the ability of semantic interaction in a visual analytic prototype, ForceSPIRE, to support sensemaking. We found that semantic interaction captures the analytical reasoning of the user through keyword weighting, and aids the user in co-creating a spatialization based on the user's reasoning and intuition.
-
Transforming Undergraduate Education Through the use of Analytical Reasoning (TUETAR)
Bishop, M. P.; Houser, C.; Lemmons, K.
2015-12-01
Traditional learning limits the potential for self-discovery, and the use of data and knowledge to understand Earth system relationships, processes, feedback mechanisms and system coupling. It is extremely difficult for undergraduate students to analyze, synthesize, and integrate quantitative information related to complex systems, as many concepts may not be mathematically tractable or yet to be formalized. Conceptual models have long served as a means for Earth scientists to organize their understanding of Earth's dynamics, and have served as a basis for human analytical reasoning and landscape interpretation. Consequently, we evaluated the use of conceptual modeling, knowledge representation and analytical reasoning to provide undergraduate students with an opportunity to develop and test geocomputational conceptual models based upon their understanding of Earth science concepts. This study describes the use of geospatial technologies and fuzzy cognitive maps to predict desertification across the South-Texas Sandsheet in an upper-level geomorphology course. Students developed conceptual models based on their understanding of aeolian processes from lectures, and then compared and evaluated their modeling results against an expert conceptual model and spatial predictions, and the observed distribution of dune activity in 2010. Students perceived that the analytical reasoning approach was significantly better for understanding desertification compared to traditional lecture, and promoted reflective learning, working with data, teamwork, student interaction, innovation, and creative thinking. Student evaluations support the notion that the adoption of knowledge representation and analytical reasoning in the classroom has the potential to transform undergraduate education by enabling students to formalize and test their conceptual understanding of Earth science. A model for developing and utilizing this geospatial technology approach in Earth science is presented.
-
The role of clinician emotion in clinical reasoning: Balancing the analytical process.
Langridge, Neil; Roberts, Lisa; Pope, Catherine
2016-02-01
This review paper identifies and describes the role of clinicians' memory, emotions and physical responses in clinical reasoning processes. Clinical reasoning is complex and multi-factorial and key models of clinical reasoning within musculoskeletal physiotherapy are discussed, highlighting the omission of emotion and subsequent physical responses and how these can impact upon a clinician when making a decision. It is proposed that clinicians should consider the emotions associated with decision-making, especially when there is concern surrounding a presentation. Reflecting on practice in the clinical environment and subsequently applying this to a patient presentation should involve some acknowledgement of clinicians' physical responses, emotions and how they may play a part in any decision made. Presenting intuition and gut-feeling as separate reasoning methods and how these processes co-exist with other more accepted reasoning such as hypothetico-deductive is also discussed. Musculoskeletal physiotherapy should consider the elements of feelings, emotions and physical responses when applying reflective practice principles. Furthermore, clinicians dealing with difficult and challenging presentations should look at the emotional as well as the analytical experience when justifying decisions and learning from practice. Copyright © 2015 Elsevier Ltd. All rights reserved.
-
Analytic and Heuristic Processing Influences on Adolescent Reasoning and Decision-Making.
Klaczynski, Paul A.
2001-01-01
Examined the relationship between age and the normative/descriptive gap--the discrepancy between actual reasoning and traditional standards for reasoning. Found that middle adolescents performed closer to normative ideals than early adolescents. Factor analyses suggested that performance was based on two processing systems, analytic and heuristic…
-
Analytic and heuristic processing influences on adolescent reasoning and decision-making.
Klaczynski, P A
2001-01-01
The normative/descriptive gap is the discrepancy between actual reasoning and traditional standards for reasoning. The relationship between age and the normative/descriptive gap was examined by presenting adolescents with a battery of reasoning and decision-making tasks. Middle adolescents (N = 76) performed closer to normative ideals than early adolescents (N = 66), although the normative/descriptive gap was large for both groups. Correlational analyses revealed that (1) normative responses correlated positively with each other, (2) nonnormative responses were positively interrelated, and (3) normative and nonnormative responses were largely independent. Factor analyses suggested that performance was based on two processing systems. The "analytic" system operates on "decontextualized" task representations and underlies conscious, computational reasoning. The "heuristic" system operates on "contextualized," content-laden representations and produces "cognitively cheap" responses that sometimes conflict with traditional norms. Analytic processing was more clearly linked to age and to intelligence than heuristic processing. Implications for cognitive development, the competence/performance issue, and rationality are discussed.
-
Vaitsis, Christos; Nilsson, Gunnar; Zary, Nabil
2015-01-01
The medical curriculum is the main tool representing the entire undergraduate medical education. Due to its complexity and multilayered structure it is of limited use to teachers in medical education for quality improvement purposes. In this study we evaluated three visualizations of curriculum data from a pilot course, using teachers from an undergraduate medical program and applying visual analytics methods. We found that visual analytics can be used to positively impacting analytical reasoning and decision making in medical education through the realization of variables capable to enhance human perception and cognition on complex curriculum data. The positive results derived from our evaluation of a medical curriculum and in a small scale, signify the need to expand this method to an entire medical curriculum. As our approach sustains low levels of complexity it opens a new promising direction in medical education informatics research.
-
Chen, Zhencai; De Beuckelaer, Alain; Wang, Xu; Liu, Jia
2017-11-24
Recent studies revealed spontaneous neural activity to be associated with fluid intelligence (gF) which is commonly assessed by Raven's Advanced Progressive Matrices, and embeds two types of reasoning: visuospatial and verbal-analytic reasoning. With resting-state fMRI data, using global brain connectivity (GBC) analysis which averages functional connectivity of a voxel in relation to all other voxels in the brain, distinct neural correlates of these two reasoning types were found. For visuospatial reasoning, negative correlations were observed in both the primary visual cortex (PVC) and the precuneus, and positive correlations were observed in the temporal lobe. For verbal-analytic reasoning, negative correlations were observed in the right inferior frontal gyrus (rIFG), dorsal anterior cingulate cortex and temporoparietal junction, and positive correlations were observed in the angular gyrus. Furthermore, an interaction between GBC value and type of reasoning was found in the PVC, rIFG and the temporal lobe. These findings suggest that visuospatial reasoning benefits more from elaborate perception to stimulus features, whereas verbal-analytic reasoning benefits more from feature integration and hypothesis testing. In sum, the present study offers, for different types of reasoning in gF, first empirical evidence of separate neural substrates in the resting brain.
-
Conditional Reasoning in Schizophrenic Patients.
Kornreich, Charles; Delle-Vigne, Dyna; Brevers, Damien; Tecco, Juan; Campanella, Salvatore; Noël, Xavier; Verbanck, Paul; Ermer, Elsa
2017-01-01
Conditional reasoning (if p then q) is used very frequently in everyday situations. Conditional reasoning is impaired in brain-lesion patients, psychopathy, alcoholism, and polydrug dependence. Many neurocognitive deficits have also been described in schizophrenia. We assessed conditional reasoning in 25 patients with schizophrenia, 25 depressive patients, and 25 controls, using the Wason selection task in three different domains: social contracts, precautionary rules, and descriptive rules. Control measures included depression, anxiety, and severity of schizophrenia measures as a Verbal Intelligence Scale. Patients with schizophrenia were significantly impaired on all conditional reasoning tasks compared to depressives and controls. However, the social contract and precautions tasks yielded better results than the descriptive tasks. Differences between groups disappeared for social contract but remained for precautions and descriptive tasks when verbal intelligence was used as a covariate. These results suggest that domain-specific reasoning mechanisms, proposed by evolutionary psychologists, are relatively resilient in the face of brain network disruptions that impair more general reasoning abilities. Nevertheless, patients with schizophrenia could encounter difficulties understanding precaution rules and social contracts in real-life situations resulting in unwise risk-taking and misunderstandings in the social world.
-
Negations in syllogistic reasoning: evidence for a heuristic-analytic conflict.
Stupple, Edward J N; Waterhouse, Eleanor F
2009-08-01
An experiment utilizing response time measures was conducted to test dominant processing strategies in syllogistic reasoning with the expanded quantifier set proposed by Roberts (2005). Through adding negations to existing quantifiers it is possible to change problem surface features without altering logical validity. Biases based on surface features such as atmosphere, matching, and the probability heuristics model (PHM; Chater & Oaksford, 1999; Wetherick & Gilhooly, 1995) would not be expected to show variance in response latencies, but participant responses should be highly sensitive to changes in the surface features of the quantifiers. In contrast, according to analytic accounts such as mental models theory and mental logic (e.g., Johnson-Laird & Byrne, 1991; Rips, 1994) participants should exhibit increased response times for negated premises, but not be overly impacted upon by the surface features of the conclusion. Data indicated that the dominant response strategy was based on a matching heuristic, but also provided evidence of a resource-demanding analytic procedure for dealing with double negatives. The authors propose that dual-process theories offer a stronger account of these data whereby participants employ competing heuristic and analytic strategies and fall back on a heuristic response when analytic processing fails.
-
Directory of Open Access Journals (Sweden)
Mila Kryjevskaia
2014-07-01
Full Text Available We have applied the heuristic-analytic theory of reasoning to interpret inconsistencies in student reasoning approaches to physics problems. This study was motivated by an emerging body of evidence that suggests that student conceptual and reasoning competence demonstrated on one task often fails to be exhibited on another. Indeed, even after instruction specifically designed to address student conceptual and reasoning difficulties identified by rigorous research, many undergraduate physics students fail to build reasoning chains from fundamental principles even though they possess the required knowledge and skills to do so. Instead, they often rely on a variety of intuitive reasoning strategies. In this study, we developed and employed a methodology that allowed for the disentanglement of student conceptual understanding and reasoning approaches through the use of sequences of related questions. We have shown that the heuristic-analytic theory of reasoning can be used to account for, in a mechanistic fashion, the observed inconsistencies in student responses. In particular, we found that students tended to apply their correct ideas in a selective manner that supported a specific and likely anticipated conclusion while neglecting to employ the same ideas to refute an erroneous intuitive conclusion. The observed reasoning patterns were consistent with the heuristic-analytic theory, according to which reasoners develop a “first-impression” mental model and then construct an argument in support of the answer suggested by this model. We discuss implications for instruction and argue that efforts to improve student metacognition, which serves to regulate the interaction between intuitive and analytical reasoning, is likely to lead to improved student reasoning.
-
Teaching Complex Concepts in the Geosciences by Integrating Analytical Reasoning with GIS
Houser, Chris; Bishop, Michael P.; Lemmons, Kelly
2017-01-01
Conceptual models have long served as a means for physical geographers to organize their understanding of feedback mechanisms and complex systems. Analytical reasoning provides undergraduate students with an opportunity to develop conceptual models based upon their understanding of surface processes and environmental conditions. This study…
-
Chen, Zhencai; De Beuckelaer, A.; Wang, Xu; Liu, Jia
2017-01-01
Recent studies revealed spontaneous neural activity to be associated with fluid intelligence (gF) which is commonly assessed by Raven’s Advanced Progressive Matrices, and embeds two types of reasoning: visuospatial and verbal-analytic reasoning. With resting-state fMRI data, using global brain
-
De Neys, Wim
2006-06-01
Human reasoning has been shown to overly rely on intuitive, heuristic processing instead of a more demanding analytic inference process. Four experiments tested the central claim of current dual-process theories that analytic operations involve time-consuming executive processing whereas the heuristic system would operate automatically. Participants solved conjunction fallacy problems and indicative and deontic selection tasks. Experiment 1 established that making correct analytic inferences demanded more processing time than did making heuristic inferences. Experiment 2 showed that burdening the executive resources with an attention-demanding secondary task decreased correct, analytic responding and boosted the rate of conjunction fallacies and indicative matching card selections. Results were replicated in Experiments 3 and 4 with a different secondary-task procedure. Involvement of executive resources for the deontic selection task was less clear. Findings validate basic processing assumptions of the dual-process framework and complete the correlational research programme of K. E. Stanovich and R. F. West (2000).
-
A Clinical Reasoning Tool for Virtual Patients: Design-Based Research Study.
Hege, Inga; Kononowicz, Andrzej A; Adler, Martin
2017-11-02
Clinical reasoning is a fundamental process medical students have to learn during and after medical school. Virtual patients (VP) are a technology-enhanced learning method to teach clinical reasoning. However, VP systems do not exploit their full potential concerning the clinical reasoning process; for example, most systems focus on the outcome and less on the process of clinical reasoning. Keeping our concept grounded in a former qualitative study, we aimed to design and implement a tool to enhance VPs with activities and feedback, which specifically foster the acquisition of clinical reasoning skills. We designed the tool by translating elements of a conceptual clinical reasoning learning framework into software requirements. The resulting clinical reasoning tool enables learners to build their patient's illness script as a concept map when they are working on a VP scenario. The student's map is compared with the experts' reasoning at each stage of the VP, which is technically enabled by using Medical Subject Headings, which is a comprehensive controlled vocabulary published by the US National Library of Medicine. The tool is implemented using Web technologies, has an open architecture that enables its integration into various systems through an open application program interface, and is available under a Massachusetts Institute of Technology license. We conducted usability tests following a think-aloud protocol and a pilot field study with maps created by 64 medical students. The results show that learners interact with the tool but create less nodes and connections in the concept map than an expert. Further research and usability tests are required to analyze the reasons. The presented tool is a versatile, systematically developed software component that specifically supports the clinical reasoning skills acquisition. It can be plugged into VP systems or used as stand-alone software in other teaching scenarios. The modular design allows an extension with new
-
Blumenthal, J A
1998-02-01
Courts and legislatures have begun to develop the "reasonable woman standard" (RWS) as a criterion for deciding sexual harassment trials. This standard rests on assumptions of a "wide divergence" between the perceptions of men and women when viewing social-sexual behavior that may be considered harassing. Narrative reviews of the literature on such perceptions have suggested that these assumptions are only minimally supported. To test these assumptions quantitatively, a meta-analytic review was conducted that assessed the size, stability, and moderators of gender differences in perceptions of sexual harassment. The effect of the actor's status relative to the target also was evaluated meta-analytically, as one alternative to the importance of gender effects. Results supported the claims of narrative reviews for a relatively small gender effect, and draw attention to the status effect. In discussing legal implications of the present findings, earlier claims are echoed suggesting caution in establishing the reasonable woman standard, and one alternative to the RWS, the "reasonable victim standard," is discussed.
-
Case-based clinical reasoning in feline medicine: 1: Intuitive and analytical systems.
Canfield, Paul J; Whitehead, Martin L; Johnson, Robert; O'Brien, Carolyn R; Malik, Richard
2016-01-01
This is Article 1 of a three-part series on clinical reasoning that encourages practitioners to explore and understand how they think and make case-based decisions. It is hoped that, in the process, they will learn to trust their intuition but, at the same time, put in place safeguards to diminish the impact of bias and misguided logic on their diagnostic decision-making. This first article discusses the relative merits and shortcomings of System 1 thinking (immediate and unconscious) and System 2 thinking (effortful and analytical). Articles 2 and 3, to appear in the March and May 2016 issues of JFMS, respectively, will examine managing cognitive error, and use of heuristics (mental short cuts) and illness scripts in diagnostic reasoning. © The Author(s) 2016.
-
Kryjevskaia, Mila; Stetzer, MacKenzie R.; Grosz, Nathaniel
2014-01-01
We have applied the heuristic-analytic theory of reasoning to interpret inconsistencies in student reasoning approaches to physics problems. This study was motivated by an emerging body of evidence that suggests that student conceptual and reasoning competence demonstrated on one task often fails to be exhibited on another. Indeed, even after…
-
Mujiasih; Waluya, S. B.; Kartono; Mariani
2018-03-01
Skills in working on the geometry problems great needs of the competence of Geometric Reasoning. As a teacher candidate, State Islamic University (UIN) students need to have the competence of this Geometric Reasoning. When the geometric reasoning in solving of geometry problems has grown well, it is expected the students are able to write their ideas to be communicative for the reader. The ability of a student's mathematical communication is supposed to be used as a marker of the growth of their Geometric Reasoning. Thus, the search for the growth of geometric reasoning in solving of analytic geometry problems will be characterized by the growth of mathematical communication abilities whose work is complete, correct and sequential, especially in writing. Preceded with qualitative research, this article was the result of a study that explores the problem: Was the search for the growth of geometric reasoning in solving analytic geometry problems could be characterized by the growth of mathematical communication abilities? The main activities in this research were done through a series of activities: (1) Lecturer trains the students to work on analytic geometry problems that were not routine and algorithmic process but many problems that the process requires high reasoning and divergent/open ended. (2) Students were asked to do the problems independently, in detail, complete, order, and correct. (3) Student answers were then corrected each its stage. (4) Then taken 6 students as the subject of this research. (5) Research subjects were interviewed and researchers conducted triangulation. The results of this research, (1) Mathematics Education student of UIN Semarang, had adequate the mathematical communication ability, (2) the ability of this mathematical communication, could be a marker of the geometric reasoning in solving of problems, and (3) the geometric reasoning of UIN students had grown in a category that tends to be good.
-
Mila Kryjevskaia; MacKenzie R. Stetzer; Nathaniel Grosz
2014-01-01
We have applied the heuristic-analytic theory of reasoning to interpret inconsistencies in student reasoning approaches to physics problems. This study was motivated by an emerging body of evidence that suggests that student conceptual and reasoning competence demonstrated on one task often fails to be exhibited on another. Indeed, even after instruction specifically designed to address student conceptual and reasoning difficulties identified by rigorous research, many undergraduate physics s...
-
Inductive Reasoning in Patients with Paranoid Type Schizophrenia
Mehmet Emrah Karadere; Yasir Safak; Halime Seyma Ozcelik; Emre Demir; Mehmet Hakan Turkcapar
2017-01-01
The goal of our study is to evaluate the decision making and reasoning of the paranoid type schizophrenic patients, and their confidence in reasoning and perseverance in keeping to their decisions via using Reasoning with Inductive Argument Test (RIAT). Thirty-two delusional patients and 30 healthy volunteers were included in the study. After the diagnostic interview was conducted by SCID-I to the patients who were asked to participate in the study, RIAT test was applied by the interviewe...
-
Heuristic and analytic processes in reasoning: an event-related potential study of belief bias.
Banks, Adrian P; Hope, Christopher
2014-03-01
Human reasoning involves both heuristic and analytic processes. This study of belief bias in relational reasoning investigated whether the two processes occur serially or in parallel. Participants evaluated the validity of problems in which the conclusions were either logically valid or invalid and either believable or unbelievable. Problems in which the conclusions presented a conflict between the logically valid response and the believable response elicited a more positive P3 than problems in which there was no conflict. This shows that P3 is influenced by the interaction of belief and logic rather than either of these factors on its own. These findings indicate that belief and logic influence reasoning at the same time, supporting models in which belief-based and logical evaluations occur in parallel but not theories in which belief-based heuristic evaluations precede logical analysis.
-
An integrated model of clinical reasoning: dual-process theory of cognition and metacognition.
Marcum, James A
2012-10-01
Clinical reasoning is an important component for providing quality medical care. The aim of the present paper is to develop a model of clinical reasoning that integrates both the non-analytic and analytic processes of cognition, along with metacognition. The dual-process theory of cognition (system 1 non-analytic and system 2 analytic processes) and the metacognition theory are used to develop an integrated model of clinical reasoning. In the proposed model, clinical reasoning begins with system 1 processes in which the clinician assesses a patient's presenting symptoms, as well as other clinical evidence, to arrive at a differential diagnosis. Additional clinical evidence, if necessary, is acquired and analysed utilizing system 2 processes to assess the differential diagnosis, until a clinical decision is made diagnosing the patient's illness and then how best to proceed therapeutically. Importantly, the outcome of these processes feeds back, in terms of metacognition's monitoring function, either to reinforce or to alter cognitive processes, which, in turn, enhances synergistically the clinician's ability to reason quickly and accurately in future consultations. The proposed integrated model has distinct advantages over other models proposed in the literature for explicating clinical reasoning. Moreover, it has important implications for addressing the paradoxical relationship between experience and expertise, as well as for designing a curriculum to teach clinical reasoning skills. © 2012 Blackwell Publishing Ltd.
-
PANTHER. Pattern ANalytics To support High-performance Exploitation and Reasoning.
Energy Technology Data Exchange (ETDEWEB)
Czuchlewski, Kristina Rodriguez [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Hart, William E. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)
2015-09-01
Sandia has approached the analysis of big datasets with an integrated methodology that uses computer science, image processing, and human factors to exploit critical patterns and relationships in large datasets despite the variety and rapidity of information. The work is part of a three-year LDRD Grand Challenge called PANTHER (Pattern ANalytics To support High-performance Exploitation and Reasoning). To maximize data analysis capability, Sandia pursued scientific advances across three key technical domains: (1) geospatial-temporal feature extraction via image segmentation and classification; (2) geospatial-temporal analysis capabilities tailored to identify and process new signatures more efficiently; and (3) domain- relevant models of human perception and cognition informing the design of analytic systems. Our integrated results include advances in geographical information systems (GIS) in which we discover activity patterns in noisy, spatial-temporal datasets using geospatial-temporal semantic graphs. We employed computational geometry and machine learning to allow us to extract and predict spatial-temporal patterns and outliers from large aircraft and maritime trajectory datasets. We automatically extracted static and ephemeral features from real, noisy synthetic aperture radar imagery for ingestion into a geospatial-temporal semantic graph. We worked with analysts and investigated analytic workflows to (1) determine how experiential knowledge evolves and is deployed in high-demand, high-throughput visual search workflows, and (2) better understand visual search performance and attention. Through PANTHER, Sandia's fundamental rethinking of key aspects of geospatial data analysis permits the extraction of much richer information from large amounts of data. The project results enable analysts to examine mountains of historical and current data that would otherwise go untouched, while also gaining meaningful, measurable, and defensible insights into
-
Directory of Open Access Journals (Sweden)
AB Elisabeth
2009-04-01
Full Text Available Abstract Background Lipid-lowering medication remains underused, even in high-risk populations. The objective of this study was to determine factors underlying general practitioners' decisions not to prescribe such drugs to patients with type 2 diabetes. Methods A qualitative study with semi-structured interviews using real cases was conducted to explore reasons for not prescribing lipid-lowering medication after a guideline was distributed that recommended the use of statins in most patients with type 2 diabetes. Seven interviews were conducted with general practitioners (GPs in The Netherlands, and analysed using an analytic inductive approach. Results Reasons for not-prescribing could be divided into patient and physician-attributed factors. According to the GPs, some patients do not follow-up on agreed medication and others object to taking lipid-lowering medication, partly for legitimate reasons such as expected or perceived side effects. Furthermore, the GPs themselves perceived reservations for prescribing lipid-lowering medication in patients with short life expectancy, expected compliance problems or near goal lipid levels. GPs sometimes postponed the start of treatment because of other priorities. Finally, barriers were seen in the GPs' practice organisation, and at the primary-secondary care interface. Conclusion Some of the barriers mentioned by GPs seem to be valid reasons, showing that guideline non-adherence can be quite rational. On the other hand, treatment quality could improve by addressing issues, such as lack of knowledge or motivation of both the patient and the GP. More structured management in general practice may also lead to better treatment.
-
Increasing Reasoning Awareness: Video Analysis of Students' Two-Party Virtual Patient Interactions.
Edelbring, Samuel; Parodis, Ioannis; Lundberg, Ingrid E
2018-02-27
Collaborative reasoning occurs in clinical practice but is rarely developed during education. The computerized virtual patient (VP) cases allow for a stepwise exploration of cases and thus stimulate active learning. Peer settings during VP sessions are believed to have benefits in terms of reasoning but have received scant attention in the literature. The objective of this study was to thoroughly investigate interactions during medical students' clinical reasoning in two-party VP settings. An in-depth exploration of students' interactions in dyad settings of VP sessions was performed. For this purpose, two prerecorded VP sessions lasting 1 hour each were observed, transcribed in full, and analyzed. The transcriptions were analyzed using thematic analysis, and short clips from the videos were selected for subsequent analysis in relation to clinical reasoning and clinical aspects. Four categories of interactions were identified: (1) task-related dialogue, in which students negotiated a shared understanding of the task and strategies for information gathering; (2) case-related insights and perspectives were gained, and the students consolidated and applied preexisting biomedical knowledge into a clinical setting; (3) clinical reasoning interactions were made explicit. In these, hypotheses were followed up and clinical examples were used. The researchers observed interactions not only between students and the VP but also (4) interactions with other resources, such as textbooks. The interactions are discussed in relation to theories of clinical reasoning and peer learning. The dyad VP setting is conducive to activities that promote analytic clinical reasoning. In this setting, components such as peer interaction, access to different resources, and reduced time constraints provided a productive situation in which the students pursued different lines of reasoning. ©Samuel Edelbring, Ioannis Parodis, Ingrid E Lundberg. Originally published in JMIR Medical Education (http
-
Trémolière, Bastien; Maheux-Caron, Véronique; Lepage, Jean-François; Blanchette, Isabelle
2018-01-01
There is evidence of a detrimental effect of emotion on reasoning. Recent studies suggest that this relationship is mediated by working memory, a function closely associated with the dorsolateral prefrontal cortex (dlPFC). Relying on transcranial direct current stimulation (tDCS), the present research explores the possibility that anodal stimulation of the dlPFC has the potential to prevent the effect of emotion on analytical reasoning. Thirty-four participants took part in a lab experiment and were tested twice: one session using offline anodal stimulation (with a 2 mA current stimulation applied to the left dlPFC for 20 min), one session using a control (sham) stimulation. In each session, participants solved syllogistic reasoning problems featuring neutral and emotionally negative contents. Results showed that anodal stimulation diminished the deleterious effect of emotion on syllogistic reasoning, but only for a subclass of problems: problems where the conclusion was logically valid. We discuss our results in the light of the reasoning literature as well as the apparent variability of tDCS effects.
-
Analytic information processing style in epilepsy patients.
Buonfiglio, Marzia; Di Sabato, Francesco; Mandillo, Silvia; Albini, Mariarita; Di Bonaventura, Carlo; Giallonardo, Annateresa; Avanzini, Giuliano
2017-08-01
Relevant to the study of epileptogenesis is learning processing, given the pivotal role that neuroplasticity assumes in both mechanisms. Recently, evoked potential analyses showed a link between analytic cognitive style and altered neural excitability in both migraine and healthy subjects, regardless of cognitive impairment or psychological disorders. In this study we evaluated analytic/global and visual/auditory perceptual dimensions of cognitive style in patients with epilepsy. Twenty-five cryptogenic temporal lobe epilepsy (TLE) patients matched with 25 idiopathic generalized epilepsy (IGE) sufferers and 25 healthy volunteers were recruited and participated in three cognitive style tests: "Sternberg-Wagner Self-Assessment Inventory", the C. Cornoldi test series called AMOS, and the Mariani Learning style Questionnaire. Our results demonstrate a significant association between analytic cognitive style and both IGE and TLE and respectively a predominant auditory and visual analytic style (ANOVA: p values <0,0001). These findings should encourage further research to investigate information processing style and its neurophysiological correlates in epilepsy. Copyright © 2017 Elsevier Inc. All rights reserved.
-
Casey, Beth M.; Lombardi, Caitlin McPherran; Pollock, Amanda; Fineman, Bonnie; Pezaris, Elizabeth
2017-01-01
This study investigated longitudinal pathways leading from early spatial skills in first-grade girls to their fifth-grade analytical math reasoning abilities (N = 138). First-grade assessments included spatial skills, verbal skills, addition/subtraction skills, and frequency of choice of a decomposition or retrieval strategy on the…
-
What every teacher needs to know about clinical reasoning.
Eva, Kevin W
2005-01-01
One of the core tasks assigned to clinical teachers is to enable students to sort through a cluster of features presented by a patient and accurately assign a diagnostic label, with the development of an appropriate treatment strategy being the end goal. Over the last 30 years there has been considerable debate within the health sciences education literature regarding the model that best describes how expert clinicians generate diagnostic decisions. The purpose of this essay is to provide a review of the research literature on clinical reasoning for frontline clinical teachers. The strengths and weaknesses of different approaches to clinical reasoning will be examined using one of the core divides between various models (that of analytic (i.e. conscious/controlled) versus non-analytic (i.e. unconscious/automatic) reasoning strategies) as an orienting framework. Recent work suggests that clinical teachers should stress the importance of both forms of reasoning, thereby enabling students to marshal reasoning processes in a flexible and context-specific manner. Specific implications are drawn from this overview for clinical teachers.
-
May, Stephen A
2013-01-01
Confusion about the nature of human reasoning and its appropriate application to patients has hampered veterinary students' development of these skills. Expertise is associated with greater ability to deploy pattern recognition (type 1 reasoning), which is aided by progressive development of data-driven, forward reasoning (in contrast to scientific, backward reasoning), analytical approaches that lead to schema acquisition. The associative nature of type 1 reasoning makes it prone to bias, particularly in the face of "cognitive miserliness," when clues that indicate the need for triangulation with an analytical approach are ignored. However, combined reasoning approaches, from the earliest stages, are more successful than one approach alone, so it is important that those involved in curricular design and delivery promote student understanding of reasoning generally, and the situations in which reasoning goes awry, and develop students' ability to reason safely and accurately whether presented with a familiar case or with a case that they have never seen before.
-
Reason for hospital admission: a pilot study comparing patient statements with chart reports.
Berger, Zackary; Dembitzer, Anne; Beach, Mary Catherine
2013-01-01
Providers and patients bring different understandings of health and disease to their encounters in the hospital setting. The literature to date only infrequently addresses patient and provider concordance on the reported reason for hospitalization, that is, whether they express this reason in similar ways. An agreement or common ground between such understandings can serve as a basis for future communication regarding an illness and its treatment. We interviewed a convenience sample of patients on the medical wards of an urban academic medical center. We asked subjects to state the reason why their doctors admitted them to the hospital, and then compared their statement with the reason in the medical record. We defined concordance on reported reason for hospitalization as agreement between the patient's report and the reason abstracted from the chart. We interviewed and abstracted chart data from a total of 46 subjects. Concordance on reported reason for hospitalization was present in 24 (52%) and discordance in 17 (37%); 5 patients (11%) could not give any reason for their hospitalization. Among the 17 patients whose report was discordant with their chart, 12 (71%) reported a different organ system than was recorded in the chart. A significant proportion of medical inpatients could not state their physicians' reason for admission. In addition, patients who identify a different reason for hospitalization than the chart often give a different organ system altogether. Providers should explore patient understanding of the reason for their hospitalization to facilitate communication and shared decision making.
-
Factors Affecting Mortality in Elderly Patients Hospitalized for Nonmalignant Reasons
Directory of Open Access Journals (Sweden)
Teslime Ayaz
2014-01-01
Full Text Available Elderly population is hospitalized more frequently than young people, and they suffer from more severe diseases that are difficult to diagnose and treat. The present study aimed to investigate the factors affecting mortality in elderly patients hospitalized for nonmalignant reasons. Demographic data, reason for hospitalization, comorbidities, duration of hospital stay, and results of routine blood testing at the time of first hospitalization were obtained from the hospital records of the patients, who were over 65 years of age and hospitalized primarily for nonmalignant reasons. The mean age of 1012 patients included in the study was 77.8 ± 7.6. The most common reason for hospitalization was diabetes mellitus (18.3%. Of the patients, 90.3% had at least a single comorbidity. Whilst 927 (91.6% of the hospitalized patients were discharged, 85 (8.4% died. Comparison of the characteristics of the discharged and dead groups revealed that the dead group was older and had higher rates of poor general status and comorbidity. Differences were observed between the discharged and dead groups in most of the laboratory parameters. Hypoalbuminemia, hypertriglyceridemia, hypopotassemia, hypernatremia, hyperuricemia, and high TSH level were the predictors of mortality. In order to meet the health necessities of the elderly population, it is necessary to well define the patient profiles and to identify the risk factors.
-
Relating faults in diagnostic reasoning with diagnostic errors and patient harm.
Zwaan, L.; Thijs, A.; Wagner, C.; Wal, G. van der; Timmermans, D.R.M.
2012-01-01
Purpose: The relationship between faults in diagnostic reasoning, diagnostic errors, and patient harm has hardly been studied. This study examined suboptimal cognitive acts (SCAs; i.e., faults in diagnostic reasoning), related them to the occurrence of diagnostic errors and patient harm, and studied
-
Reasons Why Trauma Patients Request for Discharge against ...
African Journals Online (AJOL)
Conclusion: Cost of treatment and believe in traditional bone setters were the 2 main reasons why most patients with fracture DAMA. Measures to reduce the cost of treatment and patient's education about the dangers with unorthodox treatment of fractures and dislocations should help to reduce this behaviour.
-
Median of patient results as a tool for assessment of analytical stability.
Jørgensen, Lars Mønster; Hansen, Steen Ingemann; Petersen, Per Hyltoft; Sölétormos, György
2015-06-15
In spite of the well-established external quality assessment and proficiency testing surveys of analytical quality performance in laboratory medicine, a simple tool to monitor the long-term analytical stability as a supplement to the internal control procedures is often needed. Patient data from daily internal control schemes was used for monthly appraisal of the analytical stability. This was accomplished by using the monthly medians of patient results to disclose deviations from analytical stability, and by comparing divergences with the quality specifications for allowable analytical bias based on biological variation. Seventy five percent of the twenty analytes achieved on two COBASs INTEGRA 800 instruments performed in accordance with the optimum and with the desirable specifications for bias. Patient results applied in analytical quality performance control procedures are the most reliable sources of material as they represent the genuine substance of the measurements and therefore circumvent the problems associated with non-commutable materials in external assessment. Patient medians in the monthly monitoring of analytical stability in laboratory medicine are an inexpensive, simple and reliable tool to monitor the steadiness of the analytical practice. Copyright © 2015 Elsevier B.V. All rights reserved.
-
Median of patient results as a tool for assessment of analytical stability
DEFF Research Database (Denmark)
Jørgensen, Lars Mønster; Hansen, Steen Ingemann; Petersen, Per Hyltoft
2015-01-01
BACKGROUND: In spite of the well-established external quality assessment and proficiency testing surveys of analytical quality performance in laboratory medicine, a simple tool to monitor the long-term analytical stability as a supplement to the internal control procedures is often needed. METHOD......: Patient data from daily internal control schemes was used for monthly appraisal of the analytical stability. This was accomplished by using the monthly medians of patient results to disclose deviations from analytical stability, and by comparing divergences with the quality specifications for allowable...... analytical bias based on biological variation. RESULTS: Seventy five percent of the twenty analytes achieved on two COBASs INTEGRA 800 instruments performed in accordance with the optimum and with the desirable specifications for bias. DISCUSSION: Patient results applied in analytical quality performance...
-
Abnormal Moral Reasoning in Complete and Partial Callosotomy Patients
Miller, Michael B.; Sinnott-Armstrong, Walter; Young, Liane; King, Danielle; Paggi, Aldo; Fabri, Mara; Polonara, Gabriele; Gazzaniga, Michael S.
2010-01-01
Recent neuroimaging studies suggest lateralized cerebral mechanisms in the right temporal parietal junction are involved in complex social and moral reasoning, such as ascribing beliefs to others. Based on this evidence, we tested 3 anterior-resected and 3 complete callosotomy patients along with 22 normal subjects on a reasoning task that…
-
A Reasoning And Hypothesis-Generation Framework Based On Scalable Graph Analytics
Energy Technology Data Exchange (ETDEWEB)
Sukumar, Sreenivas Rangan [ORNL
2016-01-01
Finding actionable insights from data has always been difficult. As the scale and forms of data increase tremendously, the task of finding value becomes even more challenging. Data scientists at Oak Ridge National Laboratory are leveraging unique leadership infrastructure (e.g. Urika-XA and Urika-GD appliances) to develop scalable algorithms for semantic, logical and statistical reasoning with unstructured Big Data. We present the deployment of such a framework called ORiGAMI (Oak Ridge Graph Analytics for Medical Innovations) on the National Library of Medicine s SEMANTIC Medline (archive of medical knowledge since 1994). Medline contains over 70 million knowledge nuggets published in 23.5 million papers in medical literature with thousands more added daily. ORiGAMI is available as an open-science medical hypothesis generation tool - both as a web-service and an application programming interface (API) at http://hypothesis.ornl.gov . Since becoming an online service, ORIGAMI has enabled clinical subject-matter experts to: (i) discover the relationship between beta-blocker treatment and diabetic retinopathy; (ii) hypothesize that xylene is an environmental cancer-causing carcinogen and (iii) aid doctors with diagnosis of challenging cases when rare diseases manifest with common symptoms. In 2015, ORiGAMI was featured in the Historical Clinical Pathological Conference in Baltimore as a demonstration of artificial intelligence to medicine, IEEE/ACM Supercomputing and recognized as a Centennial Showcase Exhibit at the Radiological Society of North America (RSNA) Conference in Chicago. The final paper will describe the workflow built for the Cray Urika-XA and Urika-GD appliances that is able to reason with the knowledge of every published medical paper every time a clinical researcher uses the tool.
-
A Novel Analog Reasoning Paradigm: New Insights in Intellectually Disabled Patients.
Curie, Aurore; Brun, Amandine; Cheylus, Anne; Reboul, Anne; Nazir, Tatjana; Bussy, Gérald; Delange, Karine; Paulignan, Yves; Mercier, Sandra; David, Albert; Marignier, Stéphanie; Merle, Lydie; de Fréminville, Bénédicte; Prieur, Fabienne; Till, Michel; Mortemousque, Isabelle; Toutain, Annick; Bieth, Eric; Touraine, Renaud; Sanlaville, Damien; Chelly, Jamel; Kong, Jian; Ott, Daniel; Kassai, Behrouz; Hadjikhani, Nouchine; Gollub, Randy L; des Portes, Vincent
2016-01-01
Intellectual Disability (ID) is characterized by deficits in intellectual functions such as reasoning, problem-solving, planning, abstract thinking, judgment, and learning. As new avenues are emerging for treatment of genetically determined ID (such as Down's syndrome or Fragile X syndrome), it is necessary to identify objective reliable and sensitive outcome measures for use in clinical trials. We developed a novel visual analogical reasoning paradigm, inspired by the Progressive Raven's Matrices, but appropriate for Intellectually Disabled patients. This new paradigm assesses reasoning and inhibition abilities in ID patients. We performed behavioural analyses for this task (with a reaction time and error rate analysis, Study 1) in 96 healthy controls (adults and typically developed children older than 4) and 41 genetically determined ID patients (Fragile X syndrome, Down syndrome and ARX mutated patients). In order to establish and quantify the cognitive strategies used to solve the task, we also performed an eye-tracking analysis (Study 2). Down syndrome, ARX and Fragile X patients were significantly slower and made significantly more errors than chronological age-matched healthy controls. The effect of inhibition on error rate was greater than the matrix complexity effect in ID patients, opposite to findings in adult healthy controls. Interestingly, ID patients were more impaired by inhibition than mental age-matched healthy controls, but not by the matrix complexity. Eye-tracking analysis made it possible to identify the strategy used by the participants to solve the task. Adult healthy controls used a matrix-based strategy, whereas ID patients used a response-based strategy. Furthermore, etiologic-specific reasoning differences were evidenced between ID patients groups. We suggest that this paradigm, appropriate for ID patients and developmental populations as well as adult healthy controls, provides an objective and quantitative assessment of visual
-
Hege, Inga; Kononowicz, Andrzej A; Berman, Norman B; Lenzer, Benedikt; Kiesewetter, Jan
2018-01-01
Background: Clinical reasoning is a complex skill students have to acquire during their education. For educators it is difficult to explain their reasoning to students, because it is partly an automatic and unconscious process. Virtual Patients (VPs) are used to support the acquisition of clinical reasoning skills in healthcare education. However, until now it remains unclear which features or settings of VPs optimally foster clinical reasoning. Therefore, our aims were to identify key concepts of the clinical reasoning process in a qualitative approach and draw conclusions on how each concept can be enhanced to advance the learning of clinical reasoning with virtual patients. Methods: We chose a grounded theory approach to identify key categories and concepts of learning clinical reasoning and develop a framework. Throughout this process, the emerging codes were discussed with a panel of interdisciplinary experts. In a second step we applied the framework to virtual patients. Results: Based on the data we identified the core category as the "multifactorial nature of learning clinical reasoning". This category is reflected in the following five main categories: Psychological Theories, Patient-centeredness, Context, Learner-centeredness, and Teaching/Assessment. Each category encompasses between four and six related concepts. Conclusions: With our approach we were able to elaborate how key categories and concepts of clinical reasoning can be applied to virtual patients. This includes aspects such as allowing learners to access a large number of VPs with adaptable levels of complexity and feedback or emphasizing dual processing, errors, and uncertainty.
-
Understanding Business Analytics
2015-01-05
analytics have been used in organizations for a variety of reasons for quite some time; ranging from the simple (generating and understanding business analytics...process. understanding business analytics 3 How well these two components are orchestrated will determine the level of success an organization has in
-
Puzzle test: A tool for non-analytical clinical reasoning assessment.
Monajemi, Alireza; Yaghmaei, Minoo
2016-01-01
Most contemporary clinical reasoning tests typically assess non-automatic thinking. Therefore, a test is needed to measure automatic reasoning or pattern recognition, which has been largely neglected in clinical reasoning tests. The Puzzle Test (PT) is dedicated to assess automatic clinical reasoning in routine situations. This test has been introduced first in 2009 by Monajemi et al in the Olympiad for Medical Sciences Students.PT is an item format that has gained acceptance in medical education, but no detailed guidelines exist for this test's format, construction and scoring. In this article, a format is described and the steps to prepare and administer valid and reliable PTs are presented. PT examines a specific clinical reasoning task: Pattern recognition. PT does not replace other clinical reasoning assessment tools. However, it complements them in strategies for assessing comprehensive clinical reasoning.
-
A Novel Analog Reasoning Paradigm: New Insights in Intellectually Disabled Patients.
Directory of Open Access Journals (Sweden)
Aurore Curie
Full Text Available Intellectual Disability (ID is characterized by deficits in intellectual functions such as reasoning, problem-solving, planning, abstract thinking, judgment, and learning. As new avenues are emerging for treatment of genetically determined ID (such as Down's syndrome or Fragile X syndrome, it is necessary to identify objective reliable and sensitive outcome measures for use in clinical trials.We developed a novel visual analogical reasoning paradigm, inspired by the Progressive Raven's Matrices, but appropriate for Intellectually Disabled patients. This new paradigm assesses reasoning and inhibition abilities in ID patients.We performed behavioural analyses for this task (with a reaction time and error rate analysis, Study 1 in 96 healthy controls (adults and typically developed children older than 4 and 41 genetically determined ID patients (Fragile X syndrome, Down syndrome and ARX mutated patients. In order to establish and quantify the cognitive strategies used to solve the task, we also performed an eye-tracking analysis (Study 2.Down syndrome, ARX and Fragile X patients were significantly slower and made significantly more errors than chronological age-matched healthy controls. The effect of inhibition on error rate was greater than the matrix complexity effect in ID patients, opposite to findings in adult healthy controls. Interestingly, ID patients were more impaired by inhibition than mental age-matched healthy controls, but not by the matrix complexity. Eye-tracking analysis made it possible to identify the strategy used by the participants to solve the task. Adult healthy controls used a matrix-based strategy, whereas ID patients used a response-based strategy. Furthermore, etiologic-specific reasoning differences were evidenced between ID patients groups.We suggest that this paradigm, appropriate for ID patients and developmental populations as well as adult healthy controls, provides an objective and quantitative assessment of
-
How Do Gut Feelings Feature in Tutorial Dialogues on Diagnostic Reasoning in GP Traineeship?
Stolper, C. F.; Van de Wiel, M. W. J.; Hendriks, R. H. M.; Van Royen, P.; Van Bokhoven, M. A.; Van der Weijden, T.; Dinant, G. J.
2015-01-01
Diagnostic reasoning is considered to be based on the interaction between analytical and non-analytical cognitive processes. Gut feelings, a specific form of non-analytical reasoning, play a substantial role in diagnostic reasoning by general practitioners (GPs) and may activate analytical reasoning. In GP traineeships in the Netherlands, trainees…
-
Appearance vs. health reasons for seeking treatment among obese patients with binge eating disorder.
Reas, Deborah L; Masheb, Robin M; Grilo, Carlos M
2004-05-01
This study examined reasons for seeking treatment reported by obese patients diagnosed with binge eating disorder (BED). Participants were 248 adults (58 men and 190 women) who met DSM criteria for BED. Participants were recruited through advertisements for treatment studies looking for persons who wanted to "stop binge eating and lose weight." Patients' reasons for seeking treatment were examined with respect to demography (gender and age), obesity (BMI and age of onset), features of eating disorders, and associated psychological functioning (depression and self-esteem). Of the 248 participants, 64% reported health concerns and 36% reported appearance concerns as their primary reason for seeking treatment. Reasons for seeking treatment did not differ significantly by gender. Patients seeking treatment because of appearance-related reasons had lower BMIs than those reporting health-related reasons (34.8 vs. 38.5, respectively), but they reported greater body dissatisfaction, more features of eating disorders, and lower self-esteem. Reasons that prompt treatment seeking among obese individuals with BED reflect meaningful patient characteristics and, therefore, warrant assessment and consideration during treatment planning. Further research is needed to determine whether reasons for treatment seeking among different obese patient groups affect treatment outcomes. Copyright 2004 NAASO
-
Inductive Reasoning in Patients with Paranoid Type Schizophrenia
Directory of Open Access Journals (Sweden)
Mehmet Emrah Karadere
2017-08-01
According to this study apart from the area of delusions, it can be say that the reasoning of the patients is normal. Our study indicates that when the delusional patients are compared to the control group in terms of jumping to conclusion and modifying their initial beliefs, they are not different when given similarly sufficient amount of data. [JCBPR 2017; 6(2.000: 67-74
-
fMRI activation patterns in an analytic reasoning task: consistency with EEG source localization
Li, Bian; Vasanta, Kalyana C.; O'Boyle, Michael; Baker, Mary C.; Nutter, Brian; Mitra, Sunanda
2010-03-01
Functional magnetic resonance imaging (fMRI) is used to model brain activation patterns associated with various perceptual and cognitive processes as reflected by the hemodynamic (BOLD) response. While many sensory and motor tasks are associated with relatively simple activation patterns in localized regions, higher-order cognitive tasks may produce activity in many different brain areas involving complex neural circuitry. We applied a recently proposed probabilistic independent component analysis technique (PICA) to determine the true dimensionality of the fMRI data and used EEG localization to identify the common activated patterns (mapped as Brodmann areas) associated with a complex cognitive task like analytic reasoning. Our preliminary study suggests that a hybrid GLM/PICA analysis may reveal additional regions of activation (beyond simple GLM) that are consistent with electroencephalography (EEG) source localization patterns.
-
Intuition, Reason, and Metacognition
Thompson, Valerie A.; Prowse Turner, Jamie A.; Pennycook, Gordon
2011-01-01
Dual Process Theories (DPT) of reasoning posit that judgments are mediated by both fast, automatic processes and more deliberate, analytic ones. A critical, but unanswered question concerns the issue of monitoring and control: When do reasoners rely on the first, intuitive output and when do they engage more effortful thinking? We hypothesised…
-
Gut feelings as a third track in general practitioners' diagnostic reasoning.
Stolper, Erik; Van de Wiel, Margje; Van Royen, Paul; Van Bokhoven, Marloes; Van der Weijden, Trudy; Dinant, Geert Jan
2011-02-01
General practitioners (GPs) are often faced with complicated, vague problems in situations of uncertainty that they have to solve at short notice. In such situations, gut feelings seem to play a substantial role in their diagnostic process. Qualitative research distinguished a sense of alarm and a sense of reassurance. However, not every GP trusted their gut feelings, since a scientific explanation is lacking. This paper explains how gut feelings arise and function in GPs' diagnostic reasoning. The paper reviews literature from medical, psychological and neuroscientific perspectives. Gut feelings in general practice are based on the interaction between patient information and a GP's knowledge and experience. This is visualized in a knowledge-based model of GPs' diagnostic reasoning emphasizing that this complex task combines analytical and non-analytical cognitive processes. The model integrates the two well-known diagnostic reasoning tracks of medical decision-making and medical problem-solving, and adds gut feelings as a third track. Analytical and non-analytical diagnostic reasoning interacts continuously, and GPs use elements of all three tracks, depending on the task and the situation. In this dual process theory, gut feelings emerge as a consequence of non-analytical processing of the available information and knowledge, either reassuring GPs or alerting them that something is wrong and action is required. The role of affect as a heuristic within the physician's knowledge network explains how gut feelings may help GPs to navigate in a mostly efficient way in the often complex and uncertain diagnostic situations of general practice. Emotion research and neuroscientific data support the unmistakable role of affect in the process of making decisions and explain the bodily sensation of gut feelings.The implications for health care practice and medical education are discussed.
-
REASONS FOR PATIENT DELAYS & HEALTH SYSTEM DELAYS FOR TUBERCULOSIS IN SOUTH INDIA
Directory of Open Access Journals (Sweden)
Kapil Goel
2011-12-01
Full Text Available Background: Globally, the burden of Tuberculosis is escalating. Early diagnosis and prompt initiation of tuberculosis treatment is essential for an effective tuberculosis control programme. Objectives: To study the self reported reasons for patient and health system (diagnosis & treatment delays in Tuberculosis patients. Methods: A community based cross sectional study was conducted among 98 new sputum positive TB cases aged > 15 years registered under RNTCP from Oct 2006 to June 2007 & receiving treatment under DOTS in Udupi taluk by interviewing them. Results: Total 98 patients were recruited and 68% were males. Out of 17 patients with patient delays, 82% felt that their symptoms were not severe, 71% felt that patient delay was due to lack of awareness and 71% did not take it seriously. Out of 86 patients with health system delays, 82.6% of patients mentioned that doctor has not advised for sputum examination, 76.7% of patients told that they first consulted a private doctor, 21% of them mentioned that doctor was unaware to diagnose TB. Conclusion: Symptoms not severe is the main reason for the patient delay and doctor didn’t advise for sputum examination is the main reason for health system delays.
-
Shen, Ji; Sung, Shannon; Zhang, Dongmei
2015-11-01
Students need to think and work across disciplinary boundaries in the twenty-first century. However, it is unclear what interdisciplinary thinking means and how to analyze interdisciplinary interactions in teamwork. In this paper, drawing on multiple theoretical perspectives and empirical analysis of discourse contents, we formulate a theoretical framework that helps analyze interdisciplinary reasoning and communication (IRC) processes in interdisciplinary collaboration. Specifically, we propose four interrelated IRC processes-integration, translation, transfer, and transformation, and develop a corresponding analytic framework. We apply the framework to analyze two meetings of a project that aims to develop interdisciplinary science assessment items. The results illustrate that the framework can help interpret the interdisciplinary meeting dynamics and patterns. Our coding process and results also suggest that these IRC processes can be further examined in terms of interconnected sub-processes. We also discuss the implications of using the framework in conceptualizing, practicing, and researching interdisciplinary learning and teaching in science education.
-
Hege, Inga; Kononowicz, Andrzej A.; Berman, Norman B.; Lenzer, Benedikt; Kiesewetter, Jan
2018-01-01
Background: Clinical reasoning is a complex skill students have to acquire during their education. For educators it is difficult to explain their reasoning to students, because it is partly an automatic and unconscious process. Virtual Patients (VPs) are used to support the acquisition of clinical reasoning skills in healthcare education. However, until now it remains unclear which features or settings of VPs optimally foster clinical reasoning. Therefore, our aims were to identify key concepts of the clinical reasoning process in a qualitative approach and draw conclusions on how each concept can be enhanced to advance the learning of clinical reasoning with virtual patients. Methods: We chose a grounded theory approach to identify key categories and concepts of learning clinical reasoning and develop a framework. Throughout this process, the emerging codes were discussed with a panel of interdisciplinary experts. In a second step we applied the framework to virtual patients. Results: Based on the data we identified the core category as the "multifactorial nature of learning clinical reasoning". This category is reflected in the following five main categories: Psychological Theories, Patient-centeredness, Context, Learner-centeredness, and Teaching/Assessment. Each category encompasses between four and six related concepts. Conclusions: With our approach we were able to elaborate how key categories and concepts of clinical reasoning can be applied to virtual patients. This includes aspects such as allowing learners to access a large number of VPs with adaptable levels of complexity and feedback or emphasizing dual processing, errors, and uncertainty. PMID:29497697
-
Patients' reasons for accepting a free community pharmacy asthma service
DEFF Research Database (Denmark)
Kaae, Susanne; Sporrong, Sofia Kälvemark
2015-01-01
few studies have been conducted so far to explore why patients accept or decline offers of cognitive services at the pharmacy counter. Objective To explore patients’ reasons for accepting a particular cognitive service (the Inhaler Technique Assessment Service) a service intended to detect inhalation...... with 24 patients suffering mainly from asthma and COPD. Researchers from Copenhagen University conducted 11 long interviews and pharmacy internship students from Copenhagen University carried out 13 short interviews. The interviews were analyzed using descriptive analysis. Main outcome measure Patients......’ perceived needs of an inhalation counseling service as well as their motivation for accepting the service, including their accounts of how the service was orally offered by staff. Results The majority of participants were used to using inhaler devices. The participants felt, for several reasons, little need...
-
Reasons for Treatment Changes in Patients With Moderate to Severe Psoriasis.
Anderson, Kathryn L; Feldman, Steven R
2015-01-01
Psoriasis treatment involves multiple treatment arms. Treatment choice depends on many factors and may change, due to the chronicity of psoriasis. The purpose of our study is to explore reasons for treatment changes in patients with moderate to severe psoriasis. Ten charts of patients with moderate to severe psoriasis were reviewed. The medication changes and reasons for change were extracted. A "treatment change" was defined as switching between medication classes, adding or removing a medication class, or switching medications within the oral or biologic medication class. Seventy-seven treatment changes were identified. On average, 1 treatment change occurred per year of follow-up. The most common reason for treatment change was inadequate disease control. Inadequate disease control with current therapy is the most common reason a physician changes treatment for moderate to severe psoriasis. More efficacious treatments or ways to improve efficacy may help improve the long-term outcomes of psoriasis. © The Author(s) 2015.
-
Data Representations, Transformations, and Statistics for Visual Reasoning
Maciejewski, Ross
2011-01-01
Analytical reasoning techniques are methods by which users explore their data to obtain insight and knowledge that can directly support situational awareness and decision making. Recently, the analytical reasoning process has been augmented through the use of interactive visual representations and tools which utilize cognitive, design and perceptual principles. These tools are commonly referred to as visual analytics tools, and the underlying methods and principles have roots in a variety of disciplines. This chapter provides an introduction to young researchers as an overview of common visual
-
Pinnock, Ralph; Welch, Paul
2014-04-01
Errors in clinical reasoning continue to account for significant morbidity and mortality, despite evidence-based guidelines and improved technology. Experts in clinical reasoning often use unconscious cognitive processes that they are not aware of unless they explain how they are thinking. Understanding the intuitive and analytical thinking processes provides a guide for instruction. How knowledge is stored is critical to expertise in clinical reasoning. Curricula should be designed so that trainees store knowledge in a way that is clinically relevant. Competence in clinical reasoning is acquired by supervised practice with effective feedback. Clinicians must recognise the common errors in clinical reasoning and how to avoid them. Trainees can learn clinical reasoning effectively in everyday practice if teachers provide guidance on the cognitive processes involved in making diagnostic decisions. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
-
Analytical investigations closer to the patient.
Watson, D
1980-01-01
Do-it-yourself bioanalytical equipment that requires no analytical skill to operate is currently available for use in intensive care units, operating suites, side wards, health centres, clinics, general practitioners' surgeries, etc. Agreement is needed between the laboratory consultant and doctors and others using laboratory-type equipment and reagents in near-bedside analyses for diagnosis, clinical management, or health screening of their patients. Choice and safety of method procedure, op...
-
MANAGEMENT OF A GUILLAIN BARRE SYNDROME PATIENT THROUGH THREE TRACK REASONING: A CASE STUDY
Directory of Open Access Journals (Sweden)
Shamima Islam Nipa
2015-12-01
Full Text Available Background: Clinical reasoning is a thinking and decision making process which occur in clinical practice. It helps the health care providers to solve the clinical problem by using their reasoning process in an effective and efficient manner. Three track reasoning in one of the clinical reasoning process which includes the procedural, interactive and conditional reasoning to diagnose as well as ensure proper rehabilitation service according to patient and patient’s family members’ needs. Methods: A single case based study through the three track reasoning process. The purpose of this study was to explore the management strategies of a Gullian Barrie Syndrome (GBS patient through three track reasoning. We have tried to show how the basic idea behind the reasoning process helped to determine the reasoning process and diagnosis. However it has performed through theory and observation. We have also showed how we used the reasoning process through with the common sense reasoning. However it was the part of procedural reasoning in three track clinical reasoning. In three track reasoning, there is also interactive and procedural reasoning part through which we told patient story about his condition, identified his and his family members expectations and to establish hypothesis as GBS. So three track reasoning also supported us to do reasoning process rather than selecting another reasoning process. Results: After analyzing the reasoning process it was identified that to be strict in a single reasoning process is very difficult. Clinical reasoning is the clinician’s ability through which they can consider the interpretation of different clinical findings. An expert clinician must have critical thinking skill rather than ignoring any symptoms or overemphasize the symptoms. In addition, patient’s knowledge, believes and reasoning was found an important part of clinical reasoning process in this study. Conclusion: We have been practicing clinical
-
Model of critical diagnostic reasoning: achieving expert clinician performance.
Harjai, Prashant Kumar; Tiwari, Ruby
2009-01-01
Diagnostic reasoning refers to the analytical processes used to determine patient health problems. While the education curriculum and health care system focus on training nurse clinicians to accurately recognize and rescue clinical situations, assessments of non-expert nurses have yielded less than satisfactory data on diagnostic competency. The contrast between the expert and non-expert nurse clinician raises the important question of how differences in thinking may contribute to a large divergence in accurate diagnostic reasoning. This article recognizes superior organization of one's knowledge base, using prototypes, and quick retrieval of pertinent information, using similarity recognition as two reasons for the expert's superior diagnostic performance. A model of critical diagnostic reasoning, using prototypes and similarity recognition, is proposed and elucidated using case studies. This model serves as a starting point toward bridging the gap between clinical data and accurate problem identification, verification, and management while providing a structure for a knowledge exchange between expert and non-expert clinicians.
-
Directory of Open Access Journals (Sweden)
Mohammad Habibur Rahman
2016-09-01
Full Text Available Background: Clinical reasoning is a process by which physiotherapists interacted with patients, their family and other health- care professionals. It is the thinking process that professionals tend to apply in clinical practice. Given that novice as well as expert practitioners prefer to go through some steps while they were dealing with unfamiliar cases. This process is known as hypothetico deductive reasoning. This reasoning approach involved the generation of hypothesis based on clinical data and knowledge and testing of hypothesis through further inquiry. We are expert in musculoskeletal physiotherapy treatment and favoring the atypical history of patient we went through step by step from assessment to discharge Methods: A case based study through hypothetico deductive reasoning model of clinical reasoning. The objective of the study was to investigate the physiotherapy management strategies of an atypical ankle sprain patient through hypothetico deductive reasoning which comprised of cue acquisition, hypothesis generation, cue interpretation and hypothesis evaluation by implementing International Classification of Functioning, Disability and Health (ICF. Results: The patient responded well to treatment as patient reported that 100% swelling decreased, could bear more weight (95% on foot, decrease pain (1 cm on 10 cm VAS scale, improved muscle strength by manual muscle testing by grade V in ankle planter flexors (PF as well as dorsiflexors (DF, invertors as well as evertors and the functional status of patient was improved by 80% according to lower extremity functional scale. Conclusion: Clinical reasoning is an important approach in physiotherapy. It helps the practitioners in decision making and choosing the best alternative options for the well being of patients. We think it is necessary for all practitioners to have sound propositional and non-propositional knowledge in order to provide effective management protocol for patients focusing
-
Theory of mind reasoning in schizophrenia patients and non-psychotic relatives.
Cassetta, Briana; Goghari, Vina
2014-08-15
Research consistently demonstrates that schizophrenia patients have theory of mind (ToM) impairments. Additionally, there is some evidence that family members of schizophrenia patients also demonstrate impairments in ToM, suggesting a genetic vulnerability for the disorder. This study assessed ToM abilities (i.e., sarcasm comprehension) in schizophrenia patients and their first-degree biological relatives during video-taped social interactions, to be representative of real-world interactions and to assess for disease-specific and/or genetic liability effects. Additionally, we assessed whether ToM abilities predicted social and global functioning in schizophrenia patients, and whether symptoms were associated with ToM deficits. Schizophrenia patients demonstrated impairments in sarcasm comprehension compared to controls and relatives, whereas relatives showed intact comprehension. Symptoms of schizophrenia significantly predicted worse ToM abilities. Furthermore, in schizophrenia patients, impaired ToM reasoning predicted worse social and global functioning. Given schizophrenia patients demonstrated impairments in ToM reasoning in a task that resembles real-life interactions, this might be a key area for remediation. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
-
Shimokawa, Kenichi; Lambert, Michael J.; Smart, David W.
2010-01-01
Objective: Outcome research has documented worsening among a minority of the patient population (5% to 10%). In this study, we conducted a meta-analytic and mega-analytic review of a psychotherapy quality assurance system intended to enhance outcomes in patients at risk of treatment failure. Method: Original data from six major studies conducted…
-
Towards Personalized Medicine: Leveraging Patient Similarity and Drug Similarity Analytics
Zhang, Ping; Wang, Fei; Hu, Jianying; Sorrentino, Robert
2014-01-01
The rapid adoption of electronic health records (EHR) provides a comprehensive source for exploratory and predictive analytic to support clinical decision-making. In this paper, we investigate how to utilize EHR to tailor treatments to individual patients based on their likelihood to respond to a therapy. We construct a heterogeneous graph which includes two domains (patients and drugs) and encodes three relationships (patient similarity, drug similarity, and patient-drug prior associations). We describe a novel approach for performing a label propagation procedure to spread the label information representing the effectiveness of different drugs for different patients over this heterogeneous graph. The proposed method has been applied on a real-world EHR dataset to help identify personalized treatments for hypercholesterolemia. The experimental results demonstrate the effectiveness of the approach and suggest that the combination of appropriate patient similarity and drug similarity analytics could lead to actionable insights for personalized medicine. Particularly, by leveraging drug similarity in combination with patient similarity, our method could perform well even on new or rarely used drugs for which there are few records of known past performance. PMID:25717413
-
Reasons for elderly patients GP visits: results of a cross-sectional study
Frese, Thomas; Mahlmeister, Jarmila; Deutsch, Tobias; Sandholzer, Hagen
2016-01-01
Thomas Frese, Jarmila Mahlmeister, Tobias Deutsch, Hagen Sandholzer Department of General Practice, Medical Faculty, University of Leipzig, Leipzig, Germany Objective: The aim of this study is to describe the frequency of reasons for elderly patients visits to a general practice (GP) setting. Subjects and methods: Cross-sectional data from 8,877 randomly selected patients were assessed during a 1-year period by 209 GPs in the German federal state of Saxony. The reasons for visits, performed...
-
Reasons for non-compliance to treatment among patients with ...
African Journals Online (AJOL)
Other reasons were respondents' different belief systems, poor insight about their illness, ineffectivity of some medication, dislike for injections, lack of continuity of care and family support, non-involvement of patients in their own management. Social stigma, objection by a particular religious group to treatment and ...
-
MANAGEMENT OF A GUILLAIN BARRE SYNDROME PATIENT THROUGH THREE TRACK REASONING: A CASE STUDY
Shamima Islam Nipa; Mohammad Mustafa Kamal Rahat Khan; Mohammad Sohrab Hossain; Mohammad Habibur Rahman; Md. Shofiqul Islam
2015-01-01
Background: Clinical reasoning is a thinking and decision making process which occur in clinical practice. It helps the health care providers to solve the clinical problem by using their reasoning process in an effective and efficient manner. Three track reasoning in one of the clinical reasoning process which includes the procedural, interactive and conditional reasoning to diagnose as well as ensure proper rehabilitation service according to patient and patient’s family members’ needs. M...
-
Big data and visual analytics in anaesthesia and health care.
Simpao, A F; Ahumada, L M; Rehman, M A
2015-09-01
Advances in computer technology, patient monitoring systems, and electronic health record systems have enabled rapid accumulation of patient data in electronic form (i.e. big data). Organizations such as the Anesthesia Quality Institute and Multicenter Perioperative Outcomes Group have spearheaded large-scale efforts to collect anaesthesia big data for outcomes research and quality improvement. Analytics--the systematic use of data combined with quantitative and qualitative analysis to make decisions--can be applied to big data for quality and performance improvements, such as predictive risk assessment, clinical decision support, and resource management. Visual analytics is the science of analytical reasoning facilitated by interactive visual interfaces, and it can facilitate performance of cognitive activities involving big data. Ongoing integration of big data and analytics within anaesthesia and health care will increase demand for anaesthesia professionals who are well versed in both the medical and the information sciences. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
-
Directory of Open Access Journals (Sweden)
Matza LS
2012-07-01
Full Text Available Louis S Matza,1 Glenn A Phillips,2 Dennis A Revicki,1 Haya Ascher-Svanum,3 Karen G Malley,4 Andrew C Palsgrove,1 Douglas E Faries,3 Virginia Stauffer,3 Bruce J Kinon,3 A George Awad,5 Richard SE Keefe,6 Dieter Naber71Outcomes Research, United BioSource Corporation, Bethesda, MD, 2Formerly with Eli Lilly and Company, Indianapolis, IN, 3Eli Lilly and Company, Indianapolis, IN, 4Malley Research Programming, Inc, Rockville, MD, USA; 5Department of Psychiatry and Behavioral Sciences; University of Toronto, Toronto, Canada; 6Duke University Medical Center, Durham NC, USA; 7Universitaetsklinikum Hamburg-Eppendorf, Hamburg, GermanyIntroduction: The Reasons for Antipsychotic Discontinuation Interview (RAD-I was developed to assess patients’ perceptions of reasons for discontinuing or continuing an antipsychotic. The current study examined reliability and validity of domain scores representing three factors contributing to these treatment decisions: treatment benefits, adverse events, and distal reasons other than direct effects of the medication.Methods: Data were collected from patients with schizophrenia or schizoaffective disorder and their treating clinicians. For approximately 25% of patients, a second rater completed the RAD-I for assessment of inter-rater reliability.Results: All patients (n = 121; 81 discontinuation, 40 continuation reported at least one reason for discontinuation or continuation (mean = 2.8 reasons for discontinuation; 3.4 for continuation. Inter-rater reliability was supported (kappas = 0.63–1.0. Validity of the discontinuation domain scores was supported by associations with symptom measures (the Positive and Negative Syndrome Scale for Schizophrenia, the Clinical Global Impression – Schizophrenia Scale; r = 0.30 to 0.51; all P < 0.01, patients’ primary reasons for discontinuation, and adverse events. However, the continuation domain scores were not significantly associated with these other indicators
-
DEFF Research Database (Denmark)
Hansen, Steen Ingemann; Petersen, Per Hyltoft; Lund, Flemming
2017-01-01
BACKGROUND: Recently, the use of separate gender-partitioned patient medians of serum sodium has revealed potential for monitoring analytical stability within the optimum analytical performance specifications for laboratory medicine. The serum albumin concentration depends on whether a patient...... patients were closely related despite considerable variation due to the current analytical variation. This relationship was confirmed by the calculated half-range for the monthly ratio between the genders of 0.44%, which surpasses the optimum analytical performance specification for bias of serum albumin...... (0.72%). The weekly ratio had a half-range of 1.83%, which surpasses the minimum analytical performance specifications of 2.15%. CONCLUSIONS: Monthly gender-partitioned patient medians of serum albumin are useful for monitoring of long-term analytical stability, where the gender medians are two...
-
Hege, Inga; Dietl, Anita; Kiesewetter, Jan; Schelling, Jörg; Kiesewetter, Isabel
2018-02-28
Virtual patients (VPs) are narrative-based educational activities to train clinical reasoning in a safe environment. Our aim was to explore the influence of the design of the narrative and level of difficulty on the clinical reasoning process, diagnostic accuracy and time-on-task. In a randomized controlled trial, we analyzed the clinical reasoning process of 46 medical students with six VPs in three different variations: (1) patients showing a friendly behavior, (2) patients showing a disruptive behavior and (3) a version without a patient story. For easy VPs, we did not see a significant difference in diagnostic accuracy. For difficult VPs, the diagnostic accuracy was significantly higher for participants who worked on the friendly VPs compared to the other two groups. Independent from VP difficulty, participants identified significantly more problems and tests for disruptive than for friendly VPs; time on task was comparable for these two groups. The extrinsic motivation of participants working on the VPs without a patient story was significantly lower than for the students working on the friendly VPs. Our results indicate that the measured VP difficulty has a higher influence on the clinical reasoning process and diagnostic accuracy than the variations in the narratives.
-
Clinical reasoning of junior doctors in emergency medicine: a grounded theory study.
Adams, E; Goyder, C; Heneghan, C; Brand, L; Ajjawi, R
2017-02-01
Emergency medicine (EM) has a high case turnover and acuity making it a demanding clinical reasoning domain especially for junior doctors who lack experience. We aimed to better understand their clinical reasoning using dual cognition as a guiding theory. EM junior doctors were recruited from six hospitals in the south of England to participate in semi-structured interviews (n=20) and focus groups (n=17) based on recall of two recent cases. Transcripts were analysed using a grounded theory approach to identify themes and to develop a model of junior doctors' clinical reasoning in EM. Within cases, clinical reasoning occurred in three phases. In phase 1 (case framing), initial case cues and first impressions were predominantly intuitive, but checked by analytical thought and determined the urgency of clinical assessment. In phase 2 (evolving reasoning), non-analytical single cue and pattern recognitions were common which were subsequently validated by specific analytical strategies such as use of red flags. In phase 3 (ongoing uncertainty) analytical self-monitoring and reassurance strategies were used to precipitate a decision regarding discharge. We found a constant dialectic between intuitive and analytical cognition throughout the reasoning process. Our model of clinical reasoning by EM junior doctors illustrates the specific contextual manifestations of the dual cognition theory. Distinct diagnostic strategies are identified and together these give EM learners and educators a framework and vocabulary for discussion and learning about clinical reasoning. 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/.
-
Hertzog, Christopher; Smith, R Marit; Ariel, Robert
2018-01-01
Background/Study Context: This study evaluated adult age differences in the original three-item Cognitive Reflection Test (CRT; Frederick, 2005, The Journal of Economic Perspectives, 19, 25-42) and an expanded seven-item version of that test (Toplak et al., 2013, Thinking and Reasoning, 20, 147-168). The CRT is a numerical problem-solving test thought to capture a disposition towards either rapid, intuition-based problem solving (Type I reasoning) or a more thoughtful, analytical problem-solving approach (Type II reasoning). Test items are designed to induce heuristically guided errors that can be avoided if using an appropriate numerical representation of the test problems. We evaluated differences between young adults and old adults in CRT performance and correlates of CRT performance. Older adults (ages 60 to 80) were paid volunteers who participated in experiments assessing age differences in self-regulated learning. Young adults (ages 17 to 35) were students participating for pay as part of a project assessing measures of critical thinking skills or as a young comparison group in the self-regulated learning study. There were age differences in the number of CRT correct responses in two independent samples. Results with the original three-item CRT found older adults to have a greater relative proportion of errors based on providing the intuitive lure. However, younger adults actually had a greater proportion of intuitive errors on the long version of the CRT, relative to older adults. Item analysis indicated a much lower internal consistency of CRT items for older adults. These outcomes do not offer full support for the argument that older adults are higher in the use of a "Type I" cognitive style. The evidence was also consistent with an alternative hypothesis that age differences were due to lower levels of numeracy in the older samples. Alternative process-oriented evaluations of how older adults solve CRT items will probably be needed to determine
-
Durning, S.J.; Dong, T.; Artino, A.R.; Vleuten, C. van der; Holmboe, E.; Schuwirth, L.
2015-01-01
BACKGROUND: An ongoing debate exists in the medical education literature regarding the potential benefits of pattern recognition (non-analytic reasoning), actively comparing and contrasting diagnostic options (analytic reasoning) or using a combination approach. Studies have not, however, explicitly
-
Gutknecht, Mandy; Danner, Marion; Schaarschmidt, Marthe-Lisa; Gross, Christian; Augustin, Matthias
2018-02-15
To define treatment benefit, the Patient Benefit Index contains a weighting of patient-relevant treatment goals using the Patient Needs Questionnaire, which includes a 5-point Likert scale ranging from 0 ("not important at all") to 4 ("very important"). These treatment goals have been assigned to five health dimensions. The importance of each dimension can be derived by averaging the importance ratings on the Likert scales of associated treatment goals. As the use of a Likert scale does not allow for a relative assessment of importance, the objective of this study was to estimate relative importance weights for health dimensions and associated treatment goals in patients with psoriasis by using the analytic hierarchy process and to compare these weights with the weights resulting from the Patient Needs Questionnaire. Furthermore, patients' judgments on the difficulty of the methods were investigated. Dimensions of the Patient Benefit Index and their treatment goals were mapped into a hierarchy of criteria and sub-criteria to develop the analytic hierarchy process questionnaire. Adult patients with psoriasis starting a new anti-psoriatic therapy in the outpatient clinic of the Institute for Health Services Research in Dermatology and Nursing at the University Medical Center Hamburg (Germany) were recruited and completed both methods (analytic hierarchy process, Patient Needs Questionnaire). Ratings of treatment goals on the Likert scales (Patient Needs Questionnaire) were summarized within each dimension to assess the importance of the respective health dimension/criterion. Following the analytic hierarchy process approach, consistency in judgments was assessed using a standardized measurement (consistency ratio). At the analytic hierarchy process level of criteria, 78 of 140 patients achieved the accepted consistency. Using the analytic hierarchy process, the dimension "improvement of physical functioning" was most important, followed by "improvement of social
-
Development and necessary norms of reasoning
Markovits, Henry
2014-01-01
The question of whether reasoning can, or should, be described by a single normative model is an important one. In the following, I combine epistemological considerations taken from Piaget’s notion of genetic epistemology, a hypothesis about the role of reasoning in communication and developmental data to argue that some basic logical principles are in fact highly normative. I argue here that explicit, analytic human reasoning, in contrast to intuitive reasoning, uniformly relies on a form of validity that allows distinguishing between valid and invalid arguments based on the existence of counterexamples to conclusions. PMID:24904501
-
Fostering Scientific Reasoning in Education--Meta-Analytic Evidence from Intervention Studies
Engelmann, Katharina; Neuhaus, Birgit J.; Fischer, Frank
2016-01-01
Scientific reasoning skills are not just for researchers, they are also increasingly relevant for making informed decisions in our everyday lives. How can these skills be facilitated? The current state of research on supporting scientific reasoning includes intervention studies but lacks an integrated analysis of the approaches to foster…
-
DEFF Research Database (Denmark)
Hansen, Steen Ingemann; Petersen, Per Hyltoft; Lund, Flemming
2017-01-01
BACKGROUND: During monitoring of monthly medians of results from patients undertaken to assess analytical stability in routine laboratory performance, the medians for serum sodium for male and female patients were found to be significantly related. METHODS: Daily, weekly and monthly patient medians...... all instruments. CONCLUSIONS: The tight relationship between the gender medians for serum sodium is only possible when raw laboratory data are used for calculation. The two patient medians can be used to confirm both and are useful as independent estimates of analytical bias during constant...... calibration periods. In contrast to the gender combined median, the estimate of analytical bias can be confirmed further by calculation of the ratios of medians for males and females....
-
Correa, John B; Brandon, Karen O; Meltzer, Lauren R; Hoehn, Hannah J; Piñeiro, Bárbara; Brandon, Thomas H; Simmons, Vani N
2018-04-19
Smoking tobacco cigarettes after a cancer diagnosis increases risk for several serious adverse outcomes. Thus, patients can significantly benefit from quitting smoking. Electronic cigarettes are an increasingly popular cessation method. Providers routinely ask about combustible cigarette use, yet little is known about use and communication surrounding e-cigarettes among patients with cancer. This study aims to describe patterns, beliefs, and communication with oncology providers about e-cigarette use of patients with cancer. Patients with cancer (N = 121) who currently used e-cigarettes were surveyed in a cross-sectional study about their patterns and reasons for use, beliefs, and perceptions of risk for e-cigarettes, combustible cigarettes, and nicotine replacement therapies. Patient perspectives on provider communication regarding e-cigarettes were also assessed. Most participants identified smoking cessation as the reason for initiating (81%) and continuing (60%) e-cigarette use. However, 51% of patients reported current dual use of combustible cigarettes and e-cigarettes, and most patients reported never having discussed their use of e-cigarettes with their oncology provider (72%). Patients characterized e-cigarettes as less addictive, less expensive, less stigmatizing, and less likely to impact cancer treatment than combustible cigarettes (Ps < .05), and more satisfying, more useful for quitting smoking, and more effective at reducing cancer-related stress than nicotine replacement therapies (Ps < .05). Patients with cancer who use e-cigarettes have positive attitudes toward these devices and use them to aid in smoking cessation. This study also highlights the need for improved patient-provider communication on the safety and efficacy of e-cigarettes for smoking cessation. Copyright © 2018 John Wiley & Sons, Ltd.
-
Are We Good at Detecting Conflict during Reasoning?
Pennycook, Gordon; Fugelsang, Jonathan A.; Koehler, Derek J.
2012-01-01
Recent evidence suggests that people are highly efficient at detecting conflicting outputs produced by competing intuitive and analytic reasoning processes. Specifically, De Neys and Glumicic (2008) demonstrated that participants reason longer about problems that are characterized by conflict (as opposed to agreement) between stereotypical…
-
Reasons and barriers for using a patient portal: survey among patients with diabetes mellitus.
Ronda, Maaike C M; Dijkhorst-Oei, Lioe-Ting; Rutten, Guy E H M
2014-11-25
The use of a Web portal for patients with diabetes mellitus to access their own personal health record may result in improved diabetes outcomes. However, the adoption by patients is slow. This may be caused by patient characteristics, but also by the content, layout, and promotion of the portal. Detailed knowledge about this could help increase patients' participation in Web portals. The aim was to study the opinions of patients with diabetes and identify perceived barriers to using a Web portal to optimize its use. We conducted a survey among patients with type 1 and type 2 diabetes mellitus from 62 primary care practices and 1 outpatient hospital clinic in the central area of the Netherlands who all used the same electronic health record with a Web portal. Questionnaires about patient characteristics, opinions about reasons for use or nonuse, and about portal content were sent to 1500 patients with a login and 3000 patients without a login to the Web portal. Patient groups were stratified according to login frequency. Demographic and diabetes-related variables were analyzed with multivariable regression analysis. The total response rate was 66.63% (2391/4399); 1390 of 4399 patients (31.60%) were eligible for analysis. There were 413 regular users (login frequency more than once) and 758 nonusers (no login). Most nonusers (72.4%) stated that the main reason for not requesting a login was that they were unaware of the existence of the portal. Other barriers reported by patients were disinterest in managing their own disease (28.5%, 216/758) and feelings of inadequacy with the use of computers and Internet (11.6%, 88/758). Patients treated by a general practitioner were more frequently nonusers compared to patients treated by an internist (78.8%, 666/846 vs 28.3%, 92/325; Ppatient portal is the main barrier of enrollment. Users and nonusers perceive the usefulness of the portal differently and do not have the same recommendations for additional functionalities. To
-
Hansen, Steen Ingemann; Petersen, Per Hyltoft; Lund, Flemming; Fraser, Callum G; Sölétormos, György
2018-04-25
Recently, the use of separate gender-partitioned patient medians of serum sodium has revealed potential for monitoring analytical stability within the optimum analytical performance specifications for laboratory medicine. The serum albumin concentration depends on whether a patient is sitting or recumbent during phlebotomy. We therefore investigated only examinations requested by general practitioners (GPs) to provide data from sitting patients. Weekly and monthly patient medians of serum albumin requested by GP for both male and female patients were calculated from the raw data obtained from three analysers in the hospital laboratory on examination of samples from those >18 years. The half-range of medians were applied as an estimate of the maximum bias. Further, the ratios between the two medians were calculated (females/males). The medians for male and female patients were closely related despite considerable variation due to the current analytical variation. This relationship was confirmed by the calculated half-range for the monthly ratio between the genders of 0.44%, which surpasses the optimum analytical performance specification for bias of serum albumin (0.72%). The weekly ratio had a half-range of 1.83%, which surpasses the minimum analytical performance specifications of 2.15%. Monthly gender-partitioned patient medians of serum albumin are useful for monitoring of long-term analytical stability, where the gender medians are two independent estimates of changes in (delta) bias: only results requested by GP are of value in this application to ensure that all patients are sitting during phlebotomy.
-
ter Hoeven, Claartje L.; Zandbelt, Linda C.; Fransen, Sanne; de Haes, Hanneke; Oort, Frans; Geijsen, Debby; Koning, Caro; Smets, Ellen
2011-01-01
Objectives: This paper describes the further development and psychometric properties of an instrument to measure cancer patients' reasons to want complete or limited information: the Considerations Concerning Cancer Information questionnaire (CCCI). Understanding cancer patients' reasons to want
-
Jeffery, Alvin D
2015-06-01
The expansion of real-time analytic abilities within current electronic health records has led to innovations in predictive modeling and clinical decision support systems. However, the ability of these systems to influence patient outcomes is currently unknown. Even though nurses are the largest profession within the healthcare workforce, little research has been performed to explore the impact of clinical decision support on their decisions and the patient outcomes associated with them. A scoping literature review explored the impact clinical decision support systems containing healthcare predictive analytics have on four nursing-sensitive patient outcomes (pressure ulcers, failure to rescue, falls, and infections). While many articles discussed variable selection and predictive model development/validation, only four articles examined the impact on patient outcomes. The novelty of predictive analytics and the inherent methodological challenges in studying clinical decision support impact are likely responsible for this paucity of literature. Major methodological challenges include (1) multilevel nature of intervention, (2) treatment fidelity, and (3) adequacy of clinicians' subsequent behavior. There is currently insufficient evidence to demonstrate efficacy of healthcare predictive analytics-enhanced clinical decision support systems on nursing-sensitive patient outcomes. Innovative research methods and a greater emphasis on studying this phenomenon are needed.
-
Increase in palliative sedation and reasons in cancer patients in Dutch general practice 2005–2014.
Donker, G.A.; Dijk, C.E. van
2015-01-01
Background: Little is known about the quantity and reasons for use of palliative sedation in cancer patients in general practice and the reason to apply palliative sedation when a request for euthanasia was pending. Aim: To gain more insight into the reasons for palliative sedation at the end of life, also when a request for euthanasia was pending in cancer patients in Dutch general practice. Design and setting: Dynamic cohort study using registrations and questionnaire data of Dutch GPs. Met...
-
Measurement Models for Reasoned Action Theory
Hennessy, Michael; Bleakley, Amy; Fishbein, Martin
2012-01-01
Quantitative researchers distinguish between causal and effect indicators. What are the analytic problems when both types of measures are present in a quantitative reasoned action analysis? To answer this question, we use data from a longitudinal study to estimate the association between two constructs central to reasoned action theory: behavioral beliefs and attitudes toward the behavior. The belief items are causal indicators that define a latent variable index while the attitude items are ...
-
Chaudhuri, Arjun; Buck, Ross
1995-01-01
Develops and tests hypotheses concerning the relationship of specific advertising strategies to affective and analytic cognitive responses of the audience. Analyses undergraduate students' responses to 240 advertisements. Demonstrates that advertising strategy variables accounted substantially for the variance in affective and analytic cognition.…
-
Gerber, Anne; Thevoz, Anne-Laure; Ramelet, Anne-Sylvie
2015-02-01
Pain assessment in mechanically ventilated patients is challenging, because nurses need to decode pain behaviour, interpret pain scores, and make appropriate decisions. This clinical reasoning process is inherent to advanced nursing practice, but is poorly understood. A better understanding of this process could contribute to improved pain assessment and management. This study aimed to describe the indicators that influence expert nurses' clinical reasoning when assessing pain in critically ill nonverbal patients. This descriptive observational study was conducted in the adult intensive care unit (ICU) of a tertiary referral hospital in Western Switzerland. A purposive sample of expert nurses, caring for nonverbal ventilated patients who received sedation and analgesia, were invited to participate in the study. Data were collected in "real life" using recorded think-aloud combined with direct non-participant observation and brief interviews. Data were analysed using deductive and inductive content analyses using a theoretical framework related to clinical reasoning and pain. Seven expert nurses with an average of 7.85 (±3.1) years of critical care experience participated in the study. The patients had respiratory distress (n=2), cardiac arrest (n=2), sub-arachnoid bleeding (n=1), and multi-trauma (n=2). A total of 1344 quotes in five categories were identified. Patients' physiological stability was the principal indicator for making decision in relation to pain management. Results also showed that it is a permanent challenge for nurses to discriminate situations requiring sedation from situations requiring analgesia. Expert nurses mainly used working knowledge and patterns to anticipate and prevent pain. Patient's clinical condition is important for making decision about pain in critically ill nonverbal patients. The concept of pain cannot be assessed in isolation and its assessment should take the patient's clinical stability and sedation into account. Further
-
Increase in palliative sedation and reasons in cancer patients in Dutch general practice 2005–2014.
Donker, G.A.; Dijk, C.E. van
2015-01-01
Background: Little is known about the quantity and reasons for use of palliative sedation in cancer patients in general practice and the reason to apply palliative sedation when a request for euthanasia was pending. Aim: To gain more insight into the reasons for palliative sedation at the end of
-
Martín Alvarez, H; Plaza Cano, M; Estirado de Cabo, E; García de Aguinaga, M; Izquierdo Martínez, M; Posada de la Paz, M
2000-06-01
To report the symptoms and analytical findings observed in the collective of patients affected with the toxic oil syndrome (TOS) 18 years after the poisoning. At the Centro de Investigación sobre el Síndrome del Aceite Tóxico (CISAT) we followed the clinical and analytical course of 758 patients affected with the TOS since December 1997 up to May 1999. Patients were evaluated by means of a previously standardized questionnaire in which a clinical review and a battery of complementary tests (thyroid hormones, spirometry with diffusion test and arterial gasometry) were included. One hundred and sixty-two patients underwent also echocardiogram because of presumptive pulmonary hypertension and/or heart disease. Out of the 758 patients, 516 were females and 242 males (M:F ratio 2:1), with ages ranging from 17 to 84 years (mean age 47 years). One of the most remarkable findings was the increased prevalence of cardiovascular risk factors: arterial hypertension (34%), dyslipemias (44%), overweight (40%), obesity (27%), carbohydrate intolerance (9%) and diabetes mellitus (9.4%). The most common reported symptoms were: cramps (78%), arthralgias (78%), and paresthesias (70%). Only 2.8% of patients reported to be asymptomatic. The analytical results most commonly changed were: changes in lipidic and carbohydrate metabolism (already reported), overt or subclinical hypothyroidism (6.6%) and respiratory changes in patients with no previous pulmonary disease: changes in spirometry (6%), diffusion test (8%) and hypoxemia (18%). Echocardiographic findings suggestive of PHT were obtained in 3.1% of cases. Although TOS occurred in 1981, this syndrome still has a relevant morbidity in a portion of the spanish population. To remark the high prevalence of cardiovascular risk factors with changes in lipidic and carbohydrate metabolism and subclinical hypothyroidism observed in our series. Further studies are necessary to evaluate the actual dimension of this poisoning.
-
The levels of the reason in Islam: An answer to the critique of the Islamic reason of Arkoun
Directory of Open Access Journals (Sweden)
Halilović Seid
2016-01-01
Full Text Available Mohammed Arkoun, who was the professor of Islamic Studies at the New Sorbonne University for many years, can be considered one of the most influential reformist thinkers of the contemporary Islamic world. In the light of his most fundamental views about the critique of the Islamic reason, he brought about many changes in the methodology of understanding of intellectual and cultural inheritance of Islam in most expert circles in the West and throughout the Islamic world. He writes in detail about this and says that the epistemological foundations and traditional analytical tools of Islam lack any kind of value today. From his epistemological standpoint, modern man, he says, sees them to be irrational. He emphasizes that traditional Muslim theologians and jurisprudents have erroneously been teaching that the Islamic reason is an absolute reason and that it is not connected to any historical contexts. In the same vein, he attempts to prove that the reason (that the Qur'an mentions is simply a practical and empirical reason. In this article, by using the philosophical analytical method, we will examine the content of some of the most important works of Arkoun. In those, he has explained in detail his critique of the Islamic reason. While answering his criticism, we will explain that the Qur'an and the totality of the Islamic scientific inheritance gives cosmological value to the different levels of the reason and that it does not in any manner reduce truth and knowledge at the level of instrumental and empirical reason. We will talk about 11 types of reasons that have been mentioned in Islam. These are the following: conceptual reason, theoretical reason, practical reason, metaphysical reason, common sense, universal reason, particular reason, empirical reason, instrumental reason, intuitive reason and sacred reason. In contrast to Arkoun, who considers Western thought to be the standard by means of which one must reconstruct the Islamic reason, we
-
Biological variation and analytical imprecision of CA 125 in patients with ovarian cancer
DEFF Research Database (Denmark)
Tuxen, M K; Sölétormos, G; Rustin, G J
2000-01-01
Despite the availability of serial data on CA 125 in ovarian cancer, the problem of interpreting a change over time is still unsolved. Changes in marker concentrations are due not only to patients improving or deteriorating but also to analytical imprecision and normal intra-individual biological...... variation. The aim of this study was to assess the analytical imprecision (CV(A)) and the intra- and inter-individual biological variation (CV(I) and CV(G), respectively) of CA 125 in a group of 26 patients with clinically stable ovarian cancer. Furthermore, the critical difference for a change between two...
-
Connecting mathematics learning through spatial reasoning
Mulligan, Joanne; Woolcott, Geoffrey; Mitchelmore, Michael; Davis, Brent
2018-03-01
Spatial reasoning, an emerging transdisciplinary area of interest to mathematics education research, is proving integral to all human learning. It is particularly critical to science, technology, engineering and mathematics (STEM) fields. This project will create an innovative knowledge framework based on spatial reasoning that identifies new pathways for mathematics learning, pedagogy and curriculum. Novel analytical tools will map the unknown complex systems linking spatial and mathematical concepts. It will involve the design, implementation and evaluation of a Spatial Reasoning Mathematics Program (SRMP) in Grades 3 to 5. Benefits will be seen through development of critical spatial skills for students, increased teacher capability and informed policy and curriculum across STEM education.
-
Castellano, Sandra; Palomares, Inés; Molina, Manuel; Pérez-García, Rafael; Aljama, Pedro; Ramos, Rosa; Merello, J Ignacio
2014-11-17
Fluid overload is an important and modifiable cardiovascular risk factor for haemodialysis patients. So far, the diagnosis was based on clinical methods alone. Nowadays, we have new tools to assess more objectively the hydration status of the patients on haemodialysis, as BCM (Body Composition Monitor). A Relative Overhydration (AvROH) higher than 15% (it means, Absolute Overhydration or AWOH higher than 2.5 Litres) is associated to greater risk in haemodialysis. However, there is a group of maintained hyperhydrated patients. The aim of the present study is to identify the characteristics of patients with maintained hyperhydrated status (AvROH higher than 15% or AWOH higher than 2.5 liters). The secondary aim is to show the hemodynamic and analytical changes that are related to the reduction in hyperhydration status. Longitudinal cohort study during six months in 2959 patients in haemodialysis (HD) that are grouped according to their hydration status by BCM. And we compare their clinical, analytical and bioimpedance spectroscopy parameters. The change in overhydration status is followed by a decrease in blood pressure and the need for hypotensive drugs (AHT) and erythropoiesis stimulating agents (ESA). The target hydration status is not reached by two subgroups of patients. First, in diabetic patients with a high comorbidity index and high number of hypotensive drugs (AHT) but a great positive sodium gradient during dialysis sessions; and, younger non-diabetic patients with longer time on hemodialysis and positive sodium gradient, lower fat tissue index (FTI) but similar lean tissue index (LTI) and albumin than those with a reduction in hyperhydration status. Those patients with a reduction in hyperhydration status, also show a better control in blood pressure and anemia with less number of AHT and ESA. The maintained hyperhydrated patients, diabetic patients with many comorbidities and young men patients with longer time on hemodialysis and non-adherence treatment
-
Use of an online survey to detect reasons for low physical activity in COPD patients
Vorrink, S.N.W.; Kort, H.S.M.; Lammers, J.J.
2012-01-01
We developed an online survey for COPD patients to investigate which reasons patients themselves list for being less active. In addition, this survey provides information on whether the internet proves to be a usable platform to administer surveys in COPD patients.
-
Reasoning Ability and Academic Achievement among Secondary School Students in Trivandrum
Rani, K. V.
2017-01-01
Reasoning ability is the 'problem solving skills' or 'analytical ability' or 'deductive and inductive reasoning'. Academic achievement is the total score one achieved at school, college, or university from class, laboratory, library, or field work. The objectives of the study were to explore the relationship between reasoning ability and academic…
-
Durning, Steven J; Dong, Ting; Artino, Anthony R; van der Vleuten, Cees; Holmboe, Eric; Schuwirth, Lambert
2015-08-01
An ongoing debate exists in the medical education literature regarding the potential benefits of pattern recognition (non-analytic reasoning), actively comparing and contrasting diagnostic options (analytic reasoning) or using a combination approach. Studies have not, however, explicitly explored faculty's thought processes while tackling clinical problems through the lens of dual process theory to inform this debate. Further, these thought processes have not been studied in relation to the difficulty of the task or other potential mediating influences such as personal factors and fatigue, which could also be influenced by personal factors such as sleep deprivation. We therefore sought to determine which reasoning process(es) were used with answering clinically oriented multiple-choice questions (MCQs) and if these processes differed based on the dual process theory characteristics: accuracy, reading time and answering time as well as psychometrically determined item difficulty and sleep deprivation. We performed a think-aloud procedure to explore faculty's thought processes while taking these MCQs, coding think-aloud data based on reasoning process (analytic, nonanalytic, guessing or combination of processes) as well as word count, number of stated concepts, reading time, answering time, and accuracy. We also included questions regarding amount of work in the recent past. We then conducted statistical analyses to examine the associations between these measures such as correlations between frequencies of reasoning processes and item accuracy and difficulty. We also observed the total frequencies of different reasoning processes in the situations of getting answers correctly and incorrectly. Regardless of whether the questions were classified as 'hard' or 'easy', non-analytical reasoning led to the correct answer more often than to an incorrect answer. Significant correlations were found between self-reported recent number of hours worked with think-aloud word count
-
Cuadrado-Cenzual, M A; García Briñón, M; de Gracia Hills, Y; González Estecha, M; Collado Yurrita, L; de Pedro Moro, J A; Fernández Pérez, C; Arroyo Fernández, M
2015-01-01
Patient identification errors and biological samples are one of the problems with the highest risk factor in causing an adverse event in the patient. To detect and analyse the causes of patient identification errors in analytical requests (PIEAR) from emergency departments, and to develop improvement strategies. A process and protocol was designed, to be followed by all professionals involved in the requesting and performing of laboratory tests. Evaluation and monitoring indicators of PIEAR were determined, before and after the implementation of these improvement measures (years 2010-2014). A total of 316 PIEAR were detected in a total of 483,254 emergency service requests during the study period, representing a mean of 6.80/10,000 requests. Patient identification failure was the most frequent in all the 6-monthly periods assessed, with a significant difference (Perrors. However, we must continue working with this strategy, promoting a culture of safety for all the professionals involved, and trying to achieve the goal that 100% of the analytical and samples are properly identified. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.
-
Bergwall, Andreas
2017-01-01
Several recent textbook studies focus on opportunities to learn reasoning-and-proving. They typically investigate the extent to which justifications are general proofs and what opportunities exist for learning important elements of mathematical reasoning. In this paper, I discuss how a particular analytical framework for this might be refined. Based on an in-depth analysis of certain textbook passages in upper secondary calculus textbooks, I make an account for analytical issues encountered d...
-
Campbell, David; Walters, Lucie; Couper, Ian; Greacen, Jane
2017-12-01
This article reports the findings from an international research workshop, held over 2 days in October 2014 in Bairnsdale, Australia, which brought together 19 clinician teachers and medical educators who work in rural primary care. The objectives of the workshop were to clarify and identify the key aspects of the development of clinical reasoning in students and junior doctors, particularly as a result of longitudinal immersion in rural community practice. Delegates were asked to prepare a 55-word vignette related to their experience of teaching clinical reasoning, and these case studies formed the basis of identification of key issues, further refined via a modified Delphi process. The workshop identified four key themes: the patient’s story, the learner’s reasoning, the context of learning, and the role of the supervisor. Exposure to undifferentiated patient presentations is increasingly common in medical education, particularly in longitudinal integrated placements. This research explored clinicians’ perspectives of how students develop their clinical reasoning: by learning from patients, from their supervisors and by understanding the context of their clinical interactions. .
-
Registered nurses' clinical reasoning skills and reasoning process: A think-aloud study.
Lee, JuHee; Lee, Young Joo; Bae, JuYeon; Seo, Minjeong
2016-11-01
As complex chronic diseases are increasing, nurses' prompt and accurate clinical reasoning skills are essential. However, little is known about the reasoning skills of registered nurses. This study aimed to determine how registered nurses use their clinical reasoning skills and to identify how the reasoning process proceeds in the complex clinical situation of hospital setting. A qualitative exploratory design was used with a think-aloud method. A total of 13 registered nurses (mean years of experience=11.4) participated in the study, solving an ill-structured clinical problem based on complex chronic patients cases in a hospital setting. Data were analyzed using deductive content analysis. Findings showed that the registered nurses used a variety of clinical reasoning skills. The most commonly used skill was 'checking accuracy and reliability.' The reasoning process of registered nurses covered assessment, analysis, diagnosis, planning/implementation, and evaluation phase. It is critical that registered nurses apply appropriate clinical reasoning skills in complex clinical practice. The main focus of registered nurses' reasoning in this study was assessing a patient's health problem, and their reasoning process was cyclic, rather than linear. There is a need for educational strategy development to enhance registered nurses' competency in determining appropriate interventions in a timely and accurate fashion. Copyright © 2016 Elsevier Ltd. All rights reserved.
-
COGITA network has constructed a glossary of diagnostic reasoning terms.
Barais, Marie; Hauswaldt, Johannes; Dinant, Geert-Jan; van de Wiel, Margje; Stolper, C F Erik; Van Royen, Paul
2017-12-01
The role of gut feelings in diagnostic reasoning is recognized by most GPs throughout Europe, and probably throughout the world. Studies on this topic have emerged from different countries but there is the risk that authors will use different terms for similar concepts. The European Expert Group on Cognitive and Interactive Processes in Diagnosis and Management in General Practice, COGITA for short, was founded in 2008 to conduct cross-border research in the area of non-analytical diagnostic reasoning. Academic GPs, PhD students, psychologists, linguists and students meet once a year to share their experiences, exchange results and initiate new studies on the topic. A milestone in their research is this publication of a short glossary of diagnostic reasoning terms relating to the gut feelings research topic. It was constructed by the COGITA group members following a literature review, which aimed to define salient terms used in their publications. They described the terms, cross-reviewed the wording and reached consensus within the group. Two sections were created: (1) a diagnostic reasoning section that describes concepts such as analytical and non-analytical reasoning, clinical mind lines, and intuition, and (2) a research methods section describing concepts such as linguistic validity and saturation. The glossary, including relevant literature, has been published on the website http://www.gutfeelingsingeneralpractice.eu . In the future, the glossary will be modified if necessary and completed by members of the COGITA group. [Box: see text].
-
Fast analytical scatter estimation using graphics processing units.
Ingleby, Harry; Lippuner, Jonas; Rickey, Daniel W; Li, Yue; Elbakri, Idris
2015-01-01
To develop a fast patient-specific analytical estimator of first-order Compton and Rayleigh scatter in cone-beam computed tomography, implemented using graphics processing units. The authors developed an analytical estimator for first-order Compton and Rayleigh scatter in a cone-beam computed tomography geometry. The estimator was coded using NVIDIA's CUDA environment for execution on an NVIDIA graphics processing unit. Performance of the analytical estimator was validated by comparison with high-count Monte Carlo simulations for two different numerical phantoms. Monoenergetic analytical simulations were compared with monoenergetic and polyenergetic Monte Carlo simulations. Analytical and Monte Carlo scatter estimates were compared both qualitatively, from visual inspection of images and profiles, and quantitatively, using a scaled root-mean-square difference metric. Reconstruction of simulated cone-beam projection data of an anthropomorphic breast phantom illustrated the potential of this method as a component of a scatter correction algorithm. The monoenergetic analytical and Monte Carlo scatter estimates showed very good agreement. The monoenergetic analytical estimates showed good agreement for Compton single scatter and reasonable agreement for Rayleigh single scatter when compared with polyenergetic Monte Carlo estimates. For a voxelized phantom with dimensions 128 × 128 × 128 voxels and a detector with 256 × 256 pixels, the analytical estimator required 669 seconds for a single projection, using a single NVIDIA 9800 GX2 video card. Accounting for first order scatter in cone-beam image reconstruction improves the contrast to noise ratio of the reconstructed images. The analytical scatter estimator, implemented using graphics processing units, provides rapid and accurate estimates of single scatter and with further acceleration and a method to account for multiple scatter may be useful for practical scatter correction schemes.
-
Biological variation and analytical imprecision of CA 125 in patients with ovarian cancer
DEFF Research Database (Denmark)
Tuxen, M K; Sölétormos, G; Rustin, G J
2000-01-01
Despite the availability of serial data on CA 125 in ovarian cancer, the problem of interpreting a change over time is still unsolved. Changes in marker concentrations are due not only to patients improving or deteriorating but also to analytical imprecision and normal intra-individual biological...... variation. The aim of this study was to assess the analytical imprecision (CV(A)) and the intra- and inter-individual biological variation (CV(I) and CV(G), respectively) of CA 125 in a group of 26 patients with clinically stable ovarian cancer. Furthermore, the critical difference for a change between two...... for serum tumor marker assessment during monitoring of patients with ovarian cancer. The cut-off value of CA 125 is of minor value in detecting unusual results for an individual subject, when previous measurements from an individual are available. These measurements should be preferred as reference...
-
Barken, Tina Lien; Thygesen, Elin; Söderhamn, Ulrika
2017-12-28
Telemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses' reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine nurses' clinical reasoning when using a computerised decision support system for the management of patients with chronic obstructive pulmonary disease. The factors influencing the reasoning and decision-making processes were investigated. In this ethnographic study, a combination of data collection methods, including participatory observations, the think-aloud technique, and a focus group interview was employed. Collected data were analysed using qualitative content analysis. When telemedicine nurses used a computerised decision support system for the management of patients with complex, unstable chronic obstructive pulmonary disease, two categories emerged: "the process of telemedicine nurses' reasoning to assess health change" and "the influence of the telemedicine setting on nurses' reasoning and decision-making processes". An overall theme, termed "advancing beyond the system", represented the connection between the reasoning processes and the telemedicine work and setting, where being familiar with the patient functioned as a foundation for the nurses' clinical reasoning process. In the telemedicine setting, when supported by a computerised decision support system, nurses' reasoning was enabled by the continuous flow of digital clinical data, regular video-mediated contact and shared decision
-
Krupa, Lukasz Z.; Kennedy, Hugh J.; Jamieson, Crawford P.; Fisher, Nicola; Hart, Andrew R.
2011-01-01
Introduction. There is little information on the reasons for discontinuing infliximab treatment in patients with Crohn's disease. The aim of this study was to document these reasons to determine if any were preventable which would allow patients to continue the therapy. Aims & Methods. A review of the medical notes was conducted at the Norfolk and Norwich University Hospital on patients with Crohn's disease treated with infliximab between 2002–2008 to determine the reasons for stopping it. Re...
-
Measurement Models for Reasoned Action Theory.
Hennessy, Michael; Bleakley, Amy; Fishbein, Martin
2012-03-01
Quantitative researchers distinguish between causal and effect indicators. What are the analytic problems when both types of measures are present in a quantitative reasoned action analysis? To answer this question, we use data from a longitudinal study to estimate the association between two constructs central to reasoned action theory: behavioral beliefs and attitudes toward the behavior. The belief items are causal indicators that define a latent variable index while the attitude items are effect indicators that reflect the operation of a latent variable scale. We identify the issues when effect and causal indicators are present in a single analysis and conclude that both types of indicators can be incorporated in the analysis of data based on the reasoned action approach.
-
Hansen, Steen Ingemann; Petersen, Per Hyltoft; Lund, Flemming; Fraser, Callum G; Sölétormos, György
2017-10-26
During monitoring of monthly medians of results from patients undertaken to assess analytical stability in routine laboratory performance, the medians for serum sodium for male and female patients were found to be significantly related. Daily, weekly and monthly patient medians of serum sodium for both male and female patients were calculated from results obtained on samples from the population >18 years on three analysers in the hospital laboratory. The half-range of medians was applied as an estimate of the maximum bias. Further, the ratios between the two medians were calculated. The medians of both genders demonstrated dispersions over time, but they were closely connected in like patterns, which were confirmed by the half-range of the ratios of medians for males and females that varied from 0.36% for daily, 0.14% for weekly and 0.036% for monthly ratios over all instruments. The tight relationship between the gender medians for serum sodium is only possible when raw laboratory data are used for calculation. The two patient medians can be used to confirm both and are useful as independent estimates of analytical bias during constant calibration periods. In contrast to the gender combined median, the estimate of analytical bias can be confirmed further by calculation of the ratios of medians for males and females.
-
Kaldjian, Lauris Christopher
2013-01-01
The communication of moral reasoning in medicine can be understood as a means of showing respect for patients and colleagues through the giving of moral reasons for actions. This communication is especially important when disagreements arise. While moral reasoning should strive for impartiality, it also needs to acknowledge the individual moral beliefs and values that distinguish each person (moral particularity) and give rise to the challenge of contrasting moral frameworks (moral pluralism). Efforts to communicate moral reasoning should move beyond common approaches to principles-based reasoning in medical ethics by addressing the underlying beliefs and values that define our moral frameworks and guide our interpretations and applications of principles. Communicating about underlying beliefs and values requires a willingness to grapple with challenges of accessibility (the degree to which particular beliefs and values are intelligible between persons) and translatability (the degree to which particular beliefs and values can be transposed from one moral framework to another) as words and concepts are used to communicate beliefs and values. Moral dialogues between professionals and patients and among professionals themselves need to be handled carefully, and sometimes these dialogues invite reference to underlying beliefs and values. When professionals choose to articulate such beliefs and values, they can do so as an expression of respectful patient care and collaboration and as a means of promoting their own moral integrity by signaling the need for consistency between their own beliefs, words and actions.
-
Annema, Coby; Luttik, Marie-Louise; Jaarsma, Tiny
2009-01-01
OBJECTIVE: Despite efforts to improve outcomes in heart failure (HF), readmission rates remain relatively high. Reasons for readmission from different perspectives (patient, caregiver, health care providers) may help to optimize the future management of patients with HF. The aims of this study are
-
Luo, Xingwei; Wang, Qin; Wang, Xiang; Cai, Taisheng
2016-07-20
The risk factors of suicidal ideation and attempts have been discussed in many researches. Few studies have examined reasons for living and hope as protective factors against suicide in a clinical population. It is unclear if these factors help to reduce suicide rates in patients with depression. The study aimed to assess the role of reasons for living and hope in the identification and reduction of suicidality and explore the influence of reasons for living or hope in the transition from suicidal ideation to suicide attempts. Patients with depression (N = 115) completed the Beck Depression Inventory, Reasons for Living Inventory, and Adult Suicidal Ideation Questionnaire. There were significant correlations among depression, hope, total reasons for living, and suicidal ideation and attempts. Further, after controlling for depression, reasons for living and hope had significant main effects on suicidal ideation. Hope also had a significant predictive effect in the transition of suicidal ideation to suicide attempt. We concluded that reasons for living and hope may protect against suicidal ideation and attempts in patients with depression. Especially hope could reduce the possibility of suicide attempt.
-
The role of the DLPFC in inductive reasoning of MCI patients and normal agings: an fMRI study.
Yang, YanHui; Liang, PeiPeng; Lu, ShengFu; Li, KunCheng; Zhong, Ning
2009-08-01
Previous studies of young people have revealed that the left dorsolateral prefrontal cortex (DLPFC) plays an important role in inductive reasoning. An fMRI experiment was performed in this study to examine whether the left DLPFC was involved in inductive reasoning of MCI patients and normal aging, and whether the activation pattern of this region was different between MCI patients and normal aging. The fMRI results indicated that MCI patients had no difference from normal aging in behavior performance (reaction time and accuracy) and the activation pattern of DLPFC. However, the BOLD response of the DLPFC region for MCI patients was weaker than that for normal aging, and the functional connectivity between the bilateral DLPFC regions for MCI patients was significantly higher than for normal aging. Taken together, these results indicated that DLPFC plays an important role in inductive reasoning of aging, and the functional abnormity of DLPFC may be an earlier marker of MCI before structural alterations.
-
Horigan, G; Davies, M; Findlay-White, F; Chaney, D; Coates, V
2017-01-01
To identify the reasons why those offered a place on diabetes education programmes declined the opportunity. It is well established that diabetes education is critical to optimum diabetes care; it improves metabolic control, prevents complications, improves quality of life and empowers people to make informed choices to manage their condition. Despite the significant clinical and personal rewards offered by diabetes education, programmes are underused, with a significant proportion of patients choosing not to attend. A systematic search of the following databases was conducted for the period from 2005-2015: Medline; EMBASE; Scopus; CINAHL; and PsycINFO. Studies that met the inclusion criteria focusing on patient-reported reasons for non-attendance at structured diabetes education were selected. A total of 12 studies spanning quantitative and qualitative methodologies were included. The selected studies were published in Europe, USA, Pakistan, Canada and India, with a total sample size of 2260 people. Two broad categories of non-attender were identified: 1) those who could not attend for logistical, medical or financial reasons (e.g. timing, costs or existing comorbidities) and 2) those who would not attend because they perceived no benefit from doing so, felt they had sufficient knowledge already or had emotional and cultural reasons (e.g. no perceived problem, denial or negative feelings towards education). Diabetes education was declined for many reasons, and the range of expressed reasons was more diverse and complex than anticipated. New and innovative methods of delivering diabetes education are required which address the needs of people with diabetes whilst maintaining quality and efficiency. © 2016 Diabetes UK.
-
The Reasons Of Patients With Headache Chosing The Neurosurgery Outpatient Clinic
Directory of Open Access Journals (Sweden)
Halil Murat Şen
2014-09-01
Full Text Available OBJECTIVE: We aimed to investigate the preference causes of the patients who were admitted to the neurosurgery clinic with complaints of headache for admission in this clinic. METHODS: The study population has been selected from brain surgery department outpatient clinic. One hundred patients with complaints of headache were enrolled in this study. RESULTS: Questioned the reasons for choosing the neurosurgical and most preferred cause of including word for brain surgery of the brain named (n=54, 54%. Patients were questioned about the information of the neurology and demostrated that there was not any knowledge about neurology (n=66, 66%. CONCLUSION: Headache causes loss of the financial and workforce. Preferences in the wrong departments of the patients, as a result of misdiagnosis and inadequate treatment, increasing the number of hospital admissions. This shows that how important names and introduction of the departments
-
Jędrkiewicz, Renata; Orłowski, Aleksander; Namieśnik, Jacek; Tobiszewski, Marek
2016-01-15
In this study we perform ranking of analytical procedures for 3-monochloropropane-1,2-diol determination in soy sauces by PROMETHEE method. Multicriteria decision analysis was performed for three different scenarios - metrological, economic and environmental, by application of different weights to decision making criteria. All three scenarios indicate capillary electrophoresis-based procedure as the most preferable. Apart from that the details of ranking results differ for these three scenarios. The second run of rankings was done for scenarios that include metrological, economic and environmental criteria only, neglecting others. These results show that green analytical chemistry-based selection correlates with economic, while there is no correlation with metrological ones. This is an implication that green analytical chemistry can be brought into laboratories without analytical performance costs and it is even supported by economic reasons. Copyright © 2015 Elsevier B.V. All rights reserved.
-
Social comparisons in adults with type 2 diabetes: Patients' reasons for target selection.
Arigo, Danielle; Cornell, Max; Smyth, Joshua M
2018-07-01
To examine reasons for selecting a social comparison target (i.e. a specific other for relative self-evaluation), and their influence on affect and motivation for self-care, in type 2 diabetes (T2DM). Adults with T2DM (n = 180, M A1c = 7.6%) chose to read about one of four targets. Participants rated five reasons for their choice (strongly disagree - strongly agree), and rated affect and self-care motivation before and after reading. To boost confidence in my ability to manage diabetes was rated highest overall (ps motivation (p motivation only among those who chose better-off targets (p = 0.01). Patients' reasons for a particular comparison are associated with short-term changes in affect and self-care motivation, and warrant greater empirical and clinical attention.
-
Kokis, Judite V.; Macpherson, Robyn; Toplak, Maggie E.; West, Richard F.; Stanovich, Keith E.
2002-01-01
Examined developmental and individual differences in tendencies to favor analytic over heuristic responses in three tasks (inductive reasoning, deduction under belief bias conditions, probabilistic reasoning) in children varying in age and cognitive ability. Found significant increases in analytic responding with development on first two tasks.…
-
Directory of Open Access Journals (Sweden)
Bolge SC
2015-01-01
Full Text Available Susan C Bolge,1 Amir Goren,2 Neeta Tandon1 1Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Horsham, PA, USA; 2Health Outcomes Practice, Kantar Health, New York, NY, USA Objective: To examine reasons why rheumatoid arthritis patients discontinued subcutaneous (SQ anti-tumor necrosis factor (anti-TNF treatment in the past 12 months, so as to help inform successful, uninterrupted therapy.Methods: Data were collected in March and April 2011 using self-reported, internet-based questionnaires. Study inclusion criteria comprised: rheumatoid arthritis diagnosis; discontinuation of SQ anti-TNF medication (adalimumab, certolizumab, etanercept, or golimumab within the past 12 months; aged ≥18 years; United States residency; and consent to participate. Patients reported primary and other reasons for discontinuation of their most recently discontinued anti-TNF.Results: Questionnaires from 250 patients were analyzed; 72.8% were female, 80.8% were white, and median age was 51 years. Patients had discontinued etanercept (n=109, adalimumab (n=98, certolizumab (n=24, or golimumab (n=19 within the past 12 months. When prompted about their primary reason for discontinuation, lack of effectiveness (40.8% was cited most often, followed by injection experience (18.4%. Combining prompted primary and other reasons for discontinuation, 60.8% of patients reported lack of effectiveness, while 40.8% reported injection experience, which included: pain/burning/discomfort after injection (14.4%; pain/burning/discomfort during injection (13.2%; injection reactions such as redness/swelling after injection (12.4%; dislike of self-injection (11.6%; dislike of frequency of injection (10.4%; and fear of injection/needles (6.8%. Conclusion: From the patient perspective, there are unmet needs with regard to the effectiveness and injection experience associated with SQ anti-TNF medications, which may lead to discontinuation. Treatment options with a
-
Using Relational Reasoning Strategies to Help Improve Clinical Reasoning Practice.
Dumas, Denis; Torre, Dario M; Durning, Steven J
2018-05-01
Clinical reasoning-the steps up to and including establishing a diagnosis and/or therapy-is a fundamentally important mental process for physicians. Unfortunately, mounting evidence suggests that errors in clinical reasoning lead to substantial problems for medical professionals and patients alike, including suboptimal care, malpractice claims, and rising health care costs. For this reason, cognitive strategies by which clinical reasoning may be improved-and that many expert clinicians are already using-are highly relevant for all medical professionals, educators, and learners.In this Perspective, the authors introduce one group of cognitive strategies-termed relational reasoning strategies-that have been empirically shown, through limited educational and psychological research, to improve the accuracy of learners' reasoning both within and outside of the medical disciplines. The authors contend that relational reasoning strategies may help clinicians to be metacognitive about their own clinical reasoning; such strategies may also be particularly well suited for explicitly organizing clinical reasoning instruction for learners. Because the particular curricular efforts that may improve the relational reasoning of medical students are not known at this point, the authors describe the nature of previous research on relational reasoning strategies to encourage the future design, implementation, and evaluation of instructional interventions for relational reasoning within the medical education literature. The authors also call for continued research on using relational reasoning strategies and their role in clinical practice and medical education, with the long-term goal of improving diagnostic accuracy.
-
Durning, Steven J; Costanzo, Michelle E; Beckman, Thomas J; Artino, Anthony R; Roy, Michael J; van der Vleuten, Cees; Holmboe, Eric S; Lipner, Rebecca S; Schuwirth, Lambert
2016-06-01
Diagnostic reasoning involves the thinking steps up to and including arrival at a diagnosis. Dual process theory posits that a physician's thinking is based on both non-analytic or fast, subconscious thinking and analytic thinking that is slower, more conscious, effortful and characterized by comparing and contrasting alternatives. Expertise in clinical reasoning may relate to the two dimensions measured by the diagnostic thinking inventory (DTI): memory structure and flexibility in thinking. Explored the functional magnetic resonance imaging (fMRI) correlates of these two aspects of the DTI: memory structure and flexibility of thinking. Participants answered and reflected upon multiple-choice questions (MCQs) during fMRI. A DTI was completed shortly after the scan. The brain processes associated with the two dimensions of the DTI were correlated with fMRI phases - assessing flexibility in thinking during analytical clinical reasoning, memory structure during non-analytical clinical reasoning and the total DTI during both non-analytical and analytical reasoning in experienced physicians. Each DTI component was associated with distinct functional neuroanatomic activation patterns, particularly in the prefrontal cortex. Our findings support diagnostic thinking conceptual models and indicate mechanisms through which cognitive demands may induce functional adaptation within the prefrontal cortex. This provides additional objective validity evidence for the use of the DTI in medical education and practice settings.
-
Kumar, Channaveerachari Naveen; Thirthalli, Jagadisha; Suresha, Kudumallige Krishnappa; Venkatesh, Basappa K; Kishorekumar, Kengeri V; Arunachala, Udupi; Gangadhar, Bangalore N
2016-01-01
A few studies have examined the factors associated with schizophrenia patients remaining untreated in India. We identified 184 schizophrenia patients in a rural community, offered the treatment with antipsychotics and followed them up in their Primary Health Centers for 1-year. Twenty-nine (15.8%) patients remained untreated at both the baseline and 1-year follow-up despite our best attempts to keep them under the treatment umbrella. They were interviewed in detail regarding the reasons for remaining untreated. This group was compared with another group of patients (n = 69) who had stopped the treatment at baseline but were successfully brought under the treatment umbrella throughout the 1-year follow-up period. The reasons for remaining untreated were (n; %): (a) Unsatisfactory improvement with previous treatment attempts (19; 65.5%), (b) poor bond between the patients and the families (6; 20.7%), (c) active symptoms not allowing any treatment efforts from the family members (6; 20.7%), (d) magico-religious beliefs about the illness and its treatment (4; 13.8%), (e) poor social support (3; 10.3%), (f) adverse effects of the medications (2; 6.9%), and (g) perception of recovery and cure (1; 3.4%). For many patients, a constellation of these reasons was responsible for them remaining untreated. In contrast, the common reasons for those who restarted medications to have stopped the treatment at some time were the lack of awareness, the need to continue medications (47; 68.1%), and the financial constraints (28; 40.6%). The predominant reason for schizophrenia patients not remaining on the treatment in this rural community was the families' lack of faith in antipsychotic treatment. Provision of comprehensive treatment package including medical, psychosocial and rehabilitative services, and sensitizing the community about benefits of the treatment may help in ensuring that all patients with psychosis receive the best care.
-
Directory of Open Access Journals (Sweden)
Velligan DI
2017-03-01
Full Text Available Dawn I Velligan,1 Martha Sajatovic,2 Ainslie Hatch,3 Pavel Kramata,4 John P Docherty3 1Department of Psychiatry, The University of Texas Health Science Center, San Antonio, TX, 2Departments of Psychiatry and Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, 3Medical Affairs, ODH, Inc., Princeton, NJ, 4C4 MedSolutions LLC, Yardley, PA, USA Background: Antipsychotic medication reduces the severity of serious mental illness (SMI and improves patient outcomes only when medicines were taken as prescribed. Nonadherence to the treatment of SMI increases the risk of relapse and hospitalization and reduces the quality of life. It is necessary to understand the factors influencing nonadherence to medication in order to identify appropriate interventions. This systematic review assessed the published evidence on modifiable reasons for nonadherence to antipsychotic medication in patients with SMI. Methods: Articles published between January 1, 2005, and September 10, 2015, were searched on MEDLINE through PubMed. Abstracts were independently screened by 2 randomly assigned authors for inclusion, and disagreement was resolved by another author. Selected full-text articles were divided among all authors for review. Results: A qualitative analysis of data from 36 articles identified 11 categories of reasons for nonadherence. Poor insight was identified as a reason for nonadherence in 55.6% (20/36 of studies, followed by substance abuse (36.1%, 13/36, a negative attitude toward medication (30.5%, 11/36, medication side effects (27.8%, 10/36, and cognitive impairments (13.4%, 7/36. A key reason directly associated with intentional nonadherence was a negative attitude toward medication, a mediator of effects of insight and therapeutic alliance. Substance abuse was the only reason consistently associated with unintentional nonadherence, regardless of type and stage of SMI. Discussion: Although adherence research is inherently biased
-
A comprehensive test of clinical reasoning for medical students: An olympiad experience in Iran.
Monajemi, Alireza; Arabshahi, Kamran Soltani; Soltani, Akbar; Arbabi, Farshid; Akbari, Roghieh; Custers, Eugene; Hadadgar, Arash; Hadizadeh, Fatemeh; Changiz, Tahereh; Adibi, Peyman
2012-01-01
Although some tests for clinical reasoning assessment are now available, the theories of medical expertise have not played a major role in this filed. In this paper, illness script theory was chose as a theoretical framework and contemporary clinical reasoning tests were put together based on this theoretical model. This paper is a qualitative study performed with an action research approach. This style of research is performed in a context where authorities focus on promoting their organizations' performance and is carried out in the form of teamwork called participatory research. Results are presented in four parts as basic concepts, clinical reasoning assessment, test framework, and scoring. we concluded that no single test could thoroughly assess clinical reasoning competency, and therefore a battery of clinical reasoning tests is needed. This battery should cover all three parts of clinical reasoning process: script activation, selection and verification. In addition, not only both analytical and non-analytical reasoning, but also both diagnostic and management reasoning should evenly take into consideration in this battery. This paper explains the process of designing and implementing the battery of clinical reasoning in the Olympiad for medical sciences students through an action research.
-
Symptoms of delirium: an exploratory factor analytic study among referred patients.
Jain, Gaurav; Chakrabarti, Subho; Kulhara, Parmanand
2011-01-01
Factor analytic studies of delirium symptoms among patients referred through consultation-liaison psychiatric services are rare. We examined the factor structure of delirium symptoms in referred patients and determined whether combining items from several delirium rating scales influenced the factor structure of delirium symptoms. Eighty-six patients with delirium (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) referred though the consultation-liaison services were assessed with structured rating scales. Nineteen symptom items extracted from the Delirium Rating Scale-Revised-98 (DRS-R-98), the Memorial Delirium Assessment Scale and the Confusional State Evaluation Scale were subjected to an exploratory (principal component) factor analysis. A second such analysis was conducted on 15 items of the DRS-R-98 for comparison. Compared with prior studies, patients were younger and the majority had hyperactive delirium. Principal components analysis identified two factors: (1) a "cognitive" factor comprising of disturbances in language, thought processes, orientation, attention, short- and long-term memory, visuospatial ability, consciousness (awareness) and perseveration accounted for 28.9% of the variance and (2) a "behavioral" factor consisting of sleep-wake cycle disturbances, delusions, perceptual disturbances, motor agitation, affect-lability, distractibility, irritability and temporal onset accounted for 18.9% of the variance. An identical factor structure was obtained with the DRS-R-98 items. Similar to previous factor analytic studies, the present study supported the existence of two principal dimensions of delirium, cognitive and behavioral. Additionally, it extended the results of earlier investigations to a wider group of patients with delirium, suggesting that these dimensions might provide important clues to the neurobiology of delirium. Copyright © 2011 Elsevier Inc. All rights reserved.
-
Directory of Open Access Journals (Sweden)
Marie-Eva Laurencet
Full Text Available Length of hospital stay (LHS is an indicator of clinical effectiveness. Early hospital discharge (≤72 hours is recommended in patients with acute coronary syndromes (ACS at low risk of complications, but reasons for prolonged LHS poorly reported.We collected data of ACS patients hospitalized at the Geneva University Hospitals from 1st July 2013 to 30th June 2015 and used the Zwolle index score to identify patients at low risk (≤ 3 points. We assessed the proportion of eligible patients who were successfully discharged within 72 hours and the reasons for prolonged LHS. Outcomes were defined as adherence to recommended therapies, major adverse events at 30 days and patients' satisfaction using a Likert-scale patient-reported questionnaire.Among 370 patients with ACS, 255 (68.9% were at low-risk of complications but only 128 (50.2%were eligible for early discharge, because of other clinical reasons for prolonged LHS (e.g. staged coronary revascularization, cardiac monitoring in 127 patients (49.8%. Of the latter, only 45 (35.2% benefitted from an early discharge. Reasons for delay in discharge in the remaining 83 patients (51.2% were mainly due to delays in additional investigations, titration of medical therapy, admission or discharge during weekends. In the early discharge group, at 30 days, only one patient (2.2% had an adverse event (minor bleeding, 97% of patients were satisfied by the medical care.Early discharge was successfully achieved in one third of eligible ACS patients at low risk of complications and appeared sufficiently safe while being overall appreciated by the patients.
-
Laurencet, Marie-Eva; Girardin, François; Rigamonti, Fabio; Bevand, Anne; Meyer, Philippe; Carballo, David; Roffi, Marco; Noble, Stéphane; Mach, François; Gencer, Baris
2016-01-01
Length of hospital stay (LHS) is an indicator of clinical effectiveness. Early hospital discharge (≤72 hours) is recommended in patients with acute coronary syndromes (ACS) at low risk of complications, but reasons for prolonged LHS poorly reported. We collected data of ACS patients hospitalized at the Geneva University Hospitals from 1st July 2013 to 30th June 2015 and used the Zwolle index score to identify patients at low risk (≤ 3 points). We assessed the proportion of eligible patients who were successfully discharged within 72 hours and the reasons for prolonged LHS. Outcomes were defined as adherence to recommended therapies, major adverse events at 30 days and patients' satisfaction using a Likert-scale patient-reported questionnaire. Among 370 patients with ACS, 255 (68.9%) were at low-risk of complications but only 128 (50.2%)were eligible for early discharge, because of other clinical reasons for prolonged LHS (e.g. staged coronary revascularization, cardiac monitoring) in 127 patients (49.8%). Of the latter, only 45 (35.2%) benefitted from an early discharge. Reasons for delay in discharge in the remaining 83 patients (51.2%) were mainly due to delays in additional investigations, titration of medical therapy, admission or discharge during weekends. In the early discharge group, at 30 days, only one patient (2.2%) had an adverse event (minor bleeding), 97% of patients were satisfied by the medical care. Early discharge was successfully achieved in one third of eligible ACS patients at low risk of complications and appeared sufficiently safe while being overall appreciated by the patients.
-
Context based support for Clinical Reasoning
DEFF Research Database (Denmark)
Vilstrup Pedersen, Klaus
2004-01-01
In many areas of the medical domain, the decision process i.e. reasoning, involving health care professionals is distributed, cooperative and complex. Computer based decision support systems has usually been focusing on the outcome of the decision making and treated it as a single task....... In this paper a framework for a Clinical Reasoning Knowledge Warehouse (CRKW) is presented, intended to support the reasoning process, by providing the decision participants with an analysis platform that captures and enhances information and knowledge. The CRKW mixes theories and models from Artificial...... Intelligence, Knowledge Management Systems and Business Intelligence to make context sensitive, patient case specific analysis and knowledge management. The knowledge base consists of patient health records, reasoning process information and clinical guidelines. Patient specific information and knowledge...
-
Estimation of Post-Test Probabilities by Residents: Bayesian Reasoning versus Heuristics?
Hall, Stacey; Phang, Sen Han; Schaefer, Jeffrey P.; Ghali, William; Wright, Bruce; McLaughlin, Kevin
2014-01-01
Although the process of diagnosing invariably begins with a heuristic, we encourage our learners to support their diagnoses by analytical cognitive processes, such as Bayesian reasoning, in an attempt to mitigate the effects of heuristics on diagnosing. There are, however, limited data on the use ± impact of Bayesian reasoning on the accuracy of…
-
Clinical reasoning: concept analysis.
Simmons, Barbara
2010-05-01
This paper is a report of a concept analysis of clinical reasoning in nursing. Clinical reasoning is an ambiguous term that is often used synonymously with decision-making and clinical judgment. Clinical reasoning has not been clearly defined in the literature. Healthcare settings are increasingly filled with uncertainty, risk and complexity due to increased patient acuity, multiple comorbidities, and enhanced use of technology, all of which require clinical reasoning. Data sources. Literature for this concept analysis was retrieved from several databases, including CINAHL, PubMed, PsycINFO, ERIC and OvidMEDLINE, for the years 1980 to 2008. Rodgers's evolutionary method of concept analysis was used because of its applicability to concepts that are still evolving. Multiple terms have been used synonymously to describe the thinking skills that nurses use. Research in the past 20 years has elucidated differences among these terms and identified the cognitive processes that precede judgment and decision-making. Our concept analysis defines one of these terms, 'clinical reasoning,' as a complex process that uses cognition, metacognition, and discipline-specific knowledge to gather and analyse patient information, evaluate its significance, and weigh alternative actions. This concept analysis provides a middle-range descriptive theory of clinical reasoning in nursing that helps clarify meaning and gives direction for future research. Appropriate instruments to operationalize the concept need to be developed. Research is needed to identify additional variables that have an impact on clinical reasoning and what are the consequences of clinical reasoning in specific situations.
-
Diagnostic reasoning: where we've been, where we're going.
Monteiro, Sandra M; Norman, Geoffrey
2013-01-01
Recently, clinical diagnostic reasoning has been characterized by "dual processing" models, which postulate a fast, unconscious (System 1) component and a slow, logical, analytical (System 2) component. However, there are a number of variants of this basic model, which may lead to conflicting claims. This paper critically reviews current theories and evidence about the nature of clinical diagnostic reasoning. We begin by briefly discussing the history of research in clinical reasoning. We then focus more specifically on the evidence to support dual-processing models. We conclude by identifying knowledge gaps about clinical reasoning and provide suggestions for future research. In contrast to work on analytical and nonanalytical knowledge as a basis for reasoning, these theories focus on the thinking process, not the nature of the knowledge retrieved. Ironically, this appears to be a revival of an outdated concept. Rather than defining diagnostic performance by problem-solving skills, it is now being defined by processing strategy. The version of dual processing that has received most attention in the literature in medical diagnosis might be labeled a "default/interventionist" model,(17) which suggests that a default system of cognitive processes (System 1) is responsible for cognitive biases that lead to diagnostic errors and that System 2 intervenes to correct these errors. Consequently, from this model, the best strategy for reducing errors is to make students aware of the biases and to encourage them to rely more on System 2. However, an accumulation of evidence suggests that (a) strategies directed at increasing analytical (System 2) processing, by slowing down, reducing distractions, paying conscious attention, and (b) strategies directed at making students aware of the effect of cognitive biases, have no impact on error rates. Conversely, strategies based on increasing application of relevant knowledge appear to have some success and are consistent with basic
-
Patterns of and reasons for electronic cigarette use in primary care patients.
Kalkhoran, Sara; Alvarado, Nicholas; Vijayaraghavan, Maya; Lum, Paula J; Yuan, Patrick; Satterfield, Jason M
2017-10-01
Electronic cigarette (e-cigarette) use is rising in both the general and clinical populations. Little is known about e-cigarette use in primary care, where physicians report discussing e-cigarette use with patients. Identify how and why smokers in primary care use e-cigarettes. Cross-sectional secondary data analysis from a randomized controlled trial of a tablet intervention to deliver the 5As for smoking cessation in primary care. Current smokers aged 18 and older in three primary care clinics in San Francisco, CA (N = 788). Patients reported sociodemographics, cigarette smoking habits, quitting readiness, and ever and current use of e-cigarettes. We also asked reasons they have used or would use e-cigarettes. ICD-9 codes from the medical record determined comorbidities. Fifty-two percent (n = 408) of patients reported ever using an e-cigarette, and 20% (n = 154) reported past-30-day use. Ever e-cigarette use was associated with younger age and negatively associated with being seen at practices at a public safety-net hospital compared to a practice at University-affiliated hospital. The most common reason for having used e-cigarettes among ever e-cigarette users, and for interest in future use of e-cigarettes among never e-cigarette users, was to cut down cigarette use. The mean number of days of e-cigarette use in the past 30 increased with duration of e-cigarette use. Most current e-cigarette users did not know the nicotine content of their e-cigarettes. Over half of smokers in primary care have ever used e-cigarettes, and one-fifth are currently using them. Most reported using e-cigarettes to cut down or quit cigarettes. Primary care providers should be prepared to discuss e-cigarettes with patients. Screening for e-cigarette use may help identify and treat patients interested in changing their cigarette smoking habits.
-
Locally analytic vectors in representations of locally
Emerton, Matthew J
2017-01-01
The goal of this memoir is to provide the foundations for the locally analytic representation theory that is required in three of the author's other papers on this topic. In the course of writing those papers the author found it useful to adopt a particular point of view on locally analytic representation theory: namely, regarding a locally analytic representation as being the inductive limit of its subspaces of analytic vectors (of various "radii of analyticity"). The author uses the analysis of these subspaces as one of the basic tools in his study of such representations. Thus in this memoir he presents a development of locally analytic representation theory built around this point of view. The author has made a deliberate effort to keep the exposition reasonably self-contained and hopes that this will be of some benefit to the reader.
-
The theory of reasoned action and patient compliance during orthodontic treatment.
Bos, Annemieke; Hoogstraten, Johan; Prahl-Andersen, Birte
2005-12-01
The aim of the present study was to investigate the potential of the theory of reasoned action (TRA) for the prediction and understanding of patients' intention to comply during orthodontic treatment and to analyze the effect of two additional variables in the model, namely perceived behavioral control and anticipated regret. Moreover, (the determinants of) intentions of orthodontic patients to comply during treatment were compared with (the determinants of) intentions of parents to stimulate this cooperation. A questionnaire was handed out to patients and parents visiting the Department of Orthodontics of the Academic Centre of Dentistry in Amsterdam. In both the patient and parent sample, independent-sample t-tests, correlation analyses and stepwise regression analyses were conducted. Variables in both samples were compared and tested. The extended version of the TRA explained 20% of the variance in the patients' intention to comply. The patients' anticipated regret, attitude and motivation to comply were significant determinants of the patients' intention to comply. In addition, the parents' attitude toward compliance was a significant predictor. The role of parents in enhancing patients' intentions to comply cannot be neglected. Our findings suggest that patients' intentions to comply during orthodontic treatment are influenced by factors outside of the TRA. Therefore, it is recommended to develop a new model, in which factors of the TRA are included, which can be used specifically for the study of compliance in orthodontics.
-
Directory of Open Access Journals (Sweden)
Julia Tabatabai
2014-09-01
Full Text Available Background: In recent years, scaling up of antiretroviral therapy (ART in resource-limited settings moved impressively towards universal access. Along with these achievements, public health HIV programs are facing a number of challenges including the support of patients on lifelong therapy and the prevention of temporary/permanent loss of patients in care. Understanding reasons for treatment interruption (TI can inform strategies for improving drug adherence and retention in care. Objective: To evaluate key characteristics of patients resuming ART after TI at the Lighthouse Clinic in Lilongwe, Malawi, and to identify their reasons for interrupting ART. Design: This study uses a mixed methods design to evaluate patients resuming ART after TI. We analysed an assessment form for patients with TI using pre-defined categories and a comments field to identify frequently stated reasons for TI. Additionally, we conducted 26 in-depth interviews to deepen our understanding of common reasons for TI. In-depth interviews also included the patients’ knowledge about ART and presence of social support systems. Qualitative data analysis was based on a thematic framework approach. Results: A total of 347 patients (58.2% female, average age 35.1±11.3 years with TI were identified. Despite the presence of social support and sufficient knowledge of possible consequences of TI, all patients experienced situations that resulted in TI. Analysis of in-depth interviews led to new and distinct categories for TI. The most common reason for TI was travel (54.5%, n=80/147, which further differentiated into work- or family-related travel. Patients also stated transport costs and health-care-provider-related reasons, which included perceived/enacted discrimination by health care workers. Other drivers of TI were treatment fatigue/forgetfulness, the patients’ health status, adverse drug effects, pregnancy/delivery, religious belief or perceived/enacted stigma. Conclusions
-
Fusar-Poli, P; Schultze-Lutter, F
2016-02-01
Prediction of psychosis in patients at clinical high risk (CHR) has become a mainstream focus of clinical and research interest worldwide. When using CHR instruments for clinical purposes, the predicted outcome is but only a probability; and, consequently, any therapeutic action following the assessment is based on probabilistic prognostic reasoning. Yet, probabilistic reasoning makes considerable demands on the clinicians. We provide here a scholarly practical guide summarising the key concepts to support clinicians with probabilistic prognostic reasoning in the CHR state. We review risk or cumulative incidence of psychosis in, person-time rate of psychosis, Kaplan-Meier estimates of psychosis risk, measures of prognostic accuracy, sensitivity and specificity in receiver operator characteristic curves, positive and negative predictive values, Bayes' theorem, likelihood ratios, potentials and limits of real-life applications of prognostic probabilistic reasoning in the CHR state. Understanding basic measures used for prognostic probabilistic reasoning is a prerequisite for successfully implementing the early detection and prevention of psychosis in clinical practice. Future refinement of these measures for CHR patients may actually influence risk management, especially as regards initiating or withholding treatment. 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/
-
When the severely ill elderly patient refuses food. Ethical reasoning among nurses.
Jansson, L; Norberg, A; Sandman, P O; Aström, G
1995-02-01
Forty registered nurses (RNs) regarded as "good and experienced" in either cancer or dementia care, were asked about their decision to feed or not feed a severely ill elderly woman (a hypothetical case). In order to compare ethical reasoning in the two groups of nurses and to illuminate what it means to RNs to face a situation where the patients can/cannot decide for themselves, a phenomenological hermeneutic approach was used for the analysis. Both groups saw themselves as the advocate for their patients but in different ways. The RNs who talked about a mentally alert patient emphasized that they encouraged their patient to speak up for herself, while the RNs who talked about a severely demented patient emphasized that they tried very hard to interpret their patient's vague and unclear communicative cues and to act as her advocate, especially in relation to physicians. Transcending experiences of dying relatives and patients as well as role models helped them to achieve their ambition of putting themselves in the patient's shoes in order to respect and understand her or his wish and/or what was best for them. The majority of RNs strongly rejected active euthanasia.
-
Midwives׳ clinical reasoning during second stage labour: Report on an interpretive study.
Jefford, Elaine; Fahy, Kathleen
2015-05-01
clinical reasoning was once thought to be the exclusive domain of medicine - setting it apart from 'non-scientific' occupations like midwifery. Poor assessment, clinical reasoning and decision-making skills are well known contributors to adverse outcomes in maternity care. Midwifery decision-making models share a common deficit: they are insufficiently detailed to guide reasoning processes for midwives in practice. For these reasons we wanted to explore if midwives actively engaged in clinical reasoning processes within their clinical practice and if so to what extent. The study was conducted using post structural, feminist methodology. to what extent do midwives engage in clinical reasoning processes when making decisions in the second stage labour? twenty-six practising midwives were interviewed. Feminist interpretive analysis was conducted by two researchers guided by the steps of a model of clinical reasoning process. Six narratives were excluded from analysis because they did not sufficiently address the research question. The midwives narratives were prepared via data reduction. A theoretically informed analysis and interpretation was conducted. using a feminist, interpretive approach we created a model of midwifery clinical reasoning grounded in the literature and consistent with the data. Thirteen of the 20 participant narratives demonstrate analytical clinical reasoning abilities but only nine completed the process and implemented the decision. Seven midwives used non-analytical decision-making without adequately checking against assessment data. over half of the participants demonstrated the ability to use clinical reasoning skills. Less than half of the midwives demonstrated clinical reasoning as their way of making decisions. The new model of Midwifery Clinical Reasoning includes 'intuition' as a valued way of knowing. Using intuition, however, should not replace clinical reasoning which promotes through decision-making can be made transparent and be
-
Donker, G.A.; Dijk, C.E. van
2015-01-01
Background: Little is known about the quantity and reasons for use of palliative sedation in cancer patients in general practice at the end of life and the reason to perform palliative sedation when also a request for euthanasia is pending. Aim: To gain more insight into the trends of and reasons
-
M.R. van Dijk (Merel); E.W. Steyerberg (Ewout); J.D.F. Habbema (Dik)
2008-01-01
textabstractBackground. Classification systems may be useful to direct more aggressive treatment to cancer patients with a relatively poor prognosis. The definition of 'poor prognosis' often lacks a formal basis. We propose a decision analytic approach to weigh benefits and harms explicitly to
-
Weiss, Roger D; Potter, Jennifer Sharpe; Griffin, Margaret L; McHugh, R Kathryn; Haller, Deborah; Jacobs, Petra; Gardin, John; Fischer, Dan; Rosen, Kristen D
2014-08-01
The number of individuals seeking treatment for prescription opioid dependence has increased dramatically, fostering a need for research on this population. The aim of this study was to examine reasons for prescription opioid use among 653 participants with and without chronic pain, enrolled in the Prescription Opioid Addiction Treatment Study, a randomized controlled trial of treatment for prescription opioid dependence. Participants identified initial and current reasons for opioid use. Participants with chronic pain were more likely to report pain as their primary initial reason for use; avoiding withdrawal was rated as the most important reason for current use in both groups. Participants with chronic pain rated using opioids to cope with physical pain as more important, and using opioids in response to social interactions and craving as less important, than those without chronic pain. Results highlight the importance of physical pain as a reason for opioid use among patients with chronic pain. Copyright © 2014 Elsevier Inc. All rights reserved.
-
A Route to Well-being: Intelligence vs. Wise Reasoning
Grossmann, Igor; Na, Jinkyung; Varnum, Michael E.W.; Kitayama, Shinobu; Nisbett, Richard E.
2012-01-01
Laypeople and many social scientists assume that superior reasoning abilities lead to greater well-being. However, previous research has been inconclusive. This may be because prior investigators used operationalizations of reasoning that favored analytic as opposed to wise thinking. We assessed wisdom in terms of the degree to which people use various pragmatic schemas to deal with social conflicts. With a random sample of Americans we found that wise reasoning is associated with greater life satisfaction, less negative affect, better social relationships, less depressive rumination, more positive vs. negative words used in speech, and greater longevity. The relationship between wise reasoning and well-being held even when controlling for socio-economic factors, verbal abilities, and several personality traits. As in prior work there was no association between intelligence and well-being. Further, wise reasoning mediated age-related differences in well-being, particularly among the middle-aged and older adults. Implications for research on reasoning, well-being and aging are discussed. PMID:22866683
-
Porter, James D; Bresick, Graham
2017-06-29
Person-centred, re-engineered primary health care (PHC) is a national and global priority. Faith-based health care is a significant provider of PHC in sub-Saharan Africa, but there is limited published data on the reasons for patient choice of faith-based health care, particularly in South Africa. The primary objective was to determine and explore the reasons for patient choice of a faith-based primary care clinic over their local public sector primary care clinic, and secondarily to determine to what extent these reasons were influenced by demography. The study was conducted at Jubilee Health Centre (JHC), a faith-based primary care clinic attached to Jubilee Community Church in Cape Town, South Africa. Focus groups, using the nominal group technique, were conducted with JHC patients and used to generate ranked reasons for attending the clinic. These were collated into the top 15 reasons and incorporated into a quantitative questionnaire which was administered to adult patients attending JHC. A total of 164 patients were surveyed (a response rate of 92.4%) of which 68.3% were female and 57.9% from the Democratic Republic of the Congo (DRC). Of patients surveyed, 98.2% chose to attend JHC because 'the staff treat me with respect', 96.3% because 'the staff are friendly' and 96.3% because 'the staff take time to listen to me'. The reason 'it is a Christian clinic' was chosen by 70.1% of patients. 'The staff speak my home language' was given as a reason by 61.1% of DRC patients and 37.1% of South African patients. 'The clinic is close to me' was chosen by 66.6% of Muslims and 40.8% of Christians. Patients chose to attend JHC (a faith-based primary care clinic) because of the quality of care received. They emphasised the staff-patient relationship and patient-centredness rather than the clinic's religious practices (prayer with patients). These findings may be important in informing efforts to improve public sector primary care.
-
Depression among HIV/AIDS Sudanese patients: a cross-sectional analytic study.
Elbadawi, Abdulateef; Mirghani, Hyder
2017-01-01
Depression and HIV/AIDS are common morbid health problems; the relationship is bidirectional exacerbating each other with deleterious consequences. There are limited studies on this topic in Sudan. In this study, we investigated depression among HIV/AIDS in Sudan. A cross-sectional analytic study was conducted among 362 HIV/AIDS patients from three centers in Khartoum, Sudan. Data were collected by the Hospital Depression and Anxiety (HADS) questionnaire. Chi-square was used for testing the significance and a P. Value of ≥ 0.05 was considered as statistically significant. Depression was evident in 332 (63.1%) of patients 68 (19.3%) had mild depression, 114 (32.4%) moderate depression, and 40 (11.4%) severe depression. Depression was commoner among women, illiterate, married/widowed, not receiving counseling, delaying the result of the test, P-value 0.05. Depression was prevalent among HIV/AIDS patients, especially females, low level of education, and widowed/married patients, and those not receiving counseling and post diagnosis sessions.
-
Maissan, Francois; Pool, Jan; de Raaij, Edwin; Mollema, Jürgen; Ostelo, Raymond; Wittink, Harriet
2018-06-01
Primarily to evaluate the completeness of the description of the clinical reasoning process in RCTs with patients with non-specific neck pain with an argued or diagnosed cause i.e. an impairment or activity limitation. Secondly, to determine the association between the completeness of the clinical reasoning process and the degree of risk of bias. Pubmed, Cinahl and PEDro were systematically searched from inception to July 2016. RCTs (n = 122) with patients with non-specific neck pain receiving physiotherapy treatment published in English were included. Data extraction included study characteristics and important features of the clinical reasoning process based on the Hypothesis-Oriented Algorithm for Clinicians II (HOAC II)]. Thirty-seven studies (30%) had a complete clinical reasoning process of which 8 (6%) had a 'diagnosed cause' and 29 (24%) had an 'argued cause'. The Spearmans rho association between the extent of the clinical reasoning process and the risk of bias was -0.2. In the majority of studies (70%) the described clinical reasoning process was incomplete. A very small proportion (6%) had a 'diagnosed cause'. Therefore, a better methodological quality does not necessarily imply a better described clinical reasoning process. Copyright © 2018 Elsevier Ltd. All rights reserved.
-
Geng, Elvin H; Bangsberg, David R; Musinguzi, Nicolas; Emenyonu, Nneka; Bwana, Mwebesa Bosco; Yiannoutsos, Constantin T; Glidden, David V; Deeks, Steven G; Martin, Jeffrey N
2010-03-01
Losses to follow-up after initiation of antiretroviral therapy (ART) are common in Africa and are a considerable obstacle to understanding the effectiveness of nascent treatment programs. We sought to characterize, through a sampling-based approach, reasons for and outcomes of patients who become lost to follow-up. Cohort study. We searched for and interviewed a representative sample of lost patients or close informants in the community to determine reasons for and outcomes among lost patients. Three thousand six hundred twenty-eight HIV-infected adults initiated ART between January 1, 2004 and September 30, 2007 in Mbarara, Uganda. Eight hundred twenty-nine became lost to follow-up (cumulative incidence at 1, 2, and 3 years of 16%, 30%, and 39%). We sought a representative sample of 128 lost patients in the community and ascertained vital status in 111 (87%). Top reasons for loss included lack of transportation or money and work/child care responsibilities. Among the 111 lost patients who had their vital status ascertained through tracking, 32 deaths occurred (cumulative 1-year incidence 36%); mortality was highest shortly after the last clinic visit. Lower pre-ART CD4 T-cell count, older age, low blood pressure, and a central nervous system syndrome at the last clinic visit predicted deaths. Of patients directly interviewed, 83% were in care at another clinic and 71% were still using ART. Sociostructural factors are the primary reasons for loss to follow-up. Outcomes among the lost are heterogeneous: both deaths and transfers to other clinics were common. Tracking a sample of lost patients is an efficient means for programs to understand site-specific reasons for and outcomes among patients lost to follow-up.
-
Reasons for patronage of traditional bone setters
Directory of Open Access Journals (Sweden)
Innocent Egbeji Abang
2016-01-01
Full Text Available Aims and Objectives: The objectives of this study were to analyze the different reasons why patients with fractures patronize traditional bone setters (TBS and their impression of the outcome of the treatment by the TBS. Materials and Methods: A 24 month prospective observational study was conducted from February 2012 to January 2014. All the patients were recruited from the orthopedics outpatient clinic. The demographic data of each patient, the type of injury, presentation to hospital or not, reasons for leaving the hospital, reasons for patronage of the TBS and their impression of the outcome of TBS′ treatment, effect of educational background on patronage of TBS and reason for presenting to hospital for orthodox treatment. Data Analysis: Analysis was done with SPSS software Version 20. Results: A total 79 patients were recruited for the study and they had different reasons for patronizing TBS. These reasons include an external locus of decision making in 19 (24.1% patients, and greater faith in TBS compared to orthodox medicine in 16 (20.3%. Twelve (15.2% believed that TBS are more competent than orthodox medical practitioners while another group 11 (13.9% considered the fees of TBS cheaper than those in the hospital. The delay in treatment in the hospital, forceful removal of patients from hospital against their will and nonsatisfaction with hospital treatment accounted for 5 (6.3%. Poor attitude of hospital staff, fear of amputation, and patients being unconscious during the injury accounted for 2 (2.5%. Their ages ranged from 17 to 83 years, with mean age of 36.8 ± 11.8 years. The male: female ratio was 1.5:1. Conclusions and Recommendations: With recent advancements in the practice of orthopedics and trauma, there is still a very high patronage of the TBS by most of our patients. This is largely due to the dependence of the patients on their sponsors for treatment, while the influence of cultural and religious beliefs continues to
-
Pelaccia, Thierry; Tardif, Jacques; Triby, Emmanuel; Charlin, Bernard
2011-03-14
Clinical reasoning plays a major role in the ability of doctors to make diagnoses and decisions. It is considered as the physician's most critical competence, and has been widely studied by physicians, educationalists, psychologists and sociologists. Since the 1970s, many theories about clinical reasoning in medicine have been put forward. This paper aims at exploring a comprehensive approach: the "dual-process theory", a model developed by cognitive psychologists over the last few years. After 40 years of sometimes contradictory studies on clinical reasoning, the dual-process theory gives us many answers on how doctors think while making diagnoses and decisions. It highlights the importance of physicians' intuition and the high level of interaction between analytical and non-analytical processes. However, it has not received much attention in the medical education literature. The implications of dual-process models of reasoning in terms of medical education will be discussed.
-
Evans, R G
2003-06-01
The ideal of patient centred medicine remains only partially realised. Within modern Western society, the highly individualistic culture and religious decline linked with medicine's reluctance to relinquish an outmoded form of scientific rationalism can act as reductive influences, stifling conceptual development. Some examples of the recent literature on communication skills in medicine are analysed to discern the underlying philosophy. A rationalist stance invites an examination of the possible nature of rationality. Another example accepts the need to accommodate the emotional and the unconscious. Issues of human suffering with an inherent spiritual dimension seem to remain excluded. The need to move beyond a duality of reason and emotion to embrace the existential and spiritual is suggested as a theoretical prerequisite for developing a more inclusive concept of patient centred medicine, which only then may be realised. Some brief examples are considered of the sort of notions and types of discourse that might effectively inform "teaching" of communication skills.
-
The Ethics of Using Learning Analytics to Categorize Students on Risk
Scholes, Vanessa
2016-01-01
There are good reasons for higher education institutions to use learning analytics to risk-screen students. Institutions can use learning analytics to better predict which students are at greater risk of dropping out or failing, and use the statistics to treat "risky" students differently. This paper analyses this practice using…
-
Dillon, Roslyn; Croner, Lisa J; Bucci, John; Kairs, Stefanie N; You, Jia; Beasley, Sharon; Blimline, Mark; Carino, Rochele B; Chan, Vicky C; Cuevas, Danissa; Diggs, Jeff; Jennings, Megan; Levy, Jacob; Mina, Ginger; Yee, Alvin; Wilcox, Bruce
2018-05-30
Early detection of colorectal cancer (CRC) is key to reducing associated mortality. Despite the importance of early detection, approximately 40% of individuals in the United States between the ages of 50-75 have never been screened for CRC. The low compliance with colonoscopy and fecal-based screening may be addressed with a non-invasive alternative such as a blood-based test. We describe here the analytical validation of a multiplexed blood-based assay that measures the plasma concentrations of 15 proteins to assess advanced adenoma (AA) and CRC risk in symptomatic patients. The test was developed on an electrochemiluminescent immunoassay platform employing four multi-marker panels, to be implemented in the clinic as a laboratory developed test (LDT). Under the Clinical Laboratory Improvement Amendments (CLIA) and College of American Pathologists (CAP) regulations, a United States-based clinical laboratory utilizing an LDT must establish performance characteristics relating to analytical validity prior to releasing patient test results. This report describes a series of studies demonstrating the precision, accuracy, analytical sensitivity, and analytical specificity for each of the 15 assays, as required by CLIA/CAP. In addition, the report describes studies characterizing each of the assays' dynamic range, parallelism, tolerance to common interfering substances, spike recovery, and stability to sample freeze-thaw cycles. Upon completion of the analytical characterization, a clinical accuracy study was performed to evaluate concordance of AA and CRC classifier model calls using the analytical method intended for use in the clinic. Of 434 symptomatic patient samples tested, the percent agreement with original CRC and AA calls was 87% and 92% respectively. All studies followed CLSI guidelines and met the regulatory requirements for implementation of a new LDT. The results provide the analytical evidence to support the implementation of the novel multi-marker test as
-
On the emergence of American analytic philosophy
Katzav, J.; Vaesen, K.
2017-01-01
This paper is concerned with the reasons for the emergence and dominance of analytic philosophy in America. It closely examines the contents of, and changing editors at, The Philosophical Review, and provides a perspective on the contents of other leading philosophy journals. It suggests that
-
Moser, Debra K; McKinley, Sharon; Dracup, Kathleen; Chung, Misook L
2005-01-01
Patients (n = 194) with confirmed acute myocardial infarction (AMI) were interviewed to determine sociodemographic, clinical, social, behavioral, cognitive and emotional factors that contribute to delay in seeking treatment for their symptoms. Initial symptom experience was similar for men and women: both were most commonly at home when symptoms began; both were most commonly in the presence of their spouse or other family member; few patients (trouble others, and prior knowledge of thrombolytics. There was no difference in delay between men and women (median 3.08 versus 3.10 h), but there are important gender differences in the reasons patients delay and in their patterns of decision-making that may assist clinicians trying to tailor interventions.
-
Pennycook, Gordon; Rand, David G
2018-06-20
Why do people believe blatantly inaccurate news headlines ("fake news")? Do we use our reasoning abilities to convince ourselves that statements that align with our ideology are true, or does reasoning allow us to effectively differentiate fake from real regardless of political ideology? Here we test these competing accounts in two studies (total N = 3446 Mechanical Turk workers) by using the Cognitive Reflection Test (CRT) as a measure of the propensity to engage in analytical reasoning. We find that CRT performance is negatively correlated with the perceived accuracy of fake news, and positively correlated with the ability to discern fake news from real news - even for headlines that align with individuals' political ideology. Moreover, overall discernment was actually better for ideologically aligned headlines than for misaligned headlines. Finally, a headline-level analysis finds that CRT is negatively correlated with perceived accuracy of relatively implausible (primarily fake) headlines, and positively correlated with perceived accuracy of relatively plausible (primarily real) headlines. In contrast, the correlation between CRT and perceived accuracy is unrelated to how closely the headline aligns with the participant's ideology. Thus, we conclude that analytic thinking is used to assess the plausibility of headlines, regardless of whether the stories are consistent or inconsistent with one's political ideology. Our findings therefore suggest that susceptibility to fake news is driven more by lazy thinking than it is by partisan bias per se - a finding that opens potential avenues for fighting fake news. Copyright © 2018 Elsevier B.V. All rights reserved.
-
Directory of Open Access Journals (Sweden)
Thierry Pelaccia
2011-03-01
Full Text Available Context. Clinical reasoning plays a major role in the ability of doctors to make diagnoses and decisions. It is considered as the physician's most critical competence, and has been widely studied by physicians, educationalists, psychologists and sociologists. Since the 1970s, many theories about clinical reasoning in medicine have been put forward.Purpose. This paper aims at exploring a comprehensive approach: the “dual-process theory”, a model developed by cognitive psychologists over the last few years.Discussion. After 40 years of sometimes contradictory studies on clinical reasoning, the dual-process theory gives us many answers on how doctors think while making diagnoses and decisions. It highlights the importance of physicians’ intuition and the high level of interaction between analytical and non-analytical processes. However, it has not received much attention in the medical education literature. The implications of dual-process models of reasoning in terms of medical education will be discussed.
-
Gorbanev, Iouri; Cortes, Ariel; Agudelo-Londoño, Sandra
2017-01-01
Objective. To compare the Business process management and the analytic hierarchy process as the tools of process performance assessment. Instruments and Methods. Case study of the attention process of rheumatology patients. Business process management and analytic hierarchy process were applied to assess the redesign of the attention process. The two methods were compared. The data were obtained through personal observations, an interview with a Colombian health insurer’s senior executive, an...
-
A Framework for a Clinical Reasoning Knowledge Warehouse
DEFF Research Database (Denmark)
Vilstrup Pedersen, Klaus; Boye, Niels
2004-01-01
is stored and made accessible when relevant to the reasoning context and the specific patient case. Furthermore, the information structure supports the creation of new generalized knowledge using data mining tools. The patient case is divided into an observation level and an opinion level. At the opinion......, Knowledge Management Systems and Business Intelligence to make context based, patient case specific analysis and knowledge management. The knowledge base integrates three sources of information that supports clinical reasoning: general information, guidelines and health records. New generalized knowledge...... level, reasoning participants can express their argument based opinions about a patient case, thereby enhancing the knowledge about the state of and plans for the patient. An opinion language that supports expressing a possible imprecise/uncertain opinion based on imprecise...
-
Analytical Sociology: A Bungean Appreciation
Wan, Poe Yu-ze
2012-10-01
Analytical sociology, an intellectual project that has garnered considerable attention across a variety of disciplines in recent years, aims to explain complex social processes by dissecting them, accentuating their most important constituent parts, and constructing appropriate models to understand the emergence of what is observed. To achieve this goal, analytical sociologists demonstrate an unequivocal focus on the mechanism-based explanation grounded in action theory. In this article I attempt a critical appreciation of analytical sociology from the perspective of Mario Bunge's philosophical system, which I characterize as emergentist systemism. I submit that while the principles of analytical sociology and those of Bunge's approach share a lot in common, the latter brings to the fore the ontological status and explanatory importance of supra-individual actors (as concrete systems endowed with emergent causal powers) and macro-social mechanisms (as processes unfolding in and among social systems), and therefore it does not stipulate that every causal explanation of social facts has to include explicit references to individual-level actors and mechanisms. In this sense, Bunge's approach provides a reasonable middle course between the Scylla of sociological reification and the Charybdis of ontological individualism, and thus serves as an antidote to the untenable "strong program of microfoundations" to which some analytical sociologists are committed.
-
Pyrrolizidine alkaloids in honey: comparison of analytical methods
Kempf, M.; Wittig, M.; Reinhard, A.; Ohe, von der K.; Blacquière, T.; Raezke, K.P.; Michel, R.; Schreier, P.; Beuerle, T.
2011-01-01
Pyrrolizidine alkaloids (PAs) are a structurally diverse group of toxicologically relevant secondary plant metabolites. Currently, two analytical methods are used to determine PA content in honey. To achieve reasonably high sensitivity and selectivity, mass spectrometry detection is demanded. One
-
Mancopes, Renata; Gonçalves, Bruna Franciele da Trindade; Costa, Cintia Conceição; Favero, Talita Cristina; Drozdz, Daniela Rejane Constantino; Bilheri, Diego Fernando Dorneles; Schumacher, Stéfani Fernanda
2014-01-01
To correlate the reason for referral to speech therapy service at a university hospital with the results of clinical and objective assessment of risk for dysphagia. This is a cross-sectional, observational, retrospective analytical and quantitative study. The data were gathered from the database, and the information used was the reason for referral to speech therapy service, results of clinical assessment of the risk for dysphagia, and also from swallowing videofluoroscopy. There was a mean difference between the variables of the reason for the referral, results of the clinical and objective swallowing assessments, and scale of penetration/aspiration, although the values were not statistically significant. Statistically significant correlation was observed between clinical and objective assessments and the penetration scale, with the largest occurring between the results of objective assessment and penetration scale. There was a correlation between clinical and objective assessments of swallowing and mean difference between the variables of the reason for the referral with their respective assessment. This shows the importance of the association between the data of patient's history and results of clinical evaluation and complementary tests, such as videofluoroscopy, for correct identification of the swallowing disorders, being important to combine the use of severity scales of penetration/aspiration for diagnosis.
-
McBee, Elexis; Ratcliffe, Temple; Picho, Katherine; Schuwirth, Lambert; Artino, Anthony R; Yepes-Rios, Ana Monica; Masel, Jennifer; van der Vleuten, Cees; Durning, Steven J
2017-11-15
The impact of context on the complex process of clinical reasoning is not well understood. Using situated cognition as the theoretical framework and videos to provide the same contextual "stimulus" to all participants, we examined the relationship between specific contextual factors on diagnostic and therapeutic reasoning accuracy in board certified internists versus resident physicians. Each participant viewed three videotaped clinical encounters portraying common diagnoses in internal medicine. We explicitly modified the context to assess its impact on performance (patient and physician contextual factors). Patient contextual factors, including English as a second language and emotional volatility, were portrayed in the videos. Physician participant contextual factors were self-rated sleepiness and burnout.. The accuracy of diagnostic and therapeutic reasoning was compared with covariates using Fisher Exact, Mann-Whitney U tests and Spearman Rho's correlations as appropriate. Fifteen board certified internists and 10 resident physicians participated from 2013 to 2014. Accuracy of diagnostic and therapeutic reasoning did not differ between groups despite residents reporting significantly higher rates of sleepiness (mean rank 20.45 vs 8.03, U = 0.5, p reasoning performance. Further, the processes of diagnostic and therapeutic reasoning, although related, may not be interchangeable. This raises important questions about the impact that contextual factors have on clinical reasoning and provides insight into how clinical reasoning processes in more authentic settings may be explained by situated cognition theory.
-
Fourier, Anthony; Portelius, Erik; Zetterberg, Henrik; Blennow, Kaj; Quadrio, Isabelle; Perret-Liaudet, Armand
2015-09-20
A panel of cerebrospinal fluid (CSF) biomarkers including total Tau (t-Tau), phosphorylated Tau protein at residue 181 (p-Tau) and β-amyloid peptides (Aβ42 and Aβ40), is frequently used as an aid in Alzheimer's disease (AD) diagnosis for young patients with cognitive impairment, for predicting prodromal AD in mild cognitive impairment (MCI) subjects, for AD discrimination in atypical clinical phenotypes and for inclusion/exclusion and stratification of patients in clinical trials. Due to variability in absolute levels between laboratories, there is no consensus on medical cut-off value for the CSF AD signature. Thus, for full implementation of this core AD biomarker panel in clinical routine, this issue has to be solved. Variability can be explained both by pre-analytical and analytical factors. For example, the plastic tubes used for CSF collection and storage, the lack of reference material and the variability of the analytical protocols were identified as important sources of variability. The aim of this review is to highlight these pre-analytical and analytical factors and describe efforts done to counteract them in order to establish cut-off values for core CSF AD biomarkers. This review will give the current state of recommendations. Copyright © 2015. Published by Elsevier B.V.
-
Big data in health care: using analytics to identify and manage high-risk and high-cost patients.
Bates, David W; Saria, Suchi; Ohno-Machado, Lucila; Shah, Anand; Escobar, Gabriel
2014-07-01
The US health care system is rapidly adopting electronic health records, which will dramatically increase the quantity of clinical data that are available electronically. Simultaneously, rapid progress has been made in clinical analytics--techniques for analyzing large quantities of data and gleaning new insights from that analysis--which is part of what is known as big data. As a result, there are unprecedented opportunities to use big data to reduce the costs of health care in the United States. We present six use cases--that is, key examples--where some of the clearest opportunities exist to reduce costs through the use of big data: high-cost patients, readmissions, triage, decompensation (when a patient's condition worsens), adverse events, and treatment optimization for diseases affecting multiple organ systems. We discuss the types of insights that are likely to emerge from clinical analytics, the types of data needed to obtain such insights, and the infrastructure--analytics, algorithms, registries, assessment scores, monitoring devices, and so forth--that organizations will need to perform the necessary analyses and to implement changes that will improve care while reducing costs. Our findings have policy implications for regulatory oversight, ways to address privacy concerns, and the support of research on analytics. Project HOPE—The People-to-People Health Foundation, Inc.
-
Analytical challenges in sports drug testing.
Thevis, Mario; Krug, Oliver; Geyer, Hans; Walpurgis, Katja; Baume, Norbert; Thomas, Andreas
2018-03-01
Analytical chemistry represents a central aspect of doping controls. Routine sports drug testing approaches are primarily designed to address the question whether a prohibited substance is present in a doping control sample and whether prohibited methods (for example, blood transfusion or sample manipulation) have been conducted by an athlete. As some athletes have availed themselves of the substantial breadth of research and development in the pharmaceutical arena, proactive and preventive measures are required such as the early implementation of new drug candidates and corresponding metabolites into routine doping control assays, even though these drug candidates are to date not approved for human use. Beyond this, analytical data are also cornerstones of investigations into atypical or adverse analytical findings, where the overall picture provides ample reason for follow-up studies. Such studies have been of most diverse nature, and tailored approaches have been required to probe hypotheses and scenarios reported by the involved parties concerning the plausibility and consistency of statements and (analytical) facts. In order to outline the variety of challenges that doping control laboratories are facing besides providing optimal detection capabilities and analytical comprehensiveness, selected case vignettes involving the follow-up of unconventional adverse analytical findings, urine sample manipulation, drug/food contamination issues, and unexpected biotransformation reactions are thematized.
-
An Analytical Hierarchy Process Model for the Evaluation of College Experimental Teaching Quality
Yin, Qingli
2013-01-01
Taking into account the characteristics of college experimental teaching, through investigaton and analysis, evaluation indices and an Analytical Hierarchy Process (AHP) model of experimental teaching quality have been established following the analytical hierarchy process method, and the evaluation indices have been given reasonable weights. An…
-
How can we study reasoning in the brain?
Papo, David
2015-01-01
The brain did not develop a dedicated device for reasoning. This fact bears dramatic consequences. While for perceptuo-motor functions neural activity is shaped by the input's statistical properties, and processing is carried out at high speed in hardwired spatially segregated modules, in reasoning, neural activity is driven by internal dynamics and processing times, stages, and functional brain geometry are largely unconstrained a priori. Here, it is shown that the complex properties of spontaneous activity, which can be ignored in a short-lived event-related world, become prominent at the long time scales of certain forms of reasoning. It is argued that the neural correlates of reasoning should in fact be defined in terms of non-trivial generic properties of spontaneous brain activity, and that this implies resorting to concepts, analytical tools, and ways of designing experiments that are as yet non-standard in cognitive neuroscience. The implications in terms of models of brain activity, shape of the neural correlates, methods of data analysis, observability of the phenomenon, and experimental designs are discussed.
-
Analytical and critical thinking skills in public relations
Directory of Open Access Journals (Sweden)
Dalibor Jakus
2014-12-01
Full Text Available This article presents more or less independent reasons why analytical and critical thinking skills should be essential part of public relations. Generally, it is considered that the analytical and critical thinking skills are part of public relations, as well as creative thinking, but they should be considered separately and given the codes of ethics of the profession used as initial criteria. For the purpose of the study, in this article is presented the result of the survey in which determine importance of using analytical and critical thinking skills in the implementation of PR projects. The second aim in the survey was to identify the target audience and how they react to the placed information.
-
Provenancing Flower Bulbs by Analytical Fingerprinting: Convallaria Majalis
Ruth, van S.M.; Visser, de R.
2015-01-01
The origin of agricultural products is gaining in appreciation while often hard to determine for various reasons. Geographical origin may be resolved using a combination of chemical and physical analytical technologies. In the present case of Lily of the Valley (Convallaria majalis) rhizomes, we
-
Patients' perception of noise in the operating room-a descriptive and analytic cross-sectional study
DEFF Research Database (Denmark)
Hasfeldt, Dorthe; Maindal, Helle Terkildsen; Toft, Palle
2014-01-01
in the OR before anesthesia, the correlation between the actual noise levels and the patient's perception of noise, and if there are particular patient subgroups that are especially vulnerable to noise. DESIGN: This cross-sectional study was performed within a mixed descriptive and analytical design, including 120...... patients (60 acute/60 elective) undergoing general anesthesia for orthopaedic surgery. METHODS: Data collection consisted of registration of demographic variables and measurements of noise levels in the OR combined with a questionnaire. FINDINGS: Results showed that 10% of the patients perceived noise...... levels in the OR as very high and experienced the noise as annoying, disruptive, and stressful. There was no correlation between the actual noise levels to which patients were exposed and their perception of noise. Acute patients perceived significantly more noise than elective patients (P
-
Reddy, Bhargava K; Delen, Dursun; Agrawal, Rupesh K
2018-01-01
Crohn's disease is among the chronic inflammatory bowel diseases that impact the gastrointestinal tract. Understanding and predicting the severity of inflammation in real-time settings is critical to disease management. Extant literature has primarily focused on studies that are conducted in clinical trial settings to investigate the impact of a drug treatment on the remission status of the disease. This research proposes an analytics methodology where three different types of prediction models are developed to predict and to explain the severity of inflammation in patients diagnosed with Crohn's disease. The results show that machine-learning-based analytic methods such as gradient boosting machines can predict the inflammation severity with a very high accuracy (area under the curve = 92.82%), followed by regularized regression and logistic regression. According to the findings, a combination of baseline laboratory parameters, patient demographic characteristics, and disease location are among the strongest predictors of inflammation severity in Crohn's disease patients.
-
Medication Error, What Is the Reason?
Directory of Open Access Journals (Sweden)
Ali Banaozar Mohammadi
2015-09-01
Full Text Available Background: Medication errors due to different reasons may alter the outcome of all patients, especially patients with drug poisoning. We introduce one of the most common type of medication error in the present article. Case:A 48 year old woman with suspected organophosphate poisoning was died due to lethal medication error. Unfortunately these types of errors are not rare and had some preventable reasons included lack of suitable and enough training and practicing of medical students and some failures in medical students’ educational curriculum. Conclusion:Hereby some important reasons are discussed because sometimes they are tre-mendous. We found that most of them are easily preventable. If someone be aware about the method of use, complications, dosage and contraindication of drugs, we can minimize most of these fatal errors.
-
The analyst's participation in the analytic process.
Levine, H B
1994-08-01
The analyst's moment-to-moment participation in the analytic process is inevitably and simultaneously determined by at least three sets of considerations. These are: (1) the application of proper analytic technique; (2) the analyst's personally-motivated responses to the patient and/or the analysis; (3) the analyst's use of him or herself to actualise, via fantasy, feeling or action, some aspect of the patient's conflicts, fantasies or internal object relationships. This formulation has relevance to our view of actualisation and enactment in the analytic process and to our understanding of a series of related issues that are fundamental to our theory of technique. These include the dialectical relationships that exist between insight and action, interpretation and suggestion, empathy and countertransference, and abstinence and gratification. In raising these issues, I do not seek to encourage or endorse wild analysis, the attempt to supply patients with 'corrective emotional experiences' or a rationalisation for acting out one's countertransferences. Rather, it is my hope that if we can better appreciate and describe these important dimensions of the analytic encounter, we can be better prepared to recognise, understand and interpret the continual streams of actualisation and enactment that are embedded in the analytic process. A deeper appreciation of the nature of the analyst's participation in the analytic process and the dimensions of the analytic process to which that participation gives rise may offer us a limited, although important, safeguard against analytic impasse.
-
A Framework for a Clinical Reasoning Knowledge Warehouse
DEFF Research Database (Denmark)
Vilstrup Pedersen, Klaus; Boye, Niels
2004-01-01
In many areas of the medical domain, the decision process i.e. reasoning, involving health care professionals is distributed, cooperative and complex. This paper presents a framework for a Clinical Reasoning Knowledge Warehouse that combines theories and models from Artificial Intelligence...... is stored and made accessible when relevant to the reasoning context and the specific patient case. Furthermore, the information structure supports the creation of new generalized knowledge using data mining tools. The patient case is divided into an observation level and an opinion level. At the opinion...
-
He, Jun; Liu, Juan; Zhou, Hua; Chen, Chao Jun
2016-11-01
To investigate the influence of granulocyte growth factor in uterine perfusion on the pregnancy outcome of patients with failure of embryo implantation for unknown reason. Then, 68 patients with failure of embryo implantation for unknown reason were enrolled in our hospital from November 2013 to February 2015, which were divided into observation group and control group by random (34 patients in each group). Patients in observation group received basic treatment for granulocyte growth factor in uterine perfusion on the next day, while patients in control group received basic treatment with placebo. Then, endometrial preparation, adverse reaction and pregnancy outcome of patients were compared between the two groups. Comparing the endometrial preparation and average endometrial thickness of patients in control group (9.87±2.12) with those in observation group [(9.87±2.12), there is no significant difference (Pfactor, patients with failure of embryo implantation can effectively improve clinical pregnancy rate and embryo implantation rate without severe complication. Therefore, treatment of granlocyte growth factor can improve the pregnancy outcome of patients.
-
Modeling of Coaxial Slot Waveguides Using Analytical and Numerical Approaches: Revisited
Directory of Open Access Journals (Sweden)
Kok Yeow You
2012-01-01
Full Text Available Our reviews of analytical methods and numerical methods for coaxial slot waveguides are presented. The theories, background, and physical principles related to frequency-domain electromagnetic equations for coaxial waveguides are reassessed. Comparisons of the accuracies of various types of admittance and impedance equations and numerical simulations are made, and the fringing field at the aperture sensor, which is represented by the lumped capacitance circuit, is evaluated. The accuracy and limitations of the analytical equations are explained in detail. The reasons for the replacement of analytical methods by numerical methods are outlined.
-
Analytical theory of noncollinear amorphous metallic magnetism
International Nuclear Information System (INIS)
Kakehashi, Y.; Uchida, T.
2001-01-01
Analytical theory of noncollinear magnetism in amorphous metals is proposed on the basis of the Gaussian model for the distribution of the interatomic distance and the saddle-point approximation. The theory removes the numerical difficulty in the previous theory based on the Monte-Carlo sampling method, and reasonably describes the magnetic properties of amorphous transition metals
-
In Their Own Words: A Text Analytics Investigation of College Course Attrition
Michalski, Greg V.
2014-01-01
Excessive course attrition is costly to both the student and the institution. While most institutions have systems to quantify and report the numbers, far less attention is typically paid to each student's reason(s) for withdrawal. In this case study, text analytics was used to analyze a large set of open-ended written comments in which students…
-
. MODERN EDUCATION: FROM RATIONALITY TO REASONABLENESS
Directory of Open Access Journals (Sweden)
O. S. Anisimov
2014-01-01
Full Text Available The paper deals with the problem of modern education development and criticizes a pragmatic attitude to education. Based on the retrospective historical analysis, the author maintains that educational systems are generally focused on fostering the pragmatic intellect rather than reasoning, which leads to a superficial world perception, and undermines personal analytical potential and capability of strategic problem solving. Concentration on rationality is unlikely to provide a way out of the world crisis. In the author’s view, education demands both the deep and solid comprehension of existential concepts and the reference to the “absolute spirit” of Confucius, Plato, Kant and Hegel. The research is aimed at justifying the civilizational paradigm of education on the basis of Hegelian fundamental ideas of intellectual perception with the emphasis on reasonability instead of rationality. As the most adequate implementation instrument, the author suggests a game simulating technique that combines the benefits of philosophical, scientific and methodological thinking.
-
Reasoning and Knowledge Acquisition Framework for 5G Network Analytics
2017-01-01
Autonomic self-management is a key challenge for next-generation networks. This paper proposes an automated analysis framework to infer knowledge in 5G networks with the aim to understand the network status and to predict potential situations that might disrupt the network operability. The framework is based on the Endsley situational awareness model, and integrates automated capabilities for metrics discovery, pattern recognition, prediction techniques and rule-based reasoning to infer anomalous situations in the current operational context. Those situations should then be mitigated, either proactive or reactively, by a more complex decision-making process. The framework is driven by a use case methodology, where the network administrator is able to customize the knowledge inference rules and operational parameters. The proposal has also been instantiated to prove its adaptability to a real use case. To this end, a reference network traffic dataset was used to identify suspicious patterns and to predict the behavior of the monitored data volume. The preliminary results suggest a good level of accuracy on the inference of anomalous traffic volumes based on a simple configuration. PMID:29065473
-
Reasoning and Knowledge Acquisition Framework for 5G Network Analytics.
Sotelo Monge, Marco Antonio; Maestre Vidal, Jorge; García Villalba, Luis Javier
2017-10-21
Autonomic self-management is a key challenge for next-generation networks. This paper proposes an automated analysis framework to infer knowledge in 5G networks with the aim to understand the network status and to predict potential situations that might disrupt the network operability. The framework is based on the Endsley situational awareness model, and integrates automated capabilities for metrics discovery, pattern recognition, prediction techniques and rule-based reasoning to infer anomalous situations in the current operational context. Those situations should then be mitigated, either proactive or reactively, by a more complex decision-making process. The framework is driven by a use case methodology, where the network administrator is able to customize the knowledge inference rules and operational parameters. The proposal has also been instantiated to prove its adaptability to a real use case. To this end, a reference network traffic dataset was used to identify suspicious patterns and to predict the behavior of the monitored data volume. The preliminary results suggest a good level of accuracy on the inference of anomalous traffic volumes based on a simple configuration.
-
The importance of the patients deemed not guilty by reason of insanity for the psychiatric reform.
Douzenis, Athanasios
2016-01-01
According to the Greek Penal Law if someone "because of a morbid disturbance of his mental functioning" (article 34) is acquitted of a crime or misdemeanour that the law punishes with more than 6 months imprisonment, then the court orders that this individual should be kept in a public psychiatric institution if the court reaches the conclusion that this person poses a threat to public safety.1 Individuals who have broken the law and deemed "not guilty by reason of insanity" are treated in psychiatric units of Psychiatric Hospitals according to the article 69 of the Penal Code. In Athens, in the Psychiatric Hospital of Athens and the Dromokaiteion Psychiatric Hospital, and in Thessaloniki in the Unit for "Not guilty by reason of insanity (NGRI)". The person who is deemed not guilty by reason of insanity following a crime is facing double stigmatisation and marginalisation from both the legal and the health system. He/she is usually treated initially with fear and later since there is no therapeutic aim but only the court instruction for "guardianship", with indifference. The patient who is committed by the courts in a psychiatric unit for being "NGRI" is facing a unique legal and psychiatric status.2 In this respect he/she is disadvantaged when compared to either convicted criminals or psychiatric inpatients. If the patient was not found "NGRI" (ie innocent as far as sentencing is concerned) he would have been punished with loss of liberty for a certain (specific) amount of time, and like all individuals convicted in court he/she would have the right to appeal and reduce his/her sentence in a higher court and maybe released from prison earlier for good behaviour etc. In this respect the individual found to be "NGRI" is disadvantaged when compared to a convicted felon since he/she is kept for an undefined period of time. Additionally, he/she will be allowed to leave the psychiatric unit following a subjective assessment of a judge with no psychiatric knowledge who
-
Reasoning in believers in the paranormal.
Lawrence, Emma; Peters, Emmanuelle
2004-11-01
Reasoning biases have been identified in deluded patients, delusion-prone individuals, and believers in the paranormal. This study examined content-specific reasoning and delusional ideation in believers in the paranormal. A total of 174 members of the Society for Psychical Research completed a delusional ideation questionnaire and a deductive reasoning task. The reasoning statements were manipulated for congruency with paranormal beliefs. As predicted, individuals who reported a strong belief in the paranormal made more errors and displayed more delusional ideation than skeptical individuals. However, no differences were found with statements that were congruent with their belief system, confirming the domain-specificity of reasoning. This reasoning bias was limited to people who reported a belief in, rather than experience of, paranormal phenomena. These results suggest that reasoning abnormalities may have a causal role in the formation of unusual beliefs. The dissociation between experiences and beliefs implies that such abnormalities operate at the evaluative, rather than the perceptual, stage of processing.
-
Operator support and diagnostic reasoning in an industrial process
Energy Technology Data Exchange (ETDEWEB)
Aaker, O.
1996-12-31
Efficient use of energy in production plants requires that the various processes are well controlled. The main focus of this doctoral thesis is on detection of errors and malfunctions using analytical redundancy and on state estimation using an open loop nonlinear model. A ``residual`` is present if a system does not behave as expected, or if a certain rule is violated. ``Reasoning`` is the action of finding process malfunctions based on observed residuals. The thesis applies a new formalism for comparing diagnostic reasoning methods both in terms of what knowledge is used and how it is used, and suggests a formal model of what is known about the process. The formalism is used to illustrate the difference between diagnostic reasoning based on physically interconnected process units and streams, and reasoning about goals and functions for finding a diagnosis. As an example of application, results and experiences from a test implementation using an open loop model for operator support in a complex fertilizer factory are reported. 108 refs., 61 figs., 37 tabs.
-
Directory of Open Access Journals (Sweden)
Siavash Savadi Oskoee
2007-06-01
Full Text Available
Background and aims. Retreatment of existing restorations not only requires a lot of money and time but also there is a danger of weakening tooth structure and irritating the pulp. Since awareness of the reasons for the retreatment of teeth will save the teeth from possible future failure, the aim of this study was to assess the reasons for retreatment of amalgam and composite restorations in patients referring to Tabriz Faculty of Dentistry.
Materials and methods. In this descriptive study, the subjects had previously received an amalgam or a composite restoration in the Operative Department by dental students and were judged to need retreatment in their second visit. A total of 300 defective teeth were selected by simple random sampling method. The data was collected through examination and questionnaires and analyzed using chi-square test.
Results. There was a statistically significant association between the type of the restorative material and the reason for retreatment (p=0.001.
Conclusion. Although the reasons for the retreatment of amalgam and composite restorations were different, recurrent caries was the main reason for the retreatment for both restorative materials.
-
Therapeutic reasoning: from hiatus to hypothetical model
Bissessur, S.; Geijteman, E.C.T.; Al-Dulaimy, M.; Teunissen, P.W.; Richir, M.C.; Arnold, A.E.R.; Vries, de T.P.G.M.
2009-01-01
Rationale Extensive research has been conducted on clinical reasoning to gain better understanding of this process. Clinical reasoning has been defined as the process of thinking critically about the diagnosis and patient management. However, most research has focused on the process of diagnostic
-
An Analysis of Machine- and Human-Analytics in Classification.
Tam, Gary K L; Kothari, Vivek; Chen, Min
2017-01-01
In this work, we present a study that traces the technical and cognitive processes in two visual analytics applications to a common theoretic model of soft knowledge that may be added into a visual analytics process for constructing a decision-tree model. Both case studies involved the development of classification models based on the "bag of features" approach. Both compared a visual analytics approach using parallel coordinates with a machine-learning approach using information theory. Both found that the visual analytics approach had some advantages over the machine learning approach, especially when sparse datasets were used as the ground truth. We examine various possible factors that may have contributed to such advantages, and collect empirical evidence for supporting the observation and reasoning of these factors. We propose an information-theoretic model as a common theoretic basis to explain the phenomena exhibited in these two case studies. Together we provide interconnected empirical and theoretical evidence to support the usefulness of visual analytics.
-
Neural basis of nonanalytical reasoning expertise during clinical evaluation
Durning, S.J.; Costanzo, M.E.; Artino, A.R.; Graner, J.; Vleuten, C.P.M. van der; Beckman, T.J.; Wittich, C.M.; Roy, M.J.H.M. van; Holmboe, E.S.; Schuwirth, L.
2015-01-01
INTRODUCTION: Understanding clinical reasoning is essential for patient care and medical education. Dual-processing theory suggests that nonanalytic reasoning is an essential aspect of expertise; however, assessing nonanalytic reasoning is challenging because it is believed to occur on the
-
Cheing, Gladys; Vong, Sinfia; Chan, Fong; Ditchman, Nicole; Brooks, Jessica; Chan, Chetwyn
2014-12-01
Pain is a complex phenomenon not easily discerned from psychological, social, and environmental characteristics and is an oft cited barrier to return to work for people experiencing low back pain (LBP). The purpose of this study was to evaluate a path-analytic mediation model to examine how motivational enhancement physiotherapy, which incorporates tenets of motivational interviewing, improves physical functioning of patients with chronic LBP. Seventy-six patients with chronic LBP were recruited from the outpatient physiotherapy department of a government hospital in Hong Kong. The re-specified path-analytic model fit the data very well, χ (2)(3, N = 76) = 3.86, p = .57; comparative fit index = 1.00; and the root mean square error of approximation = 0.00. Specifically, results indicated that (a) using motivational interviewing techniques in physiotherapy was associated with increased working alliance with patients, (b) working alliance increased patients' outcome expectancy and (c) greater outcome expectancy resulted in a reduction of subjective pain intensity and improvement in physical functioning. Change in pain intensity also directly influenced improvement in physical functioning. The effect of motivational enhancement therapy on physical functioning can be explained by social-cognitive factors such as motivation, outcome expectancy, and working alliance. The use of motivational interviewing techniques to increase outcome expectancy of patients and improve working alliance could further strengthen the impact of physiotherapy on rehabilitation outcomes of patients with chronic LBP.
-
Bakker, Arthur; Ben-Zvi, Dani; Makar, Katie
2017-12-01
To understand how statistical and other types of reasoning are coordinated with actions to reduce uncertainty, we conducted a case study in vocational education that involved statistical hypothesis testing. We analyzed an intern's research project in a hospital laboratory in which reducing uncertainties was crucial to make a valid statistical inference. In his project, the intern, Sam, investigated whether patients' blood could be sent through pneumatic post without influencing the measurement of particular blood components. We asked, in the process of making a statistical inference, how are reasons and actions coordinated to reduce uncertainty? For the analysis, we used the semantic theory of inferentialism, specifically, the concept of webs of reasons and actions—complexes of interconnected reasons for facts and actions; these reasons include premises and conclusions, inferential relations, implications, motives for action, and utility of tools for specific purposes in a particular context. Analysis of interviews with Sam, his supervisor and teacher as well as video data of Sam in the classroom showed that many of Sam's actions aimed to reduce variability, rule out errors, and thus reduce uncertainties so as to arrive at a valid inference. Interestingly, the decisive factor was not the outcome of a t test but of the reference change value, a clinical chemical measure of analytic and biological variability. With insights from this case study, we expect that students can be better supported in connecting statistics with context and in dealing with uncertainty.
-
Teaching clinical reasoning to medical students.
Gay, Simon; Bartlett, Maggie; McKinley, Robert
2013-10-01
Keele Medical School's new curriculum includes a 5-week course to extend medical students' consultation skills beyond those historically required for competent inductive diagnosis. Clinical reasoning is a core skill for the practice of medicine, and is known to have implications for patient safety, yet historically it has not been explicitly taught. Rather, it has been assumed that these skills will be learned by accumulating a body of knowledge and by observing expert clinicians. This course aims to assist students to develop their own clinical reasoning skills and promote their greater understanding of, and potential to benefit from, the clinical reasoning skills of others. The course takes place in the fourth or penultimate year, and is integrated with students' clinical placements, giving them opportunities to practise and quickly embed their learning. This course emphasises that clinical reasoning extends beyond initial diagnosis into all other aspects of clinical practice, particularly clinical management. It offers students a variety of challenging and interesting opportunities to engage with clinical reasoning across a wide range of clinical practice. It addresses bias through metacognition and increased self-awareness, considers some of the complexities of prescribing and non-pharmacological interventions, and promotes pragmatic evidence-based practice, information management within the consultation and the maximising of patient adherence. This article describes clinical reasoning-based classroom and community teaching. Early evaluation suggests that students value the course and benefit from it. © 2013 John Wiley & Sons Ltd.
-
Ruud, Sven Eirik; Hjortdahl, Per; Natvig, Bård
2017-03-01
To explore reasons for attending a general emergency outpatient clinic versus a regular general practitioner (RGP). Cross-sectional study using a multilingual anonymous questionnaire. Native and immigrant walk-in patients attending a general emergency outpatient clinic in Oslo (Monday-Friday, 08:00-23:00) during 2 weeks in September 2009. We included 1022 walk-in patients: 565 native Norwegians (55%) and 457 immigrants (45%). Patients' reasons for attending an emergency outpatient clinic versus their RGP. Among patients reporting an RGP affiliation, 49% tried to contact their RGP before this emergency encounter: 44% of native Norwegian and 58% of immigrant respondents. Immigrants from Africa [odds ratio (OR) = 2.55 (95% confidence interval [CI]: 1.46-4.46)] and Asia [OR = 2.32 (95% CI: 1.42-3.78)] were more likely to contact their RGP before attending the general emergency outpatient clinic compared with native Norwegians. The most frequent reason for attending the emergency clinic was difficulty making an immediate appointment with their RGP. A frequent reason for not contacting an RGP was lack of access: 21% of the native Norwegians versus 4% of the immigrants claimed their RGP was in another district/municipality, and 31% of the immigrants reported a lack of affiliation with the RGP scheme. Access to primary care provided by an RGP affects patients' use of emergency health care services. To facilitate continuity of health care, policymakers should emphasize initiatives to improve access to primary health care services. KEY POINTS Access to immediate primary health care provided by a regular general practitioner (RGP) can reduce patients' use of emergency health care services. The main reason for attending a general emergency outpatient clinic was difficulty obtaining an immediate appointment with an RGP. A frequent reason for native Norwegians attending a general emergency outpatient clinic during the daytime is having an RGP outside Oslo. Lack of
-
Reasons for late seeking of dental care among dental patients ...
African Journals Online (AJOL)
Reasons for delayed reporting for oral care were negligence (53.5%); poor dental services or visited but not treated (19.4%); financial reasons (14.8%); and dental fear (12.3%). Seventy seven percent of respondents who had toothache due to advanced dental caries were aware that the aching tooth was decayed, of which, ...
-
Directory of Open Access Journals (Sweden)
André Luiz Parolin Ribeiro
2002-08-01
Full Text Available Purpose: To present how the section of Refractive Surgery of the Federal University of São Paulo assesses the candidates and the reasons to indicate for corneal refractive surgery. Methods: We examined 1626 patients. Anamnesis, complete ophthalmologic examination and corneal topography were performed in all patients. The patients spontaneously seeked evaluation at the Refractive Surgery Section by telephone without a previous screening. Reasons to refuse patients for refractive surgery were previously established by the Refractive Surgery Section. Results: Based on current technology and clinical experience, 265 patients (16.29% were refused for excimer laser corneal refractive surgery. Myopia of patients who had insufficient preoperative corneal pachymetry for the laser treatment was the main cause for refusal (51 patients. Cataract (45 patients, keratoconus (31 patients, amblyopia (21 patients, hyperopia > 5 diopters and mixed astigmatism (19 patients, presbyopia (unaware ness of the need for optical correction after the procedure; 16 patients, pupillary diameter > 5mm (9 patients, single eye (9 patients, progressive myopia (8 patients, postradial keratotomy (7 patients and low ametropia (7 patients were among the reasons for the refusal. Conclusion: Candidates for excimer laser corneal refractive surgery may present risk factors that should be known in order to avoid complications.Objetivo: O objetivo deste estudo é mostrar como o setor de Cirurgia Refrativa da Escola Paulista de Medicina da Universidade Federal de São Paulo avalia seus candidatos e quais as razões para não selecioná-los para cirurgia refrativa. Métodos: Foram examinados 1626 pacientes. Anamnese, avaliação oftalmológica completa e topografia corneana foram realizadas em todos os pacientes. Os pacientes procuraram avaliação no setor de Cirurgia Refrativa espontaneamente sem triagem prévia. Resultados: Não foram selecionados 265 pacientes (16,29% para cirurgia
-
DEFF Research Database (Denmark)
Heiberg Engel, Peter Johan
2008-01-01
BACKGROUND: Much education--especially at the university level--has been criticized for having primarily dealt with explicit knowledge, i.e. those aspects of mental activities, which are verbal and conscious. Furthermore, research in medical diagnostic reasoning has been criticized for having...... focused on the specialty of intern medicine, while specialties with other skills, i.e. perceptive skills within pathology and radiology, have been ignored. AIMS: To show that the concept of tacit knowledge is important in medical education-at all levels and in medical diagnostic reasoning. METHODS...... such as "non-analytical reasoning" and "dual process of reasoning." CONCLUSION: It is important that educators are trained in how explicit and implicit knowledge is attained and that tacit knowledge is included in educational programmes of all medical specialties....
-
J. Ortega y Gasset's Vital Reason and M. Heidegger'sExistential Analytic
Directory of Open Access Journals (Sweden)
Francesco de Nigris
2012-04-01
Full Text Available According to Heidegger, being cannot be taken as a blind starting point or belief. Ortega y Gasset’s critique of this approach to the problem of being reveals the distance between two perspectives that are, nevertheless, joined by the actual horizon they explore: human life. However, their results are different because the analysis of Dasein aims at discovering the general meaning of being, while Ortega’s conception of being as a belief, as a historical interpretation of life linked to a “way of thinking”, turns his analysis of vital reason into a personal project of salvation.
-
Eco-analytical Methodology in Environmental Problems Monitoring
Agienko, M. I.; Bondareva, E. P.; Chistyakova, G. V.; Zhironkina, O. V.; Kalinina, O. I.
2017-01-01
Among the problems common to all mankind, which solutions influence the prospects of civilization, the problem of ecological situation monitoring takes very important place. Solution of this problem requires specific methodology based on eco-analytical comprehension of global issues. Eco-analytical methodology should help searching for the optimum balance between environmental problems and accelerating scientific and technical progress. The fact that Governments, corporations, scientists and nations focus on the production and consumption of material goods cause great damage to environment. As a result, the activity of environmentalists is developing quite spontaneously, as a complement to productive activities. Therefore, the challenge posed by the environmental problems for the science is the formation of geo-analytical reasoning and the monitoring of global problems common for the whole humanity. So it is expected to find the optimal trajectory of industrial development to prevent irreversible problems in the biosphere that could stop progress of civilization.
-
Al Refai, Roa'a; Saker, Samah
2018-01-01
The expected length of service and reasons for fixed dental prostheses (FDPs) replacement are a frequent inquiry by patients while the answers were mainly based on studies reports that was conducted outside the middle east region. This clinical and radiographic survey was constructed to assess and survey clinically and radiographically the reasons of replacement of metal-ceramic fixed dental prostheses, amongst patients reporting at dental school in Taibah University. Between January and May 2016, 151 patients were recruited for this study. Interview (include questions pertained to the length of service of the prosthesis, the nature of complaint as told by patient in her own words), clinical examination, intra-oral photographs, and periapical radiographs, were done by the researchers. The parameters assessed were secondary caries, open margins, loss of retention, failure of endodontic treatment of the abutment and periodontal diseases. A total number of 249 failed fixed dental prostheses were evaluated. Of which 180 (39.7%) were single crowns, 159 (35.0%) were retainers and 117 (25.8%) were pontics in 69 fixed partial denture. The most common reason for replacement of fixed restorations was periodontal diseases affecting 92.8% of all types' restorations, followed by defective margin in 90.4% of examined restoration, poor aesthetic in 88% of restorations, while periapical involvement was found in 85.5% of fixed dental prosthesis. The survival rates of fixed prostheses were not predictable, and no association was found between number of years in service and the number of restorations. The most common reasons for replacing single unit fixed dental prostheses are periodontal diseases and periapical involvement, while defective margins and poor aesthetic mainly associated with multi-unit fixed dental prostheses. Key words: Failure, Fixed dental prosthesis, Survival, Replacement.
-
Corcoran, Rhiannon; Cummins, Sinead; Rowse, Georgina; Moore, Rosie; Blackwood, Nigel; Howard, Robert; Kinderman, Peter; Bentall, Richard P
2006-08-01
The substantial literature examining social reasoning in people with delusions has, to date, neglected the commonest form of decision making in daily life. We address this imbalance by reporting here the findings of the first study to explore heuristic reasoning in people with persecutory delusions. People with active or remitted paranoid delusions, depressed and healthy adults performed two novel heuristic reasoning tasks that varied in emotional valence. The findings indicated that people with persecutory delusions displayed biases during heuristic reasoning that were most obvious when reasoning about threatening and positive material. Clear similarities existed between the currently paranoid group and the depressed group in terms of their reasoning about the likelihood of events happening to them, with both groups tending to believe that pleasant things would not happen to them. However, only the currently paranoid group showed an increased tendency to view other people as threatening. This study has initiated the exploration of heuristic reasoning in paranoia and depression. The findings have therapeutic utility and future work could focus on the differentiation of paranoia and depression at a cognitive level.
-
Freud's dreams of reason: the Kantian structure of psychoanalysis.
Tauber, Alfred I
2009-10-01
Freud (and later commentators) have failed to explain how the origins of psychoanalytical theory began with a positivist investment without recognizing a dual epistemological commitment: simply, Freud engaged positivism because he believed it generally equated with empiricism, which he valued, and he rejected "philosophy," and, more specifically, Kantianism, because of the associated transcendental qualities of its epistemology. But this simple dismissal belies a deep investment in Kant's formulation of human reason, in which rationality escapes natural cause and thereby bestows humans with cognitive and moral autonomy. Freud also segregated human rationality: he divided the mind between (1) an unconscious grounded in the biological and thus subject to its own laws, and (2) a faculty of autonomous reason, lodged in consciousness and free of natural forces to become the repository of interpretation and free will. Psychoanalysis thus rests upon a basic Kantian construction, whereby reason, through the aid of analytic techniques, provides a detached scrutiny of the natural world, i.e. the unconscious mental domain. Further, sovereign reason becomes the instrument of self-knowing in the pursuit of human perfection. Herein lies the philosophical foundation of psychoanalytic theory, a beguiling paradox in which natural cause and autonomous reason - determinism and freedom - are conjoined despite their apparent logical exclusion.
-
Lombardi, Giovanni; Sansoni, Veronica; Banfi, Giuseppe
2017-08-01
In the last few years, a growing number of molecules have been associated to an endocrine function of the skeletal muscle. Circulating myokine levels, in turn, have been associated with several pathophysiological conditions including the cardiovascular ones. However, data from different studies are often not completely comparable or even discordant. This would be due, at least in part, to the whole set of situations related to the preparation of the patient prior to blood sampling, blood sampling procedure, processing and/or store. This entire process constitutes the pre-analytical phase. The importance of the pre-analytical phase is often not considered. However, in routine diagnostics, the 70% of the errors are in this phase. Moreover, errors during the pre-analytical phase are carried over in the analytical phase and affects the final output. In research, for example, when samples are collected over a long time and by different laboratories, a standardized procedure for sample collecting and the correct procedure for sample storage are acknowledged. In this review, we discuss the pre-analytical variables potentially affecting the measurement of myokines with cardiovascular functions.
-
Behavioural health analytics using mobile phones
Directory of Open Access Journals (Sweden)
P. Wlodarczak
2015-07-01
Full Text Available Big Data analytics in healthcare has become a very active area of research since it promises to reduce costs and to improve health care quality. Behavioural analytics analyses a patients behavioural patterns with the goal of early detection if a patient becomes symptomatic and triggering treatment even before a disease outbreak happens. Behavioural analytics allows a more precise and personalised treatment and can even monitor whole populations for events such as epidemic outbreaks. With the prevalence of mobile phones, they have been used to monitor the health of patients by analysing their behavioural and movement patterns. Cell phones are always on devices and are usually close to their users. As such they can be used as social sensors to create "automated diaries" of their users. Specialised apps passively collect and analyse user data to detect if a patient shows some deviant behaviour indicating he has become symptomatic. These apps first learn a patients normal daily patterns and alert a health care centre if it detects a deviant behaviour. The health care centre can then call the patient and check on his well-being. These apps use machine learning techniques to for reality mining and predictive analysis. This paper describes some of these techniques that have been adopted recently in eHealth apps.
-
Mühlbacher, Axel C; Bethge, Susanne; Kaczynski, Anika
2016-01-01
Cardiovascular disease is one of the most common causes of death worldwide, with many individuals having experienced acute coronary syndrome (ACS). How patients with a history of ACS value aspects of their medical treatment have been evaluated rarely. The aim of this study was to determine patient priorities for long-term drug therapy after experiencing ACS. To identify patient-relevant treatment characteristics, a systematic literature review and qualitative patient interviews were conducted. A questionnaire was developed to elicit patient's priorities for different characteristics of ACS treatment using Analytic Hierarchy Process (AHP). To evaluate the patient-relevant outcomes, the eigenvector method was applied. Six-hundred twenty-three patients participated in the computer-assisted personal interviews and were included in the final analysis. Patients showed a clear priority for the attribute "reduction of mortality risk" (weight: 0.402). The second most preferred attribute was the "prevention of a new myocardial infarction" (weight: 0.272), followed by "side effect: dyspnea" (weight: 0.165) and "side effect: bleeding" (weight: 0.117). The "frequency of intake" was the least important attribute (weight: 0.044). In conclusion, this study shows that patients strongly value a reduction of the mortality risk in post-ACS treatment. Formal consideration of patient preferences and priorities can help to inform a patient-centered approach, clinical practice, development of future effective therapies, and health policy for decision makers that best represents the needs and goals of the patient.
-
Analogical reasoning in schizophrenic delusions.
Simpson, Jane; Done, D John
2004-09-01
Reasoning ability has often been argued to be impaired in people with schizophrenic delusions, although evidence for this is far from convincing. This experiment examined the analogical reasoning abilities of several groups of patients, including non-deluded and deluded schizophrenics, to test the hypothesis that performance by the deluded schizophrenic group would be impaired. Eleven deluded schizophrenics, 10 depressed subjects, seven non-deluded schizophrenics and 16 matched non-psychiatric controls, who were matched on a number of key variables, were asked to solve an analogical reasoning task. Performance by the deluded schizophrenic group was certainly impaired when compared with the depressed and non-psychiatric control groups though less convincingly so when compared with the non-deluded schizophrenic group. The impairment shown by the deluded schizophrenic group seemed to occur at the initial stage of the reasoning task. The particular type of impairment shown by the deluded subjects was assessed in relation to other cognitive problems already researched and the implications of these problems on reasoning tasks and theories of delusions was discussed.
-
Diagnostic reasoning in action
DEFF Research Database (Denmark)
Rasmussen, Jens
1993-01-01
of system failures; and in medicine, diagnosis is the basis for any patient treatment. The paper presents a discussion of the basic nature of causal reasoning as applied for diagnosis and the mental strategies applied when diagnosis is viewed as an integrated part of ''natural decision making...
-
Gil-Guillén, Vicente; Orozco-Beltrán, Domingo; Carratalá-Munuera, Concepción; Márquez-Contreras, Emilio; Durazo-Arvizu, Ramón; Cooper, Richard; Pertusa-Martínez, Salvador; Pita-Fernandez, Salvador; González-Segura, Diego; Martin-de-Pablo, José Luis; Pallarés, Vicente; Fernández, Antonio; Redón, Josep
2013-06-01
Clinical inertia, the failure of physicians to initiate or intensify therapy when indicated, is a major problem in the management of hypertension and may be more prevalent in elderly patients. Overcoming clinical inertia requires understanding its causes and evaluating certain factors, particularly those related to physicians. The objective of our study was to determine the rate of clinical inertia and the physician-reported reasons for it. An observational, cross-sectional, multi-center study was carried out in a primary care setting. We included 512 physicians, with a consecutive sampling of 1,499 hypertensive patients with clinical inertia. Clinical inertia was defined when physicians did not modify treatment despite knowing that the therapeutic target had not been reached. Clinical inertia was considered to be justified (JCI) when physicians provided an explanation for not intensifying treatment and as not justified (nJCI) when no reasons were given. JCI was observed in 30.1 % (95 % CI 27.8-32.4) of patients (n = 451) and nJCI in 69.9 % (95 % CI 67.6-72.2) (n = 1,058). JCI was associated with higher blood pressure (BP) values (both systolic and diastolic) and diabetes (p = 0.012) than nJCI. nJCI was associated with patients having an isolated increase of systolic or diastolic or high borderline BP values or cardiovascular disease. Physicians provided reasons for not intensifying treatment in poorly controlled patients in only 30 % of instances. Main reasons for not intensifying treatment were borderline BP values, co-morbidity, suspected white coat effect, or perceived difficulty achieving target. nJCI was associated with high borderline BP values and cardiovascular disease.
-
Multi-Intelligence Analytics for Next Generation Analysts (MIAGA)
Blasch, Erik; Waltz, Ed
2016-05-01
Current analysts are inundated with large volumes of data from which extraction, exploitation, and indexing are required. A future need for next-generation analysts is an appropriate balance between machine analytics from raw data and the ability of the user to interact with information through automation. Many quantitative intelligence tools and techniques have been developed which are examined towards matching analyst opportunities with recent technical trends such as big data, access to information, and visualization. The concepts and techniques summarized are derived from discussions with real analysts, documented trends of technical developments, and methods to engage future analysts with multiintelligence services. For example, qualitative techniques should be matched against physical, cognitive, and contextual quantitative analytics for intelligence reporting. Future trends include enabling knowledge search, collaborative situational sharing, and agile support for empirical decision-making and analytical reasoning.
-
Perspectives on reasons of medication nonadherence in psychiatric patients
Directory of Open Access Journals (Sweden)
Mert DG
2015-01-01
Full Text Available Derya Güliz Mert,1 Nergiz Hacer Turgut,2 Meral Kelleci,3 Murat Semiz4 1Department of Psychiatry, Faculty of Medicine, Cumhuriyet University, 2Department of Pharmacology, Faculty of Pharmacy, Cumhuriyet University, 3Department of Psychiatric Nursing, Faculty of Health Sciences, Cumhuriyet University, Sivas, Turkey; 4Department of Psychiatry, Faculty of Medicine, University of Osmangazi, Tokat, Turkey Purpose: This study was carried out to evaluate factors resulting in medication nonadherence within 6 months before admission to the psychiatric service of our hospital for bipolar disorder, schizophrenia/schizoaffective disorder, depression, and other psychiatric diseases.Patients and methods: Two hundred and three patients admitted to the Psychiatry Service of the Medical Faculty were included in this study. Sociodemographic parameters and clinical findings within 6 months before admission and patients’ views on reasons of medication nonadherence were examined.Results: Patients were classified into four groups according to their diagnosis: bipolar disorder (n=68, 33.5%, schizophrenia/schizoaffective disorder (n=59, 29.1%, depression (n=39, 19.2%, and others (n=37, 18.2%. The ratio of medication nonadherence was higher in the bipolar disorder group when compared to the groups with schizophrenia/schizoaffective disorder, depression, and other disorders (12.1%, 18.2%, and 24.2% vs 45.5%; however, the ratio of medication nonadherence was similar in schizophrenia/schizoaffective disorder, depression, and the others group. In logistic regression analysis, irregular follow-up (odds ratio [OR]: 5.7; 95% confidence interval [CI]: 2.92–11.31 and diagnosis (OR: 1.5; 95% CI: 1.07–1.95 were determined to be important risk factors for medication nonadherence. The leading factors for medication nonadherence were: “not willing to use medication”, “not accepting the disease”, and “being disturbed by side effects” in the bipolar disorder group,
-
Analytic cognitive style predicts religious and paranormal belief.
Pennycook, Gordon; Cheyne, James Allan; Seli, Paul; Koehler, Derek J; Fugelsang, Jonathan A
2012-06-01
An analytic cognitive style denotes a propensity to set aside highly salient intuitions when engaging in problem solving. We assess the hypothesis that an analytic cognitive style is associated with a history of questioning, altering, and rejecting (i.e., unbelieving) supernatural claims, both religious and paranormal. In two studies, we examined associations of God beliefs, religious engagement (attendance at religious services, praying, etc.), conventional religious beliefs (heaven, miracles, etc.) and paranormal beliefs (extrasensory perception, levitation, etc.) with performance measures of cognitive ability and analytic cognitive style. An analytic cognitive style negatively predicted both religious and paranormal beliefs when controlling for cognitive ability as well as religious engagement, sex, age, political ideology, and education. Participants more willing to engage in analytic reasoning were less likely to endorse supernatural beliefs. Further, an association between analytic cognitive style and religious engagement was mediated by religious beliefs, suggesting that an analytic cognitive style negatively affects religious engagement via lower acceptance of conventional religious beliefs. Results for types of God belief indicate that the association between an analytic cognitive style and God beliefs is more nuanced than mere acceptance and rejection, but also includes adopting less conventional God beliefs, such as Pantheism or Deism. Our data are consistent with the idea that two people who share the same cognitive ability, education, political ideology, sex, age and level of religious engagement can acquire very different sets of beliefs about the world if they differ in their propensity to think analytically. Copyright © 2012 Elsevier B.V. All rights reserved.
-
Supporting Knowledge Transfer through Decomposable Reasoning Artifacts
Energy Technology Data Exchange (ETDEWEB)
Pike, William A.; May, Richard A.; Turner, Alan E.
2007-01-03
Technology to support knowledge transfer and cooperative inquiry must offer its users the ability to effectively interpret knowledge structures produced by collaborators. Communicating the reasoning processes that underlie a finding is one method for enhancing interpretation, and can result in more effective evaluation and application of shared knowledge. In knowledge management tools, interpretation is aided by creating knowledge artifacts that can expose their provenance to scrutiny and that can be transformed into diverse representations that suit their consumers’ perspectives and preferences. We outline the information management needs of inquiring communities characterized by hypothesis generation tasks, and propose a model for communication, based in theories of hermeneutics, semiotics, and abduction, in which knowledge structures can be decomposed into the lower-level reasoning artifacts that produced them. We then present a proof-of-concept implementation for an environment to support the capture and communication of analytic products, with emphasis on the domain of intelligence analysis.
-
Using predictive analytics and big data to optimize pharmaceutical outcomes.
Hernandez, Inmaculada; Zhang, Yuting
2017-09-15
The steps involved, the resources needed, and the challenges associated with applying predictive analytics in healthcare are described, with a review of successful applications of predictive analytics in implementing population health management interventions that target medication-related patient outcomes. In healthcare, the term big data typically refers to large quantities of electronic health record, administrative claims, and clinical trial data as well as data collected from smartphone applications, wearable devices, social media, and personal genomics services; predictive analytics refers to innovative methods of analysis developed to overcome challenges associated with big data, including a variety of statistical techniques ranging from predictive modeling to machine learning to data mining. Predictive analytics using big data have been applied successfully in several areas of medication management, such as in the identification of complex patients or those at highest risk for medication noncompliance or adverse effects. Because predictive analytics can be used in predicting different outcomes, they can provide pharmacists with a better understanding of the risks for specific medication-related problems that each patient faces. This information will enable pharmacists to deliver interventions tailored to patients' needs. In order to take full advantage of these benefits, however, clinicians will have to understand the basics of big data and predictive analytics. Predictive analytics that leverage big data will become an indispensable tool for clinicians in mapping interventions and improving patient outcomes. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
-
Reasons to value the health care intangible asset valuation.
Reilly, Robert F
2012-01-01
There are numerous individual reasons to conduct a health care intangible asset valuation. This discussion summarized many of these reasons and considered the common categories of these individual reasons. Understanding the reason for the intangible asset analysis is an important prerequisite to conducting the valuation, both for the analyst and the health care owner/operator. This is because an intangible asset valuation may not be the type of analysis that the owner/operator really needs. Rather, the owner/operator may really need an economic damages measurement, a license royalty rate analysis, an intercompany transfer price study, a commercialization potential evaluation, or some other type of intangible asset analysis. In addition, a clear definition of the reason for the valuation will allow the analyst to understand if (1) any specific analytical guidelines, procedures, or regulations apply and (2) any specific reporting requirement applies. For example, intangible asset valuations prepared for fair value accounting purposes should meet specific ASC 820 fair value accounting guidance. Intangible asset valuations performed for intercompany transfer price tax purposes should comply with the guidance provided in the Section 482 regulations. Likewise, intangible asset valuations prepared for Section 170 charitable contribution purposes should comply with specific reporting requirements. The individual reasons for the health care intangible asset valuation may influence the standard of value applied, the valuation date selected, the valuation approaches and methods applied, the form and format of valuation report prepared, and even the type of professional employed to perform the valuation.
-
Reasons Internalism and the function of normative reasons
Sinclair, Neil
2017-01-01
What is the connection between reasons and motives? According to Reasons Internalism there is a non-trivial conceptual connection between normative reasons and the possibility of rationally accessing relevant motivation. Reasons Internalism is attractive insofar as it captures the thought that reasons are for reasoning with and repulsive insofar as it fails to generate sufficient critical distance between reasons and motives. Rather than directly adjudicate this dispute, I extract from it two...
-
Fu, Jack Brian; Lee, Jay; Smith, Dennis W.; Bruera, Eduardo
2012-01-01
Objective To assess the frequency and reasons for return to the primary acute care service among leukemia patients undergoing inpatient rehabilitation. Design Retrospective study of all patients with leukemia, myelodysplastic syndrome, aplastic anemia, or myelofibrosis admitted to inpatient rehabilitation at a tertiary referral-based cancer center between January 1, 2005, and April 10, 2012. Items analyzed from patient records included return to the primary acute care service with demographic information, leukemia characteristics, medications, hospital admission characteristics, and laboratory values. Results 225 patients were admitted a total of 255 times. 93/255 (37%) of leukemia inpatient rehabilitation admissions returned to the primary acute care service. 18/93 (19%) and 42/93 (45%) of these patients died in the hospital and were discharged home respectively. Statistically significant factors (p<.05) associated with return to the primary acute care service include peripheral blast percentage and the presence of an antifungal agent on the day of inpatient rehabilitation transfer. Using an additional two factors (platelet count and the presence of an antiviral agent both with a p<.11), a Return To Primary (RTP) - Leukemia index was formulated. Conclusions Leukemia patients with the presence of circulating peripheral blasts and/or antifungal agent may be at increased risk of return to the primary acute care service. The RTP-Leukemia index should be tested in prospective studies to determine its usefulness. PMID:23117267
-
Imaging deductive reasoning and the new paradigm
Oaksford, Mike
2015-01-01
There has been a great expansion of research into human reasoning at all of Marr’s explanatory levels. There is a tendency for this work to progress within a level largely ignoring the others which can lead to slippage between levels (Chater et al., 2003). It is argued that recent brain imaging research on deductive reasoning—implementational level—has largely ignored the new paradigm in reasoning—computational level (Over, 2009). Consequently, recent imaging results are reviewed with the focus on how they relate to the new paradigm. The imaging results are drawn primarily from a recent meta-analysis by Prado et al. (2011) but further imaging results are also reviewed where relevant. Three main observations are made. First, the main function of the core brain region identified is most likely elaborative, defeasible reasoning not deductive reasoning. Second, the subtraction methodology and the meta-analytic approach may remove all traces of content specific System 1 processes thought to underpin much human reasoning. Third, interpreting the function of the brain regions activated by a task depends on theories of the function that a task engages. When there are multiple interpretations of that function, interpreting what an active brain region is doing is not clear cut. It is concluded that there is a need to more tightly connect brain activation to function, which could be achieved using formalized computational level models and a parametric variation approach. PMID:25774130
-
Lesions to polar/orbital prefrontal cortex selectively impair reasoning about emotional material.
Goel, Vinod; Lam, Elaine; Smith, Kathleen W; Goel, Amit; Raymont, Vanessa; Krueger, Frank; Grafman, Jordan
2017-05-01
While it is widely accepted that lesions to orbital prefrontal cortex lead to emotion related disruptions and poor decision-making, there is very little patient data on this issue involving actual logical reasoning tasks. We tested patients with circumscribed, focal lesions largely confined to polar/orbital prefrontal cortex (BA 10 & 11) (N=17) on logical reasoning tasks involving neutral and emotional content, and compared their performance to that of an age and education-matched normal control group (N=22) and a posterior lesion control group (N=24). Our results revealed a significant group by content interaction driven by a selective impairment in the polar/orbital prefrontal cortex group compared to healthy normal controls and to the parietal patient group, in the emotional content reasoning trials. Subsequent analyses of congruent and incongruent reasoning trials indicated that this impairment was driven by the poor performance of patients with polar/orbital lesions in the incongruent trials. We conclude that the polar/orbital prefrontal cortex plays a critical role in filtering emotionally charged content from the material before it is passed on to the reasoning system in lateral/dorsal regions of prefrontal cortex. Where unfiltered content is passed to the reasoning engine, either as a result of pathology (as in the case of our patients) or as a result of individual differences, reasoning performance suffers. Copyright © 2017 Elsevier Ltd. All rights reserved.
-
A research on applications of qualitative reasoning techniques in Human Acts Simulation Program
International Nuclear Information System (INIS)
Far, B.H.
1992-04-01
Human Acts Simulation Program (HASP) is a ten-year research project of the Computing and Information Systems Center of JAERI. In HASP the goal is developing programs for an advanced intelligent robot to accomplish multiple instructions (for instance, related to surveillance, inspection and maintenance) in nuclear power plants. Some recent artificial intelligence techniques can contribute to this project. This report introduces some original contributions concerning application of Qualitative Reasoning (QR) techniques in HASP. The focus is on the knowledge-intensive tasks, including model-based reasoning, analytic learning, fault diagnosis and functional reasoning. The multi-level extended qualitative modeling for the Skill-Rule-Knowledge (S-R-K) based reasoning, that included the coordination and timing of events, Qualitative Sensitivity analysis (Q S A), Subjective Qualitative Fault Diagnosis (S Q F D) and Qualitative Function Formation (Q F F ) techniques are introduced. (author) 123 refs
-
Tsujii, Takeo; Sakatani, Kaoru; Masuda, Sayako; Akiyama, Takekazu; Watanabe, Shigeru
2011-09-15
This study used off-line repetitive transcranial magnetic stimulation (rTMS) to examine the roles of the superior parietal lobule (SPL) and inferior frontal gyrus (IFG) in a deductive reasoning task. Subjects performed a categorical syllogistic reasoning task involving congruent, incongruent, and abstract trials. Twenty four subjects received magnetic stimulation to the SPL region prior to the task. In the other 24 subjects, TMS was administered to the IFG region before the task. Stimulation lasted for 10min, with an inter-pulse frequency of 1Hz. We found that bilateral SPL (Brodmann area (BA) 7) stimulation disrupted performance on abstract and incongruent reasoning. Left IFG (BA 45) stimulation impaired congruent reasoning performance while paradoxically facilitating incongruent reasoning performance. This resulted in the elimination of the belief-bias. In contrast, right IFG stimulation only impaired incongruent reasoning performance, thus enhancing the belief-bias effect. These findings are largely consistent with the dual-process theory of reasoning, which proposes the existence of two different human reasoning systems: a belief-based heuristic system; and a logic-based analytic system. The present findings suggest that the left language-related IFG (BA 45) may correspond to the heuristic system, while bilateral SPL may underlie the analytic system. The right IFG may play a role in blocking the belief-based heuristic system for solving incongruent reasoning trials. This study could offer an insight about functional roles of distributed brain systems in human deductive reasoning by utilizing the rTMS approach. Copyright © 2011 Elsevier Inc. All rights reserved.
-
Mixed Initiative Visual Analytics Using Task-Driven Recommendations
Energy Technology Data Exchange (ETDEWEB)
Cook, Kristin A.; Cramer, Nicholas O.; Israel, David; Wolverton, Michael J.; Bruce, Joseph R.; Burtner, Edwin R.; Endert, Alexander
2015-12-07
Visual data analysis is composed of a collection of cognitive actions and tasks to decompose, internalize, and recombine data to produce knowledge and insight. Visual analytic tools provide interactive visual interfaces to data to support tasks involved in discovery and sensemaking, including forming hypotheses, asking questions, and evaluating and organizing evidence. Myriad analytic models can be incorporated into visual analytic systems, at the cost of increasing complexity in the analytic discourse between user and system. Techniques exist to increase the usability of interacting with such analytic models, such as inferring data models from user interactions to steer the underlying models of the system via semantic interaction, shielding users from having to do so explicitly. Such approaches are often also referred to as mixed-initiative systems. Researchers studying the sensemaking process have called for development of tools that facilitate analytic sensemaking through a combination of human and automated activities. However, design guidelines do not exist for mixed-initiative visual analytic systems to support iterative sensemaking. In this paper, we present a candidate set of design guidelines and introduce the Active Data Environment (ADE) prototype, a spatial workspace supporting the analytic process via task recommendations invoked by inferences on user interactions within the workspace. ADE recommends data and relationships based on a task model, enabling users to co-reason with the system about their data in a single, spatial workspace. This paper provides an illustrative use case, a technical description of ADE, and a discussion of the strengths and limitations of the approach.
-
Bernat-Adell, M D; Ballester-Arnal, R; Abizanda-Campos, R
2012-01-01
Emotional factors may lead to cognitive impairment that can adversely affect the capacity of patients to reason, and thereby, limit their participation in decision taking. To analyze critical patient aptitude for decision taking, and to identify variables that may influence competence. An observational descriptive study was carried out. Intensive care unit. Participants were 29 critically ill patients. Social, demographic and psychological variables were analyzed. Functional capacities and psychological reactions during stay in the ICU were assessed. The patients are of the firm opinion that they should have the last word in the taking of decisions; they prefer bad news to be given by the physician; and feel that the presence of a psychologist would make the process easier. Failure on the part of the professional to answer their questions is perceived as the greatest stress factor. Increased depression results in lesser cognitive capacity, and for patients with impaired cognitive capacity, participation in the decision taking process constitutes a burden. The variables anxiety and depression are significantly related to decision taking capacity. Copyright © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved.
-
Kat, M.G.; Zuidema, S.U.; Ploeg, T. van der; Kalisvaart, K.J.; Gool, W.A. van; Eikelenboom, P.; Jonghe, J.F. de
2008-01-01
OBJECTIVE: To study psychiatric consultation referrals of nursing home patients with dementia and to compare referral reasons with normative data on prevalence of neuropsychiatric symptoms. METHODS: This is part of a cross-sectional study of 787 patients residing in 14 nursing homes in the
-
Kat, Martin G.; Zuidema, Sytse U.; van der Ploeg, Tjeerd; Kalisvaart, Kees J.; van Gool, Willem A.; Eikelenboom, Piet; de Jonghe, Jos F. M.
2008-01-01
Objective To study psychiatric consultation referrals of nursing home patients with dementia and to compare referral reasons with normative data on prevalence of neuropsychiatric symptoms. Methods This is part of a cross-sectional study of 787 patients residing in 14 nursing homes in the
-
Kat, M.G.; Zuidema, S.U.; van der Ploeg, T.; Kalisvaart, K.J.; van Gool, W.A.; Eikelenboom, P.; de Jonghe, J.F.M.
2008-01-01
Objective: To study psychiatric consultation referrals of nursing home patients with dementia and to compare referral reasons with normative data on prevalence of neuropsychiatric symptoms. Methods: This is part of a cross-sectional study of 787 patients residing in 14 nursing homes in the
-
Formulating analytic expressions for atomic collision cross sections
International Nuclear Information System (INIS)
Tabata, Tatsuo; Kubo, Hirotaka; Sataka, Masao
2003-08-01
Methods to formulate analytic expression for atomic collision cross sections as a function of projectile energy are described on the basis of the experiences of the data compilation work for more than 20 years. Topics considered are the choice of appropriate functional forms for the expressions and optimization of adjustable parameters. To make extrapolation possible, functions to be used should have the form with reasonable asymptotic behavior. In this respect, modified Green-McNeal formulas have been found useful for various atomic collision cross sections. For ionization processes, a modified Lotz formula has often given a good fit. The ALESQ code for least-squares fits has been convenient to optimize adjustable parameters in analytic expressions. (author)
-
Forsberg, Elenita; Ziegert, Kristina; Hult, Håkan; Fors, Uno
2014-04-01
In health-care education, it is important to assess the competencies that are essential for the professional role. To develop clinical reasoning skills is crucial for nursing practice and therefore an important learning outcome in nursing education programmes. Virtual patients (VPs) are interactive computer simulations of real-life clinical scenarios and have been suggested for use not only for learning, but also for assessment of clinical reasoning. The aim of this study was to investigate how experienced paediatric nurses reason regarding complex VP cases and how they make clinical decisions. The study was also aimed to give information about possible issues that should be assessed in clinical reasoning exams for post-graduate students in diploma specialist paediatric nursing education. The information from this study is believed to be of high value when developing scoring and grading models for a VP-based examination for the specialist diploma in paediatric nursing education. Using the think-aloud method, data were collected from 30 RNs working in Swedish paediatric departments, and child or school health-care centres. Content analysis was used to analyse the data. The results indicate that experienced nurses try to consolidate their hypotheses by seeing a pattern and judging the value of signs, symptoms, physical examinations, laboratory tests and radiology. They show high specific competence but earlier experience of similar cases was also of importance for the decision making. The nurses thought it was an innovative assessment focusing on clinical reasoning and clinical decision making. They thought it was an enjoyable way to be assessed and that all three main issues could be assessed using VPs. In conclusion, VPs seem to be a possible model for assessing the clinical reasoning process and clinical decision making, but how to score and grade such exams needs further research. © 2013.
-
Najat, Dereen
2017-01-01
Laboratory testing is roughly divided into three phases: a pre-analytical phase, an analytical phase and a post-analytical phase. Most analytical errors have been attributed to the analytical phase. However, recent studies have shown that up to 70% of analytical errors reflect the pre-analytical phase. The pre-analytical phase comprises all processes from the time a laboratory request is made by a physician until the specimen is analyzed at the lab. Generally, the pre-analytical phase includes patient preparation, specimen transportation, specimen collection and storage. In the present study, we report the first comprehensive assessment of the frequency and types of pre-analytical errors at the Sulaimani diagnostic labs in Iraqi Kurdistan. Over 2 months, 5500 venous blood samples were observed in 10 public diagnostic labs of Sulaimani City. The percentages of rejected samples and types of sample inappropriateness were evaluated. The percentage of each of the following pre-analytical errors were recorded: delay in sample transportation, clotted samples, expired reagents, hemolyzed samples, samples not on ice, incorrect sample identification, insufficient sample, tube broken in centrifuge, request procedure errors, sample mix-ups, communication conflicts, misinterpreted orders, lipemic samples, contaminated samples and missed physician's request orders. The difference between the relative frequencies of errors observed in the hospitals considered was tested using a proportional Z test. In particular, the survey aimed to discover whether analytical errors were recorded and examine the types of platforms used in the selected diagnostic labs. The analysis showed a high prevalence of improper sample handling during the pre-analytical phase. In appropriate samples, the percentage error was as high as 39%. The major reasons for rejection were hemolyzed samples (9%), incorrect sample identification (8%) and clotted samples (6%). Most quality control schemes at Sulaimani
-
Directory of Open Access Journals (Sweden)
Dereen Najat
Full Text Available Laboratory testing is roughly divided into three phases: a pre-analytical phase, an analytical phase and a post-analytical phase. Most analytical errors have been attributed to the analytical phase. However, recent studies have shown that up to 70% of analytical errors reflect the pre-analytical phase. The pre-analytical phase comprises all processes from the time a laboratory request is made by a physician until the specimen is analyzed at the lab. Generally, the pre-analytical phase includes patient preparation, specimen transportation, specimen collection and storage. In the present study, we report the first comprehensive assessment of the frequency and types of pre-analytical errors at the Sulaimani diagnostic labs in Iraqi Kurdistan.Over 2 months, 5500 venous blood samples were observed in 10 public diagnostic labs of Sulaimani City. The percentages of rejected samples and types of sample inappropriateness were evaluated. The percentage of each of the following pre-analytical errors were recorded: delay in sample transportation, clotted samples, expired reagents, hemolyzed samples, samples not on ice, incorrect sample identification, insufficient sample, tube broken in centrifuge, request procedure errors, sample mix-ups, communication conflicts, misinterpreted orders, lipemic samples, contaminated samples and missed physician's request orders. The difference between the relative frequencies of errors observed in the hospitals considered was tested using a proportional Z test. In particular, the survey aimed to discover whether analytical errors were recorded and examine the types of platforms used in the selected diagnostic labs.The analysis showed a high prevalence of improper sample handling during the pre-analytical phase. In appropriate samples, the percentage error was as high as 39%. The major reasons for rejection were hemolyzed samples (9%, incorrect sample identification (8% and clotted samples (6%. Most quality control schemes
-
Kail, Robert V.
2013-01-01
According to dual-process models that include analytic and heuristic modes of processing, analytic processing is often expected to become more common with development. Consistent with this view, on reasoning problems, adolescents are more likely than children to select alternatives that are backed by statistical evidence. It is shown here that this pattern depends on the quality of the statistical evidence and the quality of the testimonial that is the typical alternative to statistical evide...
-
Custers, Eugène J F M
2013-08-01
Recently, human reasoning, problem solving, and decision making have been viewed as products of two separate systems: "System 1," the unconscious, intuitive, or nonanalytic system, and "System 2," the conscious, analytic, or reflective system. This view has penetrated the medical education literature, yet the idea of two independent dichotomous cognitive systems is not entirely without problems.This article outlines the difficulties of this "two-system view" and presents an alternative, developed by K.R. Hammond and colleagues, called cognitive continuum theory (CCT). CCT is featured by three key assumptions. First, human reasoning, problem solving, and decision making can be arranged on a cognitive continuum, with pure intuition at one end, pure analysis at the other, and a large middle ground called "quasirationality." Second, the nature and requirements of the cognitive task, as perceived by the person performing the task, determine to a large extent whether a task will be approached more intuitively or more analytically. Third, for optimal task performance, this approach needs to match the cognitive properties and requirements of the task. Finally, the author makes a case that CCT is better able than a two-system view to describe medical problem solving and clinical reasoning and that it provides clear clues for how to organize training in clinical reasoning.
-
The Case for Visual Analytics of Arsenic Concentrations in Foods
Directory of Open Access Journals (Sweden)
Omotayo R. Awofolu
2010-04-01
Full Text Available Arsenic is a naturally occurring toxic metal and its presence in food could be a potential risk to the health of both humans and animals. Prolonged ingestion of arsenic contaminated water may result in manifestations of toxicity in all systems of the body. Visual Analytics is a multidisciplinary field that is defined as the science of analytical reasoning facilitated by interactive visual interfaces. The concentrations of arsenic vary in foods making it impractical and impossible to provide regulatory limit for each food. This review article presents a case for the use of visual analytics approaches to provide comparative assessment of arsenic in various foods. The topics covered include (i metabolism of arsenic in the human body; (ii arsenic concentrations in various foods; (ii factors affecting arsenic uptake in plants; (ii introduction to visual analytics; and (iv benefits of visual analytics for comparative assessment of arsenic concentration in foods. Visual analytics can provide an information superstructure of arsenic in various foods to permit insightful comparative risk assessment of the diverse and continually expanding data on arsenic in food groups in the context of country of study or origin, year of study, method of analysis and arsenic species.
-
Energy Technology Data Exchange (ETDEWEB)
Rahman, M.M.; Hossain, M.M.; Crosby, D.G.; Rahman, M.K.; Rahman, S.S. [School of Petroleum Engineering, The University of New South Wales, 2052 Sydney (Australia)
2002-08-01
This paper presents results of a comprehensive study involving analytical, numerical and experimental investigations into transverse fracture propagation from horizontal wells. The propagation of transverse hydraulic fractures from horizontal wells is simulated and investigated in the laboratory using carefully designed experimental setups. Closed-form analytical theories for Mode I (opening) stress intensity factors for idealized fracture geometries are reviewed, and a boundary element-based model is used herein to investigate non-planar propagation of fractures. Using the mixed mode fracture propagation criterion of the model, a reasonable agreement is found with respect to fracture geometry, net fracture pressures and fracture propagation paths between the modeled fractures and the laboratory tested fractures. These results suggest that the propagation of multiple fractures requires higher net pressures than a single fracture, the underlying reason of which is theoretically justified on the basis of local stress distribution.
-
Analytical Computation of Information Rate for MIMO Channels
Directory of Open Access Journals (Sweden)
Jinbao Zhang
2017-01-01
Full Text Available Information rate for discrete signaling constellations is significant. However, the computational complexity makes information rate rather difficult to analyze for arbitrary fading multiple-input multiple-output (MIMO channels. An analytical method is proposed to compute information rate, which is characterized by considerable accuracy, reasonable complexity, and concise representation. These features will improve accuracy for performance analysis with criterion of information rate.
-
Feeling is believing: emotional reasoning in obsessive compulsive disorder
Lommen, Miriam; Cath, Danielle; Engelhard, I.M; van Oppen, Patricia
2016-01-01
Information processing in anxiety patients is characterized by biases and thinking errors. One of these reasoning biases includes emotional reasoning: the tendency to draw conclusions about a situation based on subjective emotional response about this situation rather than objective information.
-
What physicians reason about during admission case review.
Juma, Salina; Goldszmidt, Mark
2017-08-01
Research suggests that physicians perform multiple reasoning tasks beyond diagnosis during patient review. However, these remain largely theoretical. The purpose of this study was to explore reasoning tasks in clinical practice during patient admission review. The authors used a constant comparative approach-an iterative and inductive process of coding and recoding-to analyze transcripts from 38 audio-recorded case reviews between junior trainees and their senior residents or attendings. Using a previous list of reasoning tasks, analysis focused on what tasks were performed, when they occurred, and how they related to the other tasks. All 24 tasks were observed in at least one review with a mean of 17.9 (Min = 15, Max = 22) distinct tasks per review. Two new tasks-assess illness severity and patient decision-making capacity-were identified, thus 26 tasks were examined. Three overarching tasks were identified-assess priorities, determine and refine the most likely diagnosis and establish and refine management plans-that occurred throughout all stages of the case review starting from patient identification and continuing through to assessment and plan. A fourth possible overarching task-reflection-was also identified but only observed in four instances across three cases. The other 22 tasks appeared to be context dependent serving to support, expand, and refine one or more overarching tasks. Tasks were non-sequential and the same supporting task could serve more than one overarching task. The authors conclude that these findings provide insight into the 'what' and 'when' of physician reasoning during case review that can be used to support professional development, clinical training and patient care. In particular, they draw attention to the iterative way in which each task is addressed during a case review and how this finding may challenge conventional ways of teaching and assessing clinical communication and reasoning. They also suggest that further research
-
Analytical quality control [An IAEA service
Energy Technology Data Exchange (ETDEWEB)
NONE
1973-07-01
In analytical chemistry the determination of small or trace amounts of elements or compounds in different types of materials is increasingly important. The results of these findings have a great influence on different fields of science, and on human life. Their reliability, precision and accuracy must, therefore, be checked by analytical quality control measures. The International Atomic Energy Agency (IAEA) set up an Analytical Quality Control Service (AQCS) in 1962 to assist laboratories in Member States in the assessment of their reliability in radionuclide analysis, and in other branches of applied analysis in which radionuclides may be used as analytical implements. For practical reasons, most analytical laboratories are not in a position to check accuracy internally, as frequently resources are available for only one method; standardized sample material, particularly in the case of trace analysis, is not available and can be prepared by the institutes themselves only in exceptional cases; intercomparisons are organized rather seldom and many important types of analysis are so far not covered. AQCS assistance is provided by the shipment to laboratories of standard reference materials containing known quantities of different trace elements or radionuclides, as well as by the organization of analytical intercomparisons in which the participating laboratories are provided with aliquots of homogenized material of unknown composition for analysis. In the latter case the laboratories report their data to the Agency's laboratory, which calculates averages and distributions of results and advises each laboratory of its performance relative to all the others. Throughout the years several dozens of intercomparisons have been organized and many thousands of samples provided. The service offered, as a consequence, has grown enormously. The programme for 1973 and 1974, which is currently being distributed to Member States, will contain 31 different types of materials.
-
Heuristic errors in clinical reasoning.
Rylander, Melanie; Guerrasio, Jeannette
2016-08-01
Errors in clinical reasoning contribute to patient morbidity and mortality. The purpose of this study was to determine the types of heuristic errors made by third-year medical students and first-year residents. This study surveyed approximately 150 clinical educators inquiring about the types of heuristic errors they observed in third-year medical students and first-year residents. Anchoring and premature closure were the two most common errors observed amongst third-year medical students and first-year residents. There was no difference in the types of errors observed in the two groups. Errors in clinical reasoning contribute to patient morbidity and mortality Clinical educators perceived that both third-year medical students and first-year residents committed similar heuristic errors, implying that additional medical knowledge and clinical experience do not affect the types of heuristic errors made. Further work is needed to help identify methods that can be used to reduce heuristic errors early in a clinician's education. © 2015 John Wiley & Sons Ltd.
-
Haworth, Robert; Tagh Bostani, Sousan Sheida; Sedig, Kamran
2010-01-01
The popularity and usage of digital games has increased in recent years, bringing further attention to their design. Some digital games require a significant use of higher order thought processes, such as problem solving and reflective and analytical thinking. Through the use of appropriate and interactive representations, these thought processes could be supported. A visualization of the game's internal structure is an example of this. However, it is unknown whether including these extra rep...
-
Parfit, Derek
2016-01-01
Sidgwick believed that, when impartial reasons conflict with self-interested reasons, there are no truths about their relative strength. There are such truths, I claim, but these truths are imprecise. Many self-interested reasons are decisively outweighed by conflicting impar-tial moral reasons. But we often have sufficient self-interested reasons to do what would make things go worse, and we sometimes have sufficient self-interested reasons to act wrongly. If we reject Act Consequentialism, ...
-
Speed of reasoning and its relation to reasoning ability
Goldhammer, F.; Klein Entink, R.H.
2011-01-01
The study investigates empirical properties of reasoning speed which is conceived as the fluency of solving reasoning problems. Responses and response times in reasoning tasks are modeled jointly to clarify the covariance structure of reasoning speed and reasoning ability. To determine underlying
-
Understanding clinical reasoning in osteopathy: a qualitative research approach.
Grace, Sandra; Orrock, Paul; Vaughan, Brett; Blaich, Raymond; Coutts, Rosanne
2016-01-01
Clinical reasoning has been described as a process that draws heavily on the knowledge, skills and attributes that are particular to each health profession. However, the clinical reasoning processes of practitioners of different disciplines demonstrate many similarities, including hypothesis generation and reflective practice. The aim of this study was to understand clinical reasoning in osteopathy from the perspective of osteopathic clinical educators and the extent to which it was similar or different from clinical reasoning in other health professions. This study was informed by constructivist grounded theory. Participants were clinical educators in osteopathic teaching institutions in Australia, New Zealand and the UK. Focus groups and written critical reflections provided a rich data set. Data were analysed using constant comparison to develop inductive categories. According to participants, clinical reasoning in osteopathy is different from clinical reasoning in other health professions. Osteopaths use a two-phase approach: an initial biomedical screen for serious pathology, followed by use of osteopathic reasoning models that are based on the relationship between structure and function in the human body. Clinical reasoning in osteopathy was also described as occurring in a number of contexts (e.g. patient, practitioner and community) and drawing on a range of metaskills (e.g. hypothesis generation and reflexivity) that have been described in other health professions. The use of diagnostic reasoning models that are based on the relationship between structure and function in the human body differentiated clinical reasoning in osteopathy. These models were not used to name a medical condition but rather to guide the selection of treatment approaches. If confirmed by further research that clinical reasoning in osteopathy is distinct from clinical reasoning in other health professions, then osteopaths may have a unique perspective to bring to multidisciplinary
-
Elements Explaining Learning Clinical Reasoning Using Simulation Games
Directory of Open Access Journals (Sweden)
Jaana-Maija Koivisto
2016-12-01
Full Text Available This article presents the findings on which elements in a game-based simulation affect learning clinical reasoning in nursing education. By using engaging gaming elements in virtual simulations and integrating the clinical reasoning process into game mechanics, games can enhance learning clinical reasoning and offer meaningful learning experiences. The study was designed to explore how nursing students experience gaming and learning when playing a simulation game, as well as which gaming elements explain learning clinical reasoning. The data was collected by questionnaire from nursing students (N = 166 in autumn 2014 over thirteen gaming sessions. The findings showed that usability, application of nursing knowledge, and exploration have the most impact on learning clinical reasoning when playing simulation games. Findings also revealed that authentic patient-related experiences, feedback, and reflection have an indirect effect on learning clinical reasoning. Based on these results, more efficient simulation games to improve clinical reasoning may be developed.
-
Pomeroy, Sylvia E M; Cant, Robyn P
2010-01-01
The aim of this project was to describe general practitioners' (GPs') decision-making process for reducing nutrition risk in cardiac patients through referring a patient to a dietitian. The setting was primary care practices in Victoria. The method we employed was mixed methods research: in Study 1, 30 GPs were interviewed. Recorded interviews were transcribed and narratives analysed thematically. Study 2 involved a survey of statewide random sample of GPs. Frequencies and analyses of variance were used to explore the impact of demographic variables on decisions to refer. We found that the referral decision involved four elements: (i) synthesising management information; (ii) forecasting outcomes; (iii) planning management; and (iv) actioning referrals. GPs applied cognitive and collaborative strategies to develop a treatment plan. In Study 2, doctors (248 GPs, 30%) concurred with identified barriers/enabling factors for patients' referral. There was no association between GPs' sex, age or hours worked per week and referral factors. We conclude that a GP's judgment to offer a dietetic referral to an adult patient is a four element reasoning process. Attention to how these elements interact may assist clinical decision making. Apart from the sole use of prescribed medications/surgical procedures for cardiac care, patients offered a dietetic referral were those who were considered able to commit to dietary change and who were willing to attend a dietetic consultation. Improvements in provision of patients' nutrition intervention information to GPs are needed. Further investigation is justified to determine how to resolve this practice gap.
-
Are Psychotic Experiences Related to Poorer Reflective Reasoning?
Directory of Open Access Journals (Sweden)
Martin J. Mækelæ
2018-02-01
Full Text Available Background: Cognitive biases play an important role in the formation and maintenance of delusions. These biases are indicators of a weak reflective mind, or reduced engaging in reflective and deliberate reasoning. In three experiments, we tested whether a bias to accept non-sense statements as profound, treat metaphorical statements as literal, and suppress intuitive responses is related to psychotic-like experiences.Methods: We tested deliberate reasoning and psychotic-like experiences in the general population and in patients with a former psychotic episode. Deliberate reasoning was assessed with the bullshit receptivity scale, the ontological confabulation scale and the cognitive reflection test (CRT. We also measured algorithmic performance with the Berlin numeracy test and the wordsum test. Psychotic-like experiences were measured with the Community Assessment of Psychic Experience (CAPE-42 scale.Results: Psychotic-like experiences were positively correlated with a larger receptivity toward bullshit, more ontological confabulations, and also a lower score on the CRT but not with algorithmic task performance. In the patient group higher psychotic-like experiences significantly correlated with higher bullshit receptivity.Conclusion: Reduced deliberate reasoning may contribute to the formation of delusions, and be a general thinking bias largely independent of a person's general intelligence. Acceptance of bullshit may be facilitated the more positive symptoms a patient has, contributing to the maintenance of the delusions.
-
Heiberg Engel, Peter Johan
2008-01-01
Much education--especially at the university level--has been criticized for having primarily dealt with explicit knowledge, i.e. those aspects of mental activities, which are verbal and conscious. Furthermore, research in medical diagnostic reasoning has been criticized for having focused on the specialty of intern medicine, while specialties with other skills, i.e. perceptive skills within pathology and radiology, have been ignored. To show that the concept of tacit knowledge is important in medical education-at all levels and in medical diagnostic reasoning. Describing how tacit knowledge according to Michael Polany, is experienced and expressed in day-to-day life, it is shown that there is a tacit dimension to all knowledge. Reviewing recent literature on medical diagnostic reasoning, it is shown that tacit knowledge is recognized in connection with concepts such as "non-analytical reasoning" and "dual process of reasoning." It is important that educators are trained in how explicit and implicit knowledge is attained and that tacit knowledge is included in educational programmes of all medical specialties.
-
Denovan, Andrew; Dagnall, Neil; Drinkwater, Kenneth; Parker, Andrew; Clough, Peter
2017-01-01
The present study assessed the degree to which probabilistic reasoning performance and thinking style influenced perception of risk and self-reported levels of terrorism-related behavior change. A sample of 263 respondents, recruited via convenience sampling, completed a series of measures comprising probabilistic reasoning tasks (perception of randomness, base rate, probability, and conjunction fallacy), the Reality Testing subscale of the Inventory of Personality Organization (IPO-RT), the Domain-Specific Risk-Taking Scale, and a terrorism-related behavior change scale. Structural equation modeling examined three progressive models. Firstly, the Independence Model assumed that probabilistic reasoning, perception of risk and reality testing independently predicted terrorism-related behavior change. Secondly, the Mediation Model supposed that probabilistic reasoning and reality testing correlated, and indirectly predicted terrorism-related behavior change through perception of risk. Lastly, the Dual-Influence Model proposed that probabilistic reasoning indirectly predicted terrorism-related behavior change via perception of risk, independent of reality testing. Results indicated that performance on probabilistic reasoning tasks most strongly predicted perception of risk, and preference for an intuitive thinking style (measured by the IPO-RT) best explained terrorism-related behavior change. The combination of perception of risk with probabilistic reasoning ability in the Dual-Influence Model enhanced the predictive power of the analytical-rational route, with conjunction fallacy having a significant indirect effect on terrorism-related behavior change via perception of risk. The Dual-Influence Model possessed superior fit and reported similar predictive relations between intuitive-experiential and analytical-rational routes and terrorism-related behavior change. The discussion critically examines these findings in relation to dual-processing frameworks. This
-
Denovan, Andrew; Dagnall, Neil; Drinkwater, Kenneth; Parker, Andrew; Clough, Peter
2017-01-01
The present study assessed the degree to which probabilistic reasoning performance and thinking style influenced perception of risk and self-reported levels of terrorism-related behavior change. A sample of 263 respondents, recruited via convenience sampling, completed a series of measures comprising probabilistic reasoning tasks (perception of randomness, base rate, probability, and conjunction fallacy), the Reality Testing subscale of the Inventory of Personality Organization (IPO-RT), the Domain-Specific Risk-Taking Scale, and a terrorism-related behavior change scale. Structural equation modeling examined three progressive models. Firstly, the Independence Model assumed that probabilistic reasoning, perception of risk and reality testing independently predicted terrorism-related behavior change. Secondly, the Mediation Model supposed that probabilistic reasoning and reality testing correlated, and indirectly predicted terrorism-related behavior change through perception of risk. Lastly, the Dual-Influence Model proposed that probabilistic reasoning indirectly predicted terrorism-related behavior change via perception of risk, independent of reality testing. Results indicated that performance on probabilistic reasoning tasks most strongly predicted perception of risk, and preference for an intuitive thinking style (measured by the IPO-RT) best explained terrorism-related behavior change. The combination of perception of risk with probabilistic reasoning ability in the Dual-Influence Model enhanced the predictive power of the analytical-rational route, with conjunction fallacy having a significant indirect effect on terrorism-related behavior change via perception of risk. The Dual-Influence Model possessed superior fit and reported similar predictive relations between intuitive-experiential and analytical-rational routes and terrorism-related behavior change. The discussion critically examines these findings in relation to dual-processing frameworks. This
-
Directory of Open Access Journals (Sweden)
Andrew Denovan
2017-10-01
Full Text Available The present study assessed the degree to which probabilistic reasoning performance and thinking style influenced perception of risk and self-reported levels of terrorism-related behavior change. A sample of 263 respondents, recruited via convenience sampling, completed a series of measures comprising probabilistic reasoning tasks (perception of randomness, base rate, probability, and conjunction fallacy, the Reality Testing subscale of the Inventory of Personality Organization (IPO-RT, the Domain-Specific Risk-Taking Scale, and a terrorism-related behavior change scale. Structural equation modeling examined three progressive models. Firstly, the Independence Model assumed that probabilistic reasoning, perception of risk and reality testing independently predicted terrorism-related behavior change. Secondly, the Mediation Model supposed that probabilistic reasoning and reality testing correlated, and indirectly predicted terrorism-related behavior change through perception of risk. Lastly, the Dual-Influence Model proposed that probabilistic reasoning indirectly predicted terrorism-related behavior change via perception of risk, independent of reality testing. Results indicated that performance on probabilistic reasoning tasks most strongly predicted perception of risk, and preference for an intuitive thinking style (measured by the IPO-RT best explained terrorism-related behavior change. The combination of perception of risk with probabilistic reasoning ability in the Dual-Influence Model enhanced the predictive power of the analytical-rational route, with conjunction fallacy having a significant indirect effect on terrorism-related behavior change via perception of risk. The Dual-Influence Model possessed superior fit and reported similar predictive relations between intuitive-experiential and analytical-rational routes and terrorism-related behavior change. The discussion critically examines these findings in relation to dual
-
Warren, Amy L; Donnon, Tyrone L; Wagg, Catherine R; Priest, Heather; Fernandez, Nicole J
2018-01-18
Visual diagnostic reasoning is the cognitive process by which pathologists reach a diagnosis based on visual stimuli (cytologic, histopathologic, or gross imagery). Currently, there is little to no literature examining visual reasoning in veterinary pathology. The objective of the study was to use eye tracking to establish baseline quantitative and qualitative differences between the visual reasoning processes of novice and expert veterinary pathologists viewing cytology specimens. Novice and expert participants were each shown 10 cytology images and asked to formulate a diagnosis while wearing eye-tracking equipment (10 slides) and while concurrently verbalizing their thought processes using the think-aloud protocol (5 slides). Compared to novices, experts demonstrated significantly higher diagnostic accuracy (preasoning and script-inductive knowledge structures with system 2 (analytic) reasoning to verify their diagnosis.
-
Altschuler, Justin; Margolius, David; Bodenheimer, Thomas; Grumbach, Kevin
2012-01-01
PURPOSE Primary care faces the dilemma of excessive patient panel sizes in an environment of a primary care physician shortage. We aimed to estimate primary care panel sizes under different models of task delegation to nonphysician members of the primary care team. METHODS We used published estimates of the time it takes for a primary care physician to provide preventive, chronic, and acute care for a panel of 2,500 patients, and modeled how panel sizes would change if portions of preventive and chronic care services were delegated to nonphysician team members. RESULTS Using 3 assumptions about the degree of task delegation that could be achieved (77%, 60%, and 50% of preventive care, and 47%, 30%, and 25% of chronic care), we estimated that a primary care team could reasonably care for a panel of 1,947, 1,523, or 1,387 patients. CONCLUSIONS If portions of preventive and chronic care services are delegated to nonphysician team members, primary care practices can provide recommended preventive and chronic care with panel sizes that are achievable with the available primary care workforce.
-
Relations between Inductive Reasoning and Deductive Reasoning
Heit, Evan; Rotello, Caren M.
2010-01-01
One of the most important open questions in reasoning research is how inductive reasoning and deductive reasoning are related. In an effort to address this question, we applied methods and concepts from memory research. We used 2 experiments to examine the effects of logical validity and premise-conclusion similarity on evaluation of arguments.…
-
Assessment of Analytic Water hammer Pressure Model of FAI/08-70
International Nuclear Information System (INIS)
Park, Ju Yeop; Yoo, Seung Hun; Seul, Kwang-Won
2016-01-01
In evaluating water hammer effect on the safety related systems, methods developed by the US utility are likely to be adopted in Korea. For example, the US utility developed specific methods to evaluate pressure and loading transient on piping due to water hammer as in FAI/08-70. The methods of FAI/08-70 would be applied in Korea when any regulatory request on the evaluation of water hammer effect due to the non-condensable gas accumulation in the safety related systems. Specifically, FAI/08-70 gives an analytic model which can be used to analyze the maximum transient pressure and maximum transient loading on the piping of the safety-related systems due to the non-condensable induced water hammer effect. Therefore, it seems to be meaningful to review the FAI/08-70 methods and attempt to apply the methods to a specific case to see if they really give reasonable estimate before the application of FAI/08-70 methods to domestic nuclear power plants. In the present study, analytic water hammer pressure model of FAI/08-70 is reviewed in detail and the model is applied to the specific experiment of FAI/08-70 to see if the analytic water hammer pressure model really gives reasonable estimate of the peak water hammer pressure. Specifically, we assess the experiment 52A of FAI/08-70 which adopts flushed initial condition with a short rising piping length and a high level piping length of 51inch. The calculated analytic water hammer pressure peak shows a close agreement with the measured experimental data of 52A. Unfortunately, however, the theoretical value is a little bit less than that of the experimental value. This implies the analytic model of FAI/08-70 is not conservative
-
Assessment of Analytic Water hammer Pressure Model of FAI/08-70
Energy Technology Data Exchange (ETDEWEB)
Park, Ju Yeop; Yoo, Seung Hun; Seul, Kwang-Won [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)
2016-10-15
In evaluating water hammer effect on the safety related systems, methods developed by the US utility are likely to be adopted in Korea. For example, the US utility developed specific methods to evaluate pressure and loading transient on piping due to water hammer as in FAI/08-70. The methods of FAI/08-70 would be applied in Korea when any regulatory request on the evaluation of water hammer effect due to the non-condensable gas accumulation in the safety related systems. Specifically, FAI/08-70 gives an analytic model which can be used to analyze the maximum transient pressure and maximum transient loading on the piping of the safety-related systems due to the non-condensable induced water hammer effect. Therefore, it seems to be meaningful to review the FAI/08-70 methods and attempt to apply the methods to a specific case to see if they really give reasonable estimate before the application of FAI/08-70 methods to domestic nuclear power plants. In the present study, analytic water hammer pressure model of FAI/08-70 is reviewed in detail and the model is applied to the specific experiment of FAI/08-70 to see if the analytic water hammer pressure model really gives reasonable estimate of the peak water hammer pressure. Specifically, we assess the experiment 52A of FAI/08-70 which adopts flushed initial condition with a short rising piping length and a high level piping length of 51inch. The calculated analytic water hammer pressure peak shows a close agreement with the measured experimental data of 52A. Unfortunately, however, the theoretical value is a little bit less than that of the experimental value. This implies the analytic model of FAI/08-70 is not conservative.
-
Categories by Heart: Shortcut Reasoning in a Cardiology Clinic
Directory of Open Access Journals (Sweden)
Katarina Jacobsson
2014-09-01
Full Text Available This article examines the practice of doctors and nurses to invoke the categories of age, sex, class, ethnicity, and/or lifestyle factors when discussing individual patients and patient groups. In what situations are such references explicitly made, and what does this practice accomplish? The material consists of field notes from a cardiology clinic in Sweden, and a theory of descriptive practice guided the analysis. When professionals describe patients, discuss decisions, or explain why a patient is ill, age, sex, class, ethnicity, and/or lifestyle serve as contextualization cues, often including widespread results from epidemiological research about groups of patients at higher or lower risk for cardiac disease. These categories work as shortcut reasoning to nudge interpretations in a certain direction, legitimize decisions, and strengthen arguments. In general, studying the descriptions of patients/clients/students provides an entrance to professional methods of reasoning, including their implicit moral assumptions.
-
Collection of analytes from microneedle patches.
Romanyuk, Andrey V; Zvezdin, Vasiliy N; Samant, Pradnya; Grenader, Mark I; Zemlyanova, Marina; Prausnitz, Mark R
2014-11-04
Clinical medicine and public health would benefit from simplified acquisition of biological samples from patients that can be easily obtained at point of care, in the field, and by patients themselves. Microneedle patches are designed to serve this need by collecting dermal interstitial fluid containing biomarkers without the dangers, pain, or expertise needed to collect blood. This study presents novel methods to collect biomarker analytes from microneedle patches for analysis by integration into conventional analytical laboratory microtubes and microplates. Microneedle patches were made out of cross-linked hydrogel composed of poly(methyl vinyl ether-alt-maleic acid) and poly(ethylene glycol) prepared by micromolding. Microneedle patches were shown to swell with water up to 50-fold in volume, depending on degree of polymer cross-linking, and to collect interstitial fluid from the skin of rats. To collect analytes from microneedle patches, the patches were mounted within the cap of microcentrifuge tubes or formed the top of V-bottom multiwell microplates, and fluid was collected in the bottom of the tubes under gentle centrifugation. In another method, microneedle patches were attached to form the bottom of multiwell microplates, thereby enabling in situ analysis. The simplicity of biological sample acquisition using microneedle patches coupled with the simplicity of analyte collection from microneedles patches integrated into conventional analytical equipment could broaden the reach of future screening, diagnosis, and monitoring of biomarkers in healthcare and environmental/workplace settings.
-
Freeman, Daniel; Evans, Nicole; Lister, Rachel
2012-01-01
Rapid intuitive hunches or gut feelings may be a compelling source of evidence for paranoid ideas. Conversely, a failure to apply effortful analytic thinking may contribute to the persistence of such thoughts. Our main aim was to examine for the first time the associations of persecutory thinking with experiential and rational thinking styles. Five hundred individuals recruited from the general population completed self-report assessments of current persecutory ideation, general reasoning styles and personality traits. Persecutory ideation was independently associated with greater use of experiential reasoning and less use of rational reasoning. The correlations were small. Persecutory ideation was also positively associated with neuroticism and negatively correlated with extraversion, agreeableness and conscientiousness. There was no evidence of an interaction between neuroticism and experiential reasoning in the prediction of paranoia, but high experiential reasoning in the context of low rational reasoning was particularly associated with persecutory ideation. Overall, the study provides rare evidence of self-reported general reasoning styles being associated with delusional ideation. Perceived reliance on intuition is associated with paranoid thinking, while perceived reliance on deliberation is associated with fewer such thoughts. The dual process theory of reasoning may provide a framework to contribute to the understanding of paranoid thinking. PMID:22406393
-
Intuition & reason: re-assessing dual-process theories with representational sub-activation
Trafford, James; Tillas, Alexandros
2015-01-01
There is a prevalent distinction in the literature on reasoning, between Type-1 processes, (fast, automatic, associative, heuristic and intuitive); and Type-2 processes (rule-based, analytical and reflective). In this paper, we follow up recent empirical evidence [De Neys (2006b); Osman (2013)] in favour of a unitary cognitive system. More specifically, we suggest that intuitions (T1-processes) are sub-activated representations, which are in turn influenced by the weightings of the connection...
-
GenoSets: visual analytic methods for comparative genomics.
Directory of Open Access Journals (Sweden)
Aurora A Cain
Full Text Available Many important questions in biology are, fundamentally, comparative, and this extends to our analysis of a growing number of sequenced genomes. Existing genomic analysis tools are often organized around literal views of genomes as linear strings. Even when information is highly condensed, these views grow cumbersome as larger numbers of genomes are added. Data aggregation and summarization methods from the field of visual analytics can provide abstracted comparative views, suitable for sifting large multi-genome datasets to identify critical similarities and differences. We introduce a software system for visual analysis of comparative genomics data. The system automates the process of data integration, and provides the analysis platform to identify and explore features of interest within these large datasets. GenoSets borrows techniques from business intelligence and visual analytics to provide a rich interface of interactive visualizations supported by a multi-dimensional data warehouse. In GenoSets, visual analytic approaches are used to enable querying based on orthology, functional assignment, and taxonomic or user-defined groupings of genomes. GenoSets links this information together with coordinated, interactive visualizations for both detailed and high-level categorical analysis of summarized data. GenoSets has been designed to simplify the exploration of multiple genome datasets and to facilitate reasoning about genomic comparisons. Case examples are included showing the use of this system in the analysis of 12 Brucella genomes. GenoSets software and the case study dataset are freely available at http://genosets.uncc.edu. We demonstrate that the integration of genomic data using a coordinated multiple view approach can simplify the exploration of large comparative genomic data sets, and facilitate reasoning about comparisons and features of interest.
-
Bigi, Sarah
2014-01-01
One of the biggest challenges for doctors working in chronic care is the correct management of the argumentation phases during the encounters with their patients. During these phases doctors should provide patients with acceptable reasons for being adherent to treatment and for changing certain unhealthy behaviors and lifestyles, something which is particularly difficult for elderly patients, for whom changing life long habits can be extremely hard. However, the medical literature on the subject of communication in the chronic care encounter shows lack of theoretical models and methodological approaches that can highlight which specific linguistic structures or elements in different communication styles favor or impede patient commitment, trust in the relationship and adherence to treatment. The contribution describes ongoing research on argumentative strategies in the encounter with diabetes patients. I describe one recently concluded research project on the argumentation phases of medical encounters in diabetes care, which highlighted critical areas in need of improvement. I also describe the design and aims of a new research project, aimed at testing the effectiveness and usability of certain argumentation schemes in the medical encounter.
-
Applications of Temporal Reasoning to Intensive Care Units
Directory of Open Access Journals (Sweden)
J. M. Juarez
2010-01-01
Full Text Available Intensive Care Units (ICUs are hospital departments that focus on the evolution of patients. In this scenario, the temporal dimension plays an essential role in understanding the state of the patients from their temporal information. The development of methods for the acquisition, modelling, reasoning and knowledge discovery of temporal information is, therefore, useful to exploit the large amount of temporal data recorded daily in the ICU. During the past decades, some subfields of Artificial Intelligence have been devoted to the study of temporal models and techniques to solve generic problems and towards their practical applications in the medical domain. The main goal of this paper is to present our view of some aspects of practical problems of temporal reasoning in the ICU field, and to describe our practical experience in the field in the last decade. This paper provides a non-exhaustive review of some of the efforts made in the field and our particular contributions in the development of temporal reasoning methods to partially solve some of these problems. The results are a set of software tools that help physicians to better understand the patient's temporal evolution.
-
Analytic scattering theory of quantum mechanical three-body systems
International Nuclear Information System (INIS)
Balslev, Erik
1980-01-01
We consider a three-body Schroedinger operator H=H 0 +V in L 2 (Rsup(2n)), where V=Σ Vsub(α) and each Vsub(α) is a dilation-analytic two-body interaction decreasing faster than rsup(-β), where β>1 for negative energies and β>2 for positive energies. Together with H we consider the associated self-adjoint analytic family of operator given in momentum space by H(z)=z 2 H 0 +V(z), /Arg z/ 0 , H). The local inverse wave operators are constructed and asymptotic completeness proved. The full S-matrix S(μ) and for phi not equal to 0 the channel S-matrices are expressed in terms of boundary values of the resolvent. It is proved that the function is an analytic continuation into the lower half-plane of the diagonal element with poles at most at resolvent resonances and, under some reasonable assumptions, precisely at these resonances
-
Phronesis, clinical reasoning, and Pellegrino's philosophy of medicine.
Davis, F D
1997-01-01
In terms of Aristotle's intellectual virtues, the process of clinical reasoning and the discipline of clinical medicine are often construed as techne (art), as episteme (science), or as an amalgam or composite of techne and episteme. Although dimensions of process and discipline are appropriately described in these terms, I argue that phronesis (practical reasoning) provides the most compelling paradigm, particularly of the rationality of the physician's knowing and doing in the clinical encounter with the patient. I anchor this argument, moreover, in Pellegrino's philosophy of medicine as a healing relationship, oriented to the end of a right and good healing action for the individual patient.
-
Reason with me : 'Confabulation' and interpersonal moral reasoning
Nyholm, S.R.
2015-01-01
According to Haidt’s ‘social intuitionist model’, empirical moral psychology supports the following conclusion: intuition comes first, strategic reasoning second. Critics have responded by arguing that intuitions can depend on non-conscious reasons, that not being able to articulate one’s reasons
-
Relations between inductive reasoning and deductive reasoning.
Heit, Evan; Rotello, Caren M
2010-05-01
One of the most important open questions in reasoning research is how inductive reasoning and deductive reasoning are related. In an effort to address this question, we applied methods and concepts from memory research. We used 2 experiments to examine the effects of logical validity and premise-conclusion similarity on evaluation of arguments. Experiment 1 showed 2 dissociations: For a common set of arguments, deduction judgments were more affected by validity, and induction judgments were more affected by similarity. Moreover, Experiment 2 showed that fast deduction judgments were like induction judgments-in terms of being more influenced by similarity and less influenced by validity, compared with slow deduction judgments. These novel results pose challenges for a 1-process account of reasoning and are interpreted in terms of a 2-process account of reasoning, which was implemented as a multidimensional signal detection model and applied to receiver operating characteristic data. PsycINFO Database Record (c) 2010 APA, all rights reserved.
-
Training the next generation analyst using red cell analytics
Graham, Meghan N.; Graham, Jacob L.
2016-05-01
We have seen significant change in the study and practice of human reasoning in recent years from both a theoretical and methodological perspective. Ubiquitous communication coupled with advances in computing and a plethora of analytic support tools have created a push for instantaneous reporting and analysis. This notion is particularly prevalent in law enforcement, emergency services and the intelligence community (IC), where commanders (and their civilian leadership) expect not only a birds' eye view of operations as they occur, but a play-by-play analysis of operational effectiveness. This paper explores the use of Red Cell Analytics (RCA) as pedagogy to train the next-gen analyst. A group of Penn State students in the College of Information Sciences and Technology at the University Park campus of The Pennsylvania State University have been practicing Red Team Analysis since 2008. RCA draws heavily from the military application of the same concept, except student RCA problems are typically on non-military in nature. RCA students utilize a suite of analytic tools and methods to explore and develop red-cell tactics, techniques and procedures (TTPs), and apply their tradecraft across a broad threat spectrum, from student-life issues to threats to national security. The strength of RCA is not always realized by the solution but by the exploration of the analytic pathway. This paper describes the concept and use of red cell analytics to teach and promote the use of structured analytic techniques, analytic writing and critical thinking in the area of security and risk and intelligence training.
-
To Reason or Not to Reason: Is Autobiographical Reasoning Always Beneficial?
McLean, Kate C.; Mansfield, Cade D.
2011-01-01
Autobiographical reasoning has been found to be a critical process in identity development; however, the authors suggest that existing research shows that such reasoning may not always be critical to another important outcome: well-being. The authors describe characteristics of people such as personality and age, contexts such as conversations,…
-
International Nuclear Information System (INIS)
Kim, S. H.; Moon, J. H.; Jeong, Y. S.
2002-01-01
Two air filters (V-50, P-50) artificially loaded with urban dust were provided from IAEA and trace elements to study inter-laboratory comparison and proficiency test were determined using instrumental neutron activation analysis non-destructively. Standard reference material(Urban Particulate Matter, NIST SRM 1648) of National Institute of Standard and Technology was used for internal analytical quality control. About 20 elements in each loaded filter sample were determined, respectively. Our analytical data were compared with statistical results using neutron activation analysis, particle induced X-ray emission spectrometry, inductively coupled plasma mass spectroscopy, etc., which were collected from 49 laboratories of 40 countries. From the results that were statistically re-treated with reported values, Z-scores of our analytical values are within ±2. In addition, the results of proficiency test are passed and accuracy and precision of the analytical values are reliable. Consequently, it was proved that analytical quality control for the analysis of air dust samples is reasonable
-
Dual-process Accounts of Reasoning in User's Information System Risky Behavior
Li, Ying; Zhang, Nan
2016-01-01
End user of information system (IS) is the weakest point in terms of IS security. A variety of approaches are developed to convince end users to avoid IS risky behaviors. However, they do not always work. We would like to argue that one of the reasons is that previous studies focused on System 2 thinking (analytic, deliberate, rule-governed and effortful process) and overlooked the factors that can influence people who are using System 1 thinking (automatic, effortless, associa...
-
The analyst's anxieties in the first interview: barriers against analytic presence.
Møller, Mette
2014-06-01
To answer the questions: why don't more people enter analysis and how do we get more people to do so? Attention is drawn to anxieties in the analyst that become obstacles to the initiation of analysis. The main focus of the paper is how to understand why analysts, irrespective of patient characteristics, seem to have resistances against embarking on analysis. Being a meeting between strangers the consultation activates strong emotional reactions in both parties. One way of coping is defensively to diagnose, assess and exclude instead of being present as an analyst. The analytic frame of a consultation is ambiguous, and a secure analytic function is needed in order to meet the openness and unpredictability of this frame. A fragile psychoanalytic identity is seen as central to analysts' failure to create an analytic practice; it takes years to develop and maintain a robust analytic function, and analytic work continues to cause disturbing emotional reactions in the analyst. Analysts' vulnerable identity is also linked to the history of psychoanalysis that has fostered an ideal of analytic practice that is omnipotent and impossible to reach. Therefore it is no wonder that attempts to reach a convinced recommendation of analysis can become diverted in the process of consultation. Confronting these inner impediments in order to strengthen the analytic identity is suggested as a better way to get more analytic patients than to keep looking for so-called analysability in patients. Copyright © 2014 Institute of Psychoanalysis.
-
Thirsk, Lorraine M; Moore, Sarah G; Keyko, Kacey
2014-09-01
To explore how Registered Nurses address psychosocial issues for patients and their families living with chronic kidney disease. It is in the scope of registered nursing practice to address the emotional, psychological and relational implications of living with chronic disease through psychosocial and family interventions. Patients living with chronic kidney disease frequently report poor quality of life and numerous psychosocial issues; however, they do not find that these issues are always adequately addressed. This research was hermeneutic inquiry as guided by Gadamer's philosophy of understanding. Family/psychosocial nursing practices are examined from the perspective of self-reports of Registered Nurses working in acute care nephrology units. Interviews with nurses were conducted throughout 2012. Nurses attribute, or explain, patient and family member behaviour in a variety of ways. These explanations may or may not align with actual patient/family reasons for behaviour. Nurses' explanations influence subsequent nursing practice. While there is some evidence of practices that overcome biased attributions of patient behaviour, the cognitive processes by which nurses develop these explanations are more complex than previously reported in nursing literature. Clinical reasoning and subsequent nursing practice are influenced by how nurses explain patients'/families' behaviour. Exploration of this issue with the support of social cognition literature suggests a need for further research with significant implications for nursing education and practice to improve family/psychosocial interventions. © 2014 John Wiley & Sons Ltd.
-
Improving acute kidney injury diagnostics using predictive analytics.
Basu, Rajit K; Gist, Katja; Wheeler, Derek S
2015-12-01
Acute kidney injury (AKI) is a multifactorial syndrome affecting an alarming proportion of hospitalized patients. Although early recognition may expedite management, the ability to identify patients at-risk and those suffering real-time injury is inconsistent. The review will summarize the recent reports describing advancements in the area of AKI epidemiology, specifically focusing on risk scoring and predictive analytics. In the critical care population, the primary underlying factors limiting prediction models include an inability to properly account for patient heterogeneity and underperforming metrics used to assess kidney function. Severity of illness scores demonstrate limited AKI predictive performance. Recent evidence suggests traditional methods for detecting AKI may be leveraged and ultimately replaced by newer, more sophisticated analytical tools capable of prediction and identification: risk stratification, novel AKI biomarkers, and clinical information systems. Additionally, the utility of novel biomarkers may be optimized through targeting using patient context, and may provide more granular information about the injury phenotype. Finally, manipulation of the electronic health record allows for real-time recognition of injury. Integrating a high-functioning clinical information system with risk stratification methodology and novel biomarker yields a predictive analytic model for AKI diagnostics.
-
DEFF Research Database (Denmark)
Knudsen, Lene S; Christensen, Ib J; Lottenburger, Tine
2008-01-01
in serum IL-6 over a 3-year period (14%, p=0.33). Exercise (cycling) increased serum IL-6 in healthy subjects but not in RA patients. In conclusion, circulating IL-6 is stable regarding sample handling and shows little variation over time. Changes in IL-6 concentrations >60% (2 times the biological...... variation) are likely to reflect changes in disease activity and not only pre-analytical or normal biological variability....
-
Mobile Monitoring and Reasoning Methods to Prevent Cardiovascular Diseases
Directory of Open Access Journals (Sweden)
Diego López-de-Ipiña
2013-05-01
Full Text Available With the recent technological advances, it is possible to monitor vital signs using Bluetooth-enabled biometric mobile devices such as smartphones, tablets or electric wristbands. In this manuscript, we present a system to estimate the risk of cardiovascular diseases in Ambient Assisted Living environments. Cardiovascular disease risk is obtained from the monitoring of the blood pressure by means of mobile devices in combination with other clinical factors, and applying reasoning techniques based on the Systematic Coronary Risk Evaluation Project charts. We have developed an end-to-end software application for patients and physicians and a rule-based reasoning engine. We have also proposed a conceptual module to integrate recommendations to patients in their daily activities based on information proactively inferred through reasoning techniques and context-awareness. To evaluate the platform, we carried out usability experiments and performance benchmarks.
-
Periodontal Reasons for Tooth Extraction in Adult Population in Greece
Chrysanthakopoulos, Nikolaos A.
2010-01-01
Aim: The aim of this study was to investigate the prevalence of permanent teeth extracted due to periodontal disease and its relation to several aspects such as age, gender and type of extracted teeth due to periodontal and non-periodontal reasons, among patients attending a private practice. Material and Methods: Study population consisted of 600 patients, 270 males and 330 females, aged 18 to 74 years from a private practice in Greece. The reasons for extractions of teeth in the sample for ...
-
Analytic equation of state for FCC C60 solid based on analytic mean-field potential approach
International Nuclear Information System (INIS)
Sun Jiuxun
2006-01-01
The analytic mean-field approach (AMFP) was applied to the FCC C60 solid. For the intermolecular forces the Girifalco potential has been utilized. The analytic expressions for the Helmholtz free energy, internal energy and equation of state have been derived. The numerical results of thermodynamic quantities are compared with the molecular dynamic (MD) simulations and the unsymmetrized self-consistent field approach (CUSF) in the literature. It is shown that our AMFP results are in good agreement with the MD data both at low and high temperatures. The results of CUSF are in accordance with the AMFP at low temperature, but at high temperature the difference becomes prominent. Especially the AMFP predicted that the FCC C60 solid is stable upto 2202 K, the spinodal temperature, in good agreement with 2320 K from the MD simulation. However, the CUST just gives 1916 K, a temperature evidently lower than the MD data. The AMFP qualifies as a useful approach that can reasonably consider the anharmonic effects at high temperature
-
Fleiszer, David; Hoover, Michael L; Posel, Nancy; Razek, Tarek; Bergman, Simon
Undergraduate medical students at a large academic trauma center are required to manage a series of online virtual trauma patients as a mandatory exercise during their surgical rotation. Clinical reasoning during undergraduate medical education can be difficult to assess. The purpose of the study was to determine whether we could use components of the students' virtual patient management to measure changes in their clinical reasoning over the course of the clerkship year. In order to accomplish this, we decided to determine if the use of scoring rubrics could change the traditional subjective assessment to a more objective evaluation. Two groups of students, one at the beginning of clerkship (Juniors) and one at the end of clerkship (Seniors), were chosen. Each group was given the same virtual patient case, a clinical scenario based on the Advanced Trauma Life Support (ATLS) Primary Trauma Survey, which had to be completed during their trauma rotation. The learner was required to make several key patient management choices based on their clinical reasoning, which would take them along different routes through the case. At the end of the case they had to create a summary report akin to sign-off. These summaries were graded independently by two domain "Experts" using a traditional subjective surgical approach to assessment and by two "Non-Experts" using two internally validated scoring rubrics. One rubric assessed procedural or domain knowledge (Procedural Rubric), while the other rubric highlighted semantic qualifiers (Semantic Rubric). Each of the rubrics was designed to reflect established components of clinical reasoning. Student's t-tests were used to compare the rubric scores for the two groups and Cohen's d was used to determine effect size. Kendall's τ was used to compare the difference between the two groups based on the "Expert's" subjective assessment. Inter-rater reliability (IRR) was determined using Cronbach's alpha. The Seniors did better than the
-
Delay in a tandem queueing model with mobile queues: An analytical approximation
Al Hanbali, Ahmad; de Haan, Roland; Boucherie, Richardus J.; van Ommeren, Jan C.W.
In this paper, we analyze the end-to-end delay performance of a tandem queueing system with mobile queues. Due to state-space explosion, there is no hope for a numerical exact analysis for the joint-queue-length distribution. For this reason, we present an analytical approximation that is based on
-
A population-based investigation into the self-reported reasons for sleep problems.
Directory of Open Access Journals (Sweden)
David Armstrong
Full Text Available Typologies of sleep problems have usually relied on identifying underlying causes or symptom clusters. In this study the value of using the patient's own reasons for sleep disturbance are explored. Using secondary data analysis of a nationally representative psychiatric survey the patterning of the various reasons respondents provided for self-reported sleep problems were examined. Over two thirds (69.3% of respondents could identify a specific reason for their sleep problem with worry (37.9% and illness (20.1% representing the most commonly reported reasons. And while women reported more sleep problems for almost every reason compared with men, the patterning of reasons by age showed marked variability. Sleep problem symptoms such as difficulty getting to sleep or waking early also showed variability by different reasons as did the association with major correlates such as worry, depression, anxiety and poor health. While prevalence surveys of 'insomnia' or 'poor sleep' often assume the identification of an underlying homogeneous construct there may be grounds for recognising the existence of different sleep problem types particularly in the context of the patient's perceived reason for the problem.
-
Deducto and Color Deducto: Enhance Logical Reasoning through Educational Games
Directory of Open Access Journals (Sweden)
2010-09-01
Full Text Available The objective of this paper is to present the various features of the educational games, Deducto and Color Deducto. With a firm belief that technology can bring about a revolution in education, these activities have been designed to help enhance the logical reasoning and analytical thinking of children. They have been developed in python with a focus on Sugar environment, OLPC XO’s software paradigm. They conform to Sugar's cardinal objective of learning through reasoning, critique and experimentation. Deducto focuses on helping children learn the art of deducing logic through pattern recognition. Color Deducto, a variant of Deducto, combines pattern recognition and concepts of Munsell Color System helping children get familiar with color system concepts in a playful manner. Besides the pre-defined levels of the games, the activities empower children to design their own levels and develop games on their own.
-
Deductive way of reasoning about the internet AS level topology
International Nuclear Information System (INIS)
Szabó, Dávid; Kőrösi, Attila; Bíró, József; Gulyás, András
2015-01-01
Our current understanding about the AS level topology of the Internet is based on measurements and inductive-type models which set up rules describing the behavior (node and edge dynamics) of the individual ASes and generalize the consequences of these individual actions for the complete AS ecosystem using induction. In this paper we suggest a third, deductive approach in which we have premises for the whole AS system and the consequences of these premises are determined through deductive reasoning. We show that such a deductive approach can give complementary insights into the topological properties of the AS graph. While inductive models can mostly reflect high level statistics (e.g., degree distribution, clustering, diameter), deductive reasoning can identify omnipresent subgraphs and peering likelihood. We also propose a model, called YEAS, incorporating our deductive analytical findings that produces topologies contain both traditional and novel metrics for the AS level Internet. (paper)
-
Clarifying assumptions to enhance our understanding and assessment of clinical reasoning.
Durning, Steven J; Artino, Anthony R; Schuwirth, Lambert; van der Vleuten, Cees
2013-04-01
Deciding on a diagnosis and treatment is essential to the practice of medicine. Developing competence in these clinical reasoning processes, commonly referred to as diagnostic and therapeutic reasoning, respectively, is required for physician success. Clinical reasoning has been a topic of research for several decades, and much has been learned. However, there still exists no clear consensus regarding what clinical reasoning entails, let alone how it might best be taught, how it should be assessed, and the research and practice implications therein.In this article, the authors first discuss two contrasting epistemological views of clinical reasoning and related conceptual frameworks. They then outline four different theoretical frameworks held by medical educators that the authors believe guide educators' views on the topic, knowingly or not. Within each theoretical framework, the authors begin with a definition of clinical reasoning (from that viewpoint) and then discuss learning, assessment, and research implications. The authors believe these epistemologies and four theoretical frameworks also apply to other concepts (or "competencies") in medical education.The authors also maintain that clinical reasoning encompasses the mental processes and behaviors that are shared (or evolve) between the patient, physician, and the environment (i.e., practice setting). Clinical reasoning thus incorporates components of all three factors (patient, physician, environment). The authors conclude by outlining practical implications and potential future areas for research.
-
Gilotra, Nisha A; Shpigel, Adam; Okwuosa, Ike S; Tamrat, Ruth; Flowers, Deirdre; Russell, Stuart D
2017-03-01
There are few data describing patient-identified precipitants of heart failure (HF) hospitalization. We hypothesized a patient's perception of reason for or preventability of an admission may be related to 30-day readmission rates. Ninety-four patients admitted with decompensated HF from July 2014 to March 2015 completed a brief questionnaire regarding circumstances leading to admission. Thirty-day outcomes were assessed via telephone call and chart review. Mean age was 58 ± 14 years, with 60% blacks (n = 56) and 41% females (n = 39). Median left ventricular ejection fraction was 30%; 27 had preserved ejection fraction. Seventy-two patients identified their hospitalization to be due to HF (± another condition). Most common patient-identified precipitants of admission were worsening HF (n = 37) and dietary nonadherence (n = 11). Readmitted patients tended to have longer time until first follow-up appointment (21 vs 8 days). Seven of the 42 patients who identified their hospitalization as preventable were readmitted compared with 21/49 who believed their hospitalization was unpreventable (P = .012). On multivariate regression analysis, patients who thought their hospitalization was preventable were less likely to be readmitted (odds ratio 0.31; 95% confidence interval 0.10-0.91; P = .04). Almost 50% of patients believe their HF hospitalization is preventable, and these patients appear to be less likely to be readmitted within 30 days. Notably, patients cite nonadherence and lack of knowledge as reasons hospitalizations are preventable. These results lend insight into possible interventions to reduce HF readmissions. Copyright © 2016 Elsevier Inc. All rights reserved.
-
Reasons for family involvement in elective surgical decision-making in Taiwan: a qualitative study.
Lin, Mei-Ling; Huang, Chuen-Teng; Chen, Ching-Huey
2017-07-01
To inquire into the reasons for family involvement in adult patients' surgical decision-making processes from the point of view of the patients' family. Making a patient the centre of medical decision-making is essential for respecting individual's autonomy. However, in a Chinese society, family members are often deeply involved in a patient's medical decision-making. Although family involvement has long been viewed as an aspect of the Chinese culture, empirical evidence of the reasons for family involvement in medical decision-making has been lacking. A qualitative study. In order to record and examine reasons for family involvement in adult patients' surgical decision-making, 12 different family members of 12 elective surgery patients were interviewed for collecting and analysing data. Three major reasons for family involvement emerged from the data analyses: (1) to share responsibility; (2) to ensure the correctness of medical information; and (3) to safeguard the patient's well-being. These findings also reveal that culture is not the only reason for family involvement. Making decision to undergo a surgery is a tough and stressful process for a patient. Family may provide the patient with timely psychological support to assist the patient to communicate with his or her physician(s) and other medical personnel to ensure their rights. It is also found that due to the imbalanced doctor-patient power relationship, a patient may be unable, unwilling to, or even dare not, tell the whole truth about his or her illness or feelings to the medical personnel. Thus, a patient would expect his or her family to undertake such a mission during the informed consent and decision-making processes. The results of this study may provide medical professionals with relevant insights into family involvement in adult patients' surgical decision-making. © 2016 John Wiley & Sons Ltd.
-
Szulc, P; Naylor, K; Hoyle, N R; Eastell, R; Leary, E T
2017-09-01
The National Bone Health Alliance (NBHA) recommends standardized sample handling and patient preparation for C-terminal telopeptide of type I collagen (CTX-I) and N-terminal propeptide of type I procollagen (PINP) measurements to reduce pre-analytical variability. Controllable and uncontrollable patient-related factors are reviewed to facilitate interpretation and minimize pre-analytical variability. The IOF and the International Federation of Clinical Chemistry (IFCC) Bone Marker Standards Working Group have identified PINP and CTX-I in blood to be the reference markers of bone turnover for the fracture risk prediction and monitoring of osteoporosis treatment. Although used in clinical research for many years, bone turnover markers (BTM) have not been widely adopted in clinical practice primarily due to their poor within-subject and between-lab reproducibility. The NBHA Bone Turnover Marker Project team aim to reduce pre-analytical variability of CTX-I and PINP measurements through standardized sample handling and patient preparation. Recommendations for sample handling and patient preparations were made based on review of available publications and pragmatic considerations to reduce pre-analytical variability. Controllable and un-controllable patient-related factors were reviewed to facilitate interpretation and sample collection. Samples for CTX-I must be collected consistently in the morning hours in the fasted state. EDTA plasma is preferred for CTX-I for its greater sample stability. Sample collection conditions for PINP are less critical as PINP has minimal circadian variability and is not affected by food intake. Sample stability limits should be observed. The uncontrollable aspects (age, sex, pregnancy, immobility, recent fracture, co-morbidities, anti-osteoporotic drugs, other medications) should be considered in BTM interpretation. Adopting standardized sample handling and patient preparation procedures will significantly reduce controllable pre-analytical
-
Directory of Open Access Journals (Sweden)
Bateman James
2012-08-01
Full Text Available Abstract Background Virtual Patients (VPs are web-based representations of realistic clinical cases. They are proposed as being an optimal method for teaching clinical reasoning skills. International standards exist which define precisely what constitutes a VP. There are multiple design possibilities for VPs, however there is little formal evidence to support individual design features. The purpose of this trial is to explore the effect of two different potentially important design features on clinical reasoning skills and the student experience. These are the branching case pathways (present or absent and structured clinical reasoning feedback (present or absent. Methods/Design This is a multi-centre randomised 2x2 factorial design study evaluating two independent variables of VP design, branching (present or absent, and structured clinical reasoning feedback (present or absent.The study will be carried out in medical student volunteers in one year group from three university medical schools in the United Kingdom, Warwick, Keele and Birmingham. There are four core musculoskeletal topics. Each case can be designed in four different ways, equating to 16 VPs required for the research. Students will be randomised to four groups, completing the four VP topics in the same order, but with each group exposed to a different VP design sequentially. All students will be exposed to the four designs. Primary outcomes are performance for each case design in a standardized fifteen item clinical reasoning assessment, integrated into each VP, which is identical for each topic. Additionally a 15-item self-reported evaluation is completed for each VP, based on a widely used EViP tool. Student patterns of use of the VPs will be recorded. In one centre, formative clinical and examination performance will be recorded, along with a self reported pre and post-intervention reasoning score, the DTI. Our power calculations indicate a sample size of 112 is required for
-
Mabuza, Langalibalele H.; Okonta, Henry I.
2013-01-01
Abstract Background In 2007, a large number of hypertensive patients seen at Natalspruit Hospital had poor adherent to their anti-hypertension treatment which manifested itself through poor blood pressure control. On enquiry, they revealed that they were also taking traditional medicines. Objectives To explore the reasons given by hypertensive patients for concurrently using traditional and Western medicine. Methods A qualitative study was conducted amongst nine purposefully selected participants attending treatment at the hospital. Interviews were conducted in the Southern Sotho and IsiZulu languages and were audio-taped. The exploratory question was: ‘Would you tell us why you are taking traditional medicine together with the antihypertensive medicine your are receiving at this hospital?’ The transcribed and translated transcriptions were analysed using the ‘cut and paste’ method to identify themes. Results Themes that emerged were that traditional medicine was readily accessible; traditional healers displayed knowledge and confidence in their medicine; traditional medicine was perceived to counteract the side-effects of western medicine; the two streams were perceived to complement each other and both streams could lead to a ‘cure’. Patients were disappointed at the perceived bad attitude of the hospital staff. Conclusion The reasons given by hypertensive patients for their concurrent use of traditional and Western medicine centred around patients’ relatively favourable perception of traditional medicine and its practitioners. Western medicine health care practitioners should continue health education on antihypertensive medication in a manner acceptable to patients.
-
Analytical results for Abelian projection
International Nuclear Information System (INIS)
Ogilivie, Michael C.
1999-01-01
Analytic methods for Abelian projection are developed, and a number of results related to string tension measurements are obtained. It is proven that even without gauge fixing, Abelian projection yields string tensions of the underlying non-Abelian theory. Strong arguments are given for similar results in the case where gauge fixing is employed. The subgroup used for projection need only contain the center of the gauge group, and need not be Abelian. While gauge fixing is shown to be in principle unnecessary for the success of Abelian projection, it is computationally advantageous for the same reasons that improved operators, e.g., the use of fat links, are advantageous in Wilson loop measurements
-
Cryogenic parallel, single phase flows: an analytical approach
Eichhorn, R.
2017-02-01
Managing the cryogenic flows inside a state-of-the-art accelerator cryomodule has become a demanding endeavour: In order to build highly efficient modules, all heat transfers are usually intercepted at various temperatures. For a multi-cavity module, operated at 1.8 K, this requires intercepts at 4 K and at 80 K at different locations with sometimes strongly varying heat loads which for simplicity reasons are operated in parallel. This contribution will describe an analytical approach, based on optimization theories.
-
Directory of Open Access Journals (Sweden)
Tzeng Huey-Ming
2010-02-01
Full Text Available Abstract Background Little research has been done on patient call light use and staff response time, which were found to be associated with inpatient falls and satisfaction. Nurses' perspectives may moderate or mediate the aforementioned relationships. This exploratory study intended to understand staff's perspectives about call lights, staff responsiveness, and the reasons for and the nature of call light use. It also explored differences among hospitals and identified significant predictors of the nature of call light use. Methods This cross-sectional, multihospital survey study was conducted from September 2008 to January 2009 in four hospitals located in the Midwestern region of the United States. A brief survey was used. All 2309 licensed and unlicensed nursing staff members who provide direct patient care in 27 adult care units were invited to participate. A total of 808 completed surveys were retrieved for an overall response rate of 35%. The SPSS 16.0 Window version was used. Descriptive and binary logistic regression analyses were conducted. Results The primary reasons for patient-initiated calls were for toileting assistance, pain medication, and intravenous problems. Toileting assistance was the leading reason. Each staff responded to 6 to 7 calls per hour and a call was answered within 4 minutes (estimated. 49% of staff perceived that patient-initiated calls mattered to patient safety. 77% agreed that that these calls were meaningful. 52% thought that these calls required the attention of nursing staff. 53% thought that answering calls prevented them from doing the critical aspects of their role. Staff's perceptions about the nature of calls varied across hospitals. Junior staff tended to overlook the importance of answering calls. A nurse participant tended to perceive calls as more likely requiring nursing staff's attention than a nurse aide participant. Conclusions If answering calls was a high priority among nursing tasks, staff
-
Clinical Reasoning in Medicine: A Concept Analysis
Directory of Open Access Journals (Sweden)
Shahram Yazdani
2018-01-01
Full Text Available Background: Clinical reasoning plays an important role in the ability of physicians to make diagnoses and decisions. It is considered the physician’s most critical competence, but it is an ambiguous conceptin medicine that needs a clear analysis and definition. Our aim was to clarify the concept of clinical reasoning in medicine by identifying its components and to differentiate it from other similar concepts.It is necessary to have an operational definition of clinical reasoning, and its components must be precisely defined in order to design successful interventions and use it easily in future research.Methods: McKenna’s nine-step model was applied to facilitate the clarification of the concept of clinical reasoning. The literature for this concept analysis was retrieved from several databases, including Scopus, Elsevier, PubMed, ISI, ISC, Medline, and Google Scholar, for the years 1995– 2016 (until September 2016. An extensive search of the literature was conducted using the electronic database. Accordingly, 17 articles and one book were selected for the review. We applied McKenna’s method of concept analysis in studying clinical reasoning, so that definitional attributes, antecedents, and consequences of this concept were extracted.Results: Clinical reasoning has nine major attributes in medicine. These attributes include: (1 clinical reasoning as a cognitive process; (2 knowledge acquisition and application of different types of knowledge; (3 thinking as a part of the clinical reasoning process; (4 patient inputs; (5 contextdependent and domain-specific processes; (6 iterative and complex processes; (7 multi-modal cognitive processes; (8 professional principles; and (9 health system mandates. These attributes are influenced by the antecedents of workplace context, practice frames of reference, practice models of the practitioner, and clinical skills. The consequences of clinical reasoning are the metacognitive improvement of
-
Baker, Sarah E; Painter, Elizabeth E; Morgan, Brandon C; Kaus, Anna L; Petersen, Evan J; Allen, Christopher S; Deyle, Gail D; Jensen, Gail M
2017-01-01
Clinical reasoning is essential to physical therapist practice. Solid clinical reasoning processes may lead to greater understanding of the patient condition, early diagnostic hypothesis development, and well-tolerated examination and intervention strategies, as well as mitigate the risk of diagnostic error. However, the complex and often subconscious nature of clinical reasoning can impede the development of this skill. Protracted tools have been published to help guide self-reflection on clinical reasoning but might not be feasible in typical clinical settings. This case illustrates how the Systematic Clinical Reasoning in Physical Therapy (SCRIPT) tool can be used to guide the clinical reasoning process and prompt a physical therapist to search the literature to answer a clinical question and facilitate formal mentorship sessions in postprofessional physical therapist training programs. The SCRIPT tool enabled the mentee to generate appropriate hypotheses, plan the examination, query the literature to answer a clinical question, establish a physical therapist diagnosis, and design an effective treatment plan. The SCRIPT tool also facilitated the mentee's clinical reasoning and provided the mentor insight into the mentee's clinical reasoning. The reliability and validity of the SCRIPT tool have not been formally studied. Clinical mentorship is a cornerstone of postprofessional training programs and intended to develop advanced clinical reasoning skills. However, clinical reasoning is often subconscious and, therefore, a challenging skill to develop. The use of a tool such as the SCRIPT may facilitate developing clinical reasoning skills by providing a systematic approach to data gathering and making clinical judgments to bring clinical reasoning to the conscious level, facilitate self-reflection, and make a mentored physical therapist's thought processes explicit to his or her clinical mentor. © 2017 American Physical Therapy Association
-
Diagnostic reasoning and underlying knowledge of students with preclinical patient contacts in PBL.
Diemers, Agnes D; van de Wiel, Margje W J; Scherpbier, Albert J J A; Baarveld, Frank; Dolmans, Diana H J M
2015-12-01
Medical experts have access to elaborate and integrated knowledge networks consisting of biomedical and clinical knowledge. These coherent knowledge networks enable them to generate more accurate diagnoses in a shorter time. However, students' knowledge networks are less organised and students have difficulties linking theory and practice and transferring acquired knowledge. Therefore we wanted to explore the development and transfer of knowledge of third-year preclinical students on a problem-based learning (PBL) course with real patient contacts. Before and after a 10-week PBL course with real patients, third-year medical students were asked to think out loud while diagnosing four types of paper patient problems (two course cases and two transfer cases), and explain the underlying pathophysiological mechanisms of the patient features. Diagnostic accuracy and time needed to think through the cases were measured. The think-aloud protocols were transcribed verbatim and different types of knowledge were coded and quantitatively analysed. The written pathophysiological explanations were translated into networks of concepts. Both the concepts and the links between concepts in students' networks were compared to model networks. Over the course diagnostic accuracy increased, case-processing time decreased, and students used less biomedical and clinical knowledge during diagnostic reasoning. The quality of the pathophysiological explanations increased: the students used more concepts, especially more model concepts, and they used fewer wrong concepts and links. The findings differed across course and transfer cases. The effects were generally less strong for transfer cases. Students' improved diagnostic accuracy and the improved quality of their knowledge networks suggest that integration of biomedical and clinical knowledge took place during a 10-week course. The differences between course and transfer cases demonstrate that transfer is complex and time-consuming. We
-
Directory of Open Access Journals (Sweden)
Michael Liebrenz
Full Text Available High-dose benzodiazepine (BZD dependence is associated with a wide variety of negative health consequences. Affected individuals are reported to suffer from severe mental disorders and are often unable to achieve long-term abstinence via recommended discontinuation strategies. Although it is increasingly understood that treatment interventions should take subjective experiences and beliefs into account, the perceptions of this group of individuals remain under-investigated.We conducted an exploratory qualitative study with 41 adult subjects meeting criteria for (high-dose BZD-dependence, as defined by ICD-10. One-on-one in-depth interviews allowed for an exploration of this group's views on the reasons behind their initial and then continued use of BZDs, as well as their procurement strategies. Mayring's qualitative content analysis was used to evaluate our data.In this sample, all participants had developed explanatory models for why they began using BZDs. We identified a multitude of reasons that we grouped into four broad categories, as explaining continued BZD use: (1 to cope with symptoms of psychological distress or mental disorder other than substance use, (2 to manage symptoms of physical or psychological discomfort associated with somatic disorder, (3 to alleviate symptoms of substance-related disorders, and (4 for recreational purposes, that is, sensation-seeking and other social reasons. Subjects often considered BZDs less dangerous than other substances and associated their use more often with harm reduction than as recreational. Specific obtainment strategies varied widely: the majority of participants oscillated between legal and illegal methods, often relying on the black market when faced with treatment termination.Irrespective of comorbidity, participants expressed a clear preference for medically related explanatory models for their BZD use. We therefore suggest that clinicians consider patients' motives for long-term, high
-
The IAEA's programme in analytical quality control
International Nuclear Information System (INIS)
Suschny, O.
1980-10-01
The purpose of the Analytical Quality Control Programme of the International Atomic Energy Agency is to help laboratories in the Agency's Member States to assess and, if necessary, to improve the reliability of their analytical work in areas related to nuclear technology and radioisotope utilisation. This is done by the organisation of analytical intercomparisons and by the provision of certified or uncertified reference materials. Recently intercomparisons have been organised of trace element analysis in a soil and a lake sediment sample which have led to the certification of two new reference materials, SOIL-5 and SL-1 (lake sediment). A technique has been developed to recognise and to remove outlying results. Criteria have been established to classify element-concentration values into the categories ''established with a high degree of confidence'', ''established with a reasonable degree of confidence'' and ''information value only''. Four radionuclide intercomparisons have recently been carried out: W-1/1 and W-2/1 of the determination of selected radionuclides in water and Air-1/1 and Air-2/1 of that of selected radionuclides on simulated air filters. Details of the preparation of materials for these intercomparisons, and of data treatment and some results are discussed in the paper
-
Case-based clinical reasoning in feline medicine: 2: Managing cognitive error.
Canfield, Paul J; Whitehead, Martin L; Johnson, Robert; O'Brien, Carolyn R; Malik, Richard
2016-03-01
This is Article 2 of a three-part series on clinical reasoning that encourages practitioners to explore and understand how they think and make case-based decisions. It is hoped that, in the process, they will learn to trust their intuition but, at the same time, put in place safeguards to diminish the impact of bias and misguided logic on their diagnostic decision-making. Article 1, published in the January 2016 issue of JFMS, discussed the relative merits and shortcomings of System 1 thinking (immediate and unconscious) and System 2 thinking (effortful and analytical). This second article examines ways of managing cognitive error, particularly the negative impact of bias, when making a diagnosis. Article 3, to appear in the May 2016 issue, explores the use of heuristics (mental short cuts) and illness scripts in diagnostic reasoning. © The Author(s) 2016.
-
From Biomedical to Psychosomatic Reasoning: A Theoretical Framework
Directory of Open Access Journals (Sweden)
Alireza Monajemi
2014-01-01
Full Text Available Despite a general acceptance of the biopsychosocial model, medical education and patient care are still largely biomedical in focus, and physicians have many deficiencies in biopsychosocial formulations and care. Education in medical schools puts more emphasis on providing biomedical education (BM than biopsychosocial education (BPS; the initial knowledge formed in medical students is mainly with a biomedical approach. Therefore, it seems that psychosocial aspects play a minor role at this level and PSM knowledge will lag behind BM knowledge. However, it seems that the integration of biomedical and psychosocial-knowledge is crucial for a successful and efficient patient encounter. In this paper, based on the theory of medical expertise development, the steps through which biomedical reasoning transforms to psychosomatic reasoning will be discussed.
-
Decisions through data: analytics in healthcare.
Wills, Mary J
2014-01-01
The amount of data in healthcare is increasing at an astonishing rate. However, in general, the industry has not deployed the level of data management and analysis necessary to make use of those data. As a result, healthcare executives face the risk of being overwhelmed by a flood of unusable data. In this essay I argue that, in order to extract actionable information, leaders must take advantage of the promise of data analytics. Small data, predictive modeling expansion, and real-time analytics are three forms of data analytics. On the basis of my analysis for this study, I recommend all three for adoption. Recognizing the uniqueness of each organization's situation, I also suggest that practices, hospitals, and healthcare systems examine small data and conduct real-time analytics and that large-scale organizations managing populations of patients adopt predictive modeling. I found that all three solutions assist in the collection, management, and analysis of raw data to improve the quality of care and decrease costs.
-
Nendaz, Mathieu R; Gut, Anne M; Louis-Simonet, Martine; Perrier, Arnaud; Vu, Nu V
2011-04-01
Facets of reasoning competence influenced by an explicit insight into cognitive psychology features during clinical reasoning seminars have not been specifically explored. This prospective, controlled study, conducted at the University of Geneva Faculty of Medicine, Switzerland, assessed the impact on sixth-year medical students' patient work-up of case-based reasoning seminars, bringing them explicit insight into cognitive aspects of their reasoning. Volunteer students registered for our three-month Internal Medicine elective were assigned to one of two training conditions: standard (control) or modified (intervention) case-based reasoning seminars. These seminars start with the patient's presenting complaint and the students must ask the tutor for additional clinical information to progress through case resolution. For this intervention, the tutors made each step explicit to students and encouraged self-reflection on their reasoning processes. At the end of their elective, students' performances were assessed through encounters with two standardized patients and chart write-ups. Twenty-nine students participated, providing a total of 58 encounters. The overall differences in accuracy of the final diagnosis given to the patient at the end of the encounter (control 63% vs intervention 74%, p = 0.53) and of the final diagnosis mentioned in the patient chart (61% vs 70%, p = 0.58) were not statistically significant. The students in the intervention group significantly more often listed the correct diagnosis among the differential diagnoses in their charts (75% vs 97%, p = 0.02). This case-based clinical reasoning seminar intervention, designed to bring students insight into cognitive features of their reasoning, improved aspects of diagnostic competence.
-
Evaluating moral reasoning in nursing education.
McLeod-Sordjan, Renee
2014-06-01
Evidence-based practice suggests the best approach to improving professionalism in practice is ethics curricula. However, recent research has demonstrated that millennium graduates do not advocate for patients or assert themselves during moral conflicts. The aim of this article is the exploration of evaluation techniques to evaluate one measurable outcome of ethics curricula: moral reasoning. A review of literature, published between 1995 and 2013, demonstrated that the moral orientations of care and justice as conceptualized by Gilligan and Kohlberg are utilized by nursing students to solve ethical dilemmas. Data obtained by means of reflective journaling, Ethics of Care Interview (ECI) and Defining Issues Test (DIT), would objectively measure the interrelated pathways of care-based and justice-based moral reasoning. In conclusion, educators have an ethical responsibility to foster students' ability to exercise sound clinical judgment, and support their professional development. It is recommended that educators design authentic assessments to demonstrate student's improvement of moral reasoning. © The Author(s) 2013.
-
Multi-analytical Approaches Informing the Risk of Sepsis
Gwadry-Sridhar, Femida; Lewden, Benoit; Mequanint, Selam; Bauer, Michael
Sepsis is a significant cause of mortality and morbidity and is often associated with increased hospital resource utilization, prolonged intensive care unit (ICU) and hospital stay. The economic burden associated with sepsis is huge. With advances in medicine, there are now aggressive goal oriented treatments that can be used to help these patients. If we were able to predict which patients may be at risk for sepsis we could start treatment early and potentially reduce the risk of mortality and morbidity. Analytic methods currently used in clinical research to determine the risk of a patient developing sepsis may be further enhanced by using multi-modal analytic methods that together could be used to provide greater precision. Researchers commonly use univariate and multivariate regressions to develop predictive models. We hypothesized that such models could be enhanced by using multiple analytic methods that together could be used to provide greater insight. In this paper, we analyze data about patients with and without sepsis using a decision tree approach and a cluster analysis approach. A comparison with a regression approach shows strong similarity among variables identified, though not an exact match. We compare the variables identified by the different approaches and draw conclusions about the respective predictive capabilities,while considering their clinical significance.
-
A qualitative study of the reasons why PTB patients at clinics in the ...
African Journals Online (AJOL)
Background: Tuberculosis (TB) remains the leading infectious cause of adult mortality, despite 60 years of effective chemotherapy. One reason for this is the problem caused by the interruption and failure of treatment, which usually are related to non-adherence. The reasons for non-adherence to TB treatment are ...
-
Context and clinical reasoning : Understanding the medical student perspective.
McBee, Elexis; Ratcliffe, Temple; Schuwirth, Lambert; O'Neill, Daniel; Meyer, Holly; Madden, Shelby J; Durning, Steven J
2018-04-27
Studies have shown that a physician's clinical reasoning performance can be influenced by contextual factors. We explored how the clinical reasoning performance of medical students was impacted by contextual factors in order to expand upon previous findings in resident and board certified physicians. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of medical students in order to describe what impact the presence of contextual factors has on their reasoning performance. Seventeen medical student participants viewed three video recordings of clinical encounters portraying straightforward diagnostic cases in internal medicine with explicit contextual factors inserted. Participants completed a computerized post-encounter form as well as a think-aloud protocol. Three authors analyzed verbatim transcripts from the think-aloud protocols using a constant comparative approach. After iterative coding, utterances were analyzed and grouped into categories and themes. Six categories and ten associated themes emerged, which demonstrated overlap with findings from previous studies in resident and attending physicians. Four overlapping categories included emotional disturbances, behavioural inferences about the patient, doctor-patient relationship, and difficulty with closure. Two new categories emerged to include anchoring and misinterpretation of data. The presence of contextual factors appeared to impact clinical reasoning performance in medical students. The data suggest that a contextual factor can be innate to the clinical scenario, consistent with situated cognition theory. These findings build upon our understanding of clinical reasoning performance from both a theoretical and practical perspective.
-
Directory of Open Access Journals (Sweden)
Sikirica MV
2017-09-01
Full Text Available Mirko V Sikirica,1 Alan A Martin,2 Robert Wood,3 Andrea Leith,3 James Piercy,3 Victoria Higgins3 1Value Evidence and Outcomes, GlaxoSmithKline, Collegeville, PA, USA; 2Value Evidence and Outcomes, GlaxoSmithKline, London, UK; 3Diabetes, Adelphi Real World, Bollington, Cheshire, UK Aim: Nonadherence to glucagon-like peptide-1 receptor agonists (GLP1 RAs is relatively common among patients with type 2 diabetes mellitus (T2DM. This study sought to identify reasons why patients discontinue GLP1 RAs.Materials and methods: Retrospective data from the Adelphi Diabetes Disease Specific Programme were used. Physicians managing patients with T2DM were surveyed via face-to-face interviews, and patients treated for T2DM were surveyed via self-completed questionnaires. Patient data were stratified by current versus prior GLP1 RA use.Results: Physicians (n=443 most frequently reported inadequate blood glucose control (45.6%, nausea/vomiting (43.8%, and gastrointestinal (GI side effects (36.8% as reasons for GLP1 RA discontinuation. Patients (n=194 reported the GI-related issues “Made me feel sick” (64.4% and “Made me throw up” (45.4% as their top reasons for discontinuation. The most common problems reported (excluding cost for those currently using GLP1 RAs were “Prefer oral medication over injections” (patients 56%, physicians 32.6%, “Made me feel sick” (patients 38.1%, physicians 16.3%, and “Did not help lose weight” (patients 25.4%, physicians 18%. The most bothersome problems for patients globally (frequency reporting very/extremely bothersome (excluding cost were “Difficult to plan meals around” (55.6%, “Made me throw up” (51.6%, and “Caused weight gain” (50%.Conclusion: Both patients and physicians reported GI-related issues as a prominent factor, but disparities between patient experiences and physician perceptions were revealed, suggesting gaps in physician–patient communication. Understanding patients
-
Utilization of the Nursing Process to Foster Clinical Reasoning During a Simulation Experience
Directory of Open Access Journals (Sweden)
Amanda Lambie
2015-11-01
Full Text Available Nursing practice includes complex reasoning and multifaceted decision making with minimal standardized guidance in how to evaluate this phenomenon among nursing students. Learning outcomes related to the clinical reasoning process among novice baccalaureate nursing students during a simulation experience were evaluated. Nursing process records were utilized to evaluate and foster the development of clinical reasoning in a high-fidelity medical-surgical simulation experience. Students were unable to describe and process pertinent patient information appropriately prior to the simulation experience. Students’ ability to identify pertinent patient cues and plan appropriate patient care improved following the simulation. The learning activity afforded a structured opportunity to identify cues, prioritize the proper course of nursing interventions, and engage in collaboration among peers. The simulation experience provides faculty insight into the students’ clinical reasoning processes, while providing students with a clear framework for successfully accomplishing learning outcomes.
-
Bañuelos-Andrío, L; Espino-Hernández, M; Ruperez-Lucas, M; Villar-Del Campo, M C; Romero-Carrasco, C I; Rodríguez-Caravaca, G
To investigate the usefulness of procalcitonin (PCT) and other analytical parameters (white blood cell count [WBC], C-reactive protein [CRP]) as markers of acute renal damage in children after a first febrile or afebrile urinary tract infection (UTI). A retrospective study was conducted on children with a first episode of UTI admitted between January 2009 to December 2011, and in whom serum PCT, CRP and white blood cell count were measured, as well as assessing the acute renal damage with renal scintigraphy with 99m Tc-DMSA (DMSA) within the first 72h after referral. A descriptive study was performed and ROC curves were plotted, with optimal cut-off points calculated for each parameter. The 101 enrolled patients were divided into two groups according to DMSA scintigraphy results, with 64 patients being classified with acute pyelonephritis (APN), and 37 with UTI. The mean WBC, CRP and PCT values were significantly higher in patients with APN with respect to normal acute DMSA. The area under the ROC curve was 0.862 for PCR, 0.774 for WBC, and 0.731 for PCT. The optimum statistical cut-off value for PCT was 0.285ng/ml (sensitivity 71.4% and specificity 75%). Although the mean levels of fever, WBC, CRP, and PCT were significantly increased in patients with APN than in those who had UTI, the sensitivity and specificity of these analytical parameters are unable to predict the existence of acute renal damage, making the contribution by renal DMSA scintigraphy essential. Copyright © 2016 Elsevier España, S.L.U. y SEMNIM. All rights reserved.
-
Collaborative Web-Enabled GeoAnalytics Applied to OECD Regional Data
Jern, Mikael
Recent advances in web-enabled graphics technologies have the potential to make a dramatic impact on developing collaborative geovisual analytics (GeoAnalytics). In this paper, tools are introduced that help establish progress initiatives at international and sub-national levels aimed at measuring and collaborating, through statistical indicators, economic, social and environmental developments and to engage both statisticians and the public in such activities. Given this global dimension of such a task, the “dream” of building a repository of progress indicators, where experts and public users can use GeoAnalytics collaborative tools to compare situations for two or more countries, regions or local communities, could be accomplished. While the benefits of GeoAnalytics tools are many, it remains a challenge to adapt these dynamic visual tools to the Internet. For example, dynamic web-enabled animation that enables statisticians to explore temporal, spatial and multivariate demographics data from multiple perspectives, discover interesting relationships, share their incremental discoveries with colleagues and finally communicate selected relevant knowledge to the public. These discoveries often emerge through the diverse backgrounds and experiences of expert domains and are precious in a creative analytics reasoning process. In this context, we introduce a demonstrator “OECD eXplorer”, a customized tool for interactively analyzing, and collaborating gained insights and discoveries based on a novel story mechanism that capture, re-use and share task-related explorative events.
-
Rossi, Sandrine; Cassotti, Mathieu; Moutier, Sylvain; Delcroix, Nicolas; Houd?, Olivier
2015-01-01
Reasoners make systematic logical errors by giving heuristic responses that reflect deviations from the logical norm. Influential studies have suggested first that our reasoning is often biased because we minimize cognitive effort to surpass a cognitive conflict between heuristic response from system 1 and analytic response from system 2 thinking. Additionally, cognitive control processes might be necessary to inhibit system 1 responses to activate a system 2 response. Previous studies have s...
-
Mukherjee, Sunanda; Wu, Huanmei; Jones, Josette
2016-01-01
Parkinson's Disease (PD), a prevalent problem, especially for the aged populations, is a progressive but non-fatal nervous system disorder. PD patients have special motor as well as non-motor symptoms over time. There are several limitations in the study of PD such as unavailability of data, proper diagnosis and treatment methods. These limitations significantly reduce the quality of PD patient life quality, either directly or indirectly. PD also imposes great financial burdens to PD patients and their family. This project aims to analyze the most common reasons for PD patient hospitalization, review complications that occur during inpatient stays, and measure the costs associated with PD patient characteristics. Using the HCUP NIS data, comprehensive data analysis has been performed. The results are customized visualized using Tableau and other software systems. The preliminary findings sheds light into how to improve the life quality of PD patients.
-
Information processing systems, reasoning modules, and reasoning system design methods
Hohimer, Ryan E; Greitzer, Frank L; Hampton, Shawn D
2014-03-04
Information processing systems, reasoning modules, and reasoning system design methods are described. According to one aspect, an information processing system includes working memory comprising a semantic graph which comprises a plurality of abstractions, wherein the abstractions individually include an individual which is defined according to an ontology and a reasoning system comprising a plurality of reasoning modules which are configured to process different abstractions of the semantic graph, wherein a first of the reasoning modules is configured to process a plurality of abstractions which include individuals of a first classification type of the ontology and a second of the reasoning modules is configured to process a plurality of abstractions which include individuals of a second classification type of the ontology, wherein the first and second classification types are different.
-
Information processing systems, reasoning modules, and reasoning system design methods
Energy Technology Data Exchange (ETDEWEB)
Hohimer, Ryan E.; Greitzer, Frank L.; Hampton, Shawn D.
2016-08-23
Information processing systems, reasoning modules, and reasoning system design methods are described. According to one aspect, an information processing system includes working memory comprising a semantic graph which comprises a plurality of abstractions, wherein the abstractions individually include an individual which is defined according to an ontology and a reasoning system comprising a plurality of reasoning modules which are configured to process different abstractions of the semantic graph, wherein a first of the reasoning modules is configured to process a plurality of abstractions which include individuals of a first classification type of the ontology and a second of the reasoning modules is configured to process a plurality of abstractions which include individuals of a second classification type of the ontology, wherein the first and second classification types are different.
-
Information processing systems, reasoning modules, and reasoning system design methods
Energy Technology Data Exchange (ETDEWEB)
Hohimer, Ryan E.; Greitzer, Frank L.; Hampton, Shawn D.
2015-08-18
Information processing systems, reasoning modules, and reasoning system design methods are described. According to one aspect, an information processing system includes working memory comprising a semantic graph which comprises a plurality of abstractions, wherein the abstractions individually include an individual which is defined according to an ontology and a reasoning system comprising a plurality of reasoning modules which are configured to process different abstractions of the semantic graph, wherein a first of the reasoning modules is configured to process a plurality of abstractions which include individuals of a first classification type of the ontology and a second of the reasoning modules is configured to process a plurality of abstractions which include individuals of a second classification type of the ontology, wherein the first and second classification types are different.
-
Generalized analytic continuation
Ross, William T
2002-01-01
The theory of generalized analytic continuation studies continuations of meromorphic functions in situations where traditional theory says there is a natural boundary. This broader theory touches on a remarkable array of topics in classical analysis, as described in the book. This book addresses the following questions: (1) When can we say, in some reasonable way, that component functions of a meromorphic function on a disconnected domain, are "continuations" of each other? (2) What role do such "continuations" play in certain aspects of approximation theory and operator theory? The authors use the strong analogy with the summability of divergent series to motivate the subject. In this vein, for instance, theorems can be described as being "Abelian" or "Tauberian". The introductory overview carefully explains the history and context of the theory. The authors begin with a review of the works of Poincaré, Borel, Wolff, Walsh, and Gončar, on continuation properties of "Borel series" and other meromorphic func...
-
2017-01-01
Objective To explore reasons for attending a general emergency outpatient clinic versus a regular general practitioner (RGP). Design Cross-sectional study using a multilingual anonymous questionnaire. Setting Native and immigrant walk-in patients attending a general emergency outpatient clinic in Oslo (Monday–Friday, 08:00–23:00) during 2 weeks in September 2009. Subjects We included 1022 walk-in patients: 565 native Norwegians (55%) and 457 immigrants (45%). Main outcome measures Patients’ reasons for attending an emergency outpatient clinic versus their RGP. Results Among patients reporting an RGP affiliation, 49% tried to contact their RGP before this emergency encounter: 44% of native Norwegian and 58% of immigrant respondents. Immigrants from Africa [odds ratio (OR) = 2.55 (95% confidence interval [CI]: 1.46–4.46)] and Asia [OR = 2.32 (95% CI: 1.42–3.78)] were more likely to contact their RGP before attending the general emergency outpatient clinic compared with native Norwegians. The most frequent reason for attending the emergency clinic was difficulty making an immediate appointment with their RGP. A frequent reason for not contacting an RGP was lack of access: 21% of the native Norwegians versus 4% of the immigrants claimed their RGP was in another district/municipality, and 31% of the immigrants reported a lack of affiliation with the RGP scheme. Conclusions and implications Access to primary care provided by an RGP affects patients’ use of emergency health care services. To facilitate continuity of health care, policymakers should emphasize initiatives to improve access to primary health care services. Key points Access to immediate primary health care provided by a regular general practitioner (RGP) can reduce patients’ use of emergency health care services. The main reason for attending a general emergency outpatient clinic was difficulty obtaining an immediate appointment with an RGP. A frequent reason for native Norwegians
-
Visual Analytics in Public Safety: Example Capabilities for Example Government Agencies
2011-10-01
appelé « analytique visuel », lequel combine et approfondit les domaines de la visualisation de données et de l’analytique computationnel...Data Sources Data Analysis Analytic Reasoning Information Sharing Data types • Transaction • Image • Video • Text • Audio • Spatial...Broadcast Monitoring System creates a continuous, searchable, one-year archive of international television broadcasts. The real-time audio stream is
-
Neural correlates of belief-bias reasoning under time pressure: a near-infrared spectroscopy study.
Tsujii, Takeo; Watanabe, Shigeru
2010-04-15
The dual-process theory of reasoning explained the belief-bias effect, the tendency for human reasoning to be erroneously biased when logical conclusions are incongruent with belief about the world, by proposing a belief-based fast heuristic system and a logic-based slow analytic system. Although the claims were supported by behavioral findings that the belief-bias effect was enhanced when subjects were not given sufficient time for reasoning, the neural correlates were still unknown. The present study therefore examined the relationship between the time-pressure effect and activity in the inferior frontal cortex (IFC) during belief-bias reasoning using near-infrared spectroscopy (NIRS). Forty-eight subjects performed congruent and incongruent reasoning tasks, involving long-span (20 s) and short-span trials (10 s). Behavioral analysis found that only incongruent reasoning performance was impaired by the time-pressure of short-span trials. NIRS analysis found that the time-pressure decreased right IFC activity during incongruent trials. Correlation analysis showed that subjects with enhanced right IFC activity could perform better in incongruent trials, while subjects for whom the right IFC activity was impaired by the time-pressure could not maintain better reasoning performance. These findings suggest that the right IFC may be responsible for the time-pressure effect in conflicting reasoning processes. When the right IFC activity was impaired in the short-span trials in which subjects were not given sufficient time for reasoning, the subjects may rely on the fast heuristic system, which result in belief-bias responses. We therefore offer the first demonstration of neural correlates of time-pressure effect on the IFC activity in belief-bias reasoning. Copyright 2009 Elsevier Inc. All rights reserved.
-
Diagnostic Reasoning and Cognitive Biases of Nurse Practitioners.
Lawson, Thomas N
2018-04-01
Diagnostic reasoning is often used colloquially to describe the process by which nurse practitioners and physicians come to the correct diagnosis, but a rich definition and description of this process has been lacking in the nursing literature. A literature review was conducted with theoretical sampling seeking conceptual insight into diagnostic reasoning. Four common themes emerged: Cognitive Biases and Debiasing Strategies, the Dual Process Theory, Diagnostic Error, and Patient Harm. Relevant cognitive biases are discussed, followed by debiasing strategies and application of the dual process theory to reduce diagnostic error and harm. The accuracy of diagnostic reasoning of nurse practitioners may be improved by incorporating these items into nurse practitioner education and practice. [J Nurs Educ. 2018;57(4):203-208.]. Copyright 2018, SLACK Incorporated.
-
Critique of influential epistemological presuppositions in clinical reasoning
DEFF Research Database (Denmark)
Thorgård, Keld
2013-01-01
, better clinical reasoning is typically linked to detachment, neutrality and monological conceptions of rationality. In this article, it is argued that rational clinical decision-making must also include position-dependent experiences, values and dialogical deliberation.......Evidence-based medicine is an important resource in modern clinical reasoning. It is, however, widely discussed how judgement, experience and patient perspectives are supposed to be integrated in evidence-based decision-making. They are recognised as important aspects, but their epistemological...... status has remained unclarified. In this article, it is argued that we need to consider three different yet related epistemological problems in order to obtain a better understanding of these aspects in clinical reasoning. Even though judgement and values are mentioned in the decision-making procedure...
-
Clinical judgement in the era of big data and predictive analytics.
Chin-Yee, Benjamin; Upshur, Ross
2017-12-13
Clinical judgement is a central and longstanding issue in the philosophy of medicine which has generated significant interest over the past few decades. In this article, we explore different approaches to clinical judgement articulated in the literature, focusing in particular on data-driven, mathematical approaches which we contrast with narrative, virtue-based approaches to clinical reasoning. We discuss the tension between these different clinical epistemologies and further explore the implications of big data and machine learning for a philosophy of clinical judgement. We argue for a pluralistic, integrative approach, and demonstrate how narrative, virtue-based clinical reasoning will remain indispensable in an era of big data and predictive analytics. © 2017 John Wiley & Sons, Ltd.
-
DEFF Research Database (Denmark)
Franco de los Rios, Camilo Andres
2014-01-01
, where experts value pairs of alternatives/criteria with words, making it essentially fuzzy under the view that words can be represented by fuzzy sets for their respective computation. Hence, reasoning with fuzzy logic is justified by the analytical framework that it offers to design the meaning of words...
-
A Meta-analytic Review of Religious or Spiritual Involvement and Social Health among Cancer Patients
Sherman, Allen C; Merluzzi, Thomas V; Pustejovsky, James E; Park, Crystal L; George, Login; Fitchett, George; Jim, Heather SL; Munoz, Alexis R; Danhauer, Suzanne C; Snyder, Mallory A; Salsman, John M
2015-01-01
Background Religion and spirituality (R/S) play an important role in the daily lives of many cancer patients. There has been great interest in determining whether R/S factors are related to clinically-relevant health outcomes. This meta-analytic review examined associations between dimensions of R/S and social health (e.g., social roles and relationships). Methods A systematic search of PubMed, PsycInfo, Cochrane Library, and CINAHL databases was conducted, and data were extracted by four pairs of investigators. Bivariate associations between specific R/S dimensions and social health outcomes were examined in a meta-analysis using a generalized estimating equation (GEE) approach. Results A total of 78 independent samples encompassing 14,277 patients were included in the meta-analysis. Social health was significantly associated with overall R/S (Fisher z effect size = .20, Pcancer. Further research is needed to examine the temporal nature of these associations and the mechanisms that underlie them. PMID:26258730
-
Prelicensure Baccalaureate Nursing Students' Perceptions of Their Development of Clinical Reasoning.
Herron, Elizabeth K; Sudia, Tanya; Kimble, Laura P; Davis, Alison H
2016-06-01
Establishing a strong foundation for the development of clinical reasoning in nursing students is essential to ensure safe and effective patient care. This study explored prelicensure baccalaureate nursing students' perceptions of their development of clinical reasoning, as well as their perceptions of how it is taught. In this phenomenological study, individual semistructured interviews were conducted to gather data related to participants' perceptions of their development of clinical reasoning. Data were analyzed using procedural steps delineated by Giorgi. Data analysis revealed three main themes: Instructor Characteristics, Importance of Clinical Reasoning, and Best Place to Learn Clinical Reasoning. Students recognized how clinical reasoning enhances safe and effective clinical practice and indicated the clinical arena was the most beneficial environment in which to learn clinical reasoning. Understanding students' perceptions of learning benefits nurse educators in planning nursing program curricula to enhance and facilitate the development of clinical reasoning. [J Nurs Educ. 2016;55(6):329-335.]. Copyright 2016, SLACK Incorporated.
-
Response demands and the recruitment of heuristic strategies in syllogistic reasoning.
Reverberi, Carlo; Rusconi, Patrice; Paulesu, Eraldo; Cherubini, Paolo
2009-03-01
Two experiments investigated whether dealing with a homogeneous subset of syllogisms with time-constrained responses encouraged participants to develop and use heuristics for abstract (Experiment 1) and thematic (Experiment 2) syllogisms. An atmosphere-based heuristic accounted for most responses with both abstract and thematic syllogisms. With thematic syllogisms, a weaker effect of a belief heuristic was also observed, mainly where the correct response was inconsistent with the atmosphere of the premises. Analytic processes appear to have played little role in the time-constrained condition, whereas their involvement increased in a self-paced, unconstrained condition. From a dual-process perspective, the results further specify how task demands affect the recruitment of heuristic and analytic systems of reasoning. Because the syllogisms and experimental procedure were the same as those used in a previous neuroimaging study by Goel, Buchel, Frith, and Dolan (2000), the result also deepen our understanding of the cognitive processes investigated by that study.
-
Complexified de Sitter space: Analytic causal kernels and Kaellen-Lehmann-type representation
International Nuclear Information System (INIS)
Bros, J.
1991-01-01
Global analyticity properties of functions associated with causal kernels on de Sitter space are considered. These properties extend in a reasonable way those implied by the general framework of quantum field theory in complex Minkowski space. Mathematical results of J. Faraut, G.A. Viano and J. Bros (motivated in particular by complex angular momentum analysis in field theory) find here new applications. (orig.)
-
Analytic and heuristic processes in the detection and resolution of conflict.
Ferreira, Mário B; Mata, André; Donkin, Christopher; Sherman, Steven J; Ihmels, Max
2016-10-01
Previous research with the ratio-bias task found larger response latencies for conflict trials where the heuristic- and analytic-based responses are assumed to be in opposition (e.g., choosing between 1/10 and 9/100 ratios of success) when compared to no-conflict trials where both processes converge on the same response (e.g., choosing between 1/10 and 11/100). This pattern is consistent with parallel dual-process models, which assume that there is effective, rather than lax, monitoring of the output of heuristic processing. It is, however, unclear why conflict resolution sometimes fails. Ratio-biased choices may increase because of a decline in analytical reasoning (leaving heuristic-based responses unopposed) or to a rise in heuristic processing (making it more difficult for analytic processes to override the heuristic preferences). Using the process-dissociation procedure, we found that instructions to respond logically and response speed affected analytic (controlled) processing (C), leaving heuristic processing (H) unchanged, whereas the intuitive preference for large nominators (as assessed by responses to equal ratio trials) affected H but not C. These findings create new challenges to the debate between dual-process and single-process accounts, which are discussed.
-
Amsel, Eric; Klaczynski, Paul A.; Johnston, Adam; Bench, Shane; Close, Jason; Sadler, Eric; Walker, Rick
2008-01-01
Metacognitive knowledge of the dual-processing basis of judgment is critical to resolving conflict between analytic and experiential processing responses [Klaczynski, P. A. (2004). A dual-process model of adolescent development: Implications for decision making, reasoning, and identity. In R. V. Kail (Ed.), "Advances in child development and…
-
Development of CAD implementing the algorithm of boundary elements’ numerical analytical method
Directory of Open Access Journals (Sweden)
Yulia V. Korniyenko
2015-03-01
Full Text Available Up to recent days the algorithms for numerical-analytical boundary elements method had been implemented with programs written in MATLAB environment language. Each program had a local character, i.e. used to solve a particular problem: calculation of beam, frame, arch, etc. Constructing matrices in these programs was carried out “manually” therefore being time-consuming. The research was purposed onto a reasoned choice of programming language for new CAD development, allows to implement algorithm of numerical analytical boundary elements method and to create visualization tools for initial objects and calculation results. Research conducted shows that among wide variety of programming languages the most efficient one for CAD development, employing the numerical analytical boundary elements method algorithm, is the Java language. This language provides tools not only for development of calculating CAD part, but also to build the graphic interface for geometrical models construction and calculated results interpretation.
-
Analytic tests and their relation to jet fuel thermal stability
Energy Technology Data Exchange (ETDEWEB)
Heneghan, S.P.; Kauffman, R.E. [Univ. of Dayton Research Institute, OH (United States)
1995-05-01
The evaluation of jet fuel thermal stability (TS) by simple analytic procedures has long been a goal of fuels chemists. The reason is obvious: if the analytic chemist can determine which types of material cause his test to respond, the refiners will know which materials to remove to improve stability. Complicating this quest is the lack of an acceptable quantitative TS test with which to compare any analytic procedures. To circumvent this problem, we recently compiled the results of TS tests for 12 fuels using six separate test procedures. The results covering a range of flow and temperature conditions show that TS is not as dependent on test conditions as previously thought. Also, comparing the results from these tests with several analytic procedures shows that either a measure of the number of phenols or the total sulfur present in jet fuels is strongly indicative of the TS. The phenols have been measured using a cyclic voltammetry technique and the polar material by gas chromatography (atomic emission detection) following a solid phase extraction on silica gel. The polar material has been identified as mainly phenols (by mass spectrometry identification). Measures of the total acid number or peroxide concentration have little correlation with TS.
-
Big data analytics to improve cardiovascular care: promise and challenges.
Rumsfeld, John S; Joynt, Karen E; Maddox, Thomas M
2016-06-01
The potential for big data analytics to improve cardiovascular quality of care and patient outcomes is tremendous. However, the application of big data in health care is at a nascent stage, and the evidence to date demonstrating that big data analytics will improve care and outcomes is scant. This Review provides an overview of the data sources and methods that comprise big data analytics, and describes eight areas of application of big data analytics to improve cardiovascular care, including predictive modelling for risk and resource use, population management, drug and medical device safety surveillance, disease and treatment heterogeneity, precision medicine and clinical decision support, quality of care and performance measurement, and public health and research applications. We also delineate the important challenges for big data applications in cardiovascular care, including the need for evidence of effectiveness and safety, the methodological issues such as data quality and validation, and the critical importance of clinical integration and proof of clinical utility. If big data analytics are shown to improve quality of care and patient outcomes, and can be successfully implemented in cardiovascular practice, big data will fulfil its potential as an important component of a learning health-care system.
-
Directory of Open Access Journals (Sweden)
Carina Cesar
Full Text Available BACKGROUND: HAART rollout in Latin America and the Caribbean has increased from approximately 210,000 in 2003 to 390,000 patients in 2007, covering 62% (51%-70% of eligible patients, with considerable variation among countries. No multi-cohort study has examined rates of and reasons for change of initial HAART in this region. METHODOLOGY: Antiretroviral-naïve patients >or= 18 years who started HAART between 1996 and 2007 and had at least one follow-up visit from sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru were included. Time from HAART initiation to change (stopping or switching any antiretrovirals was estimated using Kaplan-Meier techniques. Cox proportional hazards modeled the associations between change and demographics, initial regimen, baseline CD4 count, and clinical stage. PRINCIPAL FINDINGS: Of 5026 HIV-infected patients, 35% were female, median age at HAART initiation was 37 years (interquartile range [IQR], 31-44, and median CD4 count was 105 cells/uL (IQR, 38-200. Estimated probabilities of changing within 3 months and one year of HAART initiation were 16% (95% confidence interval (CI 15-17% and 28% (95% CI 27-29%, respectively. Efavirenz-based regimens and no clinical AIDS at HAART initiation were associated with lower risk of change (hazard ratio (HR = 1.7 (95% CI 1.1-2.6 and 2.1 (95% CI 1.7-2.5 comparing neverapine-based regimens and other regimens to efavirenz, respectively; HR = 1.3 (95% CI 1.1-1.5 for clinical AIDS at HAART initiation. The primary reason for change among HAART initiators were adverse events (14%, death (5.7% and failure (1.3% with specific toxicities varying among sites. After change, most patients remained in first line regimens. CONCLUSIONS: Adverse events were the leading cause for changing initial HAART. Predictors for change due to any reason were AIDS at baseline and the use of a non-efavirenz containing regimen. Differences between participant sites were observed and require
-
Cesar, Carina; Shepherd, Bryan E.; Krolewiecki, Alejandro J.; Fink, Valeria I.; Schechter, Mauro; Tuboi, Suely H.; Wolff, Marcelo; Pape, Jean W.; Leger, Paul; Padgett, Denis; Madero, Juan Sierra; Gotuzzo, Eduardo; Sued, Omar; McGowan, Catherine C.; Masys, Daniel R.; Cahn, Pedro E.
2010-01-01
Background HAART rollout in Latin America and the Caribbean has increased from approximately 210,000 in 2003 to 390,000 patients in 2007, covering 62% (51%–70%) of eligible patients, with considerable variation among countries. No multi-cohort study has examined rates of and reasons for change of initial HAART in this region. Methodology Antiretroviral-naïve patients > = 18 years who started HAART between 1996 and 2007 and had at least one follow-up visit from sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru were included. Time from HAART initiation to change (stopping or switching any antiretrovirals) was estimated using Kaplan-Meier techniques. Cox proportional hazards modeled the associations between change and demographics, initial regimen, baseline CD4 count, and clinical stage. Principal Findings Of 5026 HIV-infected patients, 35% were female, median age at HAART initiation was 37 years (interquartile range [IQR], 31–44), and median CD4 count was 105 cells/uL (IQR, 38–200). Estimated probabilities of changing within 3 months and one year of HAART initiation were 16% (95% confidence interval (CI) 15–17%) and 28% (95% CI 27–29%), respectively. Efavirenz-based regimens and no clinical AIDS at HAART initiation were associated with lower risk of change (hazard ratio (HR) = 1.7 (95% CI 1.1–2.6) and 2.1 (95% CI 1.7–2.5) comparing neverapine-based regimens and other regimens to efavirenz, respectively; HR = 1.3 (95% CI 1.1–1.5) for clinical AIDS at HAART initiation). The primary reason for change among HAART initiators were adverse events (14%), death (5.7%) and failure (1.3%) with specific toxicities varying among sites. After change, most patients remained in first line regimens. Conclusions Adverse events were the leading cause for changing initial HAART. Predictors for change due to any reason were AIDS at baseline and the use of a non-efavirenz containing regimen. Differences between participant sites were observed
-
Drop-out from a drug treatment clinic and associated reasons.
Hoseinie, Leila; Gholami, Zhaleh; Shadloo, Behrang; Mokri, Azarakhsh; Amin-Esmaeili, Masoumeh; Rahimi-Movaghar, Afarin
2017-05-01
The aim of this study was to assess drop-out rates and associated reasons among patients at the Iranian National Center for Addiction Studies (INCAS) clinic. In a one-year period (April 2014 to March 2015), all patients with drug dependence who had been referred for treatment and attended for a first assessment were included in this study (N=242). Those who received treatment were followed until March 2016. Survival analysis showed that 70.2% had dropped out from treatment. Log rank test showed that treatment drop-out rates differed between the different approaches used (P < 0.001), with the lowest slope inbuprenorphine maintenance treatment and the highest in the detoxification programme. Drop-out rates within the first three months was 62% (SE= 0.05) and 82.4% (SE=0.03) for opioids and stimulants dependence, respectively. Analyses were performed using SPSS (Version 21.0) and STATA software, (version 13.0). From the patients' perspective, motivational inconsistencies were considered as the main reason for not starting or leaving treatment. The findings of this study could give service providers a better grasp of drop-out rates and the associated reasons.
-
Furze, Jennifer; Kenyon, Lisa K; Jensen, Gail M
2015-01-01
Clinical reasoning is an essential skill in pediatric physical therapist (PT) practice. As such, explicit instruction in clinical reasoning should be emphasized in PT education. This article provides academic faculty and clinical instructors with an overview of strategies to develop and expand the clinical reasoning capacity of PT students within the scope of pediatric PT practice. Achieving a balance between deductive reasoning strategies that provide a framework for thinking and inductive reasoning strategies that emphasize patient factors and the context of the clinical situation is an important variable in educational pedagogy. Consideration should be given to implementing various teaching and learning approaches across the curriculum that reflect the developmental level of the student(s). Deductive strategies may be helpful early in the curriculum, whereas inductive strategies are often advantageous after patient interactions; however, exposure to both is necessary to fully develop the learner's clinical reasoning abilities. For more insights from the authors, see Supplemental Digital Content 1, available at http://links.lww.com/PPT/A87.
-
Emotional reasoning and parent-based reasoning in normal children.
Morren, M.; Muris, P.; Kindt, M.
2004-01-01
A previous study by Muris, Merckelbach, and Van Spauwen demonstrated that children display emotional reasoning irrepective of their anxiety levels. That is when estimating whether a situation is dangerous, childen not only rely on objective danger information but also on their own anciety-response. The present study further examined emotional reasoning in childeren aged 7-13 years (N=508). In addition, it was investigated whether children also show parent-based reasoning, which can be defined...
-
Analytical model for relativistic corrections to the nuclear magnetic shielding constant in atoms
International Nuclear Information System (INIS)
Romero, Rodolfo H.; Gomez, Sergio S.
2006-01-01
We present a simple analytical model for calculating and rationalizing the main relativistic corrections to the nuclear magnetic shielding constant in atoms. It provides good estimates for those corrections and their trends, in reasonable agreement with accurate four-component calculations and perturbation methods. The origin of the effects in deep core atomic orbitals is manifestly shown
-
Analytical model for relativistic corrections to the nuclear magnetic shielding constant in atoms
Energy Technology Data Exchange (ETDEWEB)
Romero, Rodolfo H. [Facultad de Ciencias Exactas, Universidad Nacional del Nordeste, Avenida Libertad 5500 (3400), Corrientes (Argentina)]. E-mail: rhromero@exa.unne.edu.ar; Gomez, Sergio S. [Facultad de Ciencias Exactas, Universidad Nacional del Nordeste, Avenida Libertad 5500 (3400), Corrientes (Argentina)
2006-04-24
We present a simple analytical model for calculating and rationalizing the main relativistic corrections to the nuclear magnetic shielding constant in atoms. It provides good estimates for those corrections and their trends, in reasonable agreement with accurate four-component calculations and perturbation methods. The origin of the effects in deep core atomic orbitals is manifestly shown.
-
Syrjälä, Anna-Maija H; Niskanen, Mirka C; Knuuttila, Matti L E
2002-05-01
Preventive oral health behaviour is important among diabetic patients, as it has been found that dental diseases and insulin-dependent diabetes mellitus (IDDM) have some psychological and biological factors in common. The aim here was to analyze the variables of Ajzen and Fishbein's theory of reasoned action to explain the reported frequency of tooth brushing, dental caries, HbA1c level and diabetes adherence. Cross-sectional data were gathered from 149 IDDM patients by means of a quantitative questionnaire, clinical examination and patient records. The results showed that a firmer intention to brush the teeth was related to a higher reported frequency of tooth brushing (p < 0.001). The attitude to and the subjective norm of tooth brushing were related to the intention to brush(p < 0.001) and to the reported frequency of tooth brushing. A better dental attitude was related to better diabetes adherence (p = 0.002) and fewer decayed surfaces (p = 0.01), and a firmer intention to brush the teeth was related to a lower HbA1c level (p = 0.015). Our results suggest that in oral health promotion among diabetic patients, both subjective norm and attitude are important and that diabetes adherence may be influenced by promoting dental attitude.
-
Atamari-Anahui, Noé; Martinez-Ninanqui, Franklin W; Paucar-Tito, Liz; Morales-Concha, Luz; Miranda-Chirau, Alejandra; Gamarra-Contreras, Marco Antonio; Zea-Nuñez, Carlos Antonio; Mejia, Christian R
2017-12-05
Diabetes mortality has increased in recent years. In Peru, there are few studies on in-hospital mortality due to type 2 diabetes in the provinces. To determine factors associated to hospital mortality in patients with diabetes mellitus type 2 in three hospitals from Cusco-Peru. An analytical cross-sectional study was performed. All patients with diabetes mellitus type 2 hospitalized in the city of Cusco during the 2016 were included. Socio-educational and clinical characteristics were evaluated, with "death" as the variable of interest. The crude (cPR) and adjusted (aPR) prevalence ratios were estimated using generalized linear models with Poisson family and log link function, with their respective 95% confidence intervals (95% CI). The values p diabetes mellitus type 2 patients died during the study period. Mortality was increased as age rises, patients admitted through emergency rooms, patients who were readmitted to the hospital, and patients who had metabolic or renal complications. Patients admitted for a urinary tract infection had a lower mortality rate.
-
SU-E-T-120: Analytic Dose Verification for Patient-Specific Proton Pencil Beam Scanning Plans
International Nuclear Information System (INIS)
Chang, C; Mah, D
2015-01-01
Purpose: To independently verify the QA dose of proton pencil beam scanning (PBS) plans using an analytic dose calculation model. Methods: An independent proton dose calculation engine is created using the same commissioning measurements as those employed to build our commercially available treatment planning system (TPS). Each proton PBS plan is exported from the TPS in DICOM format and calculated by this independent dose engine in a standard 40 x 40 x 40 cm water tank. This three-dimensional dose grid is then compared with the QA dose calculated by the commercial TPS, using standard Gamma criterion. A total of 18 measured pristine Bragg peaks, ranging from 100 to 226 MeV, are used in the model. Intermediate proton energies are interpolated. Similarly, optical properties of the spots are measured in air over 15 cm upstream and downstream, and fitted to a second-order polynomial. Multiple Coulomb scattering in water is approximated analytically using Preston and Kohler formula for faster calculation. The effect of range shifters on spot size is modeled with generalized Highland formula. Note that the above formulation approximates multiple Coulomb scattering in water and we therefore chose not use the full Moliere/Hanson form. Results: Initial examination of 3 patient-specific prostate PBS plans shows that agreement exists between 3D dose distributions calculated by the TPS and the independent proton PBS dose calculation engine. Both calculated dose distributions are compared with actual measurements at three different depths per beam and good agreements are again observed. Conclusion: Results here showed that 3D dose distributions calculated by this independent proton PBS dose engine are in good agreement with both TPS calculations and actual measurements. This tool can potentially be used to reduce the amount of different measurement depths required for patient-specific proton PBS QA
-
Monte Carlo and analytic simulations in nanoparticle-enhanced radiation therapy
Directory of Open Access Journals (Sweden)
Paro AD
2016-09-01
Full Text Available Autumn D Paro,1 Mainul Hossain,2 Thomas J Webster,1,3,4 Ming Su1,4 1Department of Chemical Engineering, Northeastern University, Boston, MA, USA; 2NanoScience Technology Center and School of Electrical Engineering and Computer Science, University of Central Florida, Orlando, Florida, USA; 3Excellence for Advanced Materials Research, King Abdulaziz University, Jeddah, Saudi Arabia; 4Wenzhou Institute of Biomaterials and Engineering, Chinese Academy of Science, Wenzhou Medical University, Zhejiang, People’s Republic of China Abstract: Analytical and Monte Carlo simulations have been used to predict dose enhancement factors in nanoparticle-enhanced X-ray radiation therapy. Both simulations predict an increase in dose enhancement in the presence of nanoparticles, but the two methods predict different levels of enhancement over the studied energy, nanoparticle materials, and concentration regime for several reasons. The Monte Carlo simulation calculates energy deposited by electrons and photons, while the analytical one only calculates energy deposited by source photons and photoelectrons; the Monte Carlo simulation accounts for electron–hole recombination, while the analytical one does not; and the Monte Carlo simulation randomly samples photon or electron path and accounts for particle interactions, while the analytical simulation assumes a linear trajectory. This study demonstrates that the Monte Carlo simulation will be a better choice to evaluate dose enhancement with nanoparticles in radiation therapy. Keywords: nanoparticle, dose enhancement, Monte Carlo simulation, analytical simulation, radiation therapy, tumor cell, X-ray
-
Moving from Within The Maternal: The Choreography of Analytic Eroticism.
Elise, Dianne
2017-02-01
With Kristeva's concept of maternal eroticism (2014) as starting point, the "multiverse" of mother/child erotic sensibilities-the dance of the semiotic chora-is explored and a parallel engagement proposed within the analytic dyad. The dance of psychoanalysis is not the creative product of the patient's mind alone. Clinical work invites, requires, a choreographic engagement by the clinician in interplay with the patient. The clinician's analytic activity is thus akin to choreography: the structuring of a dance, or of a session, expresses an inner impulse brought into narrative form. The embodied art of dance parallels the clinician's creative vitality in contributing to the shaping of the movement of a session. Through formulation of an analytic eroticism, the terrain of what traditionally has been viewed as erotic transference and countertransference can be expanded to clinical benefit.
-
Otero, M.E.; Reek, J.M.P.A. van den; Seyger, M.M.B.; Kerkhof, P.C.M. van de; Kievit, W.; Jong, E.M.G.J. de
2017-01-01
BACKGROUND: As methotrexate (MTX) is a widely used treatment for psoriasis, it is important to gain insight into the reasons for the discontinuation of MTX and to understand the determinants for drug survival. OBJECTIVES: To describe 5-year drug survival for MTX in patients with psoriasis, split
-
Hyltoft Petersen, Per; Lund, Flemming; Fraser, Callum G; Sandberg, Sverre; Sölétormos, György
2018-01-01
Background Many clinical decisions are based on comparison of patient results with reference intervals. Therefore, an estimation of the analytical performance specifications for the quality that would be required to allow sharing common reference intervals is needed. The International Federation of Clinical Chemistry (IFCC) recommended a minimum of 120 reference individuals to establish reference intervals. This number implies a certain level of quality, which could then be used for defining analytical performance specifications as the maximum combination of analytical bias and imprecision required for sharing common reference intervals, the aim of this investigation. Methods Two methods were investigated for defining the maximum combination of analytical bias and imprecision that would give the same quality of common reference intervals as the IFCC recommendation. Method 1 is based on a formula for the combination of analytical bias and imprecision and Method 2 is based on the Microsoft Excel formula NORMINV including the fractional probability of reference individuals outside each limit and the Gaussian variables of mean and standard deviation. The combinations of normalized bias and imprecision are illustrated for both methods. The formulae are identical for Gaussian and log-Gaussian distributions. Results Method 2 gives the correct results with a constant percentage of 4.4% for all combinations of bias and imprecision. Conclusion The Microsoft Excel formula NORMINV is useful for the estimation of analytical performance specifications for both Gaussian and log-Gaussian distributions of reference intervals.
-
A SIMPLE ANALYTICAL METHOD TO DETERMINE SOLAR ENERGETIC PARTICLES' MEAN FREE PATH
International Nuclear Information System (INIS)
He, H.-Q.; Qin, G.
2011-01-01
To obtain the mean free path of solar energetic particles (SEPs) for a solar event, one usually has to fit time profiles of both flux and anisotropy from spacecraft observations to numerical simulations of SEPs' transport processes. This method can be called a simulation method. But a reasonably good fitting needs a lot of simulations, which demand a large amount of calculation resources. Sometimes, it is necessary to find an easy way to obtain the mean free path of SEPs quickly, for example, in space weather practice. Recently, Shalchi et al. provided an approximate analytical formula of SEPs' anisotropy time profile as a function of particles' mean free path for impulsive events. In this paper, we determine SEPs' mean free path by fitting the anisotropy time profiles from Shalchi et al.'s analytical formula to spacecraft observations. This new method can be called an analytical method. In addition, we obtain SEPs' mean free path with the traditional simulation methods. Finally, we compare the mean free path obtained with the simulation method to that of the analytical method to show that the analytical method, with some minor modifications, can give us a good, quick approximation of SEPs' mean free path for impulsive events.
-
DEFF Research Database (Denmark)
Kveladze, Irma; Kraak, Menno-Jan; van Elzakker, C. P. J. M.
2017-01-01
for pattern recognition, decision-making or analytical reasoning. However, the question is whether those visual representations are suitable for visualization of different types of data to perform similar tasks. The limited usability studies that have been done on interactive analytical environments have...... failed to yield a definite answer. Therefore, this paper presents an evaluation experiment on how an interactive GVA environment can be designed that will effectively support similar task execution processes for different use cases. In the GVA environment investigated, four graphic representations...
-
Sherwood, James L.; Corcoran, Claire; Brown, Helen; Sharpe, Alan D.; Musilova, Milena; Kohlmann, Alexander
2016-01-01
Introduction Non-invasive mutation testing using circulating tumour DNA (ctDNA) is an attractive premise. This could enable patients without available tumour sample to access more treatment options. Materials & Methods Peripheral blood and matched tumours were analysed from 45 NSCLC patients. We investigated the impact of pre-analytical variables on DNA yield and/or KRAS mutation detection: sample collection tube type, incubation time, centrifugation steps, plasma input volume and DNA extraction kits. Results 2 hr incubation time and double plasma centrifugation (2000 x g) reduced overall DNA yield resulting in lowered levels of contaminating genomic DNA (gDNA). Reduced “contamination” and increased KRAS mutation detection was observed using cell-free DNA Blood Collection Tubes (cfDNA BCT) (Streck), after 72 hrs following blood draw compared to EDTA tubes. Plasma input volume and use of different DNA extraction kits impacted DNA yield. Conclusion This study demonstrated that successful ctDNA recovery for mutation detection in NSCLC is dependent on pre-analytical steps. Development of standardised methods for the detection of KRAS mutations from ctDNA specimens is recommended to minimise the impact of pre-analytical steps on mutation detection rates. Where rapid sample processing is not possible the use of cfDNA BCT tubes would be advantageous. PMID:26918901
-
Directory of Open Access Journals (Sweden)
James L Sherwood
Full Text Available Non-invasive mutation testing using circulating tumour DNA (ctDNA is an attractive premise. This could enable patients without available tumour sample to access more treatment options.Peripheral blood and matched tumours were analysed from 45 NSCLC patients. We investigated the impact of pre-analytical variables on DNA yield and/or KRAS mutation detection: sample collection tube type, incubation time, centrifugation steps, plasma input volume and DNA extraction kits.2 hr incubation time and double plasma centrifugation (2000 x g reduced overall DNA yield resulting in lowered levels of contaminating genomic DNA (gDNA. Reduced "contamination" and increased KRAS mutation detection was observed using cell-free DNA Blood Collection Tubes (cfDNA BCT (Streck, after 72 hrs following blood draw compared to EDTA tubes. Plasma input volume and use of different DNA extraction kits impacted DNA yield.This study demonstrated that successful ctDNA recovery for mutation detection in NSCLC is dependent on pre-analytical steps. Development of standardised methods for the detection of KRAS mutations from ctDNA specimens is recommended to minimise the impact of pre-analytical steps on mutation detection rates. Where rapid sample processing is not possible the use of cfDNA BCT tubes would be advantageous.
-
CSIR Research Space (South Africa)
Britz, K
2010-05-01
Full Text Available In this paper the authors venture beyond one of the fundamental assumptions in the non-monotonic reasoning community, namely that non-monotonic entailment is supra-classical. They investigate reasoning which uses an infra-classical entailment...
-
Meta-Reasoning: Monitoring and Control of Thinking and Reasoning.
Ackerman, Rakefet; Thompson, Valerie A
2017-08-01
Meta-Reasoning refers to the processes that monitor the progress of our reasoning and problem-solving activities and regulate the time and effort devoted to them. Monitoring processes are usually experienced as feelings of certainty or uncertainty about how well a process has, or will, unfold. These feelings are based on heuristic cues, which are not necessarily reliable. Nevertheless, we rely on these feelings of (un)certainty to regulate our mental effort. Most metacognitive research has focused on memorization and knowledge retrieval, with little attention paid to more complex processes, such as reasoning and problem solving. In that context, we recently developed a Meta-Reasoning framework, used here to review existing findings, consider their consequences, and frame questions for future research. Copyright © 2017 Elsevier Ltd. All rights reserved.
-
Tsujii, Takeo; Watanabe, Shigeru
2009-09-01
Recent dual-process reasoning theories have explained the belief-bias effect, the tendency for human reasoning to be erroneously biased when logical conclusions are incongruent with beliefs about the world, by proposing a belief-based automatic heuristic system and logic-based demanding analytic system. Although these claims are supported by the behavioral finding that high-load secondary tasks enhance the belief-bias effect, the neural correlates of dual-task reasoning remain unknown. The present study therefore examined the relationship between dual-task effect and activity in the inferior frontal cortex (IFC) during belief-bias reasoning by near-infrared spectroscopy (NIRS). Forty-eight subjects participated in this study (MA=23.46 years). They were required to perform congruent and incongruent reasoning trials while responding to high- and low-load secondary tasks. Behavioral analysis showed that the high-load secondary task impaired only incongruent reasoning performance. NIRS analysis found that the high-load secondary task decreased right IFC activity during incongruent trials. Correlation analysis showed that subjects with enhanced right IFC activity could perform better in the incongruent reasoning trials, though subjects for whom right IFC activity was impaired by the secondary task could not maintain better reasoning performance. These findings suggest that the right IFC may be responsible for the dual-task effect in conflicting reasoning processes. When secondary tasks impair right IFC activity, subjects may rely on the automatic heuristic system, which results in belief-bias responses. We therefore offer the first demonstration of neural correlates of dual-task effect on IFC activity in belief-bias reasoning.
-
DEFF Research Database (Denmark)
Tønder, Lars
2014-01-01
. The article develops this argument via a sensorial orientation to politics that not only re-frames existing critiques of neo-Kantianism but also includes an alternative, renaturalized conception of public reason, one that allows us to overcome the disconnect between the account we give of reason and the way......This article takes up recent discussions of nature and the sensorium in order to rethink public reason in deeply divided societies. The aim is not to reject the role of reason-giving but rather to infuse it with new meaning, bringing the reasonable back to its sensorially inflected circumstances...... it is mobilized in a world of deep pluralism. The article concludes with a discussion of how a renaturalized conception of public reason might change the positioning of contemporary democratic theory vis-a-vis the struggle for empowerment and pluralization in an age of neo-liberalism and state-surveillance....
-
Defeasibility in Legal Reasoning
SARTOR, Giovanni
2009-01-01
I shall first introduce the idea of reasoning, and of defeasible reasoning in particular. I shall then argue that cognitive agents need to engage in defeasible reasoning for coping with a complex and changing environment. Consequently, defeasibility is needed in practical reasoning, and in particular in legal reasoning
-
EPA’s Web Analytics Program collects, analyzes, and provides reports on traffic, quality assurance, and customer satisfaction metrics for EPA’s website. The program uses a variety of analytics tools, including Google Analytics and CrazyEgg.
-
Balsa, Alejandro; Sanmarti, Raimon; Rosas, José; Martin, Victor; Cabez, Ana; Gómez, Susana; Montoro, María
2018-04-01
The aims were to evaluate the prevalence of anti-drug antibodies (ADA) in patients with RA or SpA experiencing secondary failure to anti-TNF therapy and to correlate ADA presence with anti-TNF concentration and clinical response. This was a cross-sectional, observational study of patients with active RA or SpA experiencing secondary failure to etanercept (ETN), infliximab (INF) or adalimumab (ADL). Concomitant non-biologic DMARDs were permitted. Serum anti-TNF and ADA levels were measured with two-site ELISA. Among 570 evaluable patients, those with RA (n = 276) were mostly female (80 vs 39%), older (56 vs 48 years), received concomitant DMARDs (83 vs 47%) and had maintained good clinical disease control for longer (202 vs 170 weeks) compared with patients with SpA (n = 294). ADA were found in 114/570 (20.0%) patients; 51/188 (27.1%) against INF and 63/217 (29.0%) against ADL; none against ETN. Of these 114 patients, 92 (81%) had no detectable serum drug concentrations. Proportionately more patients with SpA (31.3%) had anti-INF antibodies than those with RA (21.1%; P = 0.014). A significantly lower proportion of patients receiving concomitant DMARDs (16.5%) developed ADA than those on monotherapy (26.4%; P reasons for secondary treatment failure, but not the only one. Further investigations are needed to determine other causes of anti-TNF failure.
-
Reasons for cannabis use among youths at ultra high risk for psychosis.
Gill, Kelly E; Poe, Lucy; Azimov, Neyra; Ben-David, Shelly; Vadhan, Nehal P; Girgis, Ragy; Moore, Holly; Cressman, Victoria; Corcoran, Cheryl M
2015-06-01
Cannabis use is prevalent in schizophrenia and its risk states, despite its association with anxiety and positive symptoms. While schizophrenia patients report using cannabis for mood enhancement and social motives, it is not known what motivates clinical high risk (CHR) patients to use cannabis. Among 102 CHR patients, 24 (23%) endorsed cannabis use, and were queried as to reasons for use, using a scale previously administered in schizophrenia patients. We hypothesized a primary motivation for mood enhancement related to anhedonia. We evaluated the 'self-medication' hypothesis by examining if motivation for symptom relief was associated with concurrent severity of symptoms. The rank order of reasons for use in CHR patients was similar to that previously reported by schizophrenia patients, with mood enhancement and social motives as primary reasons for use, and the motivation to use cannabis for symptom relief comparatively less common. Motivation for mood enhancement had a trend association with anhedonia. Motivation for symptom relief was entirely unrelated to concurrent severity of positive and anxiety symptoms. As in schizophrenia, CHR patients primarily use cannabis for mood enhancement, especially in the context of decreased motivation to seek pleasure otherwise. Negative symptoms may drive cannabis use in schizophrenia and its risk states, which may exacerbate positive symptoms. By contrast, CHR patients do not report using cannabis to 'self-medicate' emergent positive symptoms. The understanding of motives for cannabis use among CHR patients may be informative for treatments aimed at reducing use, such as motivational interviewing. © 2013 Wiley Publishing Asia Pty Ltd.
-
ter Hoeven, C.L.; Zandbelt, L.C.; Fransen, S.; de Haes, H.; Oort, F.; Geijsen, D.; Koning, C.; Smets, E.
2011-01-01
Objectives: This paper describes the further development and psychometric properties of an instrument to measure cancer patients' reasons to want complete or limited information: the Considerations Concerning Cancer Information questionnaire (CCCI). Understanding cancer patients' reasons to want
-
Evaluation of analytical errors in a clinical chemistry laboratory: a 3 year experience.
Sakyi, As; Laing, Ef; Ephraim, Rk; Asibey, Of; Sadique, Ok
2015-01-01
Proficient laboratory service is the cornerstone of modern healthcare systems and has an impact on over 70% of medical decisions on admission, discharge, and medications. In recent years, there is an increasing awareness of the importance of errors in laboratory practice and their possible negative impact on patient outcomes. We retrospectively analyzed data spanning a period of 3 years on analytical errors observed in our laboratory. The data covered errors over the whole testing cycle including pre-, intra-, and post-analytical phases and discussed strategies pertinent to our settings to minimize their occurrence. We described the occurrence of pre-analytical, analytical and post-analytical errors observed at the Komfo Anokye Teaching Hospital clinical biochemistry laboratory during a 3-year period from January, 2010 to December, 2012. Data were analyzed with Graph Pad Prism 5(GraphPad Software Inc. CA USA). A total of 589,510 tests was performed on 188,503 outpatients and hospitalized patients. The overall error rate for the 3 years was 4.7% (27,520/58,950). Pre-analytical, analytical and post-analytical errors contributed 3.7% (2210/58,950), 0.1% (108/58,950), and 0.9% (512/58,950), respectively. The number of tests reduced significantly over the 3-year period, but this did not correspond with a reduction in the overall error rate (P = 0.90) along with the years. Analytical errors are embedded within our total process setup especially pre-analytical and post-analytical phases. Strategic measures including quality assessment programs for staff involved in pre-analytical processes should be intensified.
-
The growing need for analytical quality control
International Nuclear Information System (INIS)
Suschny, O.; Richman, D.M.
1974-01-01
Technological development in a country is directly dependent upon its analytical chemistry or measurement capability, because it is impossible to achieve any level of technological sophistication without the ability to measure. Measurement capability is needed to determine both technological competence and technological consequence. But measurement itself is insufficient. There must be a standard or a reference for comparison. In the complicated world of chemistry the need for reference materials grows with successful technological development. The International Atomic Energy Agency has been distributing calibrated radioisotope solutions, standard reference materials and intercomparison materials since the early 1960's. The purpose of this activity has been to help laboratories in its Member States to assess and, if necessary, to improve the reliability of their analytical work. The value and continued need of this service has been demonstrated by the results of many intercomparisons which proved that without continuing analytical quality control activities, adequate reliability of analytical data could not be taken for granted. Analytical chemistry, lacking the glamour of other aspects of the physical sciences, has not attracted the attention it deserves, but in terms of practical importance, it warrants high priority in any developing technological scheme, because without it there is little chance to evaluate technological success or failure or opportunity to identify the reasons for success or failure. The scope and the size of the future programme of the IAEA in this field has been delineated by recommendations made by several Panels of Experts; all have agreed on the importance of this programme and made detailed recommendations in their areas of expertise. The Agency's resources are limited and it cannot on its own undertake the preparation and distribution of all the materials needed. It can, however, offer a focal point to bring together different
-
The emotional reasoning heuristic in children.
Muris, P; Merckelbach, H; van Spauwen, I
2003-03-01
A previous study by Arntz, Rauner, and Van den Hout (1995; Behaviour Research and Therapy, 33, 917-925) has shown that adult anxiety patients tend to infer danger not only on the basis of objective danger information, but also on the basis of anxiety response information. The current study examined whether this so-called emotional reasoning phenomenon also occurs in children. Normal primary school children (N = 101) first completed scales tapping anxiety disorders symptoms, anxiety sensitivity, and trait anxiety. Next, they were asked to rate danger levels of scripts in which objective danger versus objective safety and anxiety response versus no anxiety response were systematically varied. Evidence was found for a general emotional reasoning effect. That is, children's danger ratings were not only a function of objective danger information, but also, in the case of objective safety scripts, by anxiety response information. This emotional reasoning effect was predicted by levels of anxiety sensitivity and trait anxiety. More specifically, high levels of anxiety sensitivity and trait anxiety were accompanied by a greater tendency to use anxiety-response information as an heuristic for assessing dangerousness of safety scripts. Implications of these findings are briefly discussed.
-
International Nuclear Information System (INIS)
Dhole, K.; Ghosh, S.; Datta, A.; Tripathy, M.K.; Bose, H.; Roy, M.; Tyagi, A.K.
2011-01-01
The method of refractometry has been investigated for the quantitative estimation of isotopic concentration of D 2 O (heavy water) in a simulated water sample. Viability of Refractometry as an excellent analytical technique for rapid and non-invasive determination of D 2 O concentration in water samples has been demonstrated. Temperature of the samples was precisely controlled to eliminate effect of temperature fluctuation on refractive index measurement. Calibration performance by this technique exhibited reasonable analytical response over a wide range (1-100%) of D 2 O concentration. (author)
-
Analytic solution for one-dimensional diffusion of radionuclides from a waste package
International Nuclear Information System (INIS)
Oliver, D.L.
1985-01-01
This work implements an analytical solution for diffusion of radionuclides from a cylindrical waste form through the packing material into the surrounding host rock. Recent interest in predicting the performance of a proposed geological repository for nuclear waste has led to the development of several computer programs to predict the performance of such a repository for the next several millenia. These numerical codes are generally designed to accommodate a broad spectrum of geometrical configurations and repository conditions in order to accurately predict the behavior of the radionuclides in the repository environment. Confidence in such general purpose codes is gained by verifying the numerical modeling and the software through comparison of the numerical predictions generated by these computer codes with analytical solutions to reasonably complex problems. The analysis discussed herein implements the analytic solution, proposed by J.C. Jaeger in 1941 for radial diffusion through two concentric circular cylinders. Jaeger's solution was applied to the problem of diffusional mass transfer from a long cylindrical waste form and subsequently into the surrounding geological formation. Analytic predictions of fractional release rates, including the effects of sorption, were generated
-
Charity, Melanie J; Britt, Helena C; Walker, Bruce F; Gunn, Jane M; Forsdike-Young, Kirsty; Polus, Barbara I; French, Simon D
2016-01-01
COAST (Chiropractic Observational and Analysis STudy) reported the clinical practices of chiropractors. The aims of this study were to: 1) describe the chiropractic patient demographic and health characteristics; 2) describe patient-stated reasons for visiting a chiropractor; 3) describe chiropractic patient lifestyle characteristics; 4) compare, where possible, chiropractic patient characteristics to the general Australian population. Fifty-two chiropractors in Victoria, Australia, provided information for up to 100 consecutive encounters. If patients attended more than once during the 100 encounters, only data from their first encounter were included in this study. Where possible patient characteristics were compared with the general Australian population. Data were collected from December 2010 to September 2012. Data were provided for 4464 encounters, representing 3287 unique individuals. The majority of chiropractic encounters were for musculoskeletal conditions or for wellness/maintenance. The majority of patient comorbidities were musculoskeletal, circulatory or endocrine/metabolic in nature. Eight hundred chiropractic patients (57 %, 95 % CI: 53-61) described their self-reported health as excellent or very good and 138 patients (10 %, 95 % CI: 8-12) as fair or poor. Seventy-one percent of adult male patients (18 years and older), and 53 % of adult female patients, were overweight or obese. Fourteen percent (n = 188, 95 % CI: 12-16) were current smokers and 27 % (n = 359, 95 % CI: 24-31) did not meet Australian alcohol consumption guidelines. Less than half of the chiropractic patients participated in vigorous exercise at least twice per week. Approximately 20 % ate one serving of vegetables or less each day, and approximately 50 % ate one serve of fruit or less each day. Compared to the general Australian population, chiropractic patients were less likely to smoke, less likely to be obese and more likely to describe their health in positive terms
-
[Schizophrenia and modern culture: reasons for insanity].
Pérez-Álvarez, Marino
2012-02-01
After pointing out the uncertainty and confusion to which neurobiological research has led schizophrenia, as shown and acknowledged in recent reviews, we offer seven reasons for reconsidering schizophrenia a disorder of the self, rather than of the brain. The first reason starts out conceiving schizophrenia as a disorder of the self, in the perspective of current phenomenology. The second relates the fact of its recent origin (as of 1750) with the particular configuration of the modern self and with the great transformation of the community into a society of individuals (industrialization, urbanization). The third reason emphasizes the affinity between schizophrenia and adolescence, a critical age in the formation of the self, which started to be problematic at the end of the 18th century. The fourth is the better prognosis of schizophrenia in developing countries, in comparison to developed countries, which probably has to do with the process of modernization (which still maintains community structures in less developed countries). The fifth is the high incidence of schizophrenia among immigrants, as a fact to be explained in terms of a socio-evolutionary model. The sixth reason reviews the genetic legend of schizophrenia, and how epigenetics gives protagonism back to the environment. The seventh and last reason refers to the reconsideration of psychological therapy as the possible treatment of choice and not merely an adjunct to medication, as it is known that, for patients, interpersonal chemistry is more important than neurochemistry.
-
Annual banned-substance review: analytical approaches in human sports drug testing.
Thevis, Mario; Kuuranne, Tiia; Walpurgis, Katja; Geyer, Hans; Schänzer, Wilhelm
2016-01-01
The aim of improving anti-doping efforts is predicated on several different pillars, including, amongst others, optimized analytical methods. These commonly result from exploiting most recent developments in analytical instrumentation as well as research data on elite athletes' physiology in general, and pharmacology, metabolism, elimination, and downstream effects of prohibited substances and methods of doping, in particular. The need for frequent and adequate adaptations of sports drug testing procedures has been incessant, largely due to the uninterrupted emergence of new chemical entities but also due to the apparent use of established or even obsolete drugs for reasons other than therapeutic means, such as assumed beneficial effects on endurance, strength, and regeneration capacities. Continuing the series of annual banned-substance reviews, literature concerning human sports drug testing published between October 2014 and September 2015 is summarized and reviewed in reference to the content of the 2015 Prohibited List as issued by the World Anti-Doping Agency (WADA), with particular emphasis on analytical approaches and their contribution to enhanced doping controls. Copyright © 2016 John Wiley & Sons, Ltd.
-
Kanoglu, U.; Wronna, M.; Baptista, M. A.; Miranda, J. M. A.
2017-12-01
The one-dimensional analytical runup theory in combination with near shore synthetic waveforms is a promising tool for tsunami rapid early warning systems. Its application in realistic cases with complex bathymetry and initial wave condition from inverse modelling have shown that maximum runup values can be estimated reasonably well. In this study we generate a simplistic bathymetry domains which resemble realistic near-shore features. We investigate the accuracy of the analytical runup formulae to the variation of fault source parameters and near-shore bathymetric features. To do this we systematically vary the fault plane parameters to compute the initial tsunami wave condition. Subsequently, we use the initial conditions to run the numerical tsunami model using coupled system of four nested grids and compare the results to the analytical estimates. Variation of the dip angle of the fault plane showed that analytical estimates have less than 10% difference for angles 5-45 degrees in a simple bathymetric domain. These results shows that the use of analytical formulae for fast run up estimates constitutes a very promising approach in a simple bathymetric domain and might be implemented in Hazard Mapping and Early Warning.
-
The Navier-Stokes equations an elementary functional analytic approach
Sohr, Hermann
2001-01-01
The primary objective of this monograph is to develop an elementary and self contained approach to the mathematical theory of a viscous incompressible fluid in a domain 0 of the Euclidean space ]Rn, described by the equations of Navier Stokes. The book is mainly directed to students familiar with basic functional analytic tools in Hilbert and Banach spaces. However, for readers' convenience, in the first two chapters we collect without proof some fundamental properties of Sobolev spaces, distributions, operators, etc. Another important objective is to formulate the theory for a completely general domain O. In particular, the theory applies to arbitrary unbounded, non-smooth domains. For this reason, in the nonlinear case, we have to restrict ourselves to space dimensions n = 2,3 that are also most significant from the physical point of view. For mathematical generality, we will develop the lin earized theory for all n 2 2. Although the functional-analytic approach developed here is, in principle, known ...
-
Stereotypical Reasoning: Logical Properties
Lehmann, Daniel
2002-01-01
Stereotypical reasoning assumes that the situation at hand is one of a kind and that it enjoys the properties generally associated with that kind of situation. It is one of the most basic forms of nonmonotonic reasoning. A formal model for stereotypical reasoning is proposed and the logical properties of this form of reasoning are studied. Stereotypical reasoning is shown to be cumulative under weak assumptions.
-
Directory of Open Access Journals (Sweden)
Robert Haworth
2010-01-01
Full Text Available The popularity and usage of digital games has increased in recent years, bringing further attention to their design. Some digital games require a significant use of higher order thought processes, such as problem solving and reflective and analytical thinking. Through the use of appropriate and interactive representations, these thought processes could be supported. A visualization of the game's internal structure is an example of this. However, it is unknown whether including these extra representations will have a negative effect on gameplay. To investigate this issue, a digital maze-like game was designed with its underlying structure represented as a decision tree. A qualitative, exploratory study with children was performed to examine whether the tree supported their thought processes and what effects, if any, the tree had on gameplay. This paper reports the findings of this research and discusses the implications for the design of games in general.
-
The Process of Clinical Reasoning among Medical Students
Directory of Open Access Journals (Sweden)
Djon Machado Lopes
Full Text Available ABSTRACT Introduction: Research in the field of medical reasoning has shed light on the reasoning process used by medical students. The strategies in this process are related to the analytical [hypothetical-deductive (HD] and nonanalytic [scheme-inductive (SI] systems, and pattern recognition (PR]. Objective: To explore the clinical reasoning process of students from the fifth year of medical school at the end of the clinical cycle of medical internship, and to identify the strategies used in preparing diagnostic hypotheses, knowledge organization and content. Method: Qualitative research conducted in 2014 at a Brazilian public university with medical interns. Following Stamm's method, a case in internal medicine (IM was built based on the theory of prototypes (Group 1 = 47 interns, in which the interns listed, according to their own perceptions, the signs, symptoms, syndromes, and diseases typical of internal medicine. This case was used for evaluating the clinical reasoning process of Group 2 (30 students = simple random sample obtained with the "think aloud" process. The verbalizations were transcribed and evaluated by Bardin's thematic analysis. The content analysis were approved by two experts at the beginning and at the end of the analysis process. Results: The interns developed 164 primary and secondary hypotheses when solving the case. The SI strategy prevailed with 48.8%, followed by PR (35.4%, HD (12.2%, and mixed (1.8 % each: SI + HD and HD + PR. The students built 146 distinct semantic axes, resulting in an average of 4.8/ participant. During the analysis, 438 interpretation processes were executed (average of 14.6/participant, and 124 combination processes (average of 4.1/participant. Conclusions: The nonanalytic strategies prevailed with the PR being the most used in the development of primary hypotheses (46.8% and the SI in secondary hypotheses (93%. The interns showed a strong semantic network and did three and a half times more
-
An analytical solution for improved HIFU SAR estimation
International Nuclear Information System (INIS)
Dillon, C R; Vyas, U; Christensen, D A; Roemer, R B; Payne, A
2012-01-01
Accurate determination of the specific absorption rates (SARs) present during high intensity focused ultrasound (HIFU) experiments and treatments provides a solid physical basis for scientific comparison of results among HIFU studies and is necessary to validate and improve SAR predictive software, which will improve patient treatment planning, control and evaluation. This study develops and tests an analytical solution that significantly improves the accuracy of SAR values obtained from HIFU temperature data. SAR estimates are obtained by fitting the analytical temperature solution for a one-dimensional radial Gaussian heating pattern to the temperature versus time data following a step in applied power and evaluating the initial slope of the analytical solution. The analytical method is evaluated in multiple parametric simulations for which it consistently (except at high perfusions) yields maximum errors of less than 10% at the center of the focal zone compared with errors up to 90% and 55% for the commonly used linear method and an exponential method, respectively. For high perfusion, an extension of the analytical method estimates SAR with less than 10% error. The analytical method is validated experimentally by showing that the temperature elevations predicted using the analytical method's SAR values determined for the entire 3D focal region agree well with the experimental temperature elevations in a HIFU-heated tissue-mimicking phantom. (paper)
-
Urbanski, Marika; Bréchemier, Marie-Laure; Garcin, Béatrice; Bendetowicz, David; Thiebaut de Schotten, Michel; Foulon, Chris; Rosso, Charlotte; Clarençon, Frédéric; Dupont, Sophie; Pradat-Diehl, Pascale; Labeyrie, Marc-Antoine; Levy, Richard; Volle, Emmanuelle
2016-06-01
SEE BURGESS DOI101093/BRAIN/AWW092 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE : Analogical reasoning is at the core of the generalization and abstraction processes that enable concept formation and creativity. The impact of neurological diseases on analogical reasoning is poorly known, despite its importance in everyday life and in society. Neuroimaging studies of healthy subjects and the few studies that have been performed on patients have highlighted the importance of the prefrontal cortex in analogical reasoning. However, the critical cerebral bases for analogical reasoning deficits remain elusive. In the current study, we examined analogical reasoning abilities in 27 patients with focal damage in the frontal lobes and performed voxel-based lesion-behaviour mapping and tractography analyses to investigate the structures critical for analogical reasoning. The findings revealed that damage to the left rostrolateral prefrontal region (or some of its long-range connections) specifically impaired the ability to reason by analogies. A short version of the analogy task predicted the existence of a left rostrolateral prefrontal lesion with good accuracy. Experimental manipulations of the analogy tasks suggested that this region plays a role in relational matching or integration. The current lesion approach demonstrated that the left rostrolateral prefrontal region is a critical node in the analogy network. Our results also suggested that analogy tasks should be translated to clinical practice to refine the neuropsychological assessment of patients with frontal lobe lesions. © The Author (2016). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
-
Provenancing Flower Bulbs by Analytical Fingerprinting: Convallaria Majalis
Directory of Open Access Journals (Sweden)
Saskia M. van Ruth
2015-01-01
Full Text Available The origin of agricultural products is gaining in appreciation while often hard to determine for various reasons. Geographical origin may be resolved using a combination of chemical and physical analytical technologies. In the present case of Lily of the Valley (Convallaria majalis rhizomes, we investigated an exploratory set of material from The Netherlands, three other European (EU countries and China. We show that the geographical origin is correlated to patterns of stable isotope ratios (isotope fingerprints and volatile organic carbon (VOC compounds (chemical fingerprints. These fingerprints allowed clear distinction using exploratory and supervised statistics. Isotope ratio mass spectrometry of 12C/13C, 14N/15N and 16O/18O isotopes separated materials from Europe and China successfully. The VOC patterns measured by Proton Transfer Reaction Mass Spectrometry (PTR-MS allowed distinction of three groups: material from The Netherlands, the other EU countries and China. This knowledge is expected to help developing a systematic and efficient analytical tool for authenticating the origin of flower bulbs.
-
Analysis of students’ mathematical reasoning
Sukirwan; Darhim; Herman, T.
2018-01-01
The reasoning is one of the mathematical abilities that have very complex implications. This complexity causes reasoning including abilities that are not easily attainable by students. Similarly, studies dealing with reason are quite diverse, primarily concerned with the quality of mathematical reasoning. The objective of this study was to determine the quality of mathematical reasoning based perspective Lithner. Lithner looked at how the environment affects the mathematical reasoning. In this regard, Lithner made two perspectives, namely imitative reasoning and creative reasoning. Imitative reasoning can be memorized and algorithmic reasoning. The Result study shows that although the students generally still have problems in reasoning. Students tend to be on imitative reasoning which means that students tend to use a routine procedure when dealing with reasoning. It is also shown that the traditional approach still dominates on the situation of students’ daily learning.
-
service line analytics in the new era.
Spence, Jay; Seargeant, Dan
2015-08-01
To succeed under the value-based business model, hospitals and health systems require effective service line analytics that combine inpatient and outpatient data and that incorporate quality metrics for evaluating clinical operations. When developing a framework for collection, analysis, and dissemination of service line data, healthcare organizations should focus on five key aspects of effective service line analytics: Updated service line definitions. Ability to analyze and trend service line net patient revenues by payment source. Access to accurate service line cost information across multiple dimensions with drill-through capabilities. Ability to redesign key reports based on changing requirements. Clear assignment of accountability.
-
Seshia, Shashi S; Bryan Young, G; Makhinson, Michael; Smith, Preston A; Stobart, Kent; Croskerry, Pat
2018-02-01
Although patient safety has improved steadily, harm remains a substantial global challenge. Additionally, safety needs to be ensured not only in hospitals but also across the continuum of care. Better understanding of the complex cognitive factors influencing health care-related decisions and organizational cultures could lead to more rational approaches, and thereby to further improvement. A model integrating the concepts underlying Reason's Swiss cheese theory and the cognitive-affective biases plus cascade could advance the understanding of cognitive-affective processes that underlie decisions and organizational cultures across the continuum of care. Thematic analysis, qualitative information from several sources being used to support argumentation. Complex covert cognitive phenomena underlie decisions influencing health care. In the integrated model, the Swiss cheese slices represent dynamic cognitive-affective (mental) gates: Reason's successive layers of defence. Like firewalls and antivirus programs, cognitive-affective gates normally allow the passage of rational decisions but block or counter unsounds ones. Gates can be breached (ie, holes created) at one or more levels of organizations, teams, and individuals, by (1) any element of cognitive-affective biases plus (conflicts of interest and cognitive biases being the best studied) and (2) other potential error-provoking factors. Conversely, flawed decisions can be blocked and consequences minimized; for example, by addressing cognitive biases plus and error-provoking factors, and being constantly mindful. Informed shared decision making is a neglected but critical layer of defence (cognitive-affective gate). The integrated model can be custom tailored to specific situations, and the underlying principles applied to all methods for improving safety. The model may also provide a framework for developing and evaluating strategies to optimize organizational cultures and decisions. The concept is abstract, the
-
Gating the holes in the Swiss cheese (part I): Expanding professor Reason's model for patient safety
Bryan Young, G.; Makhinson, Michael; Smith, Preston A.; Stobart, Kent; Croskerry, Pat
2017-01-01
Abstract Introduction Although patient safety has improved steadily, harm remains a substantial global challenge. Additionally, safety needs to be ensured not only in hospitals but also across the continuum of care. Better understanding of the complex cognitive factors influencing health care–related decisions and organizational cultures could lead to more rational approaches, and thereby to further improvement. Hypothesis A model integrating the concepts underlying Reason's Swiss cheese theory and the cognitive‐affective biases plus cascade could advance the understanding of cognitive‐affective processes that underlie decisions and organizational cultures across the continuum of care. Methods Thematic analysis, qualitative information from several sources being used to support argumentation. Discussion Complex covert cognitive phenomena underlie decisions influencing health care. In the integrated model, the Swiss cheese slices represent dynamic cognitive‐affective (mental) gates: Reason's successive layers of defence. Like firewalls and antivirus programs, cognitive‐affective gates normally allow the passage of rational decisions but block or counter unsounds ones. Gates can be breached (ie, holes created) at one or more levels of organizations, teams, and individuals, by (1) any element of cognitive‐affective biases plus (conflicts of interest and cognitive biases being the best studied) and (2) other potential error‐provoking factors. Conversely, flawed decisions can be blocked and consequences minimized; for example, by addressing cognitive biases plus and error‐provoking factors, and being constantly mindful. Informed shared decision making is a neglected but critical layer of defence (cognitive‐affective gate). The integrated model can be custom tailored to specific situations, and the underlying principles applied to all methods for improving safety. The model may also provide a framework for developing and evaluating strategies to
-
International Nuclear Information System (INIS)
Vidal-Sicart, Sergi; Pons, Francesca; Puig, Susana; Vilalta, Antonio; Palou, J.M.; Castel, Teresa; Ortega, Marisa; Martin, Francisco; Rull, Ramon
2003-01-01
Scintigraphic identification of the sentinel lymph node is achievable in nearly all patients with malignant melanoma. However, in a very small number of cases the sentinel node fails to be detected, and sometimes recurrence appears during follow-up in patients who had previously tested negative for metastatic disease. The purpose of this study was to review our experience in order to isolate the reasons for erroneous sentinel lymph node identification. The evaluation involved 435 consecutive malignant melanoma patients with AJCC stages I and II (clinically negative nodes) and Breslow thickness >0.76 mm. Lymphoscintigraphy was performed the day before surgery by intradermal administration of technetium-99m labelled nanocolloid. Dynamic and static images were obtained. The sentinel node was intraoperatively identified with the aid of patent blue dye and a hand-held gamma probe. After removal, routine histopathological examination with haematoxylin-eosin (H-E) and immunohistochemistry with S 100 and HMB45 (IHC) were performed. In those patients who developed regional recurrences during follow-up, sentinel nodes were further evaluated by reverse transcriptase-polymerase chain reaction (RT-PCR). Lymphoscintigraphy visualised at least one sentinel node in 434 out of 435 patients (99.8%). Uptake in in-transit sentinel lymph nodes was observed in 32 patients (7.4%). During surgery, localisation and removal of sentinel nodes was successful in 430/435 patients (98.8%). A total of 790 sentinel lymph nodes were harvested, with a mean of 1.8 per patient. Routine histopathological examination with H-E or IHC revealed metastatic disease in 72 patients (16.8%). During a mean follow-up of 26 months, seven of those patients with a negative sentinel node developed regional lymph node metastases. In five of them RT-PCR was positive for micrometastases within the sentinel node. In conclusion, erroneous sentinel lymph node identification can be due to changes in the surgical team
-
A workflow learning model to improve geovisual analytics utility.
Roth, Robert E; Maceachren, Alan M; McCabe, Craig A
2009-01-01
INTRODUCTION: This paper describes the design and implementation of the G-EX Portal Learn Module, a web-based, geocollaborative application for organizing and distributing digital learning artifacts. G-EX falls into the broader context of geovisual analytics, a new research area with the goal of supporting visually-mediated reasoning about large, multivariate, spatiotemporal information. Because this information is unprecedented in amount and complexity, GIScientists are tasked with the development of new tools and techniques to make sense of it. Our research addresses the challenge of implementing these geovisual analytics tools and techniques in a useful manner. OBJECTIVES: The objective of this paper is to develop and implement a method for improving the utility of geovisual analytics software. The success of software is measured by its usability (i.e., how easy the software is to use?) and utility (i.e., how useful the software is). The usability and utility of software can be improved by refining the software, increasing user knowledge about the software, or both. It is difficult to achieve transparent usability (i.e., software that is immediately usable without training) of geovisual analytics software because of the inherent complexity of the included tools and techniques. In these situations, improving user knowledge about the software through the provision of learning artifacts is as important, if not more so, than iterative refinement of the software itself. Therefore, our approach to improving utility is focused on educating the user. METHODOLOGY: The research reported here was completed in two steps. First, we developed a model for learning about geovisual analytics software. Many existing digital learning models assist only with use of the software to complete a specific task and provide limited assistance with its actual application. To move beyond task-oriented learning about software use, we propose a process-oriented approach to learning based on
-
DEFF Research Database (Denmark)
Cramer-Petersen, Claus Lundgaard; Ahmed-Kristensen, Saeema
2015-01-01
to investigate idea generation sessions of two industry cases. Reasoning was found to appear in sequences of alternating reasoning types where the initiating reasoning type was decisive. The study found that abductive reasoning led to more radical ideas, whereas deductive reasoning led to ideas being for project...... requirements, but having a higher proportion being rejected as not valuable. The study sheds light on the conditions that promote these reasoning types. The study is one of the first of its kind and advances an understanding of reasoning in design by empirical means and suggests a relationship between......Reasoning is at the core of design activity and thinking. Thus, understanding and explaining reasoning in design is fundamental to understand and support design practice. This paper investigates reasoning in design and its relationship to varying foci at the stage of idea generation and subsequent...
-
Big Data Analytics, Infectious Diseases and Associated Ethical Impacts
Garattini, C.; Raffle, J.; Aisyah, D. N.; Sartain, F.; Kozlakidis, Z.
2017-01-01
The exponential accumulation, processing and accrual of big data in healthcare are only possible through an equally rapidly evolving field of big data analytics. The latter offers the capacity to rationalize, understand and use big data to serve many different purposes, from improved services modelling to prediction of treatment outcomes, to greater patient and disease stratification. In the area of infectious diseases, the application of big data analytics has introduced a number of changes ...
-
Consequences of contextual factors on clinical reasoning in resident physicians.
McBee, Elexis; Ratcliffe, Temple; Picho, Katherine; Artino, Anthony R; Schuwirth, Lambert; Kelly, William; Masel, Jennifer; van der Vleuten, Cees; Durning, Steven J
2015-12-01
Context specificity and the impact that contextual factors have on the complex process of clinical reasoning is poorly understood. Using situated cognition as the theoretical framework, our aim was to evaluate the verbalized clinical reasoning processes of resident physicians in order to describe what impact the presence of contextual factors have on their clinical reasoning. Participants viewed three video recorded clinical encounters portraying straightforward diagnoses in internal medicine with select patient contextual factors modified. After watching each video recording, participants completed a think-aloud protocol. Transcripts from the think-aloud protocols were analyzed using a constant comparative approach. After iterative coding, utterances were analyzed for emergent themes with utterances grouped into categories, themes and subthemes. Ten residents participated in the study with saturation reached during analysis. Participants universally acknowledged the presence of contextual factors in the video recordings. Four categories emerged as a consequence of the contextual factors: (1) emotional reactions (2) behavioral inferences (3) optimizing the doctor patient relationship and (4) difficulty with closure of the clinical encounter. The presence of contextual factors may impact clinical reasoning performance in resident physicians. When confronted with the presence of contextual factors in a clinical scenario, residents experienced difficulty with closure of the encounter, exhibited as diagnostic uncertainty. This finding raises important questions about the relationship between contextual factors and clinical reasoning activities and how this relationship might influence the cost effectiveness of care. This study also provides insight into how the phenomena of context specificity may be explained using situated cognition theory.
-
Leadership styles of nurse managers in ethical dilemmas: Reasons and consequences.
Zydziunaite, Vilma; Suominen, Tarja
2014-01-01
Abstract Background: Understanding the reasons and consequences of leadership styles in ethical dilemmas is fundamental to exploring nurse managers' abilities to influence outcomes for patients and nursing personnel. To explain the associations between different leadership styles, reasons for their application and its consequences when nurse managers make decisions in ethical dilemmas. The data were collected between 15 October 2011 and 30 April 2012 by statistically validated questionnaire. The respondents (N = 278) were nurse managers. The data were analysed using SPSS 20.0, calculating Spearman's correlations, the Stepwise Regression and ANOVA. The reasons for applying different leadership styles in ethical dilemmas include personal characteristics, years in work position, institutional factors, and the professional authority of nurse managers. The applied leadership styles in ethical dilemmas are associated with the consequences regarding the satisfaction of patients,' relatives' and nurse managers' needs. Nurse managers exhibited leadership styles oriented to maintenance, focussing more on the 'doing the job' than on managing the decision-making in ethical dilemmas.
-
Estimation of post-test probabilities by residents: Bayesian reasoning versus heuristics?
Hall, Stacey; Phang, Sen Han; Schaefer, Jeffrey P; Ghali, William; Wright, Bruce; McLaughlin, Kevin
2014-08-01
Although the process of diagnosing invariably begins with a heuristic, we encourage our learners to support their diagnoses by analytical cognitive processes, such as Bayesian reasoning, in an attempt to mitigate the effects of heuristics on diagnosing. There are, however, limited data on the use ± impact of Bayesian reasoning on the accuracy of disease probability estimates. In this study our objective was to explore whether Internal Medicine residents use a Bayesian process to estimate disease probabilities by comparing their disease probability estimates to literature-derived Bayesian post-test probabilities. We gave 35 Internal Medicine residents four clinical vignettes in the form of a referral letter and asked them to estimate the post-test probability of the target condition in each case. We then compared these to literature-derived probabilities. For each vignette the estimated probability was significantly different from the literature-derived probability. For the two cases with low literature-derived probability our participants significantly overestimated the probability of these target conditions being the correct diagnosis, whereas for the two cases with high literature-derived probability the estimated probability was significantly lower than the calculated value. Our results suggest that residents generate inaccurate post-test probability estimates. Possible explanations for this include ineffective application of Bayesian reasoning, attribute substitution whereby a complex cognitive task is replaced by an easier one (e.g., a heuristic), or systematic rater bias, such as central tendency bias. Further studies are needed to identify the reasons for inaccuracy of disease probability estimates and to explore ways of improving accuracy.
-
Ferrario, Catherine G
2003-01-01
To compare the use of mental representations (heuristics) in diagnostic reasoning of expert (> or = 5 years' experience) and novice (thinking and spare cognitive reserves for reasoning needed for complex patients. Faculty need to promote student's cognitive development through strategies that promote active, reflective, and integrative learning.
-
Analytic models of NH4+ uptake and regeneration experiments
International Nuclear Information System (INIS)
Laws, E.A.
1985-01-01
Differential equations describing the uptake and regeneration of NH 4 + in both laboratory and field experiments are shown to have analytic solutions which can easily be inverted to determine the rate constants of interest. The solutions are used to study the descriptive ability of two fundamentally different models of NH 4 + cycling, one in which NH 4 + regeneration is regarded as a process that transfers N from participate N to NH 4 + , the other in which regeneration is regarded as a process that introduced NH 4 + to the dissolved phase without removing N from the particulate phase. The former model was found to give a good description of experimental field data and reasonable parameter values in all cases studied. The latter model was much less successful in describing the data and in producing reasonable parameter values. It is concluded that transfer of nitrogen from particulate N to NH 4 + is a process which must be taken into account in analyzing NH 4 + uptake and regeneration experiments
-
Kangas, Maria; Bovbjerg, Dana H.; Montgomery, Guy H.
2009-01-01
Reports an error in "Cancer-related fatigue: A systematic and meta-analytic review of non-pharmacological therapies for cancer patients" by Maria Kangas, Dana H. Bovbjerg and Guy H. Montgomery (Psychological Bulletin, 2008[Sep], Vol 134[5], 700-741). The URL to the Supplemental Materials for the article is listed incorrectly in two places in the…
-
Directory of Open Access Journals (Sweden)
Eva Kevin W.
2005-06-01
reasoning for frontline clinical teachers. The strengths and weaknesses of different approaches to clinical reasoning will be examined using one of the core divides between various models (that of analytic (i.e., conscious/controlled versus non-analytic (i.e., unconscious/automatic reasoning strategies as an orienting framework. Discussion: Recent work suggests that clinical teachers should stress the importance of both forms of reasoning, thereby enabling students to marshal reasoning processes in a flexible and context-specific manner. Specific implication are drawn from this overview for clinical teachers.
-
Analytical chemistry instrumentation
International Nuclear Information System (INIS)
Laing, W.R.
1986-01-01
In nine sections, 48 chapters cover 1) analytical chemistry and the environment 2) environmental radiochemistry 3) automated instrumentation 4) advances in analytical mass spectrometry 5) fourier transform spectroscopy 6) analytical chemistry of plutonium 7) nuclear analytical chemistry 8) chemometrics and 9) nuclear fuel technology
-
Historical reasoning: towards a framework for analyzing students' reasoning about the past
van Drie, J.; van Boxtel, C.
2008-01-01
This article explores historical reasoning, an important activity in history learning. Based upon an extensive review of empirical literature on students’ thinking and reasoning about history, a theoretical framework of historical reasoning is proposed. The framework consists of six components:
-
Preliminary Results on Uncertainty Quantification for Pattern Analytics
Energy Technology Data Exchange (ETDEWEB)
Stracuzzi, David John [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Brost, Randolph [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Chen, Maximillian Gene [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Malinas, Rebecca [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Peterson, Matthew Gregor [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Phillips, Cynthia A. [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Robinson, David G. [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States); Woodbridge, Diane [Sandia National Laboratories (SNL-NM), Albuquerque, NM (United States)
2015-09-01
This report summarizes preliminary research into uncertainty quantification for pattern ana- lytics within the context of the Pattern Analytics to Support High-Performance Exploitation and Reasoning (PANTHER) project. The primary focus of PANTHER was to make large quantities of remote sensing data searchable by analysts. The work described in this re- port adds nuance to both the initial data preparation steps and the search process. Search queries are transformed from does the specified pattern exist in the data? to how certain is the system that the returned results match the query? We show example results for both data processing and search, and discuss a number of possible improvements for each.
-
Heemskerk, Laura; Norman, Geoff; Chou, Sophia; Mintz, Marcy; Mandin, Henry; McLaughlin, Kevin
2008-11-01
Previous studies have suggested an association between reasoning strategies and diagnostic success, but the influence on this relationship of variables such as question format and task difficulty, has not been studied. Our objective was to study the association between question format, task difficulty, reasoning strategies and diagnostic success. Study participants were 13 Internal Medicine residents at the University of Calgary. Each was given eight problem-solving questions in four clinical presentations and were randomized to groups that differed only in the question format, such that a question presented as short answer (SA) to the first group was presented as extended matching (EM) to the second group. There were equal numbers of SA/EM questions and straightforward/difficult tasks. Participants performed think-aloud during diagnostic reasoning. Data were analyzed using multiple logistic regression. Question format was associated with reasoning strategies; hypothetico-deductive reasoning being used more frequently on EM questions and scheme-inductive reasoning on SA questions. For SA question, non-analytic reasoning alone was used more frequently to answer straightforward cases than difficult cases, whereas for EM questions no such association was observed. EM format and straightforward task increased the odds of diagnostic success, whereas hypothetico-deductive reasoning was associated with reduced odds of success. Question format and task difficulty both influence diagnostic reasoning strategies and studies that examine the effect of reasoning strategies on diagnostic success should control for these effects. Further studies are needed to investigate the effect of reasoning strategies on performance of different groups of learners.
-
Fletcher, Logan; Carruthers, Peter
2012-01-01
This article considers the cognitive architecture of human meta-reasoning: that is, metacognition concerning one's own reasoning and decision-making. The view we defend is that meta-reasoning is a cobbled-together skill comprising diverse self-management strategies acquired through individual and cultural learning. These approximate the monitoring-and-control functions of a postulated adaptive system for metacognition by recruiting mechanisms that were designed for quite other purposes. PMID:22492753
-
An analytic solution for one-dimensional diffusion of radionuclides from a waste package
International Nuclear Information System (INIS)
1985-01-01
This work implements an analytical solution for diffusion of radionuclides from a cylindrical waste form through the packing material into the surrounding host rock. Recent interest in predicting the performance of a proposed geological repository for nuclear waste has led to the development of several computer programs to predict the performance of such a repository for the next several millenia. These numerical codes are generally designed to accommodate a broad spectrum of geometrical configurations and repository conditions in order to accurately predict the behavior of the radionuclides in the repository environment. Confidence in such general purpose codes is gained by verifying the numerical modeling and the software through comparison of the numerical predictions generated by these computer codes with analytical solutions to reasonably complex problems. The analysis discussed herein implements the analytic solution, proposed by J.C. Jaeger in 1941 for radial diffusion through two concentric circular cylinders. Jaeger's solution was applied to the problem of diffusional mass transfer from a long cylindrical waste form and subsequently into the surrounding geological formation. Analytic predictions of fractional release rates, including the effects of sorption, were generated. 6 refs., 2 figs., 2 tabs
-
Fear of knowledge: Clinical hypotheses in diagnostic and prognostic reasoning.
Chiffi, Daniele; Zanotti, Renzo
2017-10-01
Patients are interested in receiving accurate diagnostic and prognostic information. Models and reasoning about diagnoses have been extensively investigated from a foundational perspective; however, for all its importance, prognosis has yet to receive a comparable degree of philosophical and methodological attention, and this may be due to the difficulties inherent in accurate prognostics. In the light of these considerations, we discuss a considerable body of critical thinking on the topic of prognostication and its strict relations with diagnostic reasoning, pointing out the distinction between nosographic and pathophysiological types of diagnosis and prognosis, underlying the importance of the explication and explanation processes. We then distinguish between various forms of hypothetical reasoning applied to reach diagnostic and prognostic judgments, comparing them with specific forms of abductive reasoning. The main thesis is that creative abduction regarding clinical hypotheses in diagnostic process is very unlikely to occur, whereas this seems to be often the case for prognostic judgments. The reasons behind this distinction are due to the different types of uncertainty involved in diagnostic and prognostic judgments. © 2016 John Wiley & Sons, Ltd.
-
Analytical method comparisons for the accurate determination of PCBs in sediments
Energy Technology Data Exchange (ETDEWEB)
Numata, M.; Yarita, T.; Aoyagi, Y.; Yamazaki, M.; Takatsu, A. [National Metrology Institute of Japan, Tsukuba (Japan)
2004-09-15
National Metrology Institute of Japan in National Institute of Advanced Industrial Science and Technology (NMIJ/AIST) has been developing several matrix reference materials, for example, sediments, water and biological tissues, for the determinations of heavy metals and organometallic compounds. The matrix compositions of those certified reference materials (CRMs) are similar to compositions of actual samples, and those are useful for validating analytical procedures. ''Primary methods of measurements'' are essential to obtain accurate and SI-traceable certified values in the reference materials, because the methods have the highest quality of measurement. However, inappropriate analytical operations, such as incomplete extraction of analytes or crosscontamination during analytical procedures, will cause error of analytical results, even if one of the primary methods, isotope-dilution, is utilized. To avoid possible procedural bias for the certification of reference materials, we employ more than two analytical methods which have been optimized beforehand. Because the accurate determination of trace POPs in the environment is important to evaluate their risk, reliable CRMs are required by environmental chemists. Therefore, we have also been preparing matrix CRMs for the determination of POPs. To establish accurate analytical procedures for the certification of POPs, extraction is one of the critical steps as described above. In general, conventional extraction techniques for the determination of POPs, such as Soxhlet extraction (SOX) and saponification (SAP), have been characterized well, and introduced as official methods for environmental analysis. On the other hand, emerging techniques, such as microwave-assisted extraction (MAE), pressurized fluid extraction (PFE) and supercritical fluid extraction (SFE), give higher recovery yields of analytes with relatively short extraction time and small amount of solvent, by reasons of the high
-
Case-based clinical reasoning in feline medicine: 3: Use of heuristics and illness scripts.
Whitehead, Martin L; Canfield, Paul J; Johnson, Robert; O'Brien, Carolyn R; Malik, Richard
2016-05-01
This is Article 3 of a three-part series on clinical reasoning that encourages practitioners to explore and understand how they think and make case-based decisions. It is hoped that, in the process, they will learn to trust their intuition but, at the same time, put in place safeguards to diminish the impact of bias and misguided logic on their diagnostic decision-making. Article 1, published in the January 2016 issue of JFMS, discussed the relative merits and shortcomings of System 1 thinking (immediate and unconscious) and System 2 thinking (effortful and analytical). In Article 2, published in the March 2016 issue, ways of managing cognitive error, particularly the negative impact of bias, in making a diagnosis were examined. This final article explores the use of heuristics (mental short cuts) and illness scripts in diagnostic reasoning. © The Author(s) 2016.
-
Klasifikasi Daya Tarik Konten Artikel Media Daring Dari Data Google Analytics Dengan C-FDT
Directory of Open Access Journals (Sweden)
Erlin Windia Ambarsari
2018-05-01
Full Text Available Information of article which had attractive contains as Trending Topics, although this is article hoax or not. The frequency of article's content which created by online media, it can be monitored by Google Analytics. One of the reasons for using Google Analytics is to understand the content of a site which leads to the change and behavior of behind the content. Google Analytics can be regarded as web analytics software with ease of installation. Classification of Google Analytics data with C-Fuzzy Decision Tree (C-FDT, aims to get the attraction of article content, which means having special attention from visitors and the article can be interesting or not, and observed whether C-FDT can recognize patterns from metric data Google Analytics. The purpose of this study is the results of FDT are expected to facilitate online media managers to analyze the content of articles and evaluate content groups tend to potentially gain traffic for getting promotional or marketing advertising as revenue from online media sites. The results obtained are C-FDT can recognize the pattern of Google Analytics metrics thus as facilitating the search of the article content into a simple form that is the reduction of attributes by grouping data with the same object and the data had Pruning. Online media managers can focus on certain attributes that have a big effect on Content Articles. However C-FDT is having trouble dealing with data sync due to system errors when retrieving data from Google Analytics. Therefore it is necessary to monitor data in time series.
-
A review of analytics and clinical informatics in health care.
Simpao, Allan F; Ahumada, Luis M; Gálvez, Jorge A; Rehman, Mohamed A
2014-04-01
Federal investment in health information technology has incentivized the adoption of electronic health record systems by physicians and health care organizations; the result has been a massive rise in the collection of patient data in electronic form (i.e. "Big Data"). Health care systems have leveraged Big Data for quality and performance improvements using analytics-the systematic use of data combined with quantitative as well as qualitative analysis to make decisions. Analytics have been utilized in various aspects of health care including predictive risk assessment, clinical decision support, home health monitoring, finance, and resource allocation. Visual analytics is one example of an analytics technique with an array of health care and research applications that are well described in the literature. The proliferation of Big Data and analytics in health care has spawned a growing demand for clinical informatics professionals who can bridge the gap between the medical and information sciences.
-
Logical reasoning versus information processing in the dual-strategy model of reasoning.
Markovits, Henry; Brisson, Janie; de Chantal, Pier-Luc
2017-01-01
One of the major debates concerning the nature of inferential reasoning is between counterexample-based strategies such as mental model theory and statistical strategies underlying probabilistic models. The dual-strategy model, proposed by Verschueren, Schaeken, & d'Ydewalle (2005a, 2005b), which suggests that people might have access to both kinds of strategy has been supported by several recent studies. These have shown that statistical reasoners make inferences based on using information about premises in order to generate a likelihood estimate of conclusion probability. However, while results concerning counterexample reasoners are consistent with a counterexample detection model, these results could equally be interpreted as indicating a greater sensitivity to logical form. In order to distinguish these 2 interpretations, in Studies 1 and 2, we presented reasoners with Modus ponens (MP) inferences with statistical information about premise strength and in Studies 3 and 4, naturalistic MP inferences with premises having many disabling conditions. Statistical reasoners accepted the MP inference more often than counterexample reasoners in Studies 1 and 2, while the opposite pattern was observed in Studies 3 and 4. Results show that these strategies must be defined in terms of information processing, with no clear relations to "logical" reasoning. These results have additional implications for the underlying debate about the nature of human reasoning. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
-
RUPTURES IN THE ANALYTIC SETTING AND DISTURBANCES IN THE TRANSFORMATIONAL FIELD OF DREAMS.
Brown, Lawrence J
2015-10-01
This paper explores some implications of Bleger's (1967, 2013) concept of the analytic situation, which he views as comprising the analytic setting and the analytic process. The author discusses Bleger's idea of the analytic setting as the depositary for projected painful aspects in either the analyst or patient or both-affects that are then rendered as nonprocess. In contrast, the contents of the analytic process are subject to an incessant process of transformation (Green 2005). The author goes on to enumerate various components of the analytic setting: the nonhuman, object relational, and the analyst's "person" (including mental functioning). An extended clinical vignette is offered as an illustration. © 2015 The Psychoanalytic Quarterly, Inc.
-
Curling, Louise; Kellett, Stephen; Totterdell, Peter; Parry, Glenys; Hardy, Gillian; Berry, Katherine
2018-03-01
The evidence base for the treatment of morbid jealousy with integrative therapies is thin. This study explored the efficacy of cognitive analytic therapy (CAT). An adjudicated hermeneutic single-case efficacy design evaluated the cognitive analytic treatment of a patient meeting diagnostic criteria for obsessive morbid jealousy. A rich case record was developed using a matrix of nomothetic and ideographic quantitative and qualitative outcomes. This record was then debated by sceptic and affirmative research teams. Experienced psychotherapy researchers acted as judges, assessed the original case record, and heard the affirmative-versus-sceptic debate. Judges pronounced an opinion regarding the efficacy of the therapy. The efficacy of CAT was supported by all three judges. Each ruled that change had occurred due to the action of the therapy, beyond any level of reasonable doubt. This research demonstrates the potential usefulness of CAT in treating morbid jealousy and suggests that CAT is conceptually well suited. Suggestions for future clinical and research directions are provided. The relational approach of CAT makes it a suitable therapy for morbid jealousy. The narrative reformulation component of CAT appears to facilitate early change in chronic jealousy patterns. It is helpful for therapists during sessions to use CAT theory to diagrammatically spell out the patterns maintaining jealousy. © 2017 The British Psychological Society.
-
Managing depression: analytic, antidepressants or both?
Directory of Open Access Journals (Sweden)
Lucas Richard
2003-01-01
Full Text Available Patients with depression cover the spectrum, in terms of severity of psychopathology, between those receptive to analytic psychotherapy and those that require treatment with medication. In this paper, the author demonstrates how a psychoanalytic framework of understanding has a place in the latter group, and can aid general psychiatrists in relating to their depressed patients. The notion of a pathological ego-destructive superego taking over control in depression is explored, with the need to unseat it and replace it with a more mature superego providing an overall framework of approach to treatment.
-
Oblinger, Diana G.
2012-01-01
Talk about analytics seems to be everywhere. Everyone is talking about analytics. Yet even with all the talk, many in higher education have questions about--and objections to--using analytics in colleges and universities. In this article, the author explores the use of analytics in, and all around, higher education. (Contains 1 note.)
-
Analytical benchmarks for nuclear engineering applications. Case studies in neutron transport theory
International Nuclear Information System (INIS)
2008-01-01
The developers of computer codes involving neutron transport theory for nuclear engineering applications seldom apply analytical benchmarking strategies to ensure the quality of their programs. A major reason for this is the lack of analytical benchmarks and their documentation in the literature. The few such benchmarks that do exist are difficult to locate, as they are scattered throughout the neutron transport and radiative transfer literature. The motivation for this benchmark compendium, therefore, is to gather several analytical benchmarks appropriate for nuclear engineering applications under one cover. We consider the following three subject areas: neutron slowing down and thermalization without spatial dependence, one-dimensional neutron transport in infinite and finite media, and multidimensional neutron transport in a half-space and an infinite medium. Each benchmark is briefly described, followed by a detailed derivation of the analytical solution representation. Finally, a demonstration of the evaluation of the solution representation includes qualified numerical benchmark results. All accompanying computer codes are suitable for the PC computational environment and can serve as educational tools for courses in nuclear engineering. While this benchmark compilation does not contain all possible benchmarks, by any means, it does include some of the most prominent ones and should serve as a valuable reference. (author)
-
A suspicious reason for Raynaud's phenomenon: Intrauterine device.
Diken, Adem I; Yalçınkaya, Adnan; Aksoy, Eray; Yılmaz, Seyhan; Çağlı, Kerim
2015-06-01
Primary Raynaud's phenomenon may be insistent in patients under medical therapy, and intrauterine devices may be an unnoticed reason in these patients. Fluctuations in female sex hormone status were reported to be associated with the emergence of primary Raynaud's phenomenon symptoms. The use of intrauterine devices was not reported to be associated with Raynaud's phenomenon previously. Intrauterine device may stimulate vascular hyperactivity regarding hormonal or unknown mechanisms that result in Raynaud's phenomenon. We present a postmenopausal patient who complained of primary Raynaud's phenomenon symptoms and had recovery after the removal of her copper intrauterine device. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
-
MacNeill, Sheila; Campbell, Lorna M.; Hawksey, Martin
2014-01-01
This article presents an overview of the development and use of analytics in the context of education. Using Buckingham Shum's three levels of analytics, the authors present a critical analysis of current developments in the domain of learning analytics, and contrast the potential value of analytics research and development with real world…
-
Implementing electronic health care predictive analytics: considerations and challenges.
Amarasingham, Ruben; Patzer, Rachel E; Huesch, Marco; Nguyen, Nam Q; Xie, Bin
2014-07-01
The use of predictive modeling for real-time clinical decision making is increasingly recognized as a way to achieve the Triple Aim of improving outcomes, enhancing patients' experiences, and reducing health care costs. The development and validation of predictive models for clinical practice is only the initial step in the journey toward mainstream implementation of real-time point-of-care predictions. Integrating electronic health care predictive analytics (e-HPA) into the clinical work flow, testing e-HPA in a patient population, and subsequently disseminating e-HPA across US health care systems on a broad scale require thoughtful planning. Input is needed from policy makers, health care executives, researchers, and practitioners as the field evolves. This article describes some of the considerations and challenges of implementing e-HPA, including the need to ensure patients' privacy, establish a health system monitoring team to oversee implementation, incorporate predictive analytics into medical education, and make sure that electronic systems do not replace or crowd out decision making by physicians and patients. Project HOPE—The People-to-People Health Foundation, Inc.
-
Reinforcement Learning for Predictive Analytics in Smart Cities
Directory of Open Access Journals (Sweden)
Kostas Kolomvatsos
2017-06-01
Full Text Available The digitization of our lives cause a shift in the data production as well as in the required data management. Numerous nodes are capable of producing huge volumes of data in our everyday activities. Sensors, personal smart devices as well as the Internet of Things (IoT paradigm lead to a vast infrastructure that covers all the aspects of activities in modern societies. In the most of the cases, the critical issue for public authorities (usually, local, like municipalities is the efficient management of data towards the support of novel services. The reason is that analytics provided on top of the collected data could help in the delivery of new applications that will facilitate citizens’ lives. However, the provision of analytics demands intelligent techniques for the underlying data management. The most known technique is the separation of huge volumes of data into a number of parts and their parallel management to limit the required time for the delivery of analytics. Afterwards, analytics requests in the form of queries could be realized and derive the necessary knowledge for supporting intelligent applications. In this paper, we define the concept of a Query Controller ( Q C that receives queries for analytics and assigns each of them to a processor placed in front of each data partition. We discuss an intelligent process for query assignments that adopts Machine Learning (ML. We adopt two learning schemes, i.e., Reinforcement Learning (RL and clustering. We report on the comparison of the two schemes and elaborate on their combination. Our aim is to provide an efficient framework to support the decision making of the QC that should swiftly select the appropriate processor for each query. We provide mathematical formulations for the discussed problem and present simulation results. Through a comprehensive experimental evaluation, we reveal the advantages of the proposed models and describe the outcomes results while comparing them with a
-
Deepening the quality of clinical reasoning and decision-making in rural hospital nursing practice.
Sedgwick, M G; Grigg, L; Dersch, S
2014-01-01
Rural acute care nursing requires an extensive breadth and depth of knowledge as well as the ability to quickly reason through problems in order to make sound clinical decisions. This reasoning often occurs within an environment that has minimal medical or ancillary support. Registered nurses (RN) new to rural nursing, and employers, have raised concerns about patient safety while new nurses make the transition into rural practice. In addition, feeling unprepared for the rigors of rural hospital nursing practice is a central issue influencing RN recruitment and retention. Understanding how rural RNs reason is a key element for identifying professional development needs and may support recruitment and retention of skilled rural nurses. The purpose of this study was to explore how rural RNs reason through clinical problems as well as to assess the quality of such reasoning. This study used a non-traditional approach for data collection. Fifteen rural acute care nurses with varying years of experience working in southern Alberta, Canada, were observed while they provided care to patients of varying acuity within a simulated rural setting. Following the simulation, semi-structured interviews were conducted using a substantive approach to critical thinking. Findings revealed that the ability to engage in deep clinical reasoning varied considerably among participants despite being given the same information under the same circumstances. Furthermore, the number of years of experience did not seem to be directly linked to the ability to engage in sound clinical reasoning. Novice nurses, however, did rely heavily on others in their decision making in order to ensure they were making the right decision. Hence, their relationships with other staff members influenced their ability to engage in clinical reasoning and decision making. In situations where the patient's condition was deteriorating quickly, regardless of years of experience, all of the participants depended on
-
The Journal of Learning Analytics: Supporting and Promoting Learning Analytics Research
Siemens, George
2014-01-01
The paper gives a brief overview of the main activities for the development of the emerging field of learning analytics led by the Society for Learning Analytics Research (SoLAR). The place of the Journal of Learning Analytics is identified Analytics is the most significant new initiative of SoLAR.
-
The "Journal of Learning Analytics": Supporting and Promoting Learning Analytics Research
Siemens, George
2014-01-01
The paper gives a brief overview of the main activities for the development of the emerging field of learning analytics led by the Society for Learning Analytics Research (SoLAR). The place of the "Journal of Learning Analytics" is identified. Analytics is the most significant new initiative of SoLAR.
-
Is a pre-analytical process for urinalysis required?
Petit, Morgane; Beaudeux, Jean-Louis; Majoux, Sandrine; Hennequin, Carole
2017-10-01
For the reliable urinary measurement of calcium, phosphate and uric acid, a pre-analytical process by adding acid or base to urine samples at laboratory is recommended in order to dissolve precipitated solutes. Several studies on different kind of samples and analysers have previously shown that a such pre-analytical treatment is useless. The objective was to study the necessity of pre-analytical treatment of urine on samples collected using the V-Monovette ® (Sarstedt) system and measured on the analyser Architect C16000 (Abbott Diagnostics). Sixty urinary samples of hospitalized patients were selected (n=30 for calcium and phosphate, and n=30 for uric acid). After acidification of urine samples for measurement of calcium and phosphate, and alkalinisation for measurement of uric acid respectively, differences between results before and after the pre-analytical treatment were compared to acceptable limits recommended by the French society of clinical biology (SFBC). No difference in concentration between before and after pre-analytical treatment of urine samples exceeded acceptable limits from SFBC for measurement of calcium and uric acid. For phosphate, only one sample exceeded these acceptable limits, showing a result paradoxically lower after acidification. In conclusion, in agreement with previous study, our results show that acidification or alkalinisation of urine samples from 24 h urines or from urination is not a pre-analytical necessity for measurement of calcium, phosphate and uric acid.
-
Analytical solution using computer algebra of a biosensor for detecting toxic substances in water
Rúa Taborda, María. Isabel
2014-05-01
In a relatively recent paper an electrochemical biosensor for water toxicity detection based on a bio-chip as a whole cell was proposed and numerically solved and analyzed. In such paper the kinetic processes in a miniaturized electrochemical biosensor system was described using the equations for specific enzymatic reaction and the diffusion equation. The numerical solution shown excellent agreement with the measured data but such numerical solution is not enough to design efficiently the corresponding bio-chip. For this reason an analytical solution is demanded. The object of the present work is to provide such analytical solution and then to give algebraic guides to design the bio-sensor. The analytical solution is obtained using computer algebra software, specifically Maple. The method of solution is the Laplace transform, with Bromwich integral and residue theorem. The final solution is given as a series of Bessel functions and the effective time for the bio-sensor is computed. It is claimed that the analytical solutions that were obtained will be very useful to predict further current variations in similar systems with different geometries, materials and biological components. Beside of this the analytical solution that we provide is very useful to investigate the relationship between different chamber parameters such as cell radius and height; and electrode radius.
-
International Nuclear Information System (INIS)
Mikhailovskii, A.B.; Shirokov, M.S.; Konovalov, S.V.; Tsypin, V.S.
2005-01-01
Transport threshold models of neoclassical tearing modes in tokamaks are investigated analytically. An analysis is made of the competition between strong transverse heat transport, on the one hand, and longitudinal heat transport, longitudinal heat convection, longitudinal inertial transport, and rotational transport, on the other hand, which leads to the establishment of the perturbed temperature profile in magnetic islands. It is shown that, in all these cases, the temperature profile can be found analytically by using rigorous solutions to the heat conduction equation in the near and far regions of a chain of magnetic islands and then by matching these solutions. Analytic expressions for the temperature profile are used to calculate the contribution of the bootstrap current to the generalized Rutherford equation for the island width evolution with the aim of constructing particular transport threshold models of neoclassical tearing modes. Four transport threshold models, differing in the underlying competing mechanisms, are analyzed: collisional, convective, inertial, and rotational models. The collisional model constructed analytically is shown to coincide exactly with that calculated numerically; the reason is that the analytical temperature profile turns out to be the same as the numerical profile. The results obtained can be useful in developing the next generation of general threshold models. The first steps toward such models have already been made
-
A Pilot Study of Reasons and Risk Factors for "No-Shows" in a Pediatric Neurology Clinic.
Guzek, Lindsay M; Fadel, William F; Golomb, Meredith R
2015-09-01
Missed clinic appointments lead to decreased patient access, worse patient outcomes, and increased healthcare costs. The goal of this pilot study was to identify reasons for and risk factors associated with missed pediatric neurology outpatient appointments ("no-shows"). This was a prospective cohort study of patients scheduled for 1 week of clinic. Data on patient clinical and demographic information were collected by record review; data on reasons for missed appointments were collected by phone interviews. Univariate and multivariate analyses were conducted using chi-square tests and multiple logistic regression to assess risk factors for missed appointments. Fifty-nine (25%) of 236 scheduled patients were no-shows. Scheduling conflicts (25.9%) and forgetting (20.4%) were the most common reasons for missed appointments. When controlling for confounding factors in the logistic regression, Medicaid (odds ratio 2.36), distance from clinic, and time since appointment was scheduled were associated with missed appointments. Further work in this area is needed. © The Author(s) 2014.
-
Case-Based FCTF Reasoning System
Directory of Open Access Journals (Sweden)
Jing Lu
2015-10-01
Full Text Available Case-based reasoning uses old information to infer the answer of new problems. In case-based reasoning, a reasoner firstly records the previous cases, then searches the previous case list that is similar to the current one and uses that to solve the new case. Case-based reasoning means adapting old solving solutions to new situations. This paper proposes a reasoning system based on the case-based reasoning method. To begin, we show the theoretical structure and algorithm of from coarse to fine (FCTF reasoning system, and then demonstrate that it is possible to successfully learn and reason new information. Finally, we use our system to predict practical weather conditions based on previous ones and experiments show that the prediction accuracy increases with further learning of the FCTF reasoning system.
-
Moral reasoning in women with posttraumatic stress disorder related to childhood abuse.
Nazarov, Anthony; Walaszczyk, Victoria; Frewen, Paul; Oremus, Carolina; Lanius, Ruth; McKinnon, Margaret C
2016-01-01
Preliminary evidence suggests that relative to healthy controls, patients with posttraumatic stress disorder (PTSD) show deficits on several inter-related social cognitive tasks, including theory of mind, and emotion comprehension. Systematic investigations examining other aspects of social cognition, including moral reasoning, have not been conducted in PTSD stemming from childhood trauma. To conduct a comprehensive assessment of moral reasoning performance in individuals with PTSD stemming from childhood abuse. Moral reasoning performance was assessed in 28 women with PTSD related to prolonged childhood trauma and 19 matched healthy controls. Performance was assessed using 12 modified moral dilemmas and was queried in three domains: utilitarian/deontological sacrificial dilemmas (personal and impersonal), social order vs. compassion, and altruism vs. self-interest. Participants were asked whether a proposed action was morally acceptable or unacceptable and whether or not they would perform this action under the circumstances described. Women with PTSD were less likely to carry out utilitarian actions in personal, sacrificial moral dilemmas, a choice driven primarily by consequential intrapersonal disapproval. Increased concern regarding intrapersonal disapproval was related to higher symptoms of guilt in the PTSD group. Patients with PTSD demonstrated less altruistic moral reasoning, primarily associated with decreased empathic role-taking for beneficiaries. Women with PTSD due to childhood trauma show alterations in moral reasoning marked by decreased utilitarian judgment and decreased altruism. Childhood trauma may continue to impact moral choices made into adulthood.
-
Reasons for dropping out from a waiting list for in vitro fertilization
van Dongen, Angelique J. C. M.; Verhagen, Tamara E. M.; Dumoulin, John C. M.; Land, Jolande A.; Evers, Johannes L. H.
2010-01-01
Objective: To determine the incidence of couples dropping out of the in vitro fertilization (IVF) waiting list and to describe the couples' reasons. Design: Prospective cohort study. Setting: Fertility center in an academic hospital. Patient(s): 674 women placed consecutively on the IVF waiting list
-
Directory of Open Access Journals (Sweden)
Ramezanian M.
2004-06-01
Full Text Available Statement of Problem: Tooth extraction is always considered as the final treatment option in dentistry."nConsidering the numerous advances in dentistry, nowadays the preservation of the permanent teeth until old"nage is common. However, in most economically poor countries or those without security service insurance,"nthe high rate of extraction, particularly among restorable teeth, is regrettable."nPurpose: The aim of the present study was to determine the reasons for tooth extraction among patients"nreferred to the faculty of Dentistry, Tehran University of Medical Sciences in 2002."nMaterials and Methods: This descriptive and cross-sectional study was conducted on 320 patients. The"ninformation about patient's general knowledge, oral health status, tooth location and causes of extraction were"ncollected and recorded in a questionnaire. The data were submitted to statistical Chi-Square test."nResults: No statistically significant difference was found between two genders in their mentioned causes for"nextraction. The most prevalent reasons were as follows: Caries (50%, Periodontal diseases (16.6%. Absence"nof an acceptable occlusion, prosthetic problems, patient's request, etc... make up the remaining 33.4% of the"nreasons."nConclusion: According to this study, it is suggested to investigate extraction etiology at the society level and"nif similar results are obtained, necessary steps should be taken to prevent caries and periodontal problems as"nthe major mentioned causes for tooth extraction.
-
Predictors of avoiding medical care and reasons for avoidance behavior.
Kannan, Viji Diane; Veazie, Peter J
2014-04-01
Delayed medical care has negative health and economic consequences; interventions have focused on appraising symptoms, with limited success in reducing delay. To identify predictors of care avoidance and reasons for avoiding care. Using the Health Information National Trends Survey (2007), we conducted logistic regressions to identify predictors of avoiding medical visits deemed necessary by the respondents; and, we then conducted similar analyses on reasons given for avoidance behavior. Independent variables included geographic, demographic, socioeconomic, personal health, health behavior, health care system, and cognitive characteristics. Approximately one third of adults avoided doctor visits they had deemed necessary. Although unadjusted associations existed, avoiding needed care was not independently associated with geographic, demographic, and socioeconomic characteristics. Avoidance behavior is characterized by low health self-efficacy, less experience with both quality care and getting help with uncertainty about health, having your feelings attended to by your provider, no usual source of care, negative affect, smoking daily, and fatalistic attitude toward cancer. Reasons elicited for avoidance include preference for self-care or alternative care, dislike or distrust of doctors, fear or dislike of medical treatments, time, and money; respondents also endorsed discomfort with body examinations, fear of having a serious illness, and thoughts of dying. Distinct predictors distinguish each of these reasons. Interventions to reduce patient delay could be improved by addressing the health-related behavioral, belief, experiential, and emotional traits associated with delay. Attention should also be directed toward the interpersonal communications between patients and providers.
-
DEFF Research Database (Denmark)
Sprung, C.L.; Woodcock, T.; Sjokvist, P.
2008-01-01
Objective: To evaluate physicians' reasoning, considerations and possible difficulties in end-of-life decision-making for patients in European intensive care units (ICUs). Design: A prospective observational study. Setting: Thirty-seven ICUs in 17 European countries. Patients and participants...... for, considerations in, and difficulties with end-of-life decision-making was germane in each case as it arose. Overall, 2,134 (69%) of the decisions were documented in the medical record, with inter-regional differences in documentation practice. Primary reasons given by physicians for the decision......: A total of 3,086 patients for whom an end-of-life decision was taken between January 1999 and June 2000. The dataset excludes patients who died after attempts at cardiopulmonary resuscitation and brain-dead patients. Measurements and results: Physicians indicated which of a pre-determined set of reasons...
-
What are the reasons for low use of graphene quantum dots in immunosensing of cancer biomarkers?
Energy Technology Data Exchange (ETDEWEB)
Hasanzadeh, Mohammad, E-mail: mhmmd_hasanzadeh@yahoo.com [Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz 51664 (Iran, Islamic Republic of); Pharmaceutical Analysis Research Center, Tabriz University of Medical Sciences, Tabriz 51664 (Iran, Islamic Republic of); Shadjou, Nasrin, E-mail: nasrin.shadjou@gmail.com [Department of Nanochemistry, Nano Technology Research Center, Urmia University, Urmia (Iran, Islamic Republic of); Department of Nanochemistry, Faculty of Science, Urmia University, Urmia (Iran, Islamic Republic of)
2017-02-01
Graphene quantum dots-based immunosensors have recently gained importance for detecting antigens and biomarkers responsible for cancer diagnosis. This paper reports a literature survey of the applications of graphene quantum dots for sensing cancer biomarkers. The survey sought to explore three questions: (1) Do graphene quantum dots improve immunosensing technology? (2) If so, can graphene quantum dots have a critical, positive impact on construction of immuno-devices? And (3) What is the reason for some troubles in the application of this technology? The number of published papers in the field seems positively answer the first two questions. However additional efforts must be made to move from the bench to the real diagnosis. Some approaches to improve the analytical performance of graphene quantum dots-based immunosensors through their figures of merit have been also discussed. - Highlights: • We present the state of the art of GQDs-based immunosensors employed in cancer diagnosis. • Their analytical performance was compared identifying their advantages and limitations. • Approaches to improve the analytical performance of GQDs-based immunosensors are reported.
-
Directory of Open Access Journals (Sweden)
A. V. Artemyev
2013-04-01
Full Text Available The lifetimes of electrons trapped in Earth's radiation belts can be calculated from quasi-linear pitch-angle diffusion by whistler-mode waves, provided that their frequency spectrum is broad enough and/or their average amplitude is not too large. Extensive comparisons between improved analytical lifetime estimates and full numerical calculations have been performed in a broad parameter range representative of a large part of the magnetosphere from L ~ 2 to 6. The effects of observed very oblique whistler waves are taken into account in both numerical and analytical calculations. Analytical lifetimes (and pitch-angle diffusion coefficients are found to be in good agreement with full numerical calculations based on CRRES and Cluster hiss and lightning-generated wave measurements inside the plasmasphere and Cluster lower-band chorus waves measurements in the outer belt for electron energies ranging from 100 keV to 5 MeV. Comparisons with lifetimes recently obtained from electron flux measurements on SAMPEX, SCATHA, SAC-C and DEMETER also show reasonable agreement.
-
Hoehn, Jessica R.; Finkelstein, Noah D.
2018-06-01
As part of a research study on student reasoning in quantum mechanics, we examine students' use of ontologies, or the way students' categorically organize entities they are reasoning about. In analyzing three episodes of focus group discussions with modern physics students, we present evidence of the dynamic nature of ontologies, and refine prior theoretical frameworks for thinking about dynamic ontologies. We find that in a given reasoning episode ontologies can be dynamic in construction (referring to when the reasoner constructs the ontologies) or application (referring to which ontologies are applied in a given reasoning episode). In our data, we see instances of students flexibly switching back and forth between parallel stable structures as well as constructing and negotiating new ontologies in the moment. Methodologically, we use a collective conceptual blending framework as an analytic tool for capturing student reasoning in groups. In this research, we value the messiness of student reasoning and argue that reasoning in a tentative manner can be productive for students learning quantum mechanics. As such, we shift away from a binary view of student learning which sees students as either having the correct answer or not.
-
Sievert, K-D; Chapple, C; Herschorn, S; Joshi, M; Zhou, J; Nardo, C; Nitti, V W
2014-10-01
A prespecified pooled analysis of two placebo-controlled, phase 3 trials evaluated whether the number of prior anticholinergics used or reason for their discontinuation affected the treatment response to onabotulinumtoxinA 100U in overactive bladder (OAB) patients with urinary incontinence (UI). Patients with symptoms of OAB received intradetrusor injections of onabotulinumtoxinA 100U or placebo, sparing the trigone. Change from baseline at week 12 in UI episodes/day, proportion of patients reporting a positive response ('greatly improved' or 'improved') on the treatment benefit scale (TBS), micturition and urgency were evaluated by number of prior anticholinergics (1, 2 or ≥ 3) and reason for their discontinuation (insufficient efficacy or side effects). Adverse events (AE) were assessed. Patients had taken an average of 2.4 anticholinergics before study enrolment. OnabotulinumtoxinA reduced UI episodes/day from baseline vs. placebo, regardless of the number of prior anticholinergics (-2.82 vs. -1.52 for one prior anticholinergic; -2.58 vs. -0.58 for two prior anticholinergics; and -2.92 vs. -0.73 for three or more prior anticholinergics; all p reason for discontinuation. OnabotulinumtoxinA reduced the episodes of urgency and frequency of micturition vs. placebo in all groups. AEs were well tolerated, with a comparable incidence in all groups. In patients with symptoms of OAB who were inadequately managed by one or more anticholinergics, onabotulinumtoxinA 100U provided significant and similar treatment benefit and safety profile regardless of the number of prior anticholinergics used or reason for inadequate management of OAB. ClinicalTrials.gov: NCT00910845, NCT00910520. © 2014 The Authors. International Journal of Clinical Practice published by John Wiley & Sons Ltd.
-
International Nuclear Information System (INIS)
Xi Jiayuan; Lu Liang; Deng Gang
2001-01-01
Objective: To evaluate the diagnostic value of selective angiography for unknown reason gastrointestinal hemorrhage. Methods: 32 patients with acute or chronic gastrointestinal recurrent hemorrhage were examined. Among them, 26 patients had upper gastrointestinal hemorrhage and 6 with inferior gastrointestinal hemorrhage. All patients were under gone DSA and/or Puck angiography with Seldinger's technique. Results: The accuracy of localization was 84.38% (27/32) and the coincident rates with the operation or pathology was 78.95%(15/19). In all of patients, tumor of 9 case were shown and 15 cases of vascular diseases, namely, 9 with vascular malformation, 2 with small intestinal aneurysm, 3 with arteriosclerosis and 1 with broken gallbladder aneurysm; 3 cases of ulcer or nonspecific inflammation and 5 cases were negative. 23 cases (71.87%) showed the direct hemorrhagic sign, namely the contrast media extra vacation. Conclusions: Selective angiography is very helpful for determining the location and the character of unknown reasoned acute or chronic gastrointestinal hemorrhage, especially for the hemorrhage of the small intestine and biliary tracts
-
Perturbation theory and coupling constant analyticity in two-dimensional field theories
International Nuclear Information System (INIS)
Simon, B.
1973-01-01
Conjectural material and results over a year old are presented in the discussion of perturbation theory and coupling constant analyticity in two-dimensional field theories. General properties of perturbation series are discussed rather than questions of field theory. The question is interesting for two reasons: First, one would like to understand why perturbation theory is such a good guide (to show that perturbation theory determines the theory in some way). Secondly, one hopes to prove that some or all of the theories are nontrivial. (U.S.)
-
IPOLE - semi-analytic scheme for relativistic polarized radiative transport
Mościbrodzka, M.; Gammie, C. F.
2018-03-01
We describe IPOLE, a new public ray-tracing code for covariant, polarized radiative transport. The code extends the IBOTHROS scheme for covariant, unpolarized transport using two representations of the polarized radiation field: In the coordinate frame, it parallel transports the coherency tensor; in the frame of the plasma it evolves the Stokes parameters under emission, absorption, and Faraday conversion. The transport step is implemented to be as spacetime- and coordinate- independent as possible. The emission, absorption, and Faraday conversion step is implemented using an analytic solution to the polarized transport equation with constant coefficients. As a result, IPOLE is stable, efficient, and produces a physically reasonable solution even for a step with high optical depth and Faraday depth. We show that the code matches analytic results in flat space, and that it produces results that converge to those produced by Dexter's GRTRANS polarized transport code on a complicated model problem. We expect IPOLE will mainly find applications in modelling Event Horizon Telescope sources, but it may also be useful in other relativistic transport problems such as modelling for the IXPE mission.
-
DI Pietro, Tammie L; Doran, Diane M; McArthur, Gregory
2010-01-01
Variations in nursing care have been observed, affecting patient outcomes and quality of care. Case-based reasoners that benchmark for patient indicators can reduce variation through decision support. This study evaluated and validated a case-based reasoning application to establish benchmarks for nursing-sensitive patient outcomes of pain, fatigue, and toilet use, using patient characteristic variables for generating similar cases. Three graduate nursing students participated. Each ranked 25 patient cases using demographics of age, sex, diagnosis, and comorbidities against 10 patients from a database. Participant judgments of case similarity were compared with the case-based reasoning system. Feature weights for each indicator were adjusted to make the case-based reasoning system's similarity ranking correspond more closely to participant judgment. Small differences were noted between initial weights and weights generated from participants. For example, initial weight for comorbidities was 0.35, whereas weights generated by participants for pain, fatigue, and toilet use were 0.49, 0.42, and 0.48, respectively. For the same outcomes, the initial weight for sex was 0.15, but weights generated by the participants were 0.025, 0.002, and 0.000, respectively. Refinement of the case-based reasoning tool established valid benchmarks for patient outcomes in relation to participants and assisted in point-of-care decision making.
-
Advanced analytical techniques
International Nuclear Information System (INIS)
Mrochek, J.E.; Shumate, S.E.; Genung, R.K.; Bahner, C.T.; Lee, N.E.; Dinsmore, S.R.
1976-01-01
The development of several new analytical techniques for use in clinical diagnosis and biomedical research is reported. These include: high-resolution liquid chromatographic systems for the early detection of pathological molecular constituents in physiologic body fluids; gradient elution chromatography for the analysis of protein-bound carbohydrates in blood serum samples, with emphasis on changes in sera from breast cancer patients; electrophoretic separation techniques coupled with staining of specific proteins in cellular isoenzymes for the monitoring of genetic mutations and abnormal molecular constituents in blood samples; and the development of a centrifugal elution chromatographic technique for the assay of specific proteins and immunoglobulins in human blood serum samples
-
Calkins, Monica E; Iacono, William G; Ones, Deniz S
2008-12-01
Several forms of eye movement dysfunction (EMD) are regarded as promising candidate endophenotypes of schizophrenia. Discrepancies in individual study results have led to inconsistent conclusions regarding particular aspects of EMD in relatives of schizophrenia patients. To quantitatively evaluate and compare the candidacy of smooth pursuit, saccade and fixation deficits in first-degree biological relatives, we conducted a set of meta-analytic investigations. Among 18 measures of EMD, memory-guided saccade accuracy and error rate, global smooth pursuit dysfunction, intrusive saccades during fixation, antisaccade error rate and smooth pursuit closed-loop gain emerged as best differentiating relatives from controls (standardized mean differences ranged from .46 to .66), with no significant differences among these measures. Anticipatory saccades, but no other smooth pursuit component measures were also increased in relatives. Visually-guided reflexive saccades were largely normal. Moderator analyses examining design characteristics revealed few variables affecting the magnitude of the meta-analytically observed effects. Moderate effect sizes of relatives v. controls in selective aspects of EMD supports their endophenotype potential. Future work should focus on facilitating endophenotype utility through attention to heterogeneity of EMD performance, relationships among forms of EMD, and application in molecular genetics studies.
-
Risk as analysis and risk as feelings: some thoughts about affect, reason, risk, and rationality.
Slovic, Paul; Finucane, Melissa L; Peters, Ellen; MacGregor, Donald G
2004-04-01
Modern theories in cognitive psychology and neuroscience indicate that there are two fundamental ways in which human beings comprehend risk. The "analytic system" uses algorithms and normative rules, such as probability calculus, formal logic, and risk assessment. It is relatively slow, effortful, and requires conscious control. The "experiential system" is intuitive, fast, mostly automatic, and not very accessible to conscious awareness. The experiential system enabled human beings to survive during their long period of evolution and remains today the most natural and most common way to respond to risk. It relies on images and associations, linked by experience to emotion and affect (a feeling that something is good or bad). This system represents risk as a feeling that tells us whether it is safe to walk down this dark street or drink this strange-smelling water. Proponents of formal risk analysis tend to view affective responses to risk as irrational. Current wisdom disputes this view. The rational and the experiential systems operate in parallel and each seems to depend on the other for guidance. Studies have demonstrated that analytic reasoning cannot be effective unless it is guided by emotion and affect. Rational decision making requires proper integration of both modes of thought. Both systems have their advantages, biases, and limitations. Now that we are beginning to understand the complex interplay between emotion and reason that is essential to rational behavior, the challenge before us is to think creatively about what this means for managing risk. On the one hand, how do we apply reason to temper the strong emotions engendered by some risk events? On the other hand, how do we infuse needed "doses of feeling" into circumstances where lack of experience may otherwise leave us too "coldly rational"? This article addresses these important questions.
-
Assessing clinical reasoning abilities of medical students using clinical performance examination
Directory of Open Access Journals (Sweden)
Sunju Im
2016-03-01
Full Text Available Purpose: The purpose of this study is to investigate the reliability and validity of new clinical performance examination (CPX for assessing clinical reasoning skills and evaluating clinical reasoning ability of the students. Methods: Third-year medical school students (n=313 in Busan-Gyeongnam consortium in 2014 were included in the study. One of 12 stations was developed to assess clinical reasoning abilities. The scenario and checklists of the station were revised by six experts. Chief complaint of the case was rhinorrhea, accompanied by fever, headache, and vomiting. Checklists focused on identifying of the main problem and systematic approach to the problem. Students interviewed the patient and recorded subjective and objective findings, assessments, plans (SOAP note for 15 minutes. Two professors assessed students simultaneously. We performed statistical analysis on their scores and survey. Results: The Cronbach α of subject station was 0.878 and Cohen κ coefficient between graders was 0.785. Students agreed on CPX as an adequate tool to evaluate students’ performance, but some graders argued that the CPX failed to secure its validity due to their lack of understanding the case. One hundred eight students (34.5% identified essential problem early and only 58 (18.5% performed systematic history taking and physical examination. One hundred seventy-three of them (55.3% communicated correct diagnosis with the patient. Most of them had trouble in writing SOAP notes. Conclusion: To gain reliability and validity, interrater agreement should be secured. Students' clinical reasoning skills were not enough. Students need to be trained on problem identification, reasoning skills and accurate record-keeping.
-
Extended Analytic Linear Model of Hydraulic Cylinder With Respect Different Piston Areas and Volumes
Directory of Open Access Journals (Sweden)
Petr KOŇAŘÍK
2009-06-01
Full Text Available Standard analytic linear model of hydraulic cylinder usually comes from assumptions of identical action piston areas on both sides of hydraulic cylinder (double piston rod and suitable operation point, which is usually chosen in the middle of piston. By reason of that volumes inside of cylinder are than same. Moreover for control of that arrangement of hydraulic cylinder, usually controlled by 4/3 servovalve, the same mount of flows comes in and comes out to each of chambers of hydraulic cylinder. Presented paper deal with development of extended form of analytic linear model of single piston rod hydraulic cylinder which respects different action piston areas and volumes inside of chambers of hydraulic cylinder and also two different input flows of hydraulic cylinder. In extended model are also considered possibilities of different dead volumes in hoses and intake parts of hydraulic cylinder. Dead volume has impact on damping of hydraulic cylinder. Because the system of hydraulic cylinder is generally presented as a integrative system with inertia of second order: eq , we can than obtain time constants and damping of hydraulic cylinder for each of analytic form model. The model has arisen for needs of model fractionation on two parts. Part of behaviour of chamber A and part of behaviour of chamber B of cylinder. It was created for the reason of analysis and synthesis of control parameters of regulation circuit of multivalve control concept of hydraulic drive with separately controlled chamber A and B which could be then used for.
-
Analytical Radiation Transport Benchmarks for The Next Century
International Nuclear Information System (INIS)
Ganapol, B.D.
2005-01-01
Verification of large-scale computational algorithms used in nuclear engineering and radiological applications is an essential element of reliable code performance. For this reason, the development of a suite of multidimensional semi-analytical benchmarks has been undertaken to provide independent verification of proper operation of codes dealing with the transport of neutral particles. The benchmarks considered cover several one-dimensional, multidimensional, monoenergetic and multigroup, fixed source and critical transport scenarios. The first approach, called the Green's Function. In slab geometry, the Green's function is incorporated into a set of integral equations for the boundary fluxes. Through a numerical Fourier transform inversion and subsequent matrix inversion for the boundary fluxes, a semi-analytical benchmark emerges. Multidimensional solutions in a variety of infinite media are also based on the slab Green's function. In a second approach, a new converged SN method is developed. In this method, the SN solution is ''minded'' to bring out hidden high quality solutions. For this case multigroup fixed source and criticality transport problems are considered. Remarkably accurate solutions can be obtained with this new method called the Multigroup Converged SN (MGCSN) method as will be demonstrated
-
Analytical quality by design: a tool for regulatory flexibility and robust analytics.
Peraman, Ramalingam; Bhadraya, Kalva; Padmanabha Reddy, Yiragamreddy
2015-01-01
Very recently, Food and Drug Administration (FDA) has approved a few new drug applications (NDA) with regulatory flexibility for quality by design (QbD) based analytical approach. The concept of QbD applied to analytical method development is known now as AQbD (analytical quality by design). It allows the analytical method for movement within method operable design region (MODR). Unlike current methods, analytical method developed using analytical quality by design (AQbD) approach reduces the number of out-of-trend (OOT) results and out-of-specification (OOS) results due to the robustness of the method within the region. It is a current trend among pharmaceutical industry to implement analytical quality by design (AQbD) in method development process as a part of risk management, pharmaceutical development, and pharmaceutical quality system (ICH Q10). Owing to the lack explanatory reviews, this paper has been communicated to discuss different views of analytical scientists about implementation of AQbD in pharmaceutical quality system and also to correlate with product quality by design and pharmaceutical analytical technology (PAT).
-
An analysis of basic design students' intuitive and analytic attitudes in colour decisions
Akbay, Saadet
2003-01-01
Cataloged from PDF version of article. Colour can be defined as a subjective preference, an experience and an intuitive sense, or as a theory and a science. Design education regards colour as a scientific theory by means of reasoning. The design students’ colour decisions, values, and intuitive attitudes are aimed to be developed and cultivated by colour education in basic design, and supported and equipped by knowledge towards analytical attitudes. Thus, the major concern o...
-
Comparison of a semi-analytic and a CFD model uranium combustion to experimental data
International Nuclear Information System (INIS)
Clarksean, R.
1998-01-01
Two numerical models were developed and compared for the analysis of uranium combustion and ignition in a furnace. Both a semi-analytical solution and a computational fluid dynamics (CFD) numerical solution were obtained. Prediction of uranium oxidation rates is important for fuel storage applications, fuel processing, and the development of spent fuel metal waste forms. The semi-analytical model was based on heat transfer correlations, a semi-analytical model of flow over a flat surface, and simple radiative heat transfer from the material surface. The CFD model numerically determined the flowfield over the object of interest, calculated the heat and mass transfer to the material of interest, and calculated the radiative heat exchange of the material with the furnace. The semi-analytical model is much less detailed than the CFD model, but yields reasonable results and assists in understanding the physical process. Short computation times allowed the analyst to study numerous scenarios. The CFD model had significantly longer run times, was found to have some physical limitations that were not easily modified, but was better able to yield details of the heat and mass transfer and flow field once code limitations were overcome
-
Lores, Marta; Llompart, Maria; Alvarez-Rivera, Gerardo; Guerra, Eugenia; Vila, Marlene; Celeiro, Maria; Lamas, J Pablo; Garcia-Jares, Carmen
2016-04-07
Cosmetic products placed on the market and their ingredients, must be safe under reasonable conditions of use, in accordance to the current legislation. Therefore, regulated and allowed chemical substances must meet the regulatory criteria to be used as ingredients in cosmetics and personal care products, and adequate analytical methodology is needed to evaluate the degree of compliance. This article reviews the most recent methods (2005-2015) used for the extraction and the analytical determination of the ingredients included in the positive lists of the European Regulation of Cosmetic Products (EC 1223/2009): comprising colorants, preservatives and UV filters. It summarizes the analytical properties of the most relevant analytical methods along with the possibilities of fulfilment of the current regulatory issues. The cosmetic legislation is frequently being updated; consequently, the analytical methodology must be constantly revised and improved to meet safety requirements. The article highlights the most important advances in analytical methodology for cosmetics control, both in relation to the sample pretreatment and extraction and the different instrumental approaches developed to solve this challenge. Cosmetics are complex samples, and most of them require a sample pretreatment before analysis. In the last times, the research conducted covering this aspect, tended to the use of green extraction and microextraction techniques. Analytical methods were generally based on liquid chromatography with UV detection, and gas and liquid chromatographic techniques hyphenated with single or tandem mass spectrometry; but some interesting proposals based on electrophoresis have also been reported, together with some electroanalytical approaches. Regarding the number of ingredients considered for analytical control, single analyte methods have been proposed, although the most useful ones in the real life cosmetic analysis are the multianalyte approaches. Copyright © 2016
-
Reason and ethos: Consequences of their separation and necessity of their unity
Directory of Open Access Journals (Sweden)
Marković Mihailo
2003-01-01
Full Text Available Although the concept of "reason" acquired a precise meaning and clearly defined field of validity only in Kant's critical philosophy, the term has a long genesis in European intellectual history. The roots of the concept lie in the Greek concept of the logos and may be reduced to six basic meanings. The earliest Greek thinkers used the word logos to denote the logical structure of the human thought and the rational structure of the world. Anaxagoras considered the all-embracing spiritual principle of the nous the source of overall rationality. In the philosophy of the Stoa the term - logos spermaticos is the active principle acting on passive matter in order to create the world. For the Stoics, the concept of logos is the fundamental principle of entire morality. In Christian theology, the God is logos, Holy Spirit - pneuma the soul. In modern philosophy the basic meanings of the Greek logos were taken over by Latin terms "intellectus" and "ratio". These concepts chart quite clearly two basic lines of European thought, one characterized by immediate and the other by mediated discursive understanding of the truth. Kant was the first in the history of philosophy to introduce the essential distinction between understanding and reason (Verstand and Vernunft. According to this distinction, understanding is analytical and abstract, while reason is the source of apriori principles connecting and grounding the whole of our knowledge and volition. Therefore Kant distinguishes theoretical from practical reason. Though practical reason applies the concepts and principles of theoretical reason, it has priority over the latter because it bestows practical reality also on what is theoretically unknowable (freedom, God, immortality of the soul. The primacy of practical reason was especially emphasized by Fichte in his Doctrine of Science. Reason is for him a purely purposeful activity. The idea of reason attains full articulation in Hegel's philosophy of the
-
DEFF Research Database (Denmark)
Harmsen, Charlotte Gry; Støvring, Henrik; Jarbøl, Dorte Ejg
2012-01-01
Shared decision-making and patients' choice of interventions are areas of increasing importance, not least seen in the light of the fact that chronic conditions are increasing, interventions considered important for public health, and still non-acceptance of especially risk-reducing treatments...... of cardiovascular diseases (CVD) is prevalent. A better understanding of patients' medication-taking behavior is needed and may be reached by studying the reasons why people accept or decline medication recommendations. The aim of this paper was to identify factors that may influence people's decisions...... and reasoning for accepting or declining a cardiovascular preventive medication offer....
-
Schubach, Fabian; Goos, Matthias; Fabry, Götz; Vach, Werner; Boeker, Martin
2017-09-15
The objective of this study is to compare two different instructional methods in the curricular use of computerized virtual patients in undergraduate medical education. We aim to investigate whether using many short and focused cases - the key feature principle - is more effective for the learning of clinical reasoning skills than using few long and systematic cases. We conducted a quasi-randomized, non-blinded, controlled parallel-group intervention trial in a large medical school in Southwestern Germany. During two seminar sessions, fourth- and fifth-year medical students (n = 56) worked on the differential diagnosis of the acute abdomen. The educational tool - virtual patients - was the same, but the instructional method differed: In one trial arm, students worked on multiple short cases, with the instruction being focused only on important elements ("key feature arm", n = 30). In the other trial arm, students worked on few long cases, with the instruction being comprehensive and systematic ("systematic arm", n = 26). The overall training time was the same in both arms. The students' clinical reasoning capacity was measured by a specifically developed instrument, a script concordance test. Their motivation and the perceived effectiveness of the instruction were assessed using a structured evaluation questionnaire. Upon completion of the script concordance test with a reference score of 80 points and a standard deviation of 5 for experts, students in the key feature arm attained a mean of 57.4 points (95% confidence interval: 50.9-63.9), and in the systematic arm, 62.7 points (57.2-68.2), with Cohen's d at 0.337. The difference is statistically non-significant (p = 0.214). In the evaluation survey, students in the key feature arm indicated that they experienced more time pressure and perceived the material as more difficult. In this study powered for a medium effect, we could not provide empirical evidence for the hypothesis that a key feature
-
Hammami, Muhammad M; Al-Jawarneh, Yussuf; Hammami, Muhammad B; Al Qadire, Mohammad
2014-01-10
The current doctrine of informed consent for clinical care has been developed in cultures characterized by low-context communication and monitoring-style coping. There are scarce empirical data on patients' norm perception of information disclosure in other cultures. We surveyed 470 adults who were planning to undergo or had recently undergone a written informed consent-requiring procedure in a tertiary healthcare hospital in Saudi Arabia. Perceptions of norm and current practice were explored using a 5-point Likert scale (1 = strongly agree with disclosure) and 30 information items in 7 domains: practitioners' details, benefits, risks, complications' management, available alternatives, procedure's description, and post-procedure's issues. Respondents' mean (SD) age was 38.4 (12.5); 50.2% were males, 57.2% had ≥ college education, and 37.9% had undergone a procedure. According to norm perception, strongly agree/agree responses ranged from 98.0% (major benefits) to 50.5% (assistant/trainee's name). Overall, items related to benefits and post-procedure's issues were ranked better (more agreeable) than items related to risks and available alternatives. Ranking scores were better in post-procedure respondents for 4 (13.3%) items (p s name) to 13.9% (lead practitioner's training place), ranking scores were worse for all items compared to norm perception (p norm, 2) the focus of the desired information is closer to benefits and post-procedure's issues than risks and available alternatives, 3) male, post-procedure, and older patients are in favor of more information disclosure, 4) male, older, and more educated patients may be particularly dissatisfied with current information disclosure. The focus and extent of information disclosure for clinical informed consent may need to be adjusted if a "reasonable" patient's standard is to be met.
-
Bener, Abdulbari; Dafeeah, Elnour E; Salem, Mohamad O
2013-04-01
The aim of this study was to examine the extent of psychiatric patients' compliance and non-compliance with treatment and examine the factors that affect compliance. Patients were recruited who were between 16 and 60 years of age and who were hospitalized with a psychiatric disorder and treated in the outpatient clinics of the psychiatry department. A total of 689 patients were approached and 564 patients agreed to participate in the study, a response rate of 81.8%. Participants were asked to complete a questionnaire that asked about socio-demographic characteristics (e.g., age, gender, nationality, level of education, occupation, marital status, and life style habits); medication(s) prescribed and the participant's response; the degree of social supervision (rated subjectively by the patient as "poor," "good," or "very good"); data also were obtained from clinical records. Data analyses explored significant associations between compliance and non-compliance and a group of relevant variables. Of the 564 patients studied, 328 (58.2%) were compliant with treatment and 236 (41.8%) were non-compliant. There was no significant difference between compliance and non-compliance in terms of gender (p = 0.471). Patients between 21-30 years of age were significantly more compliant with drug treatment than not. Non-compliance was more common among patients diagnosed with schizophrenia (28.4%), followed by depression (14.4%), and bipolar affective disorder (12.7%) (p = 0.001). Only 25% of compliant patients and 26.3% of non-compliant patients used non-psychotropic medication. Social supervision (40%) was very poor in non-compliant patients whereas 49.4% of compliant patients had very good family support. Notable reasons for non-compliance were irregular attendance to clinic (55.5%), ignorance about side effects of medication (61%), free medicine (45.8%), and a lack of education about medication (58.1%). This study revealed that non-compliance rates among psychiatry patients
-
Rohde, Emily; Domm, Elizabeth
2018-02-01
To review the current literature about nurses' clinical reasoning practices that support safe medication administration. The literature about medication administration frequently focuses on avoiding medication errors. Nurses' clinical reasoning used during medication administration to maintain medication safety receives less attention in the literature. As healthcare professionals, nurses work closely with patients, assessing and intervening to promote mediation safety prior to, during and after medication administration. They also provide discharge teaching about using medication safely. Nurses' clinical reasoning and practices that support medication safety are often invisible when the focus is medication errors avoidance. An integrative literature review was guided by Whittemore and Knafl's (Journal of Advanced Nursing, 5, 2005 and 546) five-stage review of the 11 articles that met review criteria. This review is modelled after Gaffney et al.'s (Journal of Clinical Nursing, 25, 2016 and 906) integrative review on medical error recovery. Health databases were accessed and systematically searched for research reporting nurses' clinical reasoning practices that supported safe medication administration. The level and quality of evidence of the included research articles were assessed using The Johns Hopkins Nursing Evidence-Based Practice Rating Scale©. Nurses have a central role in safe medication administration, including but not limited to risk awareness about the potential for medication errors. Nurses assess patients and their medication and use knowledge and clinical reasoning to administer medication safely. Results indicated nurses' use of clinical reasoning to maintain safe medication administration was inadequately articulated in 10 of 11 studies reviewed. Nurses are primarily responsible for safe medication administration. Nurses draw from their foundational knowledge of patient conditions and organisational processes and use clinical reasoning that
-
International Nuclear Information System (INIS)
Wong, K. M.; Chim, W. K.
2007-01-01
An approach for fast and accurate carrier profiling using deep-depletion analytical modeling of scanning capacitance microscopy (SCM) measurements is shown for an ultrashallow p-n junction with a junction depth of less than 30 nm and a profile steepness of about 3 nm per decade change in carrier concentration. In addition, the analytical model is also used to extract the SCM dopant profiles of three other p-n junction samples with different junction depths and profile steepnesses. The deep-depletion effect arises from rapid changes in the bias applied between the sample and probe tip during SCM measurements. The extracted carrier profile from the model agrees reasonably well with the more accurate carrier profile from inverse modeling and the dopant profile from secondary ion mass spectroscopy measurements
-
Bruce, William J; Maxwell, E A; Sneddon, I N
1963-01-01
Analytic Trigonometry details the fundamental concepts and underlying principle of analytic geometry. The title aims to address the shortcomings in the instruction of trigonometry by considering basic theories of learning and pedagogy. The text first covers the essential elements from elementary algebra, plane geometry, and analytic geometry. Next, the selection tackles the trigonometric functions of angles in general, basic identities, and solutions of equations. The text also deals with the trigonometric functions of real numbers. The fifth chapter details the inverse trigonometric functions
-
Phonon dispersion on Ag (100) surface: A modified analytic embedded atom method study
International Nuclear Information System (INIS)
Zhang Xiao-Jun; Chen Chang-Le
2016-01-01
Within the harmonic approximation, the analytic expression of the dynamical matrix is derived based on the modified analytic embedded atom method (MAEAM) and the dynamics theory of surface lattice. The surface phonon dispersions along three major symmetry directions, and XM-bar are calculated for the clean Ag (100) surface by using our derived formulas. We then discuss the polarization and localization of surface modes at points X-bar and M-bar by plotting the squared polarization vectors as a function of the layer index. The phonon frequencies of the surface modes calculated by MAEAM are compared with the available experimental and other theoretical data. It is found that the present results are generally in agreement with the referenced experimental or theoretical results, with a maximum deviation of 10.4%. The agreement shows that the modified analytic embedded atom method is a reasonable many-body potential model to quickly describe the surface lattice vibration. It also lays a significant foundation for studying the surface lattice vibration in other metals. (paper)
-
Fabbrini, G; Abbruzzese, G; Barone, P; Antonini, A; Tinazzi, M; Castegnaro, G; Rizzoli, S; Morisky, D E; Lessi, P; Ceravolo, R
2013-11-01
Information about patients' adherence to therapy represents a primary issue in Parkinson's disease (PD) management. To perform the linguistic validation of the Italian version of the self-rated 8-Item Morisky Medical Adherence Scale (MMAS-8) and to describe in a sample of Italian patients affected by PD the adherence to anti-Parkinson drug therapy and the association between adherence and some socio-demographic and clinical features. MMAS-8 was translated into Italian language by two independent Italian mother-tongue translators. The consensus version was then back-translated by an English mother-tongue translator. This translation process was followed by a consensus meeting between the authors of translation and investigators and then by two comprehension tests. The translated version of the MMAS-8 scale was then administered at the baseline visit of the "REASON" study (Italian Study on the Therapy Management in Parkinson's disease: Motor, Non-Motor, Adherence and Quality Of Life Factors) in a large sample of PD patients. The final version of the MMAS-8 was easily understood. Mean ± SD MMAS-8 score was 6.1 ± 1.2. There were no differences in adherence to therapy in relationship to disease severity, gender, educational level or decision to change therapy. The Italian version of MMAS-8, the key tool of the REASON study to assess the adherence to therapy, has shown to be understandable to patients with PD. Patients enrolled in the REASON study showed medium therapy adherence.
-
Ramírez, Juan Carlos; Cura, Carolina Inés; da Cruz Moreira, Otacilio; Lages-Silva, Eliane; Juiz, Natalia; Velázquez, Elsa; Ramírez, Juan David; Alberti, Anahí; Pavia, Paula; Flores-Chávez, María Delmans; Muñoz-Calderón, Arturo; Pérez-Morales, Deyanira; Santalla, José; Marcos da Matta Guedes, Paulo; Peneau, Julie; Marcet, Paula; Padilla, Carlos; Cruz-Robles, David; Valencia, Edward; Crisante, Gladys Elena; Greif, Gonzalo; Zulantay, Inés; Costales, Jaime Alfredo; Alvarez-Martínez, Miriam; Martínez, Norma Edith; Villarroel, Rodrigo; Villarroel, Sandro; Sánchez, Zunilda; Bisio, Margarita; Parrado, Rudy; Maria da Cunha Galvão, Lúcia; Jácome da Câmara, Antonia Cláudia; Espinoza, Bertha; Alarcón de Noya, Belkisyole; Puerta, Concepción; Riarte, Adelina; Diosque, Patricio; Sosa-Estani, Sergio; Guhl, Felipe; Ribeiro, Isabela; Aznar, Christine; Britto, Constança; Yadón, Zaida Estela; Schijman, Alejandro G
2015-09-01
An international study was performed by 26 experienced PCR laboratories from 14 countries to assess the performance of duplex quantitative real-time PCR (qPCR) strategies on the basis of TaqMan probes for detection and quantification of parasitic loads in peripheral blood samples from Chagas disease patients. Two methods were studied: Satellite DNA (SatDNA) qPCR and kinetoplastid DNA (kDNA) qPCR. Both methods included an internal amplification control. Reportable range, analytical sensitivity, limits of detection and quantification, and precision were estimated according to international guidelines. In addition, inclusivity and exclusivity were estimated with DNA from stocks representing the different Trypanosoma cruzi discrete typing units and Trypanosoma rangeli and Leishmania spp. Both methods were challenged against 156 blood samples provided by the participant laboratories, including samples from acute and chronic patients with varied clinical findings, infected by oral route or vectorial transmission. kDNA qPCR showed better analytical sensitivity than SatDNA qPCR with limits of detection of 0.23 and 0.70 parasite equivalents/mL, respectively. Analyses of clinical samples revealed a high concordance in terms of sensitivity and parasitic loads determined by both SatDNA and kDNA qPCRs. This effort is a major step toward international validation of qPCR methods for the quantification of T. cruzi DNA in human blood samples, aiming to provide an accurate surrogate biomarker for diagnosis and treatment monitoring for patients with Chagas disease. Copyright © 2015 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.
-
Groundwater Seepage Estimation into Amirkabir Tunnel Using Analytical Methods and DEM and SGR Method
Hadi Farhadian; Homayoon Katibeh
2015-01-01
In this paper, groundwater seepage into Amirkabir tunnel has been estimated using analytical and numerical methods for 14 different sections of the tunnel. Site Groundwater Rating (SGR) method also has been performed for qualitative and quantitative classification of the tunnel sections. The obtained results of above mentioned methods were compared together. The study shows reasonable accordance with results of the all methods unless for two sections of tunnel. In these t...
-
[Description of the mental processes occurring during clinical reasoning].
Pottier, P; Planchon, B
2011-06-01
Clinical reasoning is a highly complex system with multiple inter-dependent mental activities. Gaining a better understanding of those cognitive processes has two practical implications: for physicians, being able to analyse their own reasoning method may prove to be helpful in diagnostic dead end; for medical teachers, identifying problem-solving strategies used by medical students may foster an appropriate individual feed-back aiming at improving their clinical reasoning skills. On the basis of a detailed literature review, the main diagnostic strategies and their related pattern of mental processes are described and illustrated with a concrete example, going from the patient's complaint to the chosen solution. Inductive, abductive and deductive diagnostic approaches are detailed. Different strategies for collecting data (exhaustive or oriented) and for problem-building are described. The place of problem solving strategies such as pattern-recognition, scheme inductive process, using of clinical script, syndrome grouping and mental hypotheses test is considered. This work aims at breaking up mental activities in process within clinical reasoning reminding that expert reasoning is characterised by the ability to use and structure the whole of these activities in a coherent system, using combined strategies in order to guarantee a better accuracy of their diagnosis. Copyright © 2010 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.
-
International Nuclear Information System (INIS)
Dhole, K.; Tripathy, M.K.; Ghadigaonkar, R.D.; Datta, A.; Bose, H.; Roy, M.
2011-01-01
The feasibility of refractometry for rapid measurement of D 2 O (heavy water) concentration has been studied. Refractometry has been utilised to be an excellent analytical technique to quickly and non-invasively determine D 2 O concentration in water samples without using any chemical reagents. The measurement of refractive index property of water samples with use of temperature control has been utilized for the purpose of their quantitative analysis. The calibration performance provided a reasonable analytical sensitivity of this technique in the 1-100% D 2 O range. (author)
-
Moral reasoning in women with posttraumatic stress disorder related to childhood abuse
Directory of Open Access Journals (Sweden)
Anthony Nazarov
2016-11-01
Full Text Available Background: Preliminary evidence suggests that relative to healthy controls, patients with posttraumatic stress disorder (PTSD show deficits on several inter-related social cognitive tasks, including theory of mind, and emotion comprehension. Systematic investigations examining other aspects of social cognition, including moral reasoning, have not been conducted in PTSD stemming from childhood trauma. Objective: To conduct a comprehensive assessment of moral reasoning performance in individuals with PTSD stemming from childhood abuse. Method: Moral reasoning performance was assessed in 28 women with PTSD related to prolonged childhood trauma and 19 matched healthy controls. Performance was assessed using 12 modified moral dilemmas and was queried in three domains: utilitarian/deontological sacrificial dilemmas (personal and impersonal, social order vs. compassion, and altruism vs. self-interest. Participants were asked whether a proposed action was morally acceptable or unacceptable and whether or not they would perform this action under the circumstances described. Results: Women with PTSD were less likely to carry out utilitarian actions in personal, sacrificial moral dilemmas, a choice driven primarily by consequential intrapersonal disapproval. Increased concern regarding intrapersonal disapproval was related to higher symptoms of guilt in the PTSD group. Patients with PTSD demonstrated less altruistic moral reasoning, primarily associated with decreased empathic role-taking for beneficiaries. Conclusions: Women with PTSD due to childhood trauma show alterations in moral reasoning marked by decreased utilitarian judgment and decreased altruism. Childhood trauma may continue to impact moral choices made into adulthood.
-
Heuristic reasoning and relative incompleteness
Treur, J.
1993-01-01
In this paper an approach is presented in which heuristic reasoning is interpreted as strategic reasoning. This type of reasoning enables one to derive which hypothesis to investigate, and which observable information to acquire next (to be able to verify the chosen hypothesis). A compositional architecture for reasoning systems that perform such heuristic reasoning is introduced, called SIX (for Strategic Interactive eXpert systems). This compositional architecture enables user interaction a...
-
Real-Time and Retrospective Health-Analytics-as-a-Service: A Novel Framework.
Khazaei, Hamzeh; McGregor, Carolyn; Eklund, J Mikael; El-Khatib, Khalil
2015-11-18
Analytics-as-a-service (AaaS) is one of the latest provisions emerging from the cloud services family. Utilizing this paradigm of computing in health informatics will benefit patients, care providers, and governments significantly. This work is a novel approach to realize health analytics as services in critical care units in particular. To design, implement, evaluate, and deploy an extendable big-data compatible framework for health-analytics-as-a-service that offers both real-time and retrospective analysis. We present a novel framework that can realize health data analytics-as-a-service. The framework is flexible and configurable for different scenarios by utilizing the latest technologies and best practices for data acquisition, transformation, storage, analytics, knowledge extraction, and visualization. We have instantiated the proposed method, through the Artemis project, that is, a customization of the framework for live monitoring and retrospective research on premature babies and ill term infants in neonatal intensive care units (NICUs). We demonstrated the proposed framework in this paper for monitoring NICUs and refer to it as the Artemis-In-Cloud (Artemis-IC) project. A pilot of Artemis has been deployed in the SickKids hospital NICU. By infusing the output of this pilot set up to an analytical model, we predict important performance measures for the final deployment of Artemis-IC. This process can be carried out for other hospitals following the same steps with minimal effort. SickKids' NICU has 36 beds and can classify the patients generally into 5 different types including surgical and premature babies. The arrival rate is estimated as 4.5 patients per day, and the average length of stay was calculated as 16 days. Mean number of medical monitoring algorithms per patient is 9, which renders 311 live algorithms for the whole NICU running on the framework. The memory and computation power required for Artemis-IC to handle the SickKids NICU will be
-
Real-Time and Retrospective Health-Analytics-as-a-Service: A Novel Framework
McGregor, Carolyn; Eklund, J Mikael; El-Khatib, Khalil
2015-01-01
Background Analytics-as-a-service (AaaS) is one of the latest provisions emerging from the cloud services family. Utilizing this paradigm of computing in health informatics will benefit patients, care providers, and governments significantly. This work is a novel approach to realize health analytics as services in critical care units in particular. Objective To design, implement, evaluate, and deploy an extendable big-data compatible framework for health-analytics-as-a-service that offers both real-time and retrospective analysis. Methods We present a novel framework that can realize health data analytics-as-a-service. The framework is flexible and configurable for different scenarios by utilizing the latest technologies and best practices for data acquisition, transformation, storage, analytics, knowledge extraction, and visualization. We have instantiated the proposed method, through the Artemis project, that is, a customization of the framework for live monitoring and retrospective research on premature babies and ill term infants in neonatal intensive care units (NICUs). Results We demonstrated the proposed framework in this paper for monitoring NICUs and refer to it as the Artemis-In-Cloud (Artemis-IC) project. A pilot of Artemis has been deployed in the SickKids hospital NICU. By infusing the output of this pilot set up to an analytical model, we predict important performance measures for the final deployment of Artemis-IC. This process can be carried out for other hospitals following the same steps with minimal effort. SickKids’ NICU has 36 beds and can classify the patients generally into 5 different types including surgical and premature babies. The arrival rate is estimated as 4.5 patients per day, and the average length of stay was calculated as 16 days. Mean number of medical monitoring algorithms per patient is 9, which renders 311 live algorithms for the whole NICU running on the framework. The memory and computation power required for Artemis
-
Burdette, A C
1971-01-01
Analytic Geometry covers several fundamental aspects of analytic geometry needed for advanced subjects, including calculus.This book is composed of 12 chapters that review the principles, concepts, and analytic proofs of geometric theorems, families of lines, the normal equation of the line, and related matters. Other chapters highlight the application of graphing, foci, directrices, eccentricity, and conic-related topics. The remaining chapters deal with the concept polar and rectangular coordinates, surfaces and curves, and planes.This book will prove useful to undergraduate trigonometric st
-
Directory of Open Access Journals (Sweden)
Keefe Richard SE
2009-07-01
Full Text Available Abstract Background Neurocognitive impairment and psychiatric symptoms have been associated with deficits in psychosocial and occupational functioning in patients with schizophrenia. This post-hoc analysis evaluates the relationships among cognition, psychopathology, and psychosocial functioning in patients with schizophrenia at baseline and following sustained treatment with antipsychotic drugs. Methods Data were obtained from a clinical trial assessing the cognitive effects of selected antipsychotic drugs in patients with schizophrenia. Patients were randomly assigned to 24 weeks of treatment with olanzapine (n = 159, risperidone (n = 158, or haloperidol (n = 97. Psychosocial functioning was assessed with the Heinrichs-Carpenter Quality of Life Scale [QLS], cognition with a standard battery of neurocognitive tests; and psychiatric symptoms with the Positive and Negative Syndrome Scale [PANSS]. A path-analytic approach was used to evaluate the effects of changes in cognitive functioning on subdomains of quality of life, and to determine whether such effects were direct or mediated via changes in psychiatric symptoms. Results At baseline, processing speed affected functioning mainly indirectly via negative symptoms. Positive symptoms also affected functioning at baseline although independent of cognition. At 24 weeks, changes in processing speed affected changes in functioning both directly and indirectly via PANSS negative subscale scores. Positive symptoms no longer contributed to the path-analytic models. Although a consistent relationship was observed between processing speed and the 3 functional domains, variation existed as to whether the paths were direct and/or indirect. Working memory and verbal memory did not significantly contribute to any of the path-analytic models studied. Conclusion Processing speed demonstrated direct and indirect effects via negative symptoms on three domains of functioning as measured by the QLS at baseline and
-
Inductive Reasoning and Writing
Rooks, Clay; Boyd, Robert
2003-01-01
Induction, properly understood, is not merely a game, nor is it a gimmick, nor is it an artificial way of explaining an element of reasoning. Proper understanding of inductive reasoning--and the various types of reasoning that the authors term inductive--enables the student to evaluate critically other people's writing and enhances the composition…
-
International Nuclear Information System (INIS)
Gerner, C.
2013-01-01
Comprehensive understanding of complex biological processes is the basis for many biomedical issues of great relevance for modern society including risk assessment, drug development, quality control of industrial products and many more. Screening methods provide means for investigating biological samples without research hypothesis. However, the first boom of analytical screening efforts has passed and we again need to ask whether and how to apply screening methods. Mass spectrometry is a modern tool with unrivalled analytical capacities. This applies to all relevant characteristics of analytical methods such as specificity, sensitivity, accuracy, multiplicity and diversity of applications. Indeed, mass spectrometry qualifies to deal with complexity. Chronic inflammation is a common feature of almost all relevant diseases challenging our modern society; these diseases are apparently highly diverse and include arteriosclerosis, cancer, back pain, neurodegenerative diseases, depression and other. The complexity of mechanisms regulating chronic inflammation is the reason for the practical challenge to deal with it. The presentation shall give an overview of capabilities and limitations of the application of this analytical tool to solve critical questions with great relevance for our society. (author)
-
Measuring Relational Reasoning
Alexander, Patricia A.; Dumas, Denis; Grossnickle, Emily M.; List, Alexandra; Firetto, Carla M.
2016-01-01
Relational reasoning is the foundational cognitive ability to discern meaningful patterns within an informational stream, but its reliable and valid measurement remains problematic. In this investigation, the measurement of relational reasoning unfolded in three stages. Stage 1 entailed the establishment of a research-based conceptualization of…
-
Analyticity without Differentiability
Kirillova, Evgenia; Spindler, Karlheinz
2008-01-01
In this article we derive all salient properties of analytic functions, including the analytic version of the inverse function theorem, using only the most elementary convergence properties of series. Not even the notion of differentiability is required to do so. Instead, analytical arguments are replaced by combinatorial arguments exhibiting…
-
Analytical evaluation of a new point of care system for measuring cardiac Troponin I
Kemper, D.W.; Semjonow, V.; de Theije, F.; Keizer, D.; van Lippen, L.; Mair, J.; Wille, B.; Christ, M.; Geijer, F.; Hausfater, P.; Pariente, D.; Scharnhorst, V.; Curvers, J.; Nieuwenhuis, J.
2017-01-01
OBJECTIVES: Point-of-care cardiac troponin testing with adequate analytical performances has the potential to improve chest pain patients flow in the emergency department. We present the analytical evaluation of the newly developed Philips Minicare cTnI point-of-care immunoassay. DESIGN & METHODS:
-
International Nuclear Information System (INIS)
Lores, Marta; Llompart, Maria; Alvarez-Rivera, Gerardo; Guerra, Eugenia; Vila, Marlene; Celeiro, Maria; Lamas, J. Pablo; Garcia-Jares, Carmen
2016-01-01
Cosmetic products placed on the market and their ingredients, must be safe under reasonable conditions of use, in accordance to the current legislation. Therefore, regulated and allowed chemical substances must meet the regulatory criteria to be used as ingredients in cosmetics and personal care products, and adequate analytical methodology is needed to evaluate the degree of compliance. This article reviews the most recent methods (2005–2015) used for the extraction and the analytical determination of the ingredients included in the positive lists of the European Regulation of Cosmetic Products (EC 1223/2009): comprising colorants, preservatives and UV filters. It summarizes the analytical properties of the most relevant analytical methods along with the possibilities of fulfilment of the current regulatory issues. The cosmetic legislation is frequently being updated; consequently, the analytical methodology must be constantly revised and improved to meet safety requirements. The article highlights the most important advances in analytical methodology for cosmetics control, both in relation to the sample pretreatment and extraction and the different instrumental approaches developed to solve this challenge. Cosmetics are complex samples, and most of them require a sample pretreatment before analysis. In the last times, the research conducted covering this aspect, tended to the use of green extraction and microextraction techniques. Analytical methods were generally based on liquid chromatography with UV detection, and gas and liquid chromatographic techniques hyphenated with single or tandem mass spectrometry; but some interesting proposals based on electrophoresis have also been reported, together with some electroanalytical approaches. Regarding the number of ingredients considered for analytical control, single analyte methods have been proposed, although the most useful ones in the real life cosmetic analysis are the multianalyte approaches. - Highlights:
-
Energy Technology Data Exchange (ETDEWEB)
Lores, Marta, E-mail: marta.lores@usc.es; Llompart, Maria; Alvarez-Rivera, Gerardo; Guerra, Eugenia; Vila, Marlene; Celeiro, Maria; Lamas, J. Pablo; Garcia-Jares, Carmen
2016-04-07
Cosmetic products placed on the market and their ingredients, must be safe under reasonable conditions of use, in accordance to the current legislation. Therefore, regulated and allowed chemical substances must meet the regulatory criteria to be used as ingredients in cosmetics and personal care products, and adequate analytical methodology is needed to evaluate the degree of compliance. This article reviews the most recent methods (2005–2015) used for the extraction and the analytical determination of the ingredients included in the positive lists of the European Regulation of Cosmetic Products (EC 1223/2009): comprising colorants, preservatives and UV filters. It summarizes the analytical properties of the most relevant analytical methods along with the possibilities of fulfilment of the current regulatory issues. The cosmetic legislation is frequently being updated; consequently, the analytical methodology must be constantly revised and improved to meet safety requirements. The article highlights the most important advances in analytical methodology for cosmetics control, both in relation to the sample pretreatment and extraction and the different instrumental approaches developed to solve this challenge. Cosmetics are complex samples, and most of them require a sample pretreatment before analysis. In the last times, the research conducted covering this aspect, tended to the use of green extraction and microextraction techniques. Analytical methods were generally based on liquid chromatography with UV detection, and gas and liquid chromatographic techniques hyphenated with single or tandem mass spectrometry; but some interesting proposals based on electrophoresis have also been reported, together with some electroanalytical approaches. Regarding the number of ingredients considered for analytical control, single analyte methods have been proposed, although the most useful ones in the real life cosmetic analysis are the multianalyte approaches. - Highlights:
-
The Christological Ontology of Reason
DEFF Research Database (Denmark)
Nissen, Ulrik Becker
2006-01-01
Taking the startingpoint in an assertion of an ambiguity in the Lutheran tradition’s assessment of reason, the essay argues that the Kantian unreserved confidence in reason is criticised in Bonhoeffer. Based upon a Christological understanding of reason, Bonhoeffer endorses a view of reason which...... is treated in the essay. Here it is argued that Bonhoeffer may be appropriated in attempting to outline a Christological ontology of reason holding essential implications for the sources and conditions of public discourse....
-
Diagnostic Reasoning across the Medical Education Continuum
Directory of Open Access Journals (Sweden)
C. Scott Smith
2014-07-01
Full Text Available We aimed to study linguistic and non-linguistic elements of diagnostic reasoning across the continuum of medical education. We performed semi-structured interviews of premedical students, first year medical students, third year medical students, second year internal medicine residents, and experienced faculty (ten each as they diagnosed three common causes of dyspnea. A second observer recorded emotional tone. All interviews were digitally recorded and blinded transcripts were created. Propositional analysis and concept mapping were performed. Grounded theory was used to identify salient categories and transcripts were scored with these categories. Transcripts were then unblinded. Systematic differences in propositional structure, number of concept connections, distribution of grounded theory categories, episodic and semantic memories, and emotional tone were identified. Summary concept maps were created and grounded theory concepts were explored for each learning level. We identified three major findings: (1 The “apprentice effect” in novices (high stress and low narrative competence; (2 logistic concept growth in intermediates; and (3 a cognitive state transition (between analytical and intuitive approaches in experts. These findings warrant further study and comparison.
-
Teaching for Ethical Reasoning
Sternberg, Robert J.
2012-01-01
This article argues for the importance of teaching for ethical reasoning. Much of our teaching is in vain if it is not applied to life in an ethical manner. The article reviews lapses in ethical reasoning and the great costs they have had for society. It proposes that ethical reasoning can be taught across the curriculum. It presents an eight-step…
-
International Nuclear Information System (INIS)
Peters, T.; Fink, S.
2011-01-01
As part of the implementation process for the Next Generation Cesium Extraction Solvent (NGCS), SRNL and F/H Lab performed a series of analytical cross-checks to ensure that the components in the NGCS solvent system do not constitute an undue analytical challenge. For measurement of entrained Isopar(reg s ign) L in aqueous solutions, both labs performed similarly with results more reliable at higher concentrations (near 50 mg/L). Low bias occurred in both labs, as seen previously for comparable blind studies for the baseline solvent system. SRNL recommends consideration to use of Teflon(trademark) caps on all sample containers used for this purpose. For pH measurements, the labs showed reasonable agreement but considerable positive bias for dilute boric acid solutions. SRNL recommends consideration of using an alternate analytical method for qualification of boric acid concentrations.
-
Koivisto, Jaana-Maija; Multisilta, Jari; Niemi, Hannele; Katajisto, Jouko; Eriksson, Elina
2016-10-01
Clinical reasoning is viewed as a problem-solving activity; in games, players solve problems. To provide excellent patient care, nursing students must gain competence in clinical reasoning. Utilising gaming elements and virtual simulations may enhance learning of clinical reasoning. To investigate nursing students' experiences of learning clinical reasoning process by playing a 3D simulation game. Cross-sectional descriptive study. Thirteen gaming sessions at two universities of applied sciences in Finland. The prototype of the simulation game used in this study was single-player in format. The game mechanics were built around the clinical reasoning process. Nursing students from the surgical nursing course of autumn 2014 (N=166). Data were collected by means of an online questionnaire. In terms of the clinical reasoning process, students learned how to take action and collect information but were less successful in learning to establish goals for patient care or to evaluate the effectiveness of interventions. Learning of the different phases of clinical reasoning process was strongly positively correlated. The students described that they learned mainly to apply theoretical knowledge while playing. The results show that those who played digital games daily or occasionally felt that they learned clinical reasoning by playing the game more than those who did not play at all. Nursing students' experiences of learning the clinical reasoning process by playing a 3D simulation game showed that such games can be used successfully for learning. To ensure that students follow a systematic approach, the game mechanics need to be built around the clinical reasoning process. Copyright © 2016 Elsevier Ltd. All rights reserved.
-
Crunelle, Cleo L; van den Brink, Wim; Veltman, Dick J; van Emmerik-van Oortmerssen, Katelijne; Dom, Geert; Schoevers, Robert A; Booij, Jan
2013-12-01
Methylphenidate (MPH) occupies brain striatal dopamine transporters (DATs) and is an effective treatment for attention deficit hyperactivity disorder (ADHD). However, patients with ADHD and comorbid cocaine dependence do not benefit significantly from treatment with MPH. To better understand the neurobiology of this phenomenon, we examined DAT availability and the effects of MPH treatment on DAT occupancy in ADHD patients with and without cocaine dependence. ADHD patients without a comorbid substance use disorder (N=16) and ADHD patients with comorbid cocaine dependence (N=8) were imaged at baseline and after two weeks MPH treatment using single photon emission computed tomography (SPECT) with the DAT tracer [(123)I]FP-CIT. Changes in ADHD symptoms were measured with the ADHD symptom rating scale (ASRS). At baseline, we observed lower striatal DAT availability in ADHD patients with cocaine dependence. Following fixed MPH treatment, MPH occupied significantly less striatal DATs in cocaine-dependent than in non-cocaine dependent ADHD patients. There were no significant correlations between baseline DAT availability or DAT occupancy by MPH and ADHD symptom improvement. However, we did find significant correlations between DAT occupancy by MPH and decreases in impulsivity scores and years of cocaine use. These preliminary findings suggest that low DAT occupancy is not the reason why ADHD patients with cocaine dependence do not benefit from MPH treatment. It also suggests that higher dosages of MPH in these patients are probably not the solution and that medications directed at other pharmacological targets should be considered in these comorbid ADHD patients. This trial is registered at the Dutch Trial Register, www.trialregister.nl, under Trial ID number NTR3127. Copyright © 2013 Elsevier B.V. and ECNP. All rights reserved.
-
International Nuclear Information System (INIS)
Picologlou, B.F.; Reed, C.B.; Dauzvardis, P.V.; Walker, J.S.
1986-01-01
A program of analytical and experimental investigations in MHD flows has been established at Argonne National Lab. (ANL) within the framework of the Blanket Technology Program. An experimental facility for such investigations has been built and is being operated at ANL. The investigations carried out on the Argonne Liquid-Metal engineering EXperiment (ALEX) are complemented by analysis carried out at the Univ. of Illinois. The first phase of the experimental program is devoted to investigations of well-defined cases for which analytical solutions exist. Such testing will allow validation and increased confidence in the theory. Because analytical solutions exist for only a few cases, which do not cover the entire range of anticipated flow behavior, confining testing to these cases will not be an adequate validation of the theory. For this reason, this phase involves testing and a companion analytical effort aimed toward obtaining solutions for a broad range of cases, which, although simple in geometry, are believed to encompass the range of flow phenomena relevant to fusion. This parallel approach is necessary so that analysis will guide and help plan the experiments, whereas the experimental results will provide information needed to validate and/or refine the analysis
-
Analytical model for time to cover cracking in RC structures due to rebar corrosion
International Nuclear Information System (INIS)
Bhargava, Kapilesh; Ghosh, A.K.; Mori, Yasuhiro; Ramanujam, S.
2006-01-01
The structural degradation of concrete structures due to reinforcement corrosion is a major worldwide problem. Reinforcement corrosion causes a volume increase due to the oxidation of metallic iron, which is mainly responsible for exerting the expansive radial pressure at the steel-concrete interface and development of hoop tensile stresses in the surrounding concrete. Cracking occurs, once the maximum hoop tensile stress exceeds the tensile strength of the concrete. The cracking begins at the steel-concrete interface and propagates outwards and eventually results in the thorough cracking of the cover concrete and this would indicate the loss of service life for the corrosion affected structures. An analytical model is proposed to predict the time required for cover cracking and the weight loss of reinforcing bar in corrosion affected reinforced concrete structures. The modelling aspects of the residual strength of cracked concrete and the stiffness contribution from the combination of reinforcement and expansive corrosion products have also been incorporated in the model. The problem is modeled as a boundary value problem and the governing equations are expressed in terms of the radial displacement. The analytical solutions are presented considering a simple two-zone model for the cover concrete, viz. cracked or uncracked. Reasonable estimation of the various parameters in the model related to the composition and properties of expansive corrosion products based on the available published experimental data has also been discussed. The performance of the proposed corrosion cracking model is then investigated through its ability to reproduce available experimental trends. Reasonably good agreement between experimental results and the analytical predictions has been obtained. It has also been found that tensile strength and initial tangent modulus of cover concrete, annual mean corrosion rate and modulus of elasticity of reinforcement plus corrosion products combined
-
Probst, Charlotte; Manthey, Jakob; Martinez, Alicia; Rehm, Jürgen
2015-08-12
Alcohol use disorders are among the mental disorders with the lowest treatment rates. Increasing the treatment rates requires insight on the reasons why patients do not seek treatment. This study examined self-reported reasons for not seeking treatment and their association with alcohol use disorder severity among primary health care patients diagnosed with an alcohol use disorder. Alcohol use disorders, health service utilization, and reasons for not seeking treatment were assessed via interviews on regionally representative samples of primary care patients from 6 European countries (Italy, Germany, Hungary, Latvia, Poland and Spain, total N = 9,098). Additionally, general practitioners had to fill in a questionnaire assessing their patients' alcohol use and alcohol use disorders. A multinomial logistic regression was performed to investigate the association between reasons for not seeking treatment and alcohol use disorder severity. Of 1,008 patients diagnosed with an alcohol use disorder (via general practitioner or patient interview) in the past 12 months, the majority (N = 810) did not receive treatment and 251 of those gave a reason for not seeking treatment. The most frequent reason was 'lack of problem awareness' (55.3% of those who responded), the second most common response was 'stigma or shame' (28.6%), followed by 'encounter barriers' (22.8%) and 'cope alone' (20.9%). The results indicated lower probabilities of reporting 'denial' and higher probabilities to report 'encounter barriers' as alcohol use disorders severity increases. However, both trends were discontinued for patients with severe alcohol use disorders. Particularly at lower levels of alcohol use disorder severity, a lack of problem awareness prevents patients from seeking treatment. Routinely alcohol consumption monitoring in primary care practices could help primary and secondary prevention of alcohol use disorders and increase treatment coverage.
-
Ifenthaler, Dirk; Seel, Norbert M.
2013-01-01
In this paper, there will be a particular focus on mental models and their application to inductive reasoning within the realm of instruction. A basic assumption of this study is the observation that the construction of mental models and related reasoning is a slowly developing capability of cognitive systems that emerges effectively with proper…
-
Macro-reasoning and cognitive gaps: understanding post-Soviet Russians’ communication styles
Directory of Open Access Journals (Sweden)
Elena FELL
2017-07-01
Full Text Available Russians and Westerners access, process and communicate information in different ways. Whilst Westerners favour detailed analysis of subject matter, Russians tend to focus on certain components that are, in their view, significant. This disparity makes it difficult to achieve constructive dialogues between Western and Russian stakeholders contributing to cross-cultural communication problems. The author claims that the difference in the ways Russians and Westerners negotiate information is a significant cultural difference between Russia and West rather than an irritating (and in principle amenable lack of analytical skills on the Russian partners’ part. Understanding the reasons behind the Russian-specific approaches to dealing with information would be a positive step towards a more effective cross-cultural communication, important in business situations and essential in diplomacy.
-
Analytics for vaccine economics and pricing: insights and observations.
Robbins, Matthew J; Jacobson, Sheldon H
2015-04-01
Pediatric immunization programs in the USA are a successful and cost-effective public health endeavor, profoundly reducing mortalities caused by infectious diseases. Two important issues relate to the success of the immunization programs, the selection of cost-effective vaccines and the appropriate pricing of vaccines. The recommended childhood immunization schedule, published annually by the CDC, continues to expand with respect to the number of injections required and the number of vaccines available for selection. The advent of new vaccines to meet the growing requirements of the schedule results: in a large, combinatorial number of possible vaccine formularies. The expansion of the schedule and the increase in the number of available vaccines constitutes a challenge for state health departments, large city immunization programs, private practices and other vaccine purchasers, as a cost-effective vaccine formulary must be selected from an increasingly large set of possible vaccine combinations to satisfy the schedule. The pediatric vaccine industry consists of a relatively small number of pharmaceutical firms engaged in the research, development, manufacture and distribution of pediatric vaccines. The number of vaccine manufacturers has dramatically decreased in the past few decades for a myriad of reasons, most notably due to low profitability. The contraction of the industry negatively impacts the reliable provision of pediatric vaccines. The determination of appropriate vaccine prices is an important issue and influences a vaccine manufacturer's decision to remain in the market. Operations research is a discipline that applies advanced analytical methods to improve decision making; analytics is the application of operations research to a particular problem using pertinent data to provide a practical result. Analytics provides a mechanism to resolve the challenges facing stakeholders in the vaccine development and delivery system, in particular, the selection
-
Analytic study of the Migdal-Kadanoff recursion formula
International Nuclear Information System (INIS)
Ito, K.R.
1984-01-01
After proposing lattice gauge field models in which the Migdal renormalization group recursion formulas are exact, we study the recursion formulas analytically. If D is less than 4, it is shown that the effective actions of D-dimensional U(1) lattice gauge models are uniformly driven to the high temperature region no matter how low the initial temperature is. If the initial temperature is large enough, this holds for any D and gauge group G. These are also the cases for the recursion formulas of Kadanoff type. It turns out, however, that the string tension for D=3 obtained by these methods is rather big compared with the one already obtained by Mack, Goepfert and by the present author. The reason is clarified. (orig.)
-
Modern Adaptive Analytics Approach to Lowering Seismic Network Detection Thresholds
Johnson, C. E.
2017-12-01
Modern seismic networks present a number of challenges, but perhaps most notably are those related to 1) extreme variation in station density, 2) temporal variation in station availability, and 3) the need to achieve detectability for much smaller events of strategic importance. The first of these has been reasonably addressed in the development of modern seismic associators, such as GLASS 3.0 by the USGS/NEIC, though some work still remains to be done in this area. However, the latter two challenges demand special attention. Station availability is impacted by weather, equipment failure or the adding or removing of stations, and while thresholds have been pushed to increasingly smaller magnitudes, new algorithms are needed to achieve even lower thresholds. Station availability can be addressed by a modern, adaptive architecture that maintains specified performance envelopes using adaptive analytics coupled with complexity theory. Finally, detection thresholds can be lowered using a novel approach that tightly couples waveform analytics with the event detection and association processes based on a principled repicking algorithm that uses particle realignment for enhanced phase discrimination.
-
Kolliakou, A; Castle, D; Sallis, H; Joseph, C; O'Connor, J; Wiffen, B; Gayer-Anderson, C; McQueen, G; Taylor, H; Bonaccorso, S; Gaughran, F; Smith, S; Greenwood, K; Murray, R M; Di Forti, M; Atakan, Z; Ismail, K
2015-01-01
Why patients with psychosis use cannabis remains debated. The self-medication hypothesis has received some support but other evidence points towards an alleviation of dysphoria model. This study investigated the reasons for cannabis use in first-episode psychosis (FEP) and whether strength in their endorsement changed over time. FEP inpatients and outpatients at the South London and Maudsley, Oxleas and Sussex NHS Trusts UK, who used cannabis, rated their motives at baseline (n=69), 3 months (n=29) and 12 months (n=36). A random intercept model was used to test the change in strength of endorsement over the 12 months. Paired-sample t-tests assessed the differences in mean scores between the five subscales on the Reasons for Use Scale (enhancement, social motive, coping with unpleasant affect, conformity and acceptance and relief of positive symptoms and side effects), at each time-point. Time had a significant effect on scores when controlling for reason; average scores on each subscale were higher at baseline than at 3 months and 12 months. At each time-point, patients endorsed 'enhancement' followed by 'coping with unpleasant affect' and 'social motive' more highly for their cannabis use than any other reason. 'Conformity and acceptance' followed closely. 'Relief of positive symptoms and side effects' was the least endorsed motive. Patients endorsed their reasons for use at 3 months and 12 months less strongly than at baseline. Little support for the self-medication or alleviation of dysphoria models was found. Rather, patients rated 'enhancement' most highly for their cannabis use. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
-
DEFF Research Database (Denmark)
Ammari, ABH; Hendriksen, Carsten; Rydahl Hansen, Susan
2015-01-01
professionals. However, an unexpectedly high number of families declined participation in the trial. We describe and discuss the recruitment strategy and patient reported reasons for non-participation to add to the knowledge about what impedes recruitment and to identify the factors that influence willingness...... to participate in research aimed at family coping early in the palliative care trajectory. Patients with advanced cancer and their closest relative were recruited from medical, surgical, and oncological departments. Reasons for non-participation were registered and characteristics of participants and non......-participants were compared to evaluate differences between subgroups of non-participants based on reasons not to participate and reasons to participate in the trial. A total of 65.9% of the families declined participation. Two main categories for declining participation emerged: first, that the "burden of illness...
-
How People Reason: A Grounded Theory Study of Scientific Reasoning about Global Climate Change
Liu, Shiyu
Scientific reasoning is crucial in both scientific inquiry and everyday life. While the majority of researchers have studied "how people reason" by focusing on their cognitive processes, factors related to the underpinnings of scientific reasoning are still under-researched. The present study aimed to develop a grounded theory that captures not only the cognitive processes during reasoning but also their underpinnings. In particular, the grounded theory and phenomenographic methodologies were integrated to explore how undergraduate students reason about competing theories and evidence on global climate change. Twenty-six undergraduate students were recruited through theoretical sampling. Constant comparative analysis of responses from interviews and written assessments revealed that participants were mostly drawn to the surface features when reasoning about evidence. While prior knowledge might not directly contribute to participants' performance on evidence evaluation, it affected their level of engagement when reading and evaluating competing arguments on climate issues. More importantly, even though all participants acknowledged the relative correctness of multiple perspectives, they predominantly favored arguments that supported their own beliefs with weak scientific reasoning about the opposing arguments. Additionally, factors such as personal interests, religious beliefs, and reading capacity were also found to have bearings on the way participants evaluated evidence and arguments. In all, this work contributes to the current endeavors in exploring the nature of scientific reasoning. Taking a holistic perspective, it provides an in-depth discussion of factors that may affect or relate to scientific reasoning processes. Furthermore, in comparison with traditional methods used in the literature, the methodological approach employed in this work brought an innovative insight into the investigation of scientific reasoning. Last but not least, this research may
-
Thematic Reasoning and Theory of Mind. Accounting for Social Inference Difficulties in Schizophrenia
Directory of Open Access Journals (Sweden)
Rhiannon Corcoran
2005-01-01
Full Text Available Background Corcoran (2000, 2001 has suggested that theory of mind judgements can be arrived at using analogical reasoning skills and she has proposed that this is the route that people with schizophrenia take when they make inferences about others' mental states. Recent work has demonstrated a robust relationship between mental state inference and autobiographical memory, providing initial support for the model. This study examines the model further by exploring the assertion that in schizophrenia the ability to infer the mental states of others also depends upon effective social reasoning in conditional contexts. Method 59 people with a DSM IV diagnosis of schizophrenia and 44 healthy subjects performed four versions of the thematic selection task. The versions varied according to the familiarity and social nature of the material they incorporated. The same subjects also completed the Hinting Task, a measure of theory of mind and tests of intellectual functioning and narrative recall. Results The schizophrenia and the normal control groups differed in their performance on all of the measures except that of intellectual functioning. Explorations within the schizophrenia group indicated that social reasoning was most markedly affected in the patients with negative signs and in those with paranoid delusions while for the hinting task, those with negative signs performed significantly worse than those in remission but this difference seemed to be due to these patients' poorer narrative memory. There was evidence in the schizophrenia data to support the hypothesis of a relationship between theory of mind and social conditional reasoning. Conclusion This work provided further support for the idea that in patients with schizophrenia at least, judgements about the mental states of others are achieved using analogical reasoning.
-
Directory of Open Access Journals (Sweden)
Christoph Heesen
Full Text Available BACKGROUND: Prognostic counseling in multiple sclerosis (MS is difficult because of the high variability of disease progression. Simultaneously, patients and physicians are increasingly confronted with making treatment decisions at an early stage, which requires taking individual prognoses into account to strike a good balance between benefits and harms of treatments. It is therefore important to understand how patients and physicians estimate prognostic risk, and whether and how these estimates can be improved. An online analytical processing (OLAP tool based on pooled data from placebo cohorts of clinical trials offers short-term prognostic estimates that can be used for individual risk counseling. OBJECTIVE: The aim of this study was to clarify if personalized prognostic information as presented by the OLAP tool is considered useful and meaningful by patients. Furthermore, we used the OLAP tool to evaluate patients' and physicians' risk estimates. Within this evaluation process we assessed short-time prognostic risk estimates of patients with MS (final n = 110 and their physicians (n = 6 and compared them with the estimates of OLAP. RESULTS: Patients rated the OLAP tool as understandable and acceptable, but to be only of moderate interest. It turned out that patients, physicians, and the OLAP tool ranked patients similarly regarding their risk of disease progression. Both patients' and physicians' estimates correlated most strongly with those disease covariates that the OLAP tool's estimates also correlated with most strongly. Exposure to the OLAP tool did not change patients' risk estimates. CONCLUSION: While the OLAP tool was rated understandable and acceptable, it was only of modest interest and did not change patients' prognostic estimates. The results suggest, however, that patients had some idea regarding their prognosis and which factors were most important in this regard. Future work with OLAP should assess long-term prognostic
-
Heesen, Christoph; Gaissmaier, Wolfgang; Nguyen, Franziska; Stellmann, Jan-Patrick; Kasper, Jürgen; Köpke, Sascha; Lederer, Christian; Neuhaus, Anneke; Daumer, Martin
2013-01-01
Prognostic counseling in multiple sclerosis (MS) is difficult because of the high variability of disease progression. Simultaneously, patients and physicians are increasingly confronted with making treatment decisions at an early stage, which requires taking individual prognoses into account to strike a good balance between benefits and harms of treatments. It is therefore important to understand how patients and physicians estimate prognostic risk, and whether and how these estimates can be improved. An online analytical processing (OLAP) tool based on pooled data from placebo cohorts of clinical trials offers short-term prognostic estimates that can be used for individual risk counseling. The aim of this study was to clarify if personalized prognostic information as presented by the OLAP tool is considered useful and meaningful by patients. Furthermore, we used the OLAP tool to evaluate patients' and physicians' risk estimates. Within this evaluation process we assessed short-time prognostic risk estimates of patients with MS (final n = 110) and their physicians (n = 6) and compared them with the estimates of OLAP. Patients rated the OLAP tool as understandable and acceptable, but to be only of moderate interest. It turned out that patients, physicians, and the OLAP tool ranked patients similarly regarding their risk of disease progression. Both patients' and physicians' estimates correlated most strongly with those disease covariates that the OLAP tool's estimates also correlated with most strongly. Exposure to the OLAP tool did not change patients' risk estimates. While the OLAP tool was rated understandable and acceptable, it was only of modest interest and did not change patients' prognostic estimates. The results suggest, however, that patients had some idea regarding their prognosis and which factors were most important in this regard. Future work with OLAP should assess long-term prognostic estimates and clarify its usefulness for patients and physicians
-
Models of clinical reasoning with a focus on general practice: A critical review.
Yazdani, Shahram; Hosseinzadeh, Mohammad; Hosseini, Fakhrolsadat
2017-10-01
Diagnosis lies at the heart of general practice. Every day general practitioners (GPs) visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings. A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized. Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties of clinical reasoning in this setting is needed.
-
Models of clinical reasoning with a focus on general practice: a critical review
Directory of Open Access Journals (Sweden)
SHAHRAM YAZDANI
2017-10-01
Full Text Available Introduction: Diagnosis lies at the heart of general practice. Every day general practitioners (GPs visit patients with a wide variety of complaints and concerns, with often minor but sometimes serious symptoms. General practice has many features which differentiate it from specialty care setting, but during the last four decades little attention was paid to clinical reasoning in general practice. Therefore, we aimed to critically review the clinical reasoning models with a focus on the clinical reasoning in general practice or clinical reasoning of general practitioners to find out to what extent the existing models explain the clinical reasoning specially in primary care and also identity the gaps of the model for use in primary care settings Methods: A systematic search to find models of clinical reasoning were performed. To have more precision, we excluded the studies that focused on neurobiological aspects of reasoning, reasoning in disciplines other than medicine decision making or decision analysis on treatment or management plan. All the articles and documents were first scanned to see whether they include important relevant contents or any models. The selected studies which described a model of clinical reasoning in general practitioners or with a focus on general practice were then reviewed and appraisal or critics of other authors on these models were included. The reviewed documents on the model were synthesized Results: Six models of clinical reasoning were identified including hypothetic-deductive model, pattern recognition, a dual process diagnostic reasoning model, pathway for clinical reasoning, an integrative model of clinical reasoning, and model of diagnostic reasoning strategies in primary care. Only one model had specifically focused on general practitioners reasoning. Conclusion: A Model of clinical reasoning that included specific features of general practice to better help the general practitioners with the difficulties
-
Directory of Open Access Journals (Sweden)
Anthony Amatrudo
2016-12-01
Full Text Available This paper argues that both criminologists and lawyers need a far more philosophically robust account of joint action, notably as it relates to technical matters of intentionality and responsibility when dealing with joint criminal enterprise cases. Criminology seems unable to see beyond the superficiality of cultural explanations ill-suited to understanding matters of action. Law seems wedded to mystical notions of foresight. As regards the law there seems common agreement that joint enterprise prosecutions tend to over-criminalise secondary parties. This paper suggests that the current discussions around joint criminal enterprise will benefit from a critical engagement with analytical philosophy. The paper will examine a series of technical accounts of shared commitment and intention in order to explain the problems of joint criminal enterprise (multi-agent criminal activity. Este artículo defiende que tanto criminólogos como abogados necesitan ofrecer una acción conjunta más robusta, desde el punto de vista filosófico, especialmente en lo que se refiere a aspectos técnicos de intencionalidad y responsabilidad, al tratar casos de colaboración criminal. La criminología parece incapaz de ver más allá de la superficialidad de las explicaciones culturales, inadecuadas para entender cuestiones de acción. El derecho parece aliado con nociones místicas de previsión. En lo que respecta al derecho, parece que existe un consenso en que los fiscales de asociaciones de malhechores tienden a penalizar en exceso a los cómplices. Este artículo sugiere que el debate actual sobre asociaciones criminales se beneficiará de un compromiso crítico con la filosofía analítica. El artículo analiza un conjunto de explicaciones técnicas de compromiso e intención compartidos para explicar los problemas de las asociaciones criminales (actividad criminal multi-agente. DOWNLOAD THIS PAPER FROM SSRN: http://ssrn.com/abstract=2847796
-
Hungin, A P S; Hill, C; Raghunath, A
2009-08-15
Upper gastrointestinal symptoms impose a substantial illness burden and management costs. Understanding perceptions and reasons for seeking healthcare is a prerequisite for meeting patients' needs effectively. To review systematically findings on consultation frequencies for gastro-oesophageal reflux disease (GERD) and dyspepsia and patients' reasons for consultation. Systematic literature searches. Reported consultation rates ranged from 5.4% to 56% for GERD and from 26% to 70% for dyspepsia. Consultation for GERD was associated with increased symptom severity and frequency, interference with social activities, sleep disturbance, lack of timetabled work, higher levels of comorbidity, depression, anxiety, phobia, somatization and obsessionality. Some consulted because of fears that their symptoms represented serious disease; others avoided consultation because of this. Inconsistent associations were seen with medication use. Patients were less likely to consult if they felt that their doctor would trivialize their symptoms. Few factors were consistently associated with dyspepsia consultation. However, lower socio-economic status and Helicobacter pylori infection were associated with increased consultation. Patients' perceptions of their condition, comorbid factors and external reasons such as work and social factors are related to consultation rates for GERD. Awareness of these factors can guide the clinician towards a more effective strategy than one based on drug therapy alone.
-
[Reasons for exchange and explantation of intraocular lenses].
Neuhann, I; Fleischer, F; Neuhann, T
2012-08-01
This study was performed to analyse the reasons for explantation/exchange of intraocular lenses (IOL), which had originally been implanted for the correction of aphakia during cataract extraction. All cases with IOL explantation, which had been performed at one institution between 1/2008 and 12/2009 were analysed retrospectively. A total of 105 eyes of 100 patients were analysed. The median time interval between implantation and explantation of the IOL was 5.9 years (min. 0, max. 29.6). The most frequent cause for the intervention was subluxation/dislocation of the implant in 55.2% of cases. This group comprised 21% of cases with subluxation within the capsular bag in pseudoexfoliation syndrome. Other reasons were optical problems/incorrect IOL power (21%), calcification of hydrophilic acrylic IOL (7.6%), corneal decompensation associated with an anterior chamber lens (4.8%), and single cases with varying problems. The reasons for IOL exchange presented in this study are comparable to those of other series in the literature. Explantations due to optical problems may gain weight in the future due to a rise in refractive procedures and demands. © Georg Thieme Verlag KG Stuttgart · New York.
-
Promoting the self-regulation of clinical reasoning skills in nursing students.
Kuiper, R; Pesut, D; Kautz, D
2009-10-02
The purpose of this paper is to describe the research surrounding the theories and models the authors united to describe the essential components of clinical reasoning in nursing practice education. The research was conducted with nursing students in health care settings through the application of teaching and learning strategies with the Self-Regulated Learning Model (SRL) and the Outcome-Present-State-Test (OPT) Model of Reflective Clinical Reasoning. Standardized nursing languages provided the content and clinical vocabulary for the clinical reasoning task. This descriptive study described the application of the OPT model of clinical reasoning, use of nursing language content, and reflective journals based on the SRL model with 66 undergraduate nursing students over an 8 month period of time. The study tested the idea that self-regulation of clinical reasoning skills can be developed using self-regulation theory and the OPT model. This research supports a framework for effective teaching and learning methods to promote and document learner progress in mastering clinical reasoning skills. Self-regulated Learning strategies coupled with the OPT model suggest benefits of self-observation and self-monitoring during clinical reasoning activities, and pinpoints where guidance is needed for the development of cognitive and metacognitive awareness. Thinking and reasoning about the complexities of patient care needs requires attention to the content, processes and outcomes that make a nursing care difference. These principles and concepts are valuable to clinical decision making for nurses globally as they deal with local, regional, national and international health care issues.
-
Visual Analytics of Complex Genomics Data to Guide Effective Treatment Decisions
Directory of Open Access Journals (Sweden)
Quang Vinh Nguyen
2016-09-01
Full Text Available In cancer biology, genomics represents a big data problem that needs accurate visual data processing and analytics. The human genome is very complex with thousands of genes that contain the information about the individual patients and the biological mechanisms of their disease. Therefore, when building a framework for personalised treatment, the complexity of the genome must be captured in meaningful and actionable ways. This paper presents a novel visual analytics framework that enables effective analysis of large and complex genomics data. By providing interactive visualisations from the overview of the entire patient cohort to the detail view of individual genes, our work potentially guides effective treatment decisions for childhood cancer patients. The framework consists of multiple components enabling the complete analytics supporting personalised medicines, including similarity space construction, automated analysis, visualisation, gene-to-gene comparison and user-centric interaction and exploration based on feature selection. In addition to the traditional way to visualise data, we utilise the Unity3D platform for developing a smooth and interactive visual presentation of the information. This aims to provide better rendering, image quality, ergonomics and user experience to non-specialists or young users who are familiar with 3D gaming environments and interfaces. We illustrate the effectiveness of our approach through case studies with datasets from childhood cancers, B-cell Acute Lymphoblastic Leukaemia (ALL and Rhabdomyosarcoma (RMS patients, on how to guide the effective treatment decision in the cohort.
-
Faiciuc, Lucia E
2008-06-01
The majority of the existing theories explaining deductive reasoning could be included in a classic computationalist approach of the cognitive processes. In fact, deductive reasoning could be seen to be the pinnacle of the symbolic computationalism, its last fortress to be defended in the face of new, dynamic, and ecological perspectives over cognition. But are there weak points in that position regarding deductive reasoning? What would be the reasons for which new perspectives could gain in credibility? What could be their most important tenets? The answers given to those questions in the paper include two main points. The first one is that the present empirical data could not sustain unambiguously one view over the other, that they are obtained in artificial experimental conditions, and that there are data that are not easily explainable using the traditional computationalist paradigm. The second one is that approaching the deductive reasoning from dynamic and ecological perspectives could have significant advantages. The most obvious one is the possibility to integrate more easily the research regarding the deductive reasoning with the results obtained in other domains of the psychology (especially in what respects the lower cognitive processes), in artificial intelligence or in neurophysiology. The reasons for that would be that such perspectives, as they are sketched in the paper, would imply, essentially, processes of second-order pattern formation and recognition (as it is the case for perception), embodied cognition, and dynamic processes as the brain ones are.
-
Directory of Open Access Journals (Sweden)
Boretzki J
2017-11-01
Full Text Available Johanna Boretzki,1,2 Eva Wolf,3 Carmen Wiese,4 Sebastian Noe,4 Annamaria Balogh,3 Anja Meurer,5 Ivanka Krznaric,6 Alexander Zink,7 Christian Lersch,1 Christoph D Spinner1,2 1Department of Medicine II, University Hospital Klinikum rechts der Isar, Munich, 2German Center for Infection Research, Partner Site Munich, 3MUC Research, Munich, 4MVZ Karlsplatz, HIV Clinical Care Center, Munich, 5Center for Infectiology and Internal Medicine, Munich, 6Center for Infectiology Prenzlauer Berg, Berlin, 7Department of Dermatology and Allergology, University Hospital Klinikum rechts der Isar, Munich, Germany Background: Reasons for and frequency of nonadherence to antiretroviral therapy (ART may have changed due to pharmacological improvements. In addition, the importance of known non-pharmacologic reasons for nonadherence is unclear.Methods: We performed a cross-sectional, noninterventional, multicenter study to identify current reasons for nonadherence. Patients were categorized by physicians into the following adherence groups: good, unstable, or poor adherence. Co-variables of interest included age, sex, time since HIV diagnosis, ART duration, current ART regimen, HIV transmission route, comorbidity, HIV-1 RNA viral load (VL, and CD4 cell count. Patients self-reported the number of missed doses and provided their specific reasons for nonadherent behavior. Statistical analyses were performed using Fisher’s extended exact test, Kruskal–Wallis test, and logistic regression models.Results: Our study assessed 215 participants with good (n=162, unstable (n=36, and poor adherence (n=17. Compared to patients with good adherence, patients with unstable and poor adherence reported more often to have missed at least one dose during the last week (good 11% vs unstable 47% vs poor 63%, p<0.001. Physicians’ adherence assessment was concordant with patients’ self-reports of missed doses during the last week (no vs one or more in 81% cases. Similarly, we found a
-
The Christological Ontology of Reason
DEFF Research Database (Denmark)
Nissen, Ulrik Becker
2006-01-01
Taking the startingpoint in an assertion of an ambiguity in the Lutheran tradition’s assessment of reason, the essay argues that the Kantian unreserved confidence in reason is criticised in Bonhoeffer. Based upon a Christological understanding of reason, Bonhoeffer endorses a view of reason which...... is specifically Christian and yet maintains a universality. With a focus on Bonhoeffer’s »Ethik« as the hermeneutical key to his theology, Bonhoeffer’s notion is also discussed in the light of contemporary Christian ethics. In this part it is particularly the role of reason within a public dis-course which...
-
It's not all about moral reasoning: Understanding the content of Moral Case Deliberation.
Svantesson, Mia; Silén, Marit; James, Inger
2018-03-01
Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral Case Deliberation should contain. To explore and compare the content beyond moral reasoning in the dialogue in Moral Case Deliberation at Swedish workplaces. A mixed-methods approach was applied for analysing audio-recordings of 70 periodic Moral Case Deliberation meetings at 10 Swedish workplaces. Moral Case Deliberation facilitators and various healthcare professions participated, with registered nurses comprising the majority. Ethical considerations: No objection to the study was made by an Ethical Review Board. After oral and written information was provided, consent to be recorded was assumed by virtue of participation. Other than 'moral reasoning' (median (md): 45% of the spoken time), the Moral Case Deliberations consisted of 'reflections on the psychosocial work environment' to a varying extent (md: 29%). Additional content comprised 'assumptions about the patient's psychosocial situation' (md: 6%), 'facts about the patient's situation' (md: 5%), 'concrete problem-solving' (md: 6%) and 'process' (md: 3%). The findings suggest that a restorative function of staff's wellbeing in Moral Case Deliberation is needed, as this might contribute to good patient care. This supports outcome criteria of improved emotional support, which may include relief of moral distress. However, facilitators need a strategy for how to proceed from the participants' own emotional needs and to develop the use of their emotional knowing to focus on
-
Tracing Young Children's Scientific Reasoning
Tytler, Russell; Peterson, Suzanne
2003-08-01
This paper explores the scientific reasoning of 14 children across their first two years of primary school. Children's view of experimentation, their approach to exploration, and their negotiation of competing knowledge claims, are interpreted in terms of categories of epistemological reasoning. Children's epistemological reasoning is distinguished from their ability to control variables. While individual children differ substantially, they show a relatively steady growth in their reasoning, with some contextual variation. A number of these children are reasoning at a level well in advance of curriculum expectations, and it is argued that current recommended practice in primary science needs to be rethought. The data is used to explore the relationship between reasoning and knowledge, and to argue that the generation and exploration of ideas must be the key driver of scientific activity in the primary school.
-
Minimally inconsistent reasoning in Semantic Web.
Zhang, Xiaowang
2017-01-01
Reasoning with inconsistencies is an important issue for Semantic Web as imperfect information is unavoidable in real applications. For this, different paraconsistent approaches, due to their capacity to draw as nontrivial conclusions by tolerating inconsistencies, have been proposed to reason with inconsistent description logic knowledge bases. However, existing paraconsistent approaches are often criticized for being too skeptical. To this end, this paper presents a non-monotonic paraconsistent version of description logic reasoning, called minimally inconsistent reasoning, where inconsistencies tolerated in the reasoning are minimized so that more reasonable conclusions can be inferred. Some desirable properties are studied, which shows that the new semantics inherits advantages of both non-monotonic reasoning and paraconsistent reasoning. A complete and sound tableau-based algorithm, called multi-valued tableaux, is developed to capture the minimally inconsistent reasoning. In fact, the tableaux algorithm is designed, as a framework for multi-valued DL, to allow for different underlying paraconsistent semantics, with the mere difference in the clash conditions. Finally, the complexity of minimally inconsistent description logic reasoning is shown on the same level as the (classical) description logic reasoning.
-
Topçu, Mustafa Sami; Yılmaz-Tüzün, Özgül; Sadler, Troy D.
2011-06-01
The purpose of the study is to explore Turkish preservice science teachers' informal reasoning regarding socioscientific issues and the factors influencing their informal reasoning. The researchers engaged 39 preservice science teachers in informal reasoning interview and moral decision-making interview protocols. Of the seven socioscientific issues, three issues were related to gene therapy, another three were related to human cloning, and one was related to global warming. The data were analyzed using an interpretive qualitative research approach. The characteristic of informal reasoning was determined as multidimensional, and the patterns of informal reasoning emerged as rationalistic, emotive, and intuitive reasoning. The factors influencing informal reasoning were: personal experiences, social considerations, moral-ethical considerations, and technological concerns.
-
Training propositional reasoning.
Klauer, K C; Meiser, T; Naumer, B
2000-08-01
Two experiments compared the effects of four training conditions on propositional reasoning. A syntactic training demonstrated formal derivations, in an abstract semantic training the standard truth-table definitions of logical connectives were explained, and a domain-specific semantic training provided thematic contexts for the premises of the reasoning task. In a control training, an inductive reasoning task was practised. In line with the account by mental models, both kinds of semantic training were significantly more effective than the control and the syntactic training, whereas there were no significant differences between the control and the syntactic training, nor between the two kinds of semantic training. Experiment 2 replicated this pattern of effects using a different set of syntactic and domain-specific training conditions.
-
Preusser, Matthias; Berghoff, Anna S.; Manzl, Claudia; Filipits, Martin; Weinhäusel, Andreas; Pulverer, Walter; Dieckmann, Karin; Widhalm, Georg; Wöhrer, Adelheid; Knosp, Engelbert; Marosi, Christine; Hainfellner, Johannes A.
2014-01-01
Testing of the MGMT promoter methylation status in glioblastoma is relevant for clinical decision making and research applications. Two recent and independent phase III therapy trials confirmed a prognostic and predictive value of the MGMT promoter methylation status in elderly glioblastoma patients. Several methods for MGMT promoter methylation testing have been proposed, but seem to be of limited test reliability. Therefore, and also due to feasibility reasons, translation of MGMT methylation testing into routine use has been protracted so far. Pyrosequencing after prior DNA bisulfite modification has emerged as a reliable, accurate, fast and easy-to-use method for MGMT promoter methylation testing in tumor tissues (including formalin-fixed and paraffin-embedded samples). We performed an intra- and inter-laboratory ring trial which demonstrates a high analytical performance of this technique. Thus, pyrosequencing-based assessment of MGMT promoter methylation status in glioblastoma meets the criteria of high analytical test performance and can be recommended for clinical application, provided that strict quality control is performed. Our article summarizes clinical indications, practical instructions and open issues for MGMT promoter methylation testing in glioblastoma using pyrosequencing. PMID:24359605
-
Directory of Open Access Journals (Sweden)
Olajide O Adelugba
2016-01-01
Full Text Available Poor adherence to prescribed medication regimens can undermine the effectiveness of medications. This study was conducted to determine the demographic profile of forensic psychiatric inpatients refusing medications and to identify the reasons for refusal. Data were collected through interviews using a questionnaire including Drug Attitude Inventory-10. Medication refusal was more common among Aboriginals (68%, n = 34 than Caucasians (32%, n = 16 and was highest among the patients 21-30 years of age (44%, n = 22. Antisocial personality disorder and substance use disorder featured prominently among patients refusing medications. The main reasons for medication refusal were inconvenience (34%, n = 17 followed by side effects (22%, n = 11, ineffective medication (20%, n = 10, illness-related (16%, n = 8, and no reasons (8%, n = 6. Antipsychotic medications topped the list of the major classes of medications refused followed by Antidepressants and Mood Stabilizers.