WorldWideScience

Sample records for strong evidence base

  1. Starting Strong: Evidence-­Based Early Literacy Practices

    Science.gov (United States)

    Blamey, Katrin; Beauchat, Katherine

    2016-01-01

    Four evidence-based instructional approaches create an essential resource for any early literacy teacher or coach. Improve your teaching practices in all areas of early literacy. Use four proven instructional approaches--standards based, evidenced based, assessment based, and student based--to improve their teaching practice in all areas of early…

  2. Treatment of chronic pain in older people: Evidence-based choice of strong-acting opioids

    NARCIS (Netherlands)

    van Ojik, Annette L.; Jansen, Paul A. F.; Brouwers, Jacobus R. B. J.; van Roon, Eric N.

    2012-01-01

    In the treatment of chronic malignant and non-malignant pain, opioids are used as strong analgesics. Frail elderly patients often have multiple comorbidities and use multiple medicines, leading to an increased risk of clinically relevant drug-drug and drug-disease interactions. Age-related changes

  3. Strong evidence for a genetic contribution to late-onset Alzheimer's disease mortality: a population-based study.

    Directory of Open Access Journals (Sweden)

    John S K Kauwe

    Full Text Available Alzheimer's disease (AD is an international health concern that has a devastating effect on patients and families. While several genetic risk factors for AD have been identified much of the genetic variance in AD remains unexplained. There are limited published assessments of the familiality of Alzheimer's disease. Here we present the largest genealogy-based analysis of AD to date.We assessed the familiality of AD in The Utah Population Database (UPDB, a population-based resource linking electronic health data repositories for the state with the computerized genealogy of the Utah settlers and their descendants. We searched UPDB for significant familial clustering of AD to evaluate the genetic contribution to disease. We compared the Genealogical Index of Familiality (GIF between AD individuals and randomly selected controls and estimated the Relative Risk (RR for a range of family relationships. Finally, we identified pedigrees with a significant excess of AD deaths.The GIF analysis showed that pairs of individuals dying from AD were significantly more related than expected. This excess of relatedness was observed for both close and distant relationships. RRs for death from AD among relatives of individuals dying from AD were significantly increased for both close and more distant relatives. Multiple pedigrees had a significant excess of AD deaths.These data strongly support a genetic contribution to the observed clustering of individuals dying from AD. This report is the first large population-based assessment of the familiality of AD mortality and provides the only reported estimates of relative risk of AD mortality in extended relatives to date. The high-risk pedigrees identified show a true excess of AD mortality (not just multiple cases and are greater in depth and width than published AD pedigrees. The presence of these high-risk pedigrees strongly supports the possibility of rare predisposition variants not yet identified.

  4. [Use of strong opioids in chronic non-cancer pain in adults. Evidence-based recommendations from the French Society for the Study and Treatment of Pain].

    Science.gov (United States)

    Moisset, Xavier; Trouvin, Anne-Priscille; Tran, Viet-Thi; Authier, Nicolas; Vergne-Salle, Pascale; Piano, Virginie; Martinez, Valeria

    2016-04-01

    An urgent need is to improve the efficacy and safety of use of strong opioids in chronic non-cancer pain (CNCP) through responsible prescription rules supported by scientific evidence. Clinical questions addressing the indication, the benefice, the risk and the precautions were formulated. A task force composed of physicians from several medical specialties involved in managing CNCP was charged to elaborate evidence-based recommendations. A systematic literature search was performed using CENTRAL, MEDLINE and EMBASE databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. We selected 21 meta-analyses and 31 cohort studies for analysis. Fifteen recommendations are provided. Strong opioids are not recommended in fibromyalgia and primary headaches. Strong opioids have been shown to be moderately effective against CNCP due to osteoarthritis of the lower limbs, and for back pain and neuropathic pain. Their introduction is advised only after the failure of first-line treatments, combined with patient care, provided that the patient is made aware of the advantages and risks. It is not advisable to continue strong opioids treatment for longer than three months if no improvement in pain, function or quality of life is observed. It is also recommended not to prescribe doses exceeding 150mg/day morphine equivalent. Misuse risk factors should be investigated before prescription and misuse should be assessed at each renewal. Priority should be given to extended-release forms. It is recommended not to use transmucosal rapid-release forms of fentanyl for the management of CNCP. These recommendations are intended for all doctors needing to prescribe strong opioids in CNCP. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  5. Strong expectations cancel locality effects: evidence from Hindi.

    Directory of Open Access Journals (Sweden)

    Samar Husain

    Full Text Available Expectation-driven facilitation (Hale, 2001; Levy, 2008 and locality-driven retrieval difficulty (Gibson, 1998, 2000; Lewis & Vasishth, 2005 are widely recognized to be two critical factors in incremental sentence processing; there is accumulating evidence that both can influence processing difficulty. However, it is unclear whether and how expectations and memory interact. We first confirm a key prediction of the expectation account: a Hindi self-paced reading study shows that when an expectation for an upcoming part of speech is dashed, building a rarer structure consumes more processing time than building a less rare structure. This is a strong validation of the expectation-based account. In a second study, we show that when expectation is strong, i.e., when a particular verb is predicted, strong facilitation effects are seen when the appearance of the verb is delayed; however, when expectation is weak, i.e., when only the part of speech "verb" is predicted but a particular verb is not predicted, the facilitation disappears and a tendency towards a locality effect is seen. The interaction seen between expectation strength and distance shows that strong expectations cancel locality effects, and that weak expectations allow locality effects to emerge.

  6. Strong industrial base vital for economic revival

    CERN Multimedia

    2001-01-01

    At the inauguration of a 2-day conference on nuclear technology in Islamabad, the chairman of PAEC said that Pakistan needs to develop a strong industrial base and capability to export equipment to improve the economic condition of the country. He descibed how Pakistan has already had a breakthrough with the export of equipment to CERN, Geneva (1 page).

  7. Phylogenomics provides strong evidence for relationships of butterflies and moths.

    Science.gov (United States)

    Kawahara, Akito Y; Breinholt, Jesse W

    2014-08-07

    Butterflies and moths constitute some of the most popular and charismatic insects. Lepidoptera include approximately 160 000 described species, many of which are important model organisms. Previous studies on the evolution of Lepidoptera did not confidently place butterflies, and many relationships among superfamilies in the megadiverse clade Ditrysia remain largely uncertain. We generated a molecular dataset with 46 taxa, combining 33 new transcriptomes with 13 available genomes, transcriptomes and expressed sequence tags (ESTs). Using HaMStR with a Lepidoptera-specific core-orthologue set of single copy loci, we identified 2696 genes for inclusion into the phylogenomic analysis. Nucleotides and amino acids of the all-gene, all-taxon dataset yielded nearly identical, well-supported trees. Monophyly of butterflies (Papilionoidea) was strongly supported, and the group included skippers (Hesperiidae) and the enigmatic butterfly-moths (Hedylidae). Butterflies were placed sister to the remaining obtectomeran Lepidoptera, and the latter was grouped with greater than or equal to 87% bootstrap support. Establishing confident relationships among the four most diverse macroheteroceran superfamilies was previously challenging, but we recovered 100% bootstrap support for the following relationships: ((Geometroidea, Noctuoidea), (Bombycoidea, Lasiocampoidea)). We present the first robust, transcriptome-based tree of Lepidoptera that strongly contradicts historical placement of butterflies, and provide an evolutionary framework for genomic, developmental and ecological studies on this diverse insect order. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

  8. 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

  9. Strong Motion Seismograph Based On MEMS Accelerometer

    Science.gov (United States)

    Teng, Y.; Hu, X.

    2013-12-01

    The MEMS strong motion seismograph we developed used the modularization method to design its software and hardware.It can fit various needs in different application situation.The hardware of the instrument is composed of a MEMS accelerometer,a control processor system,a data-storage system,a wired real-time data transmission system by IP network,a wireless data transmission module by 3G broadband,a GPS calibration module and power supply system with a large-volumn lithium battery in it. Among it,the seismograph's sensor adopted a three-axis with 14-bit high resolution and digital output MEMS accelerometer.Its noise level just reach about 99μg/√Hz and ×2g to ×8g dynamically selectable full-scale.Its output data rates from 1.56Hz to 800Hz. Its maximum current consumption is merely 165μA,and the device is so small that it is available in a 3mm×3mm×1mm QFN package. Furthermore,there is access to both low pass filtered data as well as high pass filtered data,which minimizes the data analysis required for earthquake signal detection. So,the data post-processing can be simplified. Controlling process system adopts a 32-bit low power consumption embedded ARM9 processor-S3C2440 and is based on the Linux operation system.The processor's operating clock at 400MHz.The controlling system's main memory is a 64MB SDRAM with a 256MB flash-memory.Besides,an external high-capacity SD card data memory can be easily added.So the system can meet the requirements for data acquisition,data processing,data transmission,data storage,and so on. Both wired and wireless network can satisfy remote real-time monitoring, data transmission,system maintenance,status monitoring or updating software.Linux was embedded and multi-layer designed conception was used.The code, including sensor hardware driver,the data acquisition,earthquake setting out and so on,was written on medium layer.The hardware driver consist of IIC-Bus interface driver, IO driver and asynchronous notification driver. The

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

  11. Evidence based practice

    DEFF Research Database (Denmark)

    Hjørland, Birger

    2011-01-01

    Evidence-based practice (EBP) is an influential interdisciplinary movement that originated in medicine as evidence-based medicine (EBM) about 1992. EBP is of considerable interest to library and information science (LIS) because it focuses on a thorough documentation of the basis for the decision...... making that is established in research as well as an optimization of every link in documentation and search processes. EBP is based on the philosophical doctrine of empiricism and, therefore, it is subject to the criticism that has been raised against empiricism. The main criticism of EBP...... is that practitioners lose their autonomy, that the understanding of theory and of underlying mechanisms is weakened, and that the concept of evidence is too narrow in the empiricist tradition. In this article, it is suggested that we should speak of “research-based practice” rather than EBP, because this term is open...

  12. 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...

  13. Quorum sensing inhibitors: how strong is the evidence?

    Science.gov (United States)

    Defoirdt, Tom; Brackman, Gilles; Coenye, Tom

    2013-12-01

    Because of its promising effect as an alternative to antibiotics, quorum sensing disruption is an intensively studied field, and there are many studies that describe the quorum sensing inhibitory activity of natural and synthetic compounds. In this opinion article, we present an overview of recent literature with respect to quorum sensing inhibitors. Most of this research is based on experiments with quorum sensing signal molecule reporter strains. However, these experiments are prone to bias due to other effects compounds may have on reporter strains. We argue that researchers should perform adequate control experiments and should carefully assess toxicity of the compounds in the bacterial species they are working with in order to confirm that what they observe really is quorum sensing inhibition. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Functional Analysis of Chromosome 18 in Pancreatic Cancer: Strong Evidence for New Tumour Suppressor Genes

    Directory of Open Access Journals (Sweden)

    Liviu P. Lefter

    2004-04-01

    Conclusion: These data represent strong functional evidence that chromosome 18q encodes strong tumour and metastasis suppressor activity that is able to switch human pancreatic cancer cells to a dormant phenotype.

  15. 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

  16. Evidence-based policy

    DEFF Research Database (Denmark)

    Vohnsen, Nina Holm

    2013-01-01

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

  17. [Meeting point Stewart. Buffer bases, base excess and strong ions].

    Science.gov (United States)

    Lang, W

    2007-04-01

    Development of a two-buffer model which simulates the acid-base properties of blood and allows comparison of the different acidbase concepts according to Stewart and to Siggaard-Andersen. The two-buffer model consisted of different aqueous solutions of bicarbonate/CO(2) (pCO(2), sCO(2), pK(1)), HEPES buffer (A(tot), pK(a)) and electrolytes. These were used to calculate the pH from the independent variables according to Stewart - strong ion difference (SID), pCO(2) and total concentration of the weak acids (A(tot)) - from which all other dependent variables (cHCO(3)(-), cA(-), BB, BE) were obtained and compared with the measured values. The normal pH (7.408) was calculated from the normal values for SID (48 mmol/l), pCO(2) (40 mmHg) and A(tot) (45.2 mmol/l) and agreed perfectly with the measured value (7.409+/-0.001). This was also valid for all calculated and measured pH values when the SID was varied: non-respiratory alkalosis ( upward arrow) or acidosis ( downward arrow), pCO(2):respiratory acidosis ( upward arrow) or alkalosis ( downward arrow) and A(tot):hyperproteinemic acidosis ( upward arrow) or hypoproteinemic alkalosis ( downward arrow) were varied and the sum of the buffer bases (BB) was always equal to the SID. All changes and hence BE were also equal, providing that A(tot) was normal. This was not the case, however, if A(tot) was outside the normal range, when BE was then the difference from the normal BB at the respective reference point. Whereas the deviation of the measured pCO(2) was acceptable (1.74+/-0.86 mmHg), this was not the case for the SID (-6.18+/-3.58 mmol/l) calculated from the measured ion concentrations (Na, K, Ca, Cl). Despite controversial discussions, both concepts are much closer than might be expected. Whereas in the Stewart approach the focus of analysis is on plasma, with the Siggaard-Andersen approach it is on blood. Hence, a combined analysis of the blood gases (pH, pCO(2), pO(2), sO(2), cHb, BE) and of the strong ion gap (SIG

  18. Weak Evidence of Regeneration Habitat but Strong Evidence of Regeneration Niche for a Leguminous Shrub.

    Science.gov (United States)

    Delerue, Florian; Gonzalez, Maya; Michalet, Richard; Pellerin, Sylvain; Augusto, Laurent

    2015-01-01

    The identification of an ecological niche specific to the regeneration phase has mobilised significant attention. However, the importance of the regeneration niche concept remains unclear. Our main objective was to study the existence of such a regeneration niche for a leguminous shrub, Ulex europaeus. This study was carried out in southwest France in the context of water and nutrient stresses (mainly phosphorus limitation) due to the presence of nutrient-poor sandy soils. We analysed the regeneration of the species from the germination of seeds and emergence of new seedlings until the seedlings reached young shrub size. Our design included a P fertilisation treatment. We also investigated microsite characteristics (micro-topography and vegetation development) as they can interact with meteorological conditions and determine water availability for seeds and seedlings. We found that P availability controlled seedling growth and the time necessary to reach young shrub size. Water availability appeared to impact the species germination and seedlings survival. We also found that P and water availability depended on the interactions between microsite characteristics and climatic variations. Finally we found evidence that P and water availability are important ecological factors shaping the regeneration niche of the species, but we found weak evidence that any microsite would be appropriate for the regeneration of the species in the long term. Future studies regarding regeneration niches need to distinguish more clearly the ecological factors important for regeneration (the regeneration niche per se) and the physical world where the seedlings appear and develop (the regeneration habitat).

  19. Weak Evidence of Regeneration Habitat but Strong Evidence of Regeneration Niche for a Leguminous Shrub.

    Directory of Open Access Journals (Sweden)

    Florian Delerue

    Full Text Available The identification of an ecological niche specific to the regeneration phase has mobilised significant attention. However, the importance of the regeneration niche concept remains unclear. Our main objective was to study the existence of such a regeneration niche for a leguminous shrub, Ulex europaeus. This study was carried out in southwest France in the context of water and nutrient stresses (mainly phosphorus limitation due to the presence of nutrient-poor sandy soils. We analysed the regeneration of the species from the germination of seeds and emergence of new seedlings until the seedlings reached young shrub size. Our design included a P fertilisation treatment. We also investigated microsite characteristics (micro-topography and vegetation development as they can interact with meteorological conditions and determine water availability for seeds and seedlings. We found that P availability controlled seedling growth and the time necessary to reach young shrub size. Water availability appeared to impact the species germination and seedlings survival. We also found that P and water availability depended on the interactions between microsite characteristics and climatic variations. Finally we found evidence that P and water availability are important ecological factors shaping the regeneration niche of the species, but we found weak evidence that any microsite would be appropriate for the regeneration of the species in the long term. Future studies regarding regeneration niches need to distinguish more clearly the ecological factors important for regeneration (the regeneration niche per se and the physical world where the seedlings appear and develop (the regeneration habitat.

  20. Evidence-based playground design

    DEFF Research Database (Denmark)

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

    2015-01-01

    opportunities for play, nature exploration and sensory stimulation. As it is increasingly expected that designers base their decisions on research evidence, there is a need to develop approaches to facilitate this, which also applies to playground design. The design of PlayLab Cph was based on relevant evidence...

  1. Evidence-based clinical practice

    DEFF Research Database (Denmark)

    Gluud, Christian

    2002-01-01

    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 be...... practice. By investments in education, applied research, and The Cochrane Collaboration, evidence-based medicine may form a stronger basis for clinical practice.......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......, 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...

  2. Basicities of Strong Bases in Water: A Computational Study

    OpenAIRE

    Kaupmees, Karl; Trummal, Aleksander; Leito, Ivo

    2014-01-01

    Aqueous pKa values of strong organic bases – DBU, TBD, MTBD, different phosphazene bases, etc – were computed with CPCM, SMD and COSMO-RS approaches. Explicit solvent molecules were not used. Direct computations and computations with reference pKa values were used. The latter were of two types: (1) reliable experimental aqueous pKa value of a reference base with structure similar to the investigated base or (2) reliable experimental pKa value in acetonitrile of the investigated base itself. ...

  3. Pakistan strong industrial base urged for economic progress

    CERN Multimedia

    2001-01-01

    A conference organized by Pakistan Nuclear Society urged that Pakistan should develop a strong industrial base and capability to export equipment for economic progress. The chairmen of PAEC pointed out that Pakistan is already showing remarkable progress in export of science-related equipment to CERN. He also asked scientists to wage a war against Pakistans inability to acquire indigenous technology (1 page).

  4. Evidence-based guidelines

    DEFF Research Database (Denmark)

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

    2015-01-01

    The clinical use of MRI in patients with multiple sclerosis (MS) has advanced markedly over the past few years. Technical improvements and continuously emerging data from clinical trials and observational studies have contributed to the enhanced performance of this tool for achieving a prompt...... 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...... of MRI in clinical practice for the diagnosis of MS....

  5. Evidence-based clinical practice

    DEFF Research Database (Denmark)

    Gluud, Christian

    2002-01-01

    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 be...

  6. 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...... of Recommendations Assessment, Development and Evaluation (GRADE) assessment represent the highest level of evidence. Even though systematic reviews are trust worthier than other types of evidence, all levels of the evidence hierarchy are under threats from systematic errors (bias); design errors (abuse of surrogate...

  7. Subgap Two-Photon States in Polycyclic Aromatic Hydrocarbons: Evidence for Strong Electron Correlations

    OpenAIRE

    Aryanpour, K.; Roberts, A.; Sandhu, A.; Rathore, R.; Shukla, A.; Mazumdar, S.

    2013-01-01

    Strong electron correlation effects in the photophysics of quasi-one-dimensional $\\pi$-conjugated organic systems such as polyenes, polyacetylenes, polydiacetylenes, etc., have been extensively studied. Far less is known on correlation effects in two-dimensional $\\pi$-conjugated systems. Here we present theoretical and experimental evidence for moderate repulsive electron-electron interactions in a number of finite polycyclic aromatic hydrocarbon molecules with $D_{6h}$ symmetry. We show that...

  8. Strong Generative Capacity and the Empirical Base of Linguistic Theory

    Directory of Open Access Journals (Sweden)

    Dennis Ott

    2017-09-01

    Full Text Available This Perspective traces the evolution of certain central notions in the theory of Generative Grammar (GG. The founding documents of the field suggested a relation between the grammar, construed as recursively enumerating an infinite set of sentences, and the idealized native speaker that was essentially equivalent to the relation between a formal language (a set of well-formed formulas and an automaton that recognizes strings as belonging to the language or not. But this early view was later abandoned, when the focus of the field shifted to the grammar's strong generative capacity as recursive generation of hierarchically structured objects as opposed to strings. The grammar is now no longer seen as specifying a set of well-formed expressions and in fact necessarily constructs expressions of any degree of intuitive “acceptability.” The field of GG, however, has not sufficiently acknowledged the significance of this shift in perspective, as evidenced by the fact that (informal and experimentally-controlled observations about string acceptability continue to be treated as bona fide data and generalizations for the theory of GG. The focus on strong generative capacity, it is argued, requires a new discussion of what constitutes valid empirical evidence for GG beyond observations pertaining to weak generation.

  9. Evidence-based management reconsidered.

    Science.gov (United States)

    Kovner, Anthony R; Rundall, Thomas G

    2006-01-01

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

  10. Evidence for strong Breit interaction in dielectronic recombination of highly charged heavy ions.

    Science.gov (United States)

    Nakamura, Nobuyuki; Kavanagh, Anthony P; Watanabe, Hirofumi; Sakaue, Hiroyuki A; Li, Yueming; Kato, Daiji; Currell, Fred J; Ohtani, Shunsuke

    2008-02-22

    Resonant strengths have been measured for dielectronic recombination of Li-like iodine, holmium, and bismuth using an electron beam ion trap. By observing the atomic number dependence of the state-resolved resonant strength, clear experimental evidence has been obtained that the importance of the generalized Breit interaction (GBI) effect on dielectronic recombination increases as the atomic number increases. In particular, it has been shown that the GBI effect is exceptionally strong for the recombination through the resonant state [1s2s(2)2p(1/2)](1).

  11. When a year takes 18 months: evidence for a strong circannual clock in a shorebird

    Science.gov (United States)

    Piersma, Theunis

    2002-04-01

    During the last three of 20 years kept as a pet, a red knot (Calidris canutus) went through two complete 'circannual' cycles of body mass and plumage. With a record cycle length of 18 months, this individual shorebird provides evidence for an exceptionally strong circannual clock system. The absence of synchronisation to outdoor but visible periodic cues suggests that the constant, socially-induced, day-night environment was of overriding importance. So far, only for songbirds is there firm experimental evidence that annual cycles are orchestrated by an endogenous circannual clock system. In constant environments the circannual cycles of these passerines tend to have periods that are shorter, rather than longer, than a year.

  12. 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.

  13. 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...

  14. 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…

  15. Simulation-based marginal likelihood for cluster strong lensing cosmology

    Science.gov (United States)

    Killedar, M.; Borgani, S.; Fabjan, D.; Dolag, K.; Granato, G.; Meneghetti, M.; Planelles, S.; Ragone-Figueroa, C.

    2018-01-01

    Comparisons between observed and predicted strong lensing properties of galaxy clusters have been routinely used to claim either tension or consistency with Λ cold dark matter cosmology. However, standard approaches to such cosmological tests are unable to quantify the preference for one cosmology over another. We advocate approximating the relevant Bayes factor using a marginal likelihood that is based on the following summary statistic: the posterior probability distribution function for the parameters of the scaling relation between Einstein radii and cluster mass, α and β. We demonstrate, for the first time, a method of estimating the marginal likelihood using the X-ray selected z > 0.5 Massive Cluster Survey clusters as a case in point and employing both N-body and hydrodynamic simulations of clusters. We investigate the uncertainty in this estimate and consequential ability to compare competing cosmologies, which arises from incomplete descriptions of baryonic processes, discrepancies in cluster selection criteria, redshift distribution and dynamical state. The relation between triaxial cluster masses at various overdensities provides a promising alternative to the strong lensing test.

  16. Strong coupling and polariton lasing in Te based microcavities embedding (Cd,Zn)Te quantum wells

    Energy Technology Data Exchange (ETDEWEB)

    Rousset, J.-G., E-mail: j-g.rousset@fuw.edu.pl; Piętka, B.; Król, M.; Mirek, R.; Lekenta, K.; Szczytko, J.; Borysiuk, J.; Suffczyński, J.; Kazimierczuk, T.; Goryca, M.; Smoleński, T.; Kossacki, P.; Nawrocki, M.; Pacuski, W. [Institute of Experimental Physics, Faculty of Physics, University of Warsaw, ul. Pasteura 5, PL-02-093 Warszawa (Poland)

    2015-11-16

    We report on properties of an optical microcavity based on (Cd,Zn,Mg)Te layers and embedding (Cd,Zn)Te quantum wells. The key point of the structure design is the lattice matching of the whole structure to MgTe, which eliminates the internal strain and allows one to embed an arbitrary number of unstrained quantum wells in the microcavity. We evidence the strong light-matter coupling regime already for the structure containing a single quantum well. Embedding four unstrained quantum wells results in further enhancement of the exciton-photon coupling and the polariton lasing in the strong coupling regime.

  17. Strongly correlated impurity band superconductivity in diamond: X-ray spectroscopic evidence

    Directory of Open Access Journals (Sweden)

    G. Baskaran

    2006-01-01

    Full Text Available In a recent X-ray absorption study in boron doped diamond, Nakamura et al. have seen a well isolated narrow boron impurity band in non-superconducting samples and an additional narrow band at the chemical potential in a superconducting sample. We interpret the beautiful spectra as evidence for upper Hubbard band of a Mott insulating impurity band and an additional metallic 'mid-gap band' of a conducting 'self-doped' Mott insulator. This supports the basic framework of a recent theory of the present author of strongly correlated impurity band superconductivity (impurity band resonating valence bond, IBRVB theory in a template of a wide-gap insulator, with no direct involvement of valence band states.

  18. 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...

  19. 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).

  20. <strong>Ergonomics and epidemiology in evidence based health prevention strong>

    DEFF Research Database (Denmark)

    Jensen, Olaf Chresten

    2009-01-01

    According to the definitions, ergonomics is a natural part of the health and safety activity but it has its own research methods and causal models. Public health, occupational and clinical medicines are closely related to epidemiology and differ from ergonomics by using a disease model with a wide...... for patients or for persons with pre-conditions of diseases like pre-hypertension and pre-diabetes and for the most vulnerable parts of the populations....

  1. USE OF BETA-BLOCKERS IN THE PERIOPERATIVE PERIOD: HOW STRONG ARE THE EVIDENCES?

    Directory of Open Access Journals (Sweden)

    V. V. Samoylenko

    2015-09-01

    Full Text Available Optimization of the pharmacotherapy in preoperative period is the cornerstone of the concept of risk modification of cardiovascular complications in the perioperative period. Therefore, special attention has recently been focused on the use of beta-blockers in the postoperative period. Nowadays convincing evidence base for the use of this class of drugs in the perioperative period that was the basis for the development of clinical guidelines is accumulated. Moreover, results of large randomized trials of beta-blockers are controversial. This has resulted in significant differences in the classes of recommendations and levels of evidence.Analysis of the results of basic researches and the provisions of recommendations of the international and national professional medical societies on the use of beta-blockers in patients with cardiovascular disease to reduce the risk of cardiac complications in the perioperative period for planned extracardiac surgical procedures is presented.

  2. Providing Climate Policy Makers With a Strong Scientific Base (Invited)

    Science.gov (United States)

    Struzik, E.

    2009-12-01

    Scientists can and should inform public policy decisions in the Arctic. But the pace of climate change in the polar world has been occurring far more quickly than most scientists have been able to predict. This creates problems for decision-makers who recognize that difficult management decisions have to be made in matters pertaining to wildlife management, cultural integrity and economic development. With sea ice melting, glaciers receding, permafrost thawing, forest fires intensifying, and disease and invasive species rapidly moving north, the challenge for scientists to provide climate policy makers with a strong scientific base has been daunting. Clashing as this data sometimes does with the “traditional knowledge” of indigenous peoples in the north, it can also become very political. As a result the need to effectively communicate complex data is more imperative now than ever before. Here, the author describes how the work of scientists can often be misinterpreted or exploited in ways that were not intended. Examples include the inappropriate use of scientific data in decision-making on polar bears, caribou and other wildlife populations; the use of scientific data to debunk the fact that greenhouse gases are driving climate change, and the use of scientific data to position one scientist against another when there is no inherent conflict. This work will highlight the need for climate policy makers to increase support for scientists working in the Arctic, as well as illustrate why it is important to find new and more effective ways of communicating scientific data. Strategies that might be considered by granting agencies, scientists and climate policy decision-makers will also be discussed.

  3. Evidence-Based Reform in Education

    Science.gov (United States)

    Slavin, Robert E.

    2017-01-01

    Education policies should support the use of programs and practices with strong evidence of effectiveness. The Every Student Succeeds Act (ESSA) contains evidence standards and incentives to use programs that meet them. This provides a great opportunity for evidence to play a stronger role in decisions about education programs and practices.…

  4. Evidence-based recommendation on toothpaste use

    Directory of Open Access Journals (Sweden)

    Jaime Aparecido Cury

    2014-01-01

    Full Text Available Toothpaste can be used as a vehicle for substances to improve the oral health of individuals and populations. Therefore, it should be recommended based on the best scientific evidence available, and not on the opinion of authorities or specialists. Fluoride is the most important therapeutic substance used in toothpastes, adding to the effect of mechanical toothbrushing on dental caries control. The use of fluoride toothpaste to reduce caries in children and adults is strongly based on evidence, and is dependent on the concentration (minimum of 1000 ppm F and frequency of fluoride toothpaste use (2'/day or higher. The risk of dental fluorosis due to toothpaste ingestion by children has been overestimated, since there is no evidence that: 1 fluoride toothpaste use should be postponed until the age of 3-4 or older, 2 low-fluoride toothpaste avoids fluorosis and 3 fluorosis has a detrimental effect on the quality of life of individuals exposed to fluoridated water and toothpaste. Among other therapeutic substances used in toothpastes, there is evidence that triclosan/copolymer reduce dental biofilm, gingivitis, periodontitis, calculus and halitosis, and that toothpastes containing stannous fluoride reduce biofilm and gingivitis.

  5. UCLA, British astronomers discover wake of planet around nearby star. Strong evidence for solar system like ours

    CERN Multimedia

    2002-01-01

    "An international team of astronomers reports the first strong evidence for the existence of massive planets on wide orbits - like those of Saturn, Uranus and Neptune - around many stars. The new research provides some of the strongest evidence so far that solar systems similar to our own, or even larger, are likely to exist: (1 page).

  6. The evidence-based paradox.

    Science.gov (United States)

    Hinojosa, Jim

    2013-01-01

    Many occupational therapy practitioners consider evidence-based practice (EBP) to be the means by which occupational therapy can prove the validity of its services and thus support the legitimacy of our profession. The unquestioned acceptance of EBP as the way to establish credibility concerns me; unchallenged acceptance of any idea concerns me. Do practitioners accept EBP as the paradigm for guiding occupational therapy practice and research solely because it is presented as what we must do? I believe that practitioners must examine the implications for our profession of accepting EBP without question. In this article, I review EBP, present criticisms and concerns voiced by other professions and, finally, examine the implications of adopting an EBP perspective that replaces theory-directed practice. Copyright © 2013 by the American Occupational Therapy Association, Inc.

  7. Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components.

    Science.gov (United States)

    Huber, Douglas; Curtis, Carolyn; Irani, Laili; Pappa, Sara; Arrington, Lauren

    2016-09-28

    Worldwide 75 million women need postabortion care (PAC) services each year following safe or unsafe induced abortions and miscarriages. We reviewed more than 550 studies on PAC published between 1994 and 2013 in the peer-reviewed and gray literature, covering emergency treatment, postabortion family planning, organization of services, and related topics that impact practices and health outcomes, particularly in the Global South. In this article, we present findings from studies with strong evidence that have major implications for programs and practice. For example, vacuum aspiration reduced morbidity, costs, and time in comparison to sharp curettage. Misoprostol 400 mcg sublingually or 600 mcg orally achieved 89% to 99% complete evacuation rates within 2 weeks in multiple studies and was comparable in effectiveness, safety, and acceptability to manual vacuum aspiration. Misoprostol was safely introduced in several PAC programs through mid-level providers, extending services to secondary hospitals and primary health centers. In multiple studies, postabortion family planning uptake before discharge increased by 30-70 percentage points within 1-3 years of strengthening postabortion family planning services; in some cases, increases up to 60 percentage points in 4 months were achieved. Immediate postabortion contraceptive acceptance increased on average from 32% before the interventions to 69% post-intervention. Several studies found that women receiving immediate postabortion intrauterine devices and implants had fewer unintended pregnancies and repeat abortions than those who were offered delayed insertions. Postabortion family planning is endorsed by the professional organizations of obstetricians/gynecologists, midwives, and nurses as a standard of practice; major donors agree, and governments should be encouraged to provide universal access to postabortion family planning. Important program recommendations include offering all postabortion women family planning

  8. 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.

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

    OpenAIRE

    Wendy A. Abbott

    2006-01-01

    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 firs...

  10. Leveraging Evidence-Based Practice through Partnerships Based on Practice-Based Evidence

    Science.gov (United States)

    Cook, Bryan G.; Cook, Lysandra

    2016-01-01

    Evidence-based practice is among the most influential and compelling reforms in contemporary education. Despite their potential to improve the outcomes of students with disabilities, adoption and implementation of evidence-based reforms have been disappointing, with the gap between research and practice remaining wide. Practice-based evidence…

  11. Synthesis of novel carbon/silica composites based strong acid ...

    Indian Academy of Sciences (India)

    hydrophobic acid-catalyzed reactions proceed in poor or with no catalytic activity (Nakajima et al 2009). The novel car- bon/silica composites based solid acid was synthesized for the purpose. However, the new method added the step of impregnating sucrose to the channels of SBA-15, which fur- ther added to the cost for ...

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. 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.

  17. Evidence for selection maintaining MHC diversity in a rodent species despite strong density fluctuations.

    Science.gov (United States)

    Schuster, Andrea C; Herde, Antje; Mazzoni, Camila J; Eccard, Jana A; Sommer, Simone

    2016-07-01

    Strong spatiotemporal variation in population size often leads to reduced genetic diversity limiting the adaptive potential of individual populations. Key genes of adaptive variation are encoded by the immune genes of the major histocompatibility complex (MHC) playing an essential role in parasite resistance. How MHC variation persists in rodent populations that regularly experience population bottlenecks remains an important topic in evolutionary genetics. We analysed the consequences of strong population fluctuations on MHC class II DRB exon 2 diversity in two distant common vole (Microtus arvalis) populations in three consecutive years using a high-throughput sequencing approach. In 143 individuals, we detected 25 nucleotide alleles translating into 14 unique amino acid MHC alleles belonging to at least three loci. Thus, the overall allelic diversity and amino acid distance among the remaining MHC alleles, used as a surrogate for the range of pathogenic antigens that can be presented to T-cells, are still remarkably high. Both study populations did not show significant population differentiation between years, but significant differences were found between sites. We concluded that selection processes seem to be strong enough to maintain moderate levels of MHC diversity in our study populations outcompeting genetic drift, as the same MHC alleles were conserved between years. Differences in allele frequencies between populations might be the outcome of different local parasite pressures and/or genetic drift. Further understanding of how pathogens vary across space and time will be crucial to further elucidate the mechanisms maintaining MHC diversity in cyclic populations.

  18. Long memory volatility of gold price returns: How strong is the evidence from distinct economic cycles?

    Science.gov (United States)

    Bentes, Sonia R.

    2016-02-01

    This paper examines the long memory behavior in the volatility of gold returns using daily data for the period 1985-2009. We divided the whole sample into eight sub-samples in order to analyze the robustness and consistency of our results during different crisis periods. This constitutes our main contribution. We cover four major world crises, namely, (i) the US stock market crash of 1987; (ii) the Asian financial crisis of 1997; (iii) the World Trade Center terrorist attack of 2001 and finally, (iv) the sub-prime crisis of 2007, in order to investigate how the fractional integrated parameter of the FIGARCH(1, d,1) model evolves over time. Our findings are twofold: (i) there is evidence of long memory in the conditional variance over the whole sample period; (ii) when we consider the sub-sample analysis, the results show mixed evidence. Thus, for the 1985-2003 period the long memory parameter is positive and statistically significant in the pre-crisis sub-samples, and there is no evidence of long memory in the crisis sub-sample periods; however the reverse pattern occurs for the 2005-2009 period. This highlights the unique characteristics of the 2007 sub-prime crisis.

  19. Strong contribution of immigration to local population regulation: evidence from a migratory passerine.

    Science.gov (United States)

    Schaub, Michael; Jakober, Hans; Stauber, Wolfgang

    2013-08-01

    A mechanistic understanding of the dynamics of populations requires knowledge about the variation of the underlying demographic rates and about the reasons for their variability. In geographically open populations, immigration is often necessary to prevent declines, but little is known about whether immigration can contribute to its regulation. We studied the dynamics of a Red-backed Shrike population (Lanius collurio) over 36 years in Germany with a Bayesian integrated population model. We estimated mean and temporal variability of population sizes, productivity, apparent survival, and immigration. We assessed how strongly the demographic rates were correlated with population growth to understand the demographic reasons of population change and how strongly the demographic rates were correlated with population size to identify possible density-dependent mechanisms. The shrike population varied between 35 and 74 breeding pairs but did not show a significant trend in population size over time (growth rate 1.002 +/- 0.001 [mean +/- SD]). Apparent survival of females (juveniles 0.06 +/- 0.01; adults 0.37 +/- 0.03) was lower than that of males (juveniles 0.10 +/- 0.01; adults 0.44 +/- 0.02). Immigration rates were substantial and higher in females (0.56 +/- 0.02) than in males (0.43 +/- 0.02), and average productivity was 2.76 +/- 0.14. Without immigration, the Red-backed Shrike population would have declined strongly. Immigration was the strongest driver for the number of females while local recruitment was the most important driver for the number of males. Immigration of both sexes and productivity, but not local recruitment and survival, were subject to density dependence. Density-dependent productivity was not effectively regulating the local population but may have contributed to regulate shrike populations at larger spatial scales. These findings suggest that immigration is not only an important component to prevent a geographically open population from decline

  20. 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 ) of evidence through baseline condition assessment, proper goal setting, sound monitoring of the impacts of the chosen intervention as well as effective dissemination of resulting evidence. To answer the question whether restoration is evidence-based would...

  1. 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'.

  2. Sicily statement on evidence-based practice.

    Science.gov (United States)

    Dawes, Martin; Summerskill, William; Glasziou, Paul; Cartabellotta, Antonino; Martin, Janet; Hopayian, Kevork; Porzsolt, Franz; Burls, Amanda; Osborne, James

    2005-01-05

    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"). 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. 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'.

  3. Are strong empathizers better mentalizers? Evidence for independence and interaction between the routes of social cognition.

    Science.gov (United States)

    Kanske, Philipp; Böckler, Anne; Trautwein, Fynn-Mathis; Parianen Lesemann, Franca H; Singer, Tania

    2016-09-01

    Although the processes that underlie sharing others' emotions (empathy) and understanding others' mental states (mentalizing, Theory of Mind) have received increasing attention, it is yet unclear how they relate to each other. For instance, are people who strongly empathize with others also more proficient in mentalizing? And (how) do the neural networks supporting empathy and mentalizing interact? Assessing both functions simultaneously in a large sample (N = 178), we show that people's capacities to empathize and mentalize are independent, both on a behavioral and neural level. Thus, strong empathizers are not necessarily proficient mentalizers, arguing against a general capacity of social understanding. Second, we applied dynamic causal modeling to investigate how the neural networks underlying empathy and mentalizing are orchestrated in naturalistic social settings. Results reveal that in highly emotional situations, empathic sharing can inhibit mentalizing-related activity and thereby harm mentalizing performance. Taken together, our findings speak against a unitary construct of social understanding and suggest flexible interplay of distinct social functions. © The Author (2016). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

  4. Evidence-Based Practice: Management of Vertigo

    Science.gov (United States)

    Nguyen-Huynh, Anh T.

    2012-01-01

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

  5. 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.

  6. Experimental evidence for strong stabilizing forces at high functional diversity of aquatic microbial communities.

    Science.gov (United States)

    Carrara, Francesco; Giometto, Andrea; Seymour, Mathew; Rinaldo, Andrea; Altermatt, Florian

    2015-05-01

    Unveiling the mechanisms that promote coexistence in biological communities is a fundamental problem in ecology. Stable coexistence of many species is commonly observed in natural communities. Most of these natural communities, however, are composed of species from multiple trophic and functional groups, while theory and experiments on coexistence have been focusing on functionally similar species. Here, we investigated how functional diversity affects the stability of species coexistence and productivity in multispecies communities by characterizing experimentally all pairwise species interactions in a pool of 11 species of eukaryotes (10 protists and one rotifer) belonging to three different functional groups. Species within the same functional group showed stronger competitive interactions compared to among-functional group interactions. This often led to competitive exclusion between species that had higher functional relatedness, but only at low levels of species richness. Communities with higher functional diversity resulted in increased species coexistence and community biomass production. Our experimental findings and the results of a stochastic model tailored to the experimental interaction matrix suggest the emergence of strong stabilizing forces when species from different functional groups interact in a homogeneous environment. By combining theoretical analysis with experiments we could also disentangle the relationship between species richness and functional diversity, showing that functional diversity per se is a crucial driver of productivity and stability in multispecies community.

  7. No evidence for strong cytonuclear conflict over sex allocation in a simultaneously hermaphroditic flatworm.

    Science.gov (United States)

    Vellnow, Nikolas; Vizoso, Dita B; Viktorin, Gudrun; Schärer, Lukas

    2017-04-20

    Cytoplasmic sex allocation distorters, which arise from cytonuclear conflict over the optimal investment into male versus female reproductive function, are some of the best-researched examples for genomic conflict. Among hermaphrodites, many such distorters have been found in plants, while, to our knowledge, none have been clearly documented in animals. Here we provide a quantitative test for cytonuclear conflict over sex allocation in the simultaneously hermaphroditic flatworm Macrostomum lignano. We used a quantitative genetic breeding design, employing pair-wise crosses of 2 × 15 independent inbred lines, to partition the phenotypic variance in several traits (including sex allocation) into its nuclear and cytoplasmic components. Although the nuclear genetic background had a significant effect on all traits analyzed, we found significant cytoplasmic genetic variation only for ovary size, there explaining just 4.1% of the variance. A subsequent statistical power analysis showed that the experimental design had considerable power to detect cytonuclear interactions. We conclude that there were no strong effects of cytonuclear conflict in the studied populations, possibly because the usually compact mitochondrial genomes in animals have a lower evolvability than the large mitochondrial genomes in plants or because the sampled populations currently do not harbor variation at putative distorter and/or the restorer loci.

  8. 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.

  9. On the integration of financial markets: How strong is the evidence from five international stock markets?

    Science.gov (United States)

    Bentes, Sónia R.

    2015-07-01

    This paper examines the integration of financial markets using data from five international stock markets in the context of globalization. The theoretical basis of this study relies on the price theory and the Law of One Price, which was adjusted to the framework of financial markets. When price levels are nonstationary, cointegration and the error correction model constitute a powerful tool for the empirical examination of market integration. The error correction model provides a fully dynamic framework that allows to separating the long and the short run effects of the integration process. A dataset encompassing the daily stock price series of the PSI 20 (Portugal), IBEX 35 (Spain), FTSE 100 (UK), NIKKEI 225 (Japan) and SP 500 (US) indices from January 4th 1999 to September 19th 2014 is employed. The results highlight that these five stock markets are linked together by just one long-run relationship, although short-run movements are also present, which causes distinct deviations from the long-run equilibrium relationship. Endogeneity prevails in the system as a whole. While market integration in the sense of the Law of One Price holds, pairwise full price transmission has limited evidence. The results therefore show that stock market price movements are highly nonlinear and complex.

  10. Antioxidants and embryo phenotype: is there experimental evidence for strong integration of the antioxidant system?

    Science.gov (United States)

    Possenti, Cristina Daniela; Karadas, Filiz; Colombo, Graziano; Caprioli, Manuela; Rubolini, Diego; Milzani, Aldo; Donne, Isabella Dalle; Saino, Nicola; Parolini, Marco

    2017-02-15

    Organisms have evolved complex defense systems against oxidative stress. Bird eggs contain maternally derived antioxidants that protect embryos from oxidative damage. The antioxidant system components are thought to be integrated, but few studies have analyzed the covariation between antioxidant concentrations, embryo 'oxidative status' and morphology. In addition, no study has tested the effects of experimental change in yolk antioxidant concentration on other antioxidants, on their reciprocal relationships and on their relationships with embryo oxidative status or growth, which are expected if antioxidants defenses are integrated. In yellow-legged gull ( Larus michahellis ) embryos, we analyzed the covariation between several antioxidants, markers of 'oxidative status' [total antioxidant capacity (TAC), concentration of pro-oxidants (TOS), lipid peroxidation (LPO) and protein carbonylation (PC)] in the yolk, liver and brain, and morphology. Yolk and liver antioxidant concentrations were positively correlated reciprocally and with embryo size, and positively predicted TAC but not oxidative status. TOS and LPO were positively correlated in the liver, while TAC and LPO were negatively correlated in the brain. Weak relationships existed between antioxidants and TOS, PC and LPO. The effects of antioxidants on oxidative status and morphology were non-synergistic. An experimental physiological increase in yolk vitamin E had very weak effects on the relationships between other antioxidants or oxidative status and vitamin E concentration, the concentration of other antioxidants or oxidative status; the covariation between other antioxidants and oxidative status, and relationships between morphology or oxidative status and other antioxidants, challenging the common wisdom of strong functional relationships among antioxidants, at least for embryos in the wild. © 2017. Published by The Company of Biologists Ltd.

  11. Strong evidence for changing fish reproductive phenology under climate warming on the Tibetan Plateau.

    Science.gov (United States)

    Tao, Juan; He, Dekui; Kennard, Mark J; Ding, Chengzhi; Bunn, Stuart E; Liu, Chunlong; Jia, Yintao; Che, Rongxiao; Chen, Yifeng

    2018-05-01

    Phenological responses to climate change have been widely observed and have profound and lasting effects on ecosystems and biodiversity. However, compared to terrestrial ecosystems, the long-term effects of climate change on species' phenology are poorly understood in aquatic ecosystems. Understanding the long-term changes in fish reproductive phenology is essential for predicting population dynamics and for informing management strategies, but is currently hampered by the requirement for intensive field observations and larval identification. In this study, a very low-frequency sampling of juveniles and adults combined with otolith measurements (long axis length of the first annulus; LAFA) of an endemic Tibetan Plateau fish (Gymnocypris selincuoensis) was used to examine changes in reproductive phenology associated with climate changes from the 1970s to 2000s. Assigning individual fish to their appropriate calendar year class was assisted by dendrochronological methods (crossdating). The results demonstrated that LAFA was significantly and positively associated with temperature and growing season length. To separate the effects of temperature and the growing season length on LAFA growth, measurements of larval otoliths from different sites were conducted and revealed that daily increment additions were the main contributor (46.3%), while temperature contributed less (12.0%). Using constructed water-air temperature relationships and historical air temperature records, we found that the reproductive phenology of G. selincuoensis was strongly advanced in the spring during the 1970s and 1990s, while the increased growing season length in the 2000s was mainly due to a delayed onset of winter. The reproductive phenology of G. selincuoensis advanced 2.9 days per decade on average from the 1970s to 2000s, and may have effects on recruitment success and population dynamics of this species and other biota in the ecosystem via the food web. The methods used in this study

  12. Evidence Based Education: un quadro storico

    OpenAIRE

    Giuliano Vivanet

    2013-01-01

    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 m...

  13. 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.

  14. Breaking boundaries: optimizing reconsolidation-based interventions for strong and old memories.

    Science.gov (United States)

    Elsey, James W B; Kindt, Merel

    2017-09-01

    Recent research has demonstrated that consolidated memories can enter a temporary labile state after reactivation, requiring restabilization in order to persist. This process, known as reconsolidation, potentially allows for the modification and disruption of memory. Much interest in reconsolidation stems from the possibility that maladaptive memory traces-a core feature of several psychiatric conditions-could be tackled by disrupting their reconsolidation. However, research has indicated a range of supposed boundary conditions on the induction of reconsolidation. Stronger memories, often resulting from exposure to stressful conditions, or older memories, appear to be relatively resistant to undergoing reconsolidation. This may be taken as a potential stumbling block for reconsolidation-based interventions: in clinical practice, old and strong maladaptive memories are the norm rather than the exception. Yet, boundary conditions have been derived from limited experimental evidence, are not unique to reconsolidation-based interventions, and do not seem to be absolute. In this paper, we review a range of experimental studies that have aimed to disrupt old memories, or memories that were strengthened by stress manipulations, through reconsolidation. Such research highlights several techniques that could be used to optimize reconsolidation-based approaches and overcome putative boundary conditions. We supplement this review of experimental literature with a case study of a reconsolidation-based treatment of a strong and decades-old phobia for mice, further suggesting that age and strength of memory may not be insurmountable barriers. Translating findings from basic science, to human experiments, to clinical applications and back again, can potentially unlock powerful new treatments for the many people who suffer daily from anxiety disorders. © 2017 Elsey and Kindt; Published by Cold Spring Harbor Laboratory Press.

  15. 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...

  16. 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.

  17. [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.

  18. Evidence-based Utilization of Noninvasive Ventilation and Patient Outcomes.

    Science.gov (United States)

    Mehta, Anuj B; Douglas, Ivor S; Walkey, Allan J

    2017-11-01

    Strong evidence supports use of noninvasive ventilation (NIV) for patients with respiratory distress from chronic obstructive pulmonary disease and heart failure (strong evidence conditions [SECs]). Despite unclear benefits of NIV for other causes of acute respiratory failure, utilization for conditions with weaker evidence is increasing, despite evidence demonstrating higher mortality for patients who suffer NIV failure (progression from NIV to invasive mechanical ventilation [IMV])) compared with being treated initially with IMV. To determine the association of hospital variation in evidence-based utilization of NIV with patient outcomes. Using the California State Inpatient Database 2011, we identified adult patients who received NIV. Patients were considered to have an SEC for NIV if they had an acute exacerbation of chronic obstructive pulmonary disease or heart failure. We used multivariable hierarchical logistic regression to determine the association between hospital rates of NIV use for SECs and patient risk of NIV failure (need for IMV after NIV). Among 22,706 hospitalizations with NIV as the initial ventilatory strategy, 6,820 (30.0%) had SECs. Patients with SECs had lower risk of NIV failure than patients with weak evidence conditions (8.1 vs. 18.2%, P benefited from admission to hospitals that used NIV more often for patients with SECs (Quartile 4 vs. Quartile 1 adjusted odds ratio for NIV failure = 0.68; 95% CI = 0.52-0.88). Most patients who received NIV did not have conditions with strong supporting evidence for its use with wide institutional variation in patient selection for NIV. Surprisingly, we found that all patients, even those without an SEC, benefited from admission to hospitals with greater evidence-based utilization of NIV, suggesting a "hospital effect" that is synergistic with patient selection.

  19. Professionalism and evidence-based practice

    DEFF Research Database (Denmark)

    Rasmussen, Palle

    2015-01-01

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

  20. Starting Strong: A School-Based Indicated Prevention Program during the Transition to Kindergarten

    Science.gov (United States)

    Eisenhower, Abbey; Taylor, Heather; Baker, Bruce L.

    2016-01-01

    Starting Strong in Kindergarten (Starting Strong) is a school-based indicated prevention targeting behavior problems, student-teacher relationships, and parent-school connectedness for children with or at risk for disruptive behavior problems during the transition to kindergarten. By use of a block-randomized, controlled trial to test program…

  1. SEARCHING FOR COOLING SIGNATURES IN STRONG LENSING GALAXY CLUSTERS: EVIDENCE AGAINST BARYONS SHAPING THE MATTER DISTRIBUTION IN CLUSTER CORES

    International Nuclear Information System (INIS)

    Blanchard, Peter K.; Bayliss, Matthew B.; McDonald, Michael; Dahle, Håkon; Gladders, Michael D.; Sharon, Keren; Mushotzky, Richard

    2013-01-01

    The process by which the mass density profile of certain galaxy clusters becomes centrally concentrated enough to produce high strong lensing (SL) cross-sections is not well understood. It has been suggested that the baryonic condensation of the intracluster medium (ICM) due to cooling may drag dark matter to the cores and thus steepen the profile. In this work, we search for evidence of ongoing ICM cooling in the first large, well-defined sample of SL selected galaxy clusters in the range 0.1 0.2 and shows no statistically significant deviation from the total cluster population. Specific star formation rates, as traced by the strength of the 4000 Å break, D 4000 , are also consistent with the general cluster population. Finally, we use optical imaging of the SL clusters to measure the angular separation, R arc , between the arc and the center of mass of each lensing cluster in our sample and test for evidence of changing [O II] emission and D 4000 as a function of R arc , a proxy observable for SL cross-sections. D 4000 is constant with all values of R arc , and the [O II] emission fractions show no dependence on R arc for R arc > 10'' and only very marginal evidence of increased weak [O II] emission for systems with R arc < 10''. These results argue against the ability of baryonic cooling associated with cool core activity in the cores of galaxy clusters to strongly modify the underlying dark matter potential, leading to an increase in SL cross-sections

  2. Evidence-based Practice of Radiology.

    Science.gov (United States)

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

    2015-10-01

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

  3. 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.

  4. The religion of evidence-based practice

    DEFF Research Database (Denmark)

    Wigram, Tony; Gold, Christian

    2012-01-01

    , and discusses autism spectrum disorders and EBP. The chapter concludes that, based on last sixty years of the development of music therapy as a recognized and relevant intervention, there is no doubt that the honeymoon period is over, and EBP is here to stay. Despite examples of attrition in music therapy......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....

  5. 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.)

  6. 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.

  7. 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

  8. 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

  9. 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

  10. Evidence-Based Education in Plastic Surgery.

    Science.gov (United States)

    Johnson, Shepard P; Chung, Kevin C; Waljee, Jennifer F

    2015-08-01

    Educational reforms in resident training have historically been driven by reports from medical societies and organizations. Although educational initiatives are well intended, they are rarely supported by robust evidence. The Accreditation Council for Graduate Medical Education recently introduced competency-based training, a form of outcomes-based education that has been used successfully in nonmedical professional vocations. This initiative has promise to advance the quality of resident education, but questions remain regarding implementation within plastic surgery. In particular, how will competency-based training impact patient outcomes, and will the methodologies used to assess competencies (i.e., milestones) be accurate and validated by literature? This report investigates resident educational reform and the need for more evidence-based educational initiatives in plastic surgery training.

  11. Theory- and evidence-based Intervention

    DEFF Research Database (Denmark)

    Nissen, Poul

    2011-01-01

    In this paper, a model for assessment and intervention is presented. This model explains how to perform theory- and evidence-based as well as practice-based assessment and intervention. The assessment model applies a holistic approach to treatment planning which includes recognition of the influe......In this paper, a model for assessment and intervention is presented. This model explains how to perform theory- and evidence-based as well as practice-based assessment and intervention. The assessment model applies a holistic approach to treatment planning which includes recognition...... of the influence of community, school, peers, famely and the functional and structural domains of personality at the behavioural, psenomenological, intra-psychic and biophysical level in a dialectical process. One important aspect of the theoretical basis for presentation of this model is that the child...

  12. Evidence-Based Special Education in the Context of Scarce Evidence-Based Practices

    Science.gov (United States)

    TEACHING Exceptional Children, 2014

    2014-01-01

    Evidence-based practices (EBPs) are supported as generally effective for populations of learners by bodies of high-quality and experimental research and, when aligned with stakeholder values and practical needs, should be prioritized for implementation. However, evidence-based practices are not currently available for all learner types in all…

  13. Evidence Based Education Request Desk. EBE #741

    Science.gov (United States)

    Regional Educational Laboratory Southeast, 2010

    2010-01-01

    This Evidence Based Education (EBE) request asks for information relating to funding for virtual schools. The EBE Request Desk was asked to provide a scan of states for information on how they fund virtual schools and what the current funding levels are (most current year for which such data is available). This paper provides answers to this…

  14. Evidence Based Education Request Desk. EBE #510

    Science.gov (United States)

    Regional Educational Laboratory Southeast, 2009

    2009-01-01

    This Evidence Based Education (EBE) request focused on research-supported vocabulary interventions for middle elementary students. Limited vocabulary is an important factor in underachievement of children in disadvantaged homes. Children with larger vocabularies find reading easier, read more widely, and do better in school (Lubliner & Smetana,…

  15. Evidence Based Education Request Desk. EBE #359

    Science.gov (United States)

    Regional Educational Laboratory Southeast, 2008

    2008-01-01

    This Evidence Based Education (EBE) response describes characteristics of graduation coach initiatives in three states (Georgia, Alabama, and California). Regional Educational Laboratory (REL) Southeast has received over 19 requests for information on various initiatives, programs or research related to improving graduation rates. For example, the…

  16. Evidence Based Education Request Desk. EBE #798

    Science.gov (United States)

    Regional Educational Laboratory Southeast, 2011

    2011-01-01

    Evidence Based Education (EBE) #555 was in response to the request "Is there any new compelling research for turning around low-performing schools?" The articles included in that document are on target, but include articles through 2009. This EBE Request seeks to provide an updated review of recent research (2009-present) regarding school…

  17. Evidence Based Education Request Desk. EBE #555

    Science.gov (United States)

    Regional Educational Laboratory Southeast, 2009

    2009-01-01

    This Evidence Based Education (EBE) Request seeks to provide an overview of recent research regarding school improvement and reform with special concentration on turning around chronically low-performing schools. The response is divided into four main sections: Research on Effective Methods for Turning Around Low-Performing Schools, Frameworks for…

  18. Evidence-based care and the curriculum

    NARCIS (Netherlands)

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

    2008-01-01

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

  19. Evidence-based management of sepsis.

    Science.gov (United States)

    O'Leary, Colleen

    2014-06-01

    Sepsis is a potential life-threatening oncologic emergency. Early recognition and prompt intervention can decrease the morbidity and mortality associated with sepsis. The Surviving Sepsis Campaign Guidelines Committee updated its recommendations in 2012, outlining specific evidence-based interventions to manage sepsis.

  20. Pilot projects in Evidence Based Policy Making

    NARCIS (Netherlands)

    Vreugdenhil, H.S.I.; Ker Rault, P.A.

    2010-01-01

    In Evidence Based Policy Making, pilot projects have been recognized as important tools to develop ‘evidence’ of policy innovations. This paper presents a theoretical and empirical study of three water management pilot projects in the Rhine basin to deepen understanding of how they can contri-bute

  1. Evidence theory and differential evolution based uncertainty ...

    Indian Academy of Sciences (India)

    Evidence theory and differential evolution based uncertainty quantification for buckling load of semi-rigid jointed frames ... State Key Laboratory for Disaster Reduction in Civil Engineering, Tongji University, Shanghai 200092, China; Research Institute of Structural Engineering and Disaster Reduction, College of Civil ...

  2. 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...

  3. <strong>A Language-Based Approach for Improving the Robustness of Network Application Protocol Implementationsstrong>

    DEFF Research Database (Denmark)

    Burgy, Laurent; Reveillere, Laurent; Lawall, Julia Laetitia

    2007-01-01

    -specific language, Zebu, for generating robust and efficient message processing layers. A Zebu specification, based on the notation used in RFCs, describes protocol message formats and related processing constraints. Zebu-based applications are efficient, since message fragments can be specified to be processed...

  4. 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...

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

    Directory of Open Access Journals (Sweden)

    Denise Koufogiannakis

    2011-03-01

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

  6. Are alcohol outlet densities strongly associated with alcohol-related outcomes? A critical review of recent evidence.

    Science.gov (United States)

    Gmel, Gerhard; Holmes, John; Studer, Joseph

    2015-06-29

    There have been reviews on the association between density of alcohol outlets and harm including studies published up to December 2008. Since then the number of publications has increased dramatically. The study reviews the more recent studies with regard to their utility to inform policy. A systematic review found more than 160 relevant studies (published between January 2009 and October 2014). The review focused on: (i) outlet density and assaultive or intimate partner violence; (ii) studies including individual level data; or (iii) 'natural experiments'. Despite overall evidence for an association between density and harm, there is little evidence on causal direction (i.e. whether demand leads to more supply or increased availability increases alcohol use and harm). When outlet types (e.g. bars, supermarkets) are analysed separately, studies are too methodologically diverse and partly contradictory to permit firm conclusions besides those pertaining to high outlet densities in areas such as entertainment districts. Outlet density commonly had little effect on individual-level alcohol use, and the few 'natural experiments' on restricting densities showed little or no effects. Although outlet densities are likely to be positively related to alcohol use and harm, few policy recommendations can be given as effects vary across study areas, outlet types and outlet cluster size. Future studies should examine in detail outlet types, compare different outcomes associated with different strengths of association with alcohol, analyse non-linear effects and compare different methodologies. Purely aggregate-level studies examining total outlet density only should be abandoned. [Gmel G, Holmes J, Studer J. Are alcohol outlet densities strongly associated with alcohol-related outcomes? A critical review of recent evidence. Drug Alcohol Rev 2015]. © 2015 Australasian Professional Society on Alcohol and other Drugs.

  7. Ion exchange behaviour of citrate and EDTA anions on strong and weak base organic ion exchangers

    International Nuclear Information System (INIS)

    Askarieh, M.M.; White, D.A.

    1988-01-01

    The exchange of citrate and EDTA ions with two strong base and two weak base exchangers is considered. Citrate and EDTA analysis for this work was performed using a colorimetric method developed here. The ions most selectively exchanged on the resins are H 2 cit - and H 2 EDTA 2- , though EDTA is generally less strongly sorbed on strong base resins. In contact with weak base resins, deprotonation of the resin occurs during ion exchange with a noticeable drop in solution pH. Although EDTA sorption can be reversed by nitric acid, citrate ions are significantly held on the resin at low pH. The exchange of citrate can be made reversible if bicarbonate is added to the initial solutions. Alkaline regeneration of exchangers loaded with EDTA proved to be very effective. (author)

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. Evidence-Based Chinese Medicine for Hypertension

    Directory of Open Access Journals (Sweden)

    Jie Wang

    2013-01-01

    Full Text Available Hypertension is an important worldwide public -health challenge with high mortality and disability. Due to the limitations and concerns with current available hypertension treatments, many hypertensive patients, especially in Asia, have turned to Chinese medicine (CM. Although hypertension is not a CM term, physicians who practice CM in China attempt to treat the disease using CM principles. A variety of approaches for treating hypertension have been taken in CM. For seeking the best evidence of CM in making decisions for hypertensive patients, a number of clinical studies have been conducted in China, which has paved the evidence-based way. After literature searching and analyzing, it appeared that CM was effective for hypertension in clinical use, such as Chinese herbal medicine, acupuncture, moxibustion, cupping, qigong, and Tai Chi. However, due to the poor quality of primary studies, clinical evidence is still weak. The potential benefits and safety of CM for hypertension still need to be confirmed in the future with well-designed RCTs of more persuasive primary endpoints and high-quality SRs. Evidence-based Chinese medicine for hypertension still has a long way to go.

  13. 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.

  14. Vortex trapping in Pb-alloy Josephson junctions induced by strong sputtering of the base electrode

    International Nuclear Information System (INIS)

    Wada, M.; Nakano, J.; Yanagawa, F.

    1985-01-01

    It is observed that strong rf sputtering of the Pb-alloy base electrodes causes the junctions to trap magnetic vortices and thus induces Josephson current (I/sub J/) suppression. Trapping begins to occur when the rf sputtering that removes the native thermal oxide on the base electrode is carried out prior to rf plasma oxidation. Observed large I/sub J/ suppression is presumably induced by the concentration of vortices into the sputtered area upon cooling the sample below the transition temperature. This suggests a new method of the circumvention of the vortex trapping by strongly rf sputtering the areas of the electrode other than the junction areas

  15. Why evidence-based medicine failed in patient care and medicine-based evidence will succeed.

    Science.gov (United States)

    Horwitz, Ralph I; Singer, Burton H

    2017-04-01

    Evidence-based medicine (EBM) has succeeded in strengthening the evidence base for population medicine. Where EBM has failed is in answering the practicing doctor's question of what a likely outcome would be when a given treatment is administered to a particular patient with her own distinctive biological and biographical (life experience) profile. We propose Medicine-based evidence (MBE), based on the profiles of individual patients, as the evidence base for individualized or personalized medicine. MBE will build an archive of patient profiles using data from all study types and data sources, and will include both clinical and socio-behavioral information. The clinician seeking guidance for the management of an individual patient will start with the patient's longitudinal profile and find approximate matches in the archive that describes how similar patients responded to a contemplated treatment and alternative treatments. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. 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...

  17. 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.

  18. 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.

  19. 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.

  20. Topographic gradient based site characterization in India complemented by strong ground-motion spectral attributes

    KAUST Repository

    Nath, Sankar Kumar

    2013-12-01

    We appraise topographic-gradient approach for site classification that employs correlations between 30. m column averaged shear-wave velocity and topographic gradients. Assessments based on site classifications reported from cities across India indicate that the approach is reasonably viable at regional level. Additionally, we experiment three techniques for site classification based on strong ground-motion recordings, namely Horizontal-to-Vertical Spectral Ratio (HVSR), Response Spectra Shape (RSS), and Horizontal-to-Vertical Response Spectral Ratio (HVRSR) at the strong motion stations located across the Himalayas and northeast India. Statistical tests on the results indicate that these three techniques broadly differentiate soil and rock sites while RSS and HVRSR yield better signatures. The results also support the implemented site classification in the light of strong ground-motion spectral attributes observed in different parts of the globe. © 2013 Elsevier Ltd.

  1. Formation of Globular Clusters with Internal Abundance Spreads in r -Process Elements: Strong Evidence for Prolonged Star Formation

    Energy Technology Data Exchange (ETDEWEB)

    Bekki, Kenji [ICRAR, M468, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009 (Australia); Tsujimoto, Takuji [National Astronomical Observatory of Japan, Mitaka-shi, Tokyo 181-8588 (Japan)

    2017-07-20

    Several globular clusters (GCs) in the Galaxy are observed to show internal abundance spreads in r -process elements (e.g., Eu). We propose a new scenario that explains the origin of these GCs (e.g., M5 and M15). In this scenario, stars with no/little abundance variations first form from a massive molecular cloud (MC). After all of the remaining gas of the MC is expelled by numerous supernovae, gas ejected from asymptotic giant branch stars can be accumulated in the central region of the GC to form a high-density intracluster medium (ICM). Merging of neutron stars then occurs to eject r -process elements, which can be efficiently trapped in and subsequently mixed with the ICM. New stars formed from the ICM can have r -process abundances that are quite different from those of earlier generations of stars within the GC. This scenario can explain both (i) why r -process elements can be trapped within GCs and (ii) why GCs with internal abundance spreads in r -process elements do not show [Fe/H] spreads. Our model shows (i) that a large fraction of Eu-rich stars can be seen in Na-enhanced stellar populations of GCs, as observed in M15, and (ii) why most of the Galactic GCs do not exhibit such internal abundance spreads. Our model demonstrates that the observed internal spreads of r -process elements in GCs provide strong evidence for prolonged star formation (∼10{sup 8} yr).

  2. Further evidence for the strong steepening of the median radio spectrum with decreasing intensity of sources selected at 5 GHz

    Science.gov (United States)

    Machalski, J.; Rys, S.

    1981-06-01

    Results are presented of a comparison of the spectral indices of radio sources selected at 5 GHz with their 5-GHz intensities which provides further evidence for the strong steepening of the radio spectrum with decreasing flux density. Distributions of spectral index between 5000 and 1400 MHz are compared for radio sources of 5-GHz intensity greater than or equal to 800 mJy of Witzel et al. (1979), sources selected from the S5 installment of the NRAO-Bonn survey with intensity between 250 and 800 mJy, and sources selected from the 4755-MHz survey of Ledden et al. (1980) with intensity between 40 and 250 mJy. As 5-GHz flux density decreases, it is observed that (1) the secondary peak of the spectral index distribution decreases; (2) the main peak of the distribution is shifted to steeper values; and (3) the dispersion systematically decreases. It is pointed out that further optical identifications of faint radio sources at 5 GHz are required to determine whether the observed steepening is due to a decline of quasars, or a variation in quasar spectral properties with increasing distance.

  3. Genetic evidence strongly support an essential role for PfPV1 in intra-erythrocytic growth of P. falciparum.

    Directory of Open Access Journals (Sweden)

    Trang Chu

    Full Text Available Upon invading the host erythrocyte, the human malaria parasite P. falciparum lives and replicates within a membrane bound compartment referred to as the parasitophorous vacuole. Recently, interest in this compartment and its protein content has grown, due to the important roles these play in parasite egress and protein traffic to the host cell. Surprisingly, the function of many proteins within this compartment has not been experimentally addressed. Here, we study the importance of one of these proteins, termed PfPV1, for intra-erythrocytic parasite survival. Despite numerous attempts to inactivate the gene encoding PfPV1, we were unable to recover deletion mutants. Control experiments verified that the pv1 gene locus was per se open for gene targeting experiments, allowing us to exclude technical limitations in our experimental strategy. Our data provide strong genetic evidence that PfPV1 is essential for survival of blood stage P. falciparum, and further highlight the importance of parasitophorous vacuole proteins in this part of the parasite's life cycle.

  4. Evidence-based ethics? On evidence-based practice and the "empirical turn" from normative bioethics.

    Science.gov (United States)

    Goldenberg, Maya J

    2005-11-08

    The increase in empirical methods of research in bioethics over the last two decades is typically perceived as a welcomed broadening of the discipline, with increased integration of social and life scientists into the field and ethics consultants into the clinical setting, however it also represents a loss of confidence in the typical normative and analytic methods of bioethics. The recent incipiency of "Evidence-Based Ethics" attests to this phenomenon and should be rejected as a solution to the current ambivalence toward the normative resolution of moral problems in a pluralistic society. While "evidence-based" is typically read in medicine and other life and social sciences as the empirically-adequate standard of reasonable practice and a means for increasing certainty, I propose that the evidence-based movement in fact gains consensus by displacing normative discourse with aggregate or statistically-derived empirical evidence as the "bottom line". Therefore, along with wavering on the fact/value distinction, evidence-based ethics threatens bioethics' normative mandate. The appeal of the evidence-based approach is that it offers a means of negotiating the demands of moral pluralism. Rather than appealing to explicit values that are likely not shared by all, "the evidence" is proposed to adjudicate between competing claims. Quantified measures are notably more "neutral" and democratic than liberal markers like "species normal functioning". Yet the positivist notion that claims stand or fall in light of the evidence is untenable; furthermore, the legacy of positivism entails the quieting of empirically non-verifiable (or at least non-falsifiable) considerations like moral claims and judgments. As a result, evidence-based ethics proposes to operate with the implicit normativity that accompanies the production and presentation of all biomedical and scientific facts unchecked. The "empirical turn" in bioethics signals a need for reconsideration of the methods used

  5. Identity Based Strong Designated Verifier Parallel Multi-Proxy Signature Scheme

    OpenAIRE

    Lal, Sunder; Verma, Vandani

    2009-01-01

    This paper presents a new identity based strong designated verifier parallel multi-proxy signature scheme. Multi-Proxy signatures allow the original signer to delegate his signing power to a group of proxy signers. In our scheme, the designated verifier can only validate proxy signatures created by a group of proxy signer.

  6. Strong Teens: A School-Based Small Group Experience for African American Males

    Science.gov (United States)

    White, Nathan J.; Rayle, Andrea Dixon

    2007-01-01

    This article describes the school-based, small group adaptation of the existing Strong Teens Curriculum (STC) for African American male adolescents in high schools. The STC was created to equip adolescents with skills that promote more effective social interaction and enhance personal emotional and psychological wellness. The authors present a…

  7. Cellulite: an evidence-based review.

    Science.gov (United States)

    Luebberding, Stefanie; Krueger, Nils; Sadick, Neil S

    2015-08-01

    Cellulite is a multifactorial condition that is present in 80-90 % of post-pubertal women. Despite its high prevalence, it remains a major cosmetic concern for women. A wide range of products and treatments for cellulite reduction is available; however, no systematic review has been performed so far to evaluate the efficacy of the available treatment options for cellulite. The objective of this review is to provide a systematic evaluation of the scientific evidence of the efficacy of treatments for cellulite reduction. This systematic review followed the PRISMA guidelines for reporting systematic reviews and meta-analyses. Only original articles in English or German reporting data on the efficacy of cellulite treatments from in vivo human studies were considered. In total, 67 articles were analyzed for the following information: therapy, presence of a control group, randomization, blinding, sample size, description of statistical methods, results, and level of evidence. Most of the evaluated studies, including laser- and light-based modalities, radiofrequency, and others had important methodological flaws; some did not use cellulite severity as an endpoint or did not provide sufficient statistical analyses. Of the 67 studies analyzed in this review, only 19 were placebo-controlled studies with randomization. Some evidence for potential benefit was only seen for acoustic wave therapy (AWT) and the 1440 nm Nd:YAG minimally invasive laser. This article provides a systematic evaluation of the scientific evidence of the efficacy of treatment for cellulite reduction. No clear evidence of good efficacy could be identified in any of the evaluated cellulite treatments.

  8. 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.

  9. Strong ion difference in urine: new perspectives in acid-base assessment.

    OpenAIRE

    Gattinoni, L.; Carlesso, E.; Cadringher, P.; Caironi, P.

    2006-01-01

    The plasmatic strong ion difference (SID) is the difference between positively and negatively charged strong ions. At pH 7.4, temperature 37°C and partial carbon dioxide tension 40 mmHg, the ideal value of SID is 42 mEq/l. The buffer base is the sum of negatively charged weak acids ([HCO3 -], [A-], [H2PO4 -]) and its normal value is 42 mEq/l. According to the law of electroneutrality, the amount of positive and negative charges must be equal, and therefore the SID value is equal to the buffer...

  10. A method for designing strong S-Boxes based on chaotic Lorenz system

    Energy Technology Data Exchange (ETDEWEB)

    Ozkaynak, Fatih, E-mail: ozkaynak_fatih@hotmail.co [Tunceli University, Department of Computer Engineering, Tunceli (Turkey); Ozer, Ahmet Bedri, E-mail: bedriozer@firat.edu.t [Firat University, Department of Computer Engineering, 23119 Elazig (Turkey)

    2010-08-09

    It is important to design cryptographically strong S-Boxes in order to design secure systems. In this study, a strong, chaos-based S-Box design is proposed. Continuous-time Lorenz system is chosen as the chaotic system. Proposed methodology is analyzed and tested for the following criteria: Bijective property, nonlinearity, strict avalanche criterion, output bits independence criterion and equiprobable input/output XOR distribution. The results of the analysis show that the proposed cryptosystem is a highly reliable system suitable for secure communication.

  11. Low-temperature fabrication of mesoporous solid strong bases by using multifunction of a carbon interlayer.

    Science.gov (United States)

    Liu, Xiao-Yan; Sun, Lin-Bing; Liu, Xiao-Dan; Li, Ai-Guo; Lu, Feng; Liu, Xiao-Qin

    2013-10-09

    Mesoporous solid strong bases are highly promising for applications as environmentally benign catalysts in various reactions. Their preparation attracts increasing attention for the demand of sustainable chemistry. In the present study, a new strategy was designed to fabricate strong basicity on mesoporous silica by using multifunction of a carbon interlayer. A typical mesoporous silica, SBA-15, was precoated with a layer of carbon prior to the introduction of base precursor LiNO3. The carbon interlayer performs two functions by promoting the conversion of LiNO3 at low temperatures and by improving the alkali-resistant ability of siliceous host. Only a tiny amount of LiNO3 was decomposed on pristine SBA-15 at 400 °C; for the samples containing >8 wt % of carbon, however, LiNO3 can be entirely converted to strongly basic sites Li2O under the same conditions. The guest-host redox reaction was proven to be the answer for the conversion of LiNO3, which breaks the tradition of thermally induced decomposition. More importantly, the residual carbon layer can prevent the siliceous frameworks from corroding by the newly formed strongly basic species, which is different from the complete destruction of mesostructure in the absence of carbon. Therefore, materials possessing both ordered mesostructure and strong basicity were successfully fabricated, which is extremely desirable for catalysis and impossible to realize by conventional methods. We also demonstrated that the resultant mesoporous basic materials are active in heterogeneous synthesis of dimethyl carbonate (DMC) and the yield of DMC can reach 32.4%, which is apparently higher than that over the catalysts without a carbon interlayer (<12.9%) despite the same lithium content. The strong basicity, in combination with the uniform mesopores, is believed to be responsible for such a high activity.

  12. The Strong Gravitationally Lensed Herschel Galaxy HLock01: Optical Spectroscopy Reveals a Close Galaxy Merger with Evidence of Inflowing Gas

    Science.gov (United States)

    Marques-Chaves, Rui; Pérez-Fournon, Ismael; Gavazzi, Raphael; Martínez-Navajas, Paloma I.; Riechers, Dominik; Rigopoulou, Dimitra; Cabrera-Lavers, Antonio; Clements, David L.; Cooray, Asantha; Farrah, Duncan; Ivison, Rob J.; Jiménez-Ángel, Camilo E.; Nayyeri, Hooshang; Oliver, Seb; Omont, Alain; Scott, Douglas; Shu, Yiping; Wardlow, Julie

    2018-02-01

    The submillimeter galaxy (SMG) HERMES J105751.1+573027 (hereafter HLock01) at z = 2.9574 ± 0.0001 is one of the brightest gravitationally lensed sources discovered in the Herschel Multi-tiered Extragalactic Survey. Apart from the high flux densities in the far-infrared, it is also extremely bright in the rest-frame ultraviolet (UV), with a total apparent magnitude m UV ≃ 19.7 mag. We report here deep spectroscopic observations with the Gran Telescopio Canarias of the optically bright lensed images of HLock01. Our results suggest that HLock01 is a merger system composed of the Herschel-selected SMG and an optically bright Lyman break-like galaxy (LBG), separated by only 3.3 kpc in projection. While the SMG appears very massive (M * ≃ 5 × 1011 M ⊙), with a highly extinguished stellar component (A V ≃ 4.3 ), the LBG is a young, lower-mass (M * ≃ 1 × 1010 M ⊙), but still luminous (10× {L}UV}* ) satellite galaxy. Detailed analysis of the high signal-to-noise ratio (S/N) rest-frame UV spectrum of the LBG shows complex kinematics of the gas, exhibiting both blueshifted and redshifted absorption components. While the blueshifted component is associated with strong galactic outflows from the massive stars in the LBG, as is common in most star-forming galaxies, the redshifted component may be associated with gas inflow seen along a favorable sightline to the LBG. We also find evidence of an extended gas reservoir around HLock01 at an impact parameter of 110 kpc, through the detection of C II λλ1334 absorption in the red wing of a bright Lyα emitter at z ≃ 3.327. The data presented here highlight the power of gravitational lensing in high S/N studies to probe deeply into the physics of high-z star-forming galaxies.

  13. Evidence-based management of Raynaud's phenomenon.

    Science.gov (United States)

    Herrick, Ariane L

    2017-12-01

    Raynaud's phenomenon (RP) is relevant to the rheumatologist because it may signify an underlying connective tissue disease and also because it can be very challenging to treat, especially when it has progressed to digital ulceration or critical ischaemia. This review article discusses diagnosis (does this patient have an underlying connective tissue disease?), including the role for nailfold capillaroscopy, and treatment. Management of 'uncomplicated' RP is first described and then treatment of RP complicated by progression to digital ulceration or critical ischaemia, highlighting recent advances (including phosphodiesterase type 5 inhibition, and endothelin 1 receptor antagonism) and the evidence base underpinning these. Possible future therapies are briefly discussed.

  14. 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.

  15. 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.

  16. Managing and reviewing evidence-based changes.

    Science.gov (United States)

    Carter, Helen; Price, Lynda

    Nurses lead many projects to manage change aimed at improving patient safety and care. This two-part series offers practical guidance on how to bring about an evidence-based change in practice, and how to demonstrate the success, or otherwise, of that change. Part 2 is concerned with discovering why the practice is falling short, how to implement improvements and measure the effect of the changes. It also highlights ways in which nurses can use their work as part of the revalidation process.

  17. Evidence-Based Rabbit Housing and Nutrition.

    Science.gov (United States)

    Clauss, Marcus; Hatt, Jean-Michel

    2017-09-01

    Because most research on rabbit husbandry, welfare, and nutrition was performed on production animals, evidence for best practices in pet rabbits is scarce, and guidelines must be based on transfer of results, deduction, and common sense. Rabbits benefit from being kept with at least one conspecific; from large enclosures and multistory hutches; from drinking water offered ad libitum in open dish drinker systems; and from receiving hay ad libitum, with restricted amounts of fresh grass, herbs, or green leafy vegetables, and a high-fiber complete diet. Offering hay ad libitum bears several advantages and should be considered a matter of course. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Evidence-Based Medicine: Breast Augmentation.

    Science.gov (United States)

    Schwartz, Michael R

    2017-07-01

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

  19. How to teach evidence-based medicine.

    Science.gov (United States)

    Bradt, Pamela; Moyer, Virginia

    2003-06-01

    Learning to practice EBM provides physicians with the tools needed to overcome some of the common barriers they face when trying to use the medical literature to solve patient problems. It does require a change in attitude and behavior and is likely to be met with some resistance. Understanding the learners' stage of behavior change is likely to facilitate educational intervention. Behavior change does not occur unless physicians are convinced of the benefits of practicing EBM. Easy access to evidence-based summaries facilitates the use of high-quality evidence. Developing the ability to access information from the medical literature, critically appraising it, and applying it to patient care requires skills that need to be taught. Most practicing physicians were not taught these skills in medical school. Excellent resources are available from which to learn and teach EBM. Multiple exposures using a variety of formats are most effective. Finally, a tool to evaluate the acquisition of knowledge and skills needed to practice EBM recently has been validated. Despite ongoing challenges, learning and teaching EBM has never been easier and each year brings new and better tools to help practitioners and educators use the best available evidence. Box 2 lists suggestions for getting started.

  20. Chronic constipation: an evidence-based review.

    Science.gov (United States)

    Leung, Lawrence; Riutta, Taylor; Kotecha, Jyoti; Rosser, Walter

    2011-01-01

    Chronic constipation is a common condition seen in family practice among the elderly and women. There is no consensus regarding its exact definition, and it may be interpreted differently by physicians and patients. Physicians prescribe various treatments, and patients often adopt different over-the-counter remedies. Chronic constipation is either caused by slow colonic transit or pelvic floor dysfunction, and treatment differs accordingly. To update our knowledge of chronic constipation and its etiology and best-evidence treatment, information was synthesized from articles published in PubMed, EMBASE, and Cochrane Database of Systematic Reviews. Levels of evidence and recommendations were made according to the Strength of Recommendation taxonomy. The standard advice of increasing dietary fibers, fluids, and exercise for relieving chronic constipation will only benefit patients with true deficiency. Biofeedback works best for constipation caused by pelvic floor dysfunction. Pharmacological agents increase bulk or water content in the bowel lumen or aim to stimulate bowel movements. Novel classes of compounds have emerged for treating chronic constipation, with promising clinical trial data. Finally, the link between senna abuse and colon cancer remains unsupported. Chronic constipation should be managed according to its etiology and guided by the best evidence-based treatment.

  1. 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 ...

  2. Particle-Hole Transformation in Strongly-Doped Iron-Based Superconductors

    OpenAIRE

    Rodriguez, J. P.

    2016-01-01

    An exact particle-hole transformation is discovered in a local-moment description of a single layer in an iron-based superconductor. Application of the transformation to a surface layer of heavily electron-doped FeSe predicts a surface-layer high-temperature superconductor at strong hole doping. Comparison with existing low-T_c iron superconductors suggests that the critical temperature at heavy hole doping can be increased by increasing direct ferromagnetic exchange in between nearest neighb...

  3. 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

  4. A provably secure identity-based strong designated verifier proxy signature scheme from bilinear pairings

    Directory of Open Access Journals (Sweden)

    SK Hafizul Islam

    2014-01-01

    Full Text Available The proxy signature, a variant of the ordinary digital signature, has been an active research topic in recent years; it has many useful applications, including distributed systems and grid computing. Although many identity-based proxy signature schemes have been proposed in the literature, only a few proposals for identity-based strong designated verifier proxy signature (ID-SDVPS schemes are available. However, it has been found that most of the ID-SDVPS schemes that have been proposed to date are not efficient in terms of computation and security, and a computationally efficient and secured ID-SDVPS scheme using elliptic curve bilinear pairing has been proposed in this paper. The security of the scheme is mainly based on the hardness assumption of CDH and GBDH problems in the random oracle model, which is existentially unforgeable against different types of adversaries. Furthermore, the security of our scheme is simulated in the AVISPA (Automated Validation of Internet Security Protocols and Applications software, a widely used automated internet protocol validation tool, and the simulation results confirm strong security against both active and passive attacks. In addition, because of a high processing capability and supporting additional security features, the scheme is suitable for the environments in which less computational cost with strong security is required.

  5. An Examination of the Bases of Evidence-Based Interventions.

    Science.gov (United States)

    Wampold, Bruce E.

    2002-01-01

    School psychology has proposed a system to aid in the identification of evidence-based interventions (Kratochwill & Stoiber, this issue; Lewis-Snyder, Stoiber, & Kratochwill, this issue; Shernoff, Kratochwill, & Stoiber, this issue). In this commentary, issues related to the politics of exclusion, design and theory, methods, and…

  6. 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.

  7. 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

    2018-02-21

    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.

  8. Evidence-based neuroethics for neurodevelopmental disorders.

    Science.gov (United States)

    Racine, Eric; Bell, Emily; Di Pietro, Nina C; Wade, Lucie; Illes, Judy

    2011-03-01

    Many neurodevelopmental disorders affect early brain development in ways that are still poorly understood; yet, these disorders can place an enormous toll on patients, families, and society as a whole and affect all aspects of daily living for patients and their families. We describe a pragmatic, evidence-based framework for engaging in empiric ethics inquiry for a large consortium of researchers in neurodevelopmental disorders and provide relevant case studies of pragmatic neuroethics. The 3 neurodevelopmental disorders that are at the focus of our research, cerebral palsy (CP), autism spectrum disorder (ASD), and fetal alcohol spectrum disorder (FASD), bring unique and intersecting challenges of translating ethically research into clinical care for children and neonates. We identify and discuss challenges related to health care delivery in CP; neonatal neurological decision making; alternative therapies; and identity, integrity, and personhood. Copyright © 2011 Elsevier Inc. All rights reserved.

  9. Evidence-based medicine: medical librarians providing evidence at the point of care.

    Science.gov (United States)

    Yaeger, Lauren H; Kelly, Betsy

    2014-01-01

    Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. .. by best available external clinical evidence we mean clinically relevant research.' Health care reform authorized by the Affordable Care Act is based on the belief that evidence-based practice (EBP) generates cost savings due to the delivery of more effective care.2 Medical librarians, skilled in identifying appropriate resources and working with multiple complex interfaces, can support clinicians' efforts to practice evidence based medicine by providing time and expertise in articulating the clinical question and identifying the best evidence.

  10. 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

  11. Identification of strong promoters based on the transcriptome of Bacillus licheniformis.

    Science.gov (United States)

    Liu, Xin; Yang, Haiyan; Zheng, Junwei; Ye, Yanrui; Pan, Li

    2017-06-01

    To expand the repertoire of strong promoters for high level expression of proteins based on the transcriptome of Bacillus licheniformis. The transcriptome of B. licheniformis ATCC14580 grown to the early stationary phase was analyzed and the top 10 highly expressed genes/operons out of the 3959 genes and 1249 operons identified were chosen for study promoter activity. Using beta-galactosidase gene as a reporter, the candidate promoter pBL9 exhibited the strongest activity which was comparable to that of the widely used strong promoter p43. Furthermore, the pro-transglutaminase from Streptomyces mobaraensis (pro-MTG) was expressed under the control of promoter pBL9 and the activity of pro-MTG reached 82 U/ml after 36 h, which is 23% higher than that of promoter p43 (66.8 U/ml). In our analyses of the transcriptome of B. licheniformis, we have identified a strong promoter pBL9, which could be adapted for high level expression of proteins in the host Bacillus subtilis.

  12. Designed microtremor array based actual measurement and analysis of strong ground motion at Palu city, Indonesia

    Energy Technology Data Exchange (ETDEWEB)

    Thein, Pyi Soe, E-mail: pyisoethein@yahoo.com [Geology Department, Yangon University (Myanmar); Pramumijoyo, Subagyo; Wilopo, Wahyu; Setianto, Agung [Geological Engineering Department, Gadjah Mada University (Indonesia); Brotopuspito, Kirbani Sri [Physics Department, Gadjah Mada University (Indonesia); Kiyono, Junji; Putra, Rusnardi Rahmat [Graduate School of Global Environmental Studies, Kyoto University (Japan)

    2015-04-24

    In this study, we investigated the strong ground motion characteristics under Palu City, Indonesia. The shear wave velocity structures evaluated by eight microtremors measurement are the most applicable to determine the thickness of sediments and average shear wave velocity with Vs ≤ 300 m/s. Based on subsurface underground structure models identified, earthquake ground motion was estimated in the future Palu-Koro earthquake by using statistical green’s function method. The seismic microzonation parameters were carried out by considering several significant controlling factors on ground response at January 23, 2005 earthquake.

  13. Synergistic desorption of molybdenum from the strong base anion exchange resin by molybdnum fouling

    International Nuclear Information System (INIS)

    Zhang Guowei; Zhao Guirong

    1988-01-01

    In this paper the synerglstic desorption of molybdenum from the strong base anion exchange resin is studied using ammonium hydroxide and ammonium sulfate, sodium hydroxide and sodium sulfate or sodium hydroxide and sodium chloride mixed chloride mixed desorbents. The coefficients of synergistlc desorption for various mixed desorbents are obtained. The experimental results show that the desorption efficiency of the mixed desorbent containing ammonium hydroxide and ammonium sulfate is so high that it can substitute for the mixed desorbent used in the plant. The harmful affect of the chloride ion on production can be eliminated if this mixed desorbent is used for the plant

  14. Evidence-based Diagnostics: Adult Septic Arthritis

    Science.gov (United States)

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

    2011-01-01

    Background 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. Objectives 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. Methods 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. Results The prevalence of nongonococcal septic arthritis in ED patients with a single acutely painful joint is approximately 27

  15. Mantle fluids ascent in the regions of strong earthquake sources and large deep fault zones: geochemical evidences

    International Nuclear Information System (INIS)

    Kopnichev, Yu.F.; Sokolova, I.N.

    2005-01-01

    Data on variations of a ratio of the helium isotope content (parameter R= 3 He/ 4 He) near the sources of strong earthquakes and some large fault zones (in the regions of Tien Shan, Mongolia, California, Central Japan and Central Apennines) are being analyzed. It was shown that in many cases R values regularly diminish with the distance from epicenters and large regional faults. This testifies to the ascent of mantle fluids into the earth's crust after strong earthquakes and in some deep fault zones, which are characterized by superhigh permeability and their further migration in horizontal direction. (author)

  16. 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...... 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...... that the wide range of terminologies and typologies creates “an epistemological mess” that causes confusion and ruins effective communication and understanding among practitioners, educators and researchers (e.g. Titchen & Ersser, 2001). Taking a Wittgensteinian approach, my paper will argue that ending...

  17. Evidence-based Update of Pediatric Dental Restorative Procedures: Preventive Strategies.

    Science.gov (United States)

    Tinanoff, N; Coll, J A; Dhar, V; Maas, W R; Chhibber, S; Zokaei, L

    2015-01-01

    There has been significant advances in the understanding of preventive restorative procedures regarding the advantages and disadvantages for restorative procedures; the evidence for conservative techniques for deep carious lesions; the effectiveness of pit and fissure sealants; and the evidence for use of resin infiltration techniques. The intent of this review is to help practitioners use evidence to make decisions regarding preventive restorative dentistry in children and young adolescents. This evidence-based review appraises the literature, primarily between the years 1995-2013, on preventive restorative strategies. The evidence was graded as to strong evidence, evidence in favor, or expert opinion by consensus of authors Results: The preventive strategy for dental caries includes individualized assessment of disease progression and management with appropriate preventive and restorative therapy. There is strong evidence that restoration of teeth with incomplete caries excavation results in fewer signs and symptoms of pulpal disease than complete excavation. There is strong evidence that sealants should be placed on pit and fissure surfaces judged to be at risk for dental caries, and surfaces that already exhibit incipient, non-cavitated carious lesions. There is evidence in favor for resin infiltration to improve the clinical appearance of white spot lesions. Substantial evidence exists in the literature regarding the value of preventive dental restorative procedures.

  18. 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.

  19. Information literacy for evidence-based practice in perianesthesia nurses: readiness for evidence-based practice.

    Science.gov (United States)

    Ross, Jacqueline

    2010-04-01

    Information literacy, the recognition of information required, and the development of skills for locating, evaluating, and effectively using relevant evidence is needed for evidence-based practice (EBP). The purpose of this study was to examine perianesthesia nurses' perception of searching skills and access to evidence sources. The design was a descriptive, exploratory survey. The sample consisted of ASPAN members (n = 64) and nonmembers (n = 64). The Information Literacy for Evidence-Based Nursing Practice instrument was used. Findings were that ASPAN members read more journal articles, were more proficient with computers, and used Cumulative Index to Nursing and Allied Health Literature (CINAHL) more frequently than nonmembers. The three top barriers to use of research were: lack of understanding of organization or structure of electronic databases, lack of skills to critique and/or synthesize the literature, and difficulty in accessing research materials. In conclusion, education is needed for critiquing literature and understanding electronic databases and research articles to promote EBP in perianesthesia areas. Copyright 2010. Published by Elsevier Inc.

  20. Stagnation and Storage of Strongly Depleted Melts in Slow-Ultraslow Spreading Oceans: Evidence from the Ligurian Tethys

    Science.gov (United States)

    Piccardo, Giovanni; Guarnieri, Luisa; Padovano, Matteo

    2013-04-01

    Our studies of Alpine-Apennine ophiolite massifs (i.e., Lanzo, Voltri, Ligurides, Corsica) show that the Jurassic Ligurian Tethys oceanic basin was a slow-ultraslow spreading basin, characterized by the exposures on the seafloor of mantle peridotites with extreme compositional variability. The large majority of these peridotites are made of depleted spinel harzburgites and plagioclase peridotites. The former are interpreted as reactive peridotites formed by the reactive percolation of under-saturated, strongly trace element depleted asthenospheric melts migrated by porous flow through the mantle lithosphere. The latter are considered as refertilized peridotites formed by peridotite impregnation by percolated silica-saturated, strongly trace element depleted melts. Strongly depleted melts were produced as low-degrees, single melt increments by near fractional melting of the passively upwelling asthenosphere during the rifting stage of the basin. They escaped single melt increment aggregation, migrated isolated through the mantle lithosphere by reactive porous or channeled flow before oceanic opening, and were transformed into silica-saturated derivative liquids that underwent entrapment and stagnation in the shallow mantle lithosphere forming plagioclase-enriched peridotites. Widespread small bodies of strongly depleted gabbro-norites testify for the local coalescence of these derivative liquids. These melts never reached the surface (i.e., the hidden magmatism), since lavas with their composition have never been found in the basin. Subsequently, aggregated MORB melts upwelled within replacive dunite channels (as evidenced by composition of magmatic clinopyroxenes in dunites), intruded at shallow levels as olivine gabbro bodies and extruded as basaltic lavas, to form the crustal rocks of the oceanic lithosphere (i.e., the oceanic magmatism). Km-scale bodies of MORB olivine gabbros were intruded into the plagioclase-enriched peridotites, which were formed in the

  1. Finite Elements Based on Strong and Weak Formulations for Structural Mechanics: Stability, Accuracy and Reliability

    Directory of Open Access Journals (Sweden)

    Francesco Tornabene

    2017-07-01

    Full Text Available The authors are presenting a novel formulation based on the Differential Quadrature (DQ method which is used to approximate derivatives and integrals. The resulting scheme has been termed strong and weak form finite elements (SFEM or WFEM, according to the numerical scheme employed in the computation. Such numerical methods are applied to solve some structural problems related to the mechanical behavior of plates and shells, made of isotropic or composite materials. The main differences between these two approaches rely on the initial formulation – which is strong or weak (variational – and the implementation of the boundary conditions, that for the former include the continuity of stresses and displacements, whereas in the latter can consider the continuity of the displacements or both. The two methodologies consider also a mapping technique to transform an element of general shape described in Cartesian coordinates into the same element in the computational space. Such technique can be implemented by employing the classic Lagrangian-shaped elements with a fixed number of nodes along the element edges or blending functions which allow an “exact mapping” of the element. In particular, the authors are employing NURBS (Not-Uniform Rational B-Splines for such nonlinear mapping in order to use the “exact” shape of CAD designs.

  2. Creating Evidence-Based Research in Adapted Physical Activity

    Science.gov (United States)

    Reid, Greg; Bouffard, Marcel; MacDonald, Catherine

    2012-01-01

    Professional practice guided by the best research evidence is a usually referred to as evidence-based practice. The aim of the present paper is to describe five fundamental beliefs of adapted physical activity practices that should be considered in an 8-step research model to create evidence-based research in adapted physical activity. The five…

  3. 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...

  4. School Librarianship and Evidence Based Practice: Progress, Perspectives, and Challenges

    Directory of Open Access Journals (Sweden)

    Ross J. Todd

    2009-06-01

    Full Text Available Objective – This paper provides an overview of progress and developments surrounding evidence based practice in school librarianship, and seeks to provide a picture of current thinking about evidence based practice as it relates to the field. It addresses current issues and challenges facing the adoption of evidence based practice in school librarianship.Methods – The paper is based on a narrative review of a small but growing body of literature on evidence based practice in school librarianship, set within a broader perspective of evidence based education. In addition, it presents the outcomes of a collaborative process of input from 200 school libraries leaders collected at a School Library summit in 2007 specifically to address the emerging arena of evidence based practice in this field.Results – A holistic model of evidence based practice for school libraries is presented, centering on three integrated dimensions of evidence: evidence for practice, evidence in practice, and evidence of practice.Conclusion – The paper identifies key challenges ahead if evidence based school librarianship is to develop further. These include: building research credibility within the broader educational environment; the need for ongoing review and evaluation of the diverse body of research in education, librarianship and allied fields to make quality evidence available in ways that can enable practicing school librarians to build a culture of evidence based practice; development of tools, strategies, and exemplars to use to facilitate evidence based decision-making; and, ensuring that the many and diverse advances in education and librarianship become part of the practice of school librarianship.

  5. Strong crustal seismic anisotropy in the Kalahari Craton based on Receiver Functions

    DEFF Research Database (Denmark)

    Thybo, Hans; Soliman, Mohammad Youssof Ahmad; Artemieva, Irina

    2015-01-01

    anisotropy in the crust of the Kalahari craton, which is 30-40% of the total anisotropy as measured by SKS splitting. Our analysis is based on calculation of receiver functions for the data from the SASE experiment which shows strong splitting between the SV and SH components. The direction of the fast axes...... is uniform within tectonic units and parallel to orogenic strike in the Limpopo and Cape fold belts. It is further parallel to the strike of major dyke swarms which indicates that a large part of the observed anisotropy is controlled by lithosphere fabrics and macroscopic effects. The directions of the fast...... axes for the crustal anisotropy are parallel to the general directions determined from SKS splitting, although the directions from our analysis of receiver functions is more homogeneous than for SKS splitting. This analysis indicates parallel fast axes in the crust and in the mantle, which suggests...

  6. Laser based imaging of time depending microscopic scenes with strong light emission

    Science.gov (United States)

    Hahlweg, Cornelius; Wilhelm, Eugen; Rothe, Hendrik

    2011-10-01

    Investigating volume scatterometry methods based on short range LIDAR devices for non-static objects we achieved interesting results aside the intended micro-LIDAR: the high speed camera recording of the illuminated scene of an exploding wire -intended for Doppler LIDAR tests - delivered a very effective method of observing details of objects with extremely strong light emission. As a side effect a schlieren movie is gathered without any special effort. The fact that microscopic features of short time processes with high emission and material flow might be imaged without endangering valuable equipment makes this technique at least as interesting as the intended one. So we decided to present our results - including latest video and photo material - instead of a more theoretical paper on our progress concerning the primary goal.

  7. Effects of weak and strong localization in tunnel characteristics of contacts on HTSC base

    International Nuclear Information System (INIS)

    Revenko, Yu.V.; Svistunov, V.M.; Grigut', O.V.; Belogolovskij, M.A.; Khachaturov, A.I.

    1992-01-01

    It is found that a phenomena governed by the electronic processes in the disordered surface normal layer of material are observed in the tunnel contatcs bases on metal oxide superconductors of 1-2-3 group. Measured characteristics σ(U)=dI/dU ore determined both by contact's barrier properties and conductivity in the disordered region of metal oxides in the vicinity of a barrier. As regards high-temperature contacts σ(U) value at high temperatures us determined by the Schottky barrier and at low temperatures - by activation processes of charge transfer over strongly localized states in near-the-barrier region of the contact. Crossing over towards logarithmic dependence in the tunnel conductuvity σ(U) of low-Ohmic transitions are attributed to the occurrence of 2D state density conditions in the tunnel surface layers of metal oxides

  8. 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.

  9. 3. Neurological & Psychiatric Society of Zambia's Evidence-Based ...

    African Journals Online (AJOL)

    Esem

    ”. No evidence provided. Not evidence-based and impractical for a resource .... European Federation of. Neurological Sciences. Task Force[18]. Non-acute headache. EEG is not routinely indicated in the diagnostic evaluation of headache.

  10. Nationwide Registry-Based Analysis of Cancer Clustering Detects Strong Familial Occurrence of Kaposi Sarcoma

    Science.gov (United States)

    Vahteristo, Pia; Patama, Toni; Li, Yilong; Saarinen, Silva; Kilpivaara, Outi; Pitkänen, Esa; Knekt, Paul; Laaksonen, Maarit; Artama, Miia; Lehtonen, Rainer; Aaltonen, Lauri A.; Pukkala, Eero

    2013-01-01

    Many cancer predisposition syndromes are rare or have incomplete penetrance, and traditional epidemiological tools are not well suited for their detection. Here we have used an approach that employs the entire population based data in the Finnish Cancer Registry (FCR) for analyzing familial aggregation of all types of cancer, in order to find evidence for previously unrecognized cancer susceptibility conditions. We performed a systematic clustering of 878,593 patients in FCR based on family name at birth, municipality of birth, and tumor type, diagnosed between years 1952 and 2011. We also estimated the familial occurrence of the tumor types using cluster score that reflects the proportion of patients belonging to the most significant clusters compared to all patients in Finland. The clustering effort identified 25,910 birth name-municipality based clusters representing 183 different tumor types characterized by topography and morphology. We produced information about familial occurrence of hundreds of tumor types, and many of the tumor types with high cluster score represented known cancer syndromes. Unexpectedly, Kaposi sarcoma (KS) also produced a very high score (cluster score 1.91, p-value <0.0001). We verified from population records that many of the KS patients forming the clusters were indeed close relatives, and identified one family with five affected individuals in two generations and several families with two first degree relatives. Our approach is unique in enabling systematic examination of a national epidemiological database to derive evidence of aberrant familial aggregation of all tumor types, both common and rare. It allowed effortless identification of families displaying features of both known as well as potentially novel cancer predisposition conditions, including striking familial aggregation of KS. Further work with high-throughput methods should elucidate the molecular basis of the potentially novel predisposition conditions found in this

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

    OpenAIRE

    Shea Beverley; Hatcher-Roberts Jan; Robinson Vivian; Jacobsen Mary; Kristjansson Elizabeth; Mhatre Sharmila; Andersson Neil; O'Connor Annette; Tugwell Peter; Francis Daniel; Beardmore Jil; Wells George A; Losos Joe

    2006-01-01

    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...

  12. Art Therapy, Research and Evidence-Based Practice

    OpenAIRE

    Gilroy, Andrea

    2007-01-01

    Art Therapy around the world is under increasing pressure to become more "evidence-based". As a result, practitioners now need to get to grips with what constitutes "evidence", how to apply research in appropriate ways and also how to contribute to the body of evidence through their own research and other related activities.\\ud \\ud Written specifically for art therapy practitioners and students, Art Therapy, Research & Evidence Based Practice traces the background to EBP, critically reviews t...

  13. Antimicrobial drug use in food-producing animals and associated human health risks: what, and how strong, is the evidence?

    Science.gov (United States)

    Hoelzer, Karin; Wong, Nora; Thomas, Joe; Talkington, Kathy; Jungman, Elizabeth; Coukell, Allan

    2017-07-04

    Antimicrobial resistance is a public health threat. Because antimicrobial consumption in food-producing animals contributes to the problem, policies restricting the inappropriate or unnecessary agricultural use of antimicrobial drugs are important. However, this link between agricultural antibiotic use and antibiotic resistance has remained contested by some, with potentially disruptive effects on efforts to move towards the judicious or prudent use of these drugs. The goal of this review is to systematically evaluate the types of evidence available for each step in the causal pathway from antimicrobial use on farms to human public health risk, and to evaluate the strength of evidence within a 'Grades of Recommendations Assessment, Development and Evaluation'(GRADE) framework. The review clearly demonstrates that there is compelling scientific evidence available to support each step in the causal pathway, from antimicrobial use on farms to a public health burden caused by infections with resistant pathogens. Importantly, the pathogen, antimicrobial drug and treatment regimen, and general setting (e.g., feed type) can have significant impacts on how quickly resistance emerges or spreads, for how long resistance may persist after antimicrobial exposures cease, and what public health impacts may be associated with antimicrobial use on farms. Therefore an exact quantification of the public health burden attributable to antimicrobial drug use in animal agriculture compared to other sources remains challenging. Even though more research is needed to close existing data gaps, obtain a better understanding of how antimicrobial drugs are actually used on farms or feedlots, and quantify the risk associated with antimicrobial use in animal agriculture, these findings reinforce the need to act now and restrict antibiotic use in animal agriculture to those instances necessary to ensure the health and well-being of the animals.

  14. Evidence based practice of chronic pain

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2012-01-01

    Full Text Available The patients with chronic pain are increasingly reporting to the physicians for its management. Chronic pain are associated with head, neck and shoulder pain, spinal pain, pain in the joints and extremities, complex regional pain syndrome and phantom pain. The chronic pain is being managed worldwide. The different specialty of medicine is producing a lot of evidence through the published literature but the same is not being published in the field of chronic pain management. Though some evidence is being reported as to different aspects of pain management from different parts of the world but same is lacking from Indian subcontinent. This is in contrast to much done clinical work in this field as well. We present here the available evidence in relation to chronic pain management.

  15. Reduced ratings of physical and relational aggression for youths with a strong cultural identity: evidence from the Naskapi people.

    Science.gov (United States)

    Flanagan, Tara; Iarocci, Grace; D'Arrisso, Alexandra; Mandour, Tarek; Tootoosis, Curtis; Robinson, Sandy; Burack, Jacob A

    2011-08-01

    Minority youth in general, and Aboriginal youth in particular, are at increased statistical risk for being perpetrators or victims of aggression. We examined the potential protective aspect of cultural identity in relation to peer ratings of physical and relational aggression and factors typically associated with each among almost the entire cohort of Naskapi youths from Kawawachikamach, Québec. Hierarchical multiple regressions revealed that a strong identity with their own Native culture predicted less perceived physical and social aggression by their peers. These findings are discussed in the context of the role of a positive affiliation with ancestral culture for the diminishment of adolescent aggression and for general adaptive development and well-being. Copyright © 2011 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  16. Ohio's Foray into Evidence-Based Practice

    Science.gov (United States)

    Findlay, Christine

    2006-01-01

    Ohio Educational Library Media Association (OELMA) has been working for many years to gather evidence in hopes of convincing their state government of the need for a certified library media specialist in every school. Its latest efforts began in 2002 when the board of OELMA applied for a grant to do a state study. Board members of OELMA, however,…

  17. 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 ...

  18. 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…

  19. The SNARC effect in the processing of second-language number words: further evidence for strong lexico-semantic connections.

    Science.gov (United States)

    De Brauwer, Jolien; Duyck, Wouter; Brysbaert, Marc

    2008-03-01

    We present new evidence that word translation involves semantic mediation. It has been shown that participants react faster to small numbers with their left hand and to large numbers with their right hand. This SNARC (spatial-numerical association of response codes) effect is due to the fact that in Western cultures the semantic number line is oriented from left (small) to right (large). We obtained a SNARC effect when participants had to indicate the parity of second-language (L2) number words, but not when they had to indicate whether L2 number words contained a particular sound. Crucially, the SNARC effect was also obtained in a translation verification task, indicating that this task involved the activation of number magnitude.

  20. Review of the centre for evidence-based veterinary medicine's "using an evidence-based approach in your practice" course

    OpenAIRE

    Buckley, LA; Hall, EJ

    2017-01-01

    The practice of evidence–based veterinary nursing is a day one skill expected of veterinary nurses, and veterinary nursing educators are required to prepare student veterinary nurses to meet this competency. This article reviewed the Centre for Evidencebased Veterinary Medicine's course "Using an evidencebased approach in your practice" from the perspective of two Veterinary nursing educators. This four month blended learning course covered the importance of evidence based medicine (EBV...

  1. Evidence-based clinical guidelines for eating disorders: international comparison

    OpenAIRE

    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 international comparison demonstrated notable commonalities and differences among these current clinical guidelines. Summary Evidence-based clinical guidelines represent an important step toward the dissemina...

  2. EVIDENCE FOR QUASI-ADIABATIC MOTION OF CHARGED PARTICLES IN STRONG CURRENT SHEETS IN THE SOLAR WIND

    Energy Technology Data Exchange (ETDEWEB)

    Malova, H. V. [Scobeltsyn Nuclear Physics Institute of Lomonosov Moscow State University, Moscow (Russian Federation); Popov, V. Yu.; Grigorenko, E. E.; Petrukovich, A. A.; Zelenyi, L. M. [Space Research Institute of the Russian Academy of Sciences, Moscow (Russian Federation); Delcourt, D. [Laboratoire de Physique des Plasmas, Ecole Politechnique, CNRS (France); Sharma, A. S. [Department of Astronomy, University of Maryland, College Park, MD (United States); Khabarova, O. V. [Pushkov Institute of Terrestrial Magnetism, Ionosphere and Radio Wave Propagation of the Russian Academy of Sciences (IZMIRAN), Moscow (Russian Federation)

    2017-01-01

    We investigate quasi-adiabatic dynamics of charged particles in strong current sheets (SCSs) in the solar wind, including the heliospheric current sheet (HCS), both theoretically and observationally. A self-consistent hybrid model of an SCS is developed in which ion dynamics is described at the quasi-adiabatic approximation, while the electrons are assumed to be magnetized, and their motion is described in the guiding center approximation. The model shows that the SCS profile is determined by the relative contribution of two currents: (i) the current supported by demagnetized protons that move along open quasi-adiabatic orbits, and (ii) the electron drift current. The simplest modeled SCS is found to be a multi-layered structure that consists of a thin current sheet embedded into a much thicker analog of a plasma sheet. This result is in good agreement with observations of SCSs at ∼1 au. The analysis of fine structure of different SCSs, including the HCS, shows that an SCS represents a narrow current layer (with a thickness of ∼10{sup 4} km) embedded into a wider region of about 10{sup 5} km, independently of the SCS origin. Therefore, multi-scale structuring is very likely an intrinsic feature of SCSs in the solar wind.

  3. Evidence of a Strong Domestication Bottleneck in the Recently Cultivated New Zealand Endemic Root Crop, Arthropodium cirratum (Asparagaceae.

    Directory of Open Access Journals (Sweden)

    Lara D Shepherd

    Full Text Available We use chloroplast DNA sequencing to examine aspects of the pre-European Māori cultivation of an endemic New Zealand root crop, Arthropodium cirratum (rengarenga. Researching the early stages of domestication is not possible for the majority of crops, because their cultivation began many thousands of years ago and/or they have been substantially altered by modern breeding methods. We found high levels of genetic variation and structuring characterised the natural distribution of A. cirratum, while the translocated populations only retained low levels of this diversity, indicating a strong bottleneck even at the early stages of this species' cultivation. The high structuring detected at four chloroplast loci within the natural A. cirratum range enabled the putative source(s of the translocated populations to be identified as most likely located in the eastern Bay of Plenty/East Cape region. The high structuring within A. cirratum also has implications for the conservation of genetic diversity within this species, which has undergone recent declines in both its natural and translocated ranges.

  4. Evidence of a Strong Domestication Bottleneck in the Recently Cultivated New Zealand Endemic Root Crop, Arthropodium cirratum (Asparagaceae).

    Science.gov (United States)

    Shepherd, Lara D; de Lange, Peter J; Cox, Simon; McLenachan, Patricia A; Roskruge, Nick R; Lockhart, Peter J

    2016-01-01

    We use chloroplast DNA sequencing to examine aspects of the pre-European Māori cultivation of an endemic New Zealand root crop, Arthropodium cirratum (rengarenga). Researching the early stages of domestication is not possible for the majority of crops, because their cultivation began many thousands of years ago and/or they have been substantially altered by modern breeding methods. We found high levels of genetic variation and structuring characterised the natural distribution of A. cirratum, while the translocated populations only retained low levels of this diversity, indicating a strong bottleneck even at the early stages of this species' cultivation. The high structuring detected at four chloroplast loci within the natural A. cirratum range enabled the putative source(s) of the translocated populations to be identified as most likely located in the eastern Bay of Plenty/East Cape region. The high structuring within A. cirratum also has implications for the conservation of genetic diversity within this species, which has undergone recent declines in both its natural and translocated ranges.

  5. Arsenic metabolism and one-carbon metabolism at low-moderate arsenic exposure: Evidence from the Strong Heart Study.

    Science.gov (United States)

    Spratlen, Miranda Jones; Gamble, Mary V; Grau-Perez, Maria; Kuo, Chin-Chi; Best, Lyle G; Yracheta, Joseph; Francesconi, Kevin; Goessler, Walter; Mossavar-Rahmani, Yasmin; Hall, Meghan; Umans, Jason G; Fretts, Amanda; Navas-Acien, Ana

    2017-07-01

    B-vitamins involved in one-carbon metabolism (OCM) can affect arsenic metabolism efficiency in highly arsenic exposed, undernourished populations. We evaluated whether dietary intake of OCM nutrients (including vitamins B2, B6, folate (B9), and B12) was associated with arsenic metabolism in a more nourished population exposed to lower arsenic than previously studied. Dietary intake of OCM nutrients and urine arsenic was evaluated in 405 participants from the Strong Heart Study. Arsenic exposure was measured as the sum of iAs, monomethylarsonate (MMA) and dimethylarsenate (DMA) in urine. Arsenic metabolism was measured as the individual percentages of each metabolite over their sum (iAs%, MMA%, DMA%). In adjusted models, increasing intake of vitamins B2 and B6 was associated with modest but significant decreases in iAs% and MMA% and increases in DMA%. A significant interaction was found between high folate and B6 with enhanced arsenic metabolism efficiency. Our findings suggest OCM nutrients may influence arsenic metabolism in populations with moderate arsenic exposure. Stronger and independent associations were observed with B2 and B6, vitamins previously understudied in relation to arsenic. Research is needed to evaluate whether targeting B-vitamin intake can serve as a strategy for the prevention of arsenic-related health effects at low-moderate arsenic exposure. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Diclofenac removal in urine using strong-base anion exchange polymer resins.

    Science.gov (United States)

    Landry, Kelly A; Boyer, Treavor H

    2013-11-01

    One of the major sources of pharmaceuticals in the environment is wastewater effluent of which human urine contributes the majority of pharmaceuticals. Urine source separation has the potential to isolate pharmaceuticals at a higher concentration for efficient removal as well as produce a nutrient byproduct. This research investigated the efficacy of using strong-base anion exchange polymer resins to remove the widely detected and abundant pharmaceutical, diclofenac, from synthetic human urine under fresh and ureolyzed conditions. The majority of experiments were conducted using a strong-base, macroporous, polystyrene resin (Purolite A520E). Ion-exchange followed a two-step removal rate with rapid removal in 1 h and equilibrium removal in 24 h. Diclofenac removal was >90% at a resin dose of 8 mL/L in both fresh and ureolyzed urine. Sorption of diclofenac onto A520E resin was concurrent with desorption of an equivalent amount of chloride, which indicates the ion-exchange mechanism is occurring. The presence of competing ions such as phosphate and citrate did not significantly impact diclofenac removal. Comparisons of three polystyrene resins (A520E, Dowex 22, Dowex Marathon 11) as well as one polyacrylic resin (IRA958) were conducted to determine the major interactions between anion exchange resin and diclofenac. The results showed that polystyrene resins provide the highest level of diclofenac removal due to electrostatic interactions between quaternary ammonium functional groups of resin and carboxylic acid of diclofenac and non-electrostatic interactions between resin matrix and benzene rings of diclofenac. Diclofenac was effectively desorbed from A520E resin using a regeneration solution that contained 4.5% (m/m) NaCl in an equal-volume mixture of methanol and water. The greater regeneration efficiency of the NaCl/methanol-water mixture over the aqueous NaCl solution supports the importance of non-electrostatic interactions between resin matrix and benzene rings

  7. Why the Evidence-Based Paradigm in Early Childhood Education and Care Is Anything but Evident

    Science.gov (United States)

    Vandenbroeck, Michel; Roets, Griet; Roose, Rudi

    2012-01-01

    Praxeological research is a necessary contribution to the research field in early childhood education and care, which is currently dominated by an evidence-based paradigm that tends to consider the measurement of predefined outcomes as the most valid form of research. We analyse the history of the evidence-based paradigm in the field of medicine…

  8. Evidence-Based Medicine: Wound Management.

    Science.gov (United States)

    Jones, Christine M; Rothermel, Alexis T; Mackay, Donald R

    2017-07-01

    After reading this article, the participant should be able to: 1. Describe the basic science of chronic wounds. 2. Discuss the general and local factors that should be considered in any patient with a chronic wound. 3. Discuss the rationale of converting a chronic wound into an acute wound. 4. Describe techniques used to prepare chronic wounds. 5. Discuss the appropriate use of different dressings presented in this article. 6. Discuss the pros and cons of the adjuncts to wound healing discussed in this article. This is the second Maintenance of Certification article on wound healing. In the first, Buchanan, Kung, and Cederna dealt with the mechanism and reconstructive techniques for closing wounds. In this article, the authors have concentrated on the chronic wound. The authors present a summary of the basic science of chronic wounds and the general and local clinical factors important in assessing any chronic wound. The evidence for interventions of these conditions is presented. The surgical and nonsurgical methods of wound preparation and the evidence supporting the use of the popular wound dressings are presented. The authors then present the evidence for some of the popular adjuncts for wound healing, including hyperbaric oxygen, electrotherapy, and ultrasound. A number of excellent articles on negative-pressure wound therapy have been written, and are not covered in this article.

  9. Strong dependence of rain-induced lidar depolarization on the illumination angle: experimental evidence and geometrical-optics interpretation.

    Science.gov (United States)

    Roy, G; Bissonnette, L R

    2001-09-20

    Backscatter and depolarization lidar measurements from clouds and precipitation are reported as functions of the elevation angle of the pointing lidar direction. We recorded the data by scanning the lidar beam (Nd:YAG) at a constant angular speed of ~3.5 degrees /s while operating at a repetition rate of 10 Hz. We show that in rain there is an evident and at times spectacular dependence on the elevation angle. That dependence appears to be sensitive to raindrop size. We have developed a three-dimensional polarization-dependent ray-tracing algorithm to calculate the backscatter and the depolarization ratio by large nonspherical droplets. We have applied it to raindrop shapes derived from existing static and dynamic (oscillating) models. We show that many of the observed complex backscatter and depolarization features can be interpreted to a good extent by geometrical optics. These results suggest that there is a definite need for more extensive calculations of the scattering phase matrix elements for large deformed raindrops as functions of the direction of illumination. Obvious applications are retrieval of information on the liquid-solid phase of precipitation and on the size and the vibration state of raindrops.

  10. Evidence for carbon flux shortage and strong carbon/nitrogen interactions in pea nodules at early stages of water stress.

    Science.gov (United States)

    Gálvez, Loli; González, Esther M; Arrese-Igor, Cesar

    2005-09-01

    Symbiotic N2 fixation in legume nodules declines under a wide range of environmental stresses. A high correlation between N2 fixation decline and sucrose synthase (SS; EC 2.4.1.13) activity down-regulation has been reported, although it has still to be elucidated whether a causal relationship between SS activity down-regulation and N2 fixation decline can be established. In order to study the likely C/N interactions within nodules and the effects on N2 fixation, pea plants (Pisum sativum L. cv. Sugar snap) were subjected to progressive water stress by withholding irrigation. Under these conditions, nodule SS activity declined concomitantly with apparent nitrogenase activity. The levels of UDP-glucose, glucose-1-phosphate, glucose-6-phosphate, and fructose-6-phosphate decreased in water-stressed nodules compared with unstressed nodules. Drought also had a marked effect on nodule concentrations of malate, succinate, and alpha-ketoglutarate. Moreover, a general decline in nodule adenylate content was detected. NADP+-dependent isocitrate dehydrogenase (ICDH; EC 1.1.1.42) was the only enzyme whose activity increased as a result of water deficit, compensating for a possible C/N imbalance and/or supplying NADPH in circumstances that the pentose phosphate pathway was impaired, as suggested by the decline in glucose-6-phosphate dehydrogenase (G6PDH; EC 1.1.1.49) activity. The overall results show the occurrence of strong C/N interactions in nodules subjected to water stress and support a likely limitation of carbon flux that might be involved in the decline of N2 fixation under drought.

  11. Active galaxies. A strong magnetic field in the jet base of a supermassive black hole.

    Science.gov (United States)

    Martí-Vidal, Ivan; Muller, Sébastien; Vlemmings, Wouter; Horellou, Cathy; Aalto, Susanne

    2015-04-17

    Active galactic nuclei (AGN) host some of the most energetic phenomena in the universe. AGN are thought to be powered by accretion of matter onto a rotating disk that surrounds a supermassive black hole. Jet streams can be boosted in energy near the event horizon of the black hole and then flow outward along the rotation axis of the disk. The mechanism that forms such a jet and guides it over scales from a few light-days up to millions of light-years remains uncertain, but magnetic fields are thought to play a critical role. Using the Atacama Large Millimeter/submillimeter Array (ALMA), we have detected a polarization signal (Faraday rotation) related to the strong magnetic field at the jet base of a distant AGN, PKS 1830-211. The amount of Faraday rotation (rotation measure) is proportional to the integral of the magnetic field strength along the line of sight times the density of electrons. The high rotation measures derived suggest magnetic fields of at least tens of Gauss (and possibly considerably higher) on scales of the order of light-days (0.01 parsec) from the black hole. Copyright © 2015, American Association for the Advancement of Science.

  12. Polymer/Pristine Graphene Based Composites: From Emulsions to Strong, Electrically Conducting Foams

    Science.gov (United States)

    Woltornist, Steven; Carrillo, Jan-Michael; Xu, Thomas; Dobrynin, Andrey; Adamson, Douglas

    2015-03-01

    The unique electrical, thermal and mechanical properties of graphene make it a perfect candidate for applications in graphene/graphite based polymer composites, yet challenges due to the lack of solubility of pristine graphene/graphite in water, common organic solvents, and polymer solutions and melts have limited its practical utilization. Here we report a scalable and environmentally friendly technique to form water-in-oil type emulsions stabilized by a graphitic skin consisting of overlapping pristine graphene sheets that enables the synthesis of open cell foams containing a continuous graphitic skin network. At the heart of our technique is the strong attraction of graphene to high-energy oil and water interfaces. This allows for the creation of stable water-in-oil emulsions with controlled droplet size and overlapping graphene sheets playing the role of surfactant by covering the droplet surface and stabilizing the interfaces with a thin graphitic skin. These emulsions are used as templates for the synthesis of the open cell foams with densities below 0.35 g/cm3 and exhibiting remarkable mechanical and electrical properties including compressive moduli up to ~ 100 MPa, compressive strengths of over 8.3 MPa, and bulk conductivities approaching 7 S/m.

  13. 3D printable highly conductive and mechanically strong thermoplastic-based nanocomposites

    Science.gov (United States)

    Tabiai, Ilyass; Therriault, Daniel

    Highly conductive 3D printable inks can be used to design electrical devices with various functionalities and geometries. We use the solvent evaporation assisted 3D-printing method to create high resolution structures made of poly(lactid) acid (PLA) reinforced with multi-walled carbon nanotube (MWCNTs). We characterize fibers with diameters ranging between 100 μm to 330 μm and reinforced with MWCNTs from 0.5 up to 40wt% here. Tensile test, shrinkage ratio, density and electrical conductivity measurements of the printed nanocomposite are presented. The material's electrical conductivity is strongly improved by adding MWCNTs (up to 3000S/m), this value was found to be higher than any 3D-printable carbon based material available in the literature. It is observed that MWCNTs significantly increase the material's strength and stiffness while reducing its ductility. The ink's density was also higher while still being in the range of polymers' densities. The presented nanocomposite is light weight, highly conductive, has good mechanical properties and can be printed in a freeform fashion at the micro scale. A myriad of low power consumption with less resistive heating sensors and devices can potentially be designed using it and integrated into other 3D printable products.

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

    Directory of Open Access Journals (Sweden)

    Phumza Ntshotsho

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

  15. Teaching Evidence-Based Practice in Service-Learning: A Model for Education and Service

    Science.gov (United States)

    Terry, John D.; Smith, Bradley H.; McQuillin, Samuel D.

    2014-01-01

    Evidence-based practice (EBP) is strongly emphasized in many professions and should be taught as part of pre-professional training or to promote the development of enlightened citizens who utilize professional services. Service-learning (SL) classes provide an excellent opportunity to provide meaningful training in how EBP relates to education,…

  16. 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.

  17. Lokale wondzorg: evidence-based behandelingen en verbandmaterialen

    NARCIS (Netherlands)

    Ubbink, D. Th; Vermeulen, H.; Lubbers, M. J.

    2006-01-01

    Patients with open wounds require specific local-wound care. There is huge variety in methods of local-wound care. This is due not only to the many different types of wounds but also to the widely varying preferences of doctors and nurses, and to the lack of strong evidence and relevant guidelines

  18. Unto the third generation: evidence for strong familial aggregation of physicians, psychologists, and psychotherapists among first-year medical and psychology students in a nationwide Austrian cohort census.

    Science.gov (United States)

    Tran, Ulrich S; Berger, Nina; Arendasy, Martin E; Greitemeyer, Tobias; Himmelbauer, Monika; Hutzler, Florian; Kraft, Hans-Georg; Oettl, Karl; Papousek, Ilona; Vitouch, Oliver; Voracek, Martin

    2017-05-03

    Medical students present higher numbers of physician relatives than expectable from the total population prevalence of physicians. Evidence for such a familial aggregation effect of physicians has emerged in investigations from the Anglo-American, Scandinavian, and German-speaking areas. In particular, past data from Austria suggest a familial aggregation of the medical, as well as of the psychological and psychotherapeutic, professions among medical and psychology undergraduates alike. Here, we extend prior related studies by examining (1) the extent to which familial aggregation effects apply to the whole nation-wide student census of all relevant (eight) public universities in Austria; (2) whether effects are comparable for medical and psychology students; (3) and whether these effects generalize to relatives of three interrelated health professions (medicine, psychology, and psychotherapy). We investigated the familial aggregation of physicians, psychologists, and psychotherapists, based on an entire cohort census of first-year medical and psychology students (n = 881 and 920) in Austria with generalized linear mixed models. For both disciplines, we found strong familial aggregation of physicians, psychologists, and psychotherapists. As compared with previous results, directionally opposite time trends within disciplines emerged: familial aggregation of physicians among medical students has decreased, whilst familial aggregation of psychologists among psychology students has increased. Further, there were sex-of-relative effects (i.e., more male than female physician relatives), but no substantial sex-of-student effects (i.e., male and female students overall reported similar numbers of relatives for all three professions of interest). In addition, there were age-benefit effects, i.e., students with a relative in the medical or the psychotherapeutic profession were younger than students without, thus suggesting earlier career decisions. The familial

  19. 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

  20. Personalizing Research: Special Educators' Awareness of Evidence-Based Practice

    Science.gov (United States)

    Guckert, Mary; Mastropieri, Margo A.; Scruggs, Thomas E.

    2016-01-01

    Although evidence-based practices are considered critical to student success, a research-to-practice gap exists. This qualitative study examined practicing special education teachers' perceptions of their use of evidence-based practices. Special education teachers were interviewed and their classroom practices examined. Major themes emerged and…

  1. Barriers and Enablers to Evidence-Based Practices

    Science.gov (United States)

    Foster, Robyn

    2014-01-01

    The importance of educational practices based on evidence is well-supported in the literature, however barriers to their implementation in classrooms still exist. This paper examines the phenomenon of evidence-based practice in education highlighting enablers and barriers to their implementation with particular reference to RTLB practice.

  2. 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…

  3. 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

  4. 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 ...

  5. Evidence-based doceren in het hoger onderwijs met ICT

    NARCIS (Netherlands)

    Van den Berg, Ellen; Kirschner, Paul A.

    2013-01-01

    Van den Berg, E., & Kirschner, P. A. (2012). Evidence-based doceren in het hoger onderwijs met ICT [Evidence based teaching in higher education with ICT]. In L. A. Plugge (Ed.), WTR Trendrapport 2012 De Bakens verzetten (pp. 1-10). Utrecht, Nederland: Stichting SURF.

  6. Semantic Representation of Evidence-based Clinical Guidelines

    NARCIS (Netherlands)

    Huang, Zhisheng; Harmelen, Frank Van

    2014-01-01

    Evidence-based Clinical Guidelines (EbCGs) are that the document or recommendation has been created using the best clinical research findings of the highest value to aid in the delivery of optimum clinical care to patients. In this paper, we propose a lightweight formal-ism of evidence-based

  7. Quaternized dimethylaminoethyl methacrylate strong base anion exchange fibers for As(V) adsorption

    International Nuclear Information System (INIS)

    Kavaklı, Cengiz; Akkaş Kavaklı, Pınar; Turan, Burcu Dila; Hamurcu, Aslı; Güven, Olgun

    2014-01-01

    N,N-Dimethylaminoethyl methacrylate (DMAEMA) grafted polyethylene/polypropylene (PE/PP) nonwoven fibers (DMAEMA-g-PE/PP) was prepared by radiation-induced graft polymerization. DMAEMA graft chains on nonwoven fibers were quaternized with dimethyl sulfate solution for the preparation of strong base anion exchange fibers (QDMAEMA-g-PE/PP). Fiber structures were characterized by FTIR, XPS and SEM techniques. The effect of solution pH, contact time, initial As(V) ion concentration and coexisting ions on the As(V) adsorption capacity of the QDMAEMA-g-PE/PP fibers were investigated by performing batch adsorption experiments. The adsorption of As(V) by QDMAEMA-g-PE/PP fibers was found to be independent on solution pH in the range 4.00–10.00. Kinetic experiments show that the As(V) adsorption rate was rapid and As(V) adsorption follows pseudo second-order kinetic model. As(V) adsorption equilibrium data were analyzed using Langmuir and Freundlich adsorption isotherm model equations. Langmuir and Freundlich adsorption isotherm models fitted the experimental data well. The maximum adsorption capacity (q max ) calculated from Langmuir isotherm was found to be 83.33 mg As(V)/g polymer at pH 7.00. The adsorbent was used for three cycles without significant loss of adsorption capacity. The adsorbed As(V) ions were desorbed effectively by a 0.1 M NaOH solution. - Highlights: • QDMAEMA-g-PE/PP fibers have high adsorption capacity for As(V) ions. • Adsorption of As(V) is independent on the solution pH over a wide range (4−10). • As(V) adsorption rate of QDMAEMA-g-PE/PP fibers is considerably fast. • The maximum adsorption capacity (q max ) was found to be 83.33 mg As(V)/g polymer

  8. Teaching evidence based practice to undergraduate nursing students.

    Science.gov (United States)

    Sin, Mo-Kyung; Bliquez, Rebecca

    Considering the heightened importance of evidence-based practice in healthcare settings, incorporating evidence-based practice into the nursing curriculum, especially in baccalaureate programs is essential because this is a first step to prepare students for their professional role as an RN, and the undergraduate nursing students are the ones who will spend the most time with patients at their bedside providing direct care. Teaching evidence-based practice at the undergraduate level, however, can be challenging. Creative and enjoyable teaching strategies are instrumental in order to promote students' engagement and learning about evidence-based practice. This paper describes useful strategies for teaching evidence-based practice in an undergraduate nursing research course. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. [Forensic evidence-based medicine in computer communication networks].

    Science.gov (United States)

    Qiu, Yun-Liang; Peng, Ming-Qi

    2013-12-01

    As an important component of judicial expertise, forensic science is broad and highly specialized. With development of network technology, increasement of information resources, and improvement of people's legal consciousness, forensic scientists encounter many new problems, and have been required to meet higher evidentiary standards in litigation. In view of this, evidence-based concept should be established in forensic medicine. We should find the most suitable method in forensic science field and other related area to solve specific problems in the evidence-based mode. Evidence-based practice can solve the problems in legal medical field, and it will play a great role in promoting the progress and development of forensic science. This article reviews the basic theory of evidence-based medicine and its effect, way, method, and evaluation in the forensic medicine in order to discuss the application value of forensic evidence-based medicine in computer communication networks.

  10. 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...

  11. 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 evidence-based research and practice, I argue that, while psychological interventions are primarily meant to work in people’s everyday lives, how interventions do so is barely addressed and poorly captured. Evidence-based research, as currently conceived, is an obstacle to overcome this shortcoming...

  12. Guidelines for selecting weak-base versus strong-base anion-exchange resins for the recovery of chromate from cooling tower blowdown

    Energy Technology Data Exchange (ETDEWEB)

    Newman, J.; Reed, L.W.

    1980-01-01

    Guidelines for selecting weak-base versus strong-base anion-exchange resins for the recovery of chromate from cooling tower blowdown are given, together with actual operating data on large-scale industrial systems based on strong-base anion-exchange resins, data from a similar pilot system based on weak-base anion resin, and the chemical costs for operating both systems for a cooling tower blowdown containing 2500 ppm total dissolved solids and 20 ppm chromata.

  13. Evidence Based Education Request Desk. EBE #492

    Science.gov (United States)

    Regional Educational Laboratory Southeast, 2009

    2009-01-01

    As attention to ninth grade transitions has grown, so has the need to carefully gauge the impacts of efforts to improve student outcomes. The What Works Clearinghouse (WWC), supported by the Institute for Education Sciences at the US Department of Education, sorts interventions based on the quality and the outcomes of the scientifically based…

  14. Evidence Based Education Request Desk. EBE #652

    Science.gov (United States)

    Regional Educational Laboratory Southeast, 2010

    2010-01-01

    Which states are using which turnaround models, as represented in the recent U.S. Department of Education's "Blueprint for Reform: The Reauthorization of the Elementary and Secondary Education Act?" A search for state-level policies on turnaround models was completed based on the targeted states list provided. According to US Department…

  15. Evidence Based Education Request Desk. EBE #791

    Science.gov (United States)

    Regional Educational Laboratory Southeast, 2011

    2011-01-01

    Would anyone in your network be aware of any states that might provide differentiated funding for virtual programs based on the model used--for example, curriculum-in-a-box vs. one with high student-teacher interaction? Are you aware of any research that examines what factors to consider when developing this type of differentiated funding? This…

  16. Strong evidence for enhanced multiple electron capture from surfaces in 46 MeV/u Pb81+ collisions with thin carbon foils.

    Science.gov (United States)

    Bräuning, H; Mokler, P H; Liesen, D; Bosch, F; Franzke, B; Krämer, A; Kozhuharov, C; Ludziejewski, T; Ma, X; Nolden, F; Steck, M; Stöhlker, T; Dunford, R W; Kanter, E P; Bednarz, G; Warczak, A; Stachura, Z; Tribedi, L; Kambara, T; Dauvergne, D; Kirsch, R; Cohen, C

    2001-02-05

    Strong evidence has been found for enhanced multiple electron capture into 46 MeV/u Pb81+ with a significant contribution from the entrance surface of thin carbon foils. Capture of up to five electrons has been observed. The multiple electron capture yield is found to increase with decreasing target thickness for thin targets. A simple model describing the data and showing the importance of capture from surfaces is discussed. Further evidence is found for a pronounced asymmetry between electron capture at the entrance and the exit surfaces. Absolute yields for multiple electron capture and projectile ionization are presented. The experimental total cross sections for single capture and ionization agree well with theory.

  17. 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

  18. Evidence-based pharmacotherapy of eating disorders.

    Science.gov (United States)

    Flament, Martine F; Bissada, Hany; Spettigue, Wendy

    2012-03-01

    The objective was to review scientific evidence for efficacy and safety of pharmacotherapy in adults or children with an eating disorder (ED). We conducted a computer search for all randomized controlled trials (RCTs) published between 1960 and May 2010 for treatment of anorexia nervosa (AN), bulimia nervosa (BN) or binge-eating disorder (BED). For drugs for which no RCT was found, open trials or case reports were retrieved. Clinically relevant RCTs in the treatment of AN have used atypical antipsychotics, selective serotonin reuptake inhibitors (SSRIs), and zinc supplementation. Olanzapine demonstrated an adjunctive effect for in-patient treatment of underweight AN patients, and fluoxetine helped prevent relapse in weight-restored AN patients in 1/2 studies. For treatment of BN, controlled studies have used SSRIs, other antidepressants, and mood stabilizers. In 9/11 studies, pharmacotherapy yielded a statistically significant although moderate reduction in binge/purge frequency, and some additional benefits. For BED, RCTs have been conducted using SSRIs and one serotonin norepinephrine reuptake inhibitor (SNRI), mood stabilizers, and anti-obesity medications. In 11/12 studies, there was a statistically significant albeit limited effect of medication. Meta-analyses on efficacy of pharmacotherapy for BN and BED support moderate effect sizes for medication, but generally low recovery rates. Treatment resistance is an inherent feature of AN, where treatment should focus on renourishment plus psychotherapy. For BN and BED, combined treatment with pharmacotherapy and cognitive behaviour therapy has been more effective than either alone. Data on the long-term efficacy of pharmacotherapy for EDs are scarce. Short- and long-term pharmacotherapy of EDs still remains a challenge for the clinician.

  19. Evidence-Based Marketing for Academic Librarians

    Directory of Open Access Journals (Sweden)

    Yoo-Seong Song

    2006-03-01

    Full Text Available Objective - In developing marketing strategies for the Business & Economics Library (BEL at the University of Illinois at Urbana-Champaign (UIUC, a survey was designed to answer the following questions: - Should BEL develop marketing strategies differently for East Asian business students? - What services do graduate business students want to receive from BEL? - With whom should BEL partner to increase visibility at the College of Business? Marketing research techniques were used to gather evidence upon which BEL could construct appropriate marketing strategies. Methods - A questionnaire was used with graduate business students enrolled at UIUC. The survey consisted of four categories of questions: 1 demographics, 2 assessment of current library services, 3 desired library services, and 4 research behavior. The data were analyzed using desriptive statistics and hypothesis testing to answer the three research questions. Results - East Asian business students showed similar assessment of current services as non-East Asian international business students. Survey results also showed the graduate business students had low awareness of current library services. The Business Career Services Office was identified as a co-branding partner for BEL to increase its visibility. Conclusion - A marketing research approach was used to help BEL make important strategic decisions before launching marketing campaigns to increase visibility to graduate business students at UIUC. As a result of the survey, a deeper understanding of graduate business students' expectations and assessment of library services was gained. Students' perceptions became a foundation that helped shape marketing strategies for BEL to increase its visibility at the College of Business. Creating marketing strategies without concrete data and analysis is a risky endeavor that librarians, not just corporate marketers, should avoid.

  20. Strong plasma shock structures based on the Navier--Stokes equations

    International Nuclear Information System (INIS)

    Abe, K.

    1975-01-01

    The structure of a plasma collisional shock wave is examined on the basis of the Navier--Stokes equations and simultaneously on the basis of the Fokker--Planck equation. The resultant structures are compared to check the validity of the Navier--Stokes equations applied to the structures of strong shock waves. The Navier--Stokes equations give quite correct structures for weak shock waves. For the strong shock waves, the detailed structures obtained from the Navier--Stokes equations differ from the results of the Fokker--Planck equation, but the shock thicknesses of the two shock waves are in relatively close agreement

  1. Note on a reformulation of the strong cosmic censor conjecture based on computability

    Science.gov (United States)

    Etesi, Gábor

    2002-12-01

    In this Letter we provide a reformulation of the strong cosmic censor conjecture taking into account recent results on Malament-Hogarth space-times. We claim that the strong version of the cosmic censor conjecture can be formulated by postulating that a physically reasonable space-time is either globally hyperbolic or possesses the Malament-Hogarth property. But it is known that a Malament-Hogarth space-time in principle is capable for performing non-Turing computations such as checking consistency of ZFC set theory. In this way we get an intimate conjectured link between the cosmic censorship scenario and computability theory.

  2. Note on a reformulation of the strong cosmic censor conjecture based on computability

    Energy Technology Data Exchange (ETDEWEB)

    Etesi, Gabor

    2002-12-12

    In this Letter we provide a reformulation of the strong cosmic censor conjecture taking into account recent results on Malament-Hogarth space-times. We claim that the strong version of the cosmic censor conjecture can be formulated by postulating that a physically reasonable space-time is either globally hyperbolic or possesses the Malament-Hogarth property. But it is known that a Malament-Hogarth space-time in principle is capable for performing non-Turing computations such as checking consistency of ZFC set theory. In this way we get an intimate conjectured link between the cosmic censorship scenario and computability theory.

  3. Note on a reformulation of the strong cosmic censor conjceture based on computability

    OpenAIRE

    Etesi, Gabor

    2002-01-01

    In this letter we provide a reformulation of the strong cosmic censor conjecture taking into account recent results on Malament--Hogarth space-times. We claim that the strong version of the cosmic censor conjecture can be formulated by postulating that a physically relevant space-time is either globally hyperbolic or possesses the Malament--Hogarth property. But it is known that a Malament--Hogarth space-time in principle is capable for performing non-Turing computations such as checking cons...

  4. Brief report on a systematic review of youth violence prevention through media campaigns: Does the limited yield of strong evidence imply methodological challenges or absence of effect?

    Science.gov (United States)

    Cassidy, Tali; Bowman, Brett; McGrath, Chloe; Matzopoulos, Richard

    2016-10-01

    We present a brief report on a systematic review which identified, assessed and synthesized the existing evidence of the effectiveness of media campaigns in reducing youth violence. Search strategies made use of terms for youth, violence and a range of terms relating to the intervention. An array of academic databases and websites were searched. Although media campaigns to reduce violence are widespread, only six studies met the inclusion criteria. There is little strong evidence to support a direct link between media campaigns and a reduction in youth violence. Several studies measure proxies for violence such as empathy or opinions related to violence, but the link between these measures and violence perpetration is unclear. Nonetheless, some evidence suggests that a targeted and context-specific campaign, especially when combined with other measures, can reduce violence. However, such campaigns are less cost-effective to replicate over large populations than generalised campaigns. It is unclear whether the paucity of evidence represents a null effect or methodological challenges with evaluating media campaigns. Future studies need to be carefully planned to accommodate for methodological difficulties as well as to identify the specific elements of campaigns that work, especially in lower and middle income countries. Copyright © 2016 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

  5. Evidence-based clinical guidelines for eating disorders: international comparison.

    Science.gov (United States)

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

    2017-11-01

    The current systematic review sought to compare available evidence-based clinical treatment guidelines for all specific eating disorders. Nine evidence-based clinical treatment guidelines for eating disorders were located through a systematic search. The international comparison demonstrated notable commonalities and differences among these current clinical guidelines. Evidence-based clinical guidelines represent an important step toward the dissemination and implementation of evidence-based treatments into clinical practice. Despite advances in clinical research on eating disorders, a growing body of literature demonstrates that individuals with eating disorders often do not receive an evidence-based treatment for their disorder. Regarding the dissemination and implementation of evidence-based treatments, current guidelines do endorse the main empirically validated treatment approaches with considerable agreement, but additional recommendations are largely inconsistent. An increased evidence base is critical in offering clinically useful and reliable guidance for the treatment of eating disorders. Because developing and updating clinical guidelines is time-consuming and complex, an international coordination of guideline development, for example, across the European Union, would be desirable.

  6. Evidence-based Update of Pediatric Dental Restorative Procedures: Dental Materials.

    Science.gov (United States)

    Dhar, V; Hsu, K L; Coll, J A; Ginsberg, E; Ball, B M; Chhibber, S; Johnson, M; Kim, M; Modaresi, N; Tinanoff, N

    2015-01-01

    The science of dental materials and restorative care in children and adolescent is constantly evolving, and the ongoing search for ideal restorative materials has led to plethora of research. To provide an evidence base to assist dental practitioners choose appropriate restorative care for children and adolescents. This evidence-based review appraises this literature, primarily between the years 1995-2013, for efficacy of dental amalgam, composites, glass ionomer cements, compomers, preformed metal crowns and anterior esthetic restorations. The assessment of evidence for each dental material was based on a strong evidence, evidence in favor, expert opinion, and evidence against by consensus of the authors. There is varying level of evidence for the use of restorative materials like amalgam, composites, glass ionomers, resin-modified glass-ionomers, compomers, stainless steel crowns and anterior crowns for both primary and permanent teeth. A substantial amount data is available on restorative materials used in pediatric dentistry; however, there exists substantial evidence from systematic reviews and randomized clinical trials and clinicians need to examine and understand the available literature evidence carefully to aid them in clinical decision making.

  7. 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.

  8. 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.

  9. 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.

  10. Review paper: epidemiology, evidence-based medicine, and public health.

    Science.gov (United States)

    Tang, Jin-Ling; Griffiths, Sian

    2009-07-01

    This article reviews the relation between evidence-based medicine and epidemiology and the recent evolution of the former. The meaning of evidence and the international efforts to collect, summarize, and disseminate findings from scientific research that are relevant for medical decision making are discussed. Evidence, current resources, and people's values, all play a role in making evidence-based medical decisions. This also has important implications for public health practice. However, decision making differs considerably between clinical care of individual patients and public health decision and policies that normally apply to populations. Although more closely related to epidemiology than clinical medicine, public health should also adopt a more systematic approach to evidence-based practice.

  11. A strategy for the preparation of thioantimonates based on the concept of weak acids and corresponding strong bases.

    Science.gov (United States)

    Anderer, Carolin; Delwa de Alarcón, Natalie; Näther, Christian; Bensch, Wolfgang

    2014-12-15

    By following a new synthetic approach, which is based on the in situ formation of a basic medium by the reaction between the strong base Sb(V)S4 (3-) and the weak acid H2 O, it was possible to prepare three layered thioantimonate(III) compounds of composition [TM(2,2'-bipyridine)3 ][Sb6 S10 ] (TM=Ni, Fe) and [Ni(4,4'-dimethyl-2,2'-bipyridine)3 ][Sb6 S10 ] under hydrothermal conditions featuring two different thioantimonate(III) network topologies. The antimony source, Na3 SbS4 ⋅ 9 H2 O, undergoes several decomposition reactions and produces the Sb(III) S3 species, which condenses to generate the layered anion. The application of transition-metal complexes avoids crystallization of dense phases. The reactions are very fast compared to conventional hydrothermal/solvothermal syntheses and are much less sensitive to changes of the reaction parameters. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  12. What Works? Evidence-Based Practice in Education Is Complex

    Science.gov (United States)

    Hempenstall, Kerry

    2014-01-01

    There is a nascent movement towards evidence-based practice in education in Australia, evident in Federal and State education documents, if not in classrooms. Such a classroom-level outcome would require a number of conditions to be met. One of the critical requirements is that teachers be provided with knowledge and training in practices that…

  13. 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

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

    CSIR Research Space (South Africa)

    Ntshotsho, P

    2015-11-01

    Full Text Available . A central tenet of this approach is decision making that is based on evidence, not intuition. Evidence can be generated experimentally and in practice but needs to be linked to baseline information collection, clear goals and monitoring of impact...

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

    African Journals Online (AJOL)

    Evidence-Based Nursing (EBN) permits the highest quality of care in meeting the multifaceted needs of clients using the best available evidence from research findings, expert ideas from specialists in the various health care sectors and feedback from clients. However, in many instances, various challenges need to be ...

  16. evidence-based care: an innovation to improve nursing practice

    African Journals Online (AJOL)

    user

    2014-10-13

    Oct 13, 2014 ... Evidence-Based Nursing (EBN) permits the highest quality of care in meeting the multifaceted needs of clients using the best available evidence from research findings, expert ideas from specialists in the various health care sectors and feedback from clients. However, in many instances, various challenges ...

  17. The challenge of teaching undergraduates evidence-based veterinary medicine.

    Science.gov (United States)

    Dean, R; Brennan, M; Ewers, R; Hudson, C; Daly, J M; Baillie, S; Eisler, M C; Place, E J; Brearley, J; Holmes, M; Handel, I; Shaw, D; McLauchlan, G; McBrearty, A; Cripps, P; Jones, P; Smith, R; Verheyen, K

    2017-09-16

    The Royal College of Veterinary Surgeons now lists 'How to evaluate evidence' as a day one competence for newly qualified vets. In this article, representatives from each of the veterinary schools in the UK discuss how the challenge of delivering and assessing the concepts of evidence-based veterinary medicine in a crowded undergraduate curriculum can be met. British Veterinary Association.

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

    African Journals Online (AJOL)

    Evidence-based dentistry (EBD) is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences.

  19. 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…

  20. Prediction of strong ground motion based on scaling law of earthquake

    International Nuclear Information System (INIS)

    Kamae, Katsuhiro; Irikura, Kojiro; Fukuchi, Yasunaga.

    1991-01-01

    In order to predict more practically strong ground motion, it is important to study how to use a semi-empirical method in case of having no appropriate observation records for actual small-events as empirical Green's functions. We propose a prediction procedure using artificially simulated small ground motions as substitute for the actual motions. First, we simulate small-event motion by means of stochastic simulation method proposed by Boore (1983) in considering pass effects such as attenuation, and broadening of waveform envelope empirically in the objective region. Finally, we attempt to predict the strong ground motion due to a future large earthquake (M 7, Δ = 13 km) using the same summation procedure as the empirical Green's function method. We obtained the results that the characteristics of the synthetic motion using M 5 motion were in good agreement with those by the empirical Green's function method. (author)

  1. 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.

  2. Oxygen reduction electrocatalyst based on strongly coupled cobalt oxide nanocrystals and carbon nanotubes.

    Science.gov (United States)

    Liang, Yongye; Wang, Hailiang; Diao, Peng; Chang, Wesley; Hong, Guosong; Li, Yanguang; Gong, Ming; Xie, Liming; Zhou, Jigang; Wang, Jian; Regier, Tom Z; Wei, Fei; Dai, Hongjie

    2012-09-26

    Electrocatalyst for oxygen reduction reaction (ORR) is crucial for a variety of renewable energy applications and energy-intensive industries. The design and synthesis of highly active ORR catalysts with strong durability at low cost is extremely desirable but remains challenging. Here, we used a simple two-step method to synthesize cobalt oxide/carbon nanotube (CNT) strongly coupled hybrid as efficient ORR catalyst by directly growing nanocrystals on oxidized multiwalled CNTs. The mildly oxidized CNTs provided functional groups on the outer walls to nucleate and anchor nanocrystals, while retaining intact inner walls for highly conducting network. Cobalt oxide was in the form of CoO due to a gas-phase annealing step in NH(3). The resulting CoO/nitrogen-doped CNT (NCNT) hybrid showed high ORR current density that outperformed Co(3)O(4)/graphene hybrid and commercial Pt/C catalyst at medium overpotential, mainly through a 4e reduction pathway. The metal oxide/carbon nanotube hybrid was found to be advantageous over the graphene counterpart in terms of active sites and charge transport. Last, the CoO/NCNT hybrid showed high ORR activity and stability under a highly corrosive condition of 10 M NaOH at 80 °C, demonstrating the potential of strongly coupled inorganic/nanocarbon hybrid as a novel catalyst system in oxygen depolarized cathode for chlor-alkali electrolysis.

  3. Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain.

    Science.gov (United States)

    Boswell, Mark V; Trescot, Andrea M; Datta, Sukdeb; Schultz, David M; Hansen, Hans C; Abdi, Salahadin; Sehgal, Nalini; Shah, Rinoo V; Singh, Vijay; Benyamin, Ramsin M; Patel, Vikram B; Buenaventura, Ricardo M; Colson, James D; Cordner, Harold J; Epter, Richard S; Jasper, Joseph F; Dunbar, Elmer E; Atluri, Sairam L; Bowman, Richard C; Deer, Timothy R; Swicegood, John R; Staats, Peter S; Smith, Howard S; Burton, Allen W; Kloth, David S; Giordano, James; Manchikanti, Laxmaiah

    2007-01-01

    The evidence-based practice guidelines for the management of chronic spinal pain with interventional techniques were developed to provide recommendations to clinicians in the United States. To develop evidence-based clinical practice guidelines for interventional techniques in the diagnosis and treatment of chronic spinal pain, utilizing all types of evidence and to apply an evidence-based approach, with broad representation by specialists from academic and clinical practices. Study design consisted of formulation of essentials of guidelines and a series of potential evidence linkages representing conclusions and statements about relationships between clinical interventions and outcomes. The elements of the guideline preparation process included literature searches, literature synthesis, systematic review, consensus evaluation, open forum presentation, and blinded peer review. Methodologic quality evaluation criteria utilized included the Agency for Healthcare Research and Quality (AHRQ) criteria, Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria, and Cochrane review criteria. The designation of levels of evidence was from Level I (conclusive), Level II (strong), Level III (moderate), Level IV (limited), to Level V (indeterminate). Among the diagnostic interventions, the accuracy of facet joint nerve blocks is strong in the diagnosis of lumbar and cervical facet joint pain, whereas, it is moderate in the diagnosis of thoracic facet joint pain. The evidence is strong for lumbar discography, whereas, the evidence is limited for cervical and thoracic discography. The evidence for transforaminal epidural injections or selective nerve root blocks in the preoperative evaluation of patients with negative or inconclusive imaging studies is moderate. The evidence for diagnostic sacroiliac joint injections is moderate. The evidence for therapeutic lumbar intraarticular facet injections is moderate for short-term and long-term improvement, whereas, it is

  4. Interventional techniques in the management of chronic spinal pain: evidence-based practice guidelines.

    Science.gov (United States)

    Boswell, Mark V; Shah, Rinoo V; Everett, Clifford R; Sehgal, Nalini; McKenzie Brown, Ann Marie; Abdi, Salahadin; Bowman, Richard C; Deer, Timothy R; Datta, Sukdeb; Colson, James D; Spillane, William F; Smith, Howard S; Lucas, Linda F; Burton, Allen W; Chopra, Pradeep; Staats, Peter S; Wasserman, Ronald A; Manchikanti, Laxmaiah

    2005-01-01

    The lifetime prevalence of spinal pain has been reported as 54% to 80%, with as many as 60% of patients continuing to have chronic pain five years or longer after the initial episode. Spinal pain is associated with significant economic, societal, and health impact. Available evidence documents a wide degree of variance in the definition and the practice of interventional pain management. To develop evidence-based clinical practice guidelines for interventional techniques in the management of chronic spinal pain, with utilization of all types of evidence, applying an evidence-based approach, with broad representation of specialists from academic and clinical practices. A systematic review of diagnostic and therapeutic interventions applied in managing chronic spinal pain by a policy committee. Design consisted of formulation of essentials of guidelines and a series of potential evidence linkages representing conclusions, and statements about relationships between clinical interventions and outcomes. The elements of the guideline preparation process included literature searches, literature synthesis, systematic review, consensus evaluation, open forum presentation, formal endorsement by the Board of Directors of the American Society of Interventional Pain Physicians (ASIPP), and blinded peer review. Methodologic quality evaluation criteria utilized included AHRQ criteria, QUADAS criteria, and Cochrane review criteria. The designation of levels of evidence was from Level I (conclusive), Level II (strong), Level III (moderate), Level IV (limited), to Level V (indeterminate). The accuracy of facet joint nerve blocks was strong in the diagnosis of lumbar and cervical facet joint pain, whereas, it was moderate in the diagnosis of thoracic facet joint pain. The evidence was strong for lumbar discography, whereas, the evidence was limited for cervical and thoracic discography. The evidence was moderate for transforaminal epidural injections or selective nerve root blocks in

  5. Evidence-Based Care of Acute Wounds: A Perspective

    NARCIS (Netherlands)

    Ubbink, Dirk T.; Brölmann, Fleur E.; Go, Peter M. N. Y. H.; Vermeulen, Hester

    2015-01-01

    Significance: Large variation and many controversies exist regarding the treatment of, and care for, acute wounds, especially regarding wound cleansing, pain relief, dressing choice, patient instructions, and organizational aspects. Recent Advances: A multidisciplinary team developed evidence-based

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

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

    ? Rapports. Research, capacity-building, advocacy and dissemination by LIRNEasia : advancing evidence-based policymaking and regulation in the emerging Asia-Pacific to ensure greater participation in ICTs (Phase II); final technical report ...

  7. Evidence-based care in Iran: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Morteza Ghojazadeh

    2014-08-01

    Conclusion: Weak knowledge, weak attitude, and time shortage .are among the most significant barriers of evidence-based care in Iran. These problems require more accurate planning and more favorable policies on the part of medical science authorities.

  8. 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.

  9. Clarification and Elaboration on Evidence-Based Practice in Psychology

    Science.gov (United States)

    Wampold, Bruce E.; Goodheart, Carol D.; Levant, Ronald F.

    2007-01-01

    Responds to comments by D. C. Wendt and B. D. Slife (see record 2007-13085-019), P. H. Hunsberger (see record 2007-13085-020), and R. B. Stuart and S. O. Lilienfeld (see record 2007-13085-021) regarding the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in…

  10. 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

  11. Hijacked evidence-based medicine: stay the course and throw the pirates overboard.

    Science.gov (United States)

    Ioannidis, John P A

    2017-04-01

    The article discusses a number of criticisms that have been raised against evidence-based medicine, such as focusing on benefits and ignoring adverse events; being interested in averages and ignoring the wide variability in individual risks and responsiveness; ignoring clinician-patient interaction and clinical judgement; leading to some sort of reductionism; and falling prey to corruption from conflicts of interest. I argue that none of these deficiencies are necessarily inherent to evidence-based medicine. In fact, work in evidence-based medicine has contributed a lot towards minimizing these deficiencies in medical research and medical care. However, evidence-based medicine is paying the price of its success: having become more widely recognized, it is manipulated and misused to support subverted or perverted agendas that are hijacking its reputation value. Sometimes the conflicts behind these agendas are so strong that one worries about whether the hijacking of evidence-based medicine is reversible. Nevertheless, evidence-based medicine is a valuable conceptual toolkit and it is worth to try to remove the biases of the pirates who have hijacked its ship. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. 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.

  13. Strong Optical Shock excitation in the mismatched regime of bubble plasma-wave based LWFA

    Science.gov (United States)

    Sahai, Aakash

    2017-10-01

    We present investigations into the excitation of a strong optical shock through slicing of a high intensity laser pulse driving a bubble plasma wave in a regime of mis-match between the incident laser waist-size and the bubble size ( = 2√{a0} c /ωpe). In the matched regime, it is well-known that over long timescales, the laser continuously undergoes differential frequency-shifts in different bubble phases, forming an optical shock. In the mis-matched regime, rapid laser waist and resulting bubble oscillations change the location of the peak laser ponderomotive force. This changes the location and the magnitude of the peak electron density interacting with the laser pulse. A sudden increase in the electron density during a laser radial squeeze event, slices the laser envelope longitudinally near its peak amplitude, exciting a strong optical shock state. This is shown to occur much earlier in laser evolution only over a narrow range of plasma densities where the imbalance between the longitudinal & radial ponderomotive forces excites elongated bubbles, injects ultra-low emittance electron beams and sustains ultra-high peak plasma fields. We acknowledge STFC Grants ST/J002062/1 and ST/P000835/1 for the John Adams Institute of Accelerator Science.

  14. 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.

  15. Effectiveness of Occupation-Based Interventions to Improve Areas of Occupation and Social Participation After Stroke: An Evidence-Based Review

    Science.gov (United States)

    Chuh, Adrianna; Floyd, Tracy; McInnis, Karen; Williams, Elizabeth

    2015-01-01

    This evidence-based review examined the evidence supporting the use of occupation-based interventions to improve areas of occupation and social participation poststroke. A total of 39 studies met the inclusion criteria and were critically evaluated. Most of the literature targeted activity of daily living (ADL)–based interventions and collectively provided strong evidence for the use of occupation-based interventions to improve ADL performance. The evidence related to instrumental ADLs was much more disparate, with limited evidence to support the use of virtual reality interventions and emerging evidence to support driver education programs to improve occupational performance poststroke. Only 6 studies addressed leisure, social participation, or rest and sleep, with sufficient evidence to support only leisure-based interventions. The implications of this review for research, education, and practice in occupational therapy are also discussed. PMID:25553745

  16. Effectiveness of occupation-based interventions to improve areas of occupation and social participation after stroke: an evidence-based review.

    Science.gov (United States)

    Wolf, Timothy J; Chuh, Adrianna; Floyd, Tracy; McInnis, Karen; Williams, Elizabeth

    2015-01-01

    This evidence-based review examined the evidence supporting the use of occupation-based interventions to improve areas of occupation and social participation poststroke. A total of 39 studies met the inclusion criteria and were critically evaluated. Most of the literature targeted activity of daily living (ADL)-based interventions and collectively provided strong evidence for the use of occupation-based interventions to improve ADL performance. The evidence related to instrumental ADLs was much more disparate, with limited evidence to support the use of virtual reality interventions and emerging evidence to support driver education programs to improve occupational performance poststroke. Only 6 studies addressed leisure, social participation, or rest and sleep, with sufficient evidence to support only leisure-based interventions. The implications of this review for research, education, and practice in occupational therapy are also discussed. Copyright © 2015 by the American Occupational Therapy Association, Inc.

  17. Rehabilitacija bolnikov po možganski kapi: Evidence-based stroke rehabilitation: Evidence-based stroke rehabilitation:

    OpenAIRE

    Goljar, Nika

    2010-01-01

    Despite recent advances in understanding of post-stroke rehabilitation, the evidence base remains weaker than in other areas of stroke management. European Stroke Organization (ESO) published (in 2008) its Guidelines for Management of Ischaemic Stroke (updated in 2009). They cover the whole spectrum of ischaemic stroke, including rehabilitation. Following the systematic literature search, the selected articles were screened for data relevance and quality, and the evidence base for post-stroke...

  18. 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

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

    Science.gov (United States)

    Tugwell, Peter; O'Connor, Annette; Andersson, Neil; Mhatre, Sharmila; Kristjansson, Elizabeth; Jacobsen, Mary Jane; Robinson, Vivian; Hatcher-Roberts, Jan; Shea, Beverley; Francis, Daniel; Beardmore, Jil; Wells, George A; Losos, Joe

    2006-01-01

    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 goal of equitable health

  20. Strong source heat transfer simulations based on a GalerKin/Gradient - least - squares method

    International Nuclear Information System (INIS)

    Franca, L.P.; Carmo, E.G.D. do.

    1989-05-01

    Heat conduction problems with temperature-dependent strong sources are modeled by an equation with a laplacian term, a linear term and a given source distribution term. When the linear-temperature-dependent source term is much larger than the laplacian term, we have a singular perturbation problem. In this case, boundary layers are formed to satisfy the Dirichlet boundary conditions. Although this is an elliptic equation, the standard Galerkin method solution is contaminated by spurious oscillations in the neighborhood of the boundary layers. Herein we employ a Galerkin/Gradient-least-squares method which eliminates all pathological phenomena of the Galerkin method. The method is constructed by adding to the Galerkin method a mesh-dependent term obtained by the least-squares form of the gradient of the Euler-Lagrange equation. Error estimates, numerical simulations in one-and multi-dimensions are given that attest the good stability and accuracy properties of the method [pt

  1. Research on killing Escherichia Coli by reactive oxygen species based on strong ionization discharging plasma

    International Nuclear Information System (INIS)

    Li, Y J; Tian, Y P; Zhang, Z T; Li, R H; Cai, L J; Gao, J Y

    2013-01-01

    Reactive oxygen species solution produced by strong ionization discharging plasma was used to kill Escherichia coli by spraying. Several effect factors such as pH value, solution temperature, spraying time and exposure time were observed in this study, and their effects on killing rate of Escherichia coli were discussed and analysed. Results show that the treating efficiency of ROS solution for Escherichia coli is higher in alkaline solution than that in acid solution. The killing rate of Escherichia coli increases while the spraying time and exposure time are longer and the temperature is lower. The effects of different factors on killing rate of Escherichia coli are as follows: spraying time > pH value > exposure time > solution temperature.

  2. Strong lethality and teratogenicity of strobilurins on Xenopus tropicalis embryos: Basing on ten agricultural fungicides

    International Nuclear Information System (INIS)

    Li, Dan; Liu, Mengyun; Yang, Yongsheng; Shi, Huahong; Zhou, Junliang; He, Defu

    2016-01-01

    Agricultural chemical inputs have been considered as a risk factor for the global declines in amphibian populations, yet the application of agricultural fungicides has increased dramatically in recent years. Currently little is known about the potential toxicity of fungicides on the embryos of amphibians. We studied the effects of ten commonly used fungicides (four strobilurins, two SDHIs, two triazoles, fludioxonil and folpet) on Xenopus tropicalis embryos. Lethal and teratogenic effects were respectively examined after 48 h exposure. The median lethal concentrations (LC50s) and the median teratogenic concentrations (TC50s) were determined in line with actual exposure concentrations. These fungicides except two triazoles showed obvious lethal effects on embryos; however LC50s of four strobilurins were the lowest and in the range of 6.81–196.59 μg/L. Strobilurins, SDHIs and fludioxonil induced severe malformations in embryos. Among the ten fungicides, the lowest TC50s were observed for four strobilurins in the range of 0.61–84.13 μg/L. The teratogenicity shared similar dose–effect relationship and consistent phenotypes mainly including microcephaly, hypopigmentation, somite segmentation and narrow fins. The findings indicate that the developmental toxicity of currently-used fungicides involved with ecologic risks on amphibians. Especially strobilurins are highly toxic to amphibian embryos at μg/L level, which is close to environmentally relevant concentrations. - Highlights: • Effects of ten agricultural fungicides were tested on Xenopus tropicalis embryos. • Strobilurin fungicides showed strong lethal and teratogenic effects on embryos. • Lowest LC50 and TC50 were observed for strobilurins in ten fungicides. • μg/L level of toxic concentrations for strobilurins was environmentally relevant. • Teratogenicity shared similar dose–effect relationship and main phenotypes. - Strobilurins induced strong lethality and teratogenicity on Xenopus

  3. Evidence-based medicine meets democracy: the role of evidence-based public health guidelines in local government.

    Science.gov (United States)

    Kelly, M P; Atkins, L; Littleford, C; Leng, G; Michie, S

    2017-12-01

    In 2013, many public health functions transferred from the National Health Service to local government in England. From 2006 NICE had produced public health guidelines based on the principles of evidence-based medicine. This study explores how the guidelines were received in the new environment in local government and related issues raised relating to the use of evidence in local authoritites. In depth, interviews with 31 elected members and officers, including Directors of Public Health, from four very different local government organizations ('local authorities'). Participants reported that (i) there were tensions between evidence-based, and political decision-making; (ii) there were differences in views about what constituted 'good' evidence and (iii) that organizational life is an important mediator in the way evidence is used. Democratic political decision-making does not necessarily naturally align with decision-making based on evidence from the international scientific literature, and local knowledge and local evidence are very important in the ways that public health decisions are made. © The Author 2017. Published by Oxford University Press on behalf of Faculty of Public Health.

  4. Body Mass Index: A Scientific Evidence-Based Inquiry

    Directory of Open Access Journals (Sweden)

    Ricardo Djalma Rabelo

    2002-01-01

    Full Text Available OBJECTVE: To objectively and critically assess body mass index and to propose alternatives for relating body weight and height that are evidence-based and that eliminate or reduce the limitations of the body mass index. METHODS: To analyze the relations involving weight and height, we used 2 databases as follows: 1 children and adolescents from Brazil, the United States, and Switzerland; and 2 538 university students. We performed mathematical simulations with height data ranging from 115 to 190 cm and weight data ranging from 25 to 105 kg. We selected 3 methods to analyze the relation of weight and height as follows: body mass index - weight (kg/height (m²; reciprocal of the ponderal index - height (cm/weight1/3 (kg; and ectomorphy. Using the normal range from 20 to 25 kg/m² for the body mass index in the reference height of 170 cm, we identified the corresponding ranges of 41 to 44 cm/kg1/3 for the reciprocal of the ponderal index, and of 1.45 to 3.60 for ectomorphy. RESULTS: The mathematical simulations showed a strong association among the 3 methods with an absolute concordance to a height of 170 cm, but with a tendency towards discrepancy in the normal ranges, which had already been observed for the heights of 165 and 175 cm. This made the direct convertibility between the indices unfeasible. The reciprocal of the ponderal index and ectomorphy with their cut points comprised a larger age range in children and adolescents and a wider and more central range in the university students, both for the reported (current and desired weights. CONCLUSION: The reciprocal of the ponderal index and ectomorphy are stronger and are more mathematically logical than body mass index; in addition, they may be applied with the same cut points for normal from the age of 5 ½ years on.

  5. On thermodynamics of rhenium ion exchange sorption by strong-base anionite from nitrate-sulfate solutions

    International Nuclear Information System (INIS)

    Blokhin, A.A.; Pak, V.I.; Siracheva, M.K.

    1984-01-01

    The apparent thermodynamic parameters of the process of rhenium absorption by strong-base anionites from nitrate-sulfate media in the range of low degrees of filling the sorbents with perrhenate ions are estimated. On the basis of studying the temperature dependence of ion-exchange rhenium sorption it is shown that this process is accompanied by heat release and entropy reduction

  6. Use of Research Evidence and Implementation of Evidence-Based Practices in Youth-Serving Systems.

    Science.gov (United States)

    Palinkas, Lawrence A; Saldana, Lisa; Chou, Chih-Ping; Chamberlain, Patricia

    2017-09-01

    Although the effectiveness of interventions for prevention and treatment of mental health and behavioral problems in abused and neglected youth is demonstrated through the accumulation of evidence through rigorous and systematic research, it is uncertain whether use of research evidence (URE) by child-serving systems leaders increases the likelihood of evidence- based practice (EBP) implementation and sustainment. Information on URE was collected from 151 directors and senior administrators of child welfare, mental health and juvenile justice systems in 40 California and 11 Ohio counties participating in an RCT of the use of community development teams (CDTs) to scale up implementation of Treatment Foster Care Oregon over a 3 year period (2010-12). Separate multivariate models were used to assess independent effects of evidence acquisition (input), evaluation (process), application (output), and URE in general (SIEU Total) on two measures of EBP implementation, highest stage reached and proportion of activities completed at pre-implementation, implementation and sustainment phases. Stage of implementation and proportion of activities completed in the implementation and sustainment phases were independently associated with acquisition of evidence and URE in general. Participation in CDTs was significantly associated with URE in general and acquisition of research evidence in particular. Implementation of EBPs for treatment of abused and neglected youth does appear to be associated with use of research evidence, especially during the later phases.

  7. 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

  8. Validating evidence based decision making in health care

    DEFF Research Database (Denmark)

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

    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......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...

  9. Evidence-Based Psychosocial Treatments for Child and Adolescent Depression

    Science.gov (United States)

    David-Ferdon, Corinne; Kaslow, Nadine J.

    2008-01-01

    The evidence-base of psychosocial treatment outcome studies for depressed youth conducted since 1998 is examined. All studies for depressed children meet Nathan and Gorman's (2002) criteria for Type 2 studies whereas the adolescent protocols meet criteria for both Type 1 and Type 2 studies. Based on the Task Force on the Promotion and…

  10. 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...

  11. 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…

  12. Urinary urgency - translating the evidence base into daily clinical practice

    NARCIS (Netherlands)

    Cardozo, L.; Chapple, C. R.; Dmochowski, R.; Fitzgerald, M. P.; Hanno, P.; Michel, M. C.; Staskin, D.; van Kerrebroeck, P.; Wyndaele, J.-J.; Yamaguchi, O.; Yoshida, M.

    2009-01-01

    P>Aim: To consider the currently available knowledge and understanding of the symptom of urgency. Materials & Methods: Each faculty member reviewed the literature base of a different aspect of urgency and along with their personal clinical experience provided a base of evidence for discussion.

  13. 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 ...

  14. Construct Definition Using Cognitively Based Evidence: A Framework for Practice

    Science.gov (United States)

    Ketterlin-Geller, Leanne R.; Yovanoff, Paul; Jung, EunJu; Liu, Kimy; Geller, Josh

    2013-01-01

    In this article, we highlight the need for a precisely defined construct in score-based validation and discuss the contribution of cognitive theories to accurately and comprehensively defining the construct. We propose a framework for integrating cognitively based theoretical and empirical evidence to specify and evaluate the construct. We apply…

  15. 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 ...

  16. 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

  17. New Liquid Phases for the Gas Chromatographic Separation of Strong Bases on Capillary Columns

    OpenAIRE

    Grob, K.

    2017-01-01

    The current practice of pretreating the solid support with free alkali to increase separation efficiency for basic compounds proved to be unsuitable for capillary columns. Instead of this, homogenous organic materials of high base strength are required. We found polyethylene imine (PEI) and polypropylene imine (PPI) to be very efficient as liquid phases of capillary columns for the separation of bases. The preparation of polymers is mentioned. Silanization or acetylation of the free hydroxyl ...

  18. Confined surface plasmon sensors based on strongly coupled disk-in-volcano arrays.

    Science.gov (United States)

    Ai, Bin; Wang, Limin; Möhwald, Helmuth; Yu, Ye; Zhang, Gang

    2015-02-14

    Disk-in-volcano arrays are reported to greatly enhance the sensing performance due to strong coupling in the nanogaps between the nanovolcanos and nanodisks. The designed structure, which is composed of a nanovolcano array film and a disk in each cavity, is fabricated by a simple and efficient colloidal lithography method. By tuning structural parameters, the disk-in-volcano arrays show greatly enhanced resonances in the nanogaps formed by the disks and the inner wall of the volcanos. Therefore they respond to the surrounding environment with a sensitivity as high as 977 nm per RIU and with excellent linear dependence on the refraction index. Moreover, through mastering the fabrication process, biological sensing can be easily confined to the cavities of the nanovolcanos. The local responsivity has the advantages of maximum surface plasmon energy density in the nanogaps, reducing the sensing background and saving expensive reagents. The disk-in-volcano arrays also possess great potential in applications of optical and electrical trapping and single-molecule analysis, because they enable establishment of electric fields across the gaps.

  19. Strongly Iridescent Hybrid Photonic Sensors Based on Self-Assembled Nanoparticles for Hazardous Solvent Detection

    Directory of Open Access Journals (Sweden)

    Ayaka Sato

    2018-03-01

    Full Text Available Facile detection and the identification of hazardous organic solvents are essential for ensuring global safety and avoiding harm to the environment caused by industrial wastes. Here, we present a simple method for the fabrication of silver-coated monodisperse polystyrene nanoparticle photonic structures that are embedded into a polydimethylsiloxane (PDMS matrix. These hybrid materials exhibit a strong green iridescence with a reflectance peak at 550 nm that originates from the close-packed arrangement of the nanoparticles. This reflectance peak measured under Wulff-Bragg conditions displays a 20 to 50 nm red shift when the photonic sensors are exposed to five commonly employed and highly hazardous organic solvents. These red-shifts correlate well with PDMS swelling ratios using the various solvents, which suggests that the observable color variations result from an increase in the photonic crystal lattice parameter with a similar mechanism to the color modulation of the chameleon skin. Dynamic reflectance measurements enable the possibility of clearly identifying each of the tested solvents. Furthermore, as small amounts of hazardous solvents such as tetrahydrofuran can be detected even when mixed with water, the nanostructured solvent sensors we introduce here could have a major impact on global safety measures as innovative photonic technology for easily visualizing and identifying the presence of contaminants in water.

  20. 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, ...

  1. 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.

  2. Sugar-Based Polyamides: Self-Organization in Strong Polar Organic Solvents.

    Science.gov (United States)

    Rosu, Cornelia; Russo, Paul S; Daly, William H; Cueto, Rafael; Pople, John A; Laine, Roger A; Negulescu, Ioan I

    2015-09-14

    Periodic patterns resembling spirals were observed to form spontaneously upon unassisted cooling of d-glucaric acid- and d-galactaric acid-based polyamide solutions in N-methyl-N-morpholine oxide (NMMO) monohydrate. Similar observations were made in d-galactaric acid-based polyamide/ionic liquid (IL) solutions. The morphologies were investigated by optical, polarized light and confocal microscopy assays to reveal pattern details. Differential scanning calorimetry was used to monitor solution thermal behavior. Small- and wide-angle X-ray scattering data reflected the complex and heterogeneous nature of the self-organized patterns. Factors such as concentration and temperature were found to influence spiral dimensions and geometry. The distance between rings followed a first-order exponential decay as a function of polymer concentration. Fourier-Transform Infrared Microspectroscopy analysis of spirals pointed to H-bonding between the solvent and the pendant hydroxyl groups of the glucose units from the polymer backbone. Tests on self-organization into spirals of ketal-protected d-galactaric acid polyamides in NMMO monohydrate confirmed the importance of the monosaccharide's pendant free hydroxyl groups on the formation of these patterns. Rheology performed on d-galactaric-based polyamides at high concentration in NMMO monohydrate solution revealed the optimum conditions necessary to process these materials as fibers by spinning. The self-organization of these sugar-based polyamides mimics certain biological materials.

  3. Knowledge base about earthquakes as a tool to minimize strong events consequences

    Science.gov (United States)

    Frolova, Nina; Bonnin, Jean; Larionov, Valery; Ugarov, Alexander; Kijko, Andrzej

    2017-04-01

    The paper describes the structure and content of the knowledge base on physical and socio-economical consequences of damaging earthquakes, which may be used for calibration of near real-time loss assessment systems based on simulation models for shaking intensity, damage to buildings and casualties estimates. Such calibration allows to compensate some factors which influence on reliability of expected damage and loss assessment in "emergency" mode. The knowledge base contains the description of past earthquakes' consequences for the area under study. It also includes the current distribution of built environment and population at the time of event occurrence. Computer simulation of the recorded in knowledge base events allow to determine the sets of regional calibration coefficients, including rating of seismological surveys, peculiarities of shaking intensity attenuation and changes in building stock and population distribution, in order to provide minimum error of damaging earthquakes loss estimations in "emergency" mode. References 1. Larionov, V., Frolova, N: Peculiarities of seismic vulnerability estimations. In: Natural Hazards in Russia, volume 6: Natural Risks Assessment and Management, Publishing House "Kruk", Moscow, 120-131, 2003. 2. Frolova, N., Larionov, V., Bonnin, J.: Data Bases Used In Worlwide Systems For Earthquake Loss Estimation In Emergency Mode: Wenchuan Earthquake. In Proc. TIEMS2010 Conference, Beijing, China, 2010. 3. Frolova N. I., Larionov V. I., Bonnin J., Sushchev S. P., Ugarov A. N., Kozlov M. A. Loss Caused by Earthquakes: Rapid Estimates. Natural Hazards Journal of the International Society for the Prevention and Mitigation of Natural Hazards, vol.84, ISSN 0921-030, Nat Hazards DOI 10.1007/s11069-016-2653

  4. 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…

  5. Searching for evidence-based geriatrics: Tips and tools for finding evidence in the medical literature

    NARCIS (Netherlands)

    van Munster, B. C.; van de Glind, E. M. M.; Hooft, L.

    2012-01-01

    Introduction: Information to treat geriatric patients evidence-based is hard to find. Recently, a sensitive and a specific search filter to improve searching for literature relevant to geriatric medicine were developed in a research setting. The aim of this study is to determine whether these

  6. Efficacy of melody-based aphasia therapy may strongly depend on rhythm and conversational speech formulas

    OpenAIRE

    Benjamin Stahl

    2014-01-01

    Left-hemisphere stroke patients suffering from language and speech disorders are often able to sing entire pieces of text fluently. This finding has inspired a number of melody-based rehabilitation programs – most notable among them a treatment known as Melodic Intonation Therapy – as well as two fundamental research questions. When the experimental design focuses on one point in time (cross section), one may determine whether or not singing has an immediate effect on syllable production in p...

  7. Evidence-Based Practice and Quality Improvement in Nursing Education.

    Science.gov (United States)

    Balakas, Karen; Smith, Joan R

    2016-01-01

    For more than a decade, nursing education has experienced several significant changes in response to challenges faced by healthcare organizations. Accrediting organizations have called for improved quality and safety in care, and the Institute of Medicine has identified evidence-based practice and quality improvement as 2 core competencies to include in the curricula for all healthcare professionals. However, the application of these competencies reaches far beyond the classroom setting. For nurses to possess the knowledge, skills, and attitudes to apply evidence-based practice and quality improvement to the real-world setting, academic-clinical institution partnerships are vital.

  8. Strategies for searching and managing evidence-based practice resources.

    Science.gov (United States)

    Robb, Meigan; Shellenbarger, Teresa

    2014-10-01

    Evidence-based nursing practice requires the use of effective search strategies to locate relevant resources to guide practice change. Continuing education and staff development professionals can assist nurses to conduct effective literature searches. This article provides suggestions for strategies to aid in identifying search terms. Strategies also are recommended for refining searches by using controlled vocabulary, truncation, Boolean operators, PICOT (Population/Patient Problem, Intervention, Comparison, Outcome, Time) searching, and search limits. Suggestions for methods of managing resources also are identified. Using these approaches will assist in more effective literature searches and may help evidence-based practice decisions. Copyright 2014, SLACK Incorporated.

  9. The professional clothing bank as evidence-based practice.

    Science.gov (United States)

    Bishop, SueZanne Monique

    2015-01-01

    Little research exists linking interview-appropriate attire to improved employment outcomes for women. Thus, it appears that the professional clothing bank has not been investigated as evidence-based practice. To provide preliminary evidence for clothing banks, in this article the author synthesizes findings from existing research on the provision of a professional clothing bank as a means for offering interview-appropriate attire to poor women in job readiness programming. For context, job readiness programs are explored and a case study of one program operating a professional clothing bank is presented. Finally, preliminary considerations for planning and implementing clothing banks based on this literature review are given.

  10. 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.

  11. 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...

  12. Integrating the online nursing evidence-based information resources for evidence-based nursing study in China.

    Science.gov (United States)

    He, Mengxue; Hu, Yan

    2012-10-01

    At present Chinese nurses could not get the up-to-date and high-quality evidences efficiently and conveniently due to language barrier and other practical difficulties. This program built a Chinese website of integrated evidence-based network information resources for EBN studies. Researchers hope to provide practical guidance and advice for nurses in non-English-speaking countries.. © 2012 Wiley Publishing Asia Pty Ltd.

  13. Neighborhood deprivation is strongly associated with participation in a population-based health check.

    Directory of Open Access Journals (Sweden)

    Anne Mette Bender

    Full Text Available We sought to examine whether neighborhood deprivation is associated with participation in a large population-based health check. Such analyses will help answer the question whether health checks, which are designed to meet the needs of residents in deprived neighborhoods, may increase participation and prove to be more effective in preventing disease. In Europe, no study has previously looked at the association between neighborhood deprivation and participation in a population-based health check.The study population comprised 12,768 persons invited for a health check including screening for ischemic heart disease and lifestyle counseling. The study population was randomly drawn from a population of 179,097 persons living in 73 neighborhoods in Denmark. Data on neighborhood deprivation (percentage with basic education, with low income and not in work and individual socioeconomic position were retrieved from national administrative registers. Multilevel regression analyses with log links and binary distributions were conducted to obtain relative risks, intraclass correlation coefficients and proportional change in variance.Large differences between neighborhoods existed in both deprivation levels and neighborhood health check participation rate (mean 53%; range 35-84%. In multilevel analyses adjusted for age and sex, higher levels of all three indicators of neighborhood deprivation and a deprivation score were associated with lower participation in a dose-response fashion. Persons living in the most deprived neighborhoods had up to 37% decreased probability of participating compared to those living in the least deprived neighborhoods. Inclusion of individual socioeconomic position in the model attenuated the neighborhood deprivation coefficients, but all except for income deprivation remained statistically significant.Neighborhood deprivation was associated with participation in a population-based health check in a dose-response manner, in which

  14. The Danish Industrial Enzyme Industry - National based Companies with strong internationalised R&D

    DEFF Research Database (Denmark)

    Pedersen, Jørgen Lindgaard; Hansen, Anne Grethe

    and energy and many other fields. Historically the industry started up in 1874 based on empiric knowledge on use of rennet in production of cheese from Switzerland and Germany and later enriched by scientific knowledge produced in the company and institutions all over the world. Important for the company......Danish industrial enzyme industry consists of three main companies (Chr. Hansen A/S, Novozymes A/S and Danisco A/S) which in total has around 75 percent of the world market for industrial enzymes. Industrial enzymes are catalysts used in biological and chemical processes in food, detergents, paper...

  15. Probabilistic seismic assessment of base-isolated NPPs subjected to strong ground motions of Tohoku earthquake

    Energy Technology Data Exchange (ETDEWEB)

    Ali, Ahmer; Hayah, Nadin Abu; Kim, Doo Kie [Dept. of Civil and Environmental Engineering, Kunsan National University, Kunsan (Korea, Republic of); Cho, Sung Gook [R and D Center, JACE KOREA Company, Gyeonggido (Korea, Republic of)

    2014-10-15

    The probabilistic seismic performance of a standard Korean nuclear power plant (NPP) with an idealized isolation is investigated in the present work. A probabilistic seismic hazard analysis (PSHA) of the Wolsong site on the Korean peninsula is performed by considering peak ground acceleration (PGA) as an earthquake intensity measure. A procedure is reported on the categorization and selection of two sets of ground motions of the Tohoku earthquake, i.e. long-period and common as Set A and Set B respectively, for the nonlinear time history response analysis of the base-isolated NPP. Limit state values as multiples of the displacement responses of the NPP base isolation are considered for the fragility estimation. The seismic risk of the NPP is further assessed by incorporation of the rate of frequency exceedance and conditional failure probability curves. Furthermore, this framework attempts to show the unacceptable performance of the isolated NPP in terms of the probabilistic distribution and annual probability of limit states. The comparative results for long and common ground motions are discussed to contribute to the future safety of nuclear facilities against drastic events like Tohoku.

  16. Competing orders in strongly correlated systems. Dirac materials and iron-based superconductors

    Energy Technology Data Exchange (ETDEWEB)

    Classen, Laura

    2016-11-04

    In this work we address the collective phenomena appearing in interacting fermion systems due to the competition of distinct orders at the example of Dirac materials and iron-based superconductors. On the one hand we determine leading ordering tendencies in an unbiased way, when Fermi liquid instabilities are expected simultaneously in the particle-particle and particle-hole channel. In this context we analyze the impact of electron-phonon interactions on the many-body instabilities of electrons on the honeycomb lattice. Furthermore we investigate the interplay between superconductivity, magnetism and orbital order in five-pocket iron-based superconductors including the full orbital composition of low-energy excitations. On the other hand we study how the close proximity of different phases affects the structure of the phase diagram and the nature of transitions, as well as the corresponding quantum multicritical behavior. To this end we consider the semimetal-insulator transitions to an antiferromagnetic and a staggered-density state of low-energy Dirac fermions. To account for the decisive role of interactions and the various degrees of freedom in these models, modern renormalization group techniques are applied.

  17. PROBABILISTIC SEISMIC ASSESSMENT OF BASE-ISOLATED NPPS SUBJECTED TO STRONG GROUND MOTIONS OF TOHOKU EARTHQUAKE

    Directory of Open Access Journals (Sweden)

    AHMER ALI

    2014-10-01

    Full Text Available The probabilistic seismic performance of a standard Korean nuclear power plant (NPP with an idealized isolation is investigated in the present work. A probabilistic seismic hazard analysis (PSHA of the Wolsong site on the Korean peninsula is performed by considering peak ground acceleration (PGA as an earthquake intensity measure. A procedure is reported on the categorization and selection of two sets of ground motions of the Tohoku earthquake, i.e. long-period and common as Set A and Set B respectively, for the nonlinear time history response analysis of the base-isolated NPP. Limit state values as multiples of the displacement responses of the NPP base isolation are considered for the fragility estimation. The seismic risk of the NPP is further assessed by incorporation of the rate of frequency exceedance and conditional failure probability curves. Furthermore, this framework attempts to show the unacceptable performance of the isolated NPP in terms of the probabilistic distribution and annual probability of limit states. The comparative results for long and common ground motions are discussed to contribute to the future safety of nuclear facilities against drastic events like Tohoku.

  18. [Pharmacist's requirements for evidence-based self-medication guidelines].

    Science.gov (United States)

    Laven, Anna; Läer, Stephanie

    2013-03-01

    Due to the removal of many pharmaceuticals from the prescription requirement, self-medication implies an increasing responsibility for pharmacists towards their patients. The application of evidence-based guidelines could be a responsible basis for consulting in pharmacies. Evidence-based guidelines represent the systematically accumulated and evaluated facts (the evidence) of desired and undesired effects of pharmaceuticals in the population. We wanted to find out which interest pharmaceutical professionals have in evidence-based guidelines and which are the exact requirements on their content, deducted from public pharmacies everyday demands. With this purpose, three surveys were conducted between March and August 2012, in which 365, 350, and 486 pharmaceutical professionals participated respectively. The results show that pharmacy staff is very interested in evidence based guidelines. Furthermore, they suggest that the pharmacy staff feel safe with the self-diagnosis of the customer, with the consideration of limits of self-medication, as well as with the selection of the--according to own assessment--appropriate active substance. For the selection of the correct active substance, the following criteria are named: self-security in the counselling, first-hand experiences as well as the wish of the customer. At the same time, it is striking that the most frequent critique the pharmacy staff gets from pharmacy customers is the lack of effectiveness of the selected medication. With that in mind, it is possible that not the appropriate medication was selected, and the chosen criteria as selection method should be replaced by an evidence-based decision. Secondly, the results show that in up to 52% of the cases, depending on the indications, the participating consultants felt less certain to uncertain with regards to possible interactions or contraindications. Also in this context, it is desirable to prepare the existing data in such a practical way, that the

  19. Evidence v. rights-based decision making for nutrition.

    Science.gov (United States)

    Shrimpton, Roger

    2003-05-01

    The need for an evidence base for human nutrition action is analysed in the context of human rights. Over the last 50 years the twin tracks of development, economical needs based and normative rights based, have come progressively closer in terms of goals and objectives, even if they do maintain different orientations and origins. The international human rights machinery is described, together with those parts that are of relevance to the right to food and nutrition. The role of the State in respecting, protecting and facilitating these rights is further described. The evidence base for the benefit of nutrition interventions during the fetal and infant period to the health and well-being of populations throughout life's course is briefly reviewed, and reasons why such a large body of evidence has not been acted upon are discussed. The power of nutrition is in prevention more than cure, and the prevention of nutritional deficiency is best suited to radical population-wide strategies rather than high-risk strategies targeted at individuals. The population-wide distribution of benefits of nutrition is in congruence with universality of human rights. In the UK much remains to be done to ensure that food and nutrition rights are realised, especially during the critical period of fetal and infant growth. What role the Nutrition Society might play in the realisation of these rights, including the creation of a robust evidence base for nutrition action, is further discussed.

  20. 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.

  1. 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

  2. Neighborhood deprivation is strongly associated with participation in a population-based health check

    DEFF Research Database (Denmark)

    Bender, Anne Mette; Kawachi, Ichiro; Jørgensen, Torben

    2015-01-01

    BACKGROUND: We sought to examine whether neighborhood deprivation is associated with participation in a large population-based health check. Such analyses will help answer the question whether health checks, which are designed to meet the needs of residents in deprived neighborhoods, may increase...... screening for ischemic heart disease and lifestyle counseling. The study population was randomly drawn from a population of 179,097 persons living in 73 neighborhoods in Denmark. Data on neighborhood deprivation (percentage with basic education, with low income and not in work) and individual socioeconomic...... in both deprivation levels and neighborhood health check participation rate (mean 53%; range 35-84%). In multilevel analyses adjusted for age and sex, higher levels of all three indicators of neighborhood deprivation and a deprivation score were associated with lower participation in a dose...

  3. Model-Based Water Wall Fault Detection and Diagnosis of FBC Boiler Using Strong Tracking Filter

    Directory of Open Access Journals (Sweden)

    Li Sun

    2014-01-01

    Full Text Available Fluidized bed combustion (FBC boilers have received increasing attention in recent decades. The erosion issue on the water wall is one of the most common and serious faults for FBC boilers. Unlike direct measurement of tube thickness used by ultrasonic methods, the wastage of water wall is reconsidered equally as the variation of the overall heat transfer coefficient in the furnace. In this paper, a model-based approach is presented to estimate internal states and heat transfer coefficient dually from the noisy measurable outputs. The estimated parameter is compared with the normal value. Then the modified Bayesian algorithm is adopted for fault detection and diagnosis (FDD. The simulation results demonstrate that the approach is feasible and effective.

  4. 2D mapping of strongly deformed cell nuclei based on contour warping.

    Science.gov (United States)

    De Vylder, Jonas; Douterloigne, Koen; De Vos, Winnok; Philips, Wilfried

    2010-01-01

    The dynamics of genome regions are associated to the functional or dysfunctional behaviour of the human cell. In order to study these dynamics it is necessary to remove perturbations coming from movement and deformation of the nucleus, i.e. the container holding the genome. In literature models have been proposed to cope with the transformations corresponding to nuclear dynamics of healthy cells. However for pathological cells, the nucleus deforms in an apparently random way, making the use of such models a non trivial task. In this paper we propose a mapping of the cell nucleus which is based on the matching of the nuclear contours. The proposed method does not put constraints on the possible shapes nor on the possible deformations, making this method suited for the analysis of pathological nuclei.

  5. High-linearity piezoresistive response of mechanically strong graphene-based elastomer

    Science.gov (United States)

    Yuanzheng, Luo; Buyin, Li; Xiaoqi

    2017-05-01

    Traditional additive-free graphene bulk materials based on mono- three dimensional(3D) graphene networks type are fragile in most cases, which is unfavorable for their potential applications. Here we present compressible graphene foams (CGF) with superior properties endowed by the hierarchical porous structure, which taking graphene sheets as an inorganic embedding material and polyurethane sponge (PUS) as a polymer open-framework. The preparation process utilized a dip-coating method associated with directional freezing followed by lyophilization. The as-synthesized CGF not only possess a combination of ultralow density and excellent electrical conductivity, but it also can withstand large strains (>99%) without permanent deformation or fracture. We believe that these sponge/graphene embeddable multifunctional nanocomposites will expand practical applications of graphene monolith in the future.

  6. 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

  7. Evidence-based ethics – What it should be and what it shouldn't

    Directory of Open Access Journals (Sweden)

    Strech Daniel

    2008-10-01

    Full Text Available Abstract Background The concept of evidence-based medicine has strongly influenced the appraisal and application of empirical information in health care decision-making. One principal characteristic of this concept is the distinction between "evidence" in the sense of high-quality empirical information on the one hand and rather low-quality empirical information on the other hand. In the last 5 to 10 years an increasing number of articles published in international journals have made use of the term "evidence-based ethics", making a systematic analysis and explication of the term and its applicability in ethics important. Discussion In this article four descriptive and two normative characteristics of the general concept "evidence-based" are presented and explained systematically. These characteristics are to then serve as a framework for assessing the methodological and practical challenges of evidence-based ethics as a developing methodology. The superiority of evidence in contrast to other empirical information has several normative implications such as the legitimization of decisions in medicine and ethics. This implicit normativity poses ethical concerns if there is no formal consent on which sort of empirical information deserves the label "evidence" and which does not. In empirical ethics, which relies primarily on interview research and other methods from the social sciences, we still lack gold standards for assessing the quality of study designs and appraising their findings. Conclusion The use of the term "evidence-based ethics" should be discouraged, unless there is enough consensus on how to differentiate between high- and low-quality information produced by empirical ethics. In the meantime, whenever empirical information plays a role, the process of ethical decision-making should make use of systematic reviews of empirical studies that involve a critical appraisal and comparative discussion of data.

  8. Strategy Iteration Is Strongly Polynomial for 2-Player Turn-Based Stochastic Games with a Constant Discount Factor

    DEFF Research Database (Denmark)

    Hansen, Thomas Dueholm; Miltersen, Peter Bro; Zwick, Uri

    2013-01-01

    -based stochastic games with discounted zero-sum rewards. This provides the first strongly polynomial algorithm for solving these games, solving a long standing open problem. Combined with other recent results, this provides a complete characterization of the complexity the standard strategy iteration algorithm...... terminates after at most O(m1−γ log n1−γ) iterations. Second, and more importantly, we show that the same bound applies to the number of iterations performed by the strategy iteration (or strategy improvement) algorithm, a generalization of Howard’s policy iteration algorithm used for solving 2-player turn...... for 2-player turn-based stochastic games; it is strongly polynomial for a fixed discount factor, and exponential otherwise....

  9. Comparison of primary and secondary 26S rRNA structures in two Tetrahymena species: evidence for a strong evolutionary and structural constraint in expansion segments

    DEFF Research Database (Denmark)

    Engberg, J; Nielsen, Henrik; Lenaers, G

    1990-01-01

    . These are regions within the common core of secondary structure where expansions have taken place during the evolution of the rRNA of higher eukaryotes. The dispensable nature of some of the expansion segments has been taken as evidence of their non-functionality. However, our data show that a considerable...... selective constraint has operated to preserve the secondary structure of these segments. Especially in the case of the D2 and D8 segments, the presence of a considerable number of compensatory base changes suggests that the secondary structure of these regions is of functional importance. Alternatively...

  10. Efficacy of melody-based aphasia therapy may strongly depend on rhythm and conversational speech formulas

    Directory of Open Access Journals (Sweden)

    Benjamin Stahl

    2014-04-01

    Full Text Available Left-hemisphere stroke patients suffering from language and speech disorders are often able to sing entire pieces of text fluently. This finding has inspired a number of melody-based rehabilitation programs – most notable among them a treatment known as Melodic Intonation Therapy – as well as two fundamental research questions. When the experimental design focuses on one point in time (cross section, one may determine whether or not singing has an immediate effect on syllable production in patients with language and speech disorders. When the design focuses on changes over several points in time (longitudinal section, one may gain insight as to whether or not singing has a long-term effect on language and speech recovery. The current work addresses both of these questions with two separate experiments that investigate the interplay of melody, rhythm and lyric type in 32 patients with non-fluent aphasia and apraxia of speech (Stahl et al., 2011; Stahl et al., 2013. Taken together, the experiments deliver three main results. First, singing and rhythmic pacing proved to be equally effective in facilitating immediate syllable production and long-term language and speech recovery. Controlling for various influences such as prosody, syllable duration and phonetic complexity, the data did not reveal any advantage of singing over rhythmic speech. This result was independent of lesion size and lesion location in the patients. Second, patients with extensive left-sided basal ganglia lesions produced more correct syllables when their speech was paced by rhythmic drumbeats. This observation is consistent with the idea that regular auditory cues may partially compensate for corticostriatal damage and thereby improve speech-motor planning (Grahn & Watson, 2013. Third, conversational speech formulas and well-known song lyrics yielded higher rates of correct syllable production than novel word sequences – whether patients were singing or speaking

  11. Strategy iteration is strongly polynomial for 2-player turn-based stochastic games with a constant discount factor

    DEFF Research Database (Denmark)

    Hansen, Thomas Dueholm; Miltersen, Peter Bro; Zwick, Uri

    2011-01-01

    iterations. Second, and more importantly, we show that the same bound applies to the number of iterations performed by the strategy iteration (or strategy improvement) algorithm, a generalization of Howard's policy iteration algorithm used for solving 2-player turn-based stochastic games with discounted zero......-sum rewards. This provides the first strongly polynomial algorithm for solving these games, resolving a long standing open problem....

  12. Strong Authentication Protocol based on Java Crypto Chip as a Secure Element

    Directory of Open Access Journals (Sweden)

    Majid Mumtaz

    2016-10-01

    Full Text Available Smart electronic devices and gadgets and their applications are becoming more and more popular. Most of those devices and their applications handle personal, financial, medical and other sensitive data that require security and privacy protection. In this paper we describe one aspect of such protection – user authentication protocol based on the use of X.509 certificates. The system uses Public Key Infrastructure (PKI, challenge/response protocol, mobile proxy servers, and Java cards with crypto capabilities used as a Secure Element. Innovative design of the protocol, its implementation, and evaluation results are described. In addition to end-user authentication, the described solution also supports the use of X.509 certificates for additional security services – confidentiality, integrity, and non-repudiation of transactions and data in an open network environment. The system uses Application Programming Interfaces (APIs to access Java cards functions and credentials that can be used as add-ons to enhance any mobile application with security features and services.

  13. Knowledge of evidence-based dentistry among academic dental practitioners of Bhopal, India: a preliminary survey

    Directory of Open Access Journals (Sweden)

    Aishwarya Singh

    2015-06-01

    Full Text Available This study aimed to characterize the knowledge of evidence-based dentistry (EBD among dental faculty members in the city of Bhopal in central India. A cross-sectional questionnaire was administered at two dental colleges in Bhopal City. All dental faculty members who were present on the day of the study and who agreed to participate were included in the study. A total of 50 dental faculty members returned the questionnaire. Six Likert-type questions were asked, and the percentages of various responses were used for analysis. Sixteen faculty members (32.0% strongly agreed that EBD is a process of making decisions based on scientifically proven evidence. Fifteen faculty members (30.0% strongly disagreed or disagreed with the item stating that the best and quickest way to find evidence is by reading textbooks or asking experienced colleagues. Thirteen faculty members (26.0% strongly agreed that EBD allows dentists to improve their scientific knowledge and clinical skills. It is recommended that EBD be included in undergraduate and postgraduate curricula and in intensive continuing dental education programs that are conducted for dental faculty members.

  14. Evidence, discovery and justification: the case of evidence-based medicine.

    Science.gov (United States)

    Gaeta, Rodolfo; Gentile, Nelida

    2016-08-01

    The purpose of this paper is to develop some thoughts on philosophical issues surrounding evidence-based medicine (EBM), especially related to its epistemological dimensions. After considering the scope of several philosophical concepts that are relevant to the discussion, and drawing some distinctions among different aspects of EBM, we evaluate the status of EBM and suggest that EBM is mainly a meta-methodology. Then, we outline an evaluation of the thesis that EBM is a 'new paradigm' in the practice of medicine. We argue that EBM does not seem to have arisen in the way Kuhn imagined paradigms to arise but as a conscious, deliberate proposal, more as programme than as a reality. Furthermore, there is something paradoxical about appealing to evidence or to the best evidence as a way of promoting a new paradigm. For the proposal seems to assume that there is something that by its own virtue is the best evidence for a given time. But this idea would have been rejected by Kuhn. If EBM involves a genuine new alternative in the field of medicine and shows a way in which the discipline will endure henceforth, this indicates that it is not what Kuhn once called a 'paradigm' and even, paradoxically, it is good evidence that scientific paradigms do not exist, at least in medicine. © 2015 John Wiley & Sons, Ltd.

  15. Severity of rhinitis and wheezing is strongly associated in preschoolers: A population-based study.

    Science.gov (United States)

    Pereira, Ana Margarida; Morais-Almeida, Mário; Santos, Natacha; Nunes, Carlos; Bousquet, Jean; Fonseca, João Almeida

    2015-11-01

    In preschool children, no study assessed the relation between wheezing and rhinitis severity. Our aims were to estimate the prevalence of current wheezing (CW) in preschoolers and to study the association between CW and current rhinitis (CR), considering its severity/persistency. This is a cross-sectional, nationwide, population-based study including a representative sample of 5003 Portuguese children aged 3-5 years. Data were collected by a face-to-face interview with caregivers using an adapted ISAAC questionnaire. CW was defined as presence of ≥1 wheezing episode in the previous 12 months. Rhinitis severity/persistency was classified according to Allergic Rhinitis and its Impact on Asthma. Current wheezing prevalence was 24.5% [95% CI 23.3-25.7]; 9.4% of the participants had ≥4 wheezing episodes in the previous year. Children with CR had an odds ratio (OR) of 4.0 [95% CI 3.4-4.5] for CW; it was highest for children with moderate-severe persistent rhinitis (11.5 [95% CI 8.1-16.3]), even after adjusting for possible confounders. Wheezers with CR reported more wheezing treatment use (p = 0.024) than those without CR. There was a trend for a higher number of wheezing episodes with more persistent and severe nasal disease - 48.4% of children with moderate-severe persistent rhinitis had >4 wheezing episodes vs. 28.9% in moderate-severe intermittent, 20.0% in mild persistent, 10.8% in mild intermittent, and 3.6% in those without CR; p rhinitis, especially moderate-severe persistent disease. Preschoolers with both CW and rhinitis seem to have a more severe phenotype, emphasizing the need for concurrent evaluation of nasal and bronchial symptoms even in small children. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Evidence-based reflective teaching practice: a preceptorship course example.

    Science.gov (United States)

    Josephsen, Jayne M

    2013-01-01

    This preceptorship course case study employed an evidence-based reflective teaching practice perspective based on a nursing process framework to develop, implement, and evaluate assignment efficacy directly related to course objectives. Journaling and article analysis had been used to assess development of role socialization, critical thinking, and self-reflective practice. These activities were found to be ineffective; new assignments were needed to address essential issues and allow for evaluation of assignment efficacy. Based upon contextual constructivism, four assignments were developed focused on learning goals, nursing skills, assumptions/biases, and role socialization.Assignment efficacy was evaluated via anonymous exploratory surveys. Student reports identified that assignments met learning outcomes. Methods for improvement in instructional practice were identified and revisions made. Participation in evidence-based reflective teaching practice can enhance reflective practice in students through appropriate assignment development, advancing the discipline of nursing education.

  17. Evidence Based Education Request Desk. EBE #833A

    Science.gov (United States)

    Regional Educational Laboratory Southeast, 2011

    2011-01-01

    Over the past decade, research on dropout prevention has become focused on using evidence-based practice, and data-driven decisions, to mitigate students' dropping out of high school and instead, support and prepare students for career and college. Early warning systems or on-track indicators, in which readily available student-level data are used…

  18. Evidence-Based Practices in Special Education: Some Practical Considerations

    Science.gov (United States)

    Cook, Bryan G.; Tankersley, Melody; Cook, Lysandra; Landrum, Timothy J.

    2008-01-01

    A major tenet of both the Individuals with Disabilities Education Act and the No Child Left Behind Act is the identification and use of evidence-based practices, or those instructional techniques shown by research as most likely to improve student outcomes meaningfully. However, much confusion exists regarding the meaning and potential…

  19. Determining Evidence-Based Practices in Special Education

    Science.gov (United States)

    Cook, Bryan G.; Tankersley, Melody; Landrum, Timothy J.

    2009-01-01

    Determining evidence-based practices is a complicated enterprise that requires analyzing the methodological quality and magnitude of the available research supporting specific practices. This article reviews criteria and procedures for identifying what works in the fields of clinical psychology, school psychology, and general education; and it…

  20. 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.

  1. 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.

  2. Validating evidence based decision making in health care

    DEFF Research Database (Denmark)

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

    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...

  3. Evidence-based treatment of acute otitis externa | Outhoff | South ...

    African Journals Online (AJOL)

    Acute otitis externa (AOE), or diffuse inflammation of the external ear canal, causes a range of symptoms, including otalgia, otorrhoea, hearing loss and itching. Despite AOE being common, with a 12-month prevalence of approximately 1%, there is a paucity of evidence-based treatment guidelines. This contributes to a wide ...

  4. 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…

  5. 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 ...

  6. Pharmacologic management of neuropathic pain: Evidence-based recommendations

    DEFF Research Database (Denmark)

    Dworkin, Robert H.; O'Connor, Alec B.; Backonja, Miroslav

    2007-01-01

    for recommendation if their efficacy was supported by at least one methodologically-sound, randomized clinical trial (RCT) demonstrating superiority to placebo or a relevant comparison treatment. Recommendations were based on the amount and consistency of evidence, degree of efficacy, safety, and clinical experience...

  7. 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.

  8. 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 Participation in ICTs (LIRNEasia Phase II). Significant strides have been made in closing the digital divide in Asia, mainly due to the proliferation of mobile telephones. Close to a billion people, some among the poorest segments of society, have ...

  9. 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...

  10. Nigeria Evidence-based Health System Initiative (NEHSI ...

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

    Population weighted raster maps can communicate findings of social audits : examples from three continents. Download PDF. Journal articles. Male responsibility and maternal morbidity: a cross-sectional study in two Nigerian states. Download PDF. Studies. Impact of the Nigeria evidence-based health system initiative in ...

  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. Adherence of Healthcare Professionals to Evidence-based Clinical ...

    African Journals Online (AJOL)

    The checklist included the evidence-based clinical practice guidelines for the HD vascular access, HD adequacy, anemia of chronic kidney disease (CKD), nutrition, cardiovascular risk assessment, and hepatitis B and C virus infection control. Implementation of these guidelines was evaluated, and further graded using a ...

  13. 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…

  14. 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?

  15. 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.

  16. Foot and ankle tendoscopy: evidence-based recommendations

    NARCIS (Netherlands)

    Cychosz, Chris C.; Phisitkul, Phinit; Barg, Alexej; Nickisch, Florian; van Dijk, C. Niek; Glazebrook, Mark A.

    2014-01-01

    The purpose of this study was to provide a comprehensive review of the current literature on tendoscopy of the foot and ankle and assign an evidence-based grade of recommendation for or against intervention. A comprehensive review of the literature was performed on May 26, 2013, using the PubMed,

  17. 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, ...

  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. Event Highlight: Nigeria Evidence-based Health System Initiative

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

    From 14. May to 1 June 2012 in Calabar, Cross River State. (Nigeria), the academic non-governmental organisation CIET Trust ran the third module of an intensive degree program in epidemiology and evidence-based planning. Most course participants. (eight women and 12 men) were planners from state ministries of ...

  20. Evidence based medicine and the plastic surgery literature in ...

    African Journals Online (AJOL)

    Materials and methods: All articles described as case reports and published in the Nigerian Journal of Plastic Surgery from January 2008 to December 2012 were evaluated to investigate their impact on evidence-based practice. Result: There were 28 case reports representing 44% of all articles published. Most articles ...

  1. Knowledge Attitudes and Practices of evidence based medicine ...

    African Journals Online (AJOL)

    Objectives: The aim of this cross-sectional study was to determine the awareness and attitude of hospital resident doctors towards evidence-based medicine (EBM) and their related educational needs. Methods: A cross-sectional descriptive study was performed on a randomly selected sample of 141 hospital resident ...

  2. An Evidence Based Approach to Sepsis: Educational Program

    Science.gov (United States)

    Perez, Dolores

    2015-01-01

    Evidence-based guidelines for recognizing and treating sepsis have been available for decades, yet healthcare providers do not adhere to the recommendations. Sepsis can progress rapidly if not recognized early. Literature reports reveal that sepsis is the leading cause of death in non-cardiac intensive care units (ICUs), and it is one of the most…

  3. 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

  4. 3. Neurological & Psychiatric Society of Zambia's Evidence-Based ...

    African Journals Online (AJOL)

    Esem

    is likely to provide the greatest positive impact on patient care since prioritization may be required. Prior studies in multiple settings have established that at least a third of patients referred for EEG are. Neurological & Psychiatric Society of Zambia's. Evidence-Based Guidelines for EEG Utilization at the. University Teaching ...

  5. Abstract: Making Evidence Based Changes on the Labor Ward of ...

    African Journals Online (AJOL)

    All these things can lead to increased maternal and neonatal morbidity and mortality. ... Important evidence based changes in clinical care have been made at Muhima hospital by having staff research the internet and teach each other both didactic and clinical content with the support of advanced students and USI HRH ...

  6. [Acute bronchiolitis: evaluation of evidence-based therapy].

    Science.gov (United States)

    Martinón-Torres, F; Rodríguez Núñez, A; Martinón Sánchez, J M

    2001-10-01

    Bronchiolitis is the leading cause of lower respiratory tract infection in infants and produces significant morbidity. Limited progress has been made in the treatment of this disease and, in many cases, the therapy employed is controversial and mainly based on general recommendations and not on evidence-based strategies. This report uses evidence-based methodology to provide a critical review of the data available on the treatment of acute bronchiolitis (understood as the first episode of respiratory syncytial virus bronchiolitis in a previously healthy infant). After this analysis, we conclude that the only justifiable therapeutic interventions in these patients are supportive treatment, nebulized epinephrine and mechanical ventilation. Other therapies such us physiotherapy, nebulization, heliox, anticholinergics or exogenous surfactant, among others, require further randomized controlled trials to determine their utility. No evidence supports the routine use of corticosteroids, beta-adrenergic drugs, antibiotics, immunoglobulins, interferon, vitamin A or ribavirin in these patients. Finally, we consider that a national consensus review for the implementation of evidence-based clinical practical guidelines on the management of acute bronchiolitis would be of great interest.

  7. 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 ...

  8. The ethical approach to evidence-based medicine

    African Journals Online (AJOL)

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

  9. Chiropractic Attitudes and Utilization of Evidence-Based Practice: The Use of the EBASE Questionnaire.

    Science.gov (United States)

    Alcantara, Joel; Leach, Matthew J

    2015-01-01

    To examine the attitudes and utilization of evidence-based practice by chiropractors. Utilizing a descriptive survey implemented as an online questionnaire, we examined chiropractors׳ perception, skills, and level of training, their engagement in, the barriers and facilitators to, and possible interventions to evidence-based practice. A total of 162 of 500 chiropractors completed the survey, providing a response rate of 32.4%. The majority of respondents were 30-39 years old, female, and worked in solo practice. A high proportion agreed/strongly agreed that evidence-based practice was necessary in the practice of chiropractic. Most respondents considered themselves to have above-average skills in locating professional literature, identifying answerable clinical questions, and identifying knowledge gaps in practice. However, many indicated receiving either no training or minimal education for conducting clinical research and systematic reviews and meta-analyses Most respondents had read or reviewed one to five professional articles and/or clinical research reports pertinent to their practice in the preceding month. Identified minor to moderate barriers to evidence-based practice were lack of time and lack of clinical evidence. Activities "very useful" in participating in evidence-based practice were access to free online databases and the ability to download full-text journal articles. The responders of our survey embraced and considered themselves skillful in evidence-based practice. They utilized a number of resources to practice in such a manner and were not deterred by identified barriers. We support continued research in this field. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Yuan, Kaijuan; Xiao, Fuyuan; Fei, Liguo; Kang, Bingyi; Deng, Yong

    2016-01-18

    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.

  11. Comparison of primary and secondary 26S rRNA structures in two Tetrahymena species: evidence for a strong evolutionary and structural constraint in expansion segments

    DEFF Research Database (Denmark)

    Engberg, J; Nielsen, Henrik; Lenaers, G

    1990-01-01

    . These are regions within the common core of secondary structure where expansions have taken place during the evolution of the rRNA of higher eukaryotes. The dispensable nature of some of the expansion segments has been taken as evidence of their non-functionality. However, our data show that a considerable......We have determined the nucleotide sequence of the 26S large subunit (LSU) rRNA genes for two Tetrahymena species, T. thermophila and T. pyriformis. The inferred rRNA sequences are presented in their most probable secondary structures based on compensatory mutations, energy, and conservation...... selective constraint has operated to preserve the secondary structure of these segments. Especially in the case of the D2 and D8 segments, the presence of a considerable number of compensatory base changes suggests that the secondary structure of these regions is of functional importance. Alternatively...

  12. EPO or not-EPO? An evidence based informed consent.

    Science.gov (United States)

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

    2004-04-01

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

  13. 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.

  14. Evidence-based standard care of malignant glioma

    International Nuclear Information System (INIS)

    Shinoda, Jun; Yano, Hirohito; Sakai, Noboru

    2004-01-01

    The amount of scientific evidence regarding therapy for primary cases of glioblastoma and anaplastic astrocytoma is small compared with that for malignant tumors in other organs, and recommended therapeutic strategies derived from this evidence are not diverse. Evidence-based standard care of these tumors is very limited. At this moment, the benchmark treatment for these malignant gliomas is gross resection of the tumor bulk followed by local external beam radiotherapy (50-60 Gy) in combination with nitrosourea-based chemotherapy. Additional stereotactic radiosurgery or other strategies for localized therapeutic boosting have also been recommended. However, the clinical outcomes obtained through these standard treatments are unfortunately not always satisfactory. Novel therapeutic strategies for malignant gliomas are expected to develop and we hope that some scientific evidence would emerge from clinical trials using these novel strategies. New scientific evidence for practical and novel treatments appropriate for patients with malignant gliomas may come to be available as the evaluation of patients' quality of life is used as an end point for the analysis of clinical results, in addition to the commonly used survival analysis. (author)

  15. [Severe pre-eclampsia. An evidence-based practice proposal].

    Science.gov (United States)

    Errando, C L; Pérez-Caballero, P; Verdeguer-Ribes, S; Vila-Montañés, M

    2013-01-01

    There are several treatment proposals for the obstetric patient with pre-eclampsia, but there is limited evidence on the adequacy of standard treatment. International healthcare organisations recommend that hospitals or anaesthesia departments have written guidelines, protocols or recommendations for dealing with common or severe situations. We propose evidence-based recommendations for the treatment of pre-eclampsia. A literature review was performed using several sources, bibliography databases, recommendations made by specialist societies, and reviews. Four anaesthesiologists reviewed the references selected, in order to design clinical questions (these were obtained from recent pre-eclampsia review articles). Consensus of at least 3 out of 4 experts was required. The Oxford criteria for evidence were chosen to classify the scientific articles, and the Jadad score was applied to the final articles selected. A total of 50 clinical questions were designed and answered. These were classified into: general questions, influence of the type of delivery, pre-anaesthesia evaluation, peripartum treatment (including analgesia and anaesthesia), eclampsia, post-delivery period, and intensive care and transport. Most of the responses showed low scientific evidence. Evidence-based recommendations for severe pre-eclampsia treatment were provided with special emphasis on the anaesthesiologist point of view. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  16. Professionally applied topical fluoride: evidence-based clinical recommendations.

    Science.gov (United States)

    2007-03-01

    With the dramatic increase in the amount of scientific information available about oral health, an evidence-based approach to oral health care and the practice of dentistry is necessary. There is a need to summarize, critique, and disseminate scientific evidence and to translate the evidence into a practical format that is used easily by dentists. The evidence-based clinical recommendations in this report were developed by an expert panel established by the American Dental Association Council on Scientific Affairs that evaluated the collective body of scientific evidence on the effectiveness of professionally applied topical fluoride for caries prevention. The recommendations are intended to assist dentists in clinical decision making. MEDLINE and the Cochrane Library were searched for systematic reviews and clinical studies of professionally applied topical fluoride-including gel, foam, and varnish-through October 2005. Panelists were selected on the basis of their expertise in the relevant subject matter. The recommendations are stratified by age groups and caries risk and indicate that periodic fluoride treatments should be considered for both children and adults who are at moderate or high risk of developing caries. Included in the clinical recommendations is a summary table that can be used as a chairside resource. The dentist, knowing the patient's health history and vulnerability to oral disease, is in the best position to make treatment decisions in the interest of each patient. These clinical recommendations must be balanced with the practitioner's professional expertise and the individual patient's preferences.

  17. 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.

  18. 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

  19. eEvidence: Information Seeking Support for Evidence-based Practice: An Implementation Case Study

    Science.gov (United States)

    Zhao, Jin; Kan, Min-Yen; Procter, Paula M.; Zubaidah, Siti; Yip, Wai Kin; Li, Goh Mien

    2010-01-01

    We propose to collect freely available articles from the web to build an evidence-based practice resource collection with up-to-date coverage, and then apply automated classification and key information extraction on the collected articles to provide means for sounder relevance judgments. We implement these features into a dual-interface system that allows users to choose between an active or passive information seeking process depending on the amount of time available. PMID:21347115

  20. New Raman method for aqueous solutions: xi-function dispersion evidence for strong F(-)-water H-bonds in aqueous CsF and KF solutions.

    Science.gov (United States)

    Walrafen, George E

    2005-08-15

    instant case. NaClO4 breaks water-water H-bonds and also gives rise to weak, long (3.0-3.3 A), severely bent (approximately 140 degrees), high-energy, ClO4--water interactions. Fluoride ion scavenges the extremely weak or non-hydrogen-bonded OH groups, thus forming strong, short, linear, low-energy, H-bonds between F- and water. The strength of the F--water H-bond is evident from the fact that the OH-stretching xi-function minimum is centered approximately 200-300 cm-1 below that of ice. The diagnostic feature of the Raman spectrum from F- in water is an intense, long, low-frequency OH-stretching tail extending 800 cm-1 or more below the 3300-cm-1 peak. A similar intense, long, low-frequency Raman tail is produced by the OH- ion, which is known to H-bond very strongly when protons from water are donated to its oxygen atom.

  1. 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.

  2. 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.

  3. 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...... for a clinical trial, and only 5 trials on insulin analogues were performed as double-blinded. Current evidence suggests that CSII treatment results in a significant reduction in HbA1c without inducing more hypoglycaemia. Rapid-acting insulin analogues compared to human soluble insulin provide statistically...

  4. 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.

  5. 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.

  6. 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.

  7. Theory of titration curves-VII The properties of derivative titration curves for strong acid-strong base and other isovalent ion-combination titrations.

    Science.gov (United States)

    Meites, T; Meites, L

    1970-06-01

    This paper deals with isovalent ion-combination titrations based on reactions that can be represented by the equation M(n+) + X(n-) --> MX, where the activity of the product MX is invariant throughout a titration, and with the derivative titration curves obtained by plotting d[M(+)]/dfversus f for such titrations. It describes some of the ways in which such curves can be obtained; it compares and contrasts them both with potentiometric titration curves, which resemble them in shape, and with segmented titration curves, from which they are derived; and it discusses their properties in detail.

  8. Evidence-Based Assessment of Obsessive–Compulsive Disorder

    Science.gov (United States)

    Rapp, Amy M.; Bergman, R. Lindsay; Piacentini, John; McGuire, Joseph F.

    2016-01-01

    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. PMID:27594793

  9. Evidence-based health information and risk competence

    Directory of Open Access Journals (Sweden)

    Mühlhauser, Ingrid

    2015-07-01

    Full Text Available Consumers and patients want to be included in decisions regarding their own health and have an ethically justified claim on informed decisions. Therefore, sound information is required, but health information is often misleading and based on different interests. The risks of disease and the benefits of medical interventions tend to be overestimated, whereas harm is often underestimated. Evidence-based health information has to fulfil certain criteria, for instance, it should be evidence-based, independent, complete, true as well as understandable. The aim of a medical intervention has to be explained. The different therapeutic options including the option not to intervene have to be delineated. The probabilities for success, lack of success and unwanted side effects have to be communicated in a numerical and understandable manner. Patients have the right to reject medical interventions without any sanctions.

  10. 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.

  11. Effectiveness of an evidence-based chiropractic continuing education workshop on participant knowledge of evidence-based health care

    Directory of Open Access Journals (Sweden)

    Grod Jaroslaw P

    2006-08-01

    Full Text Available Abstract Background Chiropractors must continue to learn, develop themselves professionally throughout their careers, and become self-directed and lifelong learners. Using an evidence-based approach increases the probability of optimal patient outcomes. But most chiropractors lack knowledge and interest in evidence-based approaches. The purpose of this study was to develop and measure the effectiveness of evidence-based training for chiropractic practitioners in a continuing education setting. Methods We developed and evaluated a continuing education workshop on evidence-based principles and methods for chiropractic practitioners. Forty-seven chiropractors participated in the training and testing. The course consisted of 12.5 hours of training in which practitioners learned to develop focused questions, search electronic data bases, critically review articles and apply information from the literature to specific clinical questions. Following the workshop, we assessed the program performance through the use of knowledge testing and anonymous presentation quality surveys. Results Eighty-five percent of the participants completed all of the test, survey and data collection items. Pretest knowledge scores (15-item test were low (47%. Post intervention scores (15-item test improved with an effect size of 2.0. A 59-item knowledge posttest yielded very good results (mean score 88%. The quality of presentation was rated very good, and most participants (90% would "definitely recommend" or "recommend" the workshop to a colleague. Conclusion The results of the study suggest that the continuing education course was effective in enhancing knowledge in the evidence-based approach and that the presentation was well accepted.

  12. 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.

  13. Developing evidence-based immunization recommendations and GRADE.

    Science.gov (United States)

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

    2012-12-17

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

  14. 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.

  15. Group Targets Tracking Using Multiple Models GGIW-CPHD Based on Best-Fitting Gaussian Approximation and Strong Tracking Filter

    Directory of Open Access Journals (Sweden)

    Yun Wang

    2016-01-01

    Full Text Available Gamma Gaussian inverse Wishart cardinalized probability hypothesis density (GGIW-CPHD algorithm was always used to track group targets in the presence of cluttered measurements and missing detections. A multiple models GGIW-CPHD algorithm based on best-fitting Gaussian approximation method (BFG and strong tracking filter (STF is proposed aiming at the defect that the tracking error of GGIW-CPHD algorithm will increase when the group targets are maneuvering. The best-fitting Gaussian approximation method is proposed to implement the fusion of multiple models using the strong tracking filter to correct the predicted covariance matrix of the GGIW component. The corresponding likelihood functions are deduced to update the probability of multiple tracking models. From the simulation results we can see that the proposed tracking algorithm MM-GGIW-CPHD can effectively deal with the combination/spawning of groups and the tracking error of group targets in the maneuvering stage is decreased.

  16. High-order approximate solutions of strongly nonlinear cubic-quintic Duffing oscillator based on the harmonic balance method

    Science.gov (United States)

    Chowdhury, M. S. H.; Hosen, Md. Alal; Ahmad, Kartini; Ali, M. Y.; Ismail, A. F.

    In this paper, a new reliable analytical technique has been introduced based on the Harmonic Balance Method (HBM) to determine higher-order approximate solutions of the strongly nonlinear cubic-quintic Duffing oscillator. The application of the HBM leads to very complicated sets of nonlinear algebraic equations. In this technique, the high-order nonlinear algebraic equations are approximated in the form of a power series solution, and this solution produces desired results even for small as well as large amplitudes of oscillation. Moreover, a suitable truncation formula is found in which the solution measures better results than existing results and it saves a lot of calculation. It is highly noteworthy that using the proposed technique, the third-order approximate solutions gives an excellent agreement as compared with the numerical solutions (considered to be exact). The proposed technique is applied to the strongly nonlinear cubic-quintic Duffing oscillator to reveals its novelty, reliability and wider applicability.

  17. Use of Synergistic Interactions to Fabricate Strong, Tough, and Conductive Artificial Nacre Based on Graphene Oxide and Chitosan.

    Science.gov (United States)

    Wan, Sijie; Peng, Jingsong; Li, Yuchen; Hu, Han; Jiang, Lei; Cheng, Qunfeng

    2015-10-27

    Graphene is the strongest and stiffest material, leading to the development of promising applications in many fields. However, the assembly of graphene nanosheets into macrosized nanocomposites for practical applications remains a challenge. Nacre in its natural form sets the "gold standard" for toughness and strength, which serves as a guide to the assembly of graphene nanosheets into high-performance nanocomposites. Here we show the strong, tough, conductive artificial nacre based on graphene oxide through synergistic interactions of hydrogen and covalent bonding. Tensile strength and toughness was 4 and 10 times higher, respectively, than that of natural nacre. The exceptional integrated strong and tough artificial nacre has promising applications in aerospace, artificial muscle, and tissue engineering, especially for flexible supercapacitor electrodes due to its high electrical conductivity. The use of synergistic interactions is a strategy for the development of high-performance nanocomposites.

  18. 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

  19. Ultra-thin and strong formvar-based membranes with controlled porosity for micro- and nano-scale systems

    Science.gov (United States)

    Auchter, Eric; Marquez, Justin; Stevens, Garrison; Silva, Rebecca; Mcculloch, Quinn; Guengerich, Quintessa; Blair, Andrew; Litchfield, Sebastian; Li, Nan; Sheehan, Chris; Chamberlin, Rebecca; Yarbro, Stephen L.; Dervishi, Enkeleda

    2018-05-01

    We present a methodology for developing ultra-thin and strong formvar-based membranes with controlled morphologies. Formvar is a thin hydrophilic and oleophilic polymer inert to most chemicals and resistant to radiation. The formvar-based membranes are viable materials as support structures in micro- and macro-scale systems depending on thinness and porosity control. Tunable sub-micron thick porous membranes with 20%–65% porosity were synthesized by controlling the ratios of formvar, glycerol, and chloroform. This synthesis process does not require complex separation or handling methods and allows for the production of strong, thin, and porous formvar-based membranes. An expansive array of these membrane characterizations including chemical compatibility, mechanical responses, wettability, as well as the mathematical simulations as a function of porosity has been presented. The wide range of chemical compatibility allows for membrane applications in various environments, where other polymers would not be suitable. Our formvar-based membranes were found to have an elastic modulus of 7.8 GPa, a surface free energy of 50 mN m‑1 and an average thickness of 125 nm. Stochastic model simulations indicate that formvar with the porosity of ∼50% is the optimal membrane formulation, allowing the most material transfer across the membrane while also withstanding the highest simulated pressure loadings before tearing. Development of novel, resilient and versatile membranes with controlled porosity offers a wide range of exciting applications in the fields of nanoscience, microfluidics, and MEMS.

  20. Estimating unmeasured anions in critically ill patients: anion-gap, base-deficit, and strong-ion-gap.

    Science.gov (United States)

    Story, D A; Poustie, S; Bellomo, R

    2002-11-01

    We used 100 routine blood samples from critically ill patients to establish whether correcting the anion-gap and base-deficit for decreased plasma albumin improves agreement with the strong-ion-gap for estimating unmeasured anions and whether the modifications increase the proportion of samples with levels of anion-gap or base-deficit above the reference ranges. We used Bland-Altman analyses to compare the methods of estimating unmeasured ions. Compared with the strong-ion-gap, modification reduced the limits of agreement for both the anion-gap and the base-deficit. The bias for the base-deficit was also reduced but the bias for the anion-gap was increased. The proportion of samples with an anion-gap > 22 meq.l(-1) increased from 4 to 29% (p 5 meq.l(-1) increased from 8 to 42% (p < 0.001). Consequently, metabolic acidosis from unmeasured ions in critically ill patients maybe more frequent than often recognised.

  1. 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

  2. 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 .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 randomization, blinding, and patient enrollment significantly more than nonsurgical studies. Level I

  3. Common Drug Review recommendations: an evidence base for expectations?

    Science.gov (United States)

    Rocchi, Angela; Miller, Elizabeth; Hopkins, Robert B; Goeree, Ron

    2012-03-01

    The Common Drug Review (CDR) was created to provide a single process to review the comparative clinical efficacy and cost effectiveness of new drugs, and then to make formulary listing recommendations to Canadian publicly funded drug benefit plans. The objective was to conduct an in-depth analysis of Canadian Expert Drug Advisory Committee (CEDAC) recommendations to date, to explore predictors and possible explanatory factors associated with negative recommendations. Final recommendations were identified from inception (September 2003) to 31 December 2009. Using only publicly available information, recommendations were analysed under the following categories: submission specifics, drug characteristics, clinical factors and economic factors. Descriptive analyses were conducted, followed by statistical analyses, to determine which factors independently predicted a 'do not list' (DNL) recommendation. The database consisted of 138 unique final recommendations. The overall DNL rate was 48%. Significant differences in DNL rates were observed between therapeutic areas, ranging from 0% for HIV antivirals up to 88% for analgesic drugs. In the univariate analysis, several factors were significantly associated with a DNL recommendation, including first-in-class drugs and use of clinical scales as an outcome. In the multivariate regression, four factors were significantly predictive of a DNL recommendation: clinical uncertainty (odds ratio [OR] 14), price higher than comparators (OR 9), request for reconsideration (OR 10) and price as the only economic evidence used (OR 18). Incremental cost-effectiveness thresholds were not predictive of recommendations. The hypothesis that economic factors did not impact recommendations when clinical factors were included first was supported by the analysis. This analysis documented an evidence-driven process that simultaneously weighted multiple factors. Clinical uncertainty and price considerations, but not economic results, had a strong

  4. 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.

  5. 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.

  6. Continuing to challenge practice to be evidence based.

    Science.gov (United States)

    Makic, Mary Beth Flynn; Rauen, Carol; Jones, Kimmith; Fisk, Anna C

    2015-04-01

    Practice habits continue in clinical practice despite the availability of research and other forms of evidence that should be used to guide critical care practice interventions. This article is based on a presentation at the 2014 National Teaching Institute of the American Association of Critical-Care Nurses. The article is part of a series of articles that challenge critical care nurses to examine the evidence guiding nursing practice interventions. Four common practice interventions are reviewed: (1) weight-based medication administration, (2) chest tube patency maintenance, (3) daily interruption of sedation, and (4) use of chest physiotherapy in children. For weight-based administration of medication, the patient's actual weight should be measured, rather than using an estimate. The therapeutic effectiveness and dosages of medications used in obese patients must be critically evaluated. Maintaining patency of chest tubes does not require stripping and milking, which probably do more harm than good. Daily interruption of sedation and judicious use of sedatives are appropriate in most patients receiving mechanical ventilation. Traditional chest physiotherapy does not help children with pneumonia, bronchiolitis, or asthma and does not prevent atelectasis after extubation. Critical care nurses are challenged to evaluate their individual practice and to adopt current evidence-based practice interventions into their daily practice. ©2015 American Association of Critical-Care Nurses.

  7. 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...

  8. Evidence-based medicine: what is the evidence that it has made a difference?

    Science.gov (United States)

    McQuay, Henry

    2011-07-01

    Evidence-based medicine (EBM) has, over the past 20 years, made us all more critical in our thinking about the efficacy and safety of interventions. This is evident in the higher standards of our spoken and written work, formal and informal, and in our approach to the subject. The downside has been the coincidence of the squeeze on healthcare funding with the emergence of the EBM ideas - it has been all too easy to misuse the tools of EBM to deny patients access to treatment, and this, together with the off-putting political correctness of the EBM approach in some quarters, has made clinicians uneasy. Clinicians have to make decisions about therapy for the individual patient. Ideally this is guided by the best available evidence and their experience. EBM can guide one as to the population efficacy and safety of a particular intervention, but as we all know few patients are average. That guidance can only be given if there is adequate evidence, and the difficulty with guidance about symptom control is often the paucity of evidence of sufficient quality to yield credible guidance. Palliative care is often a 'complex intervention', and here EBM struggles to untangle which components, if any, of the complex interventions are important. The trial and review methodologies for complex intervention are wanting. Tom Chalmers, a grandfather of the EBM movement, argued late in his career that the most important function of the EBM approach was to frame the research agenda. This we think is correct. The process of systematic review of a topic throws up the deficits in trial methods and the lacunae in the data, and this then can show the way forward.

  9. Strong electroactive biodegradable shape memory polymer networks based on star-shaped polylactide and aniline trimer for bone tissue engineering.

    Science.gov (United States)

    Xie, Meihua; Wang, Ling; Ge, Juan; Guo, Baolin; Ma, Peter X

    2015-04-01

    Preparation of functional shape memory polymer (SMP) for tissue engineering remains a challenge. Here the synthesis of strong electroactive shape memory polymer (ESMP) networks based on star-shaped polylactide (PLA) and aniline trimer (AT) is reported. Six-armed PLAs with various chain lengths were chemically cross-linked to synthesize SMP. After addition of an electroactive AT segment into the SMP, ESMP was obtained. The polymers were characterized by (1)H NMR, GPC, FT-IR, CV, DSC, DMA, tensile test, and degradation test. The SMP and ESMP exhibited strong mechanical properties (modulus higher than GPa) and excellent shape memory performance: short recovery time (several seconds), high recovery ratio (over 94%), and high fixity ratio (almost 100%). Moreover, cyclic voltammetry test confirmed the electroactivity of the ESMP. The ESMP significantly enhanced the proliferation of C2C12 cells compared to SMP and linear PLA (control). In addition, the ESMP greatly improved the osteogenic differentiation of C2C12 myoblast cells compared to PH10 and PLA in terms of ALP enzyme activity, immunofluorescence staining, and relative gene expression by quantitative real-time polymerase chain reaction (qRT-PCR). These intelligent SMPs and electroactive SMP with strong mechanical properties, tunable degradability, good electroactivity, biocompatibility, and enhanced osteogenic differentiation of C2C12 cells show great potential for bone regeneration.

  10. 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.

  11. Factors that influence effective evidence-based medicine instruction.

    Science.gov (United States)

    Mi, Misa

    2013-01-01

    Evidence-based medicine (EBM) as a health care practice is being incorporated into education programs across the spectrum of medical education to develop lifelong learning skills and to enhance the practice of evidence-based health care. Since improving the quality of patient care is the ultimate goal of EBM, EBM learning must be integrated with clinical application, and resulted outcomes must be reflected in learning transfer (or EBM practice) within the context of solving patient problems. Different factors may constitute the context or environment in which EBM is learned, practiced, and sustained. However, these contextual factors are seldom considered and examined in the development, implementation, and evaluation of EBM instruction for learners at different levels. This article will introduce several contextual factors as tips and strategies that affect EBM learning and transfer. Also included in the article are recommended practices for designing effective EBM instruction that would contribute to a sustainable change in learner behavior.

  12. Evidence-based therapy relationships: research conclusions and clinical practices.

    Science.gov (United States)

    Norcross, John C; Wampold, Bruce E

    2011-03-01

    In this closing article of the special issue, we present the conclusions and recommendations of the interdivisional task force on evidence-based therapy relationships. The work was based on a series of meta-analyses conducted on the effectiveness of various relationship elements and methods of treatment adaptation. A panel of experts concluded that several relationship elements were demonstrably effective (alliance in individual psychotherapy, alliance in youth psychotherapy, alliance in family therapy, cohesion in group therapy, empathy, collecting client feedback) while others were probably effective (goal consensus, collaboration, positive regard). Three other relationship elements (congruence/genuineness, repairing alliance ruptures, and managing countertransference) were deemed promising but had insufficient evidence to conclude that they were effective. Multiple recommendations for practice, training, research, and policy are advanced. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

  13. CMU DeepLens: deep learning for automatic image-based galaxy-galaxy strong lens finding

    Science.gov (United States)

    Lanusse, François; Ma, Quanbin; Li, Nan; Collett, Thomas E.; Li, Chun-Liang; Ravanbakhsh, Siamak; Mandelbaum, Rachel; Póczos, Barnabás

    2018-01-01

    Galaxy-scale strong gravitational lensing can not only provide a valuable probe of the dark matter distribution of massive galaxies, but also provide valuable cosmological constraints, either by studying the population of strong lenses or by measuring time delays in lensed quasars. Due to the rarity of galaxy-scale strongly lensed systems, fast and reliable automated lens finding methods will be essential in the era of large surveys such as Large Synoptic Survey Telescope, Euclid and Wide-Field Infrared Survey Telescope. To tackle this challenge, we introduce CMU DeepLens, a new fully automated galaxy-galaxy lens finding method based on deep learning. This supervised machine learning approach does not require any tuning after the training step which only requires realistic image simulations of strongly lensed systems. We train and validate our model on a set of 20 000 LSST-like mock observations including a range of lensed systems of various sizes and signal-to-noise ratios (S/N). We find on our simulated data set that for a rejection rate of non-lenses of 99 per cent, a completeness of 90 per cent can be achieved for lenses with Einstein radii larger than 1.4 arcsec and S/N larger than 20 on individual g-band LSST exposures. Finally, we emphasize the importance of realistically complex simulations for training such machine learning methods by demonstrating that the performance of models of significantly different complexities cannot be distinguished on simpler simulations. We make our code publicly available at https://github.com/McWilliamsCenter/CMUDeepLens.

  14. Subcutaneous injection technique: an evidence-based approach.

    Science.gov (United States)

    Ogston-Tuck, Sherri

    2014-09-23

    Injections are routinely administered by nurses in acute care settings and in the community. Nurses require a thorough understanding of anatomy and physiology, pharmacological principles and equipment, and potential risks to the patient of injections. Nurses should also take an active approach to patient assessment before injecting medicines. This article, the first of two, provides an evidence-based review of injection administration, with particular reference to subcutaneous injections, and suggests a framework for best practice.

  15. Evidence-Based Interventions for Transitions in Care for Individuals Living With Dementia.

    Science.gov (United States)

    Hirschman, Karen B; Hodgson, Nancy A

    2018-01-18

    Despite numerous, often predictable, transitions in care, little is known about the core elements of successful transitions in care specifically for persons with dementia. The paper examines available evidence-based interventions to improve the care transitions for persons with dementia and their caregivers. A state-of-the-art review was conducted for research published on interventions targeting transitions in care for persons living with dementia and their caregivers through January 2017. Our review revealed seven evidence-based interventions to postpone/prevent or reduce care transitions specific to persons living with dementia. Effective approaches appear to be those that involve the individual and caregiver in establishing goals of care, educate the individual and caregiver about likely transitions in care; provide timely communication of information about the individual, create strong inter professional teams with competencies in dementia care, and implement evidence-based models of practice. Five essential features for consistent and supported care transitions for persons with dementia and their caregivers are recommended. Findings reinforce the need for additional research and adaptation of evidence-based transitions in care interventions. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  16. 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.

  17. Towards evidence-based medical education in Saudi medical schools.

    Science.gov (United States)

    AlFaris, Eiad; Abdulgader, Abdelgalil; Alkhenizan, Abdullah

    2006-01-01

    (EBME) [corrected] is an attitude of mind that entails the creation of a culture in which teachers think critically about what they are doing, look at the best evidence available and on this basis, make decisions about their teaching practice, and subsequently, undertake the necessary revision and change. More medical schools have opened in Saudi Arabia in the last few years than have existed over the last three decades. Currently, the education of health professionals is based on assumption and traditions and rarely on research findings. Medical teaching has evolved from being opinion-based to evidence-based and the art of teaching is rapidly becoming the 'science' of teaching. The need for evidence in our teaching and medical education practices is as important as it is in assessing a new therapy. This approach to education is not only associated with better results in terms of better learning, from the side of the students (the consumers), but also has a wider impact on patient care and the community. Moreover, in this age of accountability, litigations and quality assurance, the need for BEME becomes greater. Some suggestions to implement BEME in Saudi Arabia have been put forward and these are the training of medical education professionals in the use the existing information systems, and disseminating information through the creation of a BEME journal (secondary publication) that publishes a critically appraised summary of medical education articles that are both valid and of immediate clinical use.

  18. Evidence-based approach to harmonised reference intervals.

    Science.gov (United States)

    Koerbin, Gus; Sikaris, Ken Andrew; Jones, Graham Ross Dallas; Ryan, Julie; Reed, Maxine; Tate, Jill

    2014-05-15

    Although we are in the era of evidence-based medicine, there is still a substantial gap between theory and current practice with the application of reference intervals as decision making tools. Different laboratories may have different reference intervals for the same tests using the same analytical methods and platforms. These differences have the potential to confuse physicians making the assessment and monitoring of patients more difficult by providing discordant information. This paper attempts to demonstrate how to use evidence-based approach for harmonising reference intervals. In order to consider harmonisation we must first have an appreciation of the various factors that influence the determination of that reference interval such as the choice of individuals within the population studied, biological variability of the analyte studied, partitioning, sample collection, analytical aspects such as bias and statistical models. An a priori approach for determining reference intervals, whilst recommended, may be beyond the scope of most laboratories and consideration should be given to the use of a validated indirect a posteriori approach. Regardless of method used, the continuing application of an evidence-based approach in harmonised reference intervals to meet the quality expectations of physicians should be pursued. © 2013.

  19. Evidence-Based Education. Ten points of dispute

    Directory of Open Access Journals (Sweden)

    Camilla Moricca

    2016-07-01

    Full Text Available The approach called Evidence-Based Education (EBE has had a very large expansion in recent years and has developed an international debate on potentialities and criticalities of scientific research in education. The paper presents a debate imagined in which ten criticisms that could be addressed to EBE by researchers and teachers are discussed. To these critics it is answered by trying to explain this approach and reflect on aspects that seem to affect its future progress.Evidence-Based Education. Dieci punti di controversiaCome è noto, l’orientamento che va sotto il nome di Evidence-Based Education (EBE ha avuto una fortissima espansione negli ultimi anni e ha sviluppato un forte dibattito internazionale sulle potenzialità e criticità della ricerca scientifica nell’ambito dell’educazione. Nell’intento di contribuire ad una maggiore chiarezza sugli elementi della controversia e sugli equivoci che si possono generare intorno al diffondersi di questo orientamento, questo lavoro ha cercato di sintetizzare in dieci punti i termini essenziali del dibattito in corso. Sono state individuate le critiche più note avanzate all’EBE e ad esse sono state contrapposte le argomentazioni dei suoi fautori.

  20. 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

  1. Barriers to and Facilitators of Evidence-Based Decision Making at the Point of Care

    Directory of Open Access Journals (Sweden)

    Ann S. O’Malley MD, MPH

    2016-07-01

    Full Text Available Introduction: Physicians vary widely in how they treat some health conditions, despite strong evidence favoring certain treatments over others. We examined physicians’ perspectives on factors that support or hinder evidence-based decisions and the implications for delivery systems, payers, and policymakers. Methods: We used Choosing Wisely ® recommendations to create four clinical vignettes for common types of decisions. We conducted semi-structured interviews with 36 specialists to identify factors that support or hinder evidence-based decisions. We examined these factors using a conceptual framework that includes six levels: patients, physicians, practice sites, organizations, networks and hospital affiliations, and the local market. In this model, population characteristics and payer and regulatory factors interact to influence decisions. Results: Patient openness to behavior modification and expectations, facilitated and hindered physicians in making evidence-based recommendations. Physicians’ communication skills were the most commonly mentioned facilitator. Practice site, organization, and hospital system barriers included measures of emergency department throughput, the order in which test options are listed in electronic health records (EHR, lack of relevant decision support in EHRs, and payment incentives that maximize billing and encourage procedures rather than medical management or counseling patients on behavior change. Factors from different levels interacted to undermine evidence-based care. Most physicians received billing feedback, but quality metrics on evidence-based service use were nonexistent for the four decisions in this study. Conclusions and Implications: Additional research and quality improvement may help to modify delivery systems to overcome barriers at multiple levels. Enhancing provider communication skills, improving decision support in EHRs, modifying workflows, and refining the design and interpretation of

  2. Mind the Gap: Looking for Evidence-Based Practice of Science Literacy for All in Science Teaching Journals

    Science.gov (United States)

    Jagger, Susan L.; Yore, Larry D.

    2012-10-01

    Science literacy for all is the central goal of science education reforms, and there is a growing importance of the language arts in science. Furthermore, there are strong calls for teacher professionalism and self-directed professional learning that involve evidence-based best practices. This raises questions about whether science teaching journals' recommendations are anchored to high-quality evidence. We found that (a) most National Science Teacher Association journals' science literacy recommendations have weak or no evidence base and (b) those with evidence reference teaching journals, teacher resource books, and literacy education more often than science education research. We concluded that all participants in the knowledge production cycle and transfer process—authors, editors, and reviewers—need to encourage evidence-based practices anchored to ongoing reforms and to literacy and science education research.

  3. 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

  4. Mind the Gap: Looking for Evidence-Based Practice of "Science Literacy for All" in Science Teaching Journals

    Science.gov (United States)

    Jagger, Susan L.; Yore, Larry D.

    2012-01-01

    "Science literacy for all" is the central goal of science education reforms, and there is a growing importance of the language arts in science. Furthermore, there are strong calls for teacher professionalism and self-directed professional learning that involve evidence-based best practices. This raises questions about whether science teaching…

  5. 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

  6. 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.

  7. Drug-induced gynecomastia: an evidence-based review.

    Science.gov (United States)

    Deepinder, Fnu; Braunstein, Glenn D

    2012-09-01

    Drugs are estimated to cause about 10 - 25% of all cases of gynecomastia. Over the course of several decades, multiple medications have been implicated in the development of gynecomastia mostly in the form of case reports and case series. However, these reports suffer from a multitude of deficiencies, including poor quality of evidence. Studies were selected for this review by performing an extensive electronic and hand-search using BIOSIS, EMBASE and Medline, from 1940 to present, for all reported drug associations of gynecomastia and their possible pathophysiology. Quality of evidence was assessed on a three-point scale: good, fair and poor, and each of the drugs reported to cause gynecomastia was assigned a level of strength. The pathophysiology of gynecomastia is also discussed in detail for each of the drugs found to have a good or fair evidence of association with gynecomastia. Most of the reported drug-gynecomastia associations were based on poor quality evidence. The drugs definitely associated with the onset of gynecomastia are spironolactone, cimetidine, ketoconazole, hGH, estrogens, hCG, anti-androgens, GnRH analogs and 5-α reductase inhibitors. Medications probably associated with gynecomastia include risperidone, verapamil, nifedipine, omeprazole, alkylating agents, HIV medications (efavirenz), anabolic steroids, alcohol and opioids.

  8. 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

  9. Adaptation of evidence-based surgical wound care algorithm.

    Science.gov (United States)

    Han, Jung Yeon; Choi-Kwon, Smi

    2011-12-01

    This study was designed to adapt a surgical wound care algorithm that is used to provide evidence-based surgical wound care in a critical care unit. This study used, the 'ADAPTE process', an international clinical practice guideline development method. The 'Bonnie Sue wound care algorithm' was used as a draft for the new algorithm. A content validity index (CVI) targeting 135 critical care nurses was conducted. A 5-point Likert scale was applied to the CVI test using a statistical criterion of .75. A surgical wound care algorithm comprised 9 components: wound assessment, infection control, necrotic tissue management, wound classification by exudates and depths, dressing selection, consideration of systemic factors, wound expected outcome, reevaluate non-healing wounds, and special treatment for non-healing wounds. All of the CVI tests were ≥.75. Compared to existing wound care guidelines, the new wound care algorithm provides precise wound assessment, reliabilities of wound care, expands applicability of wound care to critically ill patients, and provides evidence and strength of recommendations. The new surgical wound care algorithm will contribute to the advancement of evidence-based nursing care, and its use is expected as a nursing intervention in critical care.

  10. 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.

  11. Controversies in multiple myeloma: Evidence-based update.

    Science.gov (United States)

    Ahn, Inhye E; Mailankody, Sham

    2016-12-01

    The US Food and Drug Administration (FDA) approved 10 new drugs for the treatment of multiple myeloma (MM) over the last two decades. The influx of new anti-myeloma agents with high efficacy and acceptable tolerability add complexity to the clinical decision-making process. First, treatment of smoldering multiple myeloma (SMM) remains investigational to date, although a randomized trial showed a survival gain in high-risk patients receiving lenalidomide. Second, in newly diagnosed MM, the majority of contemporary induction regimens have been studied in single-arm trials or compared to an older regimen, which complicates evidence-based treatment selection. Third, the role of consolidation chemotherapy followed by autologous stem cell transplant (ASCT) needs to be revisited in the context of highly effective agents, as newer regimens- such as carfilzomib, lenalidomide, and dexamethasone-are able to achieve extremely deep responses equivalent to or exceeding those seen after conventional induction and ASCT. Fourth, risks and benefits of maintenance therapy should also be redefined and individualized, as long-term survival and safety data accumulate. Here we selected four clinical settings where controversies exist, reviewed evidences behind conflicting treatment strategies, and asked myeloma experts to discuss evidence-based recommendations. Copyright © 2016 Elsevier. All rights reserved.

  12. 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

  13. Evidence-based psychological treatments for late-life anxiety.

    Science.gov (United States)

    Ayers, Catherine R; Sorrell, John T; Thorp, Steven R; Wetherell, Julie Loebach

    2007-03-01

    This project identified evidence-based psychotherapy treatments for anxiety disorders in older adults. The authors conducted a review of the geriatric anxiety treatment outcome literature by using specific coding criteria and identified 17 studies that met criteria for evidence-based treatments (EBTs). These studies reflected samples of adults with generalized anxiety disorder (GAD) or samples with mixed anxiety disorders or symptoms. Evidence was found for efficacy for 4 types of EBTs. Relaxation training, cognitive-behavioral therapy (CBT), and, to a lesser extent, supportive therapy and cognitive therapy have support for treating subjective anxiety symptoms and disorders. CBT for late-life GAD has garnered the most consistent support, and relaxation training represents an efficacious, relatively low-cost intervention. The authors provide a review of the strengths and limitations of this research literature, including a discussion of common assessment instruments. Continued investigation of EBTs is needed in clinical geriatric anxiety samples, given the small number of available studies. Future research should examine other therapy models and investigate the effects of psychotherapy on other anxiety disorders, such as phobias and posttraumatic stress disorder in older adults. ((c) 2007 APA, all rights reserved).

  14. Evidence-based therapies for upper extremity dysfunction.

    Science.gov (United States)

    Liepert, Joachim

    2010-12-01

    The diversity of interventions aimed at improving upper extremity dysfunction is increasing. This article reviews the effectiveness of different therapeutic approaches that have been published in 2009 and 2010. Evidence is based on randomized controlled trials, systematic reviews, and meta-analyses. Application of constraint-induced movement therapy in acute stroke patients was not more effective than a control intervention, and a more intense therapy may even be harmful. Botulinum toxin injections do not only reduce spasticity but, in children, also improve motor functions if combined with occupational therapy. Strength training improves arm function but not necessarily activities of daily living. Bilateral arm training is as effective as other interventions. Extrinsic feedback and sensory training may further improve motor functions. Mirror therapy was particularly effective for patients with initial hand plegia. For some interventions (e.g. constraint-induced movement therapy, botulinum toxin), efficacy is evident, for others (e.g. mental practice, virtual reality), well designed studies with sufficient numbers of patients are needed. The ultimate goal still is to develop evidence-based therapies for all different degrees of motor impairment.

  15. 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.

  16. 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

  17. 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.

  18. Strong linkage of polar cod (Boreogadus saida) to sea ice algae-produced carbon: Evidence from stomach content, fatty acid and stable isotope analyses

    Science.gov (United States)

    Kohlbach, Doreen; Schaafsma, Fokje L.; Graeve, Martin; Lebreton, Benoit; Lange, Benjamin Allen; David, Carmen; Vortkamp, Martina; Flores, Hauke

    2017-03-01

    The polar cod (Boreogadus saida) is considered an ecological key species, because it reaches high stock biomasses and constitutes an important carbon source for seabirds and marine mammals in high-Arctic ecosystems. Young polar cod (1-2 years) are often associated with the underside of sea ice. To evaluate the impact of changing Arctic sea ice habitats on polar cod, we examined the diet composition and quantified the contribution of ice algae-produced carbon (αIce) to the carbon budget of polar cod. Young polar cod were sampled in the ice-water interface layer in the central Arctic Ocean during late summer 2012. Diets and carbon sources of these fish were examined using 4 approaches: (1) stomach content analysis, (2) fatty acid (FA) analysis, (3) bulk nitrogen and carbon stable isotope analysis (BSIA) and (4) compound-specific stable isotope analysis (CSIA) of FAs. The ice-associated (sympagic) amphipod Apherusa glacialis dominated the stomach contents by mass, indicating a high importance of sympagic fauna in young polar cod diets. The biomass of food measured in stomachs implied constant feeding at daily rates of ∼1.2% body mass per fish, indicating the potential for positive growth. FA profiles of polar cod indicated that diatoms were the primary carbon source, indirectly obtained via amphipods and copepods. The αIce using bulk isotope data from muscle was estimated to be >90%. In comparison, αIce based on CSIA ranged from 34 to 65%, with the highest estimates from muscle and the lowest from liver tissue. Overall, our results indicate a strong dependency of polar cod on ice-algae produced carbon. This suggests that young polar cod may be particularly vulnerable to changes in the distribution and structure of sea ice habitats. Due to the ecological key role of polar cod, changes at the base of the sea ice-associated food web are likely to affect the higher trophic levels of high-Arctic ecosystems.

  19. 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

  20. Evidence-Based Use of Perioperative Antibiotics in Otolaryngology.

    Science.gov (United States)

    Patel, Priyesh N; Jayawardena, Asitha D L; Walden, Rachel L; Penn, Edward B; Francis, David O

    2018-01-01

    Objective To identify and clarify current evidence supporting and disputing the effectiveness of perioperative antibiotic use for common otolaryngology procedures. Data Sources PubMed, Embase (OVID), and CINAHL (EBSCO). Review Methods English-language, original research (systematic reviews/meta-analyses, randomized control trials, prospective or retrospective cohort studies, case-control studies, or case series) studies that evaluated the role of perioperative antibiotic use in common otolaryngology surgeries were systematically extracted using standardized search criteria by 2 investigators independently. Conclusions Current evidence does not support routine antibiotic prophylaxis for tonsillectomy, simple septorhinoplasty, endoscopic sinus surgery, clean otologic surgery (tympanostomy with tube placement, tympanoplasty, stapedectomy, and mastoidectomy), and clean head and neck surgeries (eg, thyroidectomy, parathyroidectomy, salivary gland excisions). Antibiotic prophylaxis is recommended for complex septorhinoplasty, skull base surgery (anterior and lateral), clean-contaminated otologic surgery (cholesteatoma, purulent otorrhea), and clean-contaminated head and neck surgery (violation of aerodigestive tract, free flaps). In these cases, antibiotic use for 24 to 48 hours postoperatively has shown equal benefit to longer duration of prophylaxis. Despite lack of high-quality evidence, the US Food and Drug Administration suggests antibiotic prophylaxis for cochlear implantation due to the devastating consequence of infection. Data are inconclusive regarding postoperative prophylaxis for nasal packing/splints after sinonasal surgery. Implications for Practice Evidence does not support the use of perioperative antibiotics for most otolaryngologic procedures. Antibiotic overuse and variability among providers may be due to lack of formal practice guidelines. This review can help otolaryngologists understand current evidence so they can make informed decisions about

  1. 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.

  2. 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.

  3. Evidence Based Prevention of Occupational Slips, Trips and Falls

    DEFF Research Database (Denmark)

    Jensen, Olaf Chresten

    2009-01-01

    It is estimated that about one third of the compensated occupational injuries and half of the most serious occupational injuries in merchant seafaring are related to slips, trips and falls (STF)-events. Among the elderly, STF is the risk factor that causes the largest number of inpatient days...... at hospitals. It is the argued that prevention of STF is insufficient and that the reason is insufficient evidence on incidence rates, the causes and the health impact of STF related injuries. Practical knowledge of the best practice and what works is also needed. Here the issue is evidence based...... on epidemiological data. STF in the injury model is considered not as an injury, but as a pre-event of an injury and in most cases a near miss without injury. The registration of whether a STF-event preceded an injury or not is important near miss information for prevention in injury registers. The quality...

  4. Evidence-Based Parenting Interventions to Promote Secure Attachment

    Directory of Open Access Journals (Sweden)

    Barry Wright MD, FRCPsych

    2016-08-01

    Full Text Available Various interventions are used in clinical practice to address insecure or disorganized attachment patterns and attachment disorders. The most common of these are parenting interventions, but not all have a robust empirical evidence base. We undertook a systematic review of randomized trials comparing a parenting intervention with a control, where these used a validated attachment instrument, in order to evaluate the clinical and cost-effectiveness of interventions aiming to improve attachment in children with severe attachment problems (mean age <13 years. This article aims to inform clinicians about the parenting interventions included in our systematic review that were clinically effective in promoting secure attachment. For completeness, we also briefly discuss other interventions without randomized controlled trial evidence, identified in Patient Public Involvement workshops and expert groups at the point our review was completed as being used or recommended. We outline the key implications of our findings for clinical practice and future research.

  5. Evidence-Based Chiropractic Education: Are We Equipping Graduates for Clinical Practice with Improved Patient Outcomes?

    OpenAIRE

    Shreeve, Michael W.

    2012-01-01

    Evidence-based practice has emerged as a driving factor in current curriculum development in chiropractic education. This commentary discusses educational strategies incorporating evidence-based practices in the doctor of chiropractic curriculum and explores whether all five steps of the evidence-based process and patient outcomes from evidence-based practice are being assessed.

  6. Evidence-Based Special Education and Professional Wisdom: Putting It All Together

    Science.gov (United States)

    Cook, Bryan G.; Tankersley, Melody; Harjusola-Webb, Sanna

    2008-01-01

    There has been an increasing focus on evidence-based practices in special education with efforts underway to authoritatively identify those practices that are evidence based. However, the identification of evidence-based practices is only the beginning of the process of implementing evidence-based special education. The professional wisdom of…

  7. Is evidence-based medicine so evident in veterinary research and practice? History, obstacles and perspectives.

    Science.gov (United States)

    Vandeweerd, Jean-Michel; Kirschvink, Nathalie; Clegg, Peter; Vandenput, Sandrine; Gustin, Pascal; Saegerman, Claude

    2012-01-01

    Evidence-based medicine (EBM) refers to the conscientious, explicit and judicious use of current best evidence from research for the care of an individual patient. The concept of EBM was first described in human medicine in the early 1990s and was introduced to veterinary medicine 10 years later. However, it is not clear that the EBM approach promulgated in human medicine can be applied to the same extent to veterinary medicine. EBM has the potential to help veterinarians to make more informed decisions, but obstacles to the implementation of EBM include a lack of high quality patient-centred research, the need for basic understanding of clinical epidemiology by veterinarians, the absence of adequate searching techniques and accessibility to scientific data bases and the inadequacy of EBM tools that can be applied to the busy daily practise of veterinarians. This review describes the development of EBM in the veterinary profession, identifies its advantages and disadvantages and discusses whether and how veterinary surgeons should further adopt the EBM approach of human medicine. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. 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

  9. [Alternative medicines and "Evidence-Based Medicine" a possible reconciliation?].

    Science.gov (United States)

    Vanherweghem, J-L

    2015-09-01

    The contrast between the efficiency of Evidence-Based Medicine (EBM), a scientific fact, and the popularity of Complementary and Alternative Medicines (CAM) is a paradox of the art of healing. EBM is based on the paradigm of positivism and materialism while CAM are based on those of relativism and vitalism. These paradigms are diametrically opposed and the aim of an integrative medicine is aporetic. However, EBM is today in a dead end. The objective proof of a disease according to the rules of EBM is often lacking face to the expectations of patients demanding their illness to be taken into account. EBM and CAM have thus to coexist. Lessons can be drawn from CAM : patient expectations should be given a meaning and be integrated in his or her psychosocial context.

  10. A systematic review of the evidence base for Schema Therapy.

    Science.gov (United States)

    Masley, Samantha A; Gillanders, David T; Simpson, Susan G; Taylor, Morag A

    2012-01-01

    Schema Therapy is becoming an increasingly popular psychological model for working with individuals who have a variety of mental health and personality difficulties. The aim of this review is to look at the current evidence base for Schema Therapy and highlight directions for further research. A systematic search of the literature was conducted up until January 2011. All studies that had clinically tested the efficacy of Schema Therapy as described by Jeffrey Young (1994 and 2003) were considered. These studies underwent detailed quality assessments based on Scottish Intercollegiate Guidelines Network (SIGN-50) culminating in 12 studies being included in the review. The culminative message (both from the popularity of this model and the medium-to-large effect sizes) is of a theory that has already demonstrated clinically effective outcomes in a small number of studies and that would benefit from ongoing research and development with complex client groups. It is imperative that psychological practice be guided by high-quality research that demonstrates efficacious, evidence-based interventions. It is therefore recommended that researchers and clinicians working with Schema Therapy seek to build on these positive outcomes and further demonstrate the clinical effectiveness of this model through ongoing research.

  11. Clinicians adopting evidence based guidelines: a case study with thromboprophylaxis.

    Science.gov (United States)

    Chapman, Nicola H; Lazar, Steven P; Fry, Margaret; Lassere, Marissa N; Chong, Beng H

    2011-09-28

    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. 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. 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. 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.

  12. Evaluation of acid-base disorders in dogs and cats presenting to an emergency room. Part 2: comparison of anion gap, strong ion gap, and semiquantitative analysis.

    Science.gov (United States)

    Hopper, Kate; Epstein, Steven E; Kass, Philip H; Mellema, Matthew S

    2014-01-01

    To compare the diagnostic performance of the anion gap (AG) with 2 physicochemical approaches to identify unmeasured anions. Prospective cohort study. University teaching hospital. Eighty-four dogs and 14 cats presenting to a university teaching hospital emergency room. All dogs and cats in which venous blood samples for acid-base, lactate, and serum biochemical analysis were all collected within 60 minutes of each other, over a 5-month enrollment period. Unmeasured anions were quantified using each of three approaches: the anion gap (AG), strong ion gap (SIG), and a semiquantitative approach (XA). An increased AG metabolic acidosis was evident in 34/98 of cases. The Stewart approach identified an increased SIG acidosis in 49/98 of cases. There was a strong correlation between SIG and AG (r = 0.89; P anions in 68/98 of cases. There was a moderate correlation between AG and XA (r = 0.68; P anions occurred commonly in this sample of small animal emergency room patients and physiochemical approaches identified more animals with unmeasured anions than the traditional AG calculation. Further studies are needed to determine if the results of the physicochemical approach improves clinical management and warrants the associated increases in cost and complexity. © Veterinary Emergency and Critical Care Society 2014.

  13. Evidence-based German guidelines for surgery for obesity.

    Science.gov (United States)

    Runkel, Norbert; Colombo-Benkmann, Mario; Hüttl, Thomas P; Tigges, Harald; Mann, Oliver; Flade-Kuthe, Ricarda; Shang, Edvard; Susewind, Martin; Wolff, Stefani; Wunder, Ricarda; Wirth, Alfred; Winckler, Klaus; Weimann, Arved; de Zwaan, Martina; Sauerland, Stefan

    2011-04-01

    The young field of obesity surgery (bariatric surgery) in Germany expands as a consequence of the rapid increase of overweight and obesity. New surgical methods, minimal access techniques, and the enormous increase of scientific studies and evidence, all contribute to the success of bariatric surgery, which is the only realistic chance of permanent weight loss and regression of secondary diseases in many cases. A systematic literature review, classification of evidence, graded recommendations, and interdisciplinary consensus. Obesity surgery is an integral component of the multimodal treatment of obesity, which consists of multidisciplinary evaluation and preparation, conservative and surgical treatment elements, and a life-long follow-up. The guideline confirms the body mass index (BMI)-based spectrum of indications (BMI > 40 kg/m(2) or >35 kg/m(2) with secondary diseases) and extends it through elimination of all age restrictions (>18 years and <60 years) and most of the contraindications. Precondition for surgery is the failure of a structured conservative program of 6-12 months or the expected futility of it. Type II diabetes mellitus becomes an independent indication criterion for BMI < 35 kg/m(2) (metabolic surgery). The standard techniques are gastric balloon, gastric banding, gastric bypass, gastric sleeve, and biliopancreatic diversion. The choice of procedure is based on profound knowledge of results, long-term effects, complications, and patient-specific circumstances. The after-care should be structured and organized long term. The S3-guidelines contain evidence-based recommendations for the indication, selection of procedure, technique, and follow-up. Patient care should improve after implementation of these guidelines in clinical practice. Compliance by decision makers and health insurers is warranted.

  14. Collaborating across services to advance evidence-based nursing practice.

    Science.gov (United States)

    Kenny, Deborah J; Richard, Maggie L; Ceniceros, Xochitl; Blaize, Kelli

    2010-01-01

    Military medical treatment facilities offer a unique environment in which to develop a culture of evidence-based practice (EBP). Distinctive issues arise in the context of changed patient care demographics because of a war-injured population. These issues offer an opportunity to enhance the quality of care through the use and adaptation of research findings in this special nursing environment. In addition, the colocation of two military medical centers offers the prospect of collaborative efforts to create a regional culture for nursing EBP. The purposes of this study were to describe the processes of a collaborative project to train nurses in EBP and to share resources in developing and implementing evidence-based clinical nursing guidelines in two large military medical centers in the Northeastern United States and to discuss the collective efforts of nurse researchers, leadership, advanced practice nurses, and staff nurses in each hospital to facilitate the EBP process. A description of the organizational structure and the climate for EBP of each facility is provided followed by discussion of training efforts and the inculcation of an organizational culture for EBP. Contextual barriers and facilitators were encountered throughout the project. The two nurse researchers leading the projects were able to overcome the barriers and capitalize on opportunities to promote EBP. Three evidence-based clinical practice guidelines were developed at each facility and are currently in various stages of implementation. Despite the barriers, EBP continues to be at the forefront of military nursing practice in the U.S. National Capital Region. Clear communication and regular meetings were essential to the success of the collaborative project within and between the two military hospitals. Military-specific barriers to EBP included high team attrition and turnover because of the war mission and the usual high staff turnover at military hospitals. Military facilitators included a

  15. 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.

  16. Curriculum for Evidence Based Medicine for MBBS II phase Graduates

    Directory of Open Access Journals (Sweden)

    Saxena R

    2014-12-01

    Full Text Available Evidence based medicine is the training of health care professionals to access, assess and apply the best scientific evidence to clinical practice. EBM is the conscientious, explicit and judicious use of current best evidence along with clinical expertise and patient values in making decisions about the case of individual patients. The current undergraduate curriculum of health profession is based on past knowledge accumulated for years. The scientific relevance of the mostly outdated information has never been questioned. The students passively absorb this available knowledge and apply it in their future professional life. There is no active learning on their part, by way of positive enquiry and critical analysis of the curriculum imposed on them. This has an undesirable impact on their competency as health professionals and the quality of the health care imparted by them. Hence there is need for emphasis on the teaching of EBM skills in undergraduate, postgraduate, and continuing medical education programs. Early introduction of EBM in the undergraduate medical curriculum, in the form of a short course, using various modes of instruction, enhances the competence of critical thinking and also influences change in attitude towards EBM positively in medical students. The EBM course is planned to introduce in the curriculum of medical undergraduates at the beginning of second phase when they enter clinical posting. Total number of student would be 100 per batch and the course duration will be of 1 year. Educational methods program incorporates multiple teaching methods like lectures, discussion sessions, demonstration, case based learning, timely feedback, real life exposure, role modeling and peer evaluation.

  17. Advances in evidence-based cancer adoptive cell therapy.

    Science.gov (United States)

    Ge, Chunlei; Li, Ruilei; Song, Xin; Qin, Shukui

    2017-04-01

    Adoptive cell therapy (ACT) has been developed in cancer treatment by transferring/infusing immune cells into cancer patients, which are able to recognize, target, and destroy tumor cells. Recently, sipuleucel-T and genetically-modified T cells expressing chimeric antigen receptors (CAR) show a great potential to control metastatic castration-resistant prostate cancer and hematologic malignancies in clinic. This review summarized some of the major evidence-based ACT and the challenges to improve cell quality and reduce the side effects in the field. This review also provided future research directions to make sure ACT widely available in clinic.

  18. 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.

  19. Developing evidence-based physical therapy clinical practice guidelines.

    Science.gov (United States)

    Kaplan, Sandra L; Coulter, Colleen; Fetters, Linda

    2013-01-01

    Recommended strategies for developing evidence-based clinical practice guidelines (CPGs) are provided. The intent is that future CPGs developed with the support of the Section on Pediatrics of the American Physical Therapy Association would consistently follow similar developmental processes to yield consistent quality and presentation. Steps in the process of developing CPGs are outlined and resources are provided to assist CPG developers in carrying out their task. These recommended processes may also be useful to CPG developers representing organizations with similar structures, objectives, and resources.

  20. How do innovative students fit into evidence-based education?

    DEFF Research Database (Denmark)

    Lund, Birthe

    to evidence-based policy and practice, which is regarded as the new epistemological basis for educational policy. Both educational discourses imply a growing political interest in pedagogy. In order to teach students from kindergarten through to PhD level how to innovate, new collaborations and partnerships...... countries (except Finland) below the expected score. The assumption is that the Nordic countries must continue to be innovative and creative in order to be competitive while, at the same time, striving to improve their PISA tests score. This is underpinned by educational practices that expect students...

  1. Developing an evidence-based list of journals for nursing.

    Science.gov (United States)

    Sherwill-Navarro, Pamela; Kennedy, Joy C; Allen, Margaret Peg

    2014-04-01

    The Nursing and Allied Health Resources Section (NAHRS) of the Medical Library Association created the 2012 NAHRS Selected List of Nursing Journals to assist librarians with collection development and to provide nurses and librarians with data on nursing and interdisciplinary journals to assist their decisions about where to submit articles for publication. This list is a continuation and expansion of a list initially known as the Key Nursing Journals list. It compares database coverage and full-text options for each title and includes an analysis of the number of evidence-based, research, and continuing education articles.

  2. 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.  

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. Is evidence-based medicine about democratizing medical practice?

    DEFF Research Database (Denmark)

    Thorgård, Keld

    2014-01-01

    -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......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...

  8. Theoretical Foundations for Evidence-Based Health Informatics: Why? How?

    Science.gov (United States)

    Scott, Philip J; Georgiou, Andrew; Hyppönen, Hannele; Craven, Catherine K; Rigby, Michael; Brender McNair, Jytte

    2016-01-01

    A scientific approach to health informatics requires sound theoretical foundations. Health informatics implementation would be more effective if evidence-based and guided by theories about what is likely to work in what circumstances. We report on a Medinfo 2015 workshop on this topic jointly organized by the EFMI Working Group on Assessment of Health Information Systems and the IMIA Working Group on Technology Assessment and Quality Development. We discuss the findings of the workshop and propose an approach to consolidate empirical knowledge into testable middle-range theories.

  9. Social media, evidence-based tweeting, and JCEHP.

    Science.gov (United States)

    Djuricich, Alexander M

    2014-01-01

    Medical practice and medical journals must adapt to a constantly changing environment, in which social media plays an ever-increasing role. Social media platforms such as Twitter can provide an opportunity to disseminate information in innovative ways. The concept of evidence-based tweeting is introduced, especially as "tweeting the meeting" continues to expand within medical conferences and other venues important for continuing education for health care providers. Future social media strategies for the journal are outlined. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

  10. 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.

  11. Qigong in Cancer Care: Theory, Evidence-Base, and Practice.

    Science.gov (United States)

    Klein, Penelope

    2017-01-12

    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.

  12. 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.

  13. Meta-analysis and Evidence-Based Psychosocial Intervention

    Directory of Open Access Journals (Sweden)

    Julio Sánchez-Meca

    2011-04-01

    Full Text Available Psychosocial interventions that are applied in practice should be those that have received the best scientific evidence about their effectiveness. Evidence-Based Psychosocial Intervention is a methodological tool that aims to raise awareness among professionals and policy makers of the need for professional practice to be guided by the best evidence. For this purpose, systematic reviews and meta-analyses of empirical evaluation studies play an important role as they allow us to synthesize the results of numerous studies on the same issue to determine which are the best treatments and interventions for solving the problem. This article presents an overview of the meta-analyses and the information they can provide for professional practice. The phases in which a meta-analysis is carried out are outlined as follows: (a formulating the problem, (b searching for the studies, (c coding the studies, (d calculating the effect size, (e statistical techniques of integration and (f publishing the study. The scope of meta-analyses and their results are illustrated with an example and their implications for professional practice are discussed.

  14. 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.

  15. Promoting health equity in cities through evidence-based action.

    Science.gov (United States)

    Kumaresan, Jacob; Prasad, Amit; Alwan, Ala; Ishikawa, Nobukatsu

    2010-09-01

    The impact of the urban setting on health and, in particular, health inequities has been widely documented. However, only a few countries have examined their inter- or intra-city health inequalities, and few do so regularly. Information that shows the gaps between cities or within the same city is a crucial requirement to trigger appropriate local actions to promote health equity. To generate relevant evidence and take appropriate actions to tackle health inequities, local authorities need a variety of tools. In order to facilitate a comprehensive understanding of health systems performance, these tools should: (1) adopt a multi-sectorial approach; (2) link evidence to actions; (3) be simple and user-friendly; and (4) be operationally feasible and sustainable. In this paper we have illustrated the use of one such tool, The World Health Organization's Urban HEART, which guides users through a process to identify health inequities, focusing on health determinants and then developing actions based on the evidence generated. In a time of increasing financial constraints, there is a pressing need to allocate scarce resources more efficiently. Tools are needed to guide policy makers in their planning process to identify best-practice interventions that promote health equity in their cities.

  16. 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

  17. 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

  18. Pressure ulcer prevention: an evidence-based analysis.

    Science.gov (United States)

    2009-01-01

    In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers.Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/tech/tech_mn.html to review these titles that are currently available within the Pressure Ulcers series.PRESSURE ULCER PREVENTION: an evidence based analysisThe cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation)MANAGEMENT OF CHRONIC PRESSURE ULCERS: an evidence-based analysis (anticipated pubicstion date - mid-2009) PURPOSE: A pressure ulcer, also known as a pressure sore, decubitus ulcer, or bedsore, is defined as a localized injury to the skin/and or underlying tissue occurring most often over a bony prominence and caused by pressure, shear, or friction, alone or in combination. (1) Those at risk for developing pressure ulcers include the elderly and critically ill as well as persons with neurological impairments and those who suffer conditions associated with immobility. Pressure ulcers are graded or staged with a 4-point classification system denoting severity. Stage I represents the beginnings of a pressure ulcer and stage IV, the severest grade, consists of full thickness tissue loss with exposed bone, tendon, and or muscle. (1) In a 2004 survey of Canadian health care settings, Woodbury and Houghton (2) estimated that the prevalence of pressure ulcers at a stage 1 or greater in Ontario ranged between 13.1% and 53% with nonacute health care settings having the highest prevalence rate (Table 1). Executive Summary Table 1: Prevalence of Pressure Ulcers()SettingCanadian Prevalence,% (95% CI)Ontario Prevalence,Range % (n)Acute care25 (23.8-26.3)23.9-29.7 (3418)Nonacute care30 (29.3-31.4)30.0-53.3 (1165)Community care15 (13.4-16.8)13.2 (91)Mixed health care22 (20.9-23.4)13.1-25.7 (3100)All health care settings26 (25

  19. Evidence-based guideline update: Medical treatment of infantile spasms

    Science.gov (United States)

    Go, C.Y.; Mackay, M.T.; Weiss, S.K.; Stephens, D.; Adams-Webber, T.; Ashwal, S.; Snead, O.C.

    2012-01-01

    Objective: To update the 2004 American Academy of Neurology/Child Neurology Society practice parameter on treatment of infantile spasms in children. Methods: MEDLINE and EMBASE were searched from 2002 to 2011 and searches of reference lists of retrieved articles were performed. Sixty-eight articles were selected for detailed review; 26 were included in the analysis. Recommendations were based on a 4-tiered classification scheme combining pre-2002 evidence and more recent evidence. Results: There is insufficient evidence to determine whether other forms of corticosteroids are as effective as adrenocorticotropic hormone (ACTH) for short-term treatment of infantile spasms. However, low-dose ACTH is probably as effective as high-dose ACTH. ACTH is more effective than vigabatrin (VGB) for short-term treatment of children with infantile spasms (excluding those with tuberous sclerosis complex). There is insufficient evidence to show that other agents and combination therapy are effective for short-term treatment of infantile spasms. Short lag time to treatment leads to better long-term developmental outcome. Successful short-term treatment of cryptogenic infantile spasms with ACTH or prednisolone leads to better long-term developmental outcome than treatment with VGB. Recommendations: Low-dose ACTH should be considered for treatment of infantile spasms. ACTH or VGB may be useful for short-term treatment of infantile spasms, with ACTH considered preferentially over VGB. Hormonal therapy (ACTH or prednisolone) may be considered for use in preference to VGB in infants with cryptogenic infantile spasms, to possibly improve developmental outcome. A shorter lag time to treatment of infantile spasms with either hormonal therapy or VGB possibly improves long-term developmental outcomes. PMID:22689735

  20. [Civilization stress, cardiovascular risk, evidence-based medicine, guidelines].

    Science.gov (United States)

    Simon, Kornél

    2009-05-10

    Cardiovascular diseases have the pole-position on the list of morbidity and mortality statistics. Despite the great advances have been made in management of cardiovascular diseases, prevalence of these disorders increases worldwide, and even younger and younger ages are threatened. This phenomenon is strongly related to obesity and type 2 diabetes pandemic, which shows an unequivocal association with expansion of modernized life-style. The pathomechanism proposed to have central role is the chronic stress induced by civilized life-conduct. The authors criticizes the everyday practice suggested for management of cardiovascular diseases, focusing on normalization of cardiovascular risk factors, instead of fighting against the primary cause ie. chronic stress. There is growing evidence, that achieving the target values defined in guide-lines will not necessarily result in improvement of patient related clinical outcomes. The statistical approach generally practiced in randomized clinical trials is primarily striving for the drug-sale, instead of discovering novel pathophysiological relations. Pharmaceutical industry having decisive role in research and patient-care is mainly interested in profit-sharing, therefore patients' interest can not be optimally realized, and costs are unnecessarily augmented. Separation of patient-, and business-oriented medical care is an ethical question of fundamental importance.

  1. Evidence-based control of plaque and gingivitis.

    Science.gov (United States)

    Santos, A

    2003-01-01

    Most adults brush and floss inadequately, and constant education and/or reinforcement is often required. Bacteria are usually left behind with mechanical oral health routines, and chemotherapeutic agents may have a key role as adjuncts to daily home-care. To date, two antiseptic mouthwashes have received the ADA Seal of Acceptance: Peridex (Zila Pharmaceuticals, Phoenix, AZ, USA; CHX, chlorhexidine) and Listerine (Pfizer Consumer Healthcare, Morris Plains, NJ, USA; essential oil (EO) mouthwash). CHX has a strong affinity for tooth and tissue surfaces, but can cause brown staining on the teeth and tongue. Patients must also wait until all traces of toothpaste are removed before rinsing with CHX. Long-term use of an EO mouthwash is microbiologically safe, with no changes observed in the bacterial composition of supragingival plaque, and no evidence of antimicrobial resistance. A number of trials have demonstrated the long-term plaque- and gingivitis-reducing properties of both CHX and EO mouthwashes. These studies clearly demonstrate that these agents have lasting efficacy, and can access hard-to-reach areas.

  2. 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.

  3. 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.    

  4. Online tools for teaching evidence-based veterinary medicine.

    Science.gov (United States)

    Steele, Michael; Crabb, Nicholas P; Moore, Lynda J; Reyher, Kristen K; Baillie, Sarah; Eisler, Mark C

    2013-01-01

    Evidence-based veterinary medicine (EBVM) is of interest and relevance to veterinary practitioners. Consequently, veterinary schools take responsibility for teaching students how to appraise scientific articles and for equipping them with the skills needed to obtain and evaluate the best evidence and to apply this approach to their own cases. As part of our farm animal clinical rotation, we train students in qualitative and quantitative EBVM methods using an e-learning environment, online teaching materials, a wiki (a Web site that allows its users to edit its content via a Web browser), and face-to-face tutorials that support learning. Students working in small groups use a wiki to record details of the history, clinical presentation, diagnostic tests, herd data, and management plans for their chosen farm animal clinical cases. Using a standardized patient, intervention, comparison, and outcome (PICO) format, each group formulates a patient question based on either a proposed intervention or diagnostic procedure for the case and conducts an online scientific literature database search. The students appraise the articles retrieved using EBVM approaches and record the information in the wiki. The summation of this body of work, the group's critically appraised topic (CAT), includes the original PICO, a standardized table of the scientific evidence for the effectiveness of the intervention or diagnostic procedure, a summary statement in the form of a clinical bottom line, and their reflections upon the CAT. At the end of the rotation, students take part in a structured "CAT Club" where they present and discuss their findings with fellow students and clinicians.

  5. Evidence-based evaluation of therapeutic measures for sleep disorders

    Directory of Open Access Journals (Sweden)

    LI Juan

    2013-05-01

    Full Text Available Objective To evaluate the therapeutic efficacy and side effects of various treatment for sleep disorders in order to provide the best therapeutic regimen for the evidence-based treatment of sleep disorders. Methods Sleep disorder, insomnia, restless legs syndrome or RLS, obstructive sleep apnea or OSA, narcolepsy, REM behaviour disorder or RBD, treatment or therapy were used as retrieval words. Cochrane Library, MEDLINE, ScienceDirect were used for retrieval, and manual searching was also used. Related clinical guidelines, systematic reviews, randomized controlled clinical trials, retrospective case analysis, case-observation studies and reviews were collected and evaluated by Jadad Scale. Results Forty related articles were selected as following: 6 clinical guidelines, 12 systematic reviews, 5 randomized controlled trials, 2 retrospective case analysis, 1 case-observation study and 14 reviews. Thirty-three were of high quality, while 7 were of low quality with score. According to the evaluation of therapeutic efficacy and side effects of various therapies, it is suggested as following: 1 insomnia is the most common in sleep disorders; the treatment methods of insomnia mainly include drug therapy and cognitive behavioral treatment (CBT; the two kinds of therapy have their own advantages and disadvantages, and the combination therapy of drugs and CBT is the best treatment plan. 2 The first-line treatment of primary RLS is dopamine agonists and anti-seizure drugs; however, the treatment of secondary RLS is mainly etiologic treatment. 3 The main treatments of OSAS are nasal continuous positive airway pressure (nCPAP, oral orthotics and surgery, and nCPAP is the first-line treatments. 4 The medication of narcolepsy is mainly modafinil, hydroxy butyric acid sodium and antidepressants, and the specific choosingshould accord to clinical classifications. 5 The main treatments of RBD include general treatments such as avoiding triggers, insuring the

  6. 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.

  7. Knowledge-Based Query Construction Using the CDSS Knowledge Base for Efficient Evidence Retrieval

    Directory of Open Access Journals (Sweden)

    Muhammad Afzal

    2015-08-01

    Full Text Available Finding appropriate evidence to support clinical practices is always challenging, and the construction of a query to retrieve such evidence is a fundamental step. Typically, evidence is found using manual or semi-automatic methods, which are time-consuming and sometimes make it difficult to construct knowledge-based complex queries. To overcome the difficulty in constructing knowledge-based complex queries, we utilized the knowledge base (KB of the clinical decision support system (CDSS, which has the potential to provide sufficient contextual information. To automatically construct knowledge-based complex queries, we designed methods to parse rule structure in KB of CDSS in order to determine an executable path and extract the terms by parsing the control structures and logic connectives used in the logic. The automatically constructed knowledge-based complex queries were executed on the PubMed search service to evaluate the results on the reduction of retrieved citations with high relevance. The average number of citations was reduced from 56,249 citations to 330 citations with the knowledge-based query construction approach, and relevance increased from 1 term to 6 terms on average. The ability to automatically retrieve relevant evidence maximizes efficiency for clinicians in terms of time, based on feedback collected from clinicians. This approach is generally useful in evidence-based medicine, especially in ambient assisted living environments where automation is highly important.

  8. 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....... Researchers usually select EDS mainly based on personal knowledge, experience, and preferences and/or recommendations by other researchers. We believe that building an evidence-based understanding of EDS can enable researchers to make more informed decisions about the selection of EDS. This paper reports our...... initial effort towards this end. We propose an initial set of metrics for characterizing the EDS from the perspective of the needs of secondary studies. We explain the usage and benefits of the proposed metrics using the data gathered from two secondary studies. We also tried to synthesize the data from...

  9. An Evidence-based Guideline for the air medical transportation of prehospital trauma patients.

    Science.gov (United States)

    Thomas, Stephen H; Brown, Kathleen M; Oliver, Zoë J; Spaite, Daniel W; Lawner, Benjamin J; Sahni, Ritu; Weik, Tasmeen S; Falck-Ytter, Yngve; Wright, Joseph L; Lang, Eddy S

    2014-01-01

    Decisions about the transportation of trauma patients by helicopter are often not well informed by research assessing the risks, benefits, and costs of such transport. The objective of this evidence-based guideline (EBG) is to recommend a strategy for the selection of prehospital trauma patients who would benefit most from aeromedical transportation. A multidisciplinary panel was recruited consisting of experts in trauma, EBG development, and emergency medical services (EMS) outcomes research. Representatives of the Federal Interagency Committee on Emergency Medical Services (FICEMS), the National Highway Traffic Safety Administration (NHTSA) (funding agency), and the Children's National Medical Center (investigative team) also contributed to the process. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to guide question formulation, evidence retrieval, appraisal/synthesis, and formulate recommendations. The process followed the National Evidence-Based Guideline Model Process, which has been approved by the Federal Interagency Committee on EMS and the National EMS Advisory Council. Two strong and three weak recommendations emerged from the process, all supported only by low or very low quality evidence. The panel strongly recommended that the 2011 CDC Guideline for the Field Triage of Injured Patients be used as the initial step in the triage process, and that ground emergency medical services (GEMS) be used for patients not meeting CDC anatomic, physiologic, and situational high-acuity criteria. The panel issued a weak recommendation to use helicopter emergency medical services (HEMS) for higher-acuity patients if there is a time-savings versus GEMS, or if an appropriate hospital is not accessible by GEMS due to systemic/logistical factors. The panel strongly recommended that online medical direction should not be required for activating HEMS. Special consideration was given to the potential need for local

  10. 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.

  11. Evidence-based guides in tracheostomy use in critical patients.

    Science.gov (United States)

    Raimondi, N; Vial, M R; Calleja, J; Quintero, A; Cortés Alban, A; Celis, E; Pacheco, C; Ugarte, S; Añón, J M; Hernández, G; Vidal, E; Chiappero, G; Ríos, F; Castilleja, F; Matos, A; Rodriguez, E; Antoniazzi, P; Teles, J M; Dueñas, C; Sinclair, J; Martínez, L; Von der Osten, I; Vergara, J; Jiménez, E; Arroyo, M; Rodriguez, C; Torres, J; Fernandez-Bussy, S; Nates, J L

    2017-03-01

    Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  12. Opinion leaders and evidence-based medicine in craniofacial surgery.

    Science.gov (United States)

    Doumit, Gaby D; Papay, Frank A; Moores, Neal; Meisler, Eileen; Zins, James E

    2014-01-01

    In health care, it is widely known that evidence-based medicine (EBM) has a significant impact on clinical practice, and opinion leaders can enhance the clinician's application of EBM in various disciplines. In this article, we examine the existence and impact of opinion leaders in craniofacial surgery as well as barriers to evidence-based practice. We compiled the answers of an Internet questionnaire, which was sent to 102 craniofacial surgeons. Our results demonstrate that opinion leaders most definitely can be identified in craniofacial surgery. They are tightly connected to their field's social network and promote EBM. In this survey, 44% of craniofacial surgeons reported that their greatest obstacle to clinical decision making in the management of nonsyndromic synostosis was lack of surgical consensus. In addition, craniofacial surgeons stated that EBM and opinion leaders are the most influential factors that caused them to change their management of craniosynostosis. We expect that the use of opinion leaders can further enhance the uptake of EBM in craniofacial surgery.

  13. [Managing constipation in the elderly: an evidence-based approach].

    Science.gov (United States)

    Lin, Yi-Chen; Yen, Miaofen; Chen, Ching-Huey

    2010-08-01

    Constipation is a common problem afflicting the elderly. When elderly patients complain of constipation to their healthcare providers, they are typically prescribed laxatives rather than given a clinical examination to explore the specific causes. This approach not only does not resolve the long-term problem of constipation, but may also lead to further complications (e.g., constipation alternating with diarrhea, abdominal distention, poor appetite, and ileus). Effective management of constipation in the elderly should in many cases be tailored to the symptoms and conditions of individual patients rather than simply applying evidence-based treatment. There is a lack of consistency amongst specialists on how best to deal with the problem of constipation. The aim of this article was to explore evidence-based management approaches to constipation in the elderly. A definition of constipation is given and relevant causes are first given. Pharmacological and non-pharmacological treatment approaches are then introduced with regard to effective approaches to conducting physical examinations, assessing patient medical history, and performing laboratory tests. In addition, this article also developed a constipation protocol as a reference tool in the clinical management of constipation in the elderly. The authors hope results can help reduce the problem of constipation in the elderly population.

  14. 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

  15. 60: EVIDENCE-BASED NURSING IN THE WOUND BED

    Science.gov (United States)

    Esmaeilnezhad, Mahdieh; Rasooli, Alehe Seyyed; Sedghivash, Saba; Vatani, Parisa

    2017-01-01

    Background and aims Pressure sores are areas of tissue in the elderly or patients who can no independently change their situation happening pressure sores significant financial burden on health care systems impose a negative impact on quality of life and their frequency. Change the status of patients in hospitals or long-term care for the prevention of pressure ulcers is a common strategy. Methods We searched the data base in COCHRANE, MEDLIBE, GOOGLE SCHOLAR, PUBMED, and UP TO DATE with keywords evidence base and nursing bed sore following evidence obtained: Results The study Qinhongzhang et al. (2015) called massage therapy to prevent bed sores showed that currently there is no credible study that shows that massage therapy can help to prevent bed sores. Study Brigidgillespie et al. (2014) “The movement to preven pressure sores showed that the movement of the patient from position 30 degrees every 3 hours instead of the standard 90 degrees every 6 hours to waste energy and time nurses a significant impact on the evolution of the treatment of patients. Chichfengchen study et al. (2014) as phototherapy for the treatment of pressure ulcers showed that the group treated with ultraviolet radiation completing the treatment period shorter than the control group (p=0.003). Conclusion According to findings from the EBN seen, non-drug, non-invasive nursing interventions can have a preventive effect on pressure sores.

  16. 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

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

    Directory of Open Access Journals (Sweden)

    Harris Claire

    2008-10-01

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

  18. 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

  19. The strong reactions of Lewis-base noble-metals with vanadium and other acidic transition metals

    Energy Technology Data Exchange (ETDEWEB)

    Ebbinghaus, Bartley B. [Univ. of California, Berkeley, CA (United States)

    1991-05-01

    The noble metals often thought of as unreactive solids,react strongly with nearly 40% of the elements in the periodictable: group IIIB-VB transition metals, lanthanides, theactinides, and group IIIA-IVA non-transition metals. These strong reactions arise from increased bonding/electron transfer fromnonbonding electrons d electron pairs on the noble metal tovacant orbitals on V, etc. This effect is a generalized Lewis acid-base interaction. The partial Gibbs energy of V in the noblemetals has been measured as a function of concentration at a temperature near 1000C. Thermodynamics of the intermetallics are determined by ternary oxide equilibria, ternary carbide equilibria, and the high-temperature galvanic cell technique. These experimental methods use equilibrated solid composite mixtures in which grains of V oxides or of V carbides are interspersed with grains of V-NM(noble-metal) alloys. In equilibrium the activity of V in the oxide or the carbide equals the activity in the alloy. Consequently, the thermodynamics available in the literature for the V oxides and V carbides are reviewed. Test runs on the galvanic cell were attempted. The V oxide electrode reacts with CaF2, ThO2, YDT(0.85ThO2-0.15YO1.5), and LDT(0.85ThO2- 0.15LaO1.5) to interfere with the measured data observed toward the beginning of a galvanic cell experiment are the most accurate. The interaction of vanadium at infinite dilution in the noble-metals was determined.

  20. The strong reactions of Lewis-base noble-metals with vanadium and other acidic transition metals

    Energy Technology Data Exchange (ETDEWEB)

    Ebbinghaus, B.B.

    1991-05-01

    The noble metals often thought of as unreactive solids,react strongly with nearly 40% of the elements in the periodictable: group IIIB-VB transition metals, lanthanides, theactinides, and group IIIA-IVA non-transition metals. These strong reactions arise from increased bonding/electron transfer fromnonbonding electrons d electron pairs on the noble metal tovacant orbitals on V, etc. This effect is a generalized Lewis acid-base interaction. The partial Gibbs energy of V in the noblemetals has been measured as a function of concentration at a temperature near 1000C. Thermodynamics of the intermetallics are determined by ternary oxide equilibria, ternary carbide equilibria, and the high-temperature galvanic cell technique. These experimental methods use equilibrated solid composite mixtures in which grains of V oxides or of V carbides are interspersed with grains of V-NM(noble-metal) alloys. In equilibrium the activity of V in the oxide or the carbide equals the activity in the alloy. Consequently, the thermodynamics available in the literature for the V oxides and V carbides are reviewed. Test runs on the galvanic cell were attempted. The V oxide electrode reacts with CaF[sub 2], ThO[sub 2], YDT(0.85ThO[sub 2]-0.15YO[sub 1.5]), and LDT(0.85ThO[sub 2]- 0.15LaO[sub 1.5]) to interfere with the measured data observed toward the beginning of a galvanic cell experiment are the most accurate. The interaction of vanadium at infinite dilution in the noble-metals was determined.

  1. Fault Diagnosis for the Heat Exchanger of the Aircraft Environmental Control System Based on the Strong Tracking Filter

    Science.gov (United States)

    Ma, Jian; Lu, Chen; Liu, Hongmei

    2015-01-01

    The aircraft environmental control system (ECS) is a critical aircraft system, which provides the appropriate environmental conditions to ensure the safe transport of air passengers and equipment. The functionality and reliability of ECS have received increasing attention in recent years. The heat exchanger is a particularly significant component of the ECS, because its failure decreases the system’s efficiency, which can lead to catastrophic consequences. Fault diagnosis of the heat exchanger is necessary to prevent risks. However, two problems hinder the implementation of the heat exchanger fault diagnosis in practice. First, the actual measured parameter of the heat exchanger cannot effectively reflect the fault occurrence, whereas the heat exchanger faults are usually depicted by utilizing the corresponding fault-related state parameters that cannot be measured directly. Second, both the traditional Extended Kalman Filter (EKF) and the EKF-based Double Model Filter have certain disadvantages, such as sensitivity to modeling errors and difficulties in selection of initialization values. To solve the aforementioned problems, this paper presents a fault-related parameter adaptive estimation method based on strong tracking filter (STF) and Modified Bayes classification algorithm for fault detection and failure mode classification of the heat exchanger, respectively. Heat exchanger fault simulation is conducted to generate fault data, through which the proposed methods are validated. The results demonstrate that the proposed methods are capable of providing accurate, stable, and rapid fault diagnosis of the heat exchanger. PMID:25823010

  2. Fault diagnosis for the heat exchanger of the aircraft environmental control system based on the strong tracking filter.

    Science.gov (United States)

    Ma, Jian; Lu, Chen; Liu, Hongmei

    2015-01-01

    The aircraft environmental control system (ECS) is a critical aircraft system, which provides the appropriate environmental conditions to ensure the safe transport of air passengers and equipment. The functionality and reliability of ECS have received increasing attention in recent years. The heat exchanger is a particularly significant component of the ECS, because its failure decreases the system's efficiency, which can lead to catastrophic consequences. Fault diagnosis of the heat exchanger is necessary to prevent risks. However, two problems hinder the implementation of the heat exchanger fault diagnosis in practice. First, the actual measured parameter of the heat exchanger cannot effectively reflect the fault occurrence, whereas the heat exchanger faults are usually depicted by utilizing the corresponding fault-related state parameters that cannot be measured directly. Second, both the traditional Extended Kalman Filter (EKF) and the EKF-based Double Model Filter have certain disadvantages, such as sensitivity to modeling errors and difficulties in selection of initialization values. To solve the aforementioned problems, this paper presents a fault-related parameter adaptive estimation method based on strong tracking filter (STF) and Modified Bayes classification algorithm for fault detection and failure mode classification of the heat exchanger, respectively. Heat exchanger fault simulation is conducted to generate fault data, through which the proposed methods are validated. The results demonstrate that the proposed methods are capable of providing accurate, stable, and rapid fault diagnosis of the heat exchanger.

  3. 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.

  4. Evidence-Based Higher Education - Is the Learning Styles 'Myth' Important?

    Science.gov (United States)

    Newton, Philip M; Miah, Mahallad

    2017-01-01

    The basic idea behind the use of 'Learning Styles' is that learners can be categorized into one or more 'styles' (e.g., Visual, Auditory, Converger) and that teaching students according to their style will result in improved learning. This idea has been repeatedly tested and there is currently no evidence to support it. Despite this, belief in the use of Learning Styles appears to be widespread amongst schoolteachers and persists in the research literature. This mismatch between evidence and practice has provoked controversy, and some have labeled Learning Styles a 'myth.' In this study, we used a survey of academics in UK Higher Education ( n = 114) to try and go beyond the controversy by quantifying belief and, crucially, actual use of Learning Styles. We also attempted to understand how academics view the potential harms associated with the use of Learning Styles. We found that general belief in the use of Learning Styles was high (58%), but lower than in similar previous studies, continuing an overall downward trend in recent years. Critically the percentage of respondents who reported actually using Learning Styles (33%) was much lower than those who reported believing in their use. Far more reported using a number of techniques that are demonstrably evidence-based. Academics agreed with all the posited weaknesses and harms of Learning Styles theory, agreeing most strongly that the basic theory of Learning Styles is conceptually flawed. However, a substantial number of participants (32%) stated that they would continue to use Learning Styles despite being presented with the lack of an evidence base to support them, suggesting that 'debunking' Learning Styles may not be effective. We argue that the interests of all may be better served by promoting evidence-based approaches to Higher Education.

  5. Evidence-Based Higher Education – Is the Learning Styles ‘Myth’ Important?

    Science.gov (United States)

    Newton, Philip M.; Miah, Mahallad

    2017-01-01

    The basic idea behind the use of ‘Learning Styles’ is that learners can be categorized into one or more ‘styles’ (e.g., Visual, Auditory, Converger) and that teaching students according to their style will result in improved learning. This idea has been repeatedly tested and there is currently no evidence to support it. Despite this, belief in the use of Learning Styles appears to be widespread amongst schoolteachers and persists in the research literature. This mismatch between evidence and practice has provoked controversy, and some have labeled Learning Styles a ‘myth.’ In this study, we used a survey of academics in UK Higher Education (n = 114) to try and go beyond the controversy by quantifying belief and, crucially, actual use of Learning Styles. We also attempted to understand how academics view the potential harms associated with the use of Learning Styles. We found that general belief in the use of Learning Styles was high (58%), but lower than in similar previous studies, continuing an overall downward trend in recent years. Critically the percentage of respondents who reported actually using Learning Styles (33%) was much lower than those who reported believing in their use. Far more reported using a number of techniques that are demonstrably evidence-based. Academics agreed with all the posited weaknesses and harms of Learning Styles theory, agreeing most strongly that the basic theory of Learning Styles is conceptually flawed. However, a substantial number of participants (32%) stated that they would continue to use Learning Styles despite being presented with the lack of an evidence base to support them, suggesting that ‘debunking’ Learning Styles may not be effective. We argue that the interests of all may be better served by promoting evidence-based approaches to Higher Education. PMID:28396647

  6. 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

  7. Organizational factors influencing implementation of evidence-based practices for integrated treatment in behavioral health agencies.

    Science.gov (United States)

    Bonham, Caroline A; Sommerfeld, David; Willging, Cathleen; Aarons, Gregory A

    2014-01-01

    Objective. In recent years, New Mexico has prioritized integrated treatment for cooccurring mental health and substance use disorders within its public behavioral health system. This report describes factors likely to be important when implementing evidence-based practices (EBPs) in community agencies. Methods. Our mixed-method research design consisted of observations, semistructured interviews, and surveys undertaken with employees at 14 agencies at baseline and after 18 months. We developed four-agency typologies based on iterative coding and analysis of observations and interviews. We then examined survey data from employees at the four exemplar agencies to validate qualitative findings. Results. Financial resources and strong leadership impacted agency capacity to train providers and implement EBPs. Quantitative analysis of service provider survey responses from these agencies (N = 38) supported qualitative findings and demonstrated significant mean score differences in leadership, organizational climate, and attitudes toward EBPs in anticipated directions. Conclusion. The availability of strong leadership and financial resources were key components to initial implementation success in this study of community agencies in New Mexico. Reliance only on external funding poses risks for sustainment when demoralizing work climates precipitate employee turnover. Strong agency leadership does not always compensate for deficient financial resources in vulnerable communities.

  8. Physiotherapy and cystic fibrosis: what is the evidence base?

    Science.gov (United States)

    McIlwaine, Maggie Patricia; Lee Son, Nicole Marie; Richmond, Melissa Lynn

    2014-11-01

    To provide a comprehensive overview and evidence to support the role of physiotherapy in the management of individuals with cystic fibrosis (CF) including airway clearance, exercise, and musculoskeletal concerns which can affect activities of daily living and respiratory health. Several long-term studies have looked at the efficacy of airway clearance techniques, including active cycle of breathing techniques, autogenic drainage, high frequency chest wall oscillation, postural drainage, positive expiratory pressure (PEP), and oscillating PEP. Each of these studies reported some efficacy of airway clearance in maintaining health with no one technique being superior to another. However, one study suggested that high frequency chest wall oscillation was not as effective as PEP in maintaining health in CF patients. Individual preference needs to be considered when selecting a technique. Recent studies have found exercise to increase mucociliary clearance peripherally. Musculoskeletal issues, including posture, bone density, urinary incontinence, and pain should be assessed and managed in individuals to improve the mechanics of breathing and overall well-being. The role of physiotherapy in CF is complex and includes airway clearance, exercise, and management of the long-term sequelae of musculoskeletal issues. More rigorous physiotherapy studies are required to assist with evidence based practice.

  9. Vitiligo: concise evidence based guidelines on diagnosis and management.

    Science.gov (United States)

    Gawkrodger, David J; Ormerod, Anthony D; Shaw, Lindsay; Mauri-Sole, Inma; Whitton, Maxine E; Watts, M Jane; Anstey, Alex V; Ingham, Jane; Young, Katharine

    2010-08-01

    Vitiligo is a common disease that causes a great degree of psychological distress. In its classical forms it is easily recognised and diagnosed. This review provides an evidence based outline of the management of vitiligo, particularly with the non-specialist in mind. Treatments for vitiligo are generally unsatisfactory. The initial approach to a patient who is thought to have vitiligo is to make a definite diagnosis, offer psychological support, and suggest supportive treatments such as the use of camouflage cosmetics and sunscreens, or in some cases after discussion the option of no treatment. Active therapies open to the non-specialist, after an explanation of potential side effects, include the topical use of potent or highly potent steroids or calcineurin inhibitors for a defined period of time (usually 2 months), following which an assessment is made to establish whether or not there has been a response. Patients whose condition is difficult to diagnose, unresponsive to straightforward treatments, or is causing psychological distress, are usually referred to a dermatologist. Specialist dermatology units have at their disposal phototherapy, either narrow band ultraviolet B or in some cases photochemotherapy, which is the most effective treatment presently available and can be considered for symmetrical types of vitiligo. Depigmenting treatments and possibly surgical approaches may be appropriate for vitiligo in selected cases. There is no evidence that presently available systemic treatments are helpful and safe in vitiligo. There is a need for further research into the causes of vitiligo, and into discovering better treatments.

  10. Evidence-based treatment of atopic dermatitis with topical moisturizers.

    Science.gov (United States)

    Micali, Giuseppe; Paternò, Valentina; Cannarella, Rossella; Dinotta, Franco; Lacarrubba, Francesco

    2018-01-24

    Skin barrier restoration represents the mainstay of the treatment of atopic dermatitis and the use of moisturizers is recommended by several international guidelines. The aim of the study was to investigate through an evidence-based medicine analysis the effectiveness and safety of different moisturizing products available for a non-pharmacological treatment of atopic dermatitis. A total of 92 randomized controlled trials (RCTs) have been identified and analyzed. The results confirm the presence of a reasonable number of studies highlighting moisturizers safety and effectiveness in the treatment of atopic dermatitis by improving disease severity, increasing the time of relapse and reducing the time of flares. Moisturizers containing urea, glycerin or glycyrrhetinic acid seem to show the greater evidence of efficacy being supported by more clinical trials. Among the existing moisturizers, those containing a single agent generally work although the heterogeneity of RCTs does not allow reaching more definitive conclusions. Moisturizers made of a mixture of substances seem to be more effective thanks to the presence of different active substances that may exert a synergistic effect. A meta-analysis of 4 RCTs confirms the efficacy of a medical device containing glycyrrhetinic acid, hyaluronic acid, shea butter, telmesteine, and vitis vinifera in the treatment of atopic dermatitis.

  11. State of Evidence-Based Practice in Physician Assistant Education.

    Science.gov (United States)

    White, Dawn M; Stephens, Phillip

    2018-03-01

    Evidence-based practice (EBP) involves using the best evidence available to guide patient care. The use of EBP improves patient outcomes and the quality of care delivered. Studies have investigated how EBP is taught in other health professions but not in physician assistant (PA) programs. The purpose of this study was to explore how PA programs teach this subject matter. After permission was obtained, a survey was adapted from a similar study completed in medical schools. Requests were emailed to 186 accredited PA programs with available contact information. These data were analyzed using descriptive statistics. The text responses were reviewed and summarized to describe how EBP was taught in the programs surveyed. Eighty-four responses were received from the 186 PA programs contacted with the survey request, giving a 45.2% return. Approximately 95% of respondents reported having formal EBP training in their curriculum. Respondents reported formal EBP training through a variety of educational activities, with time spent on these activities ranging from 4 hours to 550 hours. Barriers to implementation of an EBP curriculum were reported by 27% of respondents, with the most common barrier being lack of time. Most PA programs that responded have formal EBP training in the curriculum. There is little standardization regarding the methods used and time spent in these activities. The Accreditation Review Commission on Education for the Physician Assistant may be able to assist in overcoming the reported barriers and improving standardization by implementing a specific EBP accreditation standard.

  12. Sentiment Prediction Based on Dempster-Shafer Theory of Evidence

    Directory of Open Access Journals (Sweden)

    Mohammad Ehsan Basiri

    2014-01-01

    Full Text Available Sentiment prediction techniques are often used to assign numerical scores to free-text format reviews written by people in online review websites. In order to exploit the fine-grained structural information of textual content, a review may be considered as a collection of sentences, each with its own sentiment orientation and score. In this manner, a score aggregation method is needed to combine sentence-level scores into an overall review rating. While recent work has concentrated on designing effective sentence-level prediction methods, there remains the problem of finding efficient algorithms for score aggregation. In this study, we investigate different aggregation methods, as well as the cases in which they perform poorly. According to the analysis of existing methods, we propose a new score aggregation method based on the Dempster-Shafer theory of evidence. In the proposed method, we first detect the polarity of reviews using a machine learning approach and then, consider sentence scores as evidence for the overall review rating. The results from two public social web datasets show the higher performance of our method in comparison with existing score aggregation methods and state-of-the-art machine learning approaches.

  13. 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.

  14. 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...

  15. Mindfulness-based interventions for chronic pain: Evidence and applications.

    Science.gov (United States)

    Majeed, Muhammad Hassan; Ali, Ali Ahsan; Sudak, Donna M

    2018-02-01

    Chronic pain is estimated to occur in from 5.5% to 33% of the world's adult population (Gureje et al., 1998). Chronic pain is frequently treated with opiates, which has produced an opiate addiction crisis (Dowell et al., 2016). Several non-pharmacological treatment alternatives can help manage chronic pain. There is moderate evidence that mindfulness-based interventions (MBIs) such as meditation, yoga, and stress reduction lower the perception of pain, increase mobility, improve functioning and well-being. By integrating MBIs and other therapeutic interventions in a multi-disciplinary pain management plan, clinicians can improve treatment outcomes and potentially decrease pain-related medication utilization. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Evidence-Based Practice Guideline: Fall Prevention for Older Adults.

    Science.gov (United States)

    Kruschke, Cheryl; Butcher, Howard K

    2017-11-01

    Falls are a major cause of injury and death annually for millions of individuals 65 and older. Older adults are at risk for falls for a variety of reasons regardless of where they live. Falls are defined as any sudden drop from one surface to a lower surface. The purpose of this fall prevention evidence-based practice guideline is to describe strategies that can identify individuals at risk for falls. A 10-step protocol including screening for falls, comprehensive fall assessment, gait and balance screening when necessary, and an individualized fall intervention program addressing specific fall risks is presented. Reassessing fall risk and fall prevention programs will ensure a proactive approach to reducing falls in the aging population. [Journal of Gerontological Nursing, 43(11), 15-21.]. Copyright 2017, SLACK Incorporated.

  17. Evidence-Based Psychological Treatments of Pediatric Mental Disorders.

    Science.gov (United States)

    Wu, Monica S; Hamblin, Rebecca J; Storch, Eric A

    2015-08-01

    With many youth presenting to primary care settings for mental health difficulties, knowledge of the respective evidence-based psychotherapies is imperative in ensuring that these youth receive the appropriate interventions in a timely manner. Most frequently, children present with internalizing and/or externalizing disorders, which cover a broad range of common pediatric mental disorders. Treatments of these disorders generally incorporate cognitive and/or behavioral components, which are derived from theoretical underpinnings and empirical support. Although the interventions share common components, they are distinctive in nature and are further tailored toward the idiosyncratic needs of children and their families. Careful consideration of the apposite intervention and individual needs of youth are pertinent to the effective amelioration of symptomology.

  18. 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.

  19. 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].

  20. Familial hyperlipidemia: Resolving a case using evidence-based medicine

    Directory of Open Access Journals (Sweden)

    Edison Benavides-Hernández

    2011-03-01

    Full Text Available Background: familial hypercholesterolemia (FH and familial hyperlipidemia combined (HFC are metabolic disorders of lipids associated with increase of the risk for cerebrovascular disease. Clinical case: 8-years-old Indigenous child with HFC presented right hemiparesis, motor aphasia and right central facial paralysis for a cerebral ischemic accident; in addition, he had altered lipid profile and family history of hypercholesterolemia. Methodology: this article used patient`s therapeutic approach using evidence-based medicine (EBM, started from a structured clinical question and PubMED search. Four systematic reviews were included. Discussion: statins are safe in children with HF and HFC are effective in improving lipid profile. EBM methodology could help to solve similar therapeutic problems.