WorldWideScience

Sample records for solid evidence base

  1. Operator models for delivering municipal solid waste management services in developing countries. Part A: The evidence base.

    Science.gov (United States)

    Wilson, David C; Kanjogera, Jennifer Bangirana; Soós, Reka; Briciu, Cosmin; Smith, Stephen R; Whiteman, Andrew D; Spies, Sandra; Oelz, Barbara

    2017-08-01

    This article presents the evidence base for 'operator models' - that is, how to deliver a sustainable service through the interaction of the 'client', 'revenue collector' and 'operator' functions - for municipal solid waste management in emerging and developing countries. The companion article addresses a selection of locally appropriate operator models. The evidence shows that no 'standard' operator model is effective in all developing countries and circumstances. Each city uses a mix of different operator models; 134 cases showed on average 2.5 models per city, each applying to different elements of municipal solid waste management - that is, street sweeping, primary collection, secondary collection, transfer, recycling, resource recovery and disposal or a combination. Operator models were analysed in detail for 28 case studies; the article summarises evidence across all elements and in more detail for waste collection. Operators fall into three main groups: The public sector, formal private sector, and micro-service providers including micro-, community-based and informal enterprises. Micro-service providers emerge as a common group; they are effective in expanding primary collection service coverage into poor- or peri-urban neighbourhoods and in delivering recycling. Both public and private sector operators can deliver effective services in the appropriate situation; what matters more is a strong client organisation responsible for municipal solid waste management within the municipality, with stable political and financial backing and capacity to manage service delivery. Revenue collection is also integral to operator models: Generally the municipality pays the operator from direct charges and/or indirect taxes, rather than the operator collecting fees directly from the service user.

  2. Solid Base Catalysis

    CERN Document Server

    Ono, Yoshio

    2011-01-01

    The importance of solid base catalysts has come to be recognized for their environmentally benign qualities, and much significant progress has been made over the past two decades in catalytic materials and solid base-catalyzed reactions. The book is focused on the solid base. Because of the advantages over liquid bases, the use of solid base catalysts in organic synthesis is expanding. Solid bases are easier to dispose than liquid bases, separation and recovery of products, catalysts and solvents are less difficult, and they are non-corrosive. Furthermore, base-catalyzed reactions can be performed without using solvents and even in the gas phase, opening up more possibilities for discovering novel reaction systems. Using numerous examples, the present volume describes the remarkable role solid base catalysis can play, given the ever increasing worldwide importance of "green" chemistry. The reader will obtain an overall view of solid base catalysis and gain insight into the versatility of the reactions to whic...

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

    Science.gov (United States)

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

    2018-06-02

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

  4. Evidence for Bulk Ripplocations in Layered Solids

    Science.gov (United States)

    Gruber, Jacob; Lang, Andrew C.; Griggs, Justin; Taheri, Mitra L.; Tucker, Garritt J.; Barsoum, Michel W.

    2016-09-01

    Plastically anisotropic/layered solids are ubiquitous in nature and understanding how they deform is crucial in geology, nuclear engineering, microelectronics, among other fields. Recently, a new defect termed a ripplocation-best described as an atomic scale ripple-was proposed to explain deformation in two-dimensional solids. Herein, we leverage atomistic simulations of graphite to extend the ripplocation idea to bulk layered solids, and confirm that it is essentially a buckling phenomenon. In contrast to dislocations, bulk ripplocations have no Burgers vector and no polarity. In graphite, ripplocations are attracted to other ripplocations, both within the same, and on adjacent layers, the latter resulting in kink boundaries. Furthermore, we present transmission electron microscopy evidence consistent with the existence of bulk ripplocations in Ti3SiC2. Ripplocations are a topological imperative, as they allow atomic layers to glide relative to each other without breaking the in-plane bonds. A more complete understanding of their mechanics and behavior is critically important, and could profoundly influence our current understanding of how graphite, layered silicates, the MAX phases, and many other plastically anisotropic/layered solids, deform and accommodate strain.

  5. A solid majority remit following evidence-based OCD treatments: a 3-year naturalistic outcome study in pediatric OCD.

    Science.gov (United States)

    Melin, Karin; Skarphedinsson, Gudmundur; Skärsäter, Ingela; Haugland, Bente Storm Mowatt; Ivarsson, Tord

    2018-03-03

    This study reports follow-up 2 and 3 years after the initial assessment of a sample of youth with a primary diagnosis of OCD. Participants were 109 children and adolescents, aged 5-17 years, recruited from a specialized, outpatient OCD clinic in Sweden. Patients were treated with cognitive behavioral therapy (CBT), augmented when indicated by selective serotonin reuptake inhibitor (SSRI). In cases where SSRIs were insufficient, augmentation with a second-generation antipsychotic (SGA) was applied. Participants were assessed with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), Children's OCD Impact Scale (COIS), and Children's Depressive Inventory (CDI) at follow-ups 2 and 3 years after baseline assessment. Treatment response was defined as CY-BOCS total score ≤ 15, and remission was defined as CY-BOCS total score ≤ 10. Analyzing the outcomes with linear mixed-effects models (LME) showed a decrease in OCD symptom load from 23 to 6.9 at the 3-year follow-up. Moreover, two of three (66.1%) participants were in remission, and another 19.2% had responded to treatment at the 3-year follow-up. Thus, 85.3% of participants responded to treatment. Moreover, during the follow-up period, participants' psychosocial functioning had significantly improved, and depressive symptoms had significantly decreased. The results suggest that evidence-based treatment for pediatric OCD, following expert consensus guidelines, has long-term positive effects for most children and adolescents diagnosed with OCD. The results also indicate that improvements are maintained over a 3-year period, at least, and that improvement is also found with regard to psychosocial functioning and depressive symptoms.

  6. Evidence for existence of functional monoclinic phase in sodium niobate based solid solution by powder neutron diffraction

    Science.gov (United States)

    Mishra, S. K.; Jauhari, Mrinal; Mittal, R.; Krishna, P. S. R.; Reddy, V. R.; Chaplot, S. L.

    2018-04-01

    We have carried out systematic temperature-dependent neutron diffraction measurements in conjunction with dielectric spectroscopy from 6 to 300 K for sodium niobate based compounds (1-x) NaNbO3-xBaTiO3 (NNBTx). The dielectric constant is measured as a function of both temperature and frequency. It shows an anomaly at different temperatures in cooling and heating cycles and exhibits a large thermal hysteresis of ˜150 K for the composition x = 0.03. The dielectric constant is found to be dispersive in nature and suggests a relaxor ferroelectric behavior. In order to explore structural changes as a function of temperature, we analyzed the powder neutron diffraction data for the compositions x = 0.03 and 0.05. Drastic changes are observed in the powder profiles near 2θ ˜ 30.6°, 32.1°, and 34.6° in the diffraction pattern below 200 K during cooling and above 190 K in heating cycles, respectively. The disappearance of superlattice reflection and splitting in main perovskite peaks provide a signature for structural phase transition. We observed stabilization of a monoclinic phase (Cc) at low temperature. This monoclinic phase is believed to provide a flexible polarization rotation and considered to be directly linked to the high performance piezoelectricity in materials. The thermal hysteresis for composition x = 0.03 is larger than that for x = 0.05. This suggests that the addition of BaTiO3 to NaNbO3 suppresses the thermal hysteresis. It is also observed that the structural phase transition temperature decreases upon increasing the dopant concentration.

  7. Evidence-based radiography

    International Nuclear Information System (INIS)

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

    2008-01-01

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

  8. Evidence-Based Toxicology.

    Science.gov (United States)

    Hoffmann, Sebastian; Hartung, Thomas; Stephens, Martin

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

  9. Evidence-Based Development

    DEFF Research Database (Denmark)

    Hertzum, Morten; Simonsen, Jesper

    2004-01-01

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

  10. Evidence-based policy

    DEFF Research Database (Denmark)

    Vohnsen, Nina Holm

    2013-01-01

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

  11. Evidence-based dentistry.

    Science.gov (United States)

    Chambers, David W

    2010-01-01

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

  12. Evidence-based surgery

    Directory of Open Access Journals (Sweden)

    Miran Rems

    2007-04-01

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

  13. Evidence-based management.

    Science.gov (United States)

    Pfeffer, Jeffrey; Sutton, Robert I

    2006-01-01

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

  14. Evidence based medical imaging (EBMI)

    International Nuclear Information System (INIS)

    Smith, Tony

    2008-01-01

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

  15. Ni-Based Solid Oxide Cell Electrodes

    DEFF Research Database (Denmark)

    Mogensen, Mogens Bjerg; Holtappels, Peter

    2013-01-01

    This paper is a critical review of the literature on nickel-based electrodes for application in solid oxide cells at temperature from 500 to 1000 _C. The applications may be fuel cells or electrolyser cells. The reviewed literature is that of experimental results on both model electrodes...... and practical composite cermet electrodes. A substantially longer three-phase boundary (TPB) can be obtained per unit area of cell in such a composite of nickel and electrolyte material, provided that two interwoven solid networks of the two solid and one gaseous phases are obtained to provide a three...

  16. Evidence-based guidelines

    DEFF Research Database (Denmark)

    Rovira, Àlex; Wattjes, Mike P; Tintoré, Mar

    2015-01-01

    diagnosis in patients with MS. The aim of this article is to provide guidelines for the implementation of MRI of the brain and spinal cord in the diagnosis of patients who are suspected of having MS. These guidelines are based on an extensive review of the recent literature, as well as on the personal...

  17. Evidence-based clinical practice

    DEFF Research Database (Denmark)

    Gluud, Christian

    2002-01-01

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

  18. Evidence-based cancer imaging

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-01-15

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

  19. Exploration of solids based on representation systems

    Directory of Open Access Journals (Sweden)

    Publio Suárez Sotomonte

    2011-01-01

    Full Text Available This article refers to some of the findings of a research project implemented as a teaching strategy to generate environments for the learning of platonic and archimedean solids, with a group of eighth grade students. This strategy was based on the meaningful learning approach and on the use of representation systems using the ontosemiotic approach in mathematical education, as a framework for the construction of mathematical concepts. This geometry teaching strategy adopts the stages of exploration, representation-modeling, formal construction and study of applications. It uses concrete, physical and tangible materials for origami, die making, and structures for the construction of threedimensional solids considered external tangible solid representation systems, as well as computer based educational tools to design dynamic geometry environments as intangible external representation systems.These strategies support both the imagination and internal systems of representation, fundamental to the comprehension of geometry concepts.

  20. Development of hydrazinium nitroformate based solid propellants

    NARCIS (Netherlands)

    Schöyer, H.F.R.; Schnorhk, A.J.; Korting, P.A.O.G.; Lit, P.J. van; Mul, J.M.; Gadiot, G.; Meulenbrugge, J.J.

    1995-01-01

    The development of new high-performance propellant combinations requires the establishment of safety and handling characteristics and thermodynamic decomposition and explosive properties. This paper addresses the early development phases of a new composite solid propellant based on HNF as oxidizer

  1. Evidence-based playground design

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  2. Evidence-Based IT Development

    DEFF Research Database (Denmark)

    Simonsen, Jesper; Hertzum, Morten

    2005-01-01

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

  3. Anatomy of an Evidence Base

    Science.gov (United States)

    Malouf, David B.; Taymans, Juliana M.

    2016-01-01

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

  4. Evidence-Based Psychological Assessment.

    Science.gov (United States)

    Bornstein, Robert F

    2017-01-01

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

  5. Evidence-based clinical practice

    DEFF Research Database (Denmark)

    Garattini, Silvio; Jakobsen, Janus C; Wetterslev, Jørn

    2016-01-01

    was considered through literature searches combined with personal files. Treatments should generally not be chosen based only on evidence from observational studies or single randomised clinical trials. Systematic reviews with meta-analysis of all identifiable randomised clinical trials with Grading...

  6. Solid electroytes for CNT-based actuators

    Science.gov (United States)

    Riemenschneider, Johannes; Geier, Sebastian; Mahrholz, Thorsten; Mosch, Jürgen; Monner, Hans Peter; Sinapius, Michael

    2009-03-01

    Actuators based on carbon nanotubes (CNT) have the potential to generate high forces at very low voltages. The density of the raw material is just 1330 kg/m3, which makes them well applicable for lightweight applications. Moreover, active strains of up to 1% can be achieved - due to the CNTs dimensional changes on charge injection. Therefore the nanotubes have to be arranged and electrically wired like electrodes of a capacitor. In previous works the system's response of the Nanotubes comprising a liquid electrolyte was studied in detail. The major challenge is to repeat such experiments with solid electrolytes, which is a prerequisite for structural integration. In this paper a method is proposed which makes sure the expansion is not based on thermal expansion. This is done by analysing the electrical system response. As thermal expansion is dominated by ohmic resistance the CNT based actuators show a strong capacitive behavior. This behavior is referable to the constitution of the electrochemical double layer around the nanotubes, which causes the tubes to expand. Also a novel test setup is described, which guarantees that the displacement which is measured will not be caused by bending of a bimorph but due to expansion of a single layer of nanotubes. This paper also presents experimental results demonstrating both, the method of electrical characterization of CNT based actuators with implemented solid electrolytes and the novel test setup which is used to measure the needed data. The actuators which were characterized are hybrids of CNT and the solid electrolyte NAFION which is supplying the ions needed to constitute the electrochemical double layer. The manufacturing, processing of these actuators and also some first experimental results are shown. Unfortunately, the results are not as clear as those for liquid electrolytes, which depend on the hybrid character of the analyzed devices. In the liquid electrolyte based case the CNTs are the only source of

  7. Preparation and characterization of a novel polymeric based solid-solid phase change heat storage material

    International Nuclear Information System (INIS)

    Xi Peng; Gu Xiaohua; Cheng Bowen; Wang Yufei

    2009-01-01

    Here we reported a two-step procedure for preparing a novel polymeric based solid-solid phase change heat storage material. Firstly, a copolymer monomer containing a polyethylene glycol monomethyl ether (MPEG) phase change unit and a vinyl unit was synthesized via the modification of hydrogen group of MPEG. Secondly, by copolymerization of the copolymer monomer and phenyl ethylene, a novel polymeric based solid-solid phase change heat storage material was prepared. The composition, structure and properties of the novel polymeric based solid-solid phase change material were characterized by IR, 1 H NMR, DSC, WAXD, and POM, respectively. The results show that the novel polymeric based solid-solid phase change material possesses of excellent crystal properties and high phase change enthalpy.

  8. Evidence-based librarianship: searching for the needed EBL evidence.

    Science.gov (United States)

    Eldredge, J D

    2000-01-01

    This paper discusses the challenges of finding evidence needed to implement Evidence-Based Librarianship (EBL). Focusing first on database coverage for three health sciences librarianship journals, the article examines the information contents of different databases. Strategies are needed to search for relevant evidence in the library literature via these databases, and the problems associated with searching the grey literature of librarianship. Database coverage, plausible search strategies, and the grey literature of library science all pose challenges to finding the needed research evidence for practicing EBL. Health sciences librarians need to ensure that systems are designed that can track and provide access to needed research evidence to support Evidence-Based Librarianship (EBL).

  9. The evidence base for diabetes care

    National Research Council Canada - National Science Library

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

    2002-01-01

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

  10. Inference-based procedural modeling of solids

    KAUST Repository

    Biggers, Keith

    2011-11-01

    As virtual environments become larger and more complex, there is an increasing need for more automated construction algorithms to support the development process. We present an approach for modeling solids by combining prior examples with a simple sketch. Our algorithm uses an inference-based approach to incrementally fit patches together in a consistent fashion to define the boundary of an object. This algorithm samples and extracts surface patches from input models, and develops a Petri net structure that describes the relationship between patches along an imposed parameterization. Then, given a new parameterized line or curve, we use the Petri net to logically fit patches together in a manner consistent with the input model. This allows us to easily construct objects of varying sizes and configurations using arbitrary articulation, repetition, and interchanging of parts. The result of our process is a solid model representation of the constructed object that can be integrated into a simulation-based environment. © 2011 Elsevier Ltd. All rights reserved.

  11. Solid radiation curable polyene compositions containing liquid polythiols and solid styrene-allyl copolymer based polyenes

    International Nuclear Information System (INIS)

    Morgan, C.R.

    1977-01-01

    Novel styrene-allyl alcohol copolymer based solid polyene compositions which when mixed with liquid polythiols can form solid curable polyene-polythiol systems are claimed. These solid polyenes, containing at least two reactive carbon-to-carbon unsaturated bonds, are urethane or ester derivatives of styrene-allyl alcohol copolymers. The solid polyenes are prepared by treating the hydroxyl groups of a styrene-allyl alcohol copolymer with a reactive unsaturated isocyanate, e.g., allyl isocyanate or a reactive unsaturated carboxylic acid, e.g., acrylic acid. Upon exposure to a free radical generator, e.g., actinic radiation, the solid polyene-polythiol compositions cure to solid, insoluble, chemically resistant, cross-linked polythioether products. Since the solid polyene-liquid polythiol composition can be cured in a solid state, such a curable system finds particular use in preparation of coatings, imaged surfaces such as photoresists, particularly solder-resistant photoresists, printing plates, etc

  12. Evidence of two-stage melting of Wigner solids

    Science.gov (United States)

    Knighton, Talbot; Wu, Zhe; Huang, Jian; Serafin, Alessandro; Xia, J. S.; Pfeiffer, L. N.; West, K. W.

    2018-02-01

    Ultralow carrier concentrations of two-dimensional holes down to p =1 ×109cm-2 are realized. Remarkable insulating states are found below a critical density of pc=4 ×109cm-2 or rs≈40 . Sensitive dc V-I measurement as a function of temperature and electric field reveals a two-stage phase transition supporting the melting of a Wigner solid as a two-stage first-order transition.

  13. Simulation based engineering in solid mechanics

    CERN Document Server

    Rao, J S

    2017-01-01

    This book begins with a brief historical perspective of the advent of rotating machinery in 20th century Solid Mechanics and the development of the discipline of the Strength of Materials. High Performance Computing (HPC) and Simulation Based Engineering Science (SBES) have gradually replaced the conventional approach in Design bringing science directly into engineering without approximations. A recap of the required mathematical principles is given. The science of deformation, strain and stress at a point under the application of external traction loads is next presented. Only one-dimensional structures classified as Bars (axial loads), Rods (twisting loads) and Beams (bending loads) are considered in this book. The principal stresses and strains and von Mises stress and strain that used in design of structures are next presented. Lagrangian solution was used to derive the governing differential equations consistent with assumed deformation field and solution for deformations, strains and stresses were obtai...

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

    Science.gov (United States)

    2010-11-03

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

  15. Municipal solid waste development phases: Evidence from EU27.

    Science.gov (United States)

    Vujić, Goran; Gonzalez-Roof, Alvaro; Stanisavljević, Nemanja; Ragossnig, Arne M

    2015-12-01

    Many countries in the European Union (EU) have very developed waste management systems. Some of its members have managed to reduce their landfilled waste to values close to zero during the last decade. Thus, European Union legislation is very stringent regarding waste management for their members and candidate countries, too. This raises the following questions: Is it possible for developing and developed countries to comply with the European Union waste legislation, and under what conditions? How did waste management develop in relation to the economic development in the countries of the European Union? The correlation between waste management practices and economic development was analysed for 27 of the European Union Member States for the time period between 1995 and 2007. In addition, a regression analysis was performed to estimate landfilling of waste in relation to gross domestic product for every country. The results showed a strong correlation between the waste management variables and the gross domestic product of the EU27 members. The definition of the municipal solid waste management development phases followed a closer analysis of the relation between gross domestic product and landfilled waste. The municipal solid waste management phases are characterised by high landfilling rates at low gross domestic product levels, and landfilling rates near zero at high gross domestic product levels. Hence the results emphasize the importance of wider understanding of what is required for developing countries to comply with the European Union initiatives, and highlight the importance of allowing developing countries to make their own paths of waste management development. © The Author(s) 2015.

  16. Historical perspectives on evidence-based nursing.

    Science.gov (United States)

    Beyea, Suzanne C; Slattery, Mary Jo

    2013-04-01

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

  17. Environmental Accounting Evidence in Organic Solid Residue Treatment Companies

    Directory of Open Access Journals (Sweden)

    Bruna Batista Padilha

    2014-06-01

    Full Text Available The growing concern with natural resources and the environment brings out the true dimension of these issues. The awareness of society causes companies to adopt environmentally correct policies and attitudes, so as to contribute with the preservation of the environment. Accounting, as a social science which studies the patrimony and its affectations, has adapted to the need of its users and has started to care about proper presentation and measurement of environmental items, for effective publication to society. With this premise, this study aims to identify and describe the contributions of Environmental Accounting to the process of environmental accounting disclosure of a company, which deals with organic solid residues from agriculture. Using a case study, it has been intended to analyze the production process and to list the environmental items and events that could benefit the company through their disclosure. It was intended, with this study, to highlight the contribution that the environmental accounting may add to the company, with proper measurement and presentation proposals. We have been able to verify that, indeed, there are events of an environmental nature resulting from the production process and also of the investment that it carries out periodically to preserve nature; however, there re faults in the accounting records from an environmental point of view. The application of environmental accounting in the organization allows for a broad view of environmental management and sustainable development adopted by the entity, registering all events that may generate economic and financial changes.

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

    Science.gov (United States)

    Oh, Eui Geum

    2016-06-01

    As evidence-based practice has become an important issue in healthcare settings, the educational needs for knowledge and skills for the generation and utilization of healthcare evidence are increasing. Systematic review (SR), a way of evidence generation, is a synthesis of primary scientific evidence, which summarizes the best evidence on a specific clinical question using a transparent, a priori protocol driven approach. SR methodology requires a critical appraisal of primary studies, data extraction in a reliable and repeatable way, and examination for validity of the results. SRs are considered hierarchically as the highest form of evidence as they are a systematic search, identification, and summarization of the available evidence to answer a focused clinical question with particular attention to the methodological quality of studies or the credibility of opinion and text. The purpose of this paper is to introduce an overview of the fundamental knowledge, principals and processes in SR. The focus of this paper is on SR especially for the synthesis of quantitative data from primary research studies that examines the effectiveness of healthcare interventions. To activate evidence-based nursing care in various healthcare settings, the best and available scientific evidence are essential components. This paper will include some examples to promote understandings. Copyright © 2016. Published by Elsevier B.V.

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

    Directory of Open Access Journals (Sweden)

    Eui Geum Oh, PhD, RN

    2016-06-01

    Full Text Available As evidence-based practice has become an important issue in healthcare settings, the educational needs for knowledge and skills for the generation and utilization of healthcare evidence are increasing. Systematic review (SR, a way of evidence generation, is a synthesis of primary scientific evidence, which summarizes the best evidence on a specific clinical question using a transparent, a priori protocol driven approach. SR methodology requires a critical appraisal of primary studies, data extraction in a reliable and repeatable way, and examination for validity of the results. SRs are considered hierarchically as the highest form of evidence as they are a systematic search, identification, and summarization of the available evidence to answer a focused clinical question with particular attention to the methodological quality of studies or the credibility of opinion and text. The purpose of this paper is to introduce an overview of the fundamental knowledge, principals and processes in SR. The focus of this paper is on SR especially for the synthesis of quantitative data from primary research studies that examines the effectiveness of healthcare interventions. To activate evidence-based nursing care in various healthcare settings, the best and available scientific evidence are essential components. This paper will include some examples to promote understandings.

  20. Evidence based practice readiness: A concept analysis.

    Science.gov (United States)

    Schaefer, Jessica D; Welton, John M

    2018-01-15

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

  1. Introduction to solid supported membrane based electrophysiology.

    Science.gov (United States)

    Bazzone, Andre; Costa, Wagner Steuer; Braner, Markus; Călinescu, Octavian; Hatahet, Lina; Fendler, Klaus

    2013-05-11

    The electrophysiological method we present is based on a solid supported membrane (SSM) composed of an octadecanethiol layer chemisorbed on a gold coated sensor chip and a phosphatidylcholine monolayer on top. This assembly is mounted into a cuvette system containing the reference electrode, a chlorinated silver wire. After adsorption of membrane fragments or proteoliposomes containing the membrane protein of interest, a fast solution exchange is used to induce the transport activity of the membrane protein. In the single solution exchange protocol two solutions, one non-activating and one activating solution, are needed. The flow is controlled by pressurized air and a valve and tubing system within a faraday cage. The kinetics of the electrogenic transport activity is obtained via capacitive coupling between the SSM and the proteoliposomes or membrane fragments. The method, therefore, yields only transient currents. The peak current represents the stationary transport activity. The time dependent transporter currents can be reconstructed by circuit analysis. This method is especially suited for prokaryotic transporters or eukaryotic transporters from intracellular membranes, which cannot be investigated by patch clamp or voltage clamp methods.

  2. Inference-based procedural modeling of solids

    KAUST Repository

    Biggers, Keith; Keyser, John

    2011-01-01

    As virtual environments become larger and more complex, there is an increasing need for more automated construction algorithms to support the development process. We present an approach for modeling solids by combining prior examples with a simple

  3. Evidence-based practice of periodontics.

    Science.gov (United States)

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

    2010-01-01

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

  4. Psiquiatria baseada em evidências Evidence-based psychiatry

    Directory of Open Access Journals (Sweden)

    Maurício S de Lima

    2000-09-01

    Full Text Available Em psiquiatria, observa-se grande variabilidade de práticas clínicas, muitas vezes desnecessária. Essas variações podem estar relacionadas à ausência de evidência científica confiável ou ao desconhecimento das evidências de boa qualidade disponíveis. A medicina baseada em evidências (MBE é uma combinação de estratégias que busca assegurar que o cuidado individual do paciente seja baseado na melhor informação disponível, a qual deve ser incorporada à prática clínica. Neste artigo, conceitos de MBE são discutidos com relação a aspectos e desafios no tratamento de pacientes com distimia, bulimia nervosa e esquizofrenia. A partir de resultados de três revisões sistemáticas recentemente publicadas, conclui-se que a prática de psiquiatria baseada em evidências acrescenta qualidade à prática psiquiátrica tradicional.The unnecessary variability often seen in the clinical practice can be related to both the absence of reliable evidence and unawareness of the existence of good quality evidence. Evidence-Based Medicine (EBM is a set of linked strategies designed to assist clinicians in keeping themselves up-to-date with the best available evidence. Such evidence must be incorporated into the clinical practice. EBM concepts are discussed here through common aspects and challenges doctors face when treating patients with dysthymia, bulimia nervosa, and schizophrenia. In the light of some results from three systematic reviews it is concluded that Evidence-Based Psychiatry strategies, rather than replacing the traditional ones, may be a valuable tool to improving quality in a good clinical practice.

  5. Direct Evidence of Mg Incorporation Pathway in Vapor-Liquid-Solid Grown p-type Nonpolar GaN Nanowires

    OpenAIRE

    Patsha, Avinash; Amirthapandian, S.; Pandian, Ramanathaswamy; Bera, S.; Bhattacharya, Anirban; Dhara, Sandip

    2015-01-01

    Doping of III-nitride based compound semiconductor nanowires is still a challenging issue to have a control over the dopant distribution in precise locations of the nanowire optoelectronic devices. Knowledge of the dopant incorporation and its pathways in nanowires for such devices is limited by the growth methods. We report the direct evidence of incorporation pathway for Mg dopants in p-type nonpolar GaN nanowires grown via vapour-liquid-solid (VLS) method in a chemical vapour deposition te...

  6. Persuasive Evidence: Improving Customer Service through Evidence Based Librarianship

    Directory of Open Access Journals (Sweden)

    Wendy A. Abbott

    2006-03-01

    Full Text Available Objective - To demonstrate how evidence based practice has contributed to informaing decisions and resolving issues if concern in service delivery at Bond University Librray. Methods - This paper critically analyses three evidence based research projects conducted at Bond University Library. Each project combined a range of research methods including surveys, literature reviews and the analysis of internal performance data to find solutions to problems in library service delivery. The first research project investigated library opening hours and the feasability of twenty-four hour opening. Another project reseached questions about the management of a collection of feature films on DVD and video. The thrd project investigated issues surrounding the teaching of EndNote to undergarduate students. Results - Despite some deficiencies in the methodologies used, each evidence based research project had positive outcomes. One of the highlights asn an essential feature of the process at Bond University Library was the involvement of stakeholders. The ability to build consensus and agree action plans with stakeholders was an important outcome of that process. Conclusion - Drawing on the experience of these research projects, the paper illustrates the benefits of evidence based information practice to stimulate innovation and improve library services. Librarians, like most professionals, need to continue to develop the skills and a culture to effectively carry out evidence based practice.

  7. Solids-based concentrated solar power receiver

    Science.gov (United States)

    None

    2018-04-10

    A concentrated solar power (CSP) system includes channels arranged to convey a flowing solids medium descending under gravity. The channels form a light-absorbing surface configured to absorb solar flux from a heliostat field. The channels may be independently supported, for example by suspension, and gaps between the channels are sized to accommodate thermal expansion. The light absorbing surface may be sloped so that the inside surfaces of the channels proximate to the light absorbing surface define downward-slanting channel floors, and the flowing solids medium flows along these floors. Baffles may be disposed inside the channels and oriented across the direction of descent of the flowing solids medium. The channels may include wedge-shaped walls forming the light-absorbing surface and defining multiple-reflection light paths for solar flux from the heliostat field incident on the light-absorbing surface.

  8. Evidence-Based Psychotherapy: Advantages and Challenges.

    Science.gov (United States)

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

    2017-07-01

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

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

    CSIR Research Space (South Africa)

    Ntshotsho, P

    2012-03-01

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

  10. Reference Electrodes Based on Solid Amalgams

    Czech Academy of Sciences Publication Activity Database

    Josypčuk, Bohdan; Novotný, Ladislav

    2004-01-01

    Roč. 16, č. 3 (2004), s. 238-241 ISSN 1040-0397 Grant - others:GIT(AR) 101/02/U111/CZ Institutional research plan: CEZ:AV0Z4040901 Keywords : solid amalgam * reference electrode * voltammetry Subject RIV: CG - Electrochemistry Impact factor: 2.038, year: 2004

  11. Sicily statement on evidence-based practice

    Directory of Open Access Journals (Sweden)

    Hopayian Kevork

    2005-01-01

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

  12. A solid state actuator based on polypyrrole (PPy) and a solid electrolyte NBR working in air

    Science.gov (United States)

    Cho, Misuk; Nam, Jaedo; Choi, Hyouk Ryeol; Koo, Jachoon; Lee, Youngkwan

    2005-05-01

    The solid polymer electrolyte based conducting polymer actuator was presented. In the preparation of acutuator module, an ionic liquid impregnated a synthetic rubber (NBR) and PPy were used as a solid polymer electrolyte and conducting polymer, respectively. An ionic liquid, 1-butyl-3-methylimidazolium bis (trifluoromethyl sulfonyl)imide (BMITFSI) is gradually dispersed into the NBR film and the conducting polymer, PPy was synthesized on the surface of NBR. The ionic conductivity of new type solid polymer electrolyte as a function of the immersion time was investigated. The cyclic voltammetry responsed and the redox switching dynamics of PEDOT in NBR matrix were studied. The displacement of the actuator was measured by laser beam.

  13. Evidence-Based Dentistry in Everyday Practice.

    Science.gov (United States)

    Gudray, Kiran; Walmsley, Anthony Damien

    2016-12-01

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

  14. Evidence-Based Practice: Management of Vertigo

    Science.gov (United States)

    Nguyen-Huynh, Anh T.

    2012-01-01

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

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

    African Journals Online (AJOL)

    Rachel Magdalena (Dalena) van Rooyen

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

  16. Evidence-based management - healthcare manager viewpoints.

    Science.gov (United States)

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

    2018-06-11

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

  17. Towards Evidence Based Usability in Health Informatics?

    NARCIS (Netherlands)

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

    2015-01-01

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

  18. Quality of evidence-based pediatric guidelines

    NARCIS (Netherlands)

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

    2005-01-01

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

  19. From evidence-based to evidence-reflected practice

    DEFF Research Database (Denmark)

    Lystbæk, Christian Tang

    “Knowledge” is of the utmost significance for professional practice and learning. Today, though, the established knowledge base is changing in all areas of the labour market (Alvesson, 2004). Work and society are dominated by commitment to demands for high levels of demonstrable accountability......, cost-efficiency and measurable quality. Thus, today, evidence-based practice has become an expectation and fashion, often used to emphasize the grounding of practice in research based knowledge that provides measurable evidence for best practice. But at the same time, there is a growing distrust...... of the supremacy of this kind of knowledge, and traditional monopolies of knowledge are challenged (Gabbay & May, 2010). In the literature, there is an on-going debate about professional knowledge enacted in diverse settings. This debate presents a wide range of epistemological terminologies and typologies, which...

  20. Evidence-Based ACL Reconstruction

    Directory of Open Access Journals (Sweden)

    E. Carlos RODRIGUEZ-MERCHAN

    2015-01-01

    Full Text Available There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACLreconstruction. The purpose of this article is to answer the following questions: 1 Bone patellar tendon bone (BPTB reconstruction or hamstring reconstruction (HR; 2 Double bundle or single bundle; 3 Allograft or authograft; 4 Early or late reconstruction; 5 Rate of return to sports after ACL reconstruction; 6 Rate of osteoarthritis after ACL reconstruction. A Cochrane Library and PubMed (MEDLINE search of systematic reviews and meta-analysis related to ACL reconstruction was performed. The key words were: ACL reconstruction, systematic reviews and meta-analysis. The main criteria for selection were that the articles were systematic reviews and meta-analysesfocused on the aforementioned questions. Sixty-nine articles were found, but only 26 were selected and reviewed because they had a high grade (I-II of evidence. BPTB-R was associated with better postoperative knee stability but with a higher rate of morbidity. However, the results of both procedures in terms of functional outcome in the long-term were similar. The double-bundle ACL reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. Autograft yielded better results than allograft. There was no difference between early and delayed reconstruction. 82% of patients were able to return to some kind of sport participation. 28% of patients presented radiological signs of osteoarthritis with a follow-up of minimum 10 years.

  1. Evidence-based management: a literature review.

    Science.gov (United States)

    Young, Sam K

    2002-05-01

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

  2. Electrical conduction in solid materials physicochemical bases and possible applications

    CERN Document Server

    Suchet, J P

    2013-01-01

    Electrical Conduction in Solid Materials (Physicochemical Bases and Possible Applications) investigates the physicochemical bases and possible applications of electrical conduction in solid materials, with emphasis on conductors, semiconductors, and insulators. Topics range from the interatomic bonds of conductors to the effective atomic charge in conventional semiconductors and magnetic transitions in switching semiconductors. Comprised of 10 chapters, this volume begins with a description of electrical conduction in conductors and semiconductors, metals and alloys, as well as interatomic bon

  3. History of evidence-based medicine

    Directory of Open Access Journals (Sweden)

    Roger L Sur

    2011-01-01

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

  4. The evidence base for diabetes care

    National Research Council Canada - National Science Library

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

    2002-01-01

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

  5. Evidence-based librarianship: an overview.

    Science.gov (United States)

    Eldredge, J D

    2000-10-01

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

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

    OpenAIRE

    Denise Koufogiannakis

    2010-01-01

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

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

    Science.gov (United States)

    Coiera, Enrico

    2016-03-01

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

  8. The religion of evidence-based practice

    DEFF Research Database (Denmark)

    Wigram, Tony; Gold, Christian

    2012-01-01

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

  9. Professionalism and evidence-based practice

    DEFF Research Database (Denmark)

    Rasmussen, Palle

    2015-01-01

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

  10. Carbon-based strong solid acid for cornstarch hydrolysis

    International Nuclear Information System (INIS)

    Nata, Iryanti Fatyasari; Irawan, Chairul; Mardina, Primata; Lee, Cheng-Kang

    2015-01-01

    Highly sulfonated carbonaceous spheres with diameter of 100–500 nm can be generated by hydrothermal carbonization of glucose in the presence of hydroxyethylsulfonic acid and acrylic acid at 180 °C for 4 h. The acidity of the prepared carbonaceous sphere C4-SO 3 H can reach 2.10 mmol/g. It was used as a solid acid catalyst for the hydrolysis of cornstarch. Total reducing sugar (TRS) concentration of 19.91 mg/mL could be obtained by hydrolyzing 20 mg/mL cornstarch at 150 °C for 6 h using C4-SO 3 H as solid acid catalyst. The solid acid catalyst demonstrated good stability that only 9% decrease in TRS concentration was observed after five repeat uses. The as-prepared carbon-based solid acid catalyst can be an environmentally benign replacement for homogeneous catalyst. - Highlights: • Carbon solid acid was successfully prepared by one-step hydrothermal carbonization. • The acrylic acid as monomer was effectively reduce the diameter size of particle. • The solid acid catalyst show good catalytic performance of starch hydrolysis. • The solid acid catalyst is not significantly deteriorated after repeated use

  11. Carbon-based strong solid acid for cornstarch hydrolysis

    Energy Technology Data Exchange (ETDEWEB)

    Nata, Iryanti Fatyasari, E-mail: yanti_tkunlam@yahoo.com [Chemical Engineering Study Program, Faculty of Engineering, Lambung Mangkurat University, Jl. A. Yani Km. 36 Banjarbaru, South Kalimantan 70714 (Indonesia); Irawan, Chairul; Mardina, Primata [Chemical Engineering Study Program, Faculty of Engineering, Lambung Mangkurat University, Jl. A. Yani Km. 36 Banjarbaru, South Kalimantan 70714 (Indonesia); Lee, Cheng-Kang, E-mail: cklee@mail.ntust.edu.tw [Department of Chemical Engineering, National Taiwan University of Science and Technology, 43 Keelung Rd. Sec.4, Taipei 106, Taiwan (China)

    2015-10-15

    Highly sulfonated carbonaceous spheres with diameter of 100–500 nm can be generated by hydrothermal carbonization of glucose in the presence of hydroxyethylsulfonic acid and acrylic acid at 180 °C for 4 h. The acidity of the prepared carbonaceous sphere C4-SO{sub 3}H can reach 2.10 mmol/g. It was used as a solid acid catalyst for the hydrolysis of cornstarch. Total reducing sugar (TRS) concentration of 19.91 mg/mL could be obtained by hydrolyzing 20 mg/mL cornstarch at 150 °C for 6 h using C4-SO{sub 3}H as solid acid catalyst. The solid acid catalyst demonstrated good stability that only 9% decrease in TRS concentration was observed after five repeat uses. The as-prepared carbon-based solid acid catalyst can be an environmentally benign replacement for homogeneous catalyst. - Highlights: • Carbon solid acid was successfully prepared by one-step hydrothermal carbonization. • The acrylic acid as monomer was effectively reduce the diameter size of particle. • The solid acid catalyst show good catalytic performance of starch hydrolysis. • The solid acid catalyst is not significantly deteriorated after repeated use.

  12. Carbon-based strong solid acid for cornstarch hydrolysis

    Science.gov (United States)

    Nata, Iryanti Fatyasari; Irawan, Chairul; Mardina, Primata; Lee, Cheng-Kang

    2015-10-01

    Highly sulfonated carbonaceous spheres with diameter of 100-500 nm can be generated by hydrothermal carbonization of glucose in the presence of hydroxyethylsulfonic acid and acrylic acid at 180 °C for 4 h. The acidity of the prepared carbonaceous sphere C4-SO3H can reach 2.10 mmol/g. It was used as a solid acid catalyst for the hydrolysis of cornstarch. Total reducing sugar (TRS) concentration of 19.91 mg/mL could be obtained by hydrolyzing 20 mg/mL cornstarch at 150 °C for 6 h using C4-SO3H as solid acid catalyst. The solid acid catalyst demonstrated good stability that only 9% decrease in TRS concentration was observed after five repeat uses. The as-prepared carbon-based solid acid catalyst can be an environmentally benign replacement for homogeneous catalyst.

  13. Validity evidence based on test content.

    Science.gov (United States)

    Sireci, Stephen; Faulkner-Bond, Molly

    2014-01-01

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

  14. Evidence-based Practice of Radiology.

    Science.gov (United States)

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

    2015-10-01

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

  15. Queer challenges to evidence-based practice.

    Science.gov (United States)

    Zeeman, Laetitia; Aranda, Kay; Grant, Alec

    2014-06-01

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

  16. Evidence-based dentistry: Future aspects

    Directory of Open Access Journals (Sweden)

    Kanika Mohindra

    2017-01-01

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

  17. Evidence-based radiology: why and how?

    International Nuclear Information System (INIS)

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

    2010-01-01

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

  18. Detecting New Evidences for Evidence-Based Medical Guidelines with Journal Filtering

    NARCIS (Netherlands)

    Hu, Qing; Huang, Zisheng; ten Teije, Annette; van Harmelen, Frank; Riaño, David; Lenz, Richard; Reichert, Manfred

    2017-01-01

    Evidence-based medical guidelines are systematically developed recommendations with the aim to assist practitioner and patients decisions regarding appropriate health care for specific clinical circumstances, and are based on evidence described in medical research papers. Evidence-based medical

  19. Evidence-Based Advances in Ferret Medicine.

    Science.gov (United States)

    Huynh, Minh; Chassang, Lucile; Zoller, Graham

    2017-09-01

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

  20. Epistemologic inquiries in evidence-based medicine.

    Science.gov (United States)

    Djulbegovic, Benjamin; Guyatt, Gordon H; Ashcroft, Richard E

    2009-04-01

    Since the term "evidence-based medicine" (EBM) first appeared in the scientific literature in 1991, the concept has had considerable influence in many parts of the world. Most professional societies, the public,and funding agencies have accepted EBM with remarkable enthusiasm. The concept of evidence-based practice is now applied in management, education, criminology, and social work. Yet, EBM has attracted controversy: its critics allege that EBM uses a narrow concept of evidence and a naive conception of the relationships between evidence, theory, and practice. They also contend that EBM presents itself as a radical restructuring of medical knowledge that discredits more traditional ways of knowing in medicine, largely in the interests of people with a particular investment in the enterprise of large-scale clinical trials. Because EBM proposes aspecific relationship between theory, evidence, and knowledge, its theoretical basis can be understood as an epistemological system. Undertaking epistemological inquiry is important because the adoption of a particular epistemological view defines how science is conducted. In this paper, we challenge this critical view of EBM by examining how EBM fits into broad epistemological debates within the philosophy of science. We consider how EBM relates to some classical debates regarding the nature of science and knowledge. We investigate EBM from the perspective of major epistemological theories (logical-positivism/inductivism, deductivism/falsificationism/theory-ladeness of observations, explanationism/holism, instrumentalism, underdetermination theory by evidence). We first explore the relationship between evidence and knowledge and discuss philosophical support for the main way that evidence is used in medicine: (1) in the philosophical tradition that "rational thinkers respect their evidence," we show that EBM refers to making medical decisions that are consistent with evidence, (2) as a reliable sign, symptom, or mark to

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

    Science.gov (United States)

    Hauswaldt, Johannes

    2010-01-01

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

  2. Rocket Solid Propellant Alternative Based on Ammonium Dinitramide

    Directory of Open Access Journals (Sweden)

    Grigore CICAN

    2017-03-01

    Full Text Available Due to the continuous run for a green environment the current article proposes a new type of solid propellant based on the fairly new synthesized oxidizer, ammonium dinitramide (ADN. Apart of having a higher specific impulse than the worldwide renowned oxidizer, ammonium perchlorate, ADN has the advantage, of leaving behind only nitrogen, oxygen and water after decomposing at high temperatures and therefore totally avoiding the formation of hydrogen chloride fumes. Based on the oxidizer to fuel ratios of the current formulations of the major rocket solid booster (e.g. Space Shuttle’s SRB, Ariane 5’s SRB which comprises mass variations of ammonium perchlorate oxidizer (70-75%, atomized aluminum powder (10-18% and polybutadiene binder (12-20% a new solid propellant was formulated. As previously stated, the new propellant formula and its variations use ADN as oxidizer and erythritol tetranitrate as fuel, keeping the same polybutadiene as binder.

  3. Evidence-based medicine Training: Kazakhstan experience.

    Science.gov (United States)

    Kamalbekova, G; Kalieva, M

    2015-01-01

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

  4. Evidence-based practice within nutrition

    DEFF Research Database (Denmark)

    Laville, Martine; Segrestin, Berenice; Alligier, Maud

    2017-01-01

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

  5. Environmentally Benign Bifunctional Solid Acid and Base Catalysts

    NARCIS (Netherlands)

    Elmekawy, A.; Shiju, N.R.; Rothenberg, G.; Brown, D.R.

    2014-01-01

    Solid bifunctional acid-​base catalysts were prepd. in two ways on an amorphous silica support: (1) by grafting mercaptopropyl units (followed by oxidn. to propylsulfonic acid) and aminopropyl groups to the silica surface (NH2-​SiO2-​SO3H)​, and (2) by grafting only aminopropyl groups and then

  6. Community-Based Solid Waste Management: A Training Facilitator's Guide.

    Science.gov (United States)

    Peace Corps, Washington, DC. Information Collection and Exchange Div.

    Urban environmental management and environmental health issues are of increasing concern worldwide. The need for urban environmental management work at the local level where the Peace Corps works most effectively is significant, but training materials dedicated specifically to community-based solid waste management work in urban areas are lacking.…

  7. Modified calcium oxide as stable solid base catalyst for Aldol

    Indian Academy of Sciences (India)

    A highly efficient and stable solid-base catalyst for Aldol condensation was prepared by modifying commercial CaO with benzyl bromide in a simple way. It was found that modified CaO can effectively catalyse the Aldol condensation of cyclohexanone and benzaldehyde, as well as various benzaldehydes, to produce ...

  8. Modified calcium oxide as stable solid base catalyst for Aldol ...

    Indian Academy of Sciences (India)

    A highly efficient and stable solid-base catalyst for Aldol condensation was ... was bonded on surface of CaO chemically and almost no Ca(OH)2 formed during the modification process. ... cation, corrosion and waste generation attract great.

  9. Morphea: Evidence-based recommendations for treatment

    OpenAIRE

    Nicole M Fett

    2012-01-01

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

  10. Investigation of samarium solubility in the magnesium based solid solution

    International Nuclear Information System (INIS)

    Rokhlin, L.L.; Padezhnova, E.M.; Guzej, L.S.

    1976-01-01

    Electric resistance measurements and microscopic analysis were used to investigate the solubility of samarium in a magnesium-based solid solution. The constitutional diagram Mg-Sm on the magnesium side is of an eutectic type with the temperature of the eutectic transformation of 542 deg C. Samarium is partly soluble in solid magnesium, the less so, the lower is the temperature. The maximum solubility of samarium in magnesium (at the eutectic transformation point) is 5.8 % by mass (0.99 at. %). At 200 deg C, the solubility of samarium in magnesium is 0.4 % by mass (0.063 at. %)

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

    Science.gov (United States)

    Osborn, John

    2002-01-01

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

  12. Surface phase transitions in cu-based solid solutions

    Science.gov (United States)

    Zhevnenko, S. N.; Chernyshikhin, S. V.

    2017-11-01

    We have measured surface energy in two-component Cu-based systems in H2 + Ar gas atmosphere. The experiments on solid Cu [Ag] and Cu [Co] solutions show presence of phase transitions on the surfaces. Isotherms of the surface energy have singularities (the minimum in the case of copper solid solutions with silver and the maximum in the case of solid solutions with cobalt). In both cases, the surface phase transitions cause deficiency of surface miscibility: formation of a monolayer (multilayer) (Cu-Ag) or of nanoscale particles (Cu-Co). At the same time, according to the volume phase diagrams, the concentration and temperature of the surface phase transitions correspond to the solid solution within the volume. The method permits determining the rate of diffusional creep in addition to the surface energy. The temperature and concentration dependence of the solid solutions' viscosity coefficient supports the fact of the surface phase transitions and provides insights into the diffusion properties of the transforming surfaces.

  13. Evidence Based Education: un quadro storico

    Directory of Open Access Journals (Sweden)

    Giuliano Vivanet

    2013-08-01

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

  14. Evidence-based policymaking: A review

    Directory of Open Access Journals (Sweden)

    Karen Nortje

    2010-05-01

    Full Text Available The process of facilitating the uptake of evidence, for example, scientific research findings, into the policymaking process is multifaceted and thus complex. It is therefore important for scientists to understand this process in order to influence it more effectively. Similarly, policymakers need to understand the complexities of the scientific process to improve their interaction with the scientific sphere. This literature review addresses those factors that influence the uptake of scientific evidence into policymaking, the barriers to using science in policymaking, as well as recommendations for improved science–policymaking interaction. A visual diagram of the gears of a car is used to convey the message of the complexities around the engagement between science and policymaking. It is concluded that the issue of evidence-based policymaking remains unresolved and questions for future research on the science–policy interface are raised.

  15. Evidências de validade da Escala Brasileira de Solidão UCLA

    Directory of Open Access Journals (Sweden)

    Sabrina Martins Barroso

    2016-03-01

    Full Text Available RESUMO Objetivo Este trabalho investigou as evidências de validade da Escala de Solidão UCLA para aplicação na população brasileira. Métodos Foram seguidas as fases: (1 autorização do autor e do Comitê de Ética; (2 tradução e retrotradução; (3 adaptação semântica; (4 validação. Utilizou-se para análise dos dados análise descritiva, fatorial exploratória, alpha de Cronbach, Kappa, teste de esfericidade de Barlett, teste Kaiser-Meyer-Olkin e correlação de Pearson. Para a adaptação, a escala foi submetida a especialistas e a um grupo focal com 8 participantes para adaptação semântica e a um estudo piloto com 126 participantes para adaptação transcultural. Da validação, participaram 818 pessoas, entre 20 e 87 anos, que responderam a duas versões da UCLA, ao Questionário de Saúde do Paciente, à Escala de Percepção de Suporte Social e a um questionário elaborado pelos autores. Resultados A escala mostrou dois fatores, que explicaram 56% da variância e alpha de 0,94. Conclusões A Escala de Solidão UCLA-BR indicou evidências de validade de construto e discriminante, além de boa fidedignidade, podendo ser utilizada para avaliação da solidão na população brasileira.

  16. Teaching evidence based medicine in family medicine

    Directory of Open Access Journals (Sweden)

    Davorka Vrdoljak

    2012-05-01

    Full Text Available The concept of evidence based medicine (EBM as the integrationof clinical expertise, patient values and the best evidence was introduced by David Sackett in the 1980’s. Scientific literature in medicine is often marked by expansion, acummulation and quick expiration. Reading all important articles to keep in touch with relevant information is impossible. Finding the best evidence that answers a clinical question in general practice (GP in a short time is not easy. Five useful steps are described –represented by the acronym “5A+E”: assess, ask, acquire, appraise, apply and evaluate.The habit of conducting an evidence search “on the spot’’ is proposed. Although students of medicine at University of Split School of Medicine are taught EBM from the first day of their study and in all courses, their experience of evidence-searching and critical appraisal of the evidence, in real time with real patient is inadequate. Teaching the final-year students the practical use of EBM in a GP’s office is different and can have an important role in their professional development. It can positively impact on quality of their future work in family practice (or some other medical specialty by acquiring this habit of constant evidence-checking to ensure that best practice becomes a mechanism for life-long learning. Conclusion. EBM is a foundation stone of every branch of medicine and important part of Family Medicine as scientific and professional discipline. To have an EB answer resulting from GP’s everyday work is becoming a part of everyday practice.

  17. Can Scholarly Communication be Evidence Based? (Editorial

    Directory of Open Access Journals (Sweden)

    Denise Koufogiannakis

    2010-12-01

    Full Text Available This issue of Evidence Based Library and Information Practice includes three papers from the Evidence Based Scholarly Communication Conference (EBSCC that took place in March 2010i. Kroth, Philips and Eldredge have written a commentary that gives an overview of the conference, and introduces us to the research papers that were presented. As well, two research presentations from the conference appear in this issue, an article by Donahue about a potential new method of communicating between scholars, and a paper by Gilliland in our Using Evidence in Practice section, detailing a library’s Open Access Day preparations.Kroth, Philips and Eldredge note that “The EBSCC brought together librarians and information specialists to share evidence-based strategies for developing effective local scholarly communication support and training and, hopefully, form new coalitions to address this topic at a local and national level.” (p 108. This conference focused on translational medicine, and looked at how to promote new methods of scholarly communication, partially through the inclusion of research papers at the conference.The inclusion of these articles and the evidence based focus of the EBSCC conference, made me ask myself, can scholarly communication be evidence based? At its core, scholarly communication is anything but a scientific issue. It is charged with emotion; from authors, publishers, librarians and others involved in the business of publishing. The recent shift to look at new models of scholarly communication has been a threat to many of the established models and sparked much debate in the academic world, especially in relation to open access. In her 2006 EBLIP commentary on evidence based practice and open access, Morrison notes, “Open Access and evidence based librarianship are a natural combination” (p. 49, and outlines her perspective on many of the reasons why. Debate continues to rage, however, regarding how authors should

  18. Promoting evidence-based practice in pharmacies.

    Science.gov (United States)

    Toklu, Hale Zerrin

    2015-01-01

    Evidence-based medicine aims to optimize decision-making by using evidence from well-designed and conducted research. The concept of reliable evidence is essential, since the number of electronic information resources is increasing in parallel to the increasing number and type of drugs on the market. The decision-making process is a complex and requires an extensive evaluation as well as the interpretation of the data obtained. Different sources provide different levels of evidence for decision-making. Not all the data have the same value as the evidence. Rational use of medicine requires that the patients receive "medicines appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community." Pharmacists have a crucial role in the health system to maintain the rational use of medicine and provide pharmaceutical care to patients, because they are the drug experts who are academically trained for this purpose. The rational use of the pharmacist's workforce will improve the outcome of pharmacotherapy as well as decreasing the global health costs.

  19. Promoting evidence-based practice in pharmacies

    Directory of Open Access Journals (Sweden)

    Toklu HZ

    2015-09-01

    Full Text Available Hale Zerrin Toklu Department of Pharmacology and Therapeutics, College of Medicine, University of Florida, Gainesville, FL, USA Abstract: Evidence-based medicine aims to optimize decision-making by using evidence from well-designed and conducted research. The concept of reliable evidence is essential, since the number of electronic information resources is increasing in parallel to the increasing number and type of drugs on the market. The decision-making process is a complex and requires an extensive evaluation as well as the interpretation of the data obtained. Different sources provide different levels of evidence for decision-making. Not all the data have the same value as the evidence. Rational use of medicine requires that the patients receive “medicines appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.” Pharmacists have a crucial role in the health system to maintain the rational use of medicine and provide pharmaceutical care to patients, because they are the drug experts who are academically trained for this purpose. The rational use of the pharmacist's workforce will improve the outcome of pharmacotherapy as well as decreasing the global health costs. Keywords: pharmacist, rational use of medicine, pharmacotherapy, pharmaceutical, outcome

  20. The Evidence-Based Manifesto for School Librarians

    Science.gov (United States)

    Todd, Ross

    2008-01-01

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

  1. Evidence-based pathology: umbilical cord coiling.

    Science.gov (United States)

    Khong, T Y

    2010-12-01

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

  2. How evidence-based are the recommendations in evidence-based guidelines?

    Directory of Open Access Journals (Sweden)

    Finlay A McAlister

    2007-08-01

    Full Text Available BACKGROUND: Treatment recommendations for the same condition from different guideline bodies often disagree, even when the same randomized controlled trial (RCT evidence is cited. Guideline appraisal tools focus on methodology and quality of reporting, but not on the nature of the supporting evidence. This study was done to evaluate the quality of the evidence (based on consideration of its internal validity, clinical relevance, and applicability underlying therapy recommendations in evidence-based clinical practice guidelines. METHODS AND FINDINGS: A cross-sectional analysis of cardiovascular risk management recommendations was performed for three different conditions (diabetes mellitus, dyslipidemia, and hypertension from three pan-national guideline panels (from the United States, Canada, and Europe. Of the 338 treatment recommendations in these nine guidelines, 231 (68% cited RCT evidence but only 105 (45% of these RCT-based recommendations were based on high-quality evidence. RCT-based evidence was downgraded most often because of reservations about the applicability of the RCT to the populations specified in the guideline recommendation (64/126 cases, 51% or because the RCT reported surrogate outcomes (59/126 cases, 47%. CONCLUSIONS: The results of internally valid RCTs may not be applicable to the populations, interventions, or outcomes specified in a guideline recommendation and therefore should not always be assumed to provide high-quality evidence for therapy recommendations.

  3. Radiographers' preconditions for evidence-based radiography

    International Nuclear Information System (INIS)

    Ahonen, Sanna-Mari; Liikanen, Eeva

    2010-01-01

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

  4. Evidence-Based Advances in Reptile Medicine.

    Science.gov (United States)

    Mitchell, Mark A; Perry, Sean M

    2017-09-01

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

  5. Creative teaching an evidence-based approach

    CERN Document Server

    Sale, Dennis

    2015-01-01

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

  6. Evidence-based hypnotherapy for depression.

    Science.gov (United States)

    Alladin, Assen

    2010-04-01

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

  7. Morphea: Evidence-based recommendations for treatment

    Directory of Open Access Journals (Sweden)

    Nicole M Fett

    2012-01-01

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

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

    African Journals Online (AJOL)

    2018-05-01

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

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

    African Journals Online (AJOL)

    2018-05-01

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

  10. Zirconia-based solid state chemical gas sensors

    CERN Document Server

    Zhuiykov, S

    2000-01-01

    This paper presents an overview of chemical gas sensors, based on solid state technology, that are sensitive to environmental gases, such as O sub 2 , SO sub x , NO sub x , CO sub 2 and hydrocarbons. The paper is focussed on performance of electrochemical gas sensors that are based on zirconia as a solid electrolyte. The paper considers sensor structures and selection of electrode materials. Impact of interfaces on sensor performance is discussed. This paper also provides a brief overview of electrochemical properties of zirconia and their effect on sensor performance. Impact of auxiliary materials on sensors performance characteristics, such as sensitivity, selectivity, response time and recovery time, is also discussed. Dual gas sensors that can be applied for simultaneous monitoring of the concentration of both oxygen and other gas phase components, are briefly considered

  11. Solid-State Quantum Computer Based on Scanning Tunneling Microscopy

    Energy Technology Data Exchange (ETDEWEB)

    Berman, G. P.; Brown, G. W.; Hawley, M. E.; Tsifrinovich, V. I.

    2001-08-27

    We propose a solid-state nuclear-spin quantum computer based on application of scanning tunneling microscopy (STM) and well-developed silicon technology. It requires the measurement of tunneling-current modulation caused by the Larmor precession of a single electron spin. Our envisioned STM quantum computer would operate at the high magnetic field ({approx}10 T) and at low temperature {approx}1 K .

  12. Solid-State Quantum Computer Based on Scanning Tunneling Microscopy

    International Nuclear Information System (INIS)

    Berman, G. P.; Brown, G. W.; Hawley, M. E.; Tsifrinovich, V. I.

    2001-01-01

    We propose a solid-state nuclear-spin quantum computer based on application of scanning tunneling microscopy (STM) and well-developed silicon technology. It requires the measurement of tunneling-current modulation caused by the Larmor precession of a single electron spin. Our envisioned STM quantum computer would operate at the high magnetic field (∼10 T) and at low temperature ∼1 K

  13. Evidence-Based Interactive Management of Change

    Directory of Open Access Journals (Sweden)

    Albert Fleischmann

    2011-06-01

    Full Text Available Evidence-based interactive management of change means hands-on experience of modified work processes, given evidence of change. For this kind of pro-active organizational development support we use an organisational process memory and a communication-based representation technique for role-specific and task-oriented process execution. Both are effective means for organizations becoming agile through interactively modelling the business at the process level and re-constructing or re-arranging process representations according to various needs. The tool allows experiencing role-specific workflows, as the communication-based refinement of work models allows for executable process specifications. When presenting the interactive processes to individuals involved in the business processes, changes can be explored interactively in a context-sensitive way before re-implementing business processes and information systems. The tool is based on a service-oriented architecture and a flexible representation scheme comprising the exchange of message between actors, business objects and actors (roles. The interactive execution of workflows does not only enable the individual reorganization of work but also changes at the level of the entire organization due to the represented interactions.

  14. An evidence-based review: distracted driver.

    Science.gov (United States)

    Llerena, Luis E; Aronow, Kathy V; Macleod, Jana; Bard, Michael; Salzman, Steven; Greene, Wendy; Haider, Adil; Schupper, Alex

    2015-01-01

    Cell phone use and texting are prevalent within society and have thus pervaded the driving population. This technology is a growing concern within the confines of distracted driving, as all diversions from attention to the road have been shown to increase the risk of crashes. Adolescent, inexperienced drivers, who have the greatest prevalence of texting while driving, are at a particularly higher risk of crashes because of distraction. Members of the Injury Control Violence Prevention Committee of the Eastern Association for the Surgery of Trauma performed a PubMed search of articles related to distracted driving and cell phone use as a distractor of driving between 2000 and 2013. A total of 19 articles were found to merit inclusion as evidence in the evidence-based review. These articles provided evidence regarding the relationship between distracted driving and crashes, cell phone use contributing to automobile accidents, and/or the relationship between driver experience and automobile accidents. (Adjust methods/results sections to the number of articles that correctly corresponds to the number of references, as well as the methodology for reference inclusion.) Based on the evidence reviewed, we can recommend the following. All drivers should minimize all in-vehicle distractions while on the road. All drivers should not text or use any touch messaging system (including the use of social media sites such as Facebook and Twitter) while driving. Younger, inexperienced drivers should especially not use cell phones, texting, or any touch messaging system while driving because they pose an increased risk for death and injury caused by distractions while driving.

  15. Novel solidsolid phase change material based on polyethylene glycol and cellulose used for temperature stabilisation

    Directory of Open Access Journals (Sweden)

    Wojda Marta

    2014-01-01

    Full Text Available Thermal management is one of crucial issues in the development of modern electronic devices. In the recent years interest in phase change materials (PCMs as alternative cooling possibility has increased significantly. Preliminary results concerning the research into possibility of the use of solid-solid phase change materials (S-S PCMs for stabilisation temperature of electronic devices has been presented in the paper. Novel solid-solid phase change material based on polyethylene glycol and cellulose has been synthesized. Attempt to improve its thermal conductivity has been taken. Material has been synthesized for the purpose of stabilisation of temperature of electronic devices.

  16. Psychiatric mental health evidence-based practice.

    Science.gov (United States)

    Rice, Michael J

    2008-05-01

    This article is the first in a new column focusing on evidence-based practice (EBP) in psychiatric mental health nursing. The EBP movement was strongly influenced by a British epidemiologist, Dr. Cochrane, who advocated care based on randomized clinical controlled trials in the late 1900s. Although the majority of the EBP movement is directed toward developing clinical guidelines, the critical element focuses on the therapeutic relationship and clinical judgment associated with providing care. This column will address a clinical problem, define PICO questions, report knowledge base searches, and present existing evidence. Recommendations will be offered for potential interventions and suggestions for evaluating clinical outcomes. Nurses can no longer view clinical studies as academic exercises discarded on graduation and not applied to the clinical setting. Conscientiously applying what is known about treatments and interventions of ethical, if not legal, value is consistent with the professional definition of care. J Am Psychiatr Nurses Assoc, 2008; 14(2), 107-111. DOI: 10.1177/1078390308315798.

  17. Evidence-Based Advances in Rabbit Medicine.

    Science.gov (United States)

    Summa, Noémie M; Brandão, João

    2017-09-01

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

  18. Evidence-Based Advances in Avian Medicine.

    Science.gov (United States)

    Summa, Noémie M; Guzman, David Sanchez-Migallon

    2017-09-01

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

  19. Leading change: evidence-based transition.

    Science.gov (United States)

    Lewis, Brennan; Allen, Stephanie

    2015-01-01

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

  20. Evidence-based prevention of childhood malnutrition.

    Science.gov (United States)

    Imdad, Aamer; Sadiq, Kamran; Bhutta, Zulfiqar A

    2011-05-01

    Childhood malnutrition is prevalent in developing countries and contributes to one-third of all deaths in these countries. There have been advances in prevention of childhood malnutrition and the purpose of this article was to review the current evidence in the field. Multiple micronutrient (MMN) supplements during pregnancy reduce the incidence of maternal anemia and small for gestational-age babies. Recent evidence suggest that combined supplementation of MMNs with protein energy supplement is more effective than MMN supplementation alone. It is now recommended that HIV-infected mothers can exclusively breast-feed their infants for 6 months when the mother or infant is on effective antiretroviral therapy. Home fortification of complementary foods reduces the prevalence of anemia in infancy and combined supplementation of MMNs with lipid-based supplements improves growth in young children. Ready-to-use therapeutic foods have been successfully used to manage severe acute malnutrition in the community. Zinc supplementation is associated with a reduction in diarrhea and respiratory disease morbidity and improves linear growth. Vitamin A supplementation decreases the incidence of diarrhea and measles. Water supply, sanitation, and hygiene are important for the prevention of malnutrition because of their direct impact on infectious disease. There is clear evidence on the causes and consequences of malnutrition as well as effective interventions to prevent undernutrition. The next step is to implement these packages of interventions at large scale. A global effort is required that should entail unified and compelling advocacy among governments, lead organizations, and institutions.

  1. Evidence-Based Management of Anticoagulant Therapy

    Science.gov (United States)

    Schulman, Sam; Witt, Daniel M.; Vandvik, Per Olav; Fish, Jason; Kovacs, Michael J.; Svensson, Peter J.; Veenstra, David L.; Crowther, Mark; Guyatt, Gordon H.

    2012-01-01

    Background: High-quality anticoagulation management is required to keep these narrow therapeutic index medications as effective and safe as possible. This article focuses on the common important management questions for which, at a minimum, low-quality published evidence is available to guide best practices. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: Most practical clinical questions regarding the management of anticoagulation, both oral and parenteral, have not been adequately addressed by randomized trials. We found sufficient evidence for summaries of recommendations for 23 questions, of which only two are strong rather than weak recommendations. Strong recommendations include targeting an international normalized ratio of 2.0 to 3.0 for patients on vitamin K antagonist therapy (Grade 1B) and not routinely using pharmacogenetic testing for guiding doses of vitamin K antagonist (Grade 1B). Weak recommendations deal with such issues as loading doses, initiation overlap, monitoring frequency, vitamin K supplementation, patient self-management, weight and renal function adjustment of doses, dosing decision support, drug interactions to avoid, and prevention and management of bleeding complications. We also address anticoagulation management services and intensive patient education. Conclusions: We offer guidance for many common anticoagulation-related management problems. Most anticoagulation management questions have not been adequately studied. PMID:22315259

  2. Solid formation in piperazine rate-based simulation

    DEFF Research Database (Denmark)

    Gaspar, Jozsef; Thomsen, Kaj; von Solms, Nicolas

    2014-01-01

    of view but also from a modeling perspective. The present work develops a rate-based model for CO2 absorption and desorption modeling for gas-liquid-solid systems and it is demonstrated for the piperazine CO2 capture process. This model is an extension of the DTU CAPCO2 model to precipitating systems....... It uses the extended UNIQUAC thermodynamic model for phase equilibria and thermal properties estimation. The mass and heat transfer phenomena is implemented in a film model approach, based on second order reactions kinetics. The transfer fluxes are calculated using the concentration of the dissolved...

  3. Evidence-Based Laboratory Medicine: Is It Working in Practice?

    OpenAIRE

    Price, Christopher P

    2012-01-01

    The principles of Evidence-Based Medicine have been established for about two decades, with the need for evidence-based clinical practice now being accepted in most health systems around the world. These principles can be employed in laboratory medicine. The key steps in evidence-based practice, namely (i) formulating the question; (ii) searching for evidence; (iii) appraising evidence; (iv) applying evidence; and (v) assessing the experience are all accepted but, as yet, translation into dai...

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

    NARCIS (Netherlands)

    van Enst, W.A.

    2014-01-01

    Evidence-Based Medicine is the integration of best research evidence with clinical expertise and patient values. Systematic reviews have become the cornerstone of evidence-based medicine, which is reflected in the position systematic reviews have in the pyramid of evidence-based medicine. Systematic

  5. Information provision in medical libraries: An evidence based ...

    African Journals Online (AJOL)

    The paper examined information provision in special libraries such as medical libraries. It provides an overview of evidence based practice as a concept for information provision by librarians. It specifically proffers meaning to the term evidence as used in evidence based practice and to evidence based medicine from where ...

  6. Ethical reflections on Evidence Based Medicine

    Directory of Open Access Journals (Sweden)

    S. Corrao

    2013-05-01

    Full Text Available BACKGROUND According to Potter’s point of view, medical ethics is the science of survival, a bridge between humanistic and scientific culture. The working out of judgements on right or wrong referred to the human being are studied by this science. Methodological quality is fundamental in clinical research, and several technical issues are of paramount importance in trying to answer to the final question “what is the true, the right thing?”. We know they are essential aspects as in medical ethics as in evidence based practice. AIM OF THE STUDY The aim of this paper is to talk about relationships and implications between ethical issues and Evidence Based Medicine (EBM. DISCUSSION EBM represents a new paradigm that introduces new concepts to guide medical-decision making and health-care planning. Its principles are deeply rooted in clinical research methodology since information are derived from sound studies of strong quality. Health-care professionals have to deal with methodological concepts for critical appraisal of literature and implementation of evidences in clinical practice and healthcare planning. The central role of EBM in medical ethics is obvious, but a risk could be possible. The shift from Hippocratic point of view to community-centred one could lose sight of the centrality of the patient. CONCLUSION Both EBM principles and the needs to adequately response to economic restrictions urge a balance between individual and community ethics. All this has to represent an opportunity to place the patient at the centre of medical action considering at the same time community ethics as systemic aim, but without forgetting the risk that economic restrictions push towards veterinary ethics where herd is central and individual needs do not exist.

  7. Novel Nanostructured Solid Materials for Modulating Oral Drug Delivery from Solid-State Lipid-Based Drug Delivery Systems.

    Science.gov (United States)

    Dening, Tahnee J; Rao, Shasha; Thomas, Nicky; Prestidge, Clive A

    2016-01-01

    Lipid-based drug delivery systems (LBDDS) have gained significant attention in recent times, owing to their ability to overcome the challenges limiting the oral delivery of poorly water-soluble drugs. Despite the successful commercialization of several LBDDS products over the years, a large discrepancy exists between the number of poorly water-soluble drugs displaying suboptimal in vivo performances and the application of LBDDS to mitigate their various delivery challenges. Conventional LBDDS, including lipid solutions and suspensions, emulsions, and self-emulsifying formulations, suffer from various drawbacks limiting their widespread use and commercialization. Accordingly, solid-state LBDDS, fabricated by adsorbing LBDDS onto a chemically inert solid carrier material, have attracted substantial interest as a viable means of stabilizing LBDDS whilst eliminating some of the various limitations. This review describes the impact of solid carrier choice on LBDDS performance and highlights the importance of appropriate solid carrier material selection when designing hybrid solid-state LBDDS. Specifically, emphasis is placed on discussing the ability of the specific solid carrier to modulate drug release, control lipase action and lipid digestion, and enhance biopharmaceutical performance above the original liquid-state LBDDS. To encourage the interested reader to consider their solid carrier choice on a higher level, various novel materials with the potential for future use as solid carriers for LBDDS are described. This review is highly significant in guiding future research directions in the solid-state LBDDS field and fostering the translation of these delivery systems to the pharmaceutical marketplace.

  8. The ethical approach to evidence-based medicine

    African Journals Online (AJOL)

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

  9. Evidence Based Practice Outside the Box (Editorial

    Directory of Open Access Journals (Sweden)

    Lindsay Glynn

    2008-09-01

    Full Text Available I love food. I love cooking, baking, testing, and eating. I read about food preparation, food facts, and food service. Over the years I’ve developed my fair share of knowledge about cooking and I’m a decent cook, but I’m no chef. I guess I’m what you’d call a “foodie”. However, I have the good fortune to have a friend who is a chef and owns one of the best, and certainly the most innovative, restaurants in town. During this summer I hosted a cooking class in my home for my family with my chef friend as instructor. The Tex-Mex barbecue theme was a big hit (you can contact me for recipes, if you like, but much more fascinating was the explanation of the science behind the cooking. It turns out that there is a term for this: molecular gastronomy. Another term, and hence the genesis of my “Eureka!” moment of the summer, is evidence based cooking. Good cooking is not just following a recipe (not all of which are evidence based but at its best is the culmination of heaps of tested information regarding why and how chemical and environmental factors work together to result in a gastronomical delight. For example, will brining or marinating a pork chop make it moister? And, if brining, what temperature should the water be, how long should it soak, and how much salt is needed? Why does pounding meat increase its tenderness? What will keep guacamole from browning better – the pit or lime juice? What does baking soda do in a chocolate cake? Eggs or no eggs in fresh pasta? Like most librarians, I tend not to take information at face value. I want to know where information comes from and whether or not it is valid, based on specific factors. I’ve come to notice that evidence based, or evidence informed, practice is everywhere and has a tremendous impact on our lives. Why do you rotate the tires on your car? Evidence shows that the front tires wear more quickly (think about all those 3-pointturns, the braking, etc and therefore

  10. The Heart of the Matter of Opinion and Evidence: The Value of Evidence-Based Medicine

    OpenAIRE

    Masvidal, Daniel; Lavie, Carl J.

    2012-01-01

    Evidence-based medicine is an important aspect of continuing medical education. This article reviews previous and current examples of conflicting topics that evidence-based medicine has clarified to allow us to provide the best possible patient care.

  11. The evidence-based practice ideologies.

    Science.gov (United States)

    Mantzoukas, Stefanos

    2007-10-01

    This paper puts forward the argument that there are various, competing, and antithetical evidence-based practice (EBP) definitions and acknowledges that the different EBP definitions are based on different epistemological perspectives. However, this is not enough to understand the way in which nurse professionals choose between the various EBP formations and consequently facilitate them in choosing the most appropriate for their needs. Therefore, the current article goes beyond and behind the various EBP epistemologies to identify how individuals choose an epistemology, which consequently will assist our understanding as to how an individual chooses a specific EBP formation. Individuals choose an epistemology on the mere belief that the specific epistemology offers the ideals or ideas of best explaining or interpreting daily reality. These ideals or ideas are termed by science, history, and politics as ideology. Similarly, individual practitioners choose or should choose between the different EBP formations based on their own personal ideology. Consequently, this article proceeds to analyse the various ideologies behind different EBP definitions as to conclude that there are two broad ideologies that inform the various EBP formations, namely the ideology of truth and the ideology of individual emancipation. These two ideologies are analysed and their connections to the various EBP formations are depicted. Eventually, the article concludes that the in-depth, critical, and intentional analysis by individual nurses of their own ideology will allow them to choose the EBP formation that is most appropriate and fitting for them, and their specific situation. Hence, the conscious analysis of individual ideology becomes the criterion for choosing between competing EBP formations and allows for best evidence to be implemented in practice. Therefore, the best way to teach EBP courses is by facilitating students to analyse their own ideology.

  12. Evidence-Based Practice in Liposuction.

    Science.gov (United States)

    Collins, Patrick S; Moyer, Kurtis E

    2018-01-24

    The goal of this study is to examine the existing peer reviewed literature comparing modern adjunctive techniques in liposuction including laser-assisted liposuction (LAL) and ultrasound-assisted liposuction (UAL) to standard suction-assisted liposuction (SAL). We intend to interpret these findings into a literature-based clinical application to influence practice patterns. A literature review was conducted using a keyword search in PubMed. Keyword search items included liposuction, lipoplasty, suction assisted liposuction, ultrasound assisted liposuction, laser assisted liposuction, tumescent, liposuction comparison, liposuction review, and combinations therein. Exclusion criteria included articles with a primary focus on histologic effects of energy devices, primary animal models, primary opinion papers with no reference to available data, and industry-sponsored publications. Inclusion criteria included articles with direct comparison of liposuction modalities, randomized or blinded studies, and studies with objective outcomes. Twenty-five articles that met the inclusion criteria comparing SAL to UAL or LAL out of 9972 articles identified were obtained. The selected literature was assigned into 3 categories: evidence demonstrating an advantage of 1 modality (SAL, UAL, or LAL) over another, evidence that showed no benefit of 1 modality over another, and evidence that demonstrated risks of complications of 1 modality over another. The benefits of UAL and LAL over SAL include the following: (1) UAL over SAL in the treatment of gynecomastia, (2) LAL and UAL over SAL with decreased hemoglobin/hematocrit in high-volume lipoaspirates, and (3) LAL over SAL with skin tightening in select areas specifically the submental area. Otherwise, the literature demonstrates equivocal results among the described techniques with no clear benefit to set one apart from the other. There appears to be no demonstrable added benefit to the addition of either UAL or LAL that would urge a

  13. All-solid-state reference electrodes based on conducting polymers.

    Science.gov (United States)

    Kisiel, Anna; Marcisz, Honorata; Michalska, Agata; Maksymiuk, Krzysztof

    2005-12-01

    A novel construction of solution free (pseudo)reference electrodes, compatible with all-solid-state potentiometric indicator electrodes, has been proposed. These electrodes use conducting polymers (CP): polypyrrole (PPy) or poly(3,4-ethylenedioxythiophene) (PEDOT). Two different arrangements have been tested: solely based on CP and those where the CP phase is covered with a poly(vinyl chloride) based outer membrane of tailored composition. The former arrangement was designed to suppress or compensate cation- and anion-exchange, using mobile perchlorate ions and poly(4-styrenesulfonate) or dodecylbenzenesulfonate anions as immobilized dopants. The following systems were used: (i) polypyrrole layers doped simultaneously by two kinds of anions, both mobile and immobilized in the polymer layer; (ii) bilayers of polypyrrole with anion exchanging inner layer and cation-exchanging outer layer; (iii) polypyrrole doped by surfactant dodecylbenzenesulfonate ions, which inhibit ion exchange on the polymer/solution interface. For the above systems, recorded potentials have been found to be practically independent of electrolyte concentration. The best results, profound stability of potentials, have been obtained for poly(3,4-ethylenedioxythiophene) or polypyrrole doped by poly(4-styrenesulfonate) anions covered by a poly(vinyl chloride) based membrane, containing both anion- and cation-exchangers as well as solid potassium chloride and silver chloride with metallic silver. Differently to the cases (i)-(iii) these electrodes are much less sensitive to the influence of redox and pH interferences. This arrangement has been also characterized using electrochemical impedance spectroscopy and chronopotentiometry.

  14. Evidence-based medicine: Mandible fractures.

    Science.gov (United States)

    Morrow, Brad T; Samson, Thomas D; Schubert, Warren; Mackay, Donald R

    2014-12-01

    After studying this article, the participant should be able to: 1. Describe the anatomy and subunits of the mandible. 2. Review the cause and epidemiology of mandible fractures. 3. Discuss the preoperative evaluation and diagnostic imaging. 4. Understand the principles and techniques of mandible fracture reduction and fixation. The management of mandibular fractures has undergone significant improvement because of advancements in plating technology, imaging, and instrumentation. As the techniques in management continue to evolve, it is imperative for the practicing physician to remain up-to-date with the growing body of scientific literature. The objective of this Maintenance of Certification article is to present a review of the literature so that the physician may make treatment recommendation based on the best evidence available. Pediatric fractures have been excluded from this article.

  15. Colon Trauma: Evidence-Based Practices.

    Science.gov (United States)

    Yamamoto, Ryo; Logue, Alicia J; Muir, Mark T

    2018-01-01

    Colon injury is not uncommon and occurs in about a half of patients with penetrating hollow viscus injuries. Despite major advances in the operative management of penetrating colon wounds, there remains discussion regarding the appropriate treatment of destructive colon injuries, with a significant amount of scientific evidence supporting segmental resection with primary anastomosis in most patients without comorbidities or large transfusion requirement. Although literature is sparse concerning the management of blunt colon injuries, some studies have shown operative decision based on an algorithm originally defined for penetrating wounds should be considered in blunt colon injuries. The optimal management of colonic injuries in patients requiring damage control surgery (DCS) also remains controversial. Studies have recently reported that there is no increased risk compared with patients treated without DCS if fascial closure is completed on the first reoperation, or that a management algorithm for penetrating colon wounds is probably efficacious for colon injuries in the setting of DCS as well.

  16. EVIDENCE-BASED USE OF EPLERENONE

    Directory of Open Access Journals (Sweden)

    S. R. Gilyarevski

    2012-01-01

    Full Text Available Data of the negative effect of high concentrations of aldosterone in the blood for cardiovascular disease, which served as the theoretical basis for wider use in clinical practice of the drugs belonging to the class of aldosterone receptor blockers is presented. Evidence-based data on efficacy and safety of aldosterone receptor blockers, which were obtained in the course of several randomized clinical trials is performed. Particular attention is paid to aspects of the clinical use of selective aldosterone receptor blocker eplerenone, including current data, which makes reasonable extension of indications for its use in treating patients with chronic heart failure. Data on indications of eplerenone use in patients with hypertension, especially in the case of associated target organ damage is presented.

  17. EVIDENCE-BASED USE OF EPLERENONE

    Directory of Open Access Journals (Sweden)

    S. R. Gilyarevski

    2014-07-01

    Full Text Available Data of the negative effect of high concentrations of aldosterone in the blood for cardiovascular disease, which served as the theoretical basis for wider use in clinical practice of the drugs belonging to the class of aldosterone receptor blockers is presented. Evidence-based data on efficacy and safety of aldosterone receptor blockers, which were obtained in the course of several randomized clinical trials is performed. Particular attention is paid to aspects of the clinical use of selective aldosterone receptor blocker eplerenone, including current data, which makes reasonable extension of indications for its use in treating patients with chronic heart failure. Data on indications of eplerenone use in patients with hypertension, especially in the case of associated target organ damage is presented.

  18. Evidence Based Cataloguing: Moving Beyond the Rules

    Directory of Open Access Journals (Sweden)

    Kathy Carter

    2010-12-01

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

  19. Evidence-based treatment of metabolic myopathy

    Directory of Open Access Journals (Sweden)

    Yan LIN

    2014-05-01

    Full Text Available Objective To evaluate the current treatments and possible adverse reactions of metabolic myopathy, and to develop the best solution for evidence-based treatment.  Methods Taking metabolic myopathy, mitochondrial myopathy, lipid storage myopathy, glycogen storage diseases, endocrine myopathy, drug toxicity myopathy and treatment as search terms, retrieve in databases such as PubMed, Cochrane Library, ClinicalKey database, National Science and Technology Library (NSTL, in order to collect the relevant literature database including clinical guidelines, systematic reviews (SR, randomized controlled trials (RCT, controlled clinical trials, retrospective case analysis and case study. Jadad Scale was used to evaluate the quality of literature.  Results Twenty-eight related articles were selected, including 6 clinical guidelines, 5 systematic reviews, 10 randomized controlled trials and 7 clinical controlled trials. According to Jadad Scale, 23 articles were evaluated as high-quality literature (≥ 4, and the remaining 5 were evaluated as low-quality literature (< 4. Treatment principles of these clinical trials, efficacy of different therapies and drug safety evaluation suggest that: 1 Acid α-glycosidase (GAA enzyme replacement therapy (ERT is the main treatment for glycogen storage diseases, with taking a high-protein diet, exercising before taking a small amount of fructose orally and reducing the patient's physical activity gradually. 2 Carnitine supplementation is used in the treatment of lipid storage myopathy, with carbohydrate and low fat diet provided before exercise or sports. 3 Patients with mitochondrial myopathy can take coenzyme Q10, vitamin B, vitamin K, vitamin C, etc. Proper aerobic exercise combined with strength training is safe, and it can also enhance the exercise tolerance of patients effectively. 4 The first choice to treat the endocrine myopathy is treating primary affection. 5 Myopathies due to drugs and toxins should

  20. Theromdynamics of carbon in nickel-based multicomponent solid solutions

    International Nuclear Information System (INIS)

    Bradley, D.J.

    1978-04-01

    The activity coefficient of carbon in nickel, nickel-titanium, nickel-titanium-chromium, nickel-titanium-molybdenum and nickel-titanium-molybdenum-chromium alloys has been measured at 900, 1100 and 1215 0 C. The results indicate that carbon obeys Henry's Law over the range studied (0 to 2 at. percent). The literature for the nickel-carbon and iron-carbon systems are reviewed and corrected. For the activity of carbon in iron as a function of composition, a new relationship based on re-evaluation of the thermodynamics of the CO/CO 2 equilibrium is proposed. Calculations using this relationship reproduce the data to within 2.5 percent, but the accuracy of the calibrating standards used by many investigators to analyze for carbon is at best 5 percent. This explains the lack of agreement between the many precise sets of data. The values of the activity coefficient of carbon in the various solid solutions are used to calculate a set of parameters for the Kohler-Kaufman equation. The calculations indicate that binary interaction energies are not sufficient to describe the thermodynamics of carbon in some of the nickel-based solid solutions. The results of previous workers for carbon in nickel-iron alloys are completely described by inclusion of ternary terms in the Kohler-Kaufman equation. Most of the carbon solid solution at high temperatures in nickel and nickel-titantium alloys precipitates from solution on quenching in water. The precipitate is composed of very small particles (greater than 2.5 nm) of elemental carbon. The results of some preliminary thermomigration experiments are discussed and recommendations for further work are presented

  1. Safety - a Neglected Issue When Introducing Solid Biomass Fuel in Thermal Power Plants? Some Evidence of an Emerging Risk

    DEFF Research Database (Denmark)

    Hedlund, Frank Huess; Astad, John

    2013-01-01

    The paper examines recent evidence from Denmark and abroad with climate change projects that aim to reduce global carbon dioxide emissions by converting coal fired thermal power plants to solid biomass fuel. The paper argues that projects appear to be pursued narrow-mindedly with insufficient att...

  2. Teaching evidence-based medicine more effectively.

    Science.gov (United States)

    Hatmi, Zinat Nadia; Tahvildari, Sousan; Dabiran, Soheila; Soheili, Suraya; Sabouri Kashani, Ahmad; Raznahan, Maedeh

    2010-01-01

    Evidence-based Medicine (EBM) is becoming an integral component of graduate medical education competency and a requirement for grad medical education practice-based learning core competency. This study tries to compare the efficacy of conferences utilizing small-group discussions with the traditional conference method in enhancing EBM competency. The participants in this randomized controlled trial (RCT) were 170 members of the medical faculty who were divided into two groups of 86 (intervention) and 84 (control). Following the intervention, EBM competency was assessed by a written examination. statistical analysis made use of chi-square test, independent sample t-test and relative risks for univariate analysis. Mantel-Hanszel was used for bivariate analysis. Cox proportional hazard models were used to evaluate multivariate-adjusted associations between EBM educational intervention and EBM knowledge, attitude and skills. A new indicator of number needed to intervention (NNI) was defined and computed. The results proved conference along with small-group discussion to be a more effective teaching method with P=0.001 on knowledge, P<0.001 for attitude and skills P<0.001 in an EBM exam when compared with medical faculty members who did not participate in EBM educational intervention (n=84). Moreover, they had also increased confidence with critical appraisal skills, and searching EBM resources. Conferences followed by small-group discussions significantly enhance EBM knowledge, attitude, critical appraisal skills and literature review skills.

  3. Teaching Evidence-Based Medicine More Effectively

    Directory of Open Access Journals (Sweden)

    Zinat Nadia Hatmi

    2010-09-01

    Full Text Available "nEvidence-based Medicine (EBM is becoming an integral component of graduate medical education competency and a requirement for grad medical education practice-based learning core competency. This study tries to compare the efficacy of conferences utilizing small-group discussions with the traditional conference method in enhancing EBM competency. The participants in this randomized controlled trial (RCT were 170 members of the medical faculty who were divided into two groups of 86 (intervention and 84 (control. Following the intervention, EBM competency was assessed by a written examination. statistical analysis made use of chi-square test, independent sample t-test and relative risks for univariate analysis. Mantel-Hanszel was used for bivariate analysis. Cox proportional hazard models were used to evaluate multivariate-adjusted associations between EBM educational intervention and EBM knowledge, attitude and skills. A new indicator of number needed to intervention (NNI was defined and computed. Results: The results proved conference along with small-group discussion to be a more effective teaching method with P=0.001 on knowledge, P<0.001 for attitude and skills P<0.001 in an EBM exam when compared with medical faculty members who did not participate in EBM educational intervention (n=84. Moreover, they had also increased confidence with critical appraisal skills, and searching EBM resources. Conclusions: Conferences followed by small-group discussions significantly enhance EBM knowledge, attitude, critical appraisal skills and literature review skills.

  4. Teaching Evidence-Based Medicine More Effectively

    Directory of Open Access Journals (Sweden)

    Zinat Nadia Hatmi

    2010-10-01

    Full Text Available Evidence-based Medicine (EBM is becoming an integral component of graduate medical education competency and a requirement for grad medical education practice-based learning core competency. This study tries to compare the efficacy of conferences utilizing small-group discussions with the traditional conference method in enhancing EBM competency. The participants in this randomized controlled trial (RCT were 170 members of the medical faculty who were divided into two groups of 86 (intervention and 84 (control. Following the intervention, EBM competency was assessed by a written examination. statistical analysis made use of chi-square test, independent sample t-test and relative risks for univariate analysis. Mantel-Hanszel was used for bivariate analysis. Cox proportional hazard models were used to evaluate multivariate-adjusted associations between EBM educational intervention and EBM knowledge, attitude and skills. A new indicator of number needed to intervention (NNI was defined and computed. Results: The results proved conference along with small-group discussion to be a more effective teaching method with P=0.001 on knowledge, P

  5. Evidence-based diagnostics: adult septic arthritis.

    Science.gov (United States)

    Carpenter, Christopher R; Schuur, Jeremiah D; Everett, Worth W; Pines, Jesse M

    2011-08-01

    Acutely swollen or painful joints are common complaints in the emergency department (ED). Septic arthritis in adults is a challenging diagnosis, but prompt differentiation of a bacterial etiology is crucial to minimize morbidity and mortality. The objective was to perform a systematic review describing the diagnostic characteristics of history, physical examination, and bedside laboratory tests for nongonococcal septic arthritis. A secondary objective was to quantify test and treatment thresholds using derived estimates of sensitivity and specificity, as well as best-evidence diagnostic and treatment risks and anticipated benefits from appropriate therapy. Two electronic search engines (PUBMED and EMBASE) were used in conjunction with a selected bibliography and scientific abstract hand search. Inclusion criteria included adult trials of patients presenting with monoarticular complaints if they reported sufficient detail to reconstruct partial or complete 2 × 2 contingency tables for experimental diagnostic test characteristics using an acceptable criterion standard. Evidence was rated by two investigators using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS). When more than one similarly designed trial existed for a diagnostic test, meta-analysis was conducted using a random effects model. Interval likelihood ratios (LRs) were computed when possible. To illustrate one method to quantify theoretical points in the probability of disease whereby clinicians might cease testing altogether and either withhold treatment (test threshold) or initiate definitive therapy in lieu of further diagnostics (treatment threshold), an interactive spreadsheet was designed and sample calculations were provided based on research estimates of diagnostic accuracy, diagnostic risk, and therapeutic risk/benefits. The prevalence of nongonococcal septic arthritis in ED patients with a single acutely painful joint is approximately 27% (95% confidence interval [CI] = 17

  6. E-Learning and Evidence Based Practice in Schools

    Science.gov (United States)

    Quong, Terrence

    2016-01-01

    JCTIC has used open source software to develop a unique school online environment that has made evidence based practice viable in their school. In this paper the proposition is made that eLearning enables evidence based practice which in turn leads to improved student outcomes. Much has been written about evidence based practice in schools, but…

  7. Effectiveness of Evidence-Based Asthma Interventions.

    Science.gov (United States)

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

    2017-06-01

    Researchers often struggle with the gap between efficacy and effectiveness in clinical research. To bridge this gap, the Community Healthcare for Asthma Management and Prevention of Symptoms (CHAMPS) study adapted an efficacious, randomized controlled trial that resulted in evidence-based asthma interventions in community health centers. Children (aged 5-12 years; N = 590) with moderate to severe asthma were enrolled from 3 intervention and 3 geographically/capacity-matched control sites in high-risk, low-income communities located in Arizona, Michigan, and Puerto Rico. The asthma intervention was tailored to the participant's allergen sensitivity and exposure, and it comprised 4 visits over the course of 1 year. Study visits were documented and monitored prospectively via electronic data capture. Asthma symptoms and health care utilization were evaluated at baseline, and at 6 and 12 months. A total of 314 intervention children and 276 control children were enrolled in the study. Allergen sensitivity testing (96%) and home environmental assessments (89%) were performed on the majority of intervention children. Overall study activity completion (eg, intervention visits, clinical assessments) was 70%. Overall and individual site participant symptom days in the previous 4 weeks were significantly reduced compared with control findings (control, change of -2.28; intervention, change of -3.27; difference, -0.99; P asthma in these high-need populations. Copyright © 2017 by the American Academy of Pediatrics.

  8. Evidence-based clinical practice, [corrected] evidence-based medicine and the Cochrane collaboration.

    Science.gov (United States)

    Gambrill, E

    1999-03-01

    Encouraging professionals in training and later to consider practice-related research findings when making important clinical decisions is an on-going concern. Evidenced-Based Medicine (EBM) and the Cochrane Collaboration (CC) provide a source of tools and ideas for doing so, as well as a roster of colleagues who share this interest. Evidenced-based medicine involves integrating clinical expertise with the best available external evidence from systematic research as well as considering the values and expectations of patients/clients. Advantage can be taken of educational formats developed in EBM, such as problem-based learning and critical-appraisal workshops in which participants learn how to ask key answerable questions related to important clinical practice questions (e.g., regarding effectiveness, accuracy of assessment measures, prediction, prevention, and quality of clinical practice guidelines) and to access and critically appraise related research. The Cochrane Collaboration is a world-wide network of centers that prepare, maintain, and disseminate high-quality systematic reviews on the efficacy of healthcare. These databases allow access to evidence related to clinical practice decisions. Forging reciprocal working relationships with those involved in EBM reciprocal and the CC should contribute to the pursuit of shared goals such as basing clinical decisions on the best-available evidence and involving clients as informed consumers.

  9. Electrochemical hydrogen isotope sensor based on solid electrolytes

    International Nuclear Information System (INIS)

    Matsumoto, Hiroshige; Hayashi, Hiroyuki; Iwahara, Hiroyasu

    2002-01-01

    An electrochemical sensor of hydrogen isotopes based on solid electrolytes for determining the hydrogen isotope ratios and/or total hydrogen pressures in gases has been developed. This paper describes the methodology of the hydrogen isotope sensing together with experimental results. When hydrogen isotope gases are introduced to an electrochemical cell using a proton-conducting electrolyte (hydrogen isotope cell), the electromotive force (EMF) of the cell agrees with that theoretically estimated. The EMF signals can be used for the determination of the hydrogen isotope ratio in gases if the total hydrogen pressure is predetermined. By supplementary use of an oxide ion conductor cell, both the ratio and total pressure of the hydrogen isotopes can be simultaneously determined. (author)

  10. Mathematical modeling of ethanol production in solid-state fermentation based on solid medium' dry weight variation.

    Science.gov (United States)

    Mazaheri, Davood; Shojaosadati, Seyed Abbas; Zamir, Seyed Morteza; Mousavi, Seyyed Mohammad

    2018-04-21

    In this work, mathematical modeling of ethanol production in solid-state fermentation (SSF) has been done based on the variation in the dry weight of solid medium. This method was previously used for mathematical modeling of enzyme production; however, the model should be modified to predict the production of a volatile compound like ethanol. The experimental results of bioethanol production from the mixture of carob pods and wheat bran by Zymomonas mobilis in SSF were used for the model validation. Exponential and logistic kinetic models were used for modeling the growth of microorganism. In both cases, the model predictions matched well with the experimental results during the exponential growth phase, indicating the good ability of solid medium weight variation method for modeling a volatile product formation in solid-state fermentation. In addition, using logistic model, better predictions were obtained.

  11. From scientifically based research to evidence based learning

    Directory of Open Access Journals (Sweden)

    Rosa Cera

    2016-02-01

    Full Text Available This essay is a reflection on the peculiarities of the scientifically based research and on the distinctive elements of the EBL (evidence based learning, methodology used in the study on the “Relationship between Metacognition, Self-efficacy and Self-regulation in Learning”. The EBL method, based on the standardization of data, explains how the students’ learning experience can be considered as a set of “data” and can be used to explain how and when the research results can be considered generalizable and transferable to other learning situations. The reflections present in this study have also allowed us to illustrate the impact that its results have had on the micro and macro level of reality. They helped to fill in the gaps concerning the learning/teaching processes, contributed to the enrichment of the scientific literature on this subject and allowed to establish standards through rigorous techniques such as systematic reviews and meta-analysis.

  12. Evidence-based surgery: Dissemination, communication, decision aids

    NARCIS (Netherlands)

    Knops, A.M.

    2013-01-01

    Surgeons are expected to make treatment decisions that are based on the best available evidence. Moreover, they are called to recognise that important decisions should also be shared with patients. While dissemination of evidence-based surgery and communication of evidence to patients have been

  13. Evidence based policy-making: A review

    CSIR Research Space (South Africa)

    Strydom, FW

    2010-04-01

    Full Text Available The process of facilitating the uptake of evidence, for example, scientific research findings, into the policymaking process is multifaceted and thus complex. It is therefore important for scientists to understand this process in order to influence...

  14. A Model of Solid Waste Management Based Multilateral Co-Operation in Semi-Urban Community

    Science.gov (United States)

    Kanchanabhandhu, Chanchai; Woraphong, Seree

    2016-01-01

    The purpose of this research was to construct a model of solid waste management based on multilateral cooperation in semi-urban community. Its specific objectives were to 1) study the solid waste situation and involvement of community in the solid waste management in Wangtaku Sub-district, Muang District, Nakhon Pathom Province; 2) construct a…

  15. Evidence Based Management as a Tool for Special Libraries

    Directory of Open Access Journals (Sweden)

    Bill Fisher

    2007-12-01

    Full Text Available Objective ‐ To examine the evidence based management literature, as an example of evidence based practice, and determine how applicable evidence based management might be in the special library environment. Methods ‐ Recent general management literature and the subject‐focused literature of evidence based management were reviewed; likewise recent library/information science management literature and the subject‐focused literature of evidence based librarianshipwere reviewed to identify relevant examples of the introduction and use of evidence based practice in organizations. Searches were conducted in major business/management databases, major library/information science databases, and relevant Web sites, blogs and wikis. Citation searches on key articles and follow‐up searches on cited references were also conducted. Analysis of the retrieved literature was conducted to find similarities and/or differences between the management literature and the library/information scienceliterature, especially as it related to special libraries.Results ‐ The barriers to introducing evidence based management into most organizations were found to apply to many special libraries and are similar to issues involved with evidence based practice in librarianship in general. Despite these barriers, a set of resources to assist special librarians in accessing research‐based information to help them use principles of evidence based management is identified.Conclusion ‐ While most special librarians are faced with a number of barriers to using evidence based management, resources do exist to help overcome these obstacles.

  16. Methodological aspects of modeling household solid waste generation in Japan: Evidence from Okayama and Otsu cities.

    Science.gov (United States)

    Gu, Binxian; Fujiwara, Takeshi; Jia, Renfu; Duan, Ruiyang; Gu, Aijun

    2017-12-01

    This paper presents a quantitative methodology and two empirical case studies in Japan on modeling household solid waste (HSW) generation based on individual consumption expenditure (ICE) and local waste policy effects by using the coupled estimation model systems. Results indicate that ICE on food, miscellaneous commodities and services, as well as education, cultural, and recreation services are mainly associated with the changes of HSW generation and its components in Okayama and Otsu from 1980 to 2014. The effects of waste policy measures were also identified. HSW generation in Okayama will increase from 11.60 million tons (mt) in 1980 to 25.02 mt in 2025, and the corresponding figures are 6.82 mt (in 1980) and 14.00 mt (in 2025) in Otsu. To better manage local HSW, several possible and appropriate implications such as promoting a green lifestyle, extending producer responsibility, intensifying recycling and source separation, generalizing composting, and establishing flexible measures and sustainable policies should be adopted. Results of this study would facilitate consumer management of low waste generation and support an effective HSW policy design in the two case cities. Success could lead to emulation by other Japanese cities seeking to build and maintain a sustainable, eco-friendly society. Moreover, the methodologies of establishing coupled estimation model systems could be extended to China and other global cities.

  17. Bariatric surgery: an evidence-based analysis.

    Science.gov (United States)

    2005-01-01

    To conduct an evidence-based analysis of the effectiveness and cost-effectiveness of bariatric surgery. Obesity is defined as a body mass index (BMI) of at last 30 kg/m(2).() Morbid obesity is defined as a BMI of at least 40 kg/m(2) or at least 35 kg/m(2) with comorbid conditions. Comorbid conditions associated with obesity include diabetes, hypertension, dyslipidemias, obstructive sleep apnea, weight-related arthropathies, and stress urinary incontinence. It is also associated with depression, and cancers of the breast, uterus, prostate, and colon, and is an independent risk factor for cardiovascular disease. Obesity is also associated with higher all-cause mortality at any age, even after adjusting for potential confounding factors like smoking. A person with a BMI of 30 kg/m(2) has about a 50% higher risk of dying than does someone with a healthy BMI. The risk more than doubles at a BMI of 35 kg/m(2). An expert estimated that about 160,000 people are morbidly obese in Ontario. In the United States, the prevalence of morbid obesity is 4.7% (1999-2000). In Ontario, the 2004 Chief Medical Officer of Health Report said that in 2003, almost one-half of Ontario adults were overweight (BMI 25-29.9 kg/m(2)) or obese (BMI ≥ 30 kg/m(2)). About 57% of Ontario men and 42% of Ontario women were overweight or obese. The proportion of the population that was overweight or obese increased gradually from 44% in 1990 to 49% in 2000, and it appears to have stabilized at 49% in 2003. The report also noted that the tendency to be overweight and obese increases with age up to 64 years. BMI should be used cautiously for people aged 65 years and older, because the "normal" range may begin at slightly above 18.5 kg/m(2) and extend into the "overweight" range. The Chief Medical Officer of Health cautioned that these data may underestimate the true extent of the problem, because they were based on self reports, and people tend to over-report their height and under-report their weight

  18. Evidence for vitreous type orientational ordering in solid hydrogen and deuterium

    International Nuclear Information System (INIS)

    Devoret, M.

    1982-09-01

    This shown a new region in the concentration-temperature phase diagram for solid mixtures of ortho and para-hydrogen. This region is characterized by a vitreous type orientational, ordering, with the quadrupoles of the ortho molecules frozen in a random fashion. This new vitreous state is called a quadrupolar glass, with the degrees of freedom of quadrupolar moments frozen in solid hydrogen [fr

  19. Ceramic membrane fuel cells based on solid proton electrolytes

    Energy Technology Data Exchange (ETDEWEB)

    Meng, Guangyao; Ma, Qianli; Peng, Ranran; Liu, Xingqin [USTC Lab. for Solid State Chemistry and Inorganic Membranes, Department of Materials Science and Engineering, University of Science and Technology of China, Hefei 230026 (China); Ma, Guilin [School of Chemistry and Chemical Engineering, Suzhou University, Suzhou 215123 (China)

    2007-04-15

    The development of solid oxide fuel cells (SOFCs) has reached its new stage characterized with thin electrolytes on porous electrode support, and the most important fabrication techniques developed in which almost all are concerned with inorganic membranes, and so can be named as ceramic membrane fuel cells (CMFCs). CMFCs based on proton electrolytes (CMFC-H) may exhibit more advantages than CMFCs based on oxygen-ion electrolytes (CMFC-O) in many respects, such as energy efficiency and avoiding carbon deposit. Ammonia fuelled CMFC with proton-conducting BaCe{sub 0.8}Gd{sub 0.2}O{sub 2.9} (BCGO) electrolyte (50 {mu}m in thickness) is reported in this works, which showed the open current voltage (OCV) values close to theoretical ones and rather high power density. And also, we have found that the well known super oxide ion conductor, La{sub 0.9}Sr{sub 0.1}Ga{sub 0.8}Mg{sub 0.2}O{sub 3-{alpha}} (LSGM), is a pure proton conductor in H{sub 2} and mixed proton and oxide ion conductor in wet air, while it is a pure oxide ion conductor in oxygen or dry air. To demonstrate the CMFC-H concept to get high performance fuel cells the techniques for thin membranes, chemical vapor deposition (CVD), particularly novel CVD techniques, should be given more attention because of their many advantages. (author)

  20. Rheokinetic Analysis of Hydroxy Terminated Polybutadiene Based Solid Propellant Slurry

    Directory of Open Access Journals (Sweden)

    Abhay K Mahanta

    2010-01-01

    Full Text Available The cure kinetics of propellant slurry based on hydroxy-terminated polybutadiene (HTPB and toluene diisocyanate (TDI polyurethane reaction has been studied by viscosity build up method. The viscosity (ɳ–time (t plots conform to the exponential function ɳ = aebt, where a & b are empirical constants. The rate constants (k for viscosity build up at various shear rate (rpm, evaluated from the slope of dɳ/dt versus ɳ plots at different temperatures, were found to vary from 0.0032 to 0.0052 min-1. It was observed that the increasing shear rate did not have significant effect on the reaction rate constants for viscosity build up of the propellant slurry. The activation energy (Eɳ, calculated from the Arrhenius plots, was found to be 13.17±1.78 kJ mole-1, whereas the activation enthalpy (∆Hɳ* and entropy (∆Sɳ* of the propellant slurry, calculated from Eyring relationship, were found to be 10.48±1.78 kJ mole-1 and –258.51± 5.38 J mole-1K-1, respectively. The reaction quenching temperature of the propellant slurry was found to be -9 ° C, based upon the experimental data. This opens up an avenue for a “freeze-and-store”, then “warm-up and cast”, mode of manufacturing of very large solid rocket propellant grains.

  1. High temperature fuel cell with ceria-based solid electrolyte

    International Nuclear Information System (INIS)

    Arai, H.; Eguchi, K.; Yahiro, H.; Baba, Y.

    1987-01-01

    Cation-doped ceria is investigated as an electrolyte for the solid oxide fuel cell. As for application to the fuel cells, the electrolyte are desired to have high ionic conductivity in deriving a large electrical power. A series of cation-doped ceria has higher ionic conductivity than zirconia-based oxides. In the present study, the basic electrochemical properties of cation-doped ceria were studied in relation to the application of fuel cells. The performance of fuel cell with yttria-doped ceria electrolyte was evaluated. Ceria-based oxides were prepared by calcination of oxide mixtures of the components or calcination of co-precipitated hydroxide mixtures from the metal nitrate solution. The oxide mixtures thus obtained were sintered at 1650 0 C for 15 hr in air into disks. Ionic transference number, t/sub i/, was estimated from emf of oxygen concentration cell. Electrical conductivities were measured by dc-4 probe method by varying the oxygen partial pressure. The fuel cell was operated by oxygen and hydrogen

  2. An evidence-based update on vitamins.

    Science.gov (United States)

    Orr, K Kelly; Hume, Anne L

    2010-04-01

    American adults take many types of vitamin supplements, despite limited evidence of their efficacy, especially in preventing chronic diseases such as cardiovascular disease and cancer. Supplements contain significant amounts of vitamins when consumed from multiple sources. Excess consumption of some vitamins may have detrimental health effects. Use of MMVM products appears to be safe; however, clinical outcomes have not been established. Although vitamin D and preconception folic acid may be appropriate for self care, a health care provider should monitor other vitamin supplements for disease prevention, such as niacin. Beyond supplementation as treatment for vitamin deficiencies, evidence is lacking.

  3. GaN based nanorods for solid state lighting

    Energy Technology Data Exchange (ETDEWEB)

    Li Shunfeng; Waag, Andreas [Institute of Semiconductor Technology, Braunschweig University of Technology, 38106 Braunschweig (Germany)

    2012-04-01

    In recent years, GaN nanorods are emerging as a very promising novel route toward devices for nano-optoelectronics and nano-photonics. In particular, core-shell light emitting devices are thought to be a breakthrough development in solid state lighting, nanorod based LEDs have many potential advantages as compared to their 2 D thin film counterparts. In this paper, we review the recent developments of GaN nanorod growth, characterization, and related device applications based on GaN nanorods. The initial work on GaN nanorod growth focused on catalyst-assisted and catalyst-free statistical growth. The growth condition and growth mechanisms were extensively investigated and discussed. Doping of GaN nanorods, especially p-doping, was found to significantly influence the morphology of GaN nanorods. The large surface of 3 D GaN nanorods induces new optical and electrical properties, which normally can be neglected in layered structures. Recently, more controlled selective area growth of GaN nanorods was realized using patterned substrates both by metalorganic chemical vapor deposition (MOCVD) and by molecular beam epitaxy (MBE). Advanced structures, for example, photonic crystals and DBRs are meanwhile integrated in GaN nanorod structures. Based on the work of growth and characterization of GaN nanorods, GaN nanoLEDs were reported by several groups with different growth and processing methods. Core/shell nanoLED structures were also demonstrated, which could be potentially useful for future high efficient LED structures. In this paper, we will discuss recent developments in GaN nanorod technology, focusing on the potential advantages, but also discussing problems and open questions, which may impose obstacles during the future development of a GaN nanorod based LED technology.

  4. is planning in Nigeria becoming evidence based?

    African Journals Online (AJOL)

    related Millennium Development Goals high on the policy agendas of many developing nations, the costs and as well as benefits of these health interventions are extremely vital in resource poor settings such as Nigeria. Despite the body of evidence ...

  5. Justifying Physical Education Based on Neuroscience Evidence

    Science.gov (United States)

    Berg, Kris

    2010-01-01

    Research has shown that exercise improves cognitive function and psychological traits that influence behavior (e.g., mood, level of motivation). The evidence in the literature also shows that physical education may enhance learning or that academic performance is at least maintained despite a reduction in classroom time in order to increase time…

  6. An evidence-based view on hyperbilirubinaemia

    NARCIS (Netherlands)

    Dijk, Peter H.; Hulzebos, Christian V.

    Introduction: We conducted a review of the evidence which contributes to the current care of jaundiced newborn infants. Methods: Literature was searched for reviews and randomized controlled trials (RCTs). Results: Six Cochrane reviews and eight other reviews and eighteen recent RCTs are discussed.

  7. Weighted Evidence Combination Rule Based on Evidence Distance and Uncertainty Measure: An Application in Fault Diagnosis

    Directory of Open Access Journals (Sweden)

    Lei Chen

    2018-01-01

    Full Text Available Conflict management in Dempster-Shafer theory (D-S theory is a hot topic in information fusion. In this paper, a novel weighted evidence combination rule based on evidence distance and uncertainty measure is proposed. The proposed approach consists of two steps. First, the weight is determined based on the evidence distance. Then, the weight value obtained in first step is modified by taking advantage of uncertainty. Our proposed method can efficiently handle high conflicting evidences with better performance of convergence. A numerical example and an application based on sensor fusion in fault diagnosis are given to demonstrate the efficiency of our proposed method.

  8. The Heart of the Matter of Opinion and Evidence: The Value of Evidence-Based Medicine

    Science.gov (United States)

    Masvidal, Daniel; Lavie, Carl J.

    2012-01-01

    Evidence-based medicine is an important aspect of continuing medical education. This article reviews previous and current examples of conflicting topics that evidence-based medicine has clarified to allow us to provide the best possible patient care. PMID:22438783

  9. Controllable Solid Propulsion Combustion and Acoustic Knowledge Base Improvements

    Science.gov (United States)

    McCauley, Rachel; Fischbach, Sean; Fredrick, Robert

    2012-01-01

    Controllable solid propulsion systems have distinctive combustion and acoustic environments that require enhanced testing and analysis techniques to progress this new technology from development to production. In a hot gas valve actuating system, the movement of the pintle through the hot gas exhibits complex acoustic disturbances and flow characteristics that can amplify induced pressure loads that can damage or detonate the rocket motor. The geometry of a controllable solid propulsion gas chamber can set up unique unsteady flow which can feed acoustic oscillations patterns that require characterization. Research in this area aids in the understanding of how best to design, test, and analyze future controllable solid rocket motors using the lessons learned from past government programs as well as university research and testing. This survey paper will give the reader a better understanding of the potentially amplifying affects propagated by a controllable solid rocket motor system and the knowledge of the tools current available to address these acoustic disturbances in a preliminary design. Finally the paper will supply lessons learned from past experiences which will allow the reader to come away with understanding of what steps need to be taken when developing a controllable solid rocket propulsion system. The focus of this survey will be on testing and analysis work published by solid rocket programs and from combustion and acoustic books, conference papers, journal articles, and additionally from subject matter experts dealing currently with controllable solid rocket acoustic analysis.

  10. Experimental evidence of beam-foil plasma creation during ion-solid interaction

    Energy Technology Data Exchange (ETDEWEB)

    Sharma, Prashant, E-mail: prashant@iuac.res.in; Nandi, Tapan [Inter University Accelerator Centre, Aruna Asaf Ali Marg, New Delhi 110067 (India)

    2016-08-15

    Charge state evolution of the energetic projectile ions during the passage through thin carbon foils has been revisited using the X-ray spectroscopy technique. Contributions from the bulk and the solid surface in the charge changing processes have been segregated by measuring the charge state distribution of the projectile ions in the bulk of the target during the ion–solid interaction. Interestingly, the charge state distribution measured in the bulk exhibits Lorentzian profile in contrast to the well-known Gaussian structure observed using the electromagnetic methods and the theoretical predictions. The occurrence of such behavior is a direct consequence of the imbalance between charge changing processes, which has been seen in various cases of the laboratory plasma. It suggests that the ion-solid collisions constitute high-density, localized plasma in the bulk of the solid target, called the beam-foil plasma. This condensed beam-foil plasma is similar to the high-density solar and stellar plasma which may have practical implementations in various fields, in particular, plasma physics and nuclear astrophysics. The present work suggests further modification in the theoretical charge state distribution calculations by incorporating the plasma coupling effects during the ion–solid interactions. Moreover, the multi-electron capture from the target exit surface has been confirmed through comparison between experimentally measured and theoretically predicted values of the mean charge state of the projectile ions.

  11. Introduction: evidence-based action in humanitarian crises

    NARCIS (Netherlands)

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

    2013-01-01

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

  12. Evidence-based care: an innovation to improve nursing practice ...

    African Journals Online (AJOL)

    Evidence-based care: an innovation to improve nursing practice globally. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... best available evidence from research findings, expert ideas from specialists in the various health ... need to be addressed to enhance utilization of the best available evidence in nursing practice.

  13. Localized Ambient Solidity Separation Algorithm Based Computer User Segmentation

    Science.gov (United States)

    Sun, Xiao; Zhang, Tongda; Chai, Yueting; Liu, Yi

    2015-01-01

    Most of popular clustering methods typically have some strong assumptions of the dataset. For example, the k-means implicitly assumes that all clusters come from spherical Gaussian distributions which have different means but the same covariance. However, when dealing with datasets that have diverse distribution shapes or high dimensionality, these assumptions might not be valid anymore. In order to overcome this weakness, we proposed a new clustering algorithm named localized ambient solidity separation (LASS) algorithm, using a new isolation criterion called centroid distance. Compared with other density based isolation criteria, our proposed centroid distance isolation criterion addresses the problem caused by high dimensionality and varying density. The experiment on a designed two-dimensional benchmark dataset shows that our proposed LASS algorithm not only inherits the advantage of the original dissimilarity increments clustering method to separate naturally isolated clusters but also can identify the clusters which are adjacent, overlapping, and under background noise. Finally, we compared our LASS algorithm with the dissimilarity increments clustering method on a massive computer user dataset with over two million records that contains demographic and behaviors information. The results show that LASS algorithm works extremely well on this computer user dataset and can gain more knowledge from it. PMID:26221133

  14. [Evidence-based management of medical disposable materials].

    Science.gov (United States)

    Yang, Hai

    2009-03-01

    Evidence-based management of medical disposable materials pays attention to collect evidence comprehensively and systematically, accumulate and create evidence through its own work and also evaluate evidence strictly. This can be used as a function to guide out job. Medical disposable materials evidence system contains product register qualification, product quality certification, supplier's behavior, internal and external communication evidence. Managers can find different ways in creating and using evidence referring to specific inside and outside condition. Evidence-based management can help accelerating the development of management of medical disposable materials from traditional experience pattern to a systematic and scientific pattern. It also has the very important meaning to improve medical quality, control the unreasonable growth of medical expense and make purchase and supply chain be more efficient.

  15. In the teeth of the evidence: the curious case of evidence-based medicine.

    Science.gov (United States)

    Davidoff, F

    1999-03-01

    For a very long time, evidence from research has contributed to clinical decision making. Over the past 50 years, however, the nature of clinical research evidence has drastically changed compared with previous eras: its standards are higher, the tools for assembling and analyzing it are more powerful, and the context in which it is used is less authoritarian. The consequence has been a shift in both the concept and the practice of clinical decision making known as evidence-based medicine. Evidence-based decisions, by definition, use the strongest available evidence, are often more quantitatively informed than decisions made in the traditional fashion; and sometimes run counter to expert opinion. The techniques of evidence-based medicine are also helpful in resolving conflicting opinions. Evidence-based medicine did not simply appear in vacuo; its roots extend back at least as far as the great French Encyclopedia of the 18th century, and the subsequent work of Pierre Louis in Paris in the early 19th century. The power of the evidence-based approach has been enhanced in recent years by the development of the techniques of systematic review and meta-analysis. While this approach has its critics, we would all want the best available evidence used in making decisions about our care if we got sick. It is only fair that the patients under our care receive nothing less.

  16. Particle-based solid for nonsmooth multidomain dynamics

    Science.gov (United States)

    Nordberg, John; Servin, Martin

    2018-04-01

    A method for simulation of elastoplastic solids in multibody systems with nonsmooth and multidomain dynamics is developed. The solid is discretised into pseudo-particles using the meshfree moving least squares method for computing the strain tensor. The particle's strain and stress tensor variables are mapped to a compliant deformation constraint. The discretised solid model thus fit a unified framework for nonsmooth multidomain dynamics simulations including rigid multibodies with complex kinematic constraints such as articulation joints, unilateral contacts with dry friction, drivelines, and hydraulics. The nonsmooth formulation allows for impact impulses to propagate instantly between the rigid multibody and the solid. Plasticity is introduced through an associative perfectly plastic modified Drucker-Prager model. The elastic and plastic dynamics are verified for simple test systems, and the capability of simulating tracked terrain vehicles driving on a deformable terrain is demonstrated.

  17. Probiotics and Diverticular Disease: Evidence-based?

    Science.gov (United States)

    Lahner, Edith; Annibale, Bruno

    Diverticular disease (DD) is a common gastrointestinal condition. Clinical spectrum ranges from asymptomatic diverticulosis to symptomatic uncomplicated or complicated DD. Symptoms related to uncomplicated DD are not specific and may be indistinguishable from those of irritable bowel syndrome. Low-grade inflammation, altered intestinal microbiota, visceral hypersensitivity, and abnormal colonic motility have been identified as factors potentially contributing to symptoms. Probiotics may modify the gut microbial balance leading to health benefits. Probiotics, due to their anti-inflammatory effects and ability to maintain an adequate bacterial colonization in the colon, are promising treatment options for DD. This review focuses on the available evidence on the efficacy of prebiotics in uncomplicated DD.

  18. Evidence-based interventions of threatened miscarriage

    Directory of Open Access Journals (Sweden)

    Juan Li

    2017-05-01

    Full Text Available Threatened miscarriage is the commonest complication of early pregnancy and affects about 20% of pregnancies. It presents with vaginal bleeding with or without abdominal cramps. Increasing age of women, smoking, obesity or polycystic ovary syndrome (PCOS and a previous history of miscarriage are risk factors for threatened miscarriage. The pathophysiology has been associated with changes in levels of cytokines or maternal immune dysfunction. Clinical history and examination, maternal serum biochemistry and ultrasound findings are important to determine the treatment options and provide valuable information for the prognosis. Bed rest is the commonest advice, but there is little evidence of its value. Other options include progesterone, human chorionic gonadotropin (HCG and muscle relaxants. The complementary and alternative medicine (CAM therapies such as acupuncture and Chinese herbs have also been tried. There is some evidence from clinical studies indicating that CAM therapies may reduce the rate of miscarriage, but the quality of studies is poor. Thus, further double-blind, randomized-controlled trials are necessary to confirm its effectiveness, especially acupuncture and Chinese herbs.

  19. Evidence-based treatments for cluster headache

    Directory of Open Access Journals (Sweden)

    Gooriah R

    2015-11-01

    Full Text Available Rubesh Gooriah, Alina Buture, Fayyaz Ahmed Department of Neurology, Hull Royal Infirmary, Kingston upon Hull, UK Abstract: Cluster headache (CH, one of the most painful syndromes known to man, is managed with acute and preventive medications. The brief duration and severity of the attacks command the use of rapid-acting pain relievers. Inhalation of oxygen and subcutaneous sumatriptan are the two most effective acute therapeutic options for sufferers of CH. Several preventive medications are available, the most effective of which is verapamil. However, most of these agents are not backed by strong clinical evidence. In some patients, these options can be ineffective, especially in those who develop chronic CH. Surgical procedures for the chronic refractory form of the disorder should then be contemplated, the most promising of which is hypothalamic deep brain stimulation. We hereby review the pathogenesis of CH and the evidence behind the treatment options for this debilitating condition. Keywords: cluster headache, pathogenesis, vasoactive intestinal peptide, suprachiasmatic nucleus

  20. Three-body interactions in liquid and solid hydrogen: Evidence from vibrational spectroscopy

    Science.gov (United States)

    Hinde, Robert

    2008-03-01

    In the cryogenic low-density liquid and solid phases of H2 and D2, the H2 and D2 molecules retain good rotational and vibrational quantum numbers that characterize their internal degrees of freedom. High-resolution infrared and Raman spectroscopic experiments provide extremely sensitive probes of these degrees of freedom. We present here fully-first-principles calculations of the infrared and Raman spectra of liquid and solid H2 and D2, calculations that employ a high-quality six-dimensional coupled-cluster H2-H2 potential energy surface and quantum Monte Carlo treatments of the single-molecule translational degrees of freedom. The computed spectra agree very well with experimental results once we include three-body interactions among the molecules, interactions which we also compute using coupled-cluster quantum chemical methods. We predict the vibrational spectra of liquid and solid H2 at several temperatures and densities to provide a framework for interpreting recent experiments designed to search for superfluid behavior in small H2 droplets. We also present preliminary calculations of the spectra of mixed H2/D2 solids that show how positional disorder affects the spectral line shapes in these systems.

  1. From evidence-based medicine to genomic medicine

    OpenAIRE

    Kumar, Dhavendra

    2007-01-01

    The concept of ‘evidence-based medicine’ dates back to mid-19th century or even earlier. It remains pivotal in planning, funding and in delivering the health care. Clinicians, public health practitioners, health commissioners/purchasers, health planners, politicians and public seek formal ‘evidence’ in approving any form of health care provision. Essentially ‘evidence-based medicine’ aims at the conscientious, explicit and judicious use of the current best evidence in making decisions about t...

  2. Irradiation and accretion of solids in space based on observations of lunar rocks and grains

    International Nuclear Information System (INIS)

    Lal, D.

    1977-01-01

    Clues to a wide range of questions relating to the origin and evolution of the solar system and dynamic physical and electromagnetic processes occurring concurrently and in the past in our galaxy have been provided by a study of the lunar samples. This information is deduced from a variety of complementary physical and chemical evidence. In this presentation greatest emphasis is laid on information based on effects arising from interactions of low energy cosmic rays with lunar surface materials. The present discussions concern the nature of experimental data to date and implications thereof to the charged particle environment of the Moon, ancient magnetic fields and the nature of time scales involved in the irradiation and accretion of solids in space, based on lunar regolith dynamics. It becomes clear that there does not yet exist any consensus on the absolute values of charged particle or the meteorite fluxes, and also about the details of the evolution of the lunar regolith. The complex history of evolution of lunar material is slowly being understood and it is hoped that a great deal of quantitative information will soon be available which will in turn allow discussion of evolution of solid bodies in the solar system. (author)

  3. Annotating Evidence Based Clinical Guidelines : A Lightweight Ontology

    NARCIS (Netherlands)

    Hoekstra, R.; de Waard, A.; Vdovjak, R.; Paschke, A.; Burger, A.; Romano, P.; Marshall, M.S.; Splendiani, A.

    2012-01-01

    This paper describes a lightweight ontology for representing annotations of declarative evidence based clinical guidelines. We present the motivation and requirements for this representation, based on an analysis of several guidelines. The ontology provides the means to connect clinical questions

  4. Interverntion, evidence-based research and everyday life

    DEFF Research Database (Denmark)

    Dreier, Ole

    2011-01-01

    Intervention is a key concept in the technology of psychology and it plays a decisive role in evidence-based research. But analyses of this concept are remarkably sparse. Based on a critical analysis of the conception of intervention in the American Psychological Association’s guidelines for evid...

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

    African Journals Online (AJOL)

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

  6. Evidence-based clinical guidelines for eating disorders : International comparison

    NARCIS (Netherlands)

    Hilbert, Anja; Hoek, Hans W.; Schmidt, Ricarda

    2017-01-01

    Purpose of review: The current systematic review sought to compare available evidence-based clinical treatment guidelines for all specific eating disorders. Recent findings: Nine evidence-based clinical treatment guidelines for eating disorders were located through a systematic search. The

  7. De scientist practitioner en de evidence-based practice

    NARCIS (Netherlands)

    Hutschemaekers, G.J.M.; Nijnatten, C.H.C.J. van

    2008-01-01

    Het principe van evidence-based werken heeft kenmerken gekregen van een paradigma en de scientist practitioner lijkt plaatsgemaakt te hebben voor de louter uitvoerende evidence-based practitioner. Dat werkt eerder passiviteit dan wetenschappelijkheid in de hand. Er zijn zes belangrijke problemen met

  8. Illicit Drugs, Policing and the Evidence-Based Policy Paradigm

    Science.gov (United States)

    Ritter, Alison; Lancaster, Kari

    2013-01-01

    The mantra of evidence-based policy (EBP) suggests that endeavours to implement evidence-based policing will produce better outcomes. However there is dissonance between the rhetoric of EBP and the actuality of policing policy. This disjuncture is critically analysed using the case study of illicit drugs policing. The dissonance may be ameliorated…

  9. Behavioral Activation Is an Evidence-Based Treatment for Depression

    Science.gov (United States)

    Sturmey, Peter

    2009-01-01

    Recent reviews of evidence-based treatment for depression did not identify behavioral activation as an evidence-based practice. Therefore, this article conducted a systematic review of behavioral activation treatment of depression, which identified three meta-analyses, one recent randomized controlled trial and one recent follow-up of an earlier…

  10. Building a culture of evidence-based planning in Nigeria

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

    care, it is essential to base plans on evidence of what is ... For six years, the Nigerian Evidence- based Health ... best to respond to findings they participated in generating. Nigeria .... It also uses this data in evaluating ... Decision-makers work with researchers to plan the implementation ... of Nursing Services from Bauchi.

  11. Breast abscess: evidence based management recommendations.

    Science.gov (United States)

    Lam, Elaine; Chan, Tiffany; Wiseman, Sam M

    2014-07-01

    Literature review was carried out and studies reporting on treatment of breast abscesses were critically appraised for quality and their level of evidence using the Strength of Recommendation Taxonomy guidelines, and key recommendations were summarized. Needle aspiration either with or without ultrasound guidance should be employed as first line treatment of breast abscesses. This approach has the potential benefits of: superior cosmesis, shorter healing time, and avoidance of general anaesthesia. Multiple aspiration sessions may be required for cure. Ultrasound-guided percutaneous catheter placement may be considered as an alternative approach for treatment of larger abscesses (>3 cm). Surgical incision and drainage should be considered for first line therapy in large (>5 cm), multiloculated, or long standing abscesses, or if percutaneous drainage is unsuccessful. All patients should be treated concurrently with antibiotics. Patients with recurrent subareolar abscesses and fistulas should be referred for consideration of surgical treatment.

  12. Laser Based Phosphor Converted Solid State White Light Emitters

    Science.gov (United States)

    Cantore, Michael

    Artificial lighting and as a consequence the ability to be productive when the sun does not shine may be a profound achievement in society that is largely taken for granted. As concerns arise due to our dependence on energy sources with finite lifespan or environmentally negative effects, efforts to reduce energy consumption and create clean renewable alternatives has become highly valued. In the scope of artificial lighting, the use of incandescent lamps has shifted to more efficient light sources. Fluorescent lighting made the first big gains in efficiency over incandescent lamps with peak efficiency for mature designs reaching luminous efficacy of approximately 90 lm/W; more than three times as efficient as an incandescent lamp. Lamps based on light emitting diodes (LEDs) which can produce light at even greater efficiency, color quality and without the potential for hazardous chemical release from lamp failure. There is a significant challenge with LED based light sources. Their peak efficiency occurs at low current densities and then droops as the current density increases. Laser diodes (LDs) do not suffer from decreasing efficiency due to increased current. An alternative solid state light source using LDs has potential to make further gains in efficiency as well as allow novel illuminant designs which may be impractical or even impossible even with LED or other conventional sources. While similar to LEDS, the use of LDs does present new challenges largely due to the increased optical power density which must be accommodated in optics and phosphor materials. Single crystal YAG:Ce has been shown to be capable of enduring this more extreme operating environment while retaining the optical and fluorescing qualities desired for use as a wavelength converter in phosphor converted LD based white emitting systems. The incorporation of this single crystal phosphor in a system with a commercial laser diode with peak wall plug efficiency of 31% resulted in emission of

  13. How to proceed when evidence-based practice is required but very little evidence available?

    DEFF Research Database (Denmark)

    Leboeuf-Yde, Charlotte; Lanlo, Olivier; Walker, Bruce F

    2013-01-01

    All clinicians of today know that scientific evidence is the base on which clinical practice should rest. However, this is not always easy, in particular in those disciplines, where the evidence is scarce. Although the last decades have brought an impressive production of research that is of inte...

  14. Organisational support for evidence-based practice: occupational therapists perceptions.

    Science.gov (United States)

    Bennett, Sally; Allen, Shelley; Caldwell, Elizabeth; Whitehead, Mary; Turpin, Merrill; Fleming, Jennifer; Cox, Ruth

    2016-02-01

    Barriers to the use of evidence-based practice extend beyond the individual clinician and often include organisational barriers. Adoption of systematic organisational support for evidence-based practice in health care is integral to its use. This study aimed to explore the perceptions of occupational therapy staff regarding the influence of organisational initiatives to support evidence-based practice on workplace culture and clinical practice. This study used semi-structured interviews with 30 occupational therapists working in a major metropolitan hospital in Brisbane, Australia regarding their perceptions of organisational initiatives designed to support evidence-based practice. Four themes emerged from the data: (i) firmly embedding a culture valuing research and EBP, (ii) aligning professional identity with the Research and Evidence in Practice model, (iii) experiences of change: pride, confidence and pressure and (iv) making evidence-based changes to clinical practices. Organisational initiatives for evidence-based practice were perceived as influencing the culture of the workplace, therapists' sense of identity as clinicians, and as contributing to changes in clinical practice. It is therefore important to consider organisational factors when attempting to increase the use of evidence in practice. © 2016 Occupational Therapy Australia.

  15. Mistakes, Errors and Foul-Ups: Practice-Based Evidence for Evidence Based Practice

    Directory of Open Access Journals (Sweden)

    Mark Turner

    2016-11-01

    Full Text Available In human medicine, the management of care to ensure safety for the service-user constitutes an important element of the patient ‘journey.’ The name given to this discipline is patient safety. It is founded upon those elements of good medical practice which help avoid or mitigate human error.  Investigations in the U.S. first highlighted the alarming extent of medical error: Brennan et al. (1991 concluded that in the state of New York, the overall rate of adverse events was approximately 4% for hospitalised patients, which equated to over 13,000 deaths a year. Doctors looked to other safety critical industries and aviation in particular (Reason 1995, to address this phenomenon: there is now a wealth of research on the impact of various safety initiatives on measurable rates of harm. The World Health Organisation’s ‘Safe Surgery Saves Lives’ initiative - a campaign that advocates the use of a surgical checklist to standardise aspects of peri-operative care - is one example of aviation methodology successfully employed in a clinical setting (van Klei et al. 2012. The critical importance of effective communication, leadership and situational awareness has also been discussed at length in the human patient safety literature.ObjectivesVeterinary patient safety is an analogous discipline and researchers have attempted to understand more about the topic of veterinary medical error. However, the evidence-base for veterinary patient safety is sparse.  This presentation aims to summarise the evidence to date and highlight the benefits in practice of an emerging subject. MethodA search of the terms veterinary patient safety on the PubMed database from 1990 to 2016 was performed.Findings15 articles were identified as contributing to the veterinary patient safety literature.OutcomeThe available literature has addressed a number of areas. The use of checklists in a clinical setting has been proven to reduce the incidence of specific undesirable

  16. Technoeconomy of different solid oxide fuel cell based hybrid cycle

    DEFF Research Database (Denmark)

    Rokni, Masoud

    2014-01-01

    Gas turbine, steam turbine and heat engine (Stirling engine) is used as bottoming cycle for a solid oxide fuel cell plant to compare different plants efficiencies, CO2 emissionsand plants cost in terms of $/kW. Each plant is then integrated with biomass gasification and finally six plants...

  17. Interactions between lanthanum gallate based solid electrolyte and ceria

    Energy Technology Data Exchange (ETDEWEB)

    Hrovat, M.; Ahmad-Khanlou, A.; Samardzija, Z.; Holc, J.

    1999-10-01

    Possible interactions between La{sub 0.9}Sr{sub 0.1}Ga{sub 0.8}Mg{sub 0.2}O{sub 2.85} and Gd{sub 2}O{sub 3}-doped CeO{sub 2} (solid electrolyte and anode binding materials, respectively, for solid oxide fuel cells (SOFC)) at 1,300 C were studied with diffusion couples and fired powder mixtures. The SrLaGa{sub 3}O{sub 7} compound was detected and its formation was attributed to the diffusion of La{sub 2}O{sub 3} from La{sub 0.9}Sr{sub 0.1}Ga{sub 0.8}Mg{sub 0.2}O{sub 2.85} into Ce{sub 1{minus}x}La{sub x}O{sub 2{minus}x/2} solid solution. As the resistivity of SrLaGa{sub 3}O{sub 7} is rather high, around 1 M{center_dot}ohm at 800 C, its presence in the solid electrolyte/anode interface could significantly increase the internal resistivity of an SOFC.

  18. Developments on HNF based high performance and green solid propellants

    NARCIS (Netherlands)

    Keizers, H.L.J.; Heijden, A.E.D.M. van der; Vliet, L.D. van; Welland-Veltmans, W.H.M.; Ciucci, A.

    2001-01-01

    Worldwide developments are ongoing to develop new and more energetic composite solid propellant formulations for space transportation and military applications. Since the 90's, the use of HNF as a new high performance oxidiser is being reinvestigated. Within European development programmes,

  19. Evidence - based medicine/practice in sports physical therapy.

    Science.gov (United States)

    Manske, Robert C; Lehecka, B J

    2012-10-01

    A push for the use of evidence-based medicine and evidence-based practice patterns has permeated most health care disciplines. The use of evidence-based practice in sports physical therapy may improve health care quality, reduce medical errors, help balance known benefits and risks, challenge views based on beliefs rather than evidence, and help to integrate patient preferences into decision-making. In this era of health care utilization sports physical therapists are expected to integrate clinical experience with conscientious, explicit, and judicious use of research evidence in order to make clearly informed decisions in order to help maximize and optimize patient well-being. One of the more common reasons for not using evidence in clinical practice is the perceived lack of skills and knowledge when searching for or appraising research. This clinical commentary was developed to educate the readership on what constitutes evidence-based practice, and strategies used to seek evidence in the daily clinical practice of sports physical therapy.

  20. On evidence and evidence-based medicine: lessons from the philosophy of science.

    Science.gov (United States)

    Goldenberg, Maya J

    2006-06-01

    The evidence-based medicine (EBM) movement is touted as a new paradigm in medical education and practice, a description that carries with it an enthusiasm for science that has not been seen since logical positivism flourished (circa 1920-1950). At the same time, the term "evidence-based medicine" has a ring of obviousness to it, as few physicians, one suspects, would claim that they do not attempt to base their clinical decision-making on available evidence. However, the apparent obviousness of EBM can and should be challenged on the grounds of how 'evidence' has been problematised in the philosophy of science. EBM enthusiasm, it follows, ought to be tempered. The post-positivist, feminist, and phenomenological philosophies of science that are examined in this paper contest the seemingly unproblematic nature of evidence that underlies EBM by emphasizing different features of the social nature of science. The appeal to the authority of evidence that characterizes evidence-based practices does not increase objectivity but rather obscures the subjective elements that inescapably enter all forms of human inquiry. The seeming common sense of EBM only occurs because of its assumed removal from the social context of medical practice. In the current age where the institutional power of medicine is suspect, a model that represents biomedicine as politically disinterested or merely scientific should give pause.

  1. High-Efficiency Nitride-Based Solid-State Lighting

    Energy Technology Data Exchange (ETDEWEB)

    Paul T. Fini; Shuji Nakamura

    2005-07-30

    In this final technical progress report we summarize research accomplished during Department of Energy contract DE-FC26-01NT41203, entitled ''High-Efficiency Nitride-Based Solid-State Lighting''. Two teams, from the University of California at Santa Barbara (Principle Investigator: Dr. Shuji Nakamura) and the Lighting Research Center at Rensselaer Polytechnic Institute (led by Dr. N. Narendran), pursued the goals of this contract from thin film growth, characterization, and packaging/luminaire design standpoints. The UCSB team initially pursued the development of blue gallium nitride (GaN)-based vertical-cavity surface-emitting lasers, as well as ultraviolet GaN-based light emitting diodes (LEDs). In Year 2, the emphasis shifted to resonant-cavity light emitting diodes, also known as micro-cavity LEDs when extremely thin device cavities are fabricated. These devices have very directional emission and higher light extraction efficiency than conventional LEDs. Via the optimization of thin-film growth and refinement of device processing, we decreased the total cavity thickness to less than 1 {micro}m, such that micro-cavity effects were clearly observed and a light extraction efficiency of over 10% was reached. We also began the development of photonic crystals for increased light extraction, in particular for so-called ''guided modes'' which would otherwise propagate laterally in the device and be re-absorbed. Finally, we pursued the growth of smooth, high-quality nonpolar a-plane and m-plane GaN films, as well as blue light emitting diodes on these novel films. Initial nonpolar LEDs showed the expected behavior of negligible peak wavelength shift with increasing drive current. M-plane LEDs in particular show promise, as unpackaged devices had unsaturated optical output power of {approx} 3 mW at 200 mA drive current. The LRC's tasks were aimed at developing the subcomponents necessary for packaging UCSB's light

  2. Evidence-based intervention in physical activity

    DEFF Research Database (Denmark)

    Heath, Gregory W; Parra, Diana C; Sarmiento, Olga L

    2012-01-01

    Promotion of physical activity is a priority for health agencies. We searched for reviews of physical activity interventions, published between 2000 and 2011, and identified effective, promising, or emerging interventions from around the world. The informational approaches of community......-wide and mass media campaigns, and short physical activity messages targeting key community sites are recommended. Behavioural and social approaches are effective, introducing social support for physical activity within communities and worksites, and school-based strategies that encompass physical education......, classroom activities, after-school sports, and active transport. Recommended environmental and policy approaches include creation and improvement of access to places for physical activity with informational outreach activities, community-scale and street-scale urban design and land use, active transport...

  3. Implementing Evidence-Based Practices for People With Schizophrenia

    Science.gov (United States)

    Drake, Robert E.; Bond, Gary R.; Essock, Susan M.

    2009-01-01

    Over the last decade, a consensus has emerged regarding a set of evidence-based practices for schizophrenia that address symptom management and psychosocial functioning. Yet, surveys suggest that the great majority of the population of individuals with schizophrenia do not receive evidence-based care. In this article, we review the empirical literature on implementation of evidence-based practices for schizophrenia patients. We first examine lessons learned from implementation studies in general medicine. We then summarize the implementation literature specific to schizophrenia, including medication practices, psychosocial interventions, information technology, and state- and federal-level interventions. We conclude with recommendations for future directions. PMID:19491315

  4. Organizational change tactics: the evidence base in the literature.

    Science.gov (United States)

    Packard, Thomas; Shih, Amber

    2014-01-01

    Planned organizational change processes can be used to address the many challenges facing human service organizations (HSOs) and improve organizational outcomes. There is massive literature on organizational change, ranging from popular management books to academic research on specific aspects of change. Regarding HSOs, there is a growing literature, including increasing attention to implementation science and evidence-based practices. However, research which offers generalizable, evidence-based guidelines for implementing change is not common. The purpose of the authors was to assess the evidence base in this organizational change literature to lay the groundwork for more systematic knowledge development in this important field.

  5. Evidence-based music therapy practice: an integral understanding.

    Science.gov (United States)

    Abrams, Brian

    2010-01-01

    The American Music Therapy Association has recently put into action a plan called its Research Strategic Priority, with one of its central purposes to advance the music therapy field through research promoting Evidence-Based Practice of music therapy. The extant literature on music therapy practice, theory, and research conveys a range of very different perspectives on what may count as the "evidence" upon which practice is based. There is therefore a need to conceptualize evidence-based music therapy practice in a multifaceted, yet coherent and balanced way. The purpose of this paper is to illustrate a framework based upon four distinct epistemological perspectives on evidence-based music therapy practice that together represent an integral understanding.

  6. Evidence-based dentistry: fundamentals for the dentist.

    Science.gov (United States)

    Bauer, Janet; Chiappelli, Francesco; Spackman, Sue; Prolo, Paolo; Stevenson, Richard

    2006-06-01

    This article explains the fundamentals of evidence-based dentistry for the dentist. Evidence-based dentistry is a discipline whose primary participant is the translational researcher. Recent developments have emphasized the importance of this discipline (clinical and translational research) for improving health care. The process of evidence-based dentistry is the reciprocation of new and existing evidence between dentists and quantitative and qualitative researchers, facilitated by the translational researcher. The product of this reciprocation is the clinical practice guideline, or best evidence, that provides the patient options in choosing treatments or services. These options are quantified and qualified by decision, utility, and cost data. Using shared decision-making, the dentist and patient arrive at a mutual understanding of which option best meets an acceptable and preferred treatment course that is cost effective. This option becomes the clinical decision.

  7. Evidence-based medicine: the fourth revolution in American medicine?

    Science.gov (United States)

    Chung, Kevin C; Ram, Ashwin N

    2009-01-01

    The use of evidence has become a force in American medicine to improve the quality of health care. Funding decisions from payers will demand studies with high-level evidence to support many of the costly interventions in medicine. Plastic surgery is certainly not immune to this national tidal wave to revamp the health care system by embracing evidence-based medicine in our practices. In scientific contributions of plastic surgery research, application of evidence-based principles should enhance the care of all patients by relying on science rather than opinions. In this article, the genesis of evidence-based medicine is discussed to guide plastic surgery in this new revolution in American medicine.

  8. Building an evidence base for occupational health interventions

    NARCIS (Netherlands)

    Verbeek, Jos; Husman, Kaj; van Dijk, Frank; Jauhiainen, Merja; Pasternack, Iris; Vainio, Harri

    2004-01-01

    This article summarizes arguments for building an evidence base for occupational health. Evidence is needed on the most effective ways of eliminating health hazards in the workplace and at work, enhancing healthy behavior or the empowerment of workers, and preventing and treating occupational

  9. Evidence-Based Clinical Voice Assessment: A Systematic Review

    Science.gov (United States)

    Roy, Nelson; Barkmeier-Kraemer, Julie; Eadie, Tanya; Sivasankar, M. Preeti; Mehta, Daryush; Paul, Diane; Hillman, Robert

    2013-01-01

    Purpose: To determine what research evidence exists to support the use of voice measures in the clinical assessment of patients with voice disorders. Method: The American Speech-Language-Hearing Association (ASHA) National Center for Evidence-Based Practice in Communication Disorders staff searched 29 databases for peer-reviewed English-language…

  10. How to Reach Evidence-Based Usability Evaluation Methods

    NARCIS (Netherlands)

    Marcilly, Romaric; Peute, Linda

    2017-01-01

    This paper discusses how and why to build evidence-based knowledge on usability evaluation methods. At each step of building evidence, requisites and difficulties to achieve it are highlighted. Specifically, the paper presents how usability evaluation studies should be designed to allow capitalizing

  11. Jet Fuel Based High Pressure Solid Oxide Fuel Cell System

    Science.gov (United States)

    Gummalla, Mallika (Inventor); Yamanis, Jean (Inventor); Olsommer, Benoit (Inventor); Dardas, Zissis (Inventor); Bayt, Robert (Inventor); Srinivasan, Hari (Inventor); Dasgupta, Arindam (Inventor); Hardin, Larry (Inventor)

    2015-01-01

    A power system for an aircraft includes a solid oxide fuel cell system which generates electric power for the aircraft and an exhaust stream; and a heat exchanger for transferring heat from the exhaust stream of the solid oxide fuel cell to a heat requiring system or component of the aircraft. The heat can be transferred to fuel for the primary engine of the aircraft. Further, the same fuel can be used to power both the primary engine and the SOFC. A heat exchanger is positioned to cool reformate before feeding to the fuel cell. SOFC exhaust is treated and used as inerting gas. Finally, oxidant to the SOFC can be obtained from the aircraft cabin, or exterior, or both.

  12. Evidence based of chemoradiotherapy in cervix carcinoma

    International Nuclear Information System (INIS)

    Joly-Lobbedez, F.

    2009-01-01

    Since 10 years, the combination of chemoradiotherapy has become a standard of treatment of the advanced localized cervical cancer. Two systematic reviews of the literature (including the results of the different clinical trials) have already been published. The aim of this article is to present the results of the recent meta-analysis based on individual patient data and to discuss the perspectives. This meta-analysis was rigorously designed: trials selected had the same control arm with the same radiotherapy without concomitant chemotherapy, the definition of the primary outcome (overall survival) was homogeneous and analysis was made in intent to treat. The results confirm the advantage in overall survival in favor of the chemoradiotherapy with an absolute 5-year overall survival benefit of 6% (60-66%) and 8% of 5-year disease-free survival (50-58%). Interestingly, even if cisplatin seems to be the most active drug, a significant advantage is also observed with no platinum chemotherapy. A polychemotherapy is not more active than a mono chemotherapy and there was a suggestion of a difference in the size of the survival benefit with tumor stage. Larger benefits were seen for the few trials in which additional chemotherapy was administered after chemoradiotherapy, but results have to be confirmed by other clinical trials. Late toxicity was not well evaluated and a long-term follow-up of the patients is important to assess the real incidence of long-term side effects of the chemoradiotherapy and the impact on quality of life. New strategies combining new chemotherapy protocols or targeted therapy with radiation are promising but have to be evaluated in comparative clinical trials before use in routine. (authors)

  13. Eminence-based medicine versus evidence-based medicine: level V evidence in sports medicine.

    Science.gov (United States)

    Tjoumakaris, Fotios P; Ganley, Theodore J; Kapur, Rahul; Kelly, John; Sennett, Brian J; Bernstein, Joseph

    2011-11-01

    cannot replace individual judgment and certainly does not trump the primary medical literature. Yet when better evidence is lacking, expert opinion is valuable for even the staunchest practitioner of evidence-based medicine.

  14. Clinical librarians as facilitators of nurses' evidence-based practice.

    Science.gov (United States)

    Määttä, Sylvia; Wallmyr, Gudrun

    2010-12-01

    The aim of this study was to explore nurses' and ward-based clinical librarians' reflections on ward-based clinical librarians as facilitators for nurses' use of evidences-based practice. Nurses' use of evidence-based practice is reported to be weak. Studies have suggested that clinical librarians may promote evidence-based practice. To date, little is known about clinical librarians participating nurses in the wards. A descriptive, qualitative design was adopted for the study. In 2007, 16 nurses who had been attended by a clinical librarian in the wards were interviewed in focus groups. Two clinical librarians were interviewed by individual interviews. In the analysis, a content analysis was used. Three themes were generated from the interviews with nurses: 'The grip of everyday work', 'To articulate clinical nursing issues' and 'The clinical librarians at a catalyst'. The nurses experienced the grip of everyday work as a hindrance and had difficulties to articulate and formulate relevant nursing issues. In such a state, the nurses found the clinical librarian presence in the ward as enhancing the awareness of and the use of evidence-based practice. Three themes emerged from the analysis with the librarians. They felt as outsiders, had new knowledge and acquired a new role as ward-based clinical librarians. Facilitation is needed if nurses' evidence-based practice is going to increase. The combined use of nurses and clinical librarians' knowledge and skills can be optimised. To achieve this, nurses' skills in consuming and implementing evidence ought to be strengthened. The fusion of the information and knowledge management skill of the ward-based clinical librarian and the clinical expertise of the nurses can be of value. With such a collaborative model, nurse and ward-based clinical librarian might join forces to increase the use of evidence-based practice. © 2010 Blackwell Publishing Ltd.

  15. BUILDING A CULTURE OF EVIDENCE-BASED PLANNING

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

    The Nigeria Evidence-based Health System Initiative (NEHSI) is a ..... PAC structure was tested during the planning phase; the structure .... the research and training organization CIET, engaging ..... scorecards, equipment and office supplies.

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

    CSIR Research Space (South Africa)

    Ntshotsho, P

    2015-11-01

    Full Text Available Global acknowledgement of ecological restoration, as an important tool to complement conservation efforts, requires an effort to increase the effectiveness of restoration interventions. Evidence-based practice is purported to promote effectiveness...

  17. Moving Zimbabwe Forward : an Evidence Based Policy Dialogue ...

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

    Moving Zimbabwe Forward : an Evidence Based Policy Dialogue ... levels of poverty, unemployment, inflation and poor service provision in the areas of education, ... International Water Resources Association, in close collaboration with IDRC, ...

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

    African Journals Online (AJOL)

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

  19. The Care and Feeding of Evidence Based Medicine

    OpenAIRE

    Tabrah, Frank L

    2012-01-01

    Wide interest in evidence based medicine (EBM) and its value in patient care, insurance payment decisions, and public health planning has triggered intense medical journal and media coverage that merits review, explanation, and comment.

  20. Advancing Evidence Based Policymaking and Regulation to Ensure ...

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

    Advancing Evidence Based Policymaking and Regulation to Ensure Greater ... which is Communications Policy Research South (CPRsouth), a yearly conference that ... policy intellectuals through tutorials for young scholars and internships.

  1. Evidence Based Practice: Valuable and Successful Examples from ...

    African Journals Online (AJOL)

    Keywords: evidence-based practice, nursing, midwifery, education, quality improvement, ... developed by Deming, the father of quality control. ... representative of the total population. .... and helped the management engage in key areas of.

  2. An organizational cybernetics framework for achieving balance in evidence-based practice and practice-based evidence.

    Science.gov (United States)

    Fitch, Dale

    2014-01-01

    This article applies the systems science of organizational cybernetics to the implementation of evidence-based practice (EBP) in the provision of social work services in a residential treatment center setting. It does so by systemically balancing EBP with practice-based evidence (PBE) with a focus on the organizational and information system infrastructures necessary to ensure successful implementation. This application is illustrated by discussing a residential treatment program that implemented evidence-based programming and evaluated the results; however, the systemic principles articulated can be applied to any human services organizational setting.

  3. Introduction to evidence-based medicine(EBM)

    International Nuclear Information System (INIS)

    Choe, Jae Gol

    2001-01-01

    EBM is 'the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.' EBM is the integration of clinical expertise, patient values, and the best evidence into the decision making process for patient care. The practice of EBM is usually triggered by patient encounters which generate questions about the effects of therapy, the utility of diagnostic tests, the prognosis of diseases, or the etiology of disorders. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology. Evidence-based medicine requires new skills of the clinician, including efficient literature-searching, and the application of formal rules of evidence in evaluating the clinical literature. Evidence-based medicine converts the abstract exercise of reading and appraising the literature into the pragmatic process of using the literature to benefit individual patients while simultaneously expanding the clinician's knowledge base. This review will briefly discuss about concepts of evidence medicine and method of critical appraisal of literatures

  4. Evidence-Based Scholarly Communication: Information Professionals Unlocking Translational Research

    OpenAIRE

    Philip J. Kroth; Holly E. Phillips; Jonathan D. Eldredge

    2010-01-01

    The Evidence-Based Scholarly Communication Conference (EBSCC) was held March 11-12, 2010 in Albuquerque, NM. The conference addressed the perceived gap in knowledge and training for scholarly communication principles in the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) Program. The EBSCC brought together librarians and information specialists to share evidence based strategies for developing effective local scholarly communication support and training and...

  5. Model study on transesterification of soybean oil to biodiesel with methanol using solid base catalyst.

    Science.gov (United States)

    Liu, Xuejun; Piao, Xianglan; Wang, Yujun; Zhu, Shenlin

    2010-03-25

    Modeling of the transesterification of vegetable oils to biodiesel using a solid base as a catalyst is very important because the mutual solubilities of oil and methanol will increase with the increasing biodiesel yield. The heterogeneous liquid-liquid-solid reaction system would become a liquid-solid system when the biodiesel reaches a certain content. In this work, we adopted a two-film theory and a steady state approximation assumption, then established a heterogeneous liquid-liquid-solid model in the first stage. After the diffusion coefficients on the liquid-liquid interface and the liquid-solid interface were calculated on the basis of the properties of the system, the theoretical value of biodiesel productivity changing with time was obtained. The predicted values were very near the experimental data, which indicated that the proposed models were suitable for the transesterification of soybean oil to biodiesel when solid bases were used as catalysts. Meanwhile, the model indicated that the transesterification reaction was controlled by both mass transfer and reaction. The total resistance will decrease with the increase in biodiesel yield in the liquid-liquid-solid stage. The solid base catalyst exhibited an activation energy range of 9-20 kcal/mol, which was consistent with the reported activation energy range of homogeneous catalysts.

  6. Hurdles of CAR-T cell-based cancer immunotherapy directed against solid tumors.

    Science.gov (United States)

    Zhang, Bing-Lan; Qin, Di-Yuan; Mo, Ze-Ming; Li, Yi; Wei, Wei; Wang, Yong-Sheng; Wang, Wei; Wei, Yu-Quan

    2016-04-01

    Recent reports on the impressive efficacy of chimeric antigen receptor (CAR)-modified T cells against hematologic malignancies have inspired oncologists to extend these efforts for the treatment of solid tumors. Clinical trials of CAR-T-based cancer immunotherapy for solid tumors showed that the efficacies are not as remarkable as in the case of hematologic malignancies. There are several challenges that researchers must face when treating solid cancers with CAR-T cells, these include choosing an ideal target, promoting efficient trafficking and infiltration, overcoming the immunosuppressive microenvironment, and avoiding associated toxicity. In this review, we discuss the obstacles imposed by solid tumors on CAR-T cell-based immunotherapy and strategies adopted to improve the therapeutic potential of this approach. Continued investigations are necessary to improve therapeutic outcomes and decrease the adverse effects of CAR-T cell therapy in patients with solid malignancies in the future.

  7. Evidence-based medicine and epistemological imperialism: narrowing the divide between evidence and illness.

    Science.gov (United States)

    Crowther, Helen; Lipworth, Wendy; Kerridge, Ian

    2011-10-01

    Evidence-based medicine (EBM) has been rapidly and widely adopted because it claims to provide a method for determining the safety and efficacy of medical therapies and public health interventions more generally. However, as others have noted, EBM may be riven through with cultural bias, both in the generation of evidence and in its translation. We suggest that technological and scientific advances in medicine accentuate and entrench these cultural biases, to the extent that they may invalidate the evidence we have about disease and its treatment. This creates a significant ethical, epistemological and ontological challenge for medicine. © 2011 Blackwell Publishing Ltd.

  8. Towards Trustable Digital Evidence with PKIDEV: PKI Based Digital Evidence Verification Model

    Science.gov (United States)

    Uzunay, Yusuf; Incebacak, Davut; Bicakci, Kemal

    How to Capture and Preserve Digital Evidence Securely? For the investigation and prosecution of criminal activities that involve computers, digital evidence collected in the crime scene has a vital importance. On one side, it is a very challenging task for forensics professionals to collect them without any loss or damage. On the other, there is the second problem of providing the integrity and authenticity in order to achieve legal acceptance in a court of law. By conceiving digital evidence simply as one instance of digital data, it is evident that modern cryptography offers elegant solutions for this second problem. However, to our knowledge, there is not any previous work proposing a systematic model having a holistic view to address all the related security problems in this particular case of digital evidence verification. In this paper, we present PKIDEV (Public Key Infrastructure based Digital Evidence Verification model) as an integrated solution to provide security for the process of capturing and preserving digital evidence. PKIDEV employs, inter alia, cryptographic techniques like digital signatures and secure time-stamping as well as latest technologies such as GPS and EDGE. In our study, we also identify the problems public-key cryptography brings when it is applied to the verification of digital evidence.

  9. The Evidence Base for Developing a Veterinary Business Management Curriculum

    Directory of Open Access Journals (Sweden)

    Elizabeth Jackson

    2016-06-01

    Full Text Available Objective: This paper sets out to highlight the ongoing need for integrated teaching of business skills in the veterinary curriculum.Background: In response to the changing environment of the veterinary profession, it is important to understand the future needs of veterinary practitioners. While changes to the veterinary curriculum have been made in recent years, they have been highly varied across schools and little evidence is available on how these have improved students’ non-technical skills, knowledge, aptitudes, and attitudes. Evidentiary value: This literature review of 23 papers provides a solid basis for the further development of knowledge on business management issues in veterinary curricula. The impact on practice from our findings is substantial. The role of clinicians in academia is recognised as a primary source of engaging students with business management through their day-to-day teaching. Furthermore, the role of first-opinion vets who take on placement students (known as extra mural studies or ‘EMS’ in the UK cannot be underestimated as they play an essential role in ensuring that students perceive business skills with the same importance as clinical skills.Methods: This research draws on the findings of 23 papers that emerged as relevant from the structured literature search.  The search yielded 124 papers but many were excluded because they focused on issues beyond the search strategy, did not report empirical findings so were based largely on discussion and conjecture, were not about the undergraduate veterinary curriculum, were not written in English or were not related to business teaching.Results:  Employers of recent graduates highly value business skills, and often base their hiring decision on non-technical skills, rather than clinical skills. While changes to the veterinary curriculum have been made to include more non-technical training by individual veterinary schools, it is unclear how effective these

  10. Lanthanum Manganate Based Cathodes for Solid Oxide Fuel Cells

    DEFF Research Database (Denmark)

    Jørgensen, Mette Juhl

    Composite cathodes for solid oxide fuel cells were investigated using electrochemical impedance spectroscopy and scanning electron microscopy. The aim was to study the oxygen reduction process in the electrode in order to minimise the voltage drop in the cathode. The electrodes contained...... five processes were found to affect the impedance of LSM/YSZ composite electrodes. Two high frequency processes were ascribed to transport of oxide ions/oxygen intermediates across LSM/YSZ interfaces and through YSZ in the composite. Several competitive elementary reaction steps, which appear as one...

  11. Criteria for evidence-based practice in Iranian traditional medicine.

    Science.gov (United States)

    Soltani Arabshahi, SeyyedKamran; Mohammadi Kenari, Hoorieh; Kordafshari, Gholamreza; Shams-Ardakani, MohammadReza; Bigdeli, Shoaleh

    2015-07-01

    The major difference between Iranian traditional medicine and allopathic medicine is in the application  of  evidence  and  documents.  In  this  study,  criteria  for  evidence-based  practice  in  Iranian traditional medicine and its rules of practice were studied. The experts' views were investigated through in- depth, semi-structured interviews and the results were categorized into four main categories including Designing clinical questions/clinical question-based search, critical appraisal, resource search criteria and clinical prescription appraisal. Although the application of evidence in Iranian traditional medicine follows Evidence Based Medicine (EBM) principles but it benefits from its own rules, regulations, and criteria that are compatible with EBM.

  12. Bridging the gap to evidence-based eye care

    Directory of Open Access Journals (Sweden)

    Richard Wormald

    2004-10-01

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

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

    Science.gov (United States)

    Spring, Bonnie

    2008-01-01

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

  14. MEMS-Based Solid Propellant Rocket Array Thruster

    Science.gov (United States)

    Tanaka, Shuji; Hosokawa, Ryuichiro; Tokudome, Shin-Ichiro; Hori, Keiichi; Saito, Hirobumi; Watanabe, Masashi; Esashi, Masayoshi

    The prototype of a solid propellant rocket array thruster for simple attitude control of a 10 kg class micro-spacecraft was completed and tested. The prototype has 10×10 φ0.8 mm solid propellant micro-rockets arrayed at a pitch of 1.2 mm on a 20×22 mm substrate. To realize such a dense array of micro-rockets, each ignition heater is powered from the backside of the thruster through an electrical feedthrough which passes along a propellant cylinder wall. Boron/potassium nitrate propellant (NAB) is used with/without lead rhodanide/potassium chlorate/nitrocellulose ignition aid (RK). Impulse thrust was measured by a pendulum method in air. Ignition required electric power of at least 3 4 W with RK and 4 6 W without RK. Measured impulse thrusts were from 2×10-5 Ns to 3×10-4 Ns after the calculation of compensation for air dumping.

  15. Mathematical Based Calculation of Drug Penetration Depth in Solid Tumors

    Directory of Open Access Journals (Sweden)

    Hamidreza Namazi

    2016-01-01

    Full Text Available Cancer is a class of diseases characterized by out-of-control cells’ growth which affect cells and make them damaged. Many treatment options for cancer exist. Chemotherapy as an important treatment option is the use of drugs to treat cancer. The anticancer drug travels to the tumor and then diffuses in it through capillaries. The diffusion of drugs in the solid tumor is limited by penetration depth which is different in case of different drugs and cancers. The computation of this depth is important as it helps physicians to investigate about treatment of infected tissue. Although many efforts have been made on studying and measuring drug penetration depth, less works have been done on computing this length from a mathematical point of view. In this paper, first we propose phase lagging model for diffusion of drug in the tumor. Then, using this model on one side and considering the classic diffusion on the other side, we compute the drug penetration depth in the solid tumor. This computed value of drug penetration depth is corroborated by comparison with the values measured by experiments.

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

    Directory of Open Access Journals (Sweden)

    Shea Beverley

    2006-09-01

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

  17. Changes in contact angle providing evidence for surface alteration in multi-component solid foods

    International Nuclear Information System (INIS)

    Reinke, Svenja K; Hauf, Katharina; Heinrich, Stefan; Vieira, Josélio; Palzer, Stefan

    2015-01-01

    Chocolate blooming, one of the major problems in the confectionery industry, is the formation of visible white spots or a greyish haze on the surface of chocolate products due to large sugar or fat crystals on the surface. This leads to aesthetic changes and deterioration of taste and thus large sales losses for the confectionery industry due to consumer complaints. Chocolate blooming is often related to migration of lipids or sugar molecules to the chocolate surface, where they recrystallize with an associated polymorphic change of crystal structure on the surface. The wetting behaviour from contact angle measurements gives further insight into surface properties and is needed to determine surface energies and to evaluate possible migration mechanisms and preferred pathways. Therefore, an equilibrium contact angle is needed which is not directly accessible and is influenced by surface texture and interaction between solid and test liquid. In this study, the surface of cocoa butter and conventional chocolates was characterized by measuring the contact angle with the sessile drop protocol. The influence of roughness, test liquid and pre-crystallization of the samples as well as the storage temperature were investigated. In case of no pre-crystallization, a change in surface properties due to storage at 20 °C was detected, whereas samples stored at 30 °C showed the same wetting behaviour as fresh samples. This is associated with polymorphic transformation from thermodynamically less stable crystals to more stable configurations. (paper)

  18. Evidence for the direct ejection of clusters from non-metallic solids during laser vaporization

    International Nuclear Information System (INIS)

    Bloomfield, L.A.; Yang, Y.A.; Xia, P.; Junkin, A.L.

    1991-01-01

    This paper reports on the formation of molecular scale particles or clusters of alkali halides and semiconductors during laser vaporization of solids. By measuring the abundances of cluster ions produced in several different source configurations, the authors have determined that clusters are ejected directly from the source sample and do not need to grow from atomic or molecular vapor. Using samples of mixed alkali halide powders, the authors have found that unalloyed clusters are easily produced in a source that prevents growth from occurring after the clusters leave the sample surface. However, melting the sample or encouraging growth after vaporization lead to the production of alloyed cluster species. The sizes of the ejected clusters are initially random, but the population spectrum quickly becomes structured as hot, unstable-sized clusters decay into smaller particles. In carbon, large clusters with odd number of atoms decay almost immediately. The hot even clusters also decay, but much more slowly. The longest lived clusters are the magic C 50 and C 60 fullerenes. The mass spectrum of large carbon clusters evolves in time from structureless, to only the even clusters, to primarily C 50 and C 60 . If cluster growth is encouraged, the odd clusters reappear and the population spectrum again becomes relatively structureless

  19. Changes in contact angle providing evidence for surface alteration in multi-component solid foods

    Science.gov (United States)

    Reinke, Svenja K.; Hauf, Katharina; Vieira, Josélio; Heinrich, Stefan; Palzer, Stefan

    2015-11-01

    Chocolate blooming, one of the major problems in the confectionery industry, is the formation of visible white spots or a greyish haze on the surface of chocolate products due to large sugar or fat crystals on the surface. This leads to aesthetic changes and deterioration of taste and thus large sales losses for the confectionery industry due to consumer complaints. Chocolate blooming is often related to migration of lipids or sugar molecules to the chocolate surface, where they recrystallize with an associated polymorphic change of crystal structure on the surface. The wetting behaviour from contact angle measurements gives further insight into surface properties and is needed to determine surface energies and to evaluate possible migration mechanisms and preferred pathways. Therefore, an equilibrium contact angle is needed which is not directly accessible and is influenced by surface texture and interaction between solid and test liquid. In this study, the surface of cocoa butter and conventional chocolates was characterized by measuring the contact angle with the sessile drop protocol. The influence of roughness, test liquid and pre-crystallization of the samples as well as the storage temperature were investigated. In case of no pre-crystallization, a change in surface properties due to storage at 20 °C was detected, whereas samples stored at 30 °C showed the same wetting behaviour as fresh samples. This is associated with polymorphic transformation from thermodynamically less stable crystals to more stable configurations.

  20. First Solid Evidence for a Rocky Exoplanet - Mass and density of smallest exoplanet finally measured

    Science.gov (United States)

    2009-09-01

    The longest set of HARPS measurements ever made has firmly established the nature of the smallest and fastest-orbiting exoplanet known, CoRoT-7b, revealing its mass as five times that of Earth's. Combined with CoRoT-7b's known radius, which is less than twice that of our terrestrial home, this tells us that the exoplanet's density is quite similar to the Earth's, suggesting a solid, rocky world. The extensive dataset also reveals the presence of another so-called super-Earth in this alien solar system. "This is science at its thrilling and amazing best," says Didier Queloz, leader of the team that made the observations. "We did everything we could to learn what the object discovered by the CoRoT satellite looks like and we found a unique system." In February 2009, the discovery by the CoRoT satellite [1] of a small exoplanet around a rather unremarkable star named TYC 4799-1733-1 was announced one year after its detection and after several months of painstaking measurements with many telescopes on the ground, including several from ESO. The star, now known as CoRoT-7, is located towards the constellation of Monoceros (the Unicorn) at a distance of about 500 light-years. Slightly smaller and cooler than our Sun, CoRoT-7 is also thought to be younger, with an age of about 1.5 billion years. Every 20.4 hours, the planet eclipses a small fraction of the light of the star for a little over one hour by one part in 3000 [2]. This planet, designated CoRoT-7b, is only 2.5 million kilometres away from its host star, or 23 times closer than Mercury is to the Sun. It has a radius that is about 80% greater than the Earth's. The initial set of measurements, however, could not provide the mass of the exoplanet. Such a result requires extremely precise measurements of the velocity of the star, which is pulled a tiny amount by the gravitational tug of the orbiting exoplanet. The problem with CoRoT-7b is that these tiny signals are blurred by stellar activity in the form of

  1. Evidence conflict measure based on OWA operator in open world.

    Directory of Open Access Journals (Sweden)

    Wen Jiang

    Full Text Available Dempster-Shafer evidence theory has been extensively used in many information fusion systems since it was proposed by Dempster and extended by Shafer. Many scholars have been conducted on conflict management of Dempster-Shafer evidence theory in past decades. However, how to determine a potent parameter to measure evidence conflict, when the given environment is in an open world, namely the frame of discernment is incomplete, is still an open issue. In this paper, a new method which combines generalized conflict coefficient, generalized evidence distance, and generalized interval correlation coefficient based on ordered weighted averaging (OWA operator, to measure the conflict of evidence is presented. Through ordered weighted average of these three parameters, the combinatorial coefficient can still measure the conflict effectively when one or two parameters are not valid. Several numerical examples demonstrate the effectiveness of the proposed method.

  2. Visualization studies on evidence-based medicine domain knowledge (series 3): visualization for dissemination of evidence based medicine information.

    Science.gov (United States)

    Shen, Jiantong; Yao, Leye; Li, Youping; Clarke, Mike; Gan, Qi; Li, Yifei; Fan, Yi; Gou, Yongchao; Wang, Li

    2011-05-01

    To identify patterns in information sharing between a series of Chinese evidence based medicine (EBM) journals and the Cochrane Database of Systematic Reviews, to determine key evidence dissemination areas for EBM and to provide a scientific basis for improving the dissemination of EBM research. Data were collected on citing and cited from the Chinese Journal of Evidence-Based Medicine (CJEBM), Journal of Evidence-Based Medicine (JEBMc), Chinese Journal of Evidence Based Pediatrics (CJEBP), and the Cochrane Database of Systematic Reviews (CDSR). Relationships between citations were visualized. High-frequency key words from these sources were identified, to build a word co-occurrence matrix and to map research subjects. CDSR contains a large collection of information of relevance to EBM and its contents are widely cited across many journals, suggesting a well-developed citation environment. The content and citation of the Chinese journals have been increasing in recent years. However, their citation environments are much less developed, and there is a wide variation in the breadth and strength of their knowledge communication, with the ranking from highest to lowest being CJEBM, JEBMc and CJEBP. The content of CDSR is almost exclusively Cochrane intervention reviews examining the effects of healthcare interventions, so it's contribution to EBM is mostly in disease control and treatment. On the other hand, the Chinese journals on evidence-based medicine and practice focused more on areas such as education and research, design and quality of clinical trials, evidence based policymaking, evidence based clinical practice, tumor treatment, and pediatrics. Knowledge and findings of EBM are widely communicated and disseminated. However, citation environments and range of knowledge communication differ greatly between the journals examined in this study. This finds that Chinese EBM has focused mainly on clinical medicine, Traditional Chinese Medicine, pediatrics, tumor

  3. Starch saccharification by carbon-based solid acid catalyst

    Science.gov (United States)

    Yamaguchi, Daizo; Hara, Michikazu

    2010-06-01

    The hydrolysis of cornstarch using a highly active solid acid catalyst, a carbon material bearing SO 3H, COOH and OH groups, was investigated at 353-393 K through an analysis of variance (ANOVA) and an artificial neural network (ANN). ANOVA revealed that reaction temperature and time are significant parameters for the catalytic hydrolysis of starch. The ANN model indicated that the reaction efficiency reaches a maximum at an optimal condition (water, 0.8-1.0 mL; starch, 0.3-0.4 g; catalyst, 0.3 g; reaction temperature, 373 K; reaction time, 3 h). The relationship between the reaction and these parameters is discussed on the basis of the reaction mechanism.

  4. Zn-based porous coordination solid as diclofenac sodium carrier

    Science.gov (United States)

    Lucena, Guilherme Nunes; Alves, Renata Carolina; Abuçafy, Marina Paiva; Chiavacci, Leila Aparecida; da Silva, Isabel Cristiane; Pavan, Fernando Rogério; Frem, Regina Célia Galvão

    2018-04-01

    Drug delivery systems produced with biocompatible components can be used to reduce adverse effects and improve therapy efficacy. Most of the carrier materials reported in the literature show poor drug loading and rapid release. However, porous hybrid solids, such as metal-organic frameworks, are well suited to serve as carriers for delivery and imaging applications. In this work, a luminescent and nontoxic porous Zn(II) coordination polymer with 4,4‧-biphenyl-dicarboxylic acid (BPDC) and adenine linkers (BioMOF-Zn) was synthesized by a solvothermal process and characterized by PXRD, TGA, SEM-FEG, and FTIR. Nitrogen adsorption measurements revealed the presence of micropores as well as mesopores in the framework after activation of the material. The blue-emitting BioMOF-Zn exhibited an outstanding loading capacity (1.72 g g-1) and satisfactory release capability (56% after two days) for diclofenac sodium.

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

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

    2016-04-29

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

  6. Reforming European universities: Scope for an evidence-based process

    NARCIS (Netherlands)

    Veugelers, R.; van der Ploeg, F.; Dewatripont, M.; Thys-Clément, F.; Wilkin, L.

    2008-01-01

    Universities are key players in the successful transition to a knowledge-based economy and society. However, this crucial sector of society needs restructuring if Europe is not to lose out in the global competition in education, research and innovation. To allow a more evidence based process of

  7. An evidence-based rehabilitation program for tracheoesophageal speakers

    NARCIS (Netherlands)

    Jongmans, P.; Rossum, M.; As-Brooks, C.; Hilgers, F.; Pols, L.; Hilgers, F.J.M.; Pols, L.C.W.; van Rossum, M.; van den Brekel, M.W.M.

    2008-01-01

    Objectives: to develop an evidence-based therapy program aimed at improving tracheoesophageal speech intelligibility. The therapy program is based on particular problems found for TE speakers in a previous study as performed by the authors. Patients/Materials and Methods: 9 male laryngectomized

  8. Evidence-Based Practice: A Framework for Making Effective Decisions

    Science.gov (United States)

    Spencer, Trina D.; Detrich, Ronnie; Slocum, Timothy A.

    2012-01-01

    The research to practice gap in education has been a long-standing concern. The enactment of No Child Left Behind brought increased emphasis on the value of using scientifically based instructional practices to improve educational outcomes. It also brought education into the broader evidence-based practice movement that started in medicine and has…

  9. Nursing implementation science: how evidence-based nursing requires evidence-based implementation.

    NARCIS (Netherlands)

    Achterberg, T. van; Schoonhoven, L.; Grol, R.P.T.M.

    2008-01-01

    PURPOSE: Evidence is not always used in practice, and many examples of problematic implementation of research into practice exist. The aim of this paper is to provide an introduction and overview of current developments in implementation science and to apply these to nursing. METHODS: We discuss a

  10. Enhanced solubility and bioavailability of sibutramine base by solid dispersion system with aqueous medium.

    Science.gov (United States)

    Li, Dong Xun; Jang, Ki-Young; Kang, Wonku; Bae, Kyoungjin; Lee, Mann Hyung; Oh, Yu-Kyoung; Jee, Jun-Pil; Park, Young-Joon; Oh, Dong Hoon; Seo, Youn Gee; Kim, Young Ran; Kim, Jong Oh; Woo, Jong Soo; Yong, Chul Soon; Choi, Han-Gon

    2010-01-01

    To develop a novel sibutramine base-loaded solid dispersion with improved solubility bioavailability, various solid dispersions were prepared with water, hydroxypropylmethyl cellulose (HPMC), poloxamer and citric acid using spray-drying technique. The effect of HPMC, poloxamer and citric acid on the aqueous solubility of sibutramine was investigated. The physicochemical properties of solid dispersion were investigated using scanning electron microscopy (SEM), differential scanning calorimetry (DSC) and X-ray powder diffraction. The dissolution and pharmacokinetics in rats of solid dispersion were evaluated compared to the sibutramine hydrochloride monohydrate-loaded commercial product (Reductil). The sibutramine base-loaded solid dispersion gave two type forms. Like conventional solid dispersion system, one type appeared as a spherical shape with smooth surface, as the carriers and drug with relatively low melting point were soluble in water and formed it. The other appeared as an irregular form with relatively rough surface. Unlike conventional solid dispersion system, this type changed no crystalline form of drug. Our results suggested that this type was formed by attaching hydrophilic carriers to the surface of drug without crystal change, resulting from changing the hydrophobic drug to hydrophilic form. The sibutramine-loaded solid dispersion at the weight ratio of sibutramine base/HPMC/poloxamer/citric acid of 5/3/3/0.2 gave the maximum drug solubility of about 3 mg/ml. Furthermore, it showed the similar plasma concentration, area under the curve (AUC) and C(max) of parent drug, metabolite I and II to the commercial product, indicating that it might give the similar drug efficacy compared to the sibutramine hydrochloride monohydrate-loaded commercial product in rats. Thus, this solid dispersion system would be useful to deliver poorly water-soluble sibutramine base with enhanced bioavailability.

  11. Management of REM sleep behavior disorder: An evidence based review

    OpenAIRE

    Preeti Devnani; Racheal Fernandes

    2015-01-01

    Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by dream enactment behavior resulting from a loss of REM skeletal muscle atonia. The neurobiology of REM sleep and the characteristic features of REM atonia have an important basis for understanding the aggravating etiologies the proposed pharmacological interventions in its management. This review outlines the evidence for behavioral and therapeutic measures along with evidence-based guidelines for their implementation, ...

  12. Comparison of Traditional Versus Evidence-Based Journal Club Formats

    Directory of Open Access Journals (Sweden)

    Kathleen Packard, PharmD, MS, BCPS

    2011-01-01

    Full Text Available AbstractPurpose: The objective of the study was to compare a traditionally structured journal club with an evidence based structured journal club during an advanced clinical pharmacy rotation and to determine the best utilization that aligns with recent changes to the pharmacy school accreditation standards.Methods: The study included 21 students who completed journal club utilizing the traditional journal club format and 24 students who utilized an evidence based journal club format. Background characteristics, student reported beliefs, and mean critical evaluation skills scores were evaluated and compared in each group.Results: There were no statistically significant differences between the two cohorts in mean overall percentage grade for the activity. Students in the traditional cohort received significantly higher grades for the Study Analysis and Critique section (90.97 + 12.18 versus 81.25 + 11.18, P=0.01 as well as for the Preparedness section (96.11 + 8.03 versus 85.0 + 17.13, P=0.002. Students in the evidence based cohort received statistically superior grades for the Presentation Skills section (96.43 + 6.39 versus 82.47 + 14.12, P=0.0004.Conclusion: An evidence based journal club is a reasonable and effective alternative to the traditionally structured journal club when the primary objective is to assist students in understanding evidence based concepts and to apply current literature to clinical practice.

  13. [Glocalization: the outlook for Taiwan evidence based health care].

    Science.gov (United States)

    Chen, Chiehfeng

    2014-12-01

    Public attention to evidence-based health care (EBHC) has increased significantly in recent years. Key problems related to applying EBHC in current healthcare practice include the timely update of up-to-date knowledge and skills and the methodology used to implement EBHC in clinical settings. EBHC has been introduced to the Taiwan healthcare system for the past two decades. The annual EBM (Evidence based medicine) National Competition is a unique and important EBHC activity in Taiwan. EBHC has been promoted widely in medicine, nursing, pharmacy, public health and other professions, and EBHC-related organizations such as the Taiwan Evidence Based Medicine Association (TEBMA), and Taiwan Evidence Based Nursing Association (TEBNA), have increased in number and grown in membership. In addition to domestic developments, Taiwan is also actively involved in global organizations, such as the Cochrane Collaboration, East Asian Cochrane Alliance (EACA), and the International Society for Evidence Based Health Care (ISEHC). In Taiwan, most medical professionals work cooperatively to promote EBHC, which facilitates the gradual improvement of healthcare quality.

  14. Barriers to evidence-based medicine: a systematic review.

    Science.gov (United States)

    Sadeghi-Bazargani, Homayoun; Tabrizi, Jafar Sadegh; Azami-Aghdash, Saber

    2014-12-01

    Evidence-based medicine (EBM) has emerged as an effective strategy to improve health care quality. The aim of this study was to systematically review and carry out an analysis on the barriers to EBM. Different database searching methods and also manual search were employed in this study using the search words ('evidence-based' or 'evidence-based medicine' or 'evidence-based practice' or 'evidence-based guidelines' or 'research utilization') and (barrier* or challenge or hinder) in the following databases: PubMed, Scopus, Web of Knowledge, Cochrane library, Pro Quest, Magiran, SID. Out of 2592 articles, 106 articles were finally identified for study. Research barriers, lack of resources, lack of time, inadequate skills, and inadequate access, lack of knowledge and financial barriers were found to be the most common barriers to EBM. Examples of these barriers were found in primary care, hospital/specialist care, rehabilitation care, medical education, management and decision making. The most common barriers to research utilization were research barriers, cooperation barriers and changing barriers. Lack of resources was the most common barrier to implementation of guidelines. The result of this study shows that there are many barriers to the implementation and use of EBM. Identifying barriers is just the first step to removing barriers to the use of EBM. Extra resources will be needed if these barriers are to be tackled. © 2014 John Wiley & Sons, Ltd.

  15. Evidence-Based Practice and School Libraries: Interconnections of Evidence, Advocacy, and Actions

    Science.gov (United States)

    Todd, Ross J.

    2015-01-01

    This author states that a professional focus on evidence based practice (EBP) for school libraries emerged from the International Association of School Librarianship conference when he presented the concept. He challenged the school library profession to actively engage in professional and reflective practices that chart, measure, document, and…

  16. An Economic Analysis of Municipal Solid Waste Management of Toyohashi City, Japan: Evidences from Environmental Kuznets Curve

    OpenAIRE

    Miyata, Yuzuru; Shibusawa, Hiroyuki; Hossain, Nahid

    2013-01-01

    The study of Toyohashi cityfs economic growth and resultant growth in municipal solid waste management were empirically examined by the relation between city economic growth, city expenditure for solid waste management and municipal solid waste. The growth in the economy and the population has increased discharge of municipal solid waste in Toyohashi city. The economic size of the city is identified as a strong explanatory variable. Various kinds of municipal solid waste were generated with ...

  17. Developing Traditional Chinese Medicine in the Era of Evidence-Based Medicine: Current Evidences and Challenges

    Science.gov (United States)

    Fung, Foon Yin; Linn, Yeh Ching

    2015-01-01

    Evidence-based medicine (EBM), by integrating individual clinical expertise with the best available clinical evidence from systematic research, has in recent years been established as the standard of modern medical practice for greater treatment efficacy and safety. Traditional Chinese Medicine (TCM), on the other hand, evolved as a system of medical practice from ancient China more than 2000 years ago based on empirical knowledge as well as theories and concepts which are yet to be mapped by scientific equivalents. Despite the expanding TCM usage and the recognition of its therapeutic benefits worldwide, the lack of robust evidence from the EBM perspective is hindering acceptance of TCM by the Western medicine community and its integration into mainstream healthcare. For TCM to become an integral component of the healthcare system so that its benefits can be rationally harnessed in the best interests of patients, it is essential for TCM to demonstrate its efficacy and safety by high-level evidence in accordance with EBM, though much debate remains on the validity and feasibility of applying the EBM model on this traditional practice. This review aims to discuss the current status of research in TCM, explore the evidences available on its efficacy and safety, and highlight the issues and challenges faced in applying EBM to TCM. PMID:25949261

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

    Science.gov (United States)

    Patwardhan, Bhushan

    2014-01-01

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

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

    Science.gov (United States)

    French, B

    1998-01-01

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

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

    Science.gov (United States)

    Hewison, Alistair

    2008-11-01

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

  1. Evidence-Based Scholarly Communication: Information Professionals Unlocking Translational Research

    Directory of Open Access Journals (Sweden)

    Philip J. Kroth

    2010-12-01

    Full Text Available The Evidence-Based Scholarly Communication Conference (EBSCC was held March 11-12, 2010 in Albuquerque, NM. The conference addressed the perceived gap in knowledge and training for scholarly communication principles in the National Institutes of Health (NIH Clinical and Translational Science Award (CTSA Program. The EBSCC brought together librarians and information specialists to share evidence based strategies for developing effective local scholarly communication support and training and, it is hoped, to form new coalitions to address this topic at the local and national levels. This brief communication summarizes the need for theconference, highlights the general sessions in order of presentation, and introduces the EBSCC research papers appearing in this issue of Evidence Based Library and Information Practice (EBLIP. It also includes a description of a unique peer-review process methodology pioneered at EBSCC.

  2. Molecular Solid EOS based on Quasi-Harmonic Oscillator approximation for phonons

    Energy Technology Data Exchange (ETDEWEB)

    Menikoff, Ralph [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2014-09-02

    A complete equation of state (EOS) for a molecular solid is derived utilizing a Helmholtz free energy. Assuming that the solid is nonconducting, phonon excitations dominate the specific heat. Phonons are approximated as independent quasi-harmonic oscillators with vibrational frequencies depending on the specific volume. The model is suitable for calibrating an EOS based on isothermal compression data and infrared/Raman spectroscopy data from high pressure measurements utilizing a diamond anvil cell. In contrast to a Mie-Gruneisen EOS developed for an atomic solid, the specific heat and Gruneisen coefficient depend on both density and temperature.

  3. Zirconium oxide based ceramic solid electrolytes for oxygen detection

    International Nuclear Information System (INIS)

    Caproni, Erica

    2007-01-01

    Taking advantage of the high thermal shock resistance of zirconia-magnesia ceramics and the high oxide ion conductivity of zirconia-yttria ceramics, composites of these ceramics were prepared by mixing, pressing and sintering different relative concentrations of ZrO 2 : 8.6 mol% MgO and ZrO 2 : 3 mol% Y 2 O 3 solid electrolytes. Microstructural analysis of the composites was carried out by X-ray diffraction and scanning electron microscopy analyses. The thermal behavior was studied by dilatometric analysis. The electrical behavior was evaluated by the impedance spectroscopy technique. An experimental setup was designed for measurement the electrical signal generated as a function of the amount of oxygen at high temperatures. The main results show that these composites are partially stabilized (monoclinic, cubic and tetragonal) and the thermal behavior is similar to that of ZrO 2 : 8.6 mol% MgO materials used in disposable high temperature oxygen sensors. Moreover, the results of analysis of impedance spectroscopy show that the electrical conductivity of zirconia:magnesia is improved with zirconia-yttria addition and that the electrical signal depends on the amount of oxygen at 1000 deg C, showing that the ceramic composites can be used in oxygen sensors. (author)

  4. Single-photon sources based on single molecules in solids

    International Nuclear Information System (INIS)

    Moerner, W E

    2004-01-01

    Single molecules in suitable host crystals have been demonstrated to be useful single-photon emitters both at liquid-helium temperatures and at room temperature. The low-temperature source achieved controllable emission of single photons from a single terrylene molecule in p-terphenyl by an adiabatic rapid passage technique. In contrast with almost all other single-molecule systems, terrylene single molecules show extremely high photostability under continuous, high-intensity irradiation. A room-temperature source utilizing this material has been demonstrated, in which fast pumping into vibrational sidebands of the electronically excited state achieved efficient inversion of the emissive level. This source yielded a single-photon emission probability p(1) of 0.86 at a detected count rate near 300 000 photons s -1 , with very small probability of emission of more than one photon. Thus, single molecules in solids can be considered as contenders for applications of single-photon sources such as quantum key distribution

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

    Science.gov (United States)

    Lindoerfer, Doris; Mansmann, Ulrich

    2016-01-01

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

  6. Evidence-based investigations and treatments of recurrent pregnancy loss

    DEFF Research Database (Denmark)

    Christiansen, Ole B; Nybo Andersen, Anne-Marie; Bosch, Ernesto

    2005-01-01

    OBJECTIVE: To give an overview of currently used investigations and treatments offered to women with recurrent pregnancy loss (RPL) and, from an evidence-based point of view, to evaluate the usefulness of these interventions. DESIGN: Ten experts on epidemiologic, genetic, anatomic, endocrinologic......, thrombophilic, immunologic, and immunogenetic aspects of RPL discussed methodologic problems threatening the validity of research in RPL during and after an international workshop on the evidence-based management of RPL. CONCLUSION(S): Most RPL patients have several risk factors for miscarriage...

  7. Automatic evidence quality prediction to support evidence-based decision making.

    Science.gov (United States)

    Sarker, Abeed; Mollá, Diego; Paris, Cécile

    2015-06-01

    Evidence-based medicine practice requires practitioners to obtain the best available medical evidence, and appraise the quality of the evidence when making clinical decisions. Primarily due to the plethora of electronically available data from the medical literature, the manual appraisal of the quality of evidence is a time-consuming process. We present a fully automatic approach for predicting the quality of medical evidence in order to aid practitioners at point-of-care. Our approach extracts relevant information from medical article abstracts and utilises data from a specialised corpus to apply supervised machine learning for the prediction of the quality grades. Following an in-depth analysis of the usefulness of features (e.g., publication types of articles), they are extracted from the text via rule-based approaches and from the meta-data associated with the articles, and then applied in the supervised classification model. We propose the use of a highly scalable and portable approach using a sequence of high precision classifiers, and introduce a simple evaluation metric called average error distance (AED) that simplifies the comparison of systems. We also perform elaborate human evaluations to compare the performance of our system against human judgments. We test and evaluate our approaches on a publicly available, specialised, annotated corpus containing 1132 evidence-based recommendations. Our rule-based approach performs exceptionally well at the automatic extraction of publication types of articles, with F-scores of up to 0.99 for high-quality publication types. For evidence quality classification, our approach obtains an accuracy of 63.84% and an AED of 0.271. The human evaluations show that the performance of our system, in terms of AED and accuracy, is comparable to the performance of humans on the same data. The experiments suggest that our structured text classification framework achieves evaluation results comparable to those of human performance

  8. Towards evidence-based critical thinking medicine? Uses of best evidence in flawless argumentations.

    Science.gov (United States)

    Jenicek, Milos

    2006-08-01

    Uses of informal logic and critical thinking methodology are increasingly taught, learnt and advantageously applied in such diverse domains as law, the military, business, and education. Health sciences are also following this trend. However, production and critical appraisal of evidence as already practiced in Evidence-Based Medicine must be coupled with equally rigorous uses in order to ensure appropriate health problem understanding and decision-making. Making most proposals and decisions in medicine is the conclusion of an argumentation process that lies behind any communication between health professionals working with patients, performing research or sharing ideas about health problems, their interpretations and solutions with numerous stakeholders in public life. Modern critical thinking and decision making in medicine is not instantly mastered, but is instead a learnt experience as anything else in professional and social interactions. The modern argument as outlined, illustrated and applied to health problems in this essay is an extension of a previously established way of thinking in Evidence-Based Medicine. Ideally, health professionals, their patients and all other stakeholders should speak the same language and it is up to us to make this possible. Evidence and critical thinking - based medicine might be a solution. As modern critical thinkers, we are at the forefront and we must see to it that patients and professional and general communities benefit from this more so even than from other remarkable historical and current contributions to the well-being of those under our care.

  9. Variation, certainty, evidence, and change in dental education: employing evidence-based dentistry in dental education.

    Science.gov (United States)

    Marinho, V C; Richards, D; Niederman, R

    2001-05-01

    Variation in health care, and more particularly in dental care, was recently chronicled in a Readers Digest investigative report. The conclusions of this report are consistent with sound scientific studies conducted in various areas of health care, including dental care, which demonstrate substantial variation in the care provided to patients. This variation in care parallels the certainty with which clinicians and faculty members often articulate strongly held, but very different opinions. Using a case-based dental scenario, we present systematic evidence-based methods for accessing dental health care information, evaluating this information for validity and importance, and using this information to make informed curricular and clinical decisions. We also discuss barriers inhibiting these systematic approaches to evidence-based clinical decision making and methods for effectively promoting behavior change in health care professionals.

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

    Science.gov (United States)

    Cairney, Paul; Oliver, Kathryn

    2017-04-26

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

  11. Evidence-based medicine: the value of vision screening.

    Science.gov (United States)

    Beauchamp, George R; Ellepola, Chalani; Beauchamp, Cynthia L

    2010-01-01

    To review the literature for evidence-based medicine (EBM), to assess the evidence for effectiveness of vision screening, and to propose moving toward value-based medicine (VBM) as a preferred basis for comparative effectiveness research. Literature based evidence is applied to five core questions concerning vision screening: (1) Is vision valuable (an inherent good)?; (2) Is screening effective (finding amblyopia)?; (3) What are the costs of screening?; (4) Is treatment effective?; and (5) Is amblyopia detection beneficial? Based on EBM literature and clinical experience, the answers to the five questions are: (1) yes; (2) based on literature, not definitively so; (3) relatively inexpensive, although some claim benefits for more expensive options such as mandatory exams; (4) yes, for compliant care, although treatment processes may have negative aspects such as "bullying"; and (5) economic productive values are likely very high, with returns of investment on the order of 10:1, while human value returns need further elucidation. Additional evidence is required to ascertain the degree to which vision screening is effective. The processes of screening are multiple, sequential, and complicated. The disease is complex, and good visual outcomes require compliance. The value of outcomes is appropriately analyzed in clinical, human, and economic terms.

  12. Training Methods to Improve Evidence-Based Medicine Skills

    Directory of Open Access Journals (Sweden)

    Filiz Ozyigit

    2010-06-01

    Full Text Available Evidence based medicine (EBM is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. It is estimated that only 15% of medical interventions is evidence-based. Increasing demand, new technological developments, malpractice legislations, a very speed increase in knowledge and knowledge sources push the physicians forward for EBM, but at the same time increase load of physicians by giving them the responsibility to improve their skills. Clinical maneuvers are needed more, as the number of clinical trials and observational studies increase. However, many of the physicians, who are in front row of patient care do not use this increasing evidence. There are several examples related to different training methods in order to improve skills of physicians for evidence based practice. There are many training methods to improve EBM skills and these trainings might be given during medical school, during residency or as continuous trainings to the actual practitioners in the field. It is important to discuss these different training methods in our country as well and encourage dissemination of feasible and effective methods. [TAF Prev Med Bull 2010; 9(3.000: 245-254

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

    Directory of Open Access Journals (Sweden)

    Angela Čuk

    2004-01-01

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

  14. Lanthanum manganate based cathodes for solid oxide fuel cells

    Energy Technology Data Exchange (ETDEWEB)

    Juhl Joergensen, M.

    2001-07-01

    Composite cathodes for solid oxide fuel cells were investigated using electrochemical impedance spectroscopy and scanning electron microscopy. The aim was to study the oxygen reduction process in the electrode in order to minimise the voltage drop in the cathode. The electrodes contained a composite layer made from lanthanum strontium manganate (LSM) and yttria stabilised zirconia (YSZ) and a layer of pure LSM aimed for current collection. The performance of the composite electrodes was sensitive to microstructure and thickness. Further, the interface between the composite and the current collecting layer proved to affect the performance. In a durability study severe deg-radation of the composite electrodes was found when passing current through the electrode for 2000 hours at 1000 deg. C. This was ascribed to pore formation along the composite interfaces and densification of the composite and current collector microstructure. An evaluation of the measurement approach indicated that impedance spectroscopy is a very sensitive method. This affects the reproducibility, as small undesirable variations in for instance the microstructure from electrode to electrode may change the impedance. At least five processes were found to affect the impedance of LSM/YSZ composite electrodes. Two high frequency processes were ascribed to transport of oxide ions/oxygen intermediates across LSM/YSZ interfaces and through YSZ in the composite. Several competitive elementary reaction steps, which appear as one medium frequency process in the impedance spectra, were observed. A low frequency arc related to gas diffusion limitation in a stagnant gas layer above the composite structure was detected. Finally, an inductive process, assumed to be connected to an activation process involving segregates at the triple phase boundary between electrode, electrolyte and gas phase, was found. (au)

  15. CAD-based Monte Carlo automatic modeling method based on primitive solid

    International Nuclear Information System (INIS)

    Wang, Dong; Song, Jing; Yu, Shengpeng; Long, Pengcheng; Wang, Yongliang

    2016-01-01

    Highlights: • We develop a method which bi-convert between CAD model and primitive solid. • This method was improved from convert method between CAD model and half space. • This method was test by ITER model and validated the correctness and efficiency. • This method was integrated in SuperMC which could model for SuperMC and Geant4. - Abstract: Monte Carlo method has been widely used in nuclear design and analysis, where geometries are described with primitive solids. However, it is time consuming and error prone to describe a primitive solid geometry, especially for a complicated model. To reuse the abundant existed CAD models and conveniently model with CAD modeling tools, an automatic modeling method for accurate prompt modeling between CAD model and primitive solid is needed. An automatic modeling method for Monte Carlo geometry described by primitive solid was developed which could bi-convert between CAD model and Monte Carlo geometry represented by primitive solids. While converting from CAD model to primitive solid model, the CAD model was decomposed into several convex solid sets, and then corresponding primitive solids were generated and exported. While converting from primitive solid model to the CAD model, the basic primitive solids were created and related operation was done. This method was integrated in the SuperMC and was benchmarked with ITER benchmark model. The correctness and efficiency of this method were demonstrated.

  16. Evidence-Based Management and Controversies in Blunt Splenic Trauma

    NARCIS (Netherlands)

    Olthof, D. C.; van der Vlies, C. H.; Goslings, J. C.

    2017-01-01

    The study aims to describe the evidence-based management and controversies in blunt splenic trauma. A shift from operative management to non-operative management (NOM) has occurred over the past decades where NOM has now become the standard of care in haemodynamically stable patients with blunt

  17. Decision making in advanced otosclerosis: an evidence-based strategy

    NARCIS (Netherlands)

    Merkus, P.; van Loon, M.C.; Smit, C.F.G.M.; Smits, J.C.M.; de Cock, A.F.C.; Hensen, E.F.

    2011-01-01

    Objectives/Hypothesis: To propose an evidence-based strategy for the management of patients with advanced otosclerosis accompanied by severe to profound hearing loss. Study Design: Systematic review of the literature and development of treatment guidelines. Methods: A systematic review was conducted

  18. Beyond Evidence-Based Interventions for Teen Pregnancy Prevention

    OpenAIRE

    Emily Scribner-O'Pray

    2017-01-01

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

  19. Implementing an Evidence Based Preceptorship Program in a Military Center

    Science.gov (United States)

    2014-11-05

    want to act in good conscience, always trying to reach their goals without compromising their personal code of ethics . As Concrete Utilitarians ...Translate research into practice/evidence-based practice Clinical excellence Knowledge management Education and training Leadership, Ethics ...management Education and training Leadership, Ethics , and Mentoring: Health policy Recruitment and retention Preparing tomorrow’s leaders Care of

  20. Interteaching: An Evidence-Based Approach to Instruction

    Science.gov (United States)

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

    2014-01-01

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

  1. Evidence and/or Experience-Based Knowledge in Lifestyle ...

    African Journals Online (AJOL)

    More precisely, it is argued that what will be “effective” therapy for a person diagnosed as obese cannot be reduced ..... they had come to rely on their experience-based know- ledge. ..... knowledge – “tracking down the best evidence to answer.

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

    African Journals Online (AJOL)

    Methadone maintenance therapy as evidence based drug abuse planning in ... drugs are being used as artificial problem-solvers such as frustrations, stress or ... Drug use is a problem to users when it begins to cause some damage to their ...

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

    Science.gov (United States)

    Soltani, Akbar; Moayyeri, Alireza

    2007-08-01

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

  4. Implementing evidence-based practice during an economic downturn.

    Science.gov (United States)

    Beck, Mary S; Staffileno, Beth A

    2012-01-01

    Building a sustainable evidence-based practice (EBP) infrastructure during times of financial constraints poses challenges for nurse leaders. To be successful, plans need to be creative and adaptive, while mindful of limited resources. This commentary describes change management strategies used to implement an EBP infrastructure at a hospital after organizational restructuring occurred.

  5. Evidence-Based Secondary Transition Practices for Enhancing School Completion

    Science.gov (United States)

    Test, David W.; Fowler, Catherine H.; White, James; Richter, Sharon; Walker, Allison

    2009-01-01

    Approximately 28% of students with disabilities do not complete high school (National Longitudinal Transition Study-2, 2005). This increases the likelihood that these students will experience low wages, high rates of incarceration, and limited access to postsecondary education. This article reviews evidence-based secondary transition practices…

  6. Evidence-Based Practices in Outpatient Treatment for Eating Disorders

    Science.gov (United States)

    Schaffner, Angela D.; Buchanan, Linda Paulk

    2010-01-01

    This study examined the current issues relevant to implementing evidence-based practices in the context of outpatient treatment for eating disorders. The study also examined the effectiveness of an outpatient treatment program for eating disorders among a group of 196 patients presenting with anorexia nervosa, bulimia nervosa, or eating disorder…

  7. Strengthening Research Capacity and Evidence-Based Policy ...

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

    ... wider Central Asian region lack capacity to conduct empirical analysis and create policies based on research evidence. To address government priorities, the region needs quality research driven by local demands and analytical skills that can inform effective development responses through policy. This 39-month project, ...

  8. Evidence Based Practice: Valuable and Successful Examples from ...

    African Journals Online (AJOL)

    While research is needed and necessary, promoting the value of evidence-based practice (EBP), quality improvement (QI) and project evaluation (PE) initiatives could rapidly and economically further the development of nursing and midwifery disciplines globally, perhaps especially in resource constrained settings.

  9. Marketing evidence-based practice: what a CROC™!

    Science.gov (United States)

    Boyington, Alice R; Ferrall, Sheila M; Sylvanus, Terry

    2010-10-01

    Nurses should be engaged in evidence-based practice (EBP) to ensure that nursing care is efficient and effective. This article describes one cancer center's use of the Marketing Mix framework to educate staff nurses with the CROC™: Clinging Rigidly to Outdated Care campaign. As a result of the campaign, five EBP projects have been initiated in the cancer center.

  10. Integrating evidence-based principles into the undergraduate ...

    African Journals Online (AJOL)

    Background. The research methodology module was reviewed as part of the overall revision of the undergraduate physiotherapy curriculum of Stellenbosch University. This created an ideal platform from which to assess how to align the principles of evidence-based practice (EBP) with research methodology. Fostering the ...

  11. Book Review: Deployment Psychology: Evidence-based strategies ...

    African Journals Online (AJOL)

    Book Review: Deployment Psychology: Evidence-based strategies to promote mental health in the Military. AB Adler, PD Bliese, CA Castro. Abstract. Washington, DC: American Psychological Association 2011 294 pages ISBN-13: 978-1-4338-0881-4. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT

  12. Developing evidence-based guidelines for referral for short stature

    NARCIS (Netherlands)

    Grote, F.K.; Dommelen, P. van; Oostdijk, W.; Muinck Keizer-Schrama, S.M.P.F. de; Verkerk, P.H.; Wit, J.M.; Buuren, S. van

    2008-01-01

    Objective: To establish evidence based guidelines for growth monitoring on a population basis. Study design: Several auxological referral criteria were formulated and applied to longitudinal growth data from four different patient groups, as well as three samples from the general population.

  13. Evidence-Based Family-School Interventions with Preschool Children

    Science.gov (United States)

    Bates, Stacey L.

    2005-01-01

    Fifteen studies of family-school interventions with preschool children conducted between 1980 and 2002, and published in peer-reviewed journals, were reviewed and evaluated according to the criteria developed by the Task Force on Evidence-Based Intervention in School Psychology (Division 16 and Society for the Study of School Psychology Task…

  14. Evidence-Based Practices Project for Suicide Prevention

    Science.gov (United States)

    Rodgers, Philip L.; Sudak, Howard S.; Silverman, Morton M.; Litts, David A.

    2007-01-01

    Suicide continues to be a serious public health problem. In response to this problem, a myriad of suicide prevention programs have been developed and employed across the United States. Unfortunately, the effectiveness of many of these programs is unknown because they have not been evaluated using rigorous methods. The Evidence-Based Practices…

  15. Towards Evidence-Based Understanding of Electronic Data Sources

    DEFF Research Database (Denmark)

    Chen, Lianping; Ali Babar, Muhammad; Zhang, He

    2010-01-01

    Identifying relevant papers from various Electronic Data Sources (EDS) is one of the key activities of conducting these kinds of studies. Hence, the selection of EDS for searching the potentially relevant papers is an important decision, which can affect a study’s coverage of relevant papers...... the two studies and that from literature to provide initial evidence-based heuristics for EDS selection....

  16. Beyond Evidence-Based Interventions for Teen Pregnancy Prevention

    Directory of Open Access Journals (Sweden)

    Emily Scribner-O'Pray

    2017-04-01

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

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

    Science.gov (United States)

    Junod, A F

    2000-04-06

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

  18. The role of hypnotherapy in evidence-based clinical practice.

    Science.gov (United States)

    Griffiths, M J

    2017-05-01

    The purpose of this review was to discuss the place of hypnotherapy in a modern medical world dominated by so-called evidence-based clinical practice. Hypnosis is an easily learned technique that is a valuable adjuvant to many medical, dental and psychological interventions. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Evidence-based health care: its place within clinical governance.

    Science.gov (United States)

    McSherry, R; Haddock, J

    This article explores the principles of evidence-based practice and its role in achieving quality improvements within the clinical governance framework advocated by the recent White Papers 'The New NHS: Modern, Dependable' (Department of Health (DoH), 1997) and 'A First Class Service: Quality in the New NHS' (DoH, 1998a). Within these White Papers there is an emphasis on improving quality of care, treatment and services through employing the principles of clinical governance. A major feature of clinical governance is guaranteeing quality to the public and the NHS, and ensuring that clinical, managerial and educational practice is based on scientific evidence. This article also examines what evidence-based practice is and what processes are required to promote effective healthcare interventions. The authors also look at how clinical governance relates to other methods/systems involved in clinical effectiveness. Finally, the importance for nurses and other healthcare professionals of familiarizing themselves with the development of critical appraisal skills, and their implications for developing evidence-based practice, is emphasized.

  20. ADDIS: A decision support system for evidence-based medicine

    NARCIS (Netherlands)

    G. van Valkenhoef (Gert); T. Tervonen (Tommi); T. Zwinkels (Tijs); B. de Brock (Bert); H.L. Hillege (Hans)

    2013-01-01

    textabstractClinical trials are the main source of information for the efficacy and safety evaluation of medical treatments. Although they are of pivotal importance in evidence-based medicine, there is a lack of usable information systems providing data-analysis and decision support capabilities for

  1. Evidence-based ICT Policy for Development and Innovation | CRDI ...

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

    Evidence-based ICT Policy for Development and Innovation. The cost of access to information and communication technologies (ITCs) in Africa remains the major impediment to the participation of Africans in the networked society. While Africa is the region with the fastest growing number of mobile phone subscribers in the ...

  2. Evidence-based practice for information professionals a handbook

    CERN Document Server

    Booth, Andrew

    2004-01-01

    Examines to what extent the skills and techniques of evidence-based practice are transferable to the areas of professional practice of librarians and information professionals? Is it desirable for information professionals to integrate research findings into their day-to-day decision making?

  3. Maternal and Birth Characteristics and Childhood Embryonal Solid Tumors: A Population-Based Report from Brazil.

    Science.gov (United States)

    de Paula Silva, Neimar; de Souza Reis, Rejane; Garcia Cunha, Rafael; Pinto Oliveira, Júlio Fernando; Santos, Marceli de Oliveira; Pombo-de-Oliveira, Maria S; de Camargo, Beatriz

    2016-01-01

    Several maternal and birth characteristics have been reported to be associated with an increased risk of many childhood cancers. Our goal was to evaluate the risk of childhood embryonal solid tumors in relation to pre- and perinatal characteristics. A case-cohort study was performed using two population-based datasets, which were linked through R software. Tumors were classified as central nervous system (CNS) or non-CNS-embryonal (retinoblastoma, neuroblastoma, renal tumors, germ cell tumors, hepatoblastoma and soft tissue sarcoma). Children aged birth anomalies were independent risk factors. Among children diagnosed older than 24 months of age, cesarean section (CS) was a significant risk factor. Five-minute Apgar ≤8 was an independent risk factor for renal tumors. A decreasing risk with increasing birth order was observed for all tumor types except for retinoblastoma. Among children with neuroblastoma, the risk decreased with increasing birth order (OR = 0.82 (95% CI 0.67-1.01)). Children delivered by CS had a marginally significantly increased OR for all tumors except retinoblastoma. High maternal education level showed a significant increase in the odds for all tumors together, CNS tumors, and neuroblastoma. This evidence suggests that male gender, high maternal education level, and birth anomalies are risk factors for childhood tumors irrespective of the age at diagnosis. Cesarean section, birth order, and 5-minute Apgar score were risk factors for some tumor subtypes.

  4. Synthesis of Dimethyl Glutarate from Cyclobutanone and Dimethyl Carbonate over Solid Base Catalysts

    International Nuclear Information System (INIS)

    Zhi, Chen; Dudu, Wu

    2012-01-01

    A facile route for the synthesis of dimethyl glutarate (DMG) from cyclobutanone and dimethyl carbonate (DMC) in the presence of solid base catalysts has been developed. It was found that the intermediate carbomethoxycyclobutanone (CMCB) was produced from cyclobutanone with DMC in the first step, and then CMCB was further converted to DMG by reacting with a methoxide group. The role of the basic catalysts can be mainly ascribed to the activation of cyclobutanone via the abstraction of a proton in the α-position by base sites, and solid bases with moderate strength, such as MgO, favor the formation of DMG

  5. Synthesis of Dimethyl Glutarate from Cyclobutanone and Dimethyl Carbonate over Solid Base Catalysts

    Energy Technology Data Exchange (ETDEWEB)

    Zhi, Chen; Dudu, Wu [Guangdong Medical College, Dongguan (China)

    2012-06-15

    A facile route for the synthesis of dimethyl glutarate (DMG) from cyclobutanone and dimethyl carbonate (DMC) in the presence of solid base catalysts has been developed. It was found that the intermediate carbomethoxycyclobutanone (CMCB) was produced from cyclobutanone with DMC in the first step, and then CMCB was further converted to DMG by reacting with a methoxide group. The role of the basic catalysts can be mainly ascribed to the activation of cyclobutanone via the abstraction of a proton in the {alpha}-position by base sites, and solid bases with moderate strength, such as MgO, favor the formation of DMG

  6. Modeling Sensor Reliability in Fault Diagnosis Based on Evidence Theory

    Directory of Open Access Journals (Sweden)

    Kaijuan Yuan

    2016-01-01

    Full Text Available Sensor data fusion plays an important role in fault diagnosis. Dempster–Shafer (D-R evidence theory is widely used in fault diagnosis, since it is efficient to combine evidence from different sensors. However, under the situation where the evidence highly conflicts, it may obtain a counterintuitive result. To address the issue, a new method is proposed in this paper. Not only the statistic sensor reliability, but also the dynamic sensor reliability are taken into consideration. The evidence distance function and the belief entropy are combined to obtain the dynamic reliability of each sensor report. A weighted averaging method is adopted to modify the conflict evidence by assigning different weights to evidence according to sensor reliability. The proposed method has better performance in conflict management and fault diagnosis due to the fact that the information volume of each sensor report is taken into consideration. An application in fault diagnosis based on sensor fusion is illustrated to show the efficiency of the proposed method. The results show that the proposed method improves the accuracy of fault diagnosis from 81.19% to 89.48% compared to the existing methods.

  7. Evidence-based Practice in libraries - Principles and discussions

    DEFF Research Database (Denmark)

    Johannsen, Carl Gustav

    2012-01-01

    The article examines problems concerning the introduction and future implementation of evidence-based practice (EBP) in libraries. It includes important conceptual distinctions and definitions, and it reviews the more controversial aspects of EBP, primarely based on experiences from Denmark. The ....... The purpose of the article is both to qualify existing scepticism and reservations and - maybe - to clarify misunderstandings and objections through the presentation of arguments and data....

  8. A Learning Object Approach To Evidence based learning

    OpenAIRE

    Zabin Visram; Bruce Elson; Patricia Reynolds

    2005-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  10. Teaching evidence-based medical care: description and evaluation.

    Science.gov (United States)

    Grad, R; Macaulay, A C; Warner, M

    2001-09-01

    This paper describes and evaluates several years of a seminar series designed to stimulate residents to seek evidence-based answers to their clinical questions and incorporate this evidence into practice. At the first session, 86 of 89 (97%) residents completed a baseline needs assessment questionnaire. Post-course self-assessment questionnaires measured change from the first to the final seminar session in six domains of interest and skill, as well as residents' preferred sources of information for clinical problem solving up to 2 years after the course. Before the seminars, 48% of residents reported that textbooks were their most important source of information for solving clinical problems. A total of 58 of 75 (77%) residents completed the first post-course questionnaire. Residents reported significant increases in skill at formulating clinical questions and searching for evidence-based answers, appraising reviews, and deciding when and how to incorporate new findings into practice. Use of secondary sources of information such as "Best Evidence," moved up in importance from before the course to after the course. First-year family practice residents who completed our seminar series have reported increased skill at blending consideration of a clinical problem with the use of secondary sources of information to access evidence to support their health care decisions.

  11. An Evidence Base for Human Spaceflight Risks in Wikipedia

    Science.gov (United States)

    Kundrot, Craig; Steil, Jennifer; Lumpkins, Sarah; Pellis, Neal

    2013-01-01

    NASA's Human Research Program (HRP) is focused on understanding and mitigating thirty two risks to crew health and performance in exploration missions beyond low Earth orbit. The HRP has developed an evidence report for each of the risks. Most evidence reports are a brief review article describing the evidence related to a specified risk, written at a level appropriate for the scientifically educated, non-specialist reader. Each evidence report captured the current state of knowledge from both research and operations. Two limitations of the evidence reports have become apparent: 1) they are updated infrequently and 2) they do not take full advantage of the expertise available in other space agencies and in related fields of terrestrial research. Therefore, the HRP is experimenting with the use of Wikipedia articles as a repository for evidence. Wikipedia's accessibility to the international space flight community and researchers in related terrestrial fields creates the opportunity to generate a more timely and comprehensive evidence base. Initial Wikipedia articles were populated for seven risks using a subset of the information in the HRP-approved evidence reports: Fatigue and Sleep Loss, Treating An Ill or Injured Crew Member, Radiation Carcinogenesis, Visual Impairment and Intracranial Pressure, Renal Stone Formation, Team Cohesion, and Intervertebral Disc Damage. Since the initial articles were created, there have been additions to these Wikipedia articles, including content from sources outside the HRP, and editorial changes to the pages. We will report on the nature of the contributions made after the initial articles were created, the comprehensiveness of the resulting Wikipedia articles, and the effort required to maintain quality control of the content. The Wikipedia approach will also be compared to wiki efforts that exert more traditional editorial control of content prior to posting.

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

    Science.gov (United States)

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

    2001-12-01

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

  13. Recent Application of Solid Phase Based Techniques for Extraction and Preconcentration of Cyanotoxins in Environmental Matrices.

    Science.gov (United States)

    Mashile, Geaneth Pertunia; Nomngongo, Philiswa N

    2017-03-04

    Cyanotoxins are toxic and are found in eutrophic, municipal, and residential water supplies. For this reason, their occurrence in drinking water systems has become a global concern. Therefore, monitoring, control, risk assessment, and prevention of these contaminants in the environmental bodies are important subjects associated with public health. Thus, rapid, sensitive, selective, simple, and accurate analytical methods for the identification and determination of cyanotoxins are required. In this paper, the sampling methodologies and applications of solid phase-based sample preparation methods for the determination of cyanotoxins in environmental matrices are reviewed. The sample preparation techniques mainly include solid phase micro-extraction (SPME), solid phase extraction (SPE), and solid phase adsorption toxin tracking technology (SPATT). In addition, advantages and disadvantages and future prospects of these methods have been discussed.

  14. Solid tumors after chemotherapy or surgery for testicular nonseminoma: a population-based study.

    Science.gov (United States)

    Fung, Chunkit; Fossa, Sophie D; Milano, Michael T; Oldenburg, Jan; Travis, Lois B

    2013-10-20

    Increased risks of solid tumors after older radiotherapy strategies for testicular cancer (TC) are well established. Few population-based studies, however, focus on solid cancer risk among survivors of TC managed with nonradiotherapy approaches. We quantified the site-specific risk of solid cancers among testicular nonseminoma patients treated in the modern era of cisplatin-based chemotherapy, without radiotherapy. Standardized incidence ratios (SIRs) for solid tumors were calculated for 12,691 patients with testicular nonseminoma reported to the population-based Surveillance, Epidemiology, and End Results program (1980 to 2008) and treated initially with either chemotherapy (n = 6,013) or surgery (n = 6,678) without radiotherapy. Patients accrued 116,073 person-years of follow-up. Two hundred ten second solid cancers were observed. No increased risk followed surgery alone (SIR, 0.93; 95% CI, 0.76 to 1.14; n = 99 solid cancers), whereas significantly increased 40% excesses (SIR, 1.43; 95% CI, 1.18 to 1.73; n = 111 solid cancers) occurred after chemotherapy. Increased risks of solid cancers after chemotherapy were observed in most follow-up periods (median latency, 12.5 years), including more than 20 years after treatment (SIR, 1.54; 95% CI, 0.96 to 2.33); significantly increased three- to seven-fold risks occurred for cancers of the kidney (SIR, 3.37; 95% CI, 1.79 to 5.77), thyroid (SIR, 4.40; 95% CI, 2.19 to 7.88), and soft tissue (SIR, 7.49; 95% CI, 3.59 to 13.78). To our knowledge, this is the first large population-based series reporting significantly increased risks of solid cancers among patients with testicular nonseminoma treated in the modern era of cisplatin-based chemotherapy. Subsequent analytic studies should focus on the evaluation of dose-response relationships, types of solid cancers, latency patterns, and interactions with other possible factors, including genetic susceptibility.

  15. Evaluation of Evidence-based Nursing Pain Management Practice.

    Science.gov (United States)

    Song, Wenjia; Eaton, Linda H; Gordon, Debra B; Hoyle, Christine; Doorenbos, Ardith Z

    2015-08-01

    It is important to ensure that cancer pain management is based on the best evidence. Nursing evidence-based pain management can be examined through an evaluation of pain documentation. The aim of this study was to modify and test an evaluation tool for nursing cancer pain documentation, and describe the frequency and quality of nursing pain documentation in one oncology unit via the electronic medical system. A descriptive cross-sectional design was used for this study at an oncology unit of an academic medical center in the Pacific Northwest. Medical records were examined for 37 adults hospitalized during April and May 2013. Nursing pain documentations (N = 230) were reviewed using an evaluation tool modified from the Cancer Pain Practice Index to consist of 13 evidence-based pain management indicators, including pain assessment, care plan, pharmacologic and nonpharmacologic interventions, monitoring and treatment of analgesic side effects, communication with physicians, and patient education. Individual nursing documentation was assigned a score ranging from 0 (worst possible) to 13 (best possible), to reflect the delivery of evidence-based pain management. The participating nurses documented 90% of the recommended evidence-based pain management indicators. Documentation was suboptimal for pain reassessment, pharmacologic interventions, and bowel regimen. The study results provide implications for enhancing electronic medical record design and highlight a need for future research to understand the reasons for suboptimal nursing documentation of cancer pain management. For the future use of the data evaluation tool, we recommend additional modifications according to study settings. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  16. Evidence-based review on temporomandibular disorders among musicians.

    Science.gov (United States)

    van Selms, M K A; Ahlberg, J; Lobbezoo, F; Visscher, C M

    2017-07-01

    Playing a musical instrument that loads the masticatory system has frequently been linked to temporomandibular disorders (TMDs). Previous literature reviews on this topic do not conform to the current standards of evidence-based medicine. To investigate the effects of playing a musical instrument (i.e. violin/viola and wind instruments) or singing on the presence of TMDs, based on evidence derived from observational studies. Databases of Medline, Web of Science and Google Scholar were searched using MeSH and other relevant terms. For each study, a quality assessment was undertaken using a modified version of the Newcastle-Ottawa Scale (NOS). Fifteen relevant papers were identified for inclusion in this review. Of the seven possible points that could be scored with the NOS, the majority of these studies scored under half. Based on the available evidence, the purported relationship between the playing of specific musical instruments and TMDs was not as evident as reported in previous literature reviews. There is limited evidence to conclude that playing a wind instrument is a hazard to the temporomandibular system. Furthermore, there is no available evidence to suggest that vocalists experience more TMDs than controls. The studies that investigated the presence of TMDs among violists and violinists yielded ambiguous outcomes; some studies reported no association between the playing of these instruments and the presence of signs and symptoms of TMDs, whereas in studies where a clinical examination was performed (though of lower methodological quality), an association was found. © The Author 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  17. Self-association and infrared spectres of some heterocyclic compounds based on pyrrol in solid state

    International Nuclear Information System (INIS)

    Mulloev, N.; Nurulloev, M.; Narziev, B.N.

    1993-01-01

    Present article is devoted to self-association and infrared spectres of some heterocyclic compounds based on pyrrol in solid state. The study results of self-association specified by molecular hydrogen bonds of some heterocyclic compounds based on pyrrol on spectres of infrared absorption of stretching vibrations of N-H group were considered.

  18. Navigating Evidence-Based Practice Projects: The Faculty Role.

    Science.gov (United States)

    Moch, Susan D; Quinn-Lee, Lisa; Gallegos, Cara; Sortedahl, Charlotte K

    : An innovative way to facilitate evidence-based practice (EBP) learning and to get evidence into practice is through academic-clinical agency projects involving faculty, undergraduate students, and agency staff. The central role of the faculty is key to successful academic-clinical agency partnerships. Faculty navigate the often difficult process of focusing students and engaging busy staff through initiating, maintaining, and evaluating projects. Students learn valuable EBP skills, staff become engaged in EBP, and the projects are rated highly by agency administrators.

  19. Improving the evidence for ecosystem-based adaptation

    Energy Technology Data Exchange (ETDEWEB)

    Reid, Hannah

    2011-11-15

    Ecosystem-based approaches to adaptation (EBA) integrate the use of biodiversity and ecosystem services into an overall strategy for helping people adapt to climate change. The body of scientific evidence that indicates how effective they are is in some cases lacking but in other cases is dispersed across a range of related fields, such as natural resource management, disaster risk reduction and agroecology, from which it needs to be synthesised. Without presenting and strengthening this evidence in a consolidated way, EBA cannot secure the policy traction at local, national and international levels that it merits.

  20. Nanobody-based cancer therapy of solid tumors

    NARCIS (Netherlands)

    Kijanka, Marta|info:eu-repo/dai/nl/328212792; Dorresteijn, Bram|info:eu-repo/dai/nl/31401635X; Oliveira, Sabrina; van Bergen en Henegouwen, Paul M P|info:eu-repo/dai/nl/071919481

    The development of tumor-targeted therapies using monoclonal antibodies has been successful during the last 30 years. Nevertheless, the efficacy of antibody-based therapy is still limited and further improvements are eagerly awaited. One of the promising novel developments that may overcome the

  1. Haptoglobin radioassay based on binding to solid-phase hemoglobin

    International Nuclear Information System (INIS)

    Hooper, D.C.; Reed, R.A.; Peacock, A.C.

    1979-01-01

    A specific and sensitive assay for haptoglobin based on binding to an easily prepred Sepharose-bound hemoglobin reagent is described. The assay is suitable for directly determining radiolabeled amino acid incorporation into haptoglobin in several liver cell systems in vitro and can be adapted to measure unlabeled free haptoglobin in plasma samples regardlss of the presence of the haptoglobin--hemoglobin complex

  2. Activated hydrotalcites as solid base catalysts in aldol condensations

    NARCIS (Netherlands)

    Roelofs, J.C.A.A.

    2001-01-01

    The development of new catalytic materials and routes to replace environmentally unacceptable processes in the fine chemical industry is emerging due to stringent legislation. Replacement of currently applied alkali bases in liquid-phase aldol condensations can result in diminishing of waste water

  3. How Quality Improvement Practice Evidence Can Advance the Knowledge Base.

    Science.gov (United States)

    OʼRourke, Hannah M; Fraser, Kimberly D

    2016-01-01

    Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base.

  4. The personalised medicine: a paradigm of evidence-based medicine

    Directory of Open Access Journals (Sweden)

    Dhavendra Kumar

    2011-01-01

    Full Text Available The practice of "evidence-based medicine" aims at the conscientious, explicit and judicious use of the current best evidence in making decisions about the individualised patient care. The clinical genetics evolved from translational genetics research and contributes to the clinical care of patients and families through evidence-based health care in managing inherited disorders through accurate diagnosis, molecular pathology and assessing phenotypic correlations. Translational genetics and genomics research has led to the development of powerful tools for clinical diagnosis, assessing individual's genomic profile for disease prediction/prevention, high-throughput genome-wide screening for predisposition and/or protection to complex medical conditions, and discovery and development of new drugs and vaccines. Gene mapping and deciphering pathogenic mutations have helped in unravelling the basic biological mechanisms leading to new drug discovery and development. Targeted pharmacotherapy is now possible for managing the highly penetrant multi-system dominantly inherited conditions. Notable examples include rapamycin (sirolimus in suppressing the mTOR pathway associated hamartomas in dominantly inherited cancer family syndromes and angiotensin converting enzyme receptor blockers (ACE-RB in preventing aortic dilatation in Marfan syndrome and related familial arteriopathies. The translational genomic research is the essential prerequisite for developing sound evidence-based diagnostic, therapeutic and prognostic clinical protocols for the practice of personalised clinical medicine.

  5. Evidence-based Medicine Search: a customizable federated search engine.

    Science.gov (United States)

    Bracke, Paul J; Howse, David K; Keim, Samuel M

    2008-04-01

    This paper reports on the development of a tool by the Arizona Health Sciences Library (AHSL) for searching clinical evidence that can be customized for different user groups. The AHSL provides services to the University of Arizona's (UA's) health sciences programs and to the University Medical Center. Librarians at AHSL collaborated with UA College of Medicine faculty to create an innovative search engine, Evidence-based Medicine (EBM) Search, that provides users with a simple search interface to EBM resources and presents results organized according to an evidence pyramid. EBM Search was developed with a web-based configuration component that allows the tool to be customized for different specialties. Informal and anecdotal feedback from physicians indicates that EBM Search is a useful tool with potential in teaching evidence-based decision making. While formal evaluation is still being planned, a tool such as EBM Search, which can be configured for specific user populations, may help lower barriers to information resources in an academic health sciences center.

  6. Evidence-Based Assessment of Obsessive–Compulsive Disorder

    Directory of Open Access Journals (Sweden)

    Amy M. Rapp

    2016-01-01

    Full Text Available Obsessive–compulsive disorder (OCD is a neuropsychiatric illness that often develops in childhood, affects 1%–2% of the population, and causes significant impairment across the lifespan. The first step in identifying and treating OCD is a thorough evidence-based assessment. This paper reviews the administration pragmatics, psychometric properties, and limitations of commonly used assessment measures for adults and youths with OCD. This includes diagnostic interviews, clinician-administered symptom severity scales, self-report measures, and parent/child measures. Additionally, adjunctive measures that assess important related factors (ie, impairment, family accommodation, and insight are also discussed. This paper concludes with recommendations for an evidence-based assessment based on individualized assessment goals that include generating an OCD diagnosis, determining symptom severity, and monitoring treatment progress.

  7. Validating evidence based decision making in health care

    DEFF Research Database (Denmark)

    Nüssler, Emil Karl; Eskildsen, Jacob Kjær; Håkonsson, Dorthe Døjbak

    Surgeons who perform prolapse surgeries face the dilemma of choosing to use mesh, with its assumed benefits, and the risks associated with mesh. In this paper, we examine whether decisions to use mesh is evidence based. Based on data of 30,398 patients from the Swedish National Quality Register o...... are highly influenced by the geographical placement of surgeons. Therfore, decisions to use mesh are boundedly rationality, rather than rational.......Surgeons who perform prolapse surgeries face the dilemma of choosing to use mesh, with its assumed benefits, and the risks associated with mesh. In this paper, we examine whether decisions to use mesh is evidence based. Based on data of 30,398 patients from the Swedish National Quality Register...... of Gynecological Surgery we examine factors related to decisions to use mesh. Our results indicate that decisions to use mesh are not evidence based, and cannot be explained neither by FDA safety communications, nor by medical conditions usually assumed to predict its usage. Instead, decisions to use mesh...

  8. Evidence-based practice: the importance of education and leadership.

    Science.gov (United States)

    Johansson, Birgitta; Fogelberg-Dahm, Marie; Wadensten, Barbro

    2010-01-01

    To describe evidence-based practice among head nurses and to explore whether number of years of duty is associated with such activities. Further to evaluate the effects of education on evidence-based practice and perceived support from immediate superiors. Registered nurses in Sweden are required by law to perform care based on research findings and best experiences. In order to achieve this, evidence-based practice (EBP) is of key importance. All 168 head nurses at two hospitals were asked to participate. Ninety-nine (59%) completed the survey. Data were collected using a study-specific web-based questionnaire. The majority reported a positive attitude towards EBP, but also a lack of time for EBP activities. A greater number of years as a head nurse was positively correlated with research utilization. Education in research methods and perceived support from immediate superiors were statistically and significantly associated with increased EBP activities. The present study highlights the value of education in research methods and the importance of supportive leadership. Education is an important factor in the employment of head nurses. We recommend interventions to create increased support for EBP among management, the goal being to deliver high-quality care and increase patient satisfaction.

  9. Implementation of Evidence-Based Practice From a Learning Perspective.

    Science.gov (United States)

    Nilsen, Per; Neher, Margit; Ellström, Per-Erik; Gardner, Benjamin

    2017-06-01

    For many nurses and other health care practitioners, implementing evidence-based practice (EBP) presents two interlinked challenges: acquisition of EBP skills and adoption of evidence-based interventions and abandonment of ingrained non-evidence-based practices. The purpose of this study to describe two modes of learning and use these as lenses for analyzing the challenges of implementing EBP in health care. The article is theoretical, drawing on learning and habit theory. Adaptive learning involves a gradual shift from slower, deliberate behaviors to faster, smoother, and more efficient behaviors. Developmental learning is conceptualized as a process in the "opposite" direction, whereby more or less automatically enacted behaviors become deliberate and conscious. Achieving a more EBP depends on both adaptive and developmental learning, which involves both forming EBP-conducive habits and breaking clinical practice habits that do not contribute to realizing the goals of EBP. From a learning perspective, EBP will be best supported by means of adaptive learning that yields a habitual practice of EBP such that it becomes natural and instinctive to instigate EBP in appropriate contexts by means of seeking out, critiquing, and integrating research into everyday clinical practice as well as learning new interventions best supported by empirical evidence. However, the context must also support developmental learning that facilitates disruption of existing habits to ascertain that the execution of the EBP process or the use of evidence-based interventions in routine practice is carefully and consciously considered to arrive at the most appropriate response. © 2017 Sigma Theta Tau International.

  10. Evident?

    DEFF Research Database (Denmark)

    Plant, Peter

    2012-01-01

    Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind......Quality assurance and evidence in career guidance in Europe are often seen as self-evident approaches, but particular interests lie behind...

  11. Rotary Kiln Gasification of Solid Waste for Base Camps

    Science.gov (United States)

    2017-10-02

    design principles : • accept and process mixed, unsorted municipal waste materials • minimize process energy required through careful heat management ...ABSTRACT This project was undertaken to design and construct a battalion-scale waste-to-energy (WTE) system based on the principle of gasification...careful heat management and use of hydraulics, and (3) to integrate into contingency utility systems by using standard diesel generators. 15. SUBJECT TERMS

  12. Pulmonary Metastasectomy: A Common Practice Based on Weak Evidence

    Science.gov (United States)

    Treasure, Tom

    2007-01-01

    The resection of secondary metastases from the lungs is a wide-spread surgical practice. Patients are referred from coloproctology teams to thoracic surgeons specifically for this surgery. What is the expected benefit? I have explored the rationale and searched the literature in order to present these patients with a well-informed opinion for their consideration. I find only weak evidence based on uncontrolled retrospective series which have been interpreted as showing a survival benefit. This has been extrapolated to policy and practice that do not stand up to scrutiny. The practice has never been subjected to randomised trial and I will argue that the present evidence is insufficient to justify the uncontrolled use of an intervention with inescapable short-term morbidity, permanent loss of function, and major cost implications. I propose ways in which the evidence may be improved, including a trial in the areas of most uncertainty. PMID:17999813

  13. Strengths and Limitations of Evidence-Based Dermatology

    Science.gov (United States)

    Williams, Hywel C

    2014-01-01

    The need for understanding and reflecting on evidence-based dermatology (EBD) has never been greater given the exponential growth of new external evidence to inform clinical practice. Like any other branch of medicine, dermatologists need to acquire new skills in constructing answerable questions, efficiently searching electronic bibliographic databases, and critically appraising different types of studies. Secondary summaries of evidence in the form of systematic reviews (SR), that is, reviews that are conducted in a systematic, unbiased and explicit manner, reside at the top of the evidence hierarchy, because they are less prone to bias than traditional expert reviews. In addition to providing summaries of the best external evidence, systematic reviews and randomized controlled trials (RCTs) are also powerful ways of identifying research gaps and ultimately setting the agenda of future clinical research in dermatology. But like any paradigm, EBD can have its limitations. Wrong application, misuse and overuse of EBD can have serious consequences. For example, mindless pooling together of data from dissimilar studies in a meta-analysis may render it a form of reductionism that does not make any sense. Similarly, even highly protocolised study designs such as SRs and RCTs are still susceptible to some degree of dishonesty and bias. Over-reliance on randomized controlled trials (RCT) may be inappropriate, as RCTs are not a good source for picking up rare but important adverse effects such as lupus syndrome with minocycline. A common criticism leveled against SRs is that these frequently conclude that there is lack of sufficient evidence to inform current clinical practice, but arguably, such a perception is grounded more on the interpretation of the SRs than anything else. The apparent absence of evidence should not paralyze the dermatologist to adopt a state of therapeutic nihilism. Poor primary data and an SR based on evidence that is not up-to-date are also

  14. Evidence-based therapy for sleep disorders in neurodegenerative diseases

    Directory of Open Access Journals (Sweden)

    LIU Ling

    2013-08-01

    Full Text Available Objective To evaluate the effectiveness of the treatments for sleep disorders in neurodegenerative diseases so as to provide the best therapeutic regimens for the evidence-based treatment. Methods Search PubMed, MEDLINE, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure (CNKI databases with "sleep disorder or sleep disturbance", "neurodegenerative diseases", "Parkinson's disease or PD", "Alzheimer's disease or AD", "multiple system atrophy or MSA" as retrieval words. The quality of the articles were evaluated with Jadad Scale. Results A total of 35 articles, including 2 systematic reviews, 5 randomized controlled trials, 13 clinical controlled trials, 13 case series and 2 epidemiological investigation studies were included for evaluation, 13 of which were high grade and 22 were low grade articles. Clinical evidences showed that: 1 advice on sleep hygiene, careful use of dopaminergic drugs and hypnotic sedative agents should be considered for PD. Bright light therapy (BLT may improve circadian rhythm sleep disorders and clonazepam may be effective for rapid eye movement sleep behavior disorder (RBD. However, to date, very few controlled studies are available to make a recommendation for the management of sleep disorders in PD; 2 treatments for sleep disorders in AD include drug therapy (e.g. melatonin, acetylcholinesterase inhibitors, antipsychotic drugs, antidepressants and non-drug therapy (e.g. BLT, behavior therapy, but very limited evidence shows the effectiveness of these treatments; 3 the first line treatment for sleep-related breathing disorder in MSA is nasal continuous positive airway pressure (nCPAP, and clonazepam is effective for RBD in MSA; 4 there is rare evidence related to the treatment of sleep disorders in dementia with Lewy body (DLB and amyotrophic lateral sclerosis (ALS. Conclusion Evidence-based medicine can provide the best clinical evidence on sleep disorders' treatment in neurodegenerative

  15. Evidence based medicine in physical medicine and rehabilitation (German version

    Directory of Open Access Journals (Sweden)

    Helmut Kern

    2013-12-01

    Full Text Available In the last twenty years the term “Evidence Based Medicine (EBM” has been increasingly applied in all areas of medicine and is often used for decision-making in the medical and public health sector. It is also used to verify the significance and/or the effectiveness of different therapies. The original definition of EBM rests on the following three pillars: the physician’s individual expertise, the patient’s needs and the best external evidence. Today, however, the term EBM is often wrongly used as a synonym for best external evidence, without taking into consideration the other two pillars of the model which was created by Gordon Guyatt, David Sackett and Archibald Cochrane. This problem becomes even greater the more social insurance institutions and politicians use external evidence alone as the main guideline for financing therapies and therapy guidelines in physical medicine and general rehabilitation without taking into account the physician’s expertise and the patient’s needs.The wrong interpretation of EBM can lead to the following problems: well established clinical therapies are either questioned or not granted and are therefore withheld from patients (for example physical pain management. An absence of evidence for individual therapy methods does not prove their ineffectiveness! In this short statement the significance of EBM in Physical Medicine and general rehabilitation will be analysed and discussed.

  16. Opto-mechatronics issues in solid immersion lens based near-field recording

    Science.gov (United States)

    Park, No-Cheol; Yoon, Yong-Joong; Lee, Yong-Hyun; Kim, Joong-Gon; Kim, Wan-Chin; Choi, Hyun; Lim, Seungho; Yang, Tae-Man; Choi, Moon-Ho; Yang, Hyunseok; Rhim, Yoon-Chul; Park, Young-Pil

    2007-06-01

    We analyzed the effects of an external shock on a collision problem in a solid immersion lens (SIL) based near-field recording (NFR) through a shock response analysis and proposed a possible solution to this problem with adopting a protector and safety mode. With this proposed method the collision between SIL and media can be avoided. We showed possible solution for contamination problem in SIL based NFR through a numerical air flow analysis. We also introduced possible solid immersion lens designs to increase the fabrication and assembly tolerances of an optical head with replicated lens. Potentially, these research results could advance NFR technology for commercial product.

  17. Recent progress in sulfide-based solid electrolytes for Li-ion batteries

    Energy Technology Data Exchange (ETDEWEB)

    Liu, D., E-mail: liu.dongqiang@ireq.ca; Zhu, W.; Feng, Z.; Guerfi, A.; Vijh, A.; Zaghib, K.

    2016-11-15

    Graphical abstract: Li{sub 2}S-GeS{sub 2}-P{sub 2}S{sub 5} ternary diagram showing various sulphide compounds as solid electrolytes for Li-ion batteries. - Highlights: • Recent progress of sulfide-based solid electrolytes is described from point of view of structure. • Thio-LISICON type electrolytes exhibited high ionic conductivity due to their bcc sublattice and unique Li{sup +} diffusion pathway. • “Mixed-anion effect” is also an effective way to modify the energy landscape as well as the ionic conductivity. - Abstract: Sulfide-based ionic conductors are one of most attractive solid electrolyte candidates for all-solid-state batteries. In this review, recent progress of sulfide-based solid electrolytes is described from point of view of structure. In particular, lithium thio-phosphates such as Li{sub 7}P{sub 3}S{sub 11}, Li{sub 10}GeP{sub 2}S{sub 12} and Li{sub 11}Si{sub 2}PS{sub 12} etc. exhibit extremely high ionic conductivity of over 10{sup −2} S cm{sup −1} at room temperature, even higher than those of commercial organic carbonate electrolytes. The relationship between structure and unprecedented high ionic conductivity is delineated; some potential drawbacks of these electrolytes are also outlined.

  18. Polycarbonate-based polyurethane as a polymer electrolyte matrix for all-solid-state lithium batteries

    Science.gov (United States)

    Bao, Junjie; Shi, Gaojian; Tao, Can; Wang, Chao; Zhu, Chen; Cheng, Liang; Qian, Gang; Chen, Chunhua

    2018-06-01

    Four kinds of polycarbonate-based polyurethane with 8-14 wt% hard segments content are synthesized via reactions of polycarbonatediol, hexamethylene diisocyanate and diethylene glycol. The mechanical strength of the polyurethanes increase with the increase of hard segments content. Solid polymer electrolytes composed of the polycarbonate-based polyurethanes and LiTFSI exhibits fascinating characteristics for all-solid-state lithium batteries with a high ionic conductivity of 1.12 × 10-4 S cm-1 at 80 °C, an electrochemical stability window up to 4.5 V (vs. Li+/Li), excellent mechanical strength and superior interfacial stability against lithium metal. The all-solid-state batteries using LiFePO4 cathode can deliver high discharge capacities (161, 158, 134 and 93 mAh g-1 at varied rates of 0.2, 0.5, 1 and 2 C) at 80 °C and excellent cycling performance (with 91% capacity retention after 600 cycles at 1 C). All the results indicate that such a polyurethane-based solid polymer electrolyte can be a promising candidate for all-solid-state lithium batteries.

  19. Fee-based solid waste collection in economically developing countries: The case of Accra metropolis

    Directory of Open Access Journals (Sweden)

    Oduro-Appiah, K.

    2013-06-01

    Full Text Available Fee-based solid waste collection, a system that holds great promise to reducing the financial burden of solid waste management on the municipalities of developing countries is reviewed in this research study. It is to promote financial sustainability through partial or full cost sharing of solid waste collection services and intended to serve as a guide to policy makers and waste management authorities in Ghana and other countries with developing economies. Information through survey and questionnaires from residents across the socio-economic divide was collected to determine willingness and ability to pay for solid waste collection services. A critical assessment of the various capital and operational cost components that come into play in the collection process were considered and computed to determine the economic and social tariff that will be enough to offset the cost of collection, transportation and disposal of solid waste unto landfills. Residents of the metropolis have the ability and are willing to pay an economically affordable user charge of US$1.10 per household per month to offset and remove the financial burden of solid waste collection off the metropolitan assembly. Consistent and efficient collection service is recommended to ensure residents cooperation towards implementation of the system in Ghana.

  20. Knowledge and Attitude of Medical Students and Lecturers Toward Evidence-Based Medicine: Evidence from Shiraz

    Directory of Open Access Journals (Sweden)

    Ahmad Ghanizadeh

    2009-02-01

    Full Text Available Background and purpose: The application of diagnostic, therapeutic, and prognostic evidence in day-to-day management of patients has been in constant focus during the last two decades. This study is an attempt to investigate attitude and knowledge of post-graduated medical students and lecturers towards evidence-based medicine (EBM and assess their preferences to clinical practice guidelines.Methods: The designed questionnaire was posted to the randomly selected post-graduated medical students and lecturers of medical department at Shiraz University of Medical Sciences.Results: There were one hundred sixty subjects (60% who answered the questionnaire. Sixty nine percent were male, 46.3% were lecturers, and 53.2% were post-graduated medical students.About 66% of the respondents have heard of the term of EBM. Only 7.8% of the respondents have already attended to a course to learn the skills of EBM and one hundred twenty five (78.1% like to attend a course to learn the skills of EBM. The most common perceived reason for use of EBM was lack of enough motivation.Conclusion: They have not yet integrated the use of EBM into their practices widely. Their knowledge is at a high risk of becoming out of data. Education of EBM should be a hot topic among educationalplanning programmers until it becomes a part of university educational curriculum in Iran.Keywords: POST-GRADUATED MEDICAL STUDENT, LECTURER, KNOWLEDGE, ATTITUDE, EVIDENCE-BASED MEDICINE, IRAN.

  1. Evidence-based rehabilitation of athletes with glenohumeral instability.

    Science.gov (United States)

    Cools, Ann M; Borms, Dorien; Castelein, Birgit; Vanderstukken, Fran; Johansson, Fredrik R

    2016-02-01

    To give an overview of current knowledge and guidelines with respect to evidence-based rehabilitation of athletes with glenohumeral instability. This narrative review combines scientific evidence with clinical guidelines based on the current literature to highlight the different components of the rehabilitation of glenohumeral instability. Depending on the specific characteristics of the instability pattern, the severity, recurrence, and direction, the therapeutic approach may be adapted to the needs and demands of the athlete. In general, attention should go to (1) restoration of rotator cuff strength and inter-muscular balance, focusing on the eccentric capacity of the external rotators, (2) normalization of rotational range of motion with special attention to the internal rotation ROM, (3) optimization of the flexibility and muscle performance of the scapular muscles, and (4) gradually increasing the functional sport-specific load on the shoulder girdle. The functional kinetic chain should be implemented throughout all stages of the rehabilitation program. Return to play should be based on subjective assessment as well as objective measurements of ROM, strength, and function. This paper summarizes evidence-based guidelines for treatment of glenohumeral instability. These guidelines may assist the clinician in the prevention and rehabilitation of the overhead athlete. Expert opinion, Level V.

  2. Management of REM sleep behavior disorder: An evidence based review.

    Science.gov (United States)

    Devnani, Preeti; Fernandes, Racheal

    2015-01-01

    Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by dream enactment behavior resulting from a loss of REM skeletal muscle atonia. The neurobiology of REM sleep and the characteristic features of REM atonia have an important basis for understanding the aggravating etiologies the proposed pharmacological interventions in its management. This review outlines the evidence for behavioral and therapeutic measures along with evidence-based guidelines for their implementation, impact on falls, and effect on polysomnography (PSG) while highlighting the non-motor, autonomic, and cognitive impact of this entity. PubMed databases were reviewed upto May 2013 in peer-reviewed scientific literature regarding the pathophysiology and management of RBD in adults. The literature was graded according to the Oxford centre of evidence-based Medicine Levels. An early intervention that helps prevent consequences such as falls and provides a base for intervention with neuroprotective mechanisms and allocates a unique platform that RBD portrays with its high risk of disease conversion with a sufficiently long latency. RBD provides a unique platform with its high risk of disease conversion with a sufficiently long latency, providing an opportunity for early intervention both to prevent consequences such as falls and provide a base for intervention with neuroprotective mechanisms.

  3. Management of REM sleep behavior disorder: An evidence based review

    Directory of Open Access Journals (Sweden)

    Preeti Devnani

    2015-01-01

    Full Text Available Rapid eye movement (REM sleep behavior disorder (RBD is characterized by dream enactment behavior resulting from a loss of REM skeletal muscle atonia. The neurobiology of REM sleep and the characteristic features of REM atonia have an important basis for understanding the aggravating etiologies the proposed pharmacological interventions in its management. This review outlines the evidence for behavioral and therapeutic measures along with evidence-based guidelines for their implementation, impact on falls, and effect on polysomnography (PSG while highlighting the non-motor, autonomic, and cognitive impact of this entity. PubMed databases were reviewed upto May 2013 in peer-reviewed scientific literature regarding the pathophysiology and management of RBD in adults. The literature was graded according to the Oxford centre of evidence-based Medicine Levels. An early intervention that helps prevent consequences such as falls and provides a base for intervention with neuroprotective mechanisms and allocates a unique platform that RBD portrays with its high risk of disease conversion with a sufficiently long latency. RBD provides a unique platform with its high risk of disease conversion with a sufficiently long latency, providing an opportunity for early intervention both to prevent consequences such as falls and provide a base for intervention with neuroprotective mechanisms.

  4. [Evidence-based aspects of clinical mastitis treatment].

    Science.gov (United States)

    Mansion-de Vries, E M; Hoedemaker, M; Krömker, V

    2015-01-01

    Mastitis is one of the most common and expensive diseases in dairy cattle. The decision to treat clinical mastitis is usually made without any knowledge of the etiology, and can therefore only be evidence-based to a limited extent. Evidence-based medicine relies essentially on a combination of one's own clinical competence and scientific findings. In mastitis therapy, those insights depend mostly on pathogen-specific factors. Therefore, in evidence-based therapeutic decision making the pathogen identification should serve as a basis for the consideration of scientifically validated therapeutic concepts. The present paper considers evidence-based treatment of clinical mastitis based on a literature review. The authors conclude that an anti-inflammatory treatment using an NSAID should be conducted regardless of the pathogen. However, the choice of an antibiotic therapy depends on the mastitis causative pathogen, clinical symptoms and the animal itself. In principle, a local antibiotic treatment should be chosen for mild and moderate mastitis. It should be noted, that the benefit of an antibiotic therapy for coliform infections is questionable. With knowledge concerning the pathogen, it appears entirely reasonable to refrain from an antibiotic therapy. For severe (i.   e. feverish) mastitis, a parenteral antibiotic therapy should be selected. An extension of the antibiotic therapy beyond the manufacturer's information is only reasonable for streptococcal infections. It is important to make the decision on a prolonged antibiotic therapy only with the knowledge of the mastitis-causative pathogen. In terms of the therapy of a staphylococcus or streptococcus infection, a narrow-spectrum antibiotic from the penicillin family should be adopted when selecting the active agents.

  5. History and development of evidence-based medicine.

    Science.gov (United States)

    Claridge, Jeffrey A; Fabian, Timothy C

    2005-05-01

    This article illustrates the timeline of the development of evidence-based medicine (EBM). The term "evidence-based medicine" is relatively new. In fact, as far as we can tell, investigators from McMaster's University began using the term during the 1990s. EBM was defined as "a systemic approach to analyze published research as the basis of clinical decision making." Then in 1996, the term was more formally defined by Sacket et al., who stated that EBM was "the conscientious and judicious use of current best evidence from clinical care research in the management of individual patients." Ancient era EBM consists of ancient historical or anecdotal accounts of what may be loosely termed EBM. This was followed by the development of the renaissance era of EBM, which began roughly during the seventeenth century. During this era personal journals were kept and textbooks began to become more prominent. This was followed by the 1900s, during an era we term the transitional era of EBM (1900-1970s). Knowledge during this era could be shared more easily in textbooks and eventually peer-reviewed journals. Finally, during the 1970s we enter the modern era of EBM. Technology has had a large role in the advancement of EBM. Computers and database software have allowed compilation of large amounts of data. The Index Medicus has become a medical dinosaur of the past that students of today likely do not recognize. The Internet has also allowed incredible access to masses of data and information. However, we must be careful with an overabundance of "unfiltered" data. As history, as clearly shown us, evidence and data do not immediately translate into evidence based practice.

  6. [Evidence-based medicine: modern scientific methods for determining usefulness].

    Science.gov (United States)

    Schmidt, J G

    1999-01-01

    For quite some time, clinical epidemiology has introduced the art of critical appraisal of evidence as well as the methods of how to design sound clinical studies and trials. Almost unnoticed by most medical institutions a new hierarchy of evidence has emerged which puts well thought out trials, able to document unbiased treatment benefit in terms of patient suffering, above pathophysiological theory. Many controlled trials have shown, in the meantime, that the control of laboratory or other kind of pathologies and the correction of anatomical abnormalities do not necessarily mean a benefit for the patient. Concepts relating to this dissection of evidence include: Surrogate fallacy ("cosmetics" of laboratory results or ligament or cartilage "cosmetics" in surgery), confounding (spurious causal relationships), selection bias (comparison with selected groups) as well as lead-time bias (mistaking earlier diagnosis as increase of survival), length bias (overlooking differences in the aggressiveness of diseases as determinants of disease stage distributions) and overdiagnosis bias (mistaking the increasing detection of clinically silent pathologies as improvement of prognosis). Moreover, absolute instead of relative risk reduction needs to be used to measure patient benefit. The incorporation of decision-analysis and of the concepts or clinical epidemiology will improve the efficiency and quality of medicine much more effectively than the sole focus on technical medical performance. Evidence based medicine is the systematic and critical appraisal of medical interventions, based on the understanding how to avoid the fallacies and biases mentioned.

  7. [Evidence based medicine. A new paradigm for medical practice].

    Science.gov (United States)

    Carneiro, A V

    1998-01-01

    Modern medical practice is an ever-changing process, and the doctor's need for information has been partially met by continuous medical education (CME) activities. It has been shown that CME activities have not prevented clinical knowledge, as well as medical practice, from deteriorating with time. When faced with the need to get the most recent and relevant information possible, the busy clinician has two major problems: most of the published medical literature is either irrelevant or not useful; and there is little time to read it. Evidence-based medicine constitutes a new paradigm for medical practice in the sense that it tries to transform clinical problems into well formulated clinical questions, selecting and critically appraising scientific evidence with predefined and rigorous rules. It combines the expertise of the individual clinician with the best external evidence from clinical research for rational, ethical and efficacious practice. Evidence-based medicine can be taught and practiced by physicians with different degrees of autonomy, with several subspecialties, working in the hospital or in outpatient clinics, alone or in groups.

  8. The development of evidence-based guidelines in dentistry.

    Science.gov (United States)

    Faggion, C M

    2013-02-01

    Use of guidelines is an important means of reducing the gap between research and clinical practice. Sound and unbiased information should be available to enable dental professionals to provide better clinical treatment for their patients. The development of clinical guidelines in dentistry should follow standard and transparent methodology. The purpose of this article is to propose important steps for developing evidence-based clinical recommendations in dentistry. Initially, dental guidelines should be extensively sought and assessed to answer focused clinical questions. If there is a paucity of guidelines or if existing guidelines are not of good methodological quality, systematic reviews should be searched or conducted to serve as a basis for the development of evidence-based guidelines. When systematic reviews are produced, they should be rigorous in order to provide the best evidence possible. In the last phase of the process, the overall quality of evidence should be scrutinized and assessed, together with other factors (balance between treatment effects and side effects, patients' values, and cost-effectiveness of therapy) to determine the strength of recommendations. It is expected this approach will result in the development of sound clinical guidelines and consequent improvement of dental treatment.

  9. Evidence on unusual way of cocaine smuggling: cocaine-polymethyl methacrylate (PMMA) solid solution--study of clandestine laboratory samples.

    Science.gov (United States)

    Gostic, T; Klemenc, S

    2007-07-04

    An abandoned clandestine laboratory was seized in Slovenia. All confiscated exhibits were analysed in a forensic laboratory, where the following analytical methods were applied: capillary gas chromatography coupled with mass spectrometry (GC-MS) combined also by solid-phase micro extraction (SPME) and pyrolysis (Py) technique, Fourier transform infrared spectrometry (FTIR) and scanning electron microscopy with energy dispersive X-ray detector (SEM-EDX). The most interesting analytical findings can be summarised as follows: at the crime scene some plastic pieces, which contained cocaine dissolved (as solid solution) in polymethyl methacrylate-plexiglass (PMMA), were found. The highest cocaine concentration measured in the plastic sample was about 15% by weight. Two larger lumps of material (12 and 3 kg) were composed mainly of PMMA and CaCO3 and contained only 0.4 and 0.5% of cocaine, respectively. As for the low cocaine concentration, we assume that those two lumps of material represent discarded waste product--residue after the isolation of cocaine from plastic. Higher quantities of pure solvents (41 l) and solvent mixtures (87 l) were seized. We identified three types of pure solvents (acetone, gasoline and benzine) and two different types of solvent mixtures (benzine/acetone and gasoline/acetone). The total seized volume (87 l) of solvent mixtures holds approximately 395 g of solid residue formed mainly of PMMA and cocaine. Obviously solvent mixtures were used for isolation of cocaine from the plastic. Small quantities of relatively pure cocaine base were identified on different objects. There were two cotton sheets, most probably used for filtration. One sheet had traces of cocaine base (76% purity) on the surface, while cocaine in hydrochloride form (96%) was identified on the other sheet. GC-MS analyses of micro traces isolated from analytical balances showed the presence of cocaine and some common adulterants: phenacetine, lidocaine and procaine. A cocaine

  10. Fluid, solid and fluid-structure interaction simulations on patient-based abdominal aortic aneurysm models.

    Science.gov (United States)

    Kelly, Sinead; O'Rourke, Malachy

    2012-04-01

    This article describes the use of fluid, solid and fluid-structure interaction simulations on three patient-based abdominal aortic aneurysm geometries. All simulations were carried out using OpenFOAM, which uses the finite volume method to solve both fluid and solid equations. Initially a fluid-only simulation was carried out on a single patient-based geometry and results from this simulation were compared with experimental results. There was good qualitative and quantitative agreement between the experimental and numerical results, suggesting that OpenFOAM is capable of predicting the main features of unsteady flow through a complex patient-based abdominal aortic aneurysm geometry. The intraluminal thrombus and arterial wall were then included, and solid stress and fluid-structure interaction simulations were performed on this, and two other patient-based abdominal aortic aneurysm geometries. It was found that the solid stress simulations resulted in an under-estimation of the maximum stress by up to 5.9% when compared with the fluid-structure interaction simulations. In the fluid-structure interaction simulations, flow induced pressure within the aneurysm was found to be up to 4.8% higher than the value of peak systolic pressure imposed in the solid stress simulations, which is likely to be the cause of the variation in the stress results. In comparing the results from the initial fluid-only simulation with results from the fluid-structure interaction simulation on the same patient, it was found that wall shear stress values varied by up to 35% between the two simulation methods. It was concluded that solid stress simulations are adequate to predict the maximum stress in an aneurysm wall, while fluid-structure interaction simulations should be performed if accurate prediction of the fluid wall shear stress is necessary. Therefore, the decision to perform fluid-structure interaction simulations should be based on the particular variables of interest in a given

  11. Experimental quantum ratchets based on solid state nanostructures

    International Nuclear Information System (INIS)

    Linke, H.

    1999-01-01

    Ratchets are spatially asymmetric devices in which particles can move on average in one direction in the absence of external net forces or gradients. This is made possible by the rectification of fluctuations, which also provide the energy for the process. Interest in the physics of ratchets was revived in recent years when it emerged that the ratchet principle may be a suitable physical model for 'molecular motors', which are central to many fundamental biological processes, such as intracellular transport or muscle contraction. Most ratchets studied so far have relied on classical effects, but recently 'quantum ratchets', involving quantum effects, have also been studied. In the present article it is pointed out that semiconductor or metal nanostructures are very suitable systems for the realisation of experimental quantum ratchets. Recent experimental studies of a quantum ratchet based on an asymmetric quantum dot are reviewed. Copyright (1999) CSIRO Australia

  12. Calcium and lanthanum solid base catalysts for transesterification

    Science.gov (United States)

    Ng, K. Y. Simon; Yan, Shuli; Salley, Steven O.

    2015-07-28

    In one aspect, a heterogeneous catalyst comprises calcium hydroxide and lanthanum hydroxide, wherein the catalyst has a specific surface area of more than about 10 m.sup.2/g. In another aspect, a heterogeneous catalyst comprises a calcium compound and a lanthanum compound, wherein the catalyst has a specific surface area of more than about 10 m.sup.2/g, and a total basicity of about 13.6 mmol/g. In further another aspect, a heterogeneous catalyst comprises calcium oxide and lanthanum oxide, wherein the catalyst has a specific surface area of more than about 10 m.sup.2/g. In still another aspect, a process for preparing a catalyst comprises introducing a base precipitant, a neutral precipitant, and an acid precipitant to a solution comprising a first metal ion and a second metal ion to form a precipitate. The process further comprises calcining the precipitate to provide the catalyst.

  13. Silica-scavenging effects in ceria-based solid electrolytes

    Directory of Open Access Journals (Sweden)

    Ivanova, D.

    2008-08-01

    Full Text Available Composite materials based on gadolinium doped ceria (CGO with additions of silica, with both silica and lanthanum oxide, and with lanthanum silicate, were prepared by the conventional ceramic route, to assess the silica scavenging role of lanthanum oxide additions. Structural, microstructural and electrical characterization of these samples confirmed the formation of one apatite type lanthanum silicate-based phase from reaction of silica with lanthanum oxide. The formation of this phase occurred in parallel with a significant enhancement of the grain boundary conductivity of these composite materials. Further interaction between constituents, involving diffusion of La to CGO, and Ce and Gd to the apatite phase, had no significant consequences on the electrical performance of these materials. Overall, lanthanum oxide was shown to remove the siliceous phases from the grain boundaries of CGO.

    Se prepararon materiales compuestos basados en óxido de cerio dopado con gadolinio (TGO con adicciones de sílice, con sílice y óxido de lantano y silicato del lantano, mediante procesamiento cerámico convencional con objeto de confirmar el papel secuestrante de sílice de las adicciones. La caracterización estructural, microestructural y eléctrica de las muestras confirmó la formación de una fase tipo apatito basada en silicato de lantano a partir de la reacción de la sílice con el óxido de lantano. La formación de esta fase ocurre en paralelo con un incremento significativo de la conductividad a través del borde de grano de estos materiales. La interacción entre los constituyentes, incluyendo la difusión del La al CGO, y el Ce y el Gd a la fase apatito, no tiene consecuencias significativas sobre el comportamiento eléctrico de estos materiales. Resumiendo, el óxido de lantano es capaz de eliminar las fases silicias del borde de grano del CGO.

  14. An evidence-based elective on dietary supplements.

    Science.gov (United States)

    Bonafede, Machaon; Caron, Whitney; Zeolla, Mario

    2009-08-28

    To implement and evaluate the effectiveness of a pharmacy elective on dietary supplements that emphasized evidence-based care. A 3-credit elective that employed both traditional lectures and a variety of active-learning exercises was implemented. The course introduction provided a background in dietary supplement use and evidence-based medicine principles before addressing dietary supplements by primary indication. Student learning was assessed through quizzes, case assignments, discussion board participation, and completion of a longitudinal group project. Precourse and postcourse surveys were conducted to assess students' opinions, knowledge, and skills related to course objectives. The course was an effective way to increase students' knowledge of dietary supplements and skills and confidence in providing patient care in this area.

  15. Establishing CASA as an evidence-based practice.

    Science.gov (United States)

    Lawson, Jennifer; Berrick, Jill Duerr

    2013-01-01

    In this article the authors examine the evidentiary status of the Court Appointed Special Advocates (CASA) program through a review of current research findings and a critical analysis of the study methodologies used to produce those findings. Due to the equivocal research findings and widespread methodological weaknesses (most notably selection bias) in the literature base, it is determined that there is not currently enough evidence to establish CASA as an evidence-based practice. In spite of the challenges to the feasibility of such research, a future research agenda is suggested that calls for the execution of large randomized controlled trials in order to produce findings that will inform a deeper understanding of CASA effectiveness in improving child outcomes.

  16. Evidence-based medicine in rapidly changing technologies

    DEFF Research Database (Denmark)

    Schroeder, Torben Veith

    2008-01-01

    Evidence-based medicine (EBM) is not a randomised controlled trial (RCT), but EBM seeks to apply evidence gained from scientific methods - which could be RCT - to daily medical practice. Any surgical treatment reflects a certain development technically as well as skills based. The procedure may....... Special considerations should be given in rapidly developing fields. If started too early the resulting comparison will likely turn out to be irrelevant because the new technology is not fully developed, not mastered or the device may have undergone major modifications rendering the results obsolete....... On the other hand, if started too late there is a chance that data may be lost because the technology has already been introduced into the daily clinics and physicians may be unwilling to recruit patients. Or the opposite, that the technique may have been rejected without a proper trial. In this situation...

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

    Science.gov (United States)

    Kennell, J H

    1999-12-01

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

  18. Plasmonic crystal based solid substrate for biomedical application of SERS

    Science.gov (United States)

    Morasso, Carlo F.; Mehn, Dora; Picciolini, Silvia; Vanna, Renzo; Bedoni, Marzia; Gramatica, Furio; Pellacani, Paola; Frangolho, Ana; Marchesini, Gerardo; Valsesia, Andrea

    2014-02-01

    Surface Enhanced Raman Spectroscopy is a powerful analytical technique that combines the excellent chemical specificity of Raman spectroscopy with the good sensitivity provided by the enhancement of the signal observed when a molecule is located on (or very close to) the surface of suitable nanostructured metallic materials. The availability of cheap, reliable and easy to use SERS substrates would pave the road to the development of bioanalytical tests that can be used in clinical practice. SERS, in fact, is expected to provide not only higher sensitivity and specificity, but also the simultaneous and markedly improved detection of several targets at the same time with higher speed compared to the conventional analytical methods. Here, we present the SERS activity of 2-D plasmonic crystals made by polymeric pillars embedded in a gold matrix obtained through the combination of soft-lithography and plasma deposition techniques on a transparent substrates. The use of a transparent support material allowed us to perform SERS detection from support side opening the possibility to use these substrates in combination with microfluidic devices. In order to demonstrate the potentialities for bioanalytical applications, we used our SERS active gold surface to detect the oxidation product of apomorphine, a well-known drug molecule used in Parkinson's disease which has been demonstrated being difficult to study by traditional HPLC based approaches.

  19. Clinical data warehousing for evidence based decision making.

    Science.gov (United States)

    Narra, Lekha; Sahama, Tony; Stapleton, Peta

    2015-01-01

    Large volumes of heterogeneous health data silos pose a big challenge when exploring for information to allow for evidence based decision making and ensuring quality outcomes. In this paper, we present a proof of concept for adopting data warehousing technology to aggregate and analyse disparate health data in order to understand the impact various lifestyle factors on obesity. We present a practical model for data warehousing with detailed explanation which can be adopted similarly for studying various other health issues.

  20. A philosophical analysis of the evidence-based medicine debate

    OpenAIRE

    Sehon, Scott R; Stanley, Donald E

    2003-01-01

    Abstract Background The term "evidence-based medicine" (or EBM) was introduced about ten years ago, and there has been considerable debate about the value of EBM. However, this debate has sometimes been obscured by a lack of conceptual clarity concerning the nature and status of EBM. Discussion First, we note that EBM proponents have obscured the current debate by defining EBM in an overly broad, indeed almost vacuous, manner; we offer a clearer account of EBM and its relation to the alternat...

  1. Flipped classroom model for learning evidence-based medicine

    OpenAIRE

    Rucker, Sydney Y; Ozdogan, Zulfukar; Al Achkar, Morhaf

    2017-01-01

    Sydney Y Rucker,1 Zulfukar Ozdogan,1 Morhaf Al Achkar2 1School of Education, Indiana University, Bloomington, IN, 2Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA Abstract: Journal club (JC), as a pedagogical strategy, has long been used in graduate medical education (GME). As evidence-based medicine (EBM) becomes a mainstay in GME, traditional models of JC present a number of insufficiencies and call for novel models of instruction. A flipped cla...

  2. Apprehensions of nurse managers on evidence-based practice

    Directory of Open Access Journals (Sweden)

    Fernanda Carolina Camargo

    2017-12-01

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

  3. Evidence-Based Supplements for the Enhancement of Athletic Performance.

    Science.gov (United States)

    Peeling, Peter; Binnie, Martyn J; Goods, Paul S R; Sim, Marc; Burke, Louise M

    2018-03-01

    A strong foundation in physical conditioning and sport-specific experience, in addition to a bespoke and periodized training and nutrition program, are essential for athlete development. Once these underpinning factors are accounted for, and the athlete reaches a training maturity and competition level where marginal gains determine success, a role may exist for the use of evidence-based performance supplements. However, it is important that any decisions surrounding performance supplements are made in consideration of robust information that suggests the use of a product is safe, legal, and effective. The following review focuses on the current evidence-base for a number of common (and emerging) performance supplements used in sport. The supplements discussed here are separated into three categories based on the level of evidence supporting their use for enhancing sports performance: (1) established (caffeine, creatine, nitrate, beta-alanine, bicarbonate); (2) equivocal (citrate, phosphate, carnitine); and (3) developing. Within each section, the relevant performance type, the potential mechanisms of action, and the most common protocols used in the supplement dosing schedule are summarized.

  4. [Implementation of evidence based medicine in primary care].

    Science.gov (United States)

    Rinnerberger, Andreas; Grafinger, Michaela; Melchardt, Thomas; Sönnichsen, Andreas

    2009-01-01

    The particular situation of primary care - i.e. decentralized setting, comprehensive medical care, and limited access to continuous medical education - makes it difficult to implement evidence-based medicine into daily practice. Therefore, the Institute of General Practice of the Paracelsus University (PMU) in Salzburg and Actavis GmbH Austria developed "REM" (Rechercheservice evidenzbasierte Medizin). This is a web-based enquiry service offered mainly to GPs who can submit questions arising in daily practice which are answered by the service according to current best evidence. In 8.5 months 176 physicians registered to participate. A total of 31 submitted at least one question. In total, REM processed 134 questions. The number of physicians registered and the frequency of enquiries show that REM can facilitate the implementation of evidence-based medicine in primary care. Nonetheless, only a small proportion of the physicians registered actually made use of the service. Improvements are necessary to promote interest in this new way of continuous medical education.

  5. The Developing Role of Evidence-Based Environmental Health

    Directory of Open Access Journals (Sweden)

    Surindar Dhesi

    2015-10-01

    Full Text Available There has been renewed recognition that proactive strategies and interventions can address the social determinants of health, and the environmental health profession is well placed to effect positive change in many of these determinants. This qualitative research has revealed differences in the perceptions, experiences, and understandings of evidence-based practice among public health professionals from different backgrounds across different services in health care and local government in England. The absence of a strong tradition of evidence-based practice in environmental health appears to be a disadvantage in securing funding and playing a full role, as it has become the expectation in the new public health system. This has, at times, resulted in tensions between professionals with different backgrounds and frustration on the part of environmental health practitioners, who have a tradition of responding quickly to new challenges and “getting on with the job.” There is generally a willingness to develop evidence-based practice in environmental health; however, this will take time and investment.

  6. The challenge of integrating evidence-based design.

    Science.gov (United States)

    Martin, Caren S

    2009-01-01

    This paper discusses the integration of evidence-based design (EBD) into the design process as an innovation, illuminates the significance and progress of the diffusion of this innovation, and identifies EBD advocates and the consequences of meeting the EBD challenge. A free tool for engaging in EBD is explored. Healthcare designers are leading the EBD charge, because their clients depend on it. But not all designers engage in EBD, because it may be beyond the resources of a firm or outside its culture. However, as with other meaningful design innovations, designers who do not practice EBD could fall by the wayside. EBD is a product of the diffusion of the innovation of evidence-based medicine. The academy (i.e., the collective of institutions of higher education), design organizations, design communities, and the media all contribute to the diffusion of EBD. However, the quantity, quality, and understandability of evidence continue to challenge its broad adoption. InformeDesign®, a free, Internet-based tool, presents information to designers in a concise, understandable way. Firms must invest in EBD incrementally as a value-added component of design to meet current and future challenges. It is important for designers to realize that engaging in EBD is not a rejection of creativity, but a means by which to elevate their design solutions. ©2009 VENDOME GROUP, LLC

  7. Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016.

    Science.gov (United States)

    Bikson, Marom; Grossman, Pnina; Thomas, Chris; Zannou, Adantchede Louis; Jiang, Jimmy; Adnan, Tatheer; Mourdoukoutas, Antonios P; Kronberg, Greg; Truong, Dennis; Boggio, Paulo; Brunoni, André R; Charvet, Leigh; Fregni, Felipe; Fritsch, Brita; Gillick, Bernadette; Hamilton, Roy H; Hampstead, Benjamin M; Jankord, Ryan; Kirton, Adam; Knotkova, Helena; Liebetanz, David; Liu, Anli; Loo, Colleen; Nitsche, Michael A; Reis, Janine; Richardson, Jessica D; Rotenberg, Alexander; Turkeltaub, Peter E; Woods, Adam J

    2016-01-01

    This review updates and consolidates evidence on the safety of transcranial Direct Current Stimulation (tDCS). Safety is here operationally defined by, and limited to, the absence of evidence for a Serious Adverse Effect, the criteria for which are rigorously defined. This review adopts an evidence-based approach, based on an aggregation of experience from human trials, taking care not to confuse speculation on potential hazards or lack of data to refute such speculation with evidence for risk. Safety data from animal tests for tissue damage are reviewed with systematic consideration of translation to humans. Arbitrary safety considerations are avoided. Computational models are used to relate dose to brain exposure in humans and animals. We review relevant dose-response curves and dose metrics (e.g. current, duration, current density, charge, charge density) for meaningful safety standards. Special consideration is given to theoretically vulnerable populations including children and the elderly, subjects with mood disorders, epilepsy, stroke, implants, and home users. Evidence from relevant animal models indicates that brain injury by Direct Current Stimulation (DCS) occurs at predicted brain current densities (6.3-13 A/m(2)) that are over an order of magnitude above those produced by conventional tDCS. To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 milliamperes, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. An Evidence-Based Videotaped Running Biomechanics Analysis.

    Science.gov (United States)

    Souza, Richard B

    2016-02-01

    Running biomechanics play an important role in the development of injuries. Performing a running biomechanics analysis on injured runners can help to develop treatment strategies. This article provides a framework for a systematic video-based running biomechanics analysis plan based on the current evidence on running injuries, using 2-dimensional (2D) video and readily available tools. Fourteen measurements are proposed in this analysis plan from lateral and posterior video. Identifying simple 2D surrogates for 3D biomechanic variables of interest allows for widespread translation of best practices, and have the best opportunity to impact the highly prevalent problem of the injured runner. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Neuropsychology 3.0: Evidence-Based Science and Practice

    Science.gov (United States)

    Bilder, Robert M.

    2011-01-01

    Neuropsychology is poised for transformations of its concepts and methods, leveraging advances in neuroimaging, the human genome project, psychometric theory, and information technologies. It is argued that a paradigm shift towards evidence-based science and practice can be enabled by innovations, including: (1) formal definition of neuropsychological concepts and tasks in cognitive ontologies; (2) creation of collaborative neuropsychological knowledgebases; and (3) design of web-based assessment methods that permit free development, large-sample implementation, and dynamic refinement of neuropsychological tests and the constructs these aim to assess. This article considers these opportunities, highlights selected obstacles, and offers suggestions for stepwise progress towards these goals. PMID:21092355

  10. Current Treatment of Toxoplasma Retinochoroiditis: An Evidence-Based Review

    Directory of Open Access Journals (Sweden)

    Meredith Harrell

    2014-01-01

    Full Text Available Objective. To perform an evidence-based review of treatments for Toxoplasma retinochoroiditis (TRC. Methods. A systematic literature search was performed using the PubMed database and the key phrase “ocular toxoplasmosis treatment” and the filter for “controlled clinical trial” and “randomized clinical trial” as well as OVID medline (1946 to May week 2 2014 using the keyword ‘‘ocular toxoplasmosis’’. The included studies were used to evaluate the various treatment modalities of TRC. Results. The electronic search yielded a total of 974 publications of which 44 reported on the treatment of ocular toxoplasmosis. There were 9 randomized controlled studies and an additional 3 comparative studies on the treatment of acute TRC with systemic or intravitreous antibiotics or on reducing the recurrences of TRC. Endpoints of studies included visual acuity improvement, inflammatory response, lesion size changes, recurrences of lesions, and adverse effects of medications. Conclusions. There was conflicting evidence as to the effectiveness of systemic antibiotics for TRC. There is no evidence to support that one antibiotic regimen is superior to another so choice needs to be informed by the safety profile. Intravitreous clindamycin with dexamethasone seems to be as effective as systemic treatments. There is currently level I evidence that intermittent trimethoprim-sulfamethoxazole prevents recurrence of the disease.

  11. Integration of Evidence Base into a Probabilistic Risk Assessment

    Science.gov (United States)

    Saile, Lyn; Lopez, Vilma; Bickham, Grandin; Kerstman, Eric; FreiredeCarvalho, Mary; Byrne, Vicky; Butler, Douglas; Myers, Jerry; Walton, Marlei

    2011-01-01

    INTRODUCTION: A probabilistic decision support model such as the Integrated Medical Model (IMM) utilizes an immense amount of input data that necessitates a systematic, integrated approach for data collection, and management. As a result of this approach, IMM is able to forecasts medical events, resource utilization and crew health during space flight. METHODS: Inflight data is the most desirable input for the Integrated Medical Model. Non-attributable inflight data is collected from the Lifetime Surveillance for Astronaut Health study as well as the engineers, flight surgeons, and astronauts themselves. When inflight data is unavailable cohort studies, other models and Bayesian analyses are used, in addition to subject matters experts input on occasion. To determine the quality of evidence of a medical condition, the data source is categorized and assigned a level of evidence from 1-5; the highest level is one. The collected data reside and are managed in a relational SQL database with a web-based interface for data entry and review. The database is also capable of interfacing with outside applications which expands capabilities within the database itself. Via the public interface, customers can access a formatted Clinical Findings Form (CLiFF) that outlines the model input and evidence base for each medical condition. Changes to the database are tracked using a documented Configuration Management process. DISSCUSSION: This strategic approach provides a comprehensive data management plan for IMM. The IMM Database s structure and architecture has proven to support additional usages. As seen by the resources utilization across medical conditions analysis. In addition, the IMM Database s web-based interface provides a user-friendly format for customers to browse and download the clinical information for medical conditions. It is this type of functionality that will provide Exploratory Medicine Capabilities the evidence base for their medical condition list

  12. Pharmacists performing quality spirometry testing: an evidence based review.

    Science.gov (United States)

    Cawley, Michael J; Warning, William J

    2015-10-01

    The scope of pharmacist services for patients with pulmonary disease has primarily focused on drug related outcomes; however pharmacists have the ability to broaden the scope of clinical services by performing diagnostic testing including quality spirometry testing. Studies have demonstrated that pharmacists can perform quality spirometry testing based upon international guidelines. The primary aim of this review was to assess the published evidence of pharmacists performing quality spirometry testing based upon American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. In order to accomplish this, the description of evidence and type of outcome from these services were reviewed. A literature search was conducted using five databases [PubMed (1946-January 2015), International Pharmaceutical Abstracts (1970 to January 2015), Cumulative Index of Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews] with search terms including pharmacy, spirometry, pulmonary function, asthma or COPD was conducted. Searches were limited to publications in English and reported in humans. In addition, Uniform Resource Locators and Google Scholar searches were implemented to include any additional supplemental information. Eight studies (six prospective multi-center trials, two retrospective single center studies) were included. Pharmacists in all studies received specialized training in performing spirometry testing. Of the eight studies meeting inclusion and exclusion criteria, 8 (100%) demonstrated acceptable repeatability of spirometry testing based upon standards set by the ATS/ERS guidelines. Acceptable repeatability of seven studies ranged from 70 to 99% consistent with published data. Available evidence suggests that quality spirometry testing can be performed by pharmacists. More prospective studies are needed to add to the current evidence of quality spirometry testing performed by

  13. Solid Silica-based Sulphonic Acid as an Efficient Green Catalyst for ...

    African Journals Online (AJOL)

    NJD

    Solid Silica-based Sulphonic Acid as an Efficient Green. Catalyst for the Selective Oxidation of Sulphides to. Sulphoxides using NaCIO in Aqueous Media. Ali Amoozadeh* and Firouzeh Nemati. Department of Chemistry, Faculty of Science, Semnan University, Semnan, Iran. Received 21 October 2008, revised 6 December ...

  14. Encapsulation and solid state sequestration of gases by calix[6]arene-based molecular containers.

    Science.gov (United States)

    Lavendomme, Roy; Ajami, Daniela; Moerkerke, Steven; Wouters, Johan; Rissanen, Kari; Luhmer, Michel; Jabin, Ivan

    2017-06-13

    Two calix[6]arene-based molecular containers were synthesized in high yields. These containers can encapsulate small guests through a unique "rotating door" complexation process. The sequestration of greenhouse gases is clearly demonstrated. They can be stored in the solid state for long periods and released via dissolution of the inclusion complex.

  15. Operando Spectroscopy of the Gas-Phase Aldol Condensation of Propanal over Solid Base Catalysts

    NARCIS (Netherlands)

    Hernández-giménez, Ana M.; Ruiz-martínez, Javier; Puértolas, Begoña; Pérez-ramírez, Javier; Bruijnincx, Pieter C. A.; Weckhuysen, Bert M.

    2017-01-01

    The gas-phase aldol condensation of propanal, taken as model for the aldehyde components in bio-oils, has been studied with a combined operando set-up allowing to perform FT-IR & UV–Vis diffuse reflectance spectroscopy (DRS) with on-line mass spectrometry (MS). The selected solid base catalysts, a

  16. Estimation of Methane Emissions from Municipal Solid Waste Landfills in China Based on Point Emission Sources

    Directory of Open Access Journals (Sweden)

    Cai Bo-Feng

    2014-01-01

    Citation: Cai, B.-F., Liu, J.-G., Gao, Q.-X., et al., 2014. Estimation of methane emissions from municipal solid waste landfills in China based on point emission sources. Adv. Clim. Change Res. 5(2, doi: 10.3724/SP.J.1248.2014.081.

  17. Measuring Costs to Community-Based Agencies for Implementation of an Evidence-Based Practice.

    Science.gov (United States)

    Lang, Jason M; Connell, Christian M

    2017-01-01

    Healthcare reform has led to an increase in dissemination of evidence-based practices. Cost is frequently cited as a significant yet rarely studied barrier to dissemination of evidence-based practices and the associated improvements in quality of care. This study describes an approach to measuring the incremental, unreimbursed costs in staff time and direct costs to community-based clinics implementing an evidence-based practice through participating in a learning collaborative. Initial implementation costs exceeding those for providing "treatment as usual" were collected for ten clinics implementing trauma-focused cognitive behavioral therapy through participation in 10-month learning collaboratives. Incremental implementation costs of these ten community-based clinic teams averaged the equivalent of US$89,575 (US$ 2012). The most costly activities were training, supervision, preparation time, and implementation team meetings. Recommendations are made for further research on implementation costs, dissemination of evidence-based practices, and implications for researchers and policy makers.

  18. Evidence based medicine (EBM) and evidence based radiology (EBR) in the follow-up of the patients after surgery for lung and colon-rectal carcinoma

    International Nuclear Information System (INIS)

    Giovagnoni, Andrea; Ottaviani, Letizia; Mensa', Anna; Durastanti, Martina; Floriani, Irene; Cascinu, Stefano

    2005-01-01

    Purpose: a) To define the role of diagnostic imaging modalities in the follow-up of patients after surgery for solid cancer, using an Evidence Based Medicine (EBM) approach; b) to asses the possible discrepancies between the theoretical model and the clinical protocols currently used for the follow-up of treated patients; c) to compare the real costs of the radiological examinations performed in a group of cancer patients followed up after surgery and the theoretical costs that would have been incurred had the patients been followed up according to the theoretical (evidence-based) follow-up programme. Materials and methods: We searched traditional and secondary databases for research papers and guidelines by international scientific societies published in the last 10 years and concerning the clinical impact of follow-up programs in patients operated on for colorectal and lung carcinoma. The papers were selected based on level of evidence using the systematic review approach of EBM. In each paper selected, we considered the overall survival and disease-free survival, quality of life, side and toxic effects of therapy, cost and psychological aspects to formulate a judgement on the usefulness the radiological tests. Subsequently, the clinical and imaging follow-up of 40 patients who had undergone surgical resection for colorectal cancer (20 patients) and lung cancer (20 patients) between 1998 and 2004 were retrospectively reviewed, and the costs of the follow-up programs for the two groups, were analysed and compared with those of the theoretical evidence-based programmes. Results: Of the 41 papers selected after systematic review only nine datasets were considered for our final analysis. The majority of papers (7 out of 9) and all the guidelines published by International Scientific Societies agreed on the poor value of closed imaging in the follow-up of patients who have undergone surgery for colorectal and lung cancer. A significant difference was found between the

  19. Replacing HDDs with Solid-State Flash Disks in PXIbus-Based Systems

    International Nuclear Information System (INIS)

    Zhao, Z W; Zeng, L

    2006-01-01

    New security features, constantly decreasing prices, solid-state Flash disks are becoming a popular alternative for replacing failure-prone mechanical Hard Disk Drives (HDDs) in PXIbus-based military systems. The key component in high-capacity solid-state Flash disks is NAND Flash, but with a specification that shows only 100,000-300,000 write/erase cycles, engineers may be concerned that the lifetime of Flash disks cannot meet their application requirements. With the right Flash management, Flash disks are able to provide the reliability and endurance that military applications need

  20. Epilepsy, Antiepileptic Drugs, and Aggression: An Evidence-Based Review

    Science.gov (United States)

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

    2016-01-01

    Antiepileptic drugs (AEDs) have many benefits but also many side effects, including aggression, agitation, and irritability, in some patients with epilepsy. This article offers a comprehensive summary of current understanding of aggressive behaviors in patients with epilepsy, including an evidence-based review of aggression during AED treatment. Aggression is seen in a minority of people with epilepsy. It is rarely seizure related but is interictal, sometimes occurring as part of complex psychiatric and behavioral comorbidities, and it is sometimes associated with AED treatment. We review the common neurotransmitter systems and brain regions implicated in both epilepsy and aggression, including the GABA, glutamate, serotonin, dopamine, and noradrenaline systems and the hippocampus, amygdala, prefrontal cortex, anterior cingulate cortex, and temporal lobes. Few controlled clinical studies have used behavioral measures to specifically examine aggression with AEDs, and most evidence comes from adverse event reporting from clinical and observational studies. A systematic approach was used to identify relevant publications, and we present a comprehensive, evidence-based summary of available data surrounding aggression-related behaviors with each of the currently available AEDs in both adults and in children/adolescents with epilepsy. A psychiatric history and history of a propensity toward aggression/anger should routinely be sought from patients, family members, and carers; its presence does not preclude the use of any specific AEDs, but those most likely to be implicated in these behaviors should be used with caution in such cases. PMID:27255267

  1. Evidence-based medicine: what it can and cannot do

    Directory of Open Access Journals (Sweden)

    Goffredo Freddi

    2011-01-01

    Full Text Available Evidence-based medicine (EBM is not a old hat, a "cookbook" medicine perpetrated by arrogant to serve cost cutters to suppress clinical freedom, a mandatory, deterministic, totalitarian practice of medicine, a way to control cost and to ignore patient preferences, a limit to personal/humanistic/individual medicine. EBM is a reference of excellence to guide clinical decisions, the integration of own expertise with others' expertise and patient preferences, a way to improve medical practice and limit the variability and errors created when there is not evidence to identify the gold standard and differentiate among alternatives available. But evidences need to be integrated with a new thinking based on Complexity Science. Health care systems operates as complex adaptative systems rather than rigid, linear or mechanical organizations and innovation is a critical outcome of Complexity Science. How does EBM impact drug innovation? New drug approvals are not keeping pace with rising Research and Development spending, clinical approval success rate for new chemical entities (NCEs is progressively dropping and maybe, through these indicators, we are seeing the worst face of EBM: its limiting, blocking, and controlling side. If that is the case, EBM is the main ally to keep the economy of health systems under control and the great excuse to block the access of the innovation to patients. Certainly not the best way to maximize the benefits of EBM.

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

    Directory of Open Access Journals (Sweden)

    Kamel Remah M

    2010-03-01

    Full Text Available Abstract Background Infertility is defined as inability of a couple to conceive naturally after one year of regular unprotected sexual intercourse. It remains a major clinical and social problem, affecting perhaps one couple in six. Evaluation usually starts after 12 months; however it may be indicated earlier. The most common causes of infertility are: male factor such as sperm abnormalities, female factor such as ovulation dysfunction and tubal pathology, combined male and female factors and unexplained infertility. Objectives The aim of this study is to provide the healthcare professionals an evidence-based management protocol for infertile couples away from medical information overload. Methods A comprehensive review where the literature was searched for "Management of infertility and/or infertile couples" at library website of University of Bristol (MetaLib by using a cross-search of different medical databases besides the relevant printed medical journals and periodicals. Guidelines and recommendations were retrieved from the best evidence reviews such as that from the American College of Obstetricians and Gynaecologists (ACOG, American Society for Reproductive Medicine (ASRM, Canadian Fertility and Andrology Society (CFAS, and Royal College of Obstetricians and Gynaecologists (RCOG. Results A simple guide for the clinicians to manage the infertile couples. Conclusions The study deploys a new strategy to translate the research findings and evidence-base recommendations into a simplified focused guide to be applied on routine daily practice. It is an approach to disseminate the recommended medical care for infertile couple to the practicing clinicians.

  3. Flipped classroom model for learning evidence-based medicine

    Directory of Open Access Journals (Sweden)

    Rucker SY

    2017-08-01

    Full Text Available Sydney Y Rucker,1 Zulfukar Ozdogan,1 Morhaf Al Achkar2 1School of Education, Indiana University, Bloomington, IN, 2Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA Abstract: Journal club (JC, as a pedagogical strategy, has long been used in graduate medical education (GME. As evidence-based medicine (EBM becomes a mainstay in GME, traditional models of JC present a number of insufficiencies and call for novel models of instruction. A flipped classroom model appears to be an ideal strategy to meet the demands to connect evidence to practice while creating engaged, culturally competent, and technologically literate physicians. In this article, we describe a novel model of flipped classroom in JC. We present the flow of learning activities during the online and face-to-face instruction, and then we highlight specific considerations for implementing a flipped classroom model. We show that implementing a flipped classroom model to teach EBM in a residency program not only is possible but also may constitute improved learning opportunity for residents. Follow-up work is needed to evaluate the effectiveness of this model on both learning and clinical practice. Keywords: evidence-based medicine, flipped classroom, residency education

  4. Evaluation of nurse engagement in evidence-based practice.

    Science.gov (United States)

    Davidson, Judy E; Brown, Caroline

    2014-01-01

    The purpose of this project was to explore nurses' willingness to question and change practice. Nurses were invited to report practice improvement opportunities, and participants were supported through the process of a practice change. The project leader engaged to the extent desired by the participant. Meetings proceeded until the participant no longer wished to continue, progress was blocked, or practice was changed. Evaluation of the evidence-based practice change process occurred. Fifteen nurses reported 23 practice improvement opportunities. The majority (12 of 15) preferred to have the project leader review the evidence. Fourteen projects changed practice; 4 were presented at conferences. Multiple barriers were identified throughout the process and included loss of momentum, the proposed change involved other disciplines, and low level or controversial evidence. Practice issues were linked to quality metrics, cost of care, patient satisfaction, regulatory compliance, and patient safety. Active engagement by nurse leaders was needed for a practice change to occur. Participants identified important problems previously unknown to hospital administrators. The majority of nurses preferred involvement in practice change based on clinical problem solving when supported by others to provide literature review and manage the process through committees. Recommendations include supporting a culture that encourages employees to report practice improvement opportunities and provide resources to assist in navigating the identified practice change.

  5. Definition of drug-resistant epilepsy: is it evidence based?

    Science.gov (United States)

    Wiebe, Samuel

    2013-05-01

    Clinical case definitions are the cornerstone of clinical communication and of clinical and epidemiologic research. The ramifications of establishing a case definition are extensive, including potentially large changes in epidemiologic estimates of frequency, and decisions for clinical management. Yet, defining a condition entails numerous challenges such as defining the scope and purpose, incorporating the strongest evidence base with clinical expertise, accounting for patients' values, and considering impact on care. The clinical case definition of drug-resistant epilepsy, in addition, must address what constitutes an adequate intervention for an individual drug, what are the outcomes of relevance, what period of observation is sufficient to determine success or failure, how many medications should be tried, whether seizure frequency should play a role, and what is the role of side effects and tolerability. On the other hand, the principles of evidence-based medicine (EBM) aim at providing a systematic approach to incorporating the best available evidence into the process of clinical decision for individual patients. The case definition of drug-resistant epilepsy proposed by the the International League Against Epilepsy (ILAE) in 2009 is evaluated in terms of the principles of EBM as well as the stated goals of the authors of the definition. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

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

    Science.gov (United States)

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

    2012-09-01

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

  7. The Evidence-Based Practice of Applied Behavior Analysis.

    Science.gov (United States)

    Slocum, Timothy A; Detrich, Ronnie; Wilczynski, Susan M; Spencer, Trina D; Lewis, Teri; Wolfe, Katie

    2014-05-01

    Evidence-based practice (EBP) is a model of professional decision-making in which practitioners integrate the best available evidence with client values/context and clinical expertise in order to provide services for their clients. This framework provides behavior analysts with a structure for pervasive use of the best available evidence in the complex settings in which they work. This structure recognizes the need for clear and explicit understanding of the strength of evidence supporting intervention options, the important contextual factors including client values that contribute to decision making, and the key role of clinical expertise in the conceptualization, intervention, and evaluation of cases. Opening the discussion of EBP in this journal, Smith (The Behavior Analyst, 36, 7-33, 2013) raised several key issues related to EBP and applied behavior analysis (ABA). The purpose of this paper is to respond to Smith's arguments and extend the discussion of the relevant issues. Although we support many of Smith's (The Behavior Analyst, 36, 7-33, 2013) points, we contend that Smith's definition of EBP is significantly narrower than definitions that are used in professions with long histories of EBP and that this narrowness conflicts with the principles that drive applied behavior analytic practice. We offer a definition and framework for EBP that aligns with the foundations of ABA and is consistent with well-established definitions of EBP in medicine, psychology, and other professions. In addition to supporting the systematic use of research evidence in behavior analytic decision making, this definition can promote clear communication about treatment decisions across disciplines and with important outside institutions such as insurance companies and granting agencies.

  8. Evidence-based medicine - an appropriate tool for evidence-based health policy? A case study from Norway.

    Science.gov (United States)

    Malterud, Kirsti; Bjelland, Anne Karen; Elvbakken, Kari Tove

    2016-03-05

    Evidence-based policy (EBP), a concept modelled on the principles of evidence-based medicine (EBM), is widely used in different areas of policymaking. Systematic reviews (SRs) with meta-analyses gradually became the methods of choice for synthesizing research evidence about interventions and judgements about quality of evidence and strength of recommendations. Critics have argued that the relation between research evidence and service policies is weak, and that the notion of EBP rests on a misunderstanding of policy processes. Having explored EBM standards and knowledge requirements for health policy decision-making, we present an empirical point of departure for discussing the relationship between EBM and EBP. In a case study exploring the Norwegian Knowledge Centre for the Health Services (NOKC), an independent government unit, we first searched for information about the background and development of the NOKC to establish a research context. We then identified, selected and organized official NOKC publications as an empirical sample of typical top-of-the-line knowledge delivery adhering to EBM standards. Finally, we explored conclusions in this type of publication, specifically addressing their potential as policy decision tools. From a total sample of 151 SRs published by the NOKC in the period 2004-2013, a purposive subsample from 2012 (14 publications) advised major caution about their conclusions because of the quality or relevance of the underlying documentation. Although the case study did not include a systematic investigation of uptake and policy consequences, SRs were found to be inappropriate as universal tools for health policy decision-making. The case study demonstrates that EBM is not necessarily suited to knowledge provision for every kind of policy decision-making. Our analysis raises the question of whether the evidence-based movement, represented here by an independent government organization, undertakes too broad a range of commissions using

  9. [Evidence-based therapy of polycystic ovarian syndrome].

    Science.gov (United States)

    Gődény, Sándor; Csenteri, Orsolya Karola

    2015-11-08

    Polycystic ovary syndrome is recognized as the most common hormonal and metabolic disorder likely to affect women. The heterogeneous endocrinopathy is characterized by clinical and/or biochemical hyperandrogenism, oligo- or amenorrhoea, anovulatory infertility, and polycystic ovarian morphology. The syndrome is often associated with obesity, hyperinsulinemia and adversely affects endocrine, metabolic, and cardiovascular health. The symptoms and complaint of the patients vary with age. To maximise health gain of the syndrome, adequate, evidence based effective, efficient and safe treatment is necessary. This article summarises the highest available evidence provided by studies, meta-analysis and systematic reviews about the therapeutical possibilities for treating obesity, hyperandrogenism, menstrual abnormalities, infertility and psychological problems related to polycystic ovary syndrome.

  10. Strengthening the evidence base for health programming in humanitarian crises.

    Science.gov (United States)

    Ager, A; Burnham, G; Checchi, F; Gayer, M; Grais, R F; Henkens, M; Massaquoi, M B F; Nandy, R; Navarro-Colorado, C; Spiegel, P

    2014-09-12

    Given the growing scale and complexity of responses to humanitarian crises, it is important to develop a stronger evidence base for health interventions in such contexts. Humanitarian crises present unique challenges to rigorous and effective research, but there are substantial opportunities for scientific advance. Studies need to focus where the translation of evidence from noncrisis scenarios is not viable and on ethical ways of determining what happens in the absence of an intervention. Robust methodologies suited to crisis settings have to be developed and used to assess interventions with potential for delivery at scale. Strengthening research capacity in the low- to middle-income countries that are vulnerable to crises is also crucial. Copyright © 2014, American Association for the Advancement of Science.

  11. Flipped classroom model for learning evidence-based medicine.

    Science.gov (United States)

    Rucker, Sydney Y; Ozdogan, Zulfukar; Al Achkar, Morhaf

    2017-01-01

    Journal club (JC), as a pedagogical strategy, has long been used in graduate medical education (GME). As evidence-based medicine (EBM) becomes a mainstay in GME, traditional models of JC present a number of insufficiencies and call for novel models of instruction. A flipped classroom model appears to be an ideal strategy to meet the demands to connect evidence to practice while creating engaged, culturally competent, and technologically literate physicians. In this article, we describe a novel model of flipped classroom in JC. We present the flow of learning activities during the online and face-to-face instruction, and then we highlight specific considerations for implementing a flipped classroom model. We show that implementing a flipped classroom model to teach EBM in a residency program not only is possible but also may constitute improved learning opportunity for residents. Follow-up work is needed to evaluate the effectiveness of this model on both learning and clinical practice.

  12. Decisions by regulatory agencies: are they evidence-based?

    Directory of Open Access Journals (Sweden)

    Furberg Curt D

    2007-04-01

    Full Text Available Abstract Contradictory statements about the non-steroidal anti-inflammatory drugs from the European Medicines Agency and the United States Food and Drug Administration have raised questions about whether regulatory decisions are evidence-based. For the selective COX-2 inhibitors, there are clear contraindications and warnings in Europe, but only a vaguely worded Black Box warning in the United States. All the non-selective agents are given an almost "clean bill of health" in Europe, while all of them are judged to have a similar risk-benefit ratio as celecoxib in the United States. The regulatory agencies have failed to recognize the clinical trial evidence that the risk of cardiovascular events varies substantially among the non-selective agents, with diclofenac carrying the highest risk of harm.

  13. Kinetics of aging of metastable, zirconium-dioxide-based solid electrolytes

    International Nuclear Information System (INIS)

    Vlasov, A.N.; Inozemtsev, M.V.

    1985-01-01

    The kinetics of aging of zirconium-dioxide-based metastable solid oxide electrolytes stabilized with 8 to 10 mole % of yttrium, holmium, or scandium oxide were studied over the temperature range from 1200 to 1373 0 K. Kinetic equations were proposed which describe the conduction behavior of two-phase solid electrolytes in a wide time range. The processes were found to occur independently at the initial stage of aging in the cubic solution, viz., an increase in the number of nuclei of the new phase, and a growth in volume of nuclei of the new phase. After a long time the former process ceases, and the kinetics of aging of the electrolyte only are determined by the kinetics of volume growth of the inclusions of new phase. The time-dependent behavior of two-phase solid solutions is discussed theoretically and examined experimentally

  14. Kinetics of aging of metastable solid electrolytes based on zirconium dioxide

    International Nuclear Information System (INIS)

    Vlasov, A.N.; Inozemtsev, M.V.

    1985-01-01

    Kinetics of aging of metastable solid electrolytes on the base of zirconium dioxide stabilized with 8-10 mol.%of yttrium, holmium, and scandium oxides has been studied within the 1200-1373 K temperature range. Kinetic equations describibg behaviour of electric conductivity of two-phase solid electrolytes within a wide temperature interval have been suggested. It has been established that at the initial stage of ageing in cubic solid solution two processes proceed independently of one another: growth of a number of new phase centres and of a volume of new phase centres. At large times growth of a number of new phase centres stops, and kinetics of electrolyte aging is defined only by the growth kinetics of a volume of new phase inclusions

  15. Tunable ultraviolet solid-state dye laser based on MPMMA doped with pyrromethene 597

    International Nuclear Information System (INIS)

    Jiang, Y G; Fan, R W; Xia, Y Q; Chen, D Y

    2011-01-01

    Solid-state dye sample based on modified polymethyl methacrylate (MPMMA) co-doped with pyrromethene 597 (PM597), and coumarin 460 (C460) were prepared. A frequency-doubled pulsed Nd:YAG laser is used to pump solid-state dye sample, and the narrow linewidth dye laser of 94.4 mJ was obtained at 582 nm in an oscillator-amplifier configuration. Using a beta-BaB 2 O 4 (BBO) crystal to frequency double the dye laser into ultraviolet (UV), a tuning range from 279 to 305 nm was demonstrated from a single doped PM597 dye. To the best of our knowledge, the UV tuning range is the best under the same condition so far. The conversion slope efficiency from solid dye laser to UV laser was 8.9% and the highest UV laser output energy reached 6.94 mJ at 291 nm

  16. [Preparation of Oenothera biennis Oil Solid Lipid Nanoparticles Based on Microemulsion Technique].

    Science.gov (United States)

    Piao, Lin-mei; Jin, Yong; Cui, Yan-lin; Yin, Shou-yu

    2015-06-01

    To study the preparation of Oenothera biennis oil solid lipid nanoparticles and its quality evaluation. The solid lipid nanoparticles were prepared by microemulsion technique. The optimum condition was performed based on the orthogonal design to examine the entrapment efficiency, the mean diameter of the particles and so on. The optimal preparation of Oenothera biennis oil solid lipid nanoparticles was as follows: Oenothera biennis dosage 300 mg, glycerol monostearate-Oenothera biennis (2: 3), Oenothera biennis -RH/40/PEG-400 (1: 2), RH-40/PEG-400 (1: 2). The resulting nanoparticles average encapsulation efficiency was (89.89 ± 0.71)%, the average particle size was 44.43 ± 0.08 nm, and the Zeta potential was 64.72 ± 1.24 mV. The preparation process is simple, stable and feasible.

  17. Maternal and Birth Characteristics and Childhood Embryonal Solid Tumors: A Population-Based Report from Brazil.

    Directory of Open Access Journals (Sweden)

    Neimar de Paula Silva

    Full Text Available Several maternal and birth characteristics have been reported to be associated with an increased risk of many childhood cancers. Our goal was to evaluate the risk of childhood embryonal solid tumors in relation to pre- and perinatal characteristics.A case-cohort study was performed using two population-based datasets, which were linked through R software. Tumors were classified as central nervous system (CNS or non-CNS-embryonal (retinoblastoma, neuroblastoma, renal tumors, germ cell tumors, hepatoblastoma and soft tissue sarcoma. Children aged <6 years were selected. Adjustments were made for potential confounders. Odds ratios (OR with 95% confidence intervals (CI were computed by unconditional logistic regression analysis using SPSS.Males, high maternal education level, and birth anomalies were independent risk factors. Among children diagnosed older than 24 months of age, cesarean section (CS was a significant risk factor. Five-minute Apgar ≤8 was an independent risk factor for renal tumors. A decreasing risk with increasing birth order was observed for all tumor types except for retinoblastoma. Among children with neuroblastoma, the risk decreased with increasing birth order (OR = 0.82 (95% CI 0.67-1.01. Children delivered by CS had a marginally significantly increased OR for all tumors except retinoblastoma. High maternal education level showed a significant increase in the odds for all tumors together, CNS tumors, and neuroblastoma.This evidence suggests that male gender, high maternal education level, and birth anomalies are risk factors for childhood tumors irrespective of the age at diagnosis. Cesarean section, birth order, and 5-minute Apgar score were risk factors for some tumor subtypes.

  18. A GIS- Based suitability analysis for siting a solid waste in an urban area

    Directory of Open Access Journals (Sweden)

    M. Salemi

    2017-01-01

    Full Text Available An appropriate solid waste disposal has been a major problem in municipal environment. The use of landfills is the most economical and environmentally acceptable method for the disposal of solid waste all over the world. The analysis of spatial data and consideration of regulation and accepted criteria are part of the important elements in the site selection. The aim of this paper is to show how application of geographic information system could be used for siting solid waste disposal in Abadan city. In this paper, we consider types of soil suitable for solid waste disposals, land use/ land cover, transportation routes and proximity to surface water. Relative importance weight of each criteria in the geographic information system was determined and finally suitability map was prepared. Based on the final suitability map, appropriate solid waste landfill site was located in north east part of the study area. Select the best landfill site among the candidate ones, and   the output results can enable decision makers to make appropriate decisions to reduce the costs both in   economic and environmental criteria.

  19. Monte Carlo-based investigation of water-equivalence of solid phantoms at 137Cs energy

    International Nuclear Information System (INIS)

    Vishwakarma, Ramkrushna S.; Palani Selvam, T.; Sahoo, Sridhar; Mishra, Subhalaxmi; Chourasiya, Ghanshyam

    2013-01-01

    Investigation of solid phantom materials such as solid water, virtual water, plastic water, RW1, polystyrene, and polymethylmethacrylate (PMMA) for their equivalence to liquid water at 137 Cs energy (photon energy of 662 keV) under full scatter conditions is carried out using the EGSnrc Monte Carlo code system. Monte Carlo-based EGSnrc code system was used in the work to calculate distance-dependent phantom scatter corrections. The study also includes separation of primary and scattered dose components. Monte Carlo simulations are carried out using primary particle histories up to 5 x 10 9 to attain less than 0.3% statistical uncertainties in the estimation of dose. Water equivalence of various solid phantoms such as solid water, virtual water, RW1, PMMA, polystyrene, and plastic water materials are investigated at 137 Cs energy under full scatter conditions. The investigation reveals that solid water, virtual water, and RW1 phantoms are water equivalent up to 15 cm from the source. Phantom materials such as plastic water, PMMA, and polystyrene phantom materials are water equivalent up to 10 cm. At 15 cm from the source, the phantom scatter corrections are 1.035, 1.050, and 0.949 for the phantoms PMMA, plastic water, and polystyrene, respectively. (author)

  20. Current status of evidence-based sports medicine.

    Science.gov (United States)

    Harris, Joshua D; Cvetanovich, Gregory; Erickson, Brandon J; Abrams, Geoffrey D; Chahal, Jaskarndip; Gupta, Anil K; McCormick, Frank M; Bach, Bernard R

    2014-03-01

    The purpose of this investigation is to determine the proportion of sports medicine studies that are labeled as Level I Evidence in 5 journals and compare the quality of surgical and nonsurgical studies using simple quality assessment tools (Consolidated Standards of Reporting Trials [CONSORT] and Jadad). By use of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines over the prior 2 years in the top 5 (citation and impact factor based) sports medicine journals, only Level I Evidence studies were eligible for inclusion and were analyzed. All study types (therapeutic, prognostic, diagnostic, and economic) were analyzed. Study quality was assessed with the level of evidence, Jadad score, and CONSORT 2010 guidelines. Study demographic data were compared among journals and between surgical and nonsurgical studies by use of χ(2), 1-way analysis of variance, and 2-sample Z tests. We analyzed 190 Level I Evidence studies (10% of eligible studies) (119 randomized controlled trials [RCTs]). Therapeutic, nonsurgical, single-center studies from the United States were the most common studies published. Sixty-two percent of studies reported a financial conflict of interest. The knee was the most common body part studied, and track-and-field/endurance sports were the most common sports analyzed. Significant differences (P journals reviewed. Overall, the Jadad and CONSORT scores were 2.71 and 77%, respectively. No differences (P > .05) were shown among journals based on the proportion of Level I studies or appropriate randomization. Significant strengths and limitations of RCTs were identified. This study showed that Level I Evidence and RCTs comprise 10% and 6% of contemporary sports medicine literature, respectively. Therapeutic, nonsurgical, single-center studies are the most common publications with Level I Evidence. Significant differences across sports medicine journals were found in study quality. Surgical studies appropriately described

  1. Effects of accelerated degradation on metal supported thin film-based solid oxide fuel cell

    DEFF Research Database (Denmark)

    Reolon, R. P.; Sanna, S.; Xu, Yu

    2018-01-01

    A thin film-based solid oxide fuel cell is deposited on a Ni-based metal porous support by pulsed laser deposition with a multi-scale-graded microstructure design. The fuel cell, around 1 μm in thickness, is composed of a stabilized-zirconia/doped-ceria bi-layered dense electrolyte and nanostruct......A thin film-based solid oxide fuel cell is deposited on a Ni-based metal porous support by pulsed laser deposition with a multi-scale-graded microstructure design. The fuel cell, around 1 μm in thickness, is composed of a stabilized-zirconia/doped-ceria bi-layered dense electrolyte......, electrochemical performances are steady, indicating the stability of the cell. Under electrical load, a progressive degradation is activated. Post-test analysis reveals both mechanical and chemical degradation of the cell. Cracks and delamination of the thin films promote a significant nickel diffusion and new...

  2. A Learning Object Approach To Evidence based learning

    Directory of Open Access Journals (Sweden)

    Zabin Visram

    2005-06-01

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

  3. Supporting Implementation of Evidence-Based Practices through Practice-Based Coaching

    Science.gov (United States)

    Snyder, Patricia A.; Hemmeter, Mary Louise; Fox, Lise

    2015-01-01

    In active implementation science frameworks, coaching has been described as an important competency "driver" to ensure evidence-based practices are implemented as intended. Empirical evidence also has identified coaching as a promising job-embedded professional development strategy to support implementation of quality teaching practices.…

  4. Informed Systems: Enabling Collaborative Evidence Based Organizational Learning

    Directory of Open Access Journals (Sweden)

    Mary M. Somerville

    2015-12-01

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

  5. Evidence-based evaluation of treatment strategy for multiple sclerosis

    Directory of Open Access Journals (Sweden)

    LI Meng-qiu

    2012-04-01

    Full Text Available Objective To formulate the best treatment plan for multiple sclerosis (MS patients by evaluating the therapeutic efficacy and side effect of various evidence-based programs. Methods Key words were defined as multiple sclerosis, immunomodulatory therapy and therapy, etc. We searched MEDLINE, Cochrane Library, Wanfang data bases for Scientific Journals in China and National Knowledge Infrastructure for Chinese Scientific Journals Database. Additionally, we applied manual searching and screened out conference paper and academic dissertation, etc, from various references. After that we obtained and evaluated by Jadad scales on systematic reviews, randomized controlled trials, controlled clinical trials and observational study cases about glucocorticoids, plasmapheresis, intravenous immunoglobulin, IFN-β, glatiramer acetate, mitoxantrone, natalizumab, fingolimod. Results After screening, all seventeen selected resources included systematic reviews 6 articles, randomized controlled trials 7 articles, controlled clinical trials 2 articles, observational study cases 2 articles, among which fifteen articles were proved to be high quality (according to Jadad scoring system, five score 4, six score 5, four score 7, two chapters were judged to be low quality scoring 3. Finally, we summerize that: 1 The first choice of treatment for acute relapses is glucocorticoids and we suggest that plasmapheresis or intravenous immunoglobulin may be tried as an alternative therapy in acute MS relapse, especially in case of contraindications to intravenous methylprednisolone. 2 Immunomodulatory or immunosuppressive treatment (IFN-β, glatiramer acetate, mitoxantrone, natalizumab can be an option to prevent new relapses and progression of disability. 3 Fingolimod is an oral treatment for multiple sclerosis to improve treatment adherence. Conclusion Using evidence-based medicine methods can provide us best clinical evidence on MS treatment.

  6. Montessori education: a review of the evidence base

    Science.gov (United States)

    Marshall, Chloë

    2017-10-01

    The Montessori educational method has existed for over 100 years, but evaluations of its effectiveness are scarce. This review paper has three aims, namely to (1) identify some key elements of the method, (2) review existing evaluations of Montessori education, and (3) review studies that do not explicitly evaluate Montessori education but which evaluate the key elements identified in (1). The goal of the paper is therefore to provide a review of the evidence base for Montessori education, with the dual aspirations of stimulating future research and helping teachers to better understand whether and why Montessori education might be effective.

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

    CERN Document Server

    Phiri, Michael

    2014-01-01

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

  8. Evidence-Based Advances in Aquatic Animal Medicine.

    Science.gov (United States)

    Vergneau-Grosset, Claire; Larrat, Sylvain

    2017-09-01

    Fish and aquatic invertebrates deserve evidence-based medicine. Pharmacologic information is available; most pharmacokinetic studies are derived from the aquaculture industry and extrapolated to ornamental fish. Conversely, advanced diagnostics and information regarding diseases affecting only ornamental fish and invertebrates require more peer-reviewed experimental studies; the examples of carp edema virus, sea star wasting disease, seahorse nutrition, and gas bubble disease of fish under human care are discussed. Antinociception is also a controversial topic of growing interest in aquatic animal medicine. This article summarizes information regarding new topics of interest in companion fish and invertebrates and highlights some future avenues for research. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Evidence-based integrative medicine in clinical veterinary oncology.

    Science.gov (United States)

    Raditic, Donna M; Bartges, Joseph W

    2014-09-01

    Integrative medicine is the combined use of complementary and alternative medicine with conventional or traditional Western medicine systems. The demand for integrative veterinary medicine is growing, but evidence-based research on its efficacy is limited. In veterinary clinical oncology, such research could be translated to human medicine, because veterinary patients with spontaneous tumors are valuable translational models for human cancers. An overview of specific herbs, botanics, dietary supplements, and acupuncture evaluated in dogs, in vitro canine cells, and other relevant species both in vivo and in vitro is presented for their potential use as integrative therapies in veterinary clinical oncology. Published by Elsevier Inc.

  10. Creating a nursing strategic planning framework based on evidence.

    Science.gov (United States)

    Shoemaker, Lorie K; Fischer, Brenda

    2011-03-01

    This article describes an evidence-informed strategic planning process and framework used by a Magnet-recognized public health system in California. This article includes (1) an overview of the organization and its strategic planning process, (2) the structure created within nursing for collaborative strategic planning and decision making, (3) the strategic planning framework developed based on the organization's balanced scorecard domains and the new Magnet model, and (4) the process undertaken to develop the nursing strategic priorities. Outcomes associated with the structure, process, and key initiatives are discussed throughout the article. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. The Evidence-Based Evaluation of Iron Deficiency Anemia.

    Science.gov (United States)

    Hempel, Eliana V; Bollard, Edward R

    2016-09-01

    Anemia is a prevalent disease with multiple possible etiologies and resultant complications. Iron deficiency anemia is a common cause of anemia and is typically due to insufficient intake, poor absorption, or overt or occult blood loss. Distinguishing iron deficiency from other causes of anemia is integral to initiating the appropriate treatment. In addition, identifying the underlying cause of iron deficiency is also necessary to help guide management of these patients. We review the key components to an evidence-based, cost-conscious evaluation of suspected iron deficiency anemia. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Integrating evidence-based interventions into client care plans.

    Science.gov (United States)

    Doran, Diane; Carryer, Jennifer; Paterson, Jane; Goering, Paula; Nagle, Lynn; Kushniruk, Andre; Bajnok, Irmajean; Clark, Carrie; Srivastava, Rani

    2009-01-01

    Within the mental health care system, there is an opportunity to improve patient safety and the overall quality of care by integrating clinical practice guidelines with the care planning process through the use of information technology. Electronic assessment tools such as the Resident Assessment Inventory - Mental Health (RAI-MH) are widely used to identify the health care needs and outcomes of clients. In this knowledge translation initiative, an electronic care planning tool was enhanced to include evidence-based clinical interventions from schizophrenia guidelines. This paper describes the development of a mental health decision support prototype, a field test by clinicians, and user experiences with the application.

  13. Critical thinking: knowledge and skills for evidence-based practice.

    Science.gov (United States)

    Finn, Patrick

    2011-01-01

    I respond to Kamhi's (2011) conclusion in his article "Balancing Certainty and Uncertainty in Clinical Practice" that rational or critical thinking is an essential complement to evidence-based practice (EBP). I expand on Kamhi's conclusion and briefly describe what clinicians might need to know to think critically within an EBP profession. Specifically, I suggest how critical thinking is relevant to EBP, broadly summarize the relevant skills, indicate the importance of thinking dispositions, and outline the various ways our thinking can go wrong. I finish the commentary by suggesting that critical thinking skills should be considered a required outcome of our professional training programs.

  14. International Workshop on Evidence-Based Technology Enhanced Learning

    CERN Document Server

    Gennari, Rosella; Marenzi, Ivana; Prieta, Fernando; Rodríguez, Juan

    2012-01-01

    Research on Technology Enhanced Learning (TEL) investigates how information and communication technologies can be designed in order to support pedagogical activities. The workshop proceedings collects contributions concerning evidence based TEL systems, like their design following EBD principles as well as studies or best practices that educators, education stakeholders or psychologists used to diagnose or improve their students' learning skills, including students with specific difficulties. The international ebTEL’12 workshop wants to be a forum in which TEL researchers and practitioners alike can discuss ideas, projects, and lessons related to ebTEL. The workshop takes place in Salamanca, Spain, on March 28th-30th 2012.  

  15. NLM Evidence-based Information at Your Fingertips - NBNA

    Energy Technology Data Exchange (ETDEWEB)

    Womble, R.

    2010-08-06

    The workshop titled, National Library of Medicine: Evidence-based Information At Your Fingertips, is a computer training class designed to meet the needs of nurses who require access to information on specific medical topics and on the adverse health effects of exposure to hazardous substances. The Specialized Information Services Division of the National Library of Medicine (NLM) is sponsoring this workshop for the National Black Nurses Association to increase the awareness of health professionals of the availability and value of the free NLM medical, environmental health, and toxicology databases.

  16. Do evidence-based guidelines change clinical practice patterns?

    DEFF Research Database (Denmark)

    Kessel, Line; Erngaard, Ditte; Flesner, Per

    2017-01-01

    In 2013, the Danish Health and Medicines Authorities published a National Clinical Guideline on the treatment of age-related cataracts. The guideline provided evidence-based recommendations on the indication for cataract surgery, cataract surgery in patients with age-related macular degeneration......, on the use of toric intraocular lenses (IOLs) to correct preoperative corneal astigmatism, the use of intracameral and topical antibiotics to prevent endophthalmitis, choice of anti-inflammatory medication to control postoperative inflammation and prevent cystoid macular oedema, the use of immediate...

  17. Towards evidence-based medicine in specific grass pollen immunotherapy.

    Science.gov (United States)

    Calderon, M; Mösges, R; Hellmich, M; Demoly, P

    2010-04-01

    When initiating grass pollen immunotherapy for seasonal allergic rhinoconjunctivitis, specialist physicians in many European countries must choose between modalities of differing pharmaceutical and regulatory status. We applied an evidence-based medicine (EBM) approach to commercially available subcutaneous and sublingual Gramineae grass pollen immunotherapies (SCIT and SLIT) by evaluating study design, populations, pollen seasons, treatment doses and durations, efficacy, quality of life, safety and compliance. After searching MEDLINE, Embase and the Cochrane Library up until January 2009, we identified 33 randomized, double-blind, placebo-controlled trials (including seven paediatric trials) with a total of 440 specific immunotherapy (SIT)-treated subjects in seven trials (0 paediatric) for SCIT with natural pollen extracts, 168 in three trials (0 paediatric) for SCIT with allergoids, 906 in 16 trials (five paediatric) for natural extract SLIT drops, 41 in two trials (one paediatric) for allergoid SLIT tablets and 1605 in five trials (two paediatric) for natural extract SLIT tablets. Trial design and quality varied significantly within and between SIT modalities. The multinational, rigorous trials of natural extract SLIT tablets correspond to a high level of evidence in adult and paediatric populations. The limited amount of published data on allergoids prevented us from judging the level of evidence for this modality.

  18. Qigong in Cancer Care: Theory, Evidence-Base, and Practice

    Directory of Open Access Journals (Sweden)

    Penelope Klein

    2017-01-01

    Full Text Available Background: The purpose of this discussion is to explore the theory, evidence base, and practice of Qigong for individuals with cancer. Questions addressed are: What is qigong? How does it work? What evidence exists supporting its practice in integrative oncology? What barriers to wide-spread programming access exist? Methods: Sources for this discussion include a review of scholarly texts, the Internet, PubMed, field observations, and expert opinion. Results: Qigong is a gentle, mind/body exercise integral within Chinese medicine. Theoretical foundations include Chinese medicine energy theory, psychoneuroimmunology, the relaxation response, the meditation effect, and epigenetics. Research supports positive effects on quality of life (QOL, fatigue, immune function and cortisol levels, and cognition for individuals with cancer. There is indirect, scientific evidence suggesting that qigong practice may positively influence cancer prevention and survival. No one Qigong exercise regimen has been established as superior. Effective protocols do have common elements: slow mindful exercise, easy to learn, breath regulation, meditation, emphasis on relaxation, and energy cultivation including mental intent and self-massage. Conclusions: Regular practice of Qigong exercise therapy has the potential to improve cancer-related QOL and is indirectly linked to cancer prevention and survival. Wide-spread access to quality Qigong in cancer care programming may be challenged by the availability of existing programming and work force capacity.

  19. Developing evidence-based librarianship: practical steps for implementation.

    Science.gov (United States)

    Crumley, Ellen; Koufogiannakis, Denise

    2002-06-01

    Evidence-based librarianship (EBL) is a relatively new concept for librarians. This paper lays out a practical framework for the implementation of EBL. A new way of thinking about research in librarianship is introduced using the well-built question process and the assignment of librarian research questions to one of six domains specific to librarianship. As a profession, librarianship tends to reflect more qualitative, social sciences/humanities in its research methods and study types which tend to be less rigorous and more prone to bias. Randomised controlled trials (RCT) do not have to be placed at the top of an evidence 'hierarchy' for librarianship. Instead, a more encompassing model reflecting librarianship as a whole and the kind of research likely to be done by librarians is proposed. 'Evidence' from a number of disciplines including health sciences, business and education can be utilized by librarians and applied to their practice. However, access to and availability of librarianship literature needs to be further studied. While using other disciplines (e.g. EBHC) as a model for EBL has been explored in the literature, the authors develop models unique to librarianship. While research has always been a minor focus in the profession, moving research into practice is becoming more important and librarians need to consider the issues surrounding research in order to move EBL forward.

  20. From evidence based medicine to mechanism based medicine : Reviewing the role of pharmacogenetics

    NARCIS (Netherlands)

    Wilffert, Bob; Swen, Jesse; Mulder, Hans; Touw, Daan; Maitland-Van der Zee, Anke-Hilse; Deneer, Vera

    Aim of the review The translation of evidence based medicine to a specific patient presents a considerable challenge. We present by means of the examples nortriptyline, tramadol, clopidogrel, coumarins, abacavir and antipsychotics the discrepancy between available pharmacogenetic information and its

  1. From evidence based medicine to mechanism based medicine. Reviewing the role of pharmacogenetics

    NARCIS (Netherlands)

    Wilffert, Bob; Swen, Jesse; Mulder, Hans; Touw, Daan; Maitland-Van der Zee, Anke-Hilse; Deneer, Vera

    Aim of the review The translation of evidence based medicine to a specific patient presents a considerable challenge. We present by means of the examples nortriptyline, tramadol, clopidogrel, coumarins, abacavir and antipsychotics the discrepancy between available pharmacogenetic information and its

  2. Structure-property relationships of new bismuth and lead oxide based perovskite ternary solid solutions

    Science.gov (United States)

    Dwivedi, Akansha

    Two new bismuth and lead oxide based perovskite ternary solid solutions, namely xBi(Zn1/2Ti1/2)O3-yPbZrO3-zPbTiO3 [xBZT-yPZ-zPT] and xBi(Mg1/2Ti1/2)O3-yBi(Zn 1/2Ti1/2)O3-zPbTiO3 [xBMT-yBZT-zPT] have been developed and their structural and electrical properties have been determined. Various characterization techniques such as X-ray diffraction, calorimetery, electron microscopy, dielectric and piezoelectric measurements have been performed to determine the details of the phase diagram, crystal structure, and domain structure. The selection of these materials is based on the hypothesis that the presence of BZT-PT (Case I ferroelectric (FE)) will increase the transition temperature of MPB systems BMT-PT (Case II FE), and PZ-PT (Case III FE), and subsequently a MPB will be observed in the ternary phase diagrams. The Case I, II, and III classification has been outlined by Stringer et al., is on the basis of the transition temperatures (TC) behavior with composition in the Bi and Pb oxide based binary systems. Several pseudobinary lines have been investigated across the xBZT-yPZ-zPT ternary phase diagram which exhibit varied TC behavior with composition, showing both Case I- and Case III-like TC trends in different regions. A MPB between rhombohedral to tetragonal phases has been located on a pseudobinary line 0.1BZT-0.9[xPT-(1-x)PZ]. Compositions near MPB exhibit mainly soft PZT-like properties with the TC around 60°C lower than the unmodified PZT near its MPB. Electrical properties are reported for the MPB composition, TC = 325°C, Pr = 35 microC/cm2, d33 = 300 pC/N and kP =0.45. Rhombohedral compositions show diffuse phase transition with small frequency dispersion, similar to relaxors. Two transition peaks in the permittivity as well as in the latent heat has been observed in some compositions near the BZT-PT binary. This leads to the speculation for the existence of miscibility gap in the solid solutions in these regions. Transmission electron microscopy (TEM

  3. Evidence-based monitoring and evaluation of the faith-based ...

    African Journals Online (AJOL)

    Background: The Islamic Medical Association of Uganda, has been implementing the faith-based approach to HIV prevention without baseline data on expected positive outcomes. Objectives: To establish evidence-based baseline data on expected positive outcomes of the faith-based approach to HIV prevention. Methods: ...

  4. Flexible all solid-state supercapacitors based on chemical vapor deposition derived graphene fibers.

    Science.gov (United States)

    Li, Xinming; Zhao, Tianshuo; Chen, Qiao; Li, Peixu; Wang, Kunlin; Zhong, Minlin; Wei, Jinquan; Wu, Dehai; Wei, Bingqing; Zhu, Hongwei

    2013-11-07

    Flexible all-solid-state supercapacitors based on graphene fibers are demonstrated in this study. Surface-deposited oxide nanoparticles are used as pseudo-capacitor electrodes to achieve high capacitance. This supercapacitor electrode has an areal capacitance of 42 mF cm(-2), which is comparable to the capacitance for fiber-based supercapacitors reported to date. During the bending and cycling of the fiber-based supercapacitor, the stability could be maintained without sacrificing the electrochemical performance, which provides a novel and simple way to develop flexible, lightweight and efficient graphene-based devices.

  5. Educational evidence based interventions for adults with autism spectrum disorders: experimental evidence

    Directory of Open Access Journals (Sweden)

    Saverio Fontani

    2017-01-01

    Full Text Available The educational interventions for adults with autism spectrum disorders are a relatively unexplored topic, in the face of numerous studies on the educational intervention models for the child population. In this paper the results of major studies and meta-analysis on the topic are presented and their implications for educational intervention are discussed.Interventi educativi evidence based per adulti con disturbi dello spettro autistico: evidenze sperimentaliGli interventi educativi per adulti con Disturbi dello Spettro Autistico rappresentano un’area relativamente poco esplorata, a fronte di numerosi studi dedicati ai modelli di intervento educativo rivolti alla popolazione infantile. In questo articolo sono presentati i risultati dei principali studi e delle meta-analisi sul tema e vengono discusse le loro implicazioni per l’intervento educativo.

  6. Transforming lipid-based oral drug delivery systems into solid dosage forms: an overview of solid carriers, physicochemical properties, and biopharmaceutical performance.

    Science.gov (United States)

    Tan, Angel; Rao, Shasha; Prestidge, Clive A

    2013-12-01

    The diversity of lipid excipients available commercially has enabled versatile formulation design of lipid-based drug delivery systems for enhancing the oral absorption of poorly water-soluble drugs, such as emulsions, microemulsions, micelles, liposomes, niosomes and various self-emulsifying systems. The transformation of liquid lipid-based systems into solid dosage forms has been investigated for several decades, and has recently become a core subject of pharmaceutical research as solidification is regarded as viable means for stabilising lipid colloidal systems while eliminating stringent processing requirements associated with liquid systems. This review describes the types of pharmaceutical grade excipients (silica nanoparticle/microparticle, polysaccharide, polymer and protein-based materials) used as solid carriers and the current state of knowledge on the liquid-to-solid conversion approaches. Details are primarily focused on the solid-state physicochemical properties and redispersion capacity of various dry lipid-based formulations, and how these relate to the in vitro drug release and solubilisation, lipid carrier digestion and cell permeation performances. Numerous in vivo proof-of-concept studies are presented to highlight the viability of these dry lipid-based formulations. This review is significant in directing future research work in fostering translation of dry lipid-based formulations into clinical applications.

  7. Evidence Based Conservative Management of Patello-femoral Syndrome

    Directory of Open Access Journals (Sweden)

    E. Carlos Rodriguez-Merchan

    2014-03-01

    Full Text Available Background:   Patellofemoral pain syndrome (PFPS is defined as pain surrounding the patella when sitting with bent knees for prolonged periods of time or when performing activities like ascending or descending stairs, squatting or   athletic activities. Patella dislocation is not included in PFPS.     Purpose:   This review analyzes the evidence based conservative management of PFPS.   Methods:   A Cochrane Library search related to PFPS was performed until 18 January 2014. The key words were: patellofemoral pain syndrome. Eight papers were found, of which three were reviewed because they were focused   on the topic of the article. We also searched the PubMed using the following keywords: evidence based conservative   management of patellofemoral pain syndrome. Twelve articles were found, of which seven were reviewed because   they were focused on the topic of the article. Overall ten articles were analyzed.     Results:   Different treatments can be tried for PFPS, including pharmacotherapy, therapeutic ultrasound, exercise therapy, and taping and braces.     Conclusions:   Non-steroidal anti-inflammatory drugs (NSAIDs may reduce pain in the short term, but pain does not improve after three months. Therapeutic ultrasound appears not to have a clinically important effect on pain relief for   patients with PFPS. The evidence that exercise therapy is more effective in treating PFPS than no exercise is limited   with respect to pain reduction, and conflicting with respect to functional improvement. No significant difference has   been found between taping and non-taping. The role of knee braces is still controversial. More well-designed studies are needed.    

  8. Determining registered nurses' readiness for evidence-based practice.

    Science.gov (United States)

    Thiel, Linda; Ghosh, Yashowanto

    2008-01-01

    As health care systems worldwide move toward instituting evidence-based practice (EBP), its implementation can be challenging. Conducting a baseline assessment to determine nurses' readiness for EBP presents opportunities to plan strategies before implementation. Although a growing body of research literature is focused on implementing EBP, little attention has been paid to assessing nurses' readiness for EBP. The purpose of this study was to assess registered nurses' readiness for EBP in a moderate-sized acute care hospital in the Midwestern United States before implementation of a hospital-wide nursing EBP initiative. A descriptive cross-sectional survey design was used; 121 registered nurses completed the survey. The participants (n= 121) completed the 64-item Nurses' Readiness for Evidence-Based Practice Survey that allowed measurement of information needs, knowledge and skills, culture, and attitudes. Data were analyzed using descriptive statistics and a post hoc analysis. The majority (72.5%) of respondents indicated that when they needed information, they consulted colleagues and peers rather than using journals and books; 24% of nurses surveyed used the health database, Cumulative Index to Nursing & Allied Health Literature (CINAHL). The respondents perceived their EBP knowledge level as moderate. Cultural EBP scores were moderate, with unit scores being higher than organizational scores. The nurses' attitudes toward EBP were positive. The post hoc analysis showed many significant correlations. Nurses have access to technological resources and perceive that they have the ability to engage in basic information gathering but not in higher level evidence gathering. The elements important to EBP such as a workplace culture and positive attitudes are present and can be built upon. A "site-specific" baseline assessment provides direction in planning EBP initiatives. The Nurses' Readiness for EBP Survey is a streamlined tool with established reliability and

  9. Evidence based effects of yoga in neurological disorders.

    Science.gov (United States)

    Mooventhan, A; Nivethitha, L

    2017-09-01

    Though yoga is one of the widely used mind-body medicine for health promotion, disease prevention and as a possible treatment modality for neurological disorders, there is a lack of evidence-based review. Hence, we performed a comprehensive search in the PubMed/Medline electronic database to review relevant articles in English, using keywords "yoga and neurological disorder, yoga and multiple sclerosis, yoga and stroke, yoga and epilepsy, yoga and Parkinson's disease, yoga and dementia, yoga and cerebrovascular disease, yoga and Alzheimer disease, yoga and neuropathy, yoga and myelopathy, and yoga and Guillain-Barre syndrome". A total of 700 articles published from 1963 to 14th December 2016 were available. Of 700 articles, 94 articles were included in this review. Based on the available literature, it could be concluded that yoga might be considered as an effective adjuvant for the patients with various neurological disorders. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Evidence-based insulin treatment in type 1 diabetes mellitus

    DEFF Research Database (Denmark)

    Jacobsen, Iben Brock; Henriksen, J E; Hother-Nielsen, O

    2009-01-01

    AIM: Evaluation of the evidence base for recommending different insulin treatment regimens in type 1 diabetes. METHODS: A computerised literature survey was conducted using The Cochrane Controlled Trials Register and the Pub Med database for the period of 1982-2007. RESULTS: A meta-analysis on only...... 49 out of 1295 references showed that CSII compared with conventional or multiple insulin injections therapy demonstrated a significant reduction in mean HbA1c (primary outcome) of 1.2% CI [0.73; 1.59] (P... daily insulin injections was based on only one publication demonstrating an improved quality of life but no significant reduction in HbA1c or hypoglycaemia. A comparison of rapid-acting insulin analogues and human soluble insulin demonstrated a statistically significant reduction in HbA1c of 0.1% CI: [0...

  11. Pragmatic prevention of preterm birth and evidence based medicine.

    Science.gov (United States)

    Hoyme, Udo B

    2016-07-01

    Effective prevention of preterm birth is one of the unsolved problems in modern medicine. In the Thuringia campaign 2000 based on a simple screening with intravaginal pH self-measurements, adequate medical diagnosis and immediate antimicrobial therapy of genital infection, the rate of newborns ever seen in any of the German states. Therefore, the regime should be implicated as a necessary step of optimizing and rationalizing the health care system. However, in the discussion we had to learn that the best way to inhibit progress is to cope with problems by preferring the most complicated policies under persistent renunciation of simple solutions. As long as we do not have other alternative safe, simple and cheap methods, do we really have to wait even more decades to come for a prospectively randomized double-blinded almost impracticable study to convince the latest skeptical scientist that we have plenty of evidence-based means to reduce the incidence of premature birth, now, by decreasing infectious morbidity in pregnancy and by the same action childbed fever as well? Insisting scholastically on nothing but the 100 % pure evidence sometimes can hamper innovations and potential benefit. Would a similar caution ever had allowed us for instance to introduce handwashing according to Semmelweis? Good news, the Government of the State of Thuringia has decided this year to reestablish a pH selfcare screening programme.

  12. Proctalgia fugax, an evidence-based management pathway.

    Science.gov (United States)

    Jeyarajah, Santhini; Chow, Andre; Ziprin, Paul; Tilney, Henry; Purkayastha, Sanjay

    2010-09-01

    Proctalgia fugax (PF) is a benign anorectal condition which has been described in the literature since the nineteenth century commonly presenting to general surgeons. There is little high level evidence on the subject and its therapeutic modalities. We aimed through this systematic literature review to outline the definition and diagnostic criteria of this condition, the aetiology and differential diagnoses and describe the different treatment modalities that have been attempted and their success. A literature search of Google Scholar and Medline using Pubmed as the search engine was used to identify all studies directly related to the definition, aetiology and treatment options for this condition (latest at 12 August 2008) was performed. The search produced 61 references with three others obtained from the references of these papers. The prevalence of PF in the general population ranges from 4% to 18%. The diagnosis is based on the presence of characteristic symptoms as defined by Rome III guidelines and physical examination. The mainstay of treatment is reassurance and careful counselling with evidence in the literature for warm baths, topical treatment with glyceryl trinitrate or diltiazem and salbutamol inhalation. In persistent cases, local anaesthetic blocks, clonidine or Botox injections can be considered after clarification of risk and benefit. Based on this we suggest that diagnosis should be made through exclusion of common organic causes such as haemorrhoids, anal fissure or anorectal carcinoma and on the fulfillment of Rome III criteria. The main treatment for this benign condition remains reassurance and topical treatment.

  13. Improving the quality of the evidence base of health informatics.

    Science.gov (United States)

    Talmon, Jan

    2008-11-06

    Evaluation of health informatics technology has had attention from quite a few researchers in health informatics in the last few decades. In the early nineties of the past century several working groups and research projects have discussed evaluation methods and methodologies. Despite these activities, evaluation of health informatics has not received the recognition it deserves. In this presentation we will reiterate the arguments put forward in the Declaration of Innsbruck to consider evaluation an essential element of the evidence base of health informatics. Not only are evaluation studies essential, it is also required that such studies are properly reported. A joint effort of the IMIA, EFMI and AMIA working groups on evaluation has resulted in a guideline for reporting the results of evaluation studies of health informatics applications (STARE-HI). STARE-HI is currently endorsed by EFMI. The general assembly of IMIA has adopted STARE-HI as an official IMIA document. Endorsement from AMIA is being sought. A pilot study in which STARE-HI was applied to assess the quality of current reporting clearly indicates that there is quite some room for improvement. Application of guidelines such as STARE-HI would contribute to a further improvement of the evidence base of health informatics and would open the road for high quality reviews and meta-analyses.

  14. Evidence based guidelines for complex regional pain syndrome type 1

    Directory of Open Access Journals (Sweden)

    Thomassen-Hilgersom Ilona L

    2010-03-01

    Full Text Available Abstract Background Treatment of complex regional pain syndrome type I (CRPS-I is subject to discussion. The purpose of this study was to develop multidisciplinary guidelines for treatment of CRPS-I. Method A multidisciplinary task force graded literature evaluating treatment effects for CRPS-I according to their strength of evidence, published between 1980 to June 2005. Treatment recommendations based on the literature findings were formulated and formally approved by all Dutch professional associations involved in CRPS-I treatment. Results For pain treatment, the WHO analgesic ladder is advised with the exception of strong opioids. For neuropathic pain, anticonvulsants and tricyclic antidepressants may be considered. For inflammatory symptoms, free-radical scavengers (dimethylsulphoxide or acetylcysteine are advised. To promote peripheral blood flow, vasodilatory medication may be considered. Percutaneous sympathetic blockades may be used to increase blood flow in case vasodilatory medication has insufficient effect. To decrease functional limitations, standardised physiotherapy and occupational therapy are advised. To prevent the occurrence of CRPS-I after wrist fractures, vitamin C is recommended. Adequate perioperative analgesia, limitation of operating time, limited use of tourniquet, and use of regional anaesthetic techniques are recommended for secondary prevention of CRPS-I. Conclusions Based on the literature identified and the extent of evidence found for therapeutic interventions for CRPS-I, we conclude that further research is needed into each of the therapeutic modalities discussed in the guidelines.

  15. Evidence-Based Treatment of Delirium in Patients With Cancer

    Science.gov (United States)

    Breitbart, William; Alici, Yesne

    2012-01-01

    Delirium is the most common neuropsychiatric complication seen in patients with cancer, and it is associated with significant morbidity and mortality. Increased health care costs, prolonged hospital stays, and long-term cognitive decline are other well-recognized adverse outcomes of delirium. Improved recognition of delirium and early treatment are important in diminishing such morbidity. There has been an increasing number of studies published in the literature over the last 10 years regarding delirium treatment as well as prevention. Antipsychotics, cholinesterase inhibitors, and alpha-2 agonists are the three groups of medications that have been studied in randomized controlled trials in different patient populations. In patients with cancer, the evidence is most clearly supportive of short-term, low-dose use of antipsychotics for controlling the symptoms of delirium, with close monitoring for possible adverse effects, especially in older patients with multiple medical comorbidities. Nonpharmacologic interventions also appear to have a beneficial role in the treatment of patients with cancer who have or are at risk for delirium. This article presents evidence-based recommendations based on the results of pharmacologic and nonpharmacologic studies of the treatment and prevention of delirium. PMID:22412123

  16. Protocols for pressure ulcer prevention: are they evidence-based?

    Science.gov (United States)

    Chaves, Lidice M; Grypdonck, Mieke H F; Defloor, Tom

    2010-03-01

    This study is a report of a study to determine the quality of protocols for pressure ulcer prevention in home care in the Netherlands. If pressure ulcer prevention protocols are evidence-based and practitioners use them correctly in practice, this will result a reduction in pressure ulcers. Very little is known about the evidence-based content and quality of the pressure ulcer prevention protocols. In 2008, current pressure ulcer prevention protocols from 24 home-care agencies in the Netherlands were evaluated. A checklist developed and validated by two pressure ulcer prevention experts was used to assess the quality of the protocols, and weighted and unweighted quality scores were computed and analysed using descriptive statistics. The 24 pressure ulcer prevention protocols had a mean weighted quality score of 63.38 points out of a maximum of 100 (sd 5). The importance of observing the skin at the pressure points at least once a day was emphasized in 75% of the protocols. Only 42% correctly warned against the use of materials that were 'less effective or that could potentially cause harm'. Pressure ulcer prevention commands a reasonable amount of attention in home care, but the incidence of pressure ulcers and lack of a consistent, standardized document for use in actual practice indicate a need for systematic implementation of national pressure ulcer prevention standards in the Netherlands to ensure adherence to the established protocols.

  17. Edible fat structures at high solid fat concentrations: Evidence for the existence of oil-filled nanospaces

    Science.gov (United States)

    Peyronel, Fernanda; Quinn, Bonnie; Marangoni, Alejandro G.; Pink, David A.

    2015-01-01

    We have characterized the surfaces of grain boundaries in edible oils with high solid fat content by combining ultra-small angle x-ray scattering (USAXS) with theoretical modelling and computer simulation. Our results will lead to understand the solid structures formed at the time of manufacturing fats like confectionery fats as well as pave the way for the engineering of innovative fat products. Edible fats are complex semi-solid materials where a solid structure entraps liquid oil. It was not until USAXS combined with modelling was used that the nano- to meso-structures for systems with less than 20% solids were understood. The interpretation of those results utilized models of crystalline nanoplatelets represented by rigid close-packed flat aggregates made of spheres and was allowed to aggregate using the Metropolis Monte Carlo technique. Here, we report on systems containing between 50% and 90% solids. We modelled the solid phase as being formed from seeds onto which solids condensed thereby giving rise to oil-filled nanospaces. The models predicted that the system (a) exhibits structures with fractal dimensions approximately 2, (b) a broad peak somewhat masking that slope, and (c) for smaller values of q, indications that the structures with fractal dimension approximately 2 are uniformly distributed in space. The interpretation of the experimental data was completely driven by these results. The computer simulation predictions were used in conjunction with the USAXS observations to conclude that the systems studied scattered from oil-cavities with sizes between ˜800 and ˜16 000 Å and possessed rough 2-dimensional walls.

  18. Frequency of Testing for Dyslipidemia: An Evidence-Based Analysis

    Science.gov (United States)

    2014-01-01

    Background Dyslipidemias include high levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides and low levels of high-density lipoprotein (HDL) cholesterol. Dyslipidemia is a risk factor for cardiovascular disease, which is a major contributor to mortality in Canada. Approximately 23% of the 2009/11 Canadian Health Measures Survey (CHMS) participants had a high level of LDL cholesterol, with prevalence increasing with age, and approximately 15% had a total cholesterol to HDL ratio above the threshold. Objectives To evaluate the frequency of lipid testing in adults not diagnosed with dyslipidemia and in adults on treatment for dyslipidemia. Research Methods A systematic review of the literature set out to identify randomized controlled trials (RCTs), systematic reviews, health technology assessments (HTAs), and observational studies published between January 1, 2000, and November 29, 2012, that evaluated the frequency of testing for dyslipidemia in the 2 populations. Results Two observational studies assessed the frequency of lipid testing, 1 in individuals not on lipid-lowering medications and 1 in treated individuals. Both studies were based on previously collected data intended for a different objective and, therefore, no conclusions could be reached about the frequency of testing at intervals other than the ones used in the original studies. Given this limitation and generalizability issues, the quality of evidence was considered very low. No evidence for the frequency of lipid testing was identified in the 2 HTAs included. Canadian and international guidelines recommend testing for dyslipidemia in individuals at an increased risk for cardiovascular disease. The frequency of testing recommended is based on expert consensus. Conclusions Conclusions on the frequency of lipid testing could not be made based on the 2 observational studies. Current guidelines recommend lipid testing in adults with increased cardiovascular risk, with

  19. Implementing Prehospital Evidence-Based Guidelines: A Systematic Literature Review.

    Science.gov (United States)

    Fishe, Jennifer N; Crowe, Remle P; Cash, Rebecca E; Nudell, Nikiah G; Martin-Gill, Christian; Richards, Christopher T

    2018-01-19

    As prehospital research advances, more evidence-based guidelines (EBGs) are implemented into emergency medical services (EMS) practice. However, incomplete or suboptimal prehospital EBG implementation may hinder improvement in patient outcomes. To inform future efforts, this study's objective was to review existing evidence pertaining to prehospital EBG implementation methods. This study was a systematic literature review and evaluation following the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. PubMed, EMBASE, Scopus, and Google Advanced Search were searched without language or publication date filters for articles addressing prehospital EBG implementation. Conference proceedings, textbooks, and non-English articles were excluded. GRADE was applied to the remaining articles independently by three of five study investigators. Study characteristics and salient findings from the included articles are reported. The systematic literature review identified 1,367 articles, with 41 meeting inclusion criteria. Most articles described prehospital EBG implementation (n = 24, 59%), or implementation barriers (n = 13, 32%). Common study designs were statement documents (n = 12, 29%), retrospective cohort studies (n = 12, 29%), and cross-sectional studies (n = 9, 22%). Using GRADE, evidence quality was rated low (n = 18, 44%), or very low (n = 23, 56%). Salient findings from the articles included: (i) EBG adherence and patient outcomes depend upon successful implementation, (ii) published studies generally lack detailed implementation methods, (iii) EBG implementation takes longer than planned (mostly for EMS education), (iv) EMS systems' heterogeneity affects EBG implementation, and (v) multiple barriers limit successful implementation (e.g., financial constraints, equipment purchasing, coordination with hospitals, and regulatory agencies). This review found no direct evidence for best prehospital EBG implementation practices. There

  20. Synthesis of new solid polymer electrolyte and actuator based on PEDOT/NBR/ionic liquid

    Science.gov (United States)

    Cho, M. S.; Seo, H. J.; Nam, J. D.; Choi, H. R.; Koo, J. C.; Lee, Y.

    2006-03-01

    The conducting polymer actuator was presented. The solid polymer electrolyte based on nitrile rubber (NBR) activated with different ionic liquids was prepared. The three different grades of NBR films were synthesized by emulsion polymerization with different amount of acrylonitrile, 23, 35, and 40 mol. %, respectively. The effect of acrylonitrile content on the ionic conductivity and dielectric constant of solid polymer electrolytes was characterized. A conducting polymer, poly(3,4-ethylenedioxythiophene) (PEDOT), was synthesized on the surface of the NBR layer by using a chemical oxidation polymerization technique, and room temperature ionic liquids (RTIL) based on imidazolium salts, e.g. 1-butyl-3-methyl imidazolium X [where X= BF 4 -, PF 6 -, (CF 3SO II) IIN -], were absorbed into the composite film. The effects of the anion size of the ionic liquids on the displacement of the actuator were examined. The displacement increased with increasing the anion-size of the ionic liquids.

  1. The Estimation of Knowledge Solidity Based on the Comparative Analysis of Different Test Results

    Directory of Open Access Journals (Sweden)

    Y. K. Khenner

    2012-01-01

    Full Text Available At present, the testing techniques of knowledge estimation are widely spread in educational system. However, this method is seriously criticized including its application to the Unified State Examinations. The research is aimed at studying the limitations of testing techniques. The authors recommend a new way of knowledge solid- ity estimation bases on the comparative results analysis of various kinds of tests. While testing the large group of students, the authors found out that the results of the closed and open tests substantially differ. The comparative analysis demonstrates that the open tests assessment of the knowledge solidity is more adequate than that of the closed ones. As the research is only based on a single experiment, the authors recommend using this method further, substantiating the findings concerning the differences in tests results, and analyzing the advantages and disadvantages of the tests in question. 

  2. Fast Measurement of Soluble Solid Content in Mango Based on Visible and Infrared Spectroscopy Technique

    Science.gov (United States)

    Yu, Jiajia; He, Yong

    Mango is a kind of popular tropical fruit, and the soluble solid content is an important in this study visible and short-wave near-infrared spectroscopy (VIS/SWNIR) technique was applied. For sake of investigating the feasibility of using VIS/SWNIR spectroscopy to measure the soluble solid content in mango, and validating the performance of selected sensitive bands, for the calibration set was formed by 135 mango samples, while the remaining 45 mango samples for the prediction set. The combination of partial least squares and backpropagation artificial neural networks (PLS-BP) was used to calculate the prediction model based on raw spectrum data. Based on PLS-BP, the determination coefficient for prediction (Rp) was 0.757 and root mean square and the process is simple and easy to operate. Compared with the Partial least squares (PLS) result, the performance of PLS-BP is better.

  3. Valorization of Calcium Carbonate-Based Solid Wastes for the Treatment of Hydrogen Sulfide from the Gas Phase

    OpenAIRE

    Pham Xuan , Huynh; Pham Minh , Doan; Galera Martinez , Marta; Nzihou , Ange; Sharrock , Patrick

    2015-01-01

    International audience; This paper focuses on the valorization of calcium carbonate-based solid wastes for theremoval of hydrogen sulfide from gas phase. Two solid wastes taken from industrial sites for theproduction of sodium carbonate and sodium bicarbonate by the Solvay process® were analyzedby different physico-chemical methods. Calcium carbonate was found as the main component ofboth the solid wastes. Trace amounts of other elements such as Mg, Al, Fe, Si, Cl, Na etc. werealso present in...

  4. Clinicians adopting evidence based guidelines: a case study with thromboprophylaxis

    Directory of Open Access Journals (Sweden)

    Fry Margaret

    2011-09-01

    Full Text Available Abstract Background Venous Thromboembolism (VTE is a cause of hospital mortality and managing its morbidity is associated with significant expenditure. Uptake of evidenced based guideline recommendations intended to prevent VTE in hospital settings is sub-optimal. This study was conducted to explore clinicians' attitudes and the clinical environment in which they work to understand their reluctance to adopt VTE prophylaxis guidelines. Methods Between February and November 2009, 40 hospital employed doctors from 2 Australian metropolitan hospitals were interviewed in depth. Qualitative data were analysed according to thematic methodology. Results Analysis of interviews revealed that barriers to evidence based practice include i the fragmented system of care delivery where multiple members of teams and multiple teams are responsible for each patient's care, and in the case of VTE, where everyone shares responsibility and no-one in particular is responsible; ii the culture of practice where team practice is tailored to that of the team head, and where medicine is considered an 'art' in which guidelines should be adapted to each patient rather than applied universally. Interviewees recommend clear allocation of responsibility and reminders to counteract VTE risk assessment being overlooked. Conclusions Senior clinicians are the key enablers for practice change. They will need to be convinced that guideline compliance adds value to their patient care. Then with the support of systems in the organisation designed to minimize the effects of care fragmentation, they will drive practice changes in their teams. We believe that evidence based practice is only possible with a coordinated program that addresses individual, cultural and organisational constraints.

  5. Solid-state nuclear-spin quantum computer based on magnetic resonance force microscopy

    International Nuclear Information System (INIS)

    Berman, G. P.; Doolen, G. D.; Hammel, P. C.; Tsifrinovich, V. I.

    2000-01-01

    We propose a nuclear-spin quantum computer based on magnetic resonance force microscopy (MRFM). It is shown that an MRFM single-electron spin measurement provides three essential requirements for quantum computation in solids: (a) preparation of the ground state, (b) one- and two-qubit quantum logic gates, and (c) a measurement of the final state. The proposed quantum computer can operate at temperatures up to 1 K. (c) 2000 The American Physical Society

  6. Edge detection of solid motor' CT image based on gravitation model

    International Nuclear Information System (INIS)

    Yu Guanghui; Lu Hongyi; Zhu Min; Liu Xudong; Hou Zhiqiang

    2012-01-01

    In order to detect the edge of solid motor' CT image much better, a new edge detection operator base on gravitation model was put forward. The edge of CT image is got by the new operator. The superiority turned out by comparing the edge got by ordinary operator. The comparison among operators with different size shows that higher quality CT images need smaller size operator while the lower need the larger. (authors)

  7. The anatomy and relations of evidence-based medicine.

    Science.gov (United States)

    McDonald, I G; Daly, J M

    2000-06-01

    Current tensions between evidence-based medicine (EBM) and some clinicians are counterproductive and unnecessary. The most contentious issues concern (a) the limitations of efficacy data from randomised trials as evidence; (b) differences in attitudes to medical diagnosis and clinical judgement; and (c) political concerns about the use of the concept of clinical evidence and guidelines to restrict physician autonomy. Health services research has evolved in response to a bureaucratic need to study health care, including clinical practice, in order to improve its effectiveness (defined mainly in terms of technological interventions), and to contain costs. Its perspective is from the top-down representing the interests of bureaucracy and managed care, and articulates with political demands for professional accountability and cost-containment. EBM has established its place as an important contributor to the methodological toolbox for health services research. There is a need for a corresponding coherent programme of clinical practice research which would locate EBM in the clinical environment beside quality assurance, the study of the appropriateness and effectiveness of interventions, and multidisciplinary research related to the art of medicine and supportive aspects of clinical care. EBM would then be seen as one organ in relation to many others making their contribution to the body of knowledge needed for clinical decisions and policy making. A 'centre for the study of clinical practice' would be an appropriate structure to support such a comprehensive programme of clinical practice research in a tertiary hospital. The bottom-up perspective of clinical practice research would complement the current top-down perspective of most health services research, providing information to doctors, patients and administrators concerning local quality of care and health outcomes, information which could also be aggregated for guidance of health policy makers. It would also

  8. Ethical and Scientific Issues Surrounding Solid Organ Transplantation in Hiv-Positive Patients: Absence of Evidence Is Not Evidence of Absence

    Directory of Open Access Journals (Sweden)

    Timothy Christie

    2006-01-01

    Full Text Available End-stage liver disease is emerging as a leading cause of death among HIV-positive patients. Historically, an HIV diagnosis was a contraindication for a liver transplant; however, because of the efficacy of highly active antiretroviral therapy (HAART, HIV-positive patients have one-year, two-year, and three-year post-transplantation survival rates similar to that of HIV-negative patients. Based on this evidence, HIV-positive patients are now considered eligible for transplantation. However, newly emerging guidelines include the stipulation that HIV-positive patients must be on HAART to be placed on a waiting list for transplantation. The purpose of the present paper is to evaluate the scientific and ethical probity of requiring HIV-positive patients to be on HAART as a condition for being on a liver transplant waiting list. It is argued that the emphasis should be placed on the probability of post-transplantation HAART tolerance, and that concerns about pretransplantation HAART tolerance are of secondary importance.

  9. Physicochemical pretreatments and hydrolysis of furfural residues via carbon-based sulfonated solid acid.

    Science.gov (United States)

    Ma, Bao Jun; Sun, Yuan; Lin, Ke Ying; Li, Bing; Liu, Wan Yi

    2014-03-01

    Potential commercial physicochemical pretreatment methods, NaOH/microwave and NaOH/ultrasound were developed, and the carbon-based sulfonated solid acid catalysts were prepared for furfural residues conversion into reducing sugars. After the two optimum pretreatments, both the content of cellulose increased (74.03%, 72.28%, respectively) and the content of hemicellulose (94.11%, 94.17% of removal rate, respectively) and lignin (91.75%, 92.09% of removal rate, respectively) decreased in furfural residues. The reducing sugar yields of furfural residues with the two physicochemical pretreatments on coal tar-based solid acid reached 33.94% and 33.13%, respectively, higher than that pretreated via NaOH alone (27%) and comparable to that pretreated via NaOH/H2O2 (35.67%). The XRD patterns, IR spectra and SEM images show microwave and ultrasound improve the pretreatment effect. The results demonstrate the carbon-based sulfonated solid acids and the physicochemical pretreatments are green, effective, low-cost for furfural residues conversion. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. CSBB-ConeExclusion, adapting structure based solution virtual screening to libraries on solid support.

    Science.gov (United States)

    Shave, Steven; Auer, Manfred

    2013-12-23

    Combinatorial chemical libraries produced on solid support offer fast and cost-effective access to a large number of unique compounds. If such libraries are screened directly on-bead, the speed at which chemical space can be explored by chemists is much greater than that addressable using solution based synthesis and screening methods. Solution based screening has a large supporting body of software such as structure-based virtual screening tools which enable the prediction of protein-ligand complexes. Use of these techniques to predict the protein bound complexes of compounds synthesized on solid support neglects to take into account the conjugation site on the small molecule ligand. This may invalidate predicted binding modes, the linker may be clashing with protein atoms. We present CSBB-ConeExclusion, a methodology and computer program which provides a measure of the applicability of solution dockings to solid support. Output is given in the form of statistics for each docking pose, a unique 2D visualization method which can be used to determine applicability at a glance, and automatically generated PyMol scripts allowing visualization of protein atom incursion into a defined exclusion volume. CSBB-ConeExclusion is then exemplarically used to determine the optimum attachment point for a purine library targeting cyclin-dependent kinase 2 CDK2.

  11. Developing an evidence base for interdisciplinary learning: a systematic review.

    Science.gov (United States)

    Cooper, H; Carlisle, C; Gibbs, T; Watkins, C

    2001-07-01

    The overall aim of the study was to explore the feasibility of introducing interdisciplinary education within undergraduate health professional programmes. This paper reports on the first stage of the study in which a systematic review was conducted to summarize the evidence for interdisciplinary education of undergraduate health professional students. Systematic reviews integrate valid information providing a basis for rational decision making about health care which should be based on empirical and not anecdotal evidence. The accepted principles for systematic reviews were adapted in order to allow integration of the literature to produce recommendations for educational practice and guidelines for future research. The literature on interdisciplinary education was found to be diverse, including relatively small amounts of research data and much larger amounts of evaluation literature. Methodological rating schemes were used to test for confounding influences in the research studies. The number of studies found was 141 but only 30 (21%) were included in the analysis because of lack of methodological rigour in the research and poorly developed outcome measures. Student health professionals were found to benefit from interdisciplinary education with outcome effects primarily relating to changes in knowledge, skills, attitudes and beliefs. Effects upon professional practice were not discernible and educational and psychological theories were rarely used to guide the development of the educational interventions.

  12. Evidence-based post-exercise recovery strategies in basketball.

    Science.gov (United States)

    Calleja-González, Julio; Terrados, Nicolás; Mielgo-Ayuso, Juan; Delextrat, Anne; Jukic, Igor; Vaquera, Alejandro; Torres, Lorena; Schelling, Xavier; Stojanovic, Marko; Ostojic, Sergej M

    2016-01-01

    Basketball can be described as a moderate-to-long duration exercise including repeated bouts of high-intensity activity interspersed with periods of low to moderate active recovery or passive rest. A match is characterized by repeated explosive activities, such as sprints, jumps, shuffles and rapid changes in direction. In top-level modern basketball, players are frequently required to play consecutive matches with limited time to recover. To ensure adequate recovery after any basketball activity (i.e., match or training), it is necessary to know the type of fatigue induced and, if possible, its underlying mechanisms. Despite limited scientific evidence to support their effectiveness in facilitating optimal recovery, certain recovery strategies are commonly utilized in basketball. It is particularly important to optimize recovery because players spend a much greater proportion of their time recovering than they do in training. Therefore, the main aim of this report is to facilitate useful information that may lead to practical application, based on the scientific evidence and applied knowledge specifically in basketball.

  13. Vitiligo: concise evidence based guidelines on diagnosis and management.

    Science.gov (United States)

    Gawkrodger, David J; Ormerod, Anthony D; Shaw, Lindsay; Mauri-Sole, Inma; Whitton, Maxine E; Watts, M Jane; Anstey, Alex V; Ingham, Jane; Young, Katharine

    2010-08-01

    Vitiligo is a common disease that causes a great degree of psychological distress. In its classical forms it is easily recognised and diagnosed. This review provides an evidence based outline of the management of vitiligo, particularly with the non-specialist in mind. Treatments for vitiligo are generally unsatisfactory. The initial approach to a patient who is thought to have vitiligo is to make a definite diagnosis, offer psychological support, and suggest supportive treatments such as the use of camouflage cosmetics and sunscreens, or in some cases after discussion the option of no treatment. Active therapies open to the non-specialist, after an explanation of potential side effects, include the topical use of potent or highly potent steroids or calcineurin inhibitors for a defined period of time (usually 2 months), following which an assessment is made to establish whether or not there has been a response. Patients whose condition is difficult to diagnose, unresponsive to straightforward treatments, or is causing psychological distress, are usually referred to a dermatologist. Specialist dermatology units have at their disposal phototherapy, either narrow band ultraviolet B or in some cases photochemotherapy, which is the most effective treatment presently available and can be considered for symmetrical types of vitiligo. Depigmenting treatments and possibly surgical approaches may be appropriate for vitiligo in selected cases. There is no evidence that presently available systemic treatments are helpful and safe in vitiligo. There is a need for further research into the causes of vitiligo, and into discovering better treatments.

  14. DEVELOPMENT and TESTING OF A CEMENT-BASED SOLID WASTE FORM USING SYNTHETIC UP-1 GROUNDWATER

    International Nuclear Information System (INIS)

    COOKE, G.A.; LOCKREM, L.L.

    2006-01-01

    The Effluent Treatment Facility (ETF) in the 200 East Area of the Hanford Site is investigating the conversion of several liquid waste streams from evaporator operations into solid cement-based waste forms. The cement/waste mixture will be poured into plastic-lined mold boxes. After solidification the bags will be removed from the molds and sealed for land disposal at the Hanford Site. The RJ Lee Group, Inc. Center for Laboratory Sciences (CLS) at Columbia Basin College (CBC) was requested to develop and test a cementitious solids (CS) formulation to solidify evaporated groundwater brine, identified as UP-1, from Basin 43. Laboratory testing of cement/simulant mixtures is required to demonstrate the viability of cement formulations that reduce the overall cost, minimize bleed water and expansion, and provide suitable strength and cure temperature. Technical support provided mixing, testing, and reporting of values for a defined composite solid waste form. In this task, formulations utilizing Basin 43 simulant at varying wt% solids were explored. The initial mixing consisted of making small (∼ 300 g) batches and casting into 500-mL Nalgene(reg s ign) jars. The mixes were cured under adiabatic conditions and checked for bleed water and consistency at recorded time intervals over a 1-week period. After the results from the preliminary mixing, four formulations were selected for further study. The testing documentation included workability, bleed water analysis (volume and pH) after 24 hours, expansivity/shrinkage, compressive strength, and selected Toxicity Characteristic Leaching Procedure (TCLP) leach analytes of the resulting solid waste form

  15. Autopsy practice in forensic pathology - Evidence-based or experience-based?

    DEFF Research Database (Denmark)

    Colville-Ebeling, Bonnie; Freeman, Michael; Banner, Jytte

    2014-01-01

    Current autopsy practice in forensic pathology is to a large extent based on experience and individual customary practices as opposed to evidence and consensus based practices. As a result there is the potential for substantial variation in how knowledge is applied in each case. In the present case......-gathering and the use of check lists specific to certain injury causes are likely to result in less deviation from evidence-based practices in forensic pathology. Pre-autopsy data-gathering and check lists will help ensure a higher degree of standardization in autopsy reports thus enhancing the quality and accuracy...

  16. Palliative radiotherapy in head and neck cancers: Evidence based review

    Directory of Open Access Journals (Sweden)

    Talapatra Kaustav

    2006-01-01

    Full Text Available Squamous cell carcinoma of head and neck (SCCHN is one of the commonest cancers seen in India, constituting up to 25% of their overall cancer burden. Advanced SCCHN is a bad disease with a poor prognosis and patients usually die of uncontrolled loco-regional disease. Curative intent management of loco-regionally advanced SCCHN has become more evidence-based with active clinical research in the form of large prospective randomized controlled trials and meta-analyses. However, little has been written about palliative radiotherapy (PRT in head and neck cancers. It is widely recognized that PRT provides effective palliation and improved quality-of-life in advanced incurable malignancies. It is in this context that this study proposes to review the existing literature on palliative radiotherapy in advanced incurable SCCHN to help formulate consensus guidelines and recommendations.

  17. Is evidence-based medicine about democratizing medical practice?

    DEFF Research Database (Denmark)

    Thorgård, Keld

    2014-01-01

    The authoritarian standpoint in medicine has been under challenge by various groups and researchers since the 1980s. The challenges have been ethical, political and medical, with patient movements at the forefront. Over the past decade, however, a deep challenge has been posed by evidence......-based medicine (EBM), which has challenged the entire strategy of medical treatment from the point of view of a self-critical, anti-authoritarian and hereby also (it has been claimed) a more democratic medical practice. Previously, the challenges arose out of the patient rights perspective. EBM, by contrast......, was taken to challenge the way doctors consider their medical practice as a whole. The present paper puts this claim of democratization into a historical context. Two dimensions of the democratization hypothesis are discussed and it is argued that they are insufficient to capture the substantial changes...

  18. Pharmacologic management of neuropathic pain: Evidence-based recommendations

    DEFF Research Database (Denmark)

    Dworkin, Robert H.; O'Connor, Alec B.; Backonja, Miroslav

    2007-01-01

    Patients with neuropathic pain (NP) are challenging to manage and evidence-based clinical recommendations for pharmacologic management are needed. Systematic literature reviews, randomized clinical trials, and existing guidelines were evaluated at a consensus meeting. Medications were considered...... and pregabalin), and topical lidocaine. Opioid analgesics and tramadol are recommended as generally second-line treatments that can be considered for first-line use in select clinical circumstances. Other medications that would generally be used as third-line treatments but that could also be used as second......, and whether prompt onset of pain relief is necessary. To date, no medications have demonstrated efficacy in lumbosacral radiculopathy, which is probably the most common type of NP. Long-term studies, head-to-head comparisons between medications, studies involving combinations of medications, and RCTs...

  19. Evidence-based medicine and quality of care.

    Science.gov (United States)

    Dickenson, Donna; Vineis, Paolo

    2002-01-01

    In this paper we set out to examine the arguments for and against the claim that Evidence-Based Medicine (EBM) will improve the quality of care. In particular, we examine the following issues: 1. Are there hidden ethical assumptions in the methodology of EBM? 2. Is there a tension between the duty of care and EBM? 3. How can patient preferences be incorporated into quality guidelines and effectiveness studies? 4. Is there a tension between the quality of a particular intervention and overall quality of care? 5. Are certain branches of medicine and patient groups innately or prima facie disadvantaged by a shift to EBM? In addition we consider a case study in the ethics of EBM, on a clinical trial concerning the collection of umbilical cord blood in utero and ex utero, during or after labour in childbirth.

  20. Acute gastroenteritis: evidence-based management of pediatric patients [digest].

    Science.gov (United States)

    Brady, KeriAnne; Pade, Kathryn H

    2018-02-01

    Although most cases of acute gastroenteritis require minimal medical intervention, severe dehydration and hypoglycemia may develop in cases of prolonged vomiting and diarrhea. The mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis should be oral rehydration solution. Antiemetics allow for improved tolerance of oral rehydration solution, and, when used appropriately, can decrease the need for intravenous fluids and hospitalization. This issue reviews the common etiologies of acute gastroenteritis, discusses more-severe conditions that should be considered in the differential diagnosis, and provides evidence-based recommendations for management of acute gastroenteritis in patients with mild-to-moderate dehydration, severe dehydration, and hypoglycemia. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  1. Some issues related to evidence-based implantology

    Directory of Open Access Journals (Sweden)

    Gunnar E Carlsson

    2016-01-01

    Full Text Available This article reviews relevant dental literature to answer some frequent questions related to evidence-based implantology. There are hundreds of implant systems on the market, but the majority lack clinical documentation. Recommended number of implants for full-arch fixed prostheses is four or five in the mandible but at least six in the maxilla. Less expensive implant-retained overdentures make implant treatment available to a greater portion of edentulous subjects. Mandibular overdentures on two implants, and even one implant, have shown excellent long-term outcomes. In the maxilla, less than four implants are not recommended for good results. Single implant restorations have good prognosis, but placement of the implant should be postponed until adulthood. Osseointegrated implants have revolutionized clinical dentistry. However, in a global perspective, implants make up only a small part of all prosthodontic treatment. Knowledge and skill in conventional prosthodontics must be maintained as it will remain the most common part of the specialty.

  2. Social Workers’ Orientation Toward the Evidence-Based Practice Process

    Science.gov (United States)

    Kolmer, Deirdre M. Beneken genaamd; Schalk, René

    2014-01-01

    Objectives: This study assesses social workers’ orientation toward the evidence-based practice (EBP) process and explores which specific variables (e.g. age) are associated. Methods: Data were collected from 341 Dutch social workers through an online survey which included a Dutch translation of the EBP Process Assessment Scale (EBPPAS), along with 13 background/demographic questions. Results: The overall level of orientation toward the EBP process is relatively low. Although respondents are slightly familiar with it and have slightly positive attitudes about it, their intentions to engage in it and their actual engagement are relatively low. Respondents who followed a course on the EBP process as a student are more oriented toward it than those who did not. Social workers under 29 are more familiar with the EBP process than those over 29. Conclusions: We recommend educators to take a more active role in teaching the EBP process to students and social workers. PMID:27630517

  3. How do innovative students fit into evidence-based education?

    DEFF Research Database (Denmark)

    Lund, Birthe

    , competences and learning outcomes, all based on the assumption that assessing and testing student learning will improve learning, and furthermore, this is done without questioning whether the subject knowledge or competence to be developed are in fact possible to test or evaluate. This discourse is linked......This paper discusses pedagogical contradictions introduced on account of a conflict between the ‘global innovation discourse’ and the development of an ‘evidence discourse’ within the education policy that frames our understanding of “innovative students” in the Nordic countries. Two dominating...... and contradictory global education discourses have made a growing impact on education politics. The innovation discourse, which stresses the importance of generating ideas , creativity, innovation and, in general, the ability to make or bring something new into existence, in the form of solutions to problems...

  4. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium

    DEFF Research Database (Denmark)

    Aldecoa, César; Bettelli, Gabriella; Bilotta, Federico

    2017-01-01

    The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care, postoper...

  5. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium

    NARCIS (Netherlands)

    Aldecoa, César; Bettelli, Gabriella; Bilotta, Federico; Sanders, Robert D.; Audisio, Riccardo; Borozdina, Anastasia; Cherubini, Antonio; Jones, Christina; Kehlet, Henrik; Maclullich, Alasdair; Radtke, Finn; Riese, Florian; Slooter, Arjen J C; Veyckemans, Francis; Kramer, Sylvia; Neuner, Bruno; Weiss, Bjoern; Spies, Claudia D.

    2017-01-01

    The purpose of this guideline is to present evidence-based and consensus-based recommendations for the prevention and treatment of postoperative delirium. The cornerstones of the guideline are the preoperative identification and handling of patients at risk, adequate intraoperative care,

  6. Solid solution strengthening and diffusion in nickel- and cobalt-based superalloys

    Energy Technology Data Exchange (ETDEWEB)

    Rehman, Hamad ur

    2016-07-01

    Nickel and cobalt-based superalloys with a γ-γ{sup '} microstructure are known for their excellent creep resistance at high temperatures. Their microstructure is engineered using different alloying elements, that partition either to the fcc γ matrix or to the ordered γ{sup '} phase. In the present work the effect of alloying elements on their segregation behaviour in nickel-based superalloys, diffusion in cobalt-based superalloys and the temperature dependent solid solution strengthening in nickel-based alloys is investigated. The effect of dendritic segregation on the local mechanical properties of individual phases in the as-cast, heat treated and creep deformed state of a nickel-based superalloy is investigated. The local chemical composition is characterized using Electron Probe Micro Analysis and then correlated with the mechanical properties of individual phases using nanoindentation. Furthermore, the temperature dependant solid solution hardening contribution of Ta, W and Re towards fcc nickel is studied. The room temperature hardening is determined by a diffusion couple approach using nanoindentation and energy dispersive X-ray analysis for relating hardness to the chemical composition. The high temperature properties are determined using compression strain rate jump tests. The results show that at lower temperatures, the solute size is prevalent and the elements with the largest size difference with nickel, induce the greatest hardening consistent with a classical solid solution strengthening theory. At higher temperatures, the solutes interact with the dislocations such that the slowest diffusing solute poses maximal resistance to dislocation glide and climb. Lastly, the diffusion of different technically relevant solutes in fcc cobalt is investigated using diffusion couples. The results show that the large atoms diffuse faster in cobalt-based superalloys similar to their nickel-based counterparts.

  7. Solid solution strengthening and diffusion in nickel- and cobalt-based superalloys

    International Nuclear Information System (INIS)

    Rehman, Hamad ur

    2016-01-01

    Nickel and cobalt-based superalloys with a γ-γ ' microstructure are known for their excellent creep resistance at high temperatures. Their microstructure is engineered using different alloying elements, that partition either to the fcc γ matrix or to the ordered γ ' phase. In the present work the effect of alloying elements on their segregation behaviour in nickel-based superalloys, diffusion in cobalt-based superalloys and the temperature dependent solid solution strengthening in nickel-based alloys is investigated. The effect of dendritic segregation on the local mechanical properties of individual phases in the as-cast, heat treated and creep deformed state of a nickel-based superalloy is investigated. The local chemical composition is characterized using Electron Probe Micro Analysis and then correlated with the mechanical properties of individual phases using nanoindentation. Furthermore, the temperature dependant solid solution hardening contribution of Ta, W and Re towards fcc nickel is studied. The room temperature hardening is determined by a diffusion couple approach using nanoindentation and energy dispersive X-ray analysis for relating hardness to the chemical composition. The high temperature properties are determined using compression strain rate jump tests. The results show that at lower temperatures, the solute size is prevalent and the elements with the largest size difference with nickel, induce the greatest hardening consistent with a classical solid solution strengthening theory. At higher temperatures, the solutes interact with the dislocations such that the slowest diffusing solute poses maximal resistance to dislocation glide and climb. Lastly, the diffusion of different technically relevant solutes in fcc cobalt is investigated using diffusion couples. The results show that the large atoms diffuse faster in cobalt-based superalloys similar to their nickel-based counterparts.

  8. Barriers to compliance with evidence-based care in trauma.

    Science.gov (United States)

    Rayan, Nadine; Barnes, Sunni; Fleming, Neil; Kudyakov, Rustam; Ballard, David; Gentilello, Larry M; Shafi, Shahid

    2012-03-01

    We have preciously demonstrated that trauma patients receive less than two-thirds of the care recommended by evidence-based medicine. The purpose of this study was to identify patients least likely to receive optimal care. Records of a random sample of 774 patients admitted to a Level I trauma center (2006-2008) with moderate to severe injuries (Abbreviated Injury Scale score ≥3) were reviewed for compliance with 25 trauma-specific processes of care (T-POC) endorsed by Advanced Trauma Life Support, Eastern Association for the Surgery of Trauma, the Brain Trauma Foundation, Surgical Care Improvement Project, and the Glue Grant Consortium based on evidence or consensus. These encompassed all aspects of trauma care, including initial evaluation, resuscitation, operative care, critical care, rehabilitation, and injury prevention. Multivariate logistic regression was used to identify patients likely to receive recommended care. Study patients were eligible for a total of 2,603 T-POC, of which only 1,515 (58%) were provided to the patient. Compliance was highest for T-POC involving resuscitation (83%) and was lowest for neurosurgical interventions (17%). Increasing severity of head injuries was associated with lower compliance, while intensive care unit stay was associated with higher compliance. There was no relationship between compliance and patient demographics, socioeconomic status, overall injury severity, or daily volume of trauma admissions. Little over half of recommended care was delivered to trauma patients with moderate to severe injuries. Patients with increasing severity of traumatic brain injuries were least likely to receive optimal care. However, differences among patient subgroups are small in relation to the overall gap between observed and recommended care. II.

  9. Evidence-based and data-driven road safety management

    Directory of Open Access Journals (Sweden)

    Fred Wegman

    2015-07-01

    Full Text Available Over the past decades, road safety in highly-motorised countries has made significant progress. Although we have a fair understanding of the reasons for this progress, we don't have conclusive evidence for this. A new generation of road safety management approaches has entered road safety, starting when countries decided to guide themselves by setting quantitative targets (e.g. 50% less casualties in ten years' time. Setting realistic targets, designing strategies and action plans to achieve these targets and monitoring progress have resulted in more scientific research to support decision-making on these topics. Three subjects are key in this new approach of evidence-based and data-driven road safety management: ex-post and ex-ante evaluation of both individual interventions and intervention packages in road safety strategies, and transferability (external validity of the research results. In this article, we explore these subjects based on recent experiences in four jurisdictions (Western Australia, the Netherlands, Sweden and Switzerland. All four apply similar approaches and tools; differences are considered marginal. It is concluded that policy-making and political decisions were influenced to a great extent by the results of analysis and research. Nevertheless, to compensate for a relatively weak theoretical basis and to improve the power of this new approach, a number of issues will need further research. This includes ex-post and ex-ante evaluation, a better understanding of extrapolation of historical trends and the transferability of research results. This new approach cannot be realized without high-quality road safety data. Good data and knowledge are indispensable for this new and very promising approach.

  10. LEADING CHANGES IN ASSESSMENT USING AN EVIDENCE BASED APPROACH

    Directory of Open Access Journals (Sweden)

    J. O. Macaulay

    2015-08-01

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

  11. Discretionary-Based Disclosure: Evidence from the Brazilian Market

    Directory of Open Access Journals (Sweden)

    Fernando Dal-Ri Murcia

    2012-01-01

    Full Text Available The primary objective of this paper is to identify the factors that explain Brazilian companies’ level of voluntary disclosure. Underpinning this work is the Discretionary-based Disclosure theory. The sample is composed of the top 100 largest non-financial companies listed in the Bolsa de Valores de São Paulo (Brazilian Securities, Commodities, and Futures exchange - BOVESPA. Information was gathered from Financial Statements for the years ending in 2006, 2007, and 2008, with the use of content analysis. A disclosure framework based on 27 studies from these years was created, with a total of 92 voluntary items divided into two dimensions: economic (43 and socio-environmental (49. Based on the existing literature, a total of 12 hypotheses were elaborated and tested using a panel data approach. Results evidence that: (a Sector and Origin of Control are statistically significant in all three models tested: economic, socio-environmental, and total; (b ‘Profitability’ is relevant in the economic model and in the total model; (c Tobin’s Q is relevant in the socio-environmental model and in the total disclosure model; (d Leverage and Auditing Firm are only relevant in the economic disclosure model; (e Size, Governance, Stock Issuing, Growth Opportunities and Concentration of Control are not statistically significant in any of the three models.

  12. Leadership in evidence-based practice: a systematic review.

    Science.gov (United States)

    Reichenpfader, Ursula; Carlfjord, Siw; Nilsen, Per

    2015-01-01

    This study aims to systematically review published empirical research on leadership as a determinant for the implementation of evidence-based practice (EBP) and to investigate leadership conceptualization and operationalization in this field. A systematic review with narrative synthesis was conducted. Relevant electronic bibliographic databases and reference lists of pertinent review articles were searched. To be included, a study had to involve empirical research and refer to both leadership and EBP in health care. Study quality was assessed with a structured instrument based on study design. A total of 17 studies were included. Leadership was mostly viewed as a modifier for implementation success, acting through leadership support. Yet, there was definitional imprecision as well as conceptual inconsistency, and studies seemed to inadequately address situational and contextual factors. Although referring to an organizational factor, the concept was mostly analysed at the individual or group level. The concept of leadership in implementation science seems to be not fully developed. It is unclear whether attempts to tap the concept of leadership in available instruments truly capture and measure the full range of the diverse leadership elements at various levels. Research in implementation science would benefit from a better integration of research findings from other disciplinary fields. Once a more mature concept has been established, researchers in implementation science could proceed to further elaborate operationalization and measurement. Although the relevance of leadership in implementation science has been acknowledged, the conceptual base of leadership in this field has received only limited attention.

  13. X-ray photoelectron spectroscopy and paramagnetic resonance evidence for shock-induced intramolecular bond breaking in some energetic solids

    Science.gov (United States)

    Owens, F. J.; Sharma, J.

    1980-03-01

    Solid samples of 1,3,5, trinitro 1,3,5, triazacyclohexane (RDX), trinitrotoluene (TNT), and ammonium nitrate were subjected to shock pulses of strength and duration less than the threshold to cause detonation. The recovered shocked samples were studied by x-ray photoelectron spectroscopy (XPS) and electron paramagnetic resonance (EPR). The results of these measurements indicate that the shock pulse either broke or altered the internal bonds of the molecules of the solid. The results of the shock decomposition are compared with measurements of the uv and slow thermal decomposition of these materials using the same experimental techniques.

  14. Application progress of solid 29Si, 27Al NMR in the research of cement-based materials

    International Nuclear Information System (INIS)

    Feng Chunhua; Wang Xijian; Li Dongxu

    2014-01-01

    Background: The solid-state Nuclear Magnetic Resonance (NMR) is an effective method for the research of cement-based materials. Now it focuses on using solid 29 Si and 27 Al NMR to research the hydration structure of the cement-based materials in cement chemistry. Purpose: A theoretical guidance is proposed for solid 29 Si and 27 Al NMR technology used in cement chemistry research. Methods: We reviewed the application of solid 29 Si and 27 Al NMR in the cement-based materials and analyzed the problem among the researches. Results: This paper introduced an fundamental, relevant-conditions and basic parameters of NMR, and studied the technical parameters of solid 29 Si and 27 Ai NMR together with the relationship among the hydration structure of cement based material. Moreover, this paper reviewed the related domestic and overseas achievements in the research of hydration structure of the cement-based materials using solid 29 Si and 27 Al NMR. Conclusion: There were some problems in the research on cement-based materials by technology of solid 29 Si and 27 Al NMR. NMR will promote the Hydration theory of cement-based material greatly. (authors)

  15. CT assessment-based direct surgical resection of part-solid nodules with solid component larger than 5 mm without preoperative biopsy: experience at a single tertiary hospital

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Min [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Asan Medical Center, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Park, Chang Min; Song, Yong Sub; Kim, Hyungjin; Goo, Jin Mo [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Kim, Young Tae [Seoul National University College of Medicine, Department of Thoracic and Cardiovascular Surgery, Seoul (Korea, Republic of); Park, Young Sik [Seoul National University Hospital, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul (Korea, Republic of); Seoul National University College of Medicine, Department of Internal Medicine, Seoul (Korea, Republic of)

    2017-12-15

    To retrospectively evaluate the feasibility of CT assessment-based direct surgical resection of part-solid nodules (PSNs) with solid components > 5 mm without preoperative percutaneous transthoracic needle biopsies (PTNBs). From January 2009-December 2014, 85 PSNs with solid components > 5 mm on CT were included. Preoperative PTNBs were performed for 41 PSNs (biopsy group) and CT assessment-based direct resections were performed for 44 PSNs (direct surgery group). Diagnostic accuracy and complication rates of the groups were compared. Pathological results of 83 PSNs excluding two indeterminate nodules included 76 adenocarcinomas (91.6%), two adenocarcinomas in situ (2.4%) and five benign lesions (6.0%). In the biopsy group, the overall sensitivity, specificity and accuracy for the diagnosis of adenocarcinoma were 78.9% (30/38), 100% (1/1) and 79.5% (31/39), respectively. Pneumothorax and haemoptysis occurred in 11 procedures (26.8%). In the direct surgery group, the respective values for the diagnosis of adenocarcinoma were 100% (38/38), 0% (0/6) and 86.4% (38/44), respectively. Seven pneumothoraces (15.9%); no haemoptysis occurred during localization procedures. There were no significant differences in diagnostic accuracy (P = 0.559) between the two groups. CT assessment-based direct resection can be reasonable for PSNs with solid part > 5 mm. (orig.)

  16. CT assessment-based direct surgical resection of part-solid nodules with solid component larger than 5 mm without preoperative biopsy: experience at a single tertiary hospital

    International Nuclear Information System (INIS)

    Lee, Sang Min; Park, Chang Min; Song, Yong Sub; Kim, Hyungjin; Goo, Jin Mo; Kim, Young Tae; Park, Young Sik

    2017-01-01

    To retrospectively evaluate the feasibility of CT assessment-based direct surgical resection of part-solid nodules (PSNs) with solid components > 5 mm without preoperative percutaneous transthoracic needle biopsies (PTNBs). From January 2009-December 2014, 85 PSNs with solid components > 5 mm on CT were included. Preoperative PTNBs were performed for 41 PSNs (biopsy group) and CT assessment-based direct resections were performed for 44 PSNs (direct surgery group). Diagnostic accuracy and complication rates of the groups were compared. Pathological results of 83 PSNs excluding two indeterminate nodules included 76 adenocarcinomas (91.6%), two adenocarcinomas in situ (2.4%) and five benign lesions (6.0%). In the biopsy group, the overall sensitivity, specificity and accuracy for the diagnosis of adenocarcinoma were 78.9% (30/38), 100% (1/1) and 79.5% (31/39), respectively. Pneumothorax and haemoptysis occurred in 11 procedures (26.8%). In the direct surgery group, the respective values for the diagnosis of adenocarcinoma were 100% (38/38), 0% (0/6) and 86.4% (38/44), respectively. Seven pneumothoraces (15.9%); no haemoptysis occurred during localization procedures. There were no significant differences in diagnostic accuracy (P = 0.559) between the two groups. CT assessment-based direct resection can be reasonable for PSNs with solid part > 5 mm. (orig.)

  17. All-Solid-State Lithium-Sulfur Battery based on a nanoconfined LiBH 4 Electrolyte

    NARCIS (Netherlands)

    Das, Supti; Ngene, Peter; Norby, Poul; Vegge, Tejs; de Jongh, P.E.; Blanchard, Didier

    2016-01-01

    In this work we characterize all-solid-state lithium-sulfur batteries based on nano-confined LiBH4in mesoporous silica as solid electrolytes. The nano-confined LiBH4has fast ionic lithium conductivity at room temperature, 0.1 mScm-1, negligible electronic conductivity and its cationic transport

  18. Teaching evidence-based practice: developing a curriculum model to foster evidence-based practice in undergraduate student nurses.

    Science.gov (United States)

    Finotto, Stefano; Carpanoni, Marika; Turroni, Elena Casadei; Camellini, Riccarda; Mecugni, Daniela

    2013-09-01

    For the nature of the Evidence-Based Practice (EBP) and its relevance to nursing, the skills that it requires should be a component in the basic Nursing degree courses. For this reason, the EBP process should be introduced early on in nursing education to develop students' independence and ability to self-learning. the aim of this study is to describe the perception that newly graduated nurses have relative to the benefits of the skills learned during the laboratory's three-year EBP in consideration of the construction of the thesis, the research of evidence and usefulness of the EBP process for the development of their professional career. A descriptive study with a sample of 300 newly graduated nurses from the Degree Course in Nursing of the University of Modena and Reggio Emilia, venue of Reggio Emilia. The data collection instrument was an anonymous questionnaire. It was possible to answer through a 10 Likert scale. The sample considers effective the research of evidence carried out (mean 6, SD 2), related to the problems of patients (mean 7, SD 2); the sample considered the skills acquired during the laboratory's three-year EBP to be useful for career development (mean 7, SD 2). the decision to include the laboratory's three-year EBP in the curriculum of the Nursing degree promotes the development of skills relating to the use of the EBP process, competence that in the literature is indicated as one of the core competencies that all health professionals should develop and maintain throughout their professional career. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Decision fusion recognition based on modified evidence rule

    Institute of Scientific and Technical Information of China (English)

    黎湘; 刘永祥; 付耀文; 庄钊文

    2001-01-01

    A modified evidence combination rule with a combination parameter λ is proposed to solve some problems in D-S theory by considering the correlation and complement among the evidences as well as the size and intersection of subsets in evidence. It can get reasonable results even the evidences are conflicting. Applying this rule to the real infrared/millimetre wave fusion system, a satisfactory result has been obtained.

  20. Viscoelastic response of HTPB based solid fuel to horizontal and vertical storage slumping conditions and it's affect on service life

    International Nuclear Information System (INIS)

    Nawaz, Q.; Nizam, F.

    2011-01-01

    Frequent use of solid fuels as thrust generating energy source in modern day space vehicle systems has created a need to assess their serviceability for long term storage under various conditions. Solid fuel grain, the most important part of any solid fuel system, responds visco elastically to any loading condition. For the assessment of the service life of any solid fuel system, the solid fuel grain has to be structurally evaluated in applied storage conditions. Structural integrity of the grain is exceptionally significant to guarantee the successful operation of the solid fuel system. In this work, numerical simulations have been performed to assess the mechanical stresses and strains induced in an HTPB based solid fuel grain during service life employing ABAQUS standard FEA software using 4-node bilinear quadrilateral elements. For finite element analysis (FEA), typical 2-D and p/nth axisymmetric section of 5-point (n) star grain geometry is considered. Mechanical loads include the horizontal or vertical 1-g (solid fuel weight) storage condition. The simulation results are compared with the analytical results for the same grain geometry. Analytically measured slump deflections in grain segment at various storage times have been found in good relation with the FEA based simulation results. This proves the validity of the procedure adopted and is helpful in assessment of the service life of solid fuel systems. (author)

  1. All solid supercapacitor based on polyaniline and crosslinked sulfonated poly[ether ether ketone

    International Nuclear Information System (INIS)

    Sivaraman, P.; Kushwaha, R.K.; Shashidhara, K.; Hande, V.R.; Thakur, A.P.; Samui, A.B.; Khandpekar, M.M.

    2010-01-01

    All solid supercapacitor based on polyaniline (PANI) and crosslinked sulfonated poly[ether ether ketone] (XSPEEK,) is reported in this paper. The crosslinker used for sulfonated poly[ether ether ketone] (SPEEK) is 1,4-bis(hydroxymethyl) benzene. The XSPEEK is used as both solid electrolyte and separator membrane. Supercapacitors are fabricated using various PANI/XSPEEK weight ratios. These are characterized by cyclic voltammetry and galvanostatic charge-discharge studies. The supercapacitor with PANI/XSPEEK weight ratio 1:0.5, exhibit a specific capacitance of 480 F g -1 of PANI. To the best of authors' knowledge, the value reported here is the highest for a supercapacitor based on a proton conducting solid polymer electrolyte and PANI. Detailed electrochemical impedance spectroscopy analysis is carried out. The analysis shows that the complex capacitance of the supercapacitor depends on the XSPEEK content. The time constant (t 0 ), derived from the imaginary part of complex capacitance decreases with increase in the XSPEEK content in the supercapacitor. Cycle life characteristics of the supercapacitor show a decrease in specific capacitance during initial cycles and get stabilized during later cycles.

  2. Improving data retrieval quality: Evidence based medicine perspective.

    Science.gov (United States)

    Kamalov, M; Dobrynin, V; Balykina, J; Kolbin, A; Verbitskaya, E; Kasimova, M

    2015-01-01

    The actively developing approach in modern medicine is the approach focused on principles of evidence-based medicine. The assessment of quality and reliability of studies is needed. However, in some cases studies corresponding to the first level of evidence may contain errors in randomized control trials (RCTs). Solution of the problem is the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Studies both in the fields of medicine and information retrieval are conducted for developing search engines for the MEDLINE database [1]; combined techniques for summarization and information retrieval targeted to solving problems of finding the best medication based on the levels of evidence are being developed [2]. Based on the relevance and demand for studies both in the field of medicine and information retrieval, it was decided to start the development of a search engine for the MEDLINE database search on the basis of the Saint-Petersburg State University with the support of Pavlov First Saint-Petersburg State Medical University and Tashkent Institute of Postgraduate Medical Education. Novelty and value of the proposed system are characterized by the use of ranking method of relevant abstracts. It is suggested that the system will be able to perform ranking based on studies level of evidence and to apply GRADE criteria for system evaluation. The assigned task falls within the domain of information retrieval and machine learning. Based on the results of implementation from previous work [3], in which the main goal was to cluster abstracts from MEDLINE database by subtypes of medical interventions, a set of algorithms for clustering in this study was selected: K-means, K-means ++, EM from the sklearn (http://scikit-learn.org) and WEKA (http://www.cs.waikato.ac.nz/~ml/weka/) libraries, together with the methods of Latent Semantic Analysis (LSA) [4] choosing the first 210 facts and the model "bag of words" [5] to represent clustered documents

  3. A computational and cellular solids approach to the stiffness-based design of bone scaffolds.

    Science.gov (United States)

    Norato, J A; Wagoner Johnson, A J

    2011-09-01

    We derive a cellular solids approach to the design of bone scaffolds for stiffness and pore size. Specifically, we focus on scaffolds made of stacked, alternating, orthogonal layers of hydroxyapatite rods, such as those obtained via micro-robotic deposition, and aim to determine the rod diameter, spacing and overlap required to obtain specified elastic moduli and pore size. To validate and calibrate the cellular solids model, we employ a finite element model and determine the effective scaffold moduli via numerical homogenization. In order to perform an efficient, automated execution of the numerical studies, we employ a geometry projection method so that analyses corresponding to different scaffold dimensions can be performed on a fixed, non-conforming mesh. Based on the developed model, we provide design charts to aid in the selection of rod diameter, spacing and overlap to be used in the robotic deposition to attain desired elastic moduli and pore size.

  4. Synthesis of methyl esters from waste cooking oil using construction waste material as solid base catalyst.

    Science.gov (United States)

    Balakrishnan, K; Olutoye, M A; Hameed, B H

    2013-01-01

    The current research investigates synthesis of methyl esters by transesterification of waste cooking oil in a heterogeneous system, using barium meliorated construction site waste marble as solid base catalyst. The pretreated catalyst was calcined at 830 °C for 4h prior to its activity test to obtained solid oxide characterized by scanning electron microscopy/energy dispersive spectroscopy, BET surface area and pore size measurement. It was found that the as prepared catalyst has large pores which contributed to its high activity in transesterification reaction. The methyl ester yield of 88% was obtained when the methanol/oil molar ratio was 9:1, reaction temperature at 65 °C, reaction time 3h and catalyst/oil mass ratio of 3.0 wt.%. The catalyst can be reused over three cycles, offer low operating conditions, reduce energy consumption and waste generation in the production of biodiesel. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. Numerical simulation of polishing U-tube based on solid-liquid two-phase

    Science.gov (United States)

    Li, Jun-ye; Meng, Wen-qing; Wu, Gui-ling; Hu, Jing-lei; Wang, Bao-zuo

    2018-03-01

    As the advanced technology to solve the ultra-precision machining of small hole structure parts and complex cavity parts, the abrasive grain flow processing technology has the characteristics of high efficiency, high quality and low cost. So this technology in many areas of precision machining has an important role. Based on the theory of solid-liquid two-phase flow coupling, a solid-liquid two-phase MIXTURE model is used to simulate the abrasive flow polishing process on the inner surface of U-tube, and the temperature, turbulent viscosity and turbulent dissipation rate in the process of abrasive flow machining of U-tube were compared and analyzed under different inlet pressure. In this paper, the influence of different inlet pressure on the surface quality of the workpiece during abrasive flow machining is studied and discussed, which provides a theoretical basis for the research of abrasive flow machining process.

  6. Household air pollution from solid fuel use and risk of adverse pregnancy outcomes: a systematic review and meta-analysis of the empirical evidence.

    Science.gov (United States)

    Amegah, Adeladza K; Quansah, Reginald; Jaakkola, Jouni J K

    2014-01-01

    About 41% of households globally, mainly in developing countries rely on solid fuels for cooking with consequences for fetal growth and development. Previous reviews were limited in scope, assessing only two outcomes (birth weight, stillbirth). With important evidence accumulating, there is a need to improve the previous estimates and assess additional outcomes. We conducted a systematic review and meta-analysis to evaluate the quality and strength of available evidence on household air pollution (HAP) and the whole range of adverse pregnancy outcomes. PubMed, Ovid Medline, Scopus and CINAHL were searched from their inception to the end of April 2013. All epidemiological study designs were eligible for inclusion in the review. The random-effects model was applied in computing the summary-effect estimates (EE) and their corresponding 95% confidence interval (CI). Of 1505 studies screened, 19 studies satisfied the inclusion criteria. Household combustion of solid fuels resulted in an 86.43 g (95% CI: 55.49, 117.37) reduction in birth weight, and a 35% (EE = 1.35, 95% CI: 1.23, 1.48) and 29% (EE = 1.29, 95% CI: 1.18, 1.41) increased risk of LBW and stillbirth respectively. Combustion of solid fuels at home increases the risk of a wide range of adverse pregnancy outcomes. Access to clean household energy solutions is the surest way to combat HAP and mitigate their adverse effects.

  7. Nitridated fibrous silica (KCC-1) as a sustainable solid base nanocatalyst

    KAUST Repository

    Bouhrara, Mohamed; Ranga, Chanakya; Fihri, Aziz; Shaikh, Rafik; Sarawade, Pradip; Emwas, Abdul-Hamid M.; Hedhili, Mohamed N.; Polshettiwar, Vivek

    2013-01-01

    We observed that support morphology has dramatic effects on the performance of nitridated silica as a base. By simply replacing conventional silica supports (such as SBA-15 and MCM-41) with fibrous nanosilica (KCC-1), we observed multifold enhancement in the catalytic activity of the nitridated solid base for Knoevenagel condensations and transesterification reactions. This enhancement of the activity can be explained by amine accessibility, which is excellent in KCC-1 due to its open and flexible fibrous structure, that facilitates penetration and interaction with basic amine sites. © 2013 American Chemical Society.

  8. Theory of normal and superconducting properties of fullerene-based solids

    International Nuclear Information System (INIS)

    Cohen, M.L.

    1992-10-01

    Recent experiments on the normal-state and superconducting properties of fullerene-based solids are used to constrain the proposal theories of the electronic nature of these materials. In general, models of superconductivity based on electron pairing induced by phonons are consistent with electronic band theory. The latter experiments also yield estimates of the parameters characterizing these type H superconductors. It is argued that, at this point, a ''standard model'' of phonons interacting with itinerant electrons may be a good first approximation for explaining the properties of the metallic fullerenes

  9. Nitridated fibrous silica (KCC-1) as a sustainable solid base nanocatalyst

    KAUST Repository

    Bouhrara, Mohamed

    2013-09-03

    We observed that support morphology has dramatic effects on the performance of nitridated silica as a base. By simply replacing conventional silica supports (such as SBA-15 and MCM-41) with fibrous nanosilica (KCC-1), we observed multifold enhancement in the catalytic activity of the nitridated solid base for Knoevenagel condensations and transesterification reactions. This enhancement of the activity can be explained by amine accessibility, which is excellent in KCC-1 due to its open and flexible fibrous structure, that facilitates penetration and interaction with basic amine sites. © 2013 American Chemical Society.

  10. Fast-track Orthognathic Surgery: An Evidence-based Review

    Science.gov (United States)

    Otero, Joel Joshi; Detriche, Olivier; Mommaerts, Maurice Yves

    2017-01-01

    The aim of this study was to establish a fast-track protocol for bimaxillary orthognathic surgery (OGS). Fast-track surgery (FTS) is a multidisciplinary approach where the pre-, intra-, and postoperative management is focusing maximally on a quick patient recovery and early discharge. To enable this, the patients’ presurgical stress and postsurgical discomfort should be maximally reduced. Both referral patterns and expenses within the health-care system are positively influenced by FTS. University hospital-literature review through Medline, Embase, and the Cochrane Library (January 2000–July 2016) using the following words – “fast track, enhanced recovery, multimodal, and perioperative care” – to define a protocol evidence based for OGS, as well as evidenced-based medicine search of every term added to the protocol during the same period. The process has resulted in an OGS protocol that may improve the outcome of the patient through several nonoperative and operative measures such as preoperative patient education and intra/postoperative measures that should improve overall patient satisfaction, decrease morbidity such as postoperative nausea, headache, dizziness, pain, and intubation discomfort, and shorten hospital stay. A literature review allowed us to fine-tune a fast-track protocol for uncomplicated OGS that can be prospectively studied against currently applied ones. PMID:29264281

  11. Incorporating Mobile Phone Technologies to Expand Evidence-Based Care.

    Science.gov (United States)

    Jones, Deborah J; Anton, Margaret; Gonzalez, Michelle; Honeycutt, Amanda; Khavjou, Olga; Forehand, Rex; Parent, Justin

    2015-08-01

    Ownership of mobile phones is on the rise, a trend in uptake that transcends age, region, race, and ethnicity, as well as income. It is precisely the emerging ubiquity of mobile phones that has sparked enthusiasm regarding their capacity to increase the reach and impact of health care, including mental health care. Community-based clinicians charged with transporting evidence-based interventions beyond research and training clinics are in turn, ideally and uniquely situated to capitalize on mobile phone uptake and functionality to bridge the efficacy to effectiveness gap. As such, this article delineates key considerations to guide these frontline clinicians in mobile phone-enhanced clinical practice, including an overview of industry data on the uptake of and evolution in the functionality of mobile phone platforms, conceptual considerations relevant to the integration of mobile phones into practice, representative empirical illustrations of mobile-phone enhanced assessment and treatment, and practical considerations relevant to ensuring the feasibility and sustainability of such an approach.

  12. An evidence-based conceptual framework of healthy cooking

    Directory of Open Access Journals (Sweden)

    Margaret Raber

    2016-12-01

    Full Text Available Eating out of the home has been positively associated with body weight, obesity, and poor diet quality. While cooking at home has declined steadily over the last several decades, the benefits of home cooking have gained attention in recent years and many healthy cooking projects have emerged around the United States. The purpose of this study was to develop an evidence-based conceptual framework of healthy cooking behavior in relation to chronic disease prevention. A systematic review of the literature was undertaken using broad search terms. Studies analyzing the impact of cooking behaviors across a range of disciplines were included. Experts in the field reviewed the resulting constructs in a small focus group. The model was developed from the extant literature on the subject with 59 studies informing 5 individual constructs (frequency, techniques and methods, minimal usage, flavoring, and ingredient additions/replacements, further defined by a series of individual behaviors. Face validity of these constructs was supported by the focus group. A validated conceptual model is a significant step toward better understanding the relationship between cooking, disease and disease prevention and may serve as a base for future assessment tools and curricula.

  13. Incorporating Mobile Phone Technologies to Expand Evidence-Based Care

    Science.gov (United States)

    Jones, Deborah J.; Anton, Margaret; Gonzalez, Michelle; Honeycutt, Amanda; Khavjou, Olga; Forehand, Rex; Parent, Justin

    2014-01-01

    Ownership of mobile phones is on the rise, a trend in uptake that transcends age, region, race, and ethnicity, as well as income. It is precisely the emerging ubiquity of mobile phones that has sparked enthusiasm regarding their capacity to increase the reach and impact of health care, including mental health care. Community-based clinicians charged with transporting evidence-based interventions beyond research and training clinics are in turn, ideally and uniquely situated to capitalize on mobile phone uptake and functionality to bridge the efficacy to effectiveness gap. As such, this article delineates key considerations to guide these frontline clinicians in mobile phone-enhanced clinical practice, including an overview of industry data on the uptake of and evolution in the functionality of mobile phone platforms, conceptual considerations relevant to the integration of mobile phones into practice, representative empirical illustrations of mobile-phone enhanced assessment and treatment, and practical considerations relevant to ensuring the feasibility and sustainability of such an approach. PMID:26213458

  14. [Evidence-based medicine and French medical students: an appraisal].

    Science.gov (United States)

    Orsat, M; Bigot, P; Rouprêt, M; Campillo, B; Beley, S; Chautard, D; Beaufreton, C; Richard, I; Saint-André, J-P; Azzouzi, A-R

    2009-03-01

    Nowadays, evidence-based medicine (EBM) is essential to learn and to practice medicine. The aim of the current study was to investigate the baseline level of knowledge of French students regarding EBM. Between April and May2008, a questionnaire was sent by e-mail to 900students in their last year of medical study. On 327 answers, 297 (91%), 94 (29%) and 85 (26%) students declared they read, write and speak medical English. Ninety (28%) read an article of a French medical review once a month and 43 (13%) read an article of an international medical review once a month. Three hundred and eleven (95%) knew the bases of medical research on the Internet and 219 (67%) used them. Twenty-four (7%) had already participated in a editorial staff of a medical article, 7 (2%) had been co-authors. Two hundred and seventy-two (83%) had made an oral presentation during a medical staff and 3 (1%) during a congress. Finally, 237 (73%) understood the interest of the critical analysis of an article at the ECN and 70 (21%) thought they were prepared. The incapacity of learning EBM is one of the limits of the French medical training system. The introduction of the reading critical of an article at the ECN is the concrete beginning of an answer to this problem.

  15. Evidence-based decision making in health care settings: from theory to practice.

    Science.gov (United States)

    Kohn, Melanie Kazman; Berta, Whitney; Langley, Ann; Davis, David

    2011-01-01

    The relatively recent attention that evidence-based decision making has received in health care management has been at least in part due to the profound influence of evidence-based medicine. The result has been several comparisons in the literature between the use of evidence in health care management decisions and the use of evidence in medical decision making. Direct comparison, however, may be problematic, given the differences between medicine and management as they relate to (1) the nature of evidence that is brought to bear on decision making; (2) the maturity of empirical research in each field (in particular, studies that have substantiated whether or not and how evidence-based decision making is enacted); and (3) the context within which evidence-based decisions are made. By simultaneously reviewing evidence-based medicine and management, this chapter aims to inform future theorizing and empirical research on evidence-based decision making in health care settings.

  16. Encouraging appropriate, evidence-based use of oral nutritional supplements.

    Science.gov (United States)

    Stratton, Rebecca J; Elia, Marinos

    2010-11-01

    With the considerable cost of disease-related malnutrition to individuals and to society (estimated to be >£13×109 for the UK, 2007 prices), there is a need for effective and evidence-based ways of preventing and treating this condition. The wide range of oral nutritional supplements that may be prescribed for the dietary management of malnutrition and other conditions account for only about 1% (about £99×106, 2007 data) of the prescribing budget in England. Systematic reviews and meta-analyses consistently suggest that ready-made, multi-nutrient liquids which may be prescribed can improve energy and nutritional intake, body weight and have a variety of clinical and functional benefits in a number of patient groups. Meta-analyses have repeatedly shown that oral nutritional supplements produce significant reductions in complications (e.g. infections) and mortality, and a recent meta-analysis shows a reduction in hospital admissions (OR 0·56 (95% CI 0·41, 0·77), six randomised controlled trials). Such benefits suggest that the appropriate use of oral nutritional supplements should form an integral part of the management of malnutrition, particularly as there is currently a lack of evidence for alternative oral nutrition strategies (e.g. food fortification and counselling). As with all therapies, compliance to oral nutritional supplements needs to be maximised and the use monitored. To make sure that those at risk of malnutrition are identified and treated appropriately, there is a need to embed national and local policies into routine clinical practice. In doing so, the economic burden of this costly condition can be curtailed. As recently suggested by the National Institute for Health and Clinical Excellence, substantial cost savings could be made if screening and treatment of malnourished patients was undertaken.

  17. Evidence-based clinical guidelines in Kyrgyz Republic.

    Science.gov (United States)

    Zurdinova, A A

    2015-01-01

    Improving quality of care in many countries is one of the priorities of health systems. At the same time one of the most important methods of improving quality of care is the widespread use of methods and principles of evidence-based medicine (EBM) [1]. The implementation of EBM in public health practice provides for the optimization of quality of care in terms of safety, efficacy and cost, one way of which is the use of clinical guidelines. Clinical guidelines developed with the use of EBM, provide an opportunity to use the latest and accurate information to optimize or neutralize impact on physician decision-making of subjective factors such as intuition, expertise, opinion of respected colleagues, recommendations of popular manuals and handbooks, etc. To assess and analyze the developed clinical guidelines (CG) and protocols (CP) in the Kyrgyz Republic in the period from 2008 to 2014 and evaluate their implementation in practical healthcare. Retrospective analysis of the developed clinical guidelines and protocols according to the approved methodology, interviewing leaders, questioning doctors and patients for their implementation. All participants gave informed consent for voluntary participation in the study. Within the framework of the National Program "Manas Taalimi" "Strategy for development of evidence-based medicine in the Kyrgyz Republic for 2006-2010" (MOH Order №490 from 09.04.06) was developed and approved for use. Its main purpose was to create a sustainable system of development, deployment and monitoring of the CG and CP and further promotion of EBM into practical health care, education and science. As a result, a number of documents ("Expert Council for assessing the quality of clinical guidelines/protocols", "AGREE instrument to assess the methodological content of clinical guidelines" [2], "The methodology of development and adaptation of clinical guidelines based on evidence-based medicine") were approved by the Order of the Ministry of

  18. Formulation and Testing of Paraffin-Based Solid Fuels Containing Energetic Additives for Hybrid Rockets

    Science.gov (United States)

    Larson, Daniel B.; Boyer, Eric; Wachs,Trevor; Kuo, Kenneth K.; Story, George

    2012-01-01

    Many approaches have been considered in an effort to improve the regression rate of solid fuels for hybrid rocket applications. One promising method is to use a fuel with a fast burning rate such as paraffin wax; however, additional performance increases to the fuel regression rate are necessary to make the fuel a viable candidate to replace current launch propulsion systems. The addition of energetic and/or nano-sized particles is one way to increase mass-burning rates of the solid fuels and increase the overall performance of the hybrid rocket motor.1,2 Several paraffin-based fuel grains with various energetic additives (e.g., lithium aluminum hydride (LiAlH4) have been cast in an attempt to improve regression rates. There are two major advantages to introducing LiAlH4 additive into the solid fuel matrix: 1) the increased characteristic velocity, 2) decreased dependency of Isp on oxidizer-to-fuel ratio. The testing and characterization of these solid-fuel grains have shown that continued work is necessary to eliminate unburned/unreacted fuel in downstream sections of the test apparatus.3 Changes to the fuel matrix include higher melting point wax and smaller energetic additive particles. The reduction in particle size through various methods can result in more homogeneous grain structure. The higher melting point wax can serve to reduce the melt-layer thickness, allowing the LiAlH4 particles to react closer to the burning surface, thus increasing the heat feedback rate and fuel regression rate. In addition to the formulation of LiAlH4 and paraffin wax solid-fuel grains, liquid additives of triethylaluminum and diisobutylaluminum hydride will be included in this study. Another promising fuel formulation consideration is to incorporate a small percentage of RDX as an additive to paraffin. A novel casting technique will be used by dissolving RDX in a solvent to crystallize the energetic additive. After dissolving the RDX in a solvent chosen for its compatibility

  19. A Quantitative Analysis of Evidence-Based Testing Practices in Nursing Education

    Science.gov (United States)

    Moore, Wendy

    2017-01-01

    The focus of this dissertation is evidence-based testing practices in nursing education. Specifically, this research study explored the implementation of evidence-based testing practices between nursing faculty of various experience levels. While the significance of evidence-based testing in nursing education is well documented, little is known…

  20. Child debriefing: a review of the evidence base.

    Science.gov (United States)

    Pfefferbaum, Betty; Jacobs, Anne K; Nitiéma, Pascal; Everly, George S

    2015-06-01

    Debriefing, a controversial crisis intervention delivered in the early aftermath of a disaster, has not been well evaluated for use with children and adolescents. This report constitutes a review of the child debriefing evidence base. A systematic search of selected bibliographic databases (EBM Reviews, EMBASE, ERIC, Medline, Ovid, PILOTS, PubMed, and PsycINFO) was conducted in the spring of 2014 using search terms related to psychological debriefing. The search was limited to English language sources and studies of youth, aged 0 to 18 years. No time limit was placed on date of publication. The search yielded 713 references. Titles and abstracts were reviewed to select publications describing scientific studies and clinical reports. Reference sections of these publications, and of other literature known to the authors that was not generated by the search, were used to locate additional materials. Review of these materials generated 187 publications for more thorough examination; this assessment yielded a total of 91 references on debriefing in children and adolescents. Only 15 publications on debriefing in children and adolescents described empirical studies. Due to a lack of statistical analysis of effectiveness data with youth, and some articles describing the same study, only seven empirical studies described in nine papers were identified for analysis for this review. These studies were evaluated using criteria for assessment of methodological rigor in debriefing studies. Children and adolescents included in the seven empirical debriefing studies were survivors of motor-vehicle accidents, a maritime disaster, hostage taking, war, or peer suicides. The nine papers describing the seven studies were characterized by inconsistency in describing the interventions and populations and by a lack of information on intervention fidelity. Few of the studies used randomized design or blinded assessment. The results described in the reviewed studies were mixed in regard to