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Objective Data (objective + data)
Selected AbstractsProfessional and economic factors affecting access to mammography: A crisis today, or tomorrow?,CANCER, Issue 3 2005Results from a national survey Abstract BACKGROUND Objective data and anecdotal reports have suggested that access to mammography may be declining because of facility closures and difficulty in recruiting and retaining radiologists and radiologic technologists. To gain insight into the practice patterns, use of emerging technologies, and concerns of breast imagers in current practice, the Society of Breast Imaging (SBI) conducted a national survey of breast imaging practices in the U.S. METHODS Between October 2003 and April 2004, the SBI conducted a survey of the SBI membership database, and received completed surveys from 575 breast imaging practices in the U.S. Responses to the survey regarding practice characteristics, the utilization of standard and emerging technologies, staffing, malpractice, finance, and morale were analyzed. RESULTS Job vacancies for radiologists who read mammograms were reported in 163 practices (29%), 59 of which (10%) had 2 or more openings. A higher proportion of practices with job openings had long appointment waiting times for asymptomatic women when compared with fully staffed practices. Unfilled fellowship positions also were common, with 41 of 65 practices that offer fellowships reporting 47 openings. Among 554 responding practices, 55% reported that someone in their practice was sued because of a mammography related case within the past 5 years, and 50% of practices reported that the threat of lawsuits made radiologist staffing "moderately" or "a lot" more difficult. Of 521 responding practices, 35% reported financial losses in 2002. One in 5 respondents reported that they would prefer to spend less time in mammography, and fewer than 1 in 3 would recommend a breast imaging fellowship to a relative or friend. Emerging technologies, such as breast magnetic resonance imaging and screening ultrasound, currently are being performed in many practices. CONCLUSIONS The survey results provide support for anecdotal reports that breast imaging practices face significant challenges and stresses, including shortages of key personnel, a lack of trainees, malpractice concerns, financial constraints, increased workload due to emerging technologies, low appeal of breast imaging as a career specialty, and the steady rise in the population of women of screening age. Cancer 2005. © 2005 American Cancer Society. [source] Sexually Transmitted Diseases Diagnosed Among Travelers Returning from the TropicsJOURNAL OF TRAVEL MEDICINE, Issue 2 2009Séverine Ansart MD Objectives Data are lacking on the spectrum of sexually transmitted diseases (STDs) diagnosed in returning travelers. Study Design All consecutive travelers consulting our tropical unit between November 1, 2002 and October 31, 2003 were included if they presented within 1 month after their return from the tropics, with mucocutaneous signs suggesting STDs. Results Forty-nine patients (12 women and 37 men; median age 36.4 y, 35 heterosexuals) were included. Four patients had traveled with their usual sexual partner and 45 patients had casual sex while abroad (31 with locals and 14 with other tourists). The main diagnoses were gonococcal urethritis (n = 18), herpes simplex virus 2 infection (n = 12), urethritis of undetermined origin (n = 9), Chlamydia trachomatis infection (n = 4), primary syphilis (n = 4), and primary human immunodeficiency virus infection (n = 2). Conclusions These results illustrate the broad spectrum of STDs contracted by travelers to the tropics. They suggest the need to also inform travelers of the risks of STD and to promote the use of condoms in case of casual sex while abroad. [source] Zoning Marine Protected Areas through Spatial Multiple-Criteria Analysis: the Case of the Asinara Island National Marine Reserve of ItalyCONSERVATION BIOLOGY, Issue 2 2002Ferdinando Villa Systematic, objective approaches to site selection and design can help reconcile conflicting interests, represent stakeholders' viewpoints fairly and evenly, and extend the scope of planning studies from single reserves to networks. We illustrate the use of spatial multiple-criteria analysis for determining the suitability of marine areas for different uses and levels of protection. This technique couples geographic information systems (GIS) for land assessment and evaluation with a formal statement of the design priorities as seen from the different viewpoints of all involved stakeholders. The planning process, while staying focused on the main purposes of conservation and feasibility, involves all the main interest groups in the definition of priorities so that conflicts and tensions are kept under control. We used multiple-criteria analysis to integrate objective data with the contrasting priorities of different stakeholders in the planning of a marine protected area. The results of the analysis can be used to define an optimal spatial arrangement of different protection levels. As a case study, we developed a zoning plan for one of the first marine protected areas in Italy, the Asinara Island National Marine Reserve. Resumen: Puesto que el papel de las áreas marinas protegidas está siendo mejor entendido y se está volviendo más sofisticado, la planeación para abordar eficientemente estas áreas se está volviendo más complicada para las personas que toman decisiones. Las metodologías sistemáticas y objetivas para la selección de sitios y el diseño de reservas pueden ayudar a reconciliar los conflictos de intereses, representar los puntos de vista de los usuarios de manera equitativa y balanceada y extender la dimensión de los estudios de planeación para reservas individuales o en redes. Ilustramos el uso de un análisis de criterios espaciales múltiples para determinar la viabilidad de áreas marinas para diferentes usos y niveles de protección. Esta técnica une sistemas de información geográfica (GIS) para estimación y evaluación de suelos con una declaración de prioridades de diseño tal y como es percibida por los diferentes usuarios involucrados. El proceso de planeación, al mismo tiempo que se enfoca en los propósitos principales de la conservación y en su viabilidad, involucra a los principales grupos interesados en la definición de prioridades de tal manera que los conflictos y tensiones pueden ser manejadas. Utilizamos el análisis de criterios espaciales múltiples para integrar datos objetivos con las prioridades contrastantes de los diferentes usuarios en la planeación de un área marina protegida. Los resultados del análisis pueden ser usados como una guía para definir arreglos espaciales óptimos con diferentes niveles de protección. Como caso de estudio desarrollamos un plan de desarrollo de zonificación para una de las áreas marinas protegidas de Italia, la Reserva Nacional Marina de la Isla Asinara. [source] Determination of gaseous and particulate carbonyls in air by gradient-elution micellar electrokinetic capillary chromatographyELECTROPHORESIS, Issue 19 2008Hui Sun Abstract A new continuous-flow gradient-elution micellar electrokinetic capillary chromatography method is developed for the determination of airborne carbonyls after derivatization with 2,4-dinitrophenylhydrazine. A total of 16 carbonyls can be determined with detection limits ranging from 0.94 to 8.50,mg/L, working range from 4.72 to 346,mg/L, and repeatabilities (relative standard deviation, n=5) from 1.23 to 4.6% or 3.93 to 7.6% for migration time and peak area, respectively. Coupling with denuder-filter sampling, a preliminary survey has been conducted to determine gaseous and particulate carbonyls from air sampled at a roadside station. The method is shown to have sufficient sensitivity for 1-h sampling of ambient carbonyls with detection limits ranging from 0.045 to 1.2,,g/m3 and working range from 0.11 to 43.3,,g/m3 at a flow rate of 10,Lpm. The method requires minimal modification of commercially available capillary electrophoresis equipment and can differentiate gaseous and particulate carbonyls to provide essential information and objective data for adopting effective measures to combat the discharge of carbonyl compounds to the atmosphere. [source] A study of the effect of a resistive heat moisture exchanger (trachinaze) on pulmonary function and blood gas tensions in patients who have undergone a laryngectomy: A randomized control trial of 50 patients studied over a 6-month periodHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2003Andrew Simpson Jones MD Abstract Background. Previous work from this department has shown that resistive tracheostomy filters increase the partial pressure of oxygen in capillary blood and also provide a significant amount of heat/moisture exchange. Until now it has not been shown whether there is any long-term beneficial effect and in particular whether raised tissue oxygenation is maintained using a practical filter device. Methods. We carried out a 6-month randomized control trial including 50 laryngectomees. Twenty-five patients were treated with the Liverpool Heat Moisture Exchange device incorporating an airway resistor (Trachinaze). Another 25 patients were treated with a placebo device. Relevant subjective and objective data were collected before and at the end of the study. The objective measurements were capillary oxygen tension (which parallels blood arterial tension), carbon dioxide tension, FEV1, FVC, and PIF. Patients were reviewed at intervals throughout the study. Data were analyzed using the Mann,Whitney U test and the paired t test to test the difference between the active device and placebo at 6 months. Results. Subjective lower airway parameters, including cough, number of chest infections, mucus production, and shortness of breath at rest, were significantly improved in the active group compared with the placebo group. The objective parameters FEV1, FVC, and PIF were not significantly different. Capillary oxygen tension, however, was highly significantly raised in the active group at 6 months. Conclusions. Trachinaze is highly superior to placebo at improving subjective pulmonary parameters, including shortness of breath. It is also superior in its ability to maintain an increased peripheral tissue oxygen tension over a 6-month period. © 2003 Wiley Periodicals, Inc. Head Neck 25: 000,000, 2003 [source] Further experience with botox injection for tracheoesophageal speech failureHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2001Jan S. Lewin PhD Abstract Background Some patients fail to acquire tracheoesophageal (TE) speech after laryngectomy because of pharyngeal constrictor hypertonicity. Botox injection relieves hypertonicity, but there are little objective data regarding outcomes, duration of effect, and reinjection rates. Methods Hypertonicity was identified by means of insufflation testing and confirmed videofluoroscopically in 23 unsuccessful TE speakers. Each patient received an EMG-guided Botox injection. Additional injections were offered if the first injection failed to produce fluent speech. Results Overall, 20 of 23 patients (87%) achieved fluent TE speech production after Botox injections; 5 after additional injections. Two patients declined further intervention, and 1 failed to achieve fluent TE speech production even after 3 Botox injections. The longest sustained effect was 37 months, the shortest was 5 months for 1 patient who required reinjection of Botox to maintain her TE speech production. Conclusions Botox injection relieves constrictor hypertonicity in selected cases of TE speech failure with little need for reinjection to maintain long-term speech success. © 2001 John Wiley & Sons, Inc. Head Neck 23: 456,460 2001. [source] Workplace performance: a comparison of subjective and objective measures in the 2004 Workplace Employment Relations SurveyINDUSTRIAL RELATIONS JOURNAL, Issue 2 2008John Forth ABSTRACT Understanding what determines workplace performance is important for a variety of reasons. In the first place, it can inform the debate about the UK's low productivity growth. It also enables researchers to determine the efficacy of different organisational practices, policies and payment systems. In this article, we examine not the determinants of performance but how it is measured. Specifically, we assess the alternative measures of productivity and profitability that are available in the 2004 Workplace Employment Relations Survey (WERS). Previous WERS have been an important source of data in research into workplace performance. However, the subjective nature of the performance measures available in WERS prior to 2004 has attracted criticism. In the 2004 WERS, data were again collected on the subjective measure but, in addition, objective data on profitability and productivity were also collected. This allows a comparison to be made between the two types of measures. A number of validity tests are undertaken and the main conclusion is that subjective and objective measures of performance are weakly equivalent but that differences are also evident. Our findings suggest that it would be prudent to give most weight to results supported by both types of measure. [source] Testicular carcinoma in situ in subfertile Danish menINTERNATIONAL JOURNAL OF ANDROLOGY, Issue 4 2007Inge A. Olesen Summary Carcinoma in situ (CIS) testis is the precursor stage for the majority of testicular germ cell tumours (TGCT). Infertility is one of the conditions known to predispose to TGCT, but based on scarce existing data, the prevalence of CIS in this risk group was estimated at only approximately 1%. To establish more objective data, we investigated retrospectively the prevalence of CIS based on testicular biopsies performed in a well-defined group of subfertile males. We included 453 patients who had testicular biopsies performed for infertility reasons during 1995,2005 at the Copenhagen University Hospital (Rigshospitalet). Biopsies were evaluated by two experienced observers independently. CIS was detected in 10 individuals, of whom three had bilateral CIS, corresponding to a prevalence of 2.2% (95% CI 1.1,4.0%). This is greater than the estimated risk of 0.45% for the age- and birth cohort-matched general Danish population. All patients with CIS testis had severe oligozoospermia (,2.06 million/mL). We confirmed that a thorough examination of men suffering from subfertility/infertility can identify those with an increased risk for testicular neoplasia and recommend performing bilateral biopsies, especially in the subpopulation of men with atrophic testicles, severe oligozoospermia and/or irregular ultrasonic pattern of their testicles. [source] A framework guiding critical thinking through reflective journal documentation: A Middle Eastern experienceINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 4 2007Elaine Simpson PhD RN The purpose of this paper is to present a framework to guide critical thinking through reflective journaling, and describe how a group of 20 Middle Eastern nurses used reflective journaling to enhance their practice. Journal documentation was used during clinical practicum to foster the development of critical thinking in order to assist nurses when analysing and evaluating their clinical experiences. The findings from this study demonstrated that nurses accepted the framework for journal documentation because it provided structure for reflection, speculation, synthesis and metacognition of events experienced during clinical practice. Journaling gave nurses the opportunity to transfer thoughts onto paper and write down subjective and objective data, and created dialogue between the nurse educators and nurses. They were engaged in productive and positive activity to enhance their nursing practice. Nurses also commented that writing helped to develop their confidence in writing English. [source] The effectiveness of silver-releasing dressings in the management of non-healing chronic wounds: a meta-analysisJOURNAL OF CLINICAL NURSING, Issue 5 2009Shu-Fen Lo Aim., The purpose of this study was to examine the efficacy of silver-releasing dressings in the management of non-healing chronic wounds. Background., Non-healing chronic wounds often have a negative physical impact on patients and place a financial burden on healthcare systems. Silver dressings are wound products designed to control infection and provide a wound environment conducive to healing. However, validation of the clinical efficacy of these dressings is lacking. Design., Systematic review and meta-analysis. Methods., A systematic search of the major electronic databases PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO, OCLC and Proquest between 1950,June 2007 was conducted. Hand searches of selected periodicals, textbooks and checking reference lists and contacting experts was also performed. Results., Eight studies were selected from a potentially relevant 1957 references screened. Analysis incorporated data from 1399 participants in the eight randomised control trials. We found that silver dressings significantly improved wound healing (CI95: 0·16,0·39, p < 0·001), reduced odour (CI95: 0·24,0·52, p < 0·001) and pain-related symptoms (CI95: 0·18,0·47, p < 0·001), decreased wound exudates (CI95: 0·17,0·44, p < 0·001) and had a prolonged dressing wear time (CI95: 0·19,0·48, p = 0·028) when compared with alternative wound management approaches. An analysis of sensitivity in these studies by subgroup analysis generally supported these associations. Furthermore, studies indicated an improvement in quality of life (CI95: 0·04,0·33, p = 0·013) using silver dressings in wound management with no associated severe adverse events. Conclusion., This meta-analysis confirms the effectiveness of silver dressings in wound healing and improving patients' quality of life. However, it also highlights the need for additional well-designed randomised controlled trials to evaluate the effectiveness of silver-related dressings further. Relevance to clinical practice., The results of this study provide objective data on the effectiveness of silver-related dressing when applied to non-healing chronic wounds. [source] Meta-analysis of the effects of respiratory rehabilitation programmes on exercise capacity in accordance with programme characteristicsJOURNAL OF CLINICAL NURSING, Issue 1 2007HyunSoo Oh PhD Aims and objectives., This study was performed to investigate the effects of respiratory rehabilitation programmes on exercise capacity in terms of the programme type, the protocol used and other programme characteristics. Background., As the suitable rehabilitation programmes have not been specified, diverse programmes are provided in clinics. Design., Meta-analysis of the primary study results Methods., A computerized search through MEDLINE and CINHAL in addition to tracking down references cited in bibliographies of primarily searched studies were performed to obtain sample studies. Finally 19 research reports were examined. Results., The results of meta-regression showed that the combined effect size of the programmes on exercise capacity was unaffected by forced expiratory volume (in one second), age, the duration and frequency of the programme, or study quality. In addition, the results of meta- anova indicated that the combined effect size was not affected by (i) whether a programme was hospital based or not, (ii) whether a programme was lower-extremity or combined low- and upper-extremity exercise training, (iii) measurement time, and (iv) exercise intensity. Conclusions., The effects of programmes on exercise capacity were not differed in terms of the places where rehabilitation programmes were applied, programme content, measurement time, exercise target sites of body, and the duration and frequency of the programme. Relevance to clinical practice., The results of the present study can provide objective data when constructed or applied on a respiratory rehabilitation programme in clinics. [source] The role of the hospitalist in quality improvement: Systems for improving the care of patients with acute coronary syndrome,JOURNAL OF HOSPITAL MEDICINE, Issue S4 2010Chad T. Whelan MD Abstract Quality improvement (QI) initiatives for systems of care are vital to deliver quality care for patients with acute coronary syndrome (ACS) and hospitalists are instrumental to the QI process. Core hospitalist competencies include the development of protocols and outcomes measures that support quality of care measures established for ACS. The hospitalist may lead, coordinate, or participate in a multidisciplinary team that designs, implements, and assesses an institutional system of care to address rapid identification of patients with ACS, medication safety, safe discharge, and meeting core measures that are quality benchmarks for ACS. The use of metrics and tools such as process flow mapping and run charts can identify quality gaps and show progress toward goals. These tools may be used to assess whether critical timeframes are met, such as the time to fibrinolysis or percutaneous coronary intervention (PCI), or whether patients receive guideline-recommended medications and counseling. At the institutional level, Project BOOST (Better Outcomes for Older Adults Through Safe Transitions) is an initiative designed to improve outcomes in elderly patients who are at higher risk for adverse events during the transition from inpatient to outpatient care. BOOST offers resources related to project management and data collection, and tools for patients and physicians. Collection and analysis of objective data are essential for documenting quality gaps or achievement of quality benchmarks. Through QI initiatives, the hospitalist has an opportunity to contribute to an institution's success beyond direct patient care, particularly as required for public disclosure of institutional performance and financial incentives promoted by regulatory agencies. Journal of Hospital Medicine 2010;5:S1,S7. © 2010 Society of Hospital Medicine. [source] Peripheral Atherectomy: A Critical ReviewJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 6 2007TROY A. BUNTING M.D. Atherectomy is experiencing increased interest from endovascular specialists as a therapeutic treatment in the peripheral arteries. Long studied in the coronary vasculature, atherectomy has several theoretical advantages that make it uniquely suited for the peripheral circulation. In particular, infra-inguinal peripheral arterial disease experiences physiologic stresses and forces that have made traditional percutaneous coronary treatments such as angioplasty and stenting not as successful. Restenosis has been a major problem for angioplasty and stenting alone. The SilverHawk atherectomy device has favorable short-term data but important longer-term data are limited and need further study. Laser atherectomy also has favorable applications in niche patients but the number of studies is limited. Unfortunately, athero-ablative technologies for peripheral arterial disease require more definitive objective data regarding 12-month and longer-term outcomes in order to obtain widespread scientific acceptance. [source] Institutional Performance And Social Capital: An Application To The Local Government LevelJOURNAL OF URBAN AFFAIRS, Issue 5 2005Hilde Coffé This literature reveals that societies characterized by higher levels of social capital tend to achieve superior performance. Still, enquiries to date predominantly concentrate on country-level data or large sub-national units. The primary purpose of this article is to extend the empirical work to the local government level, while retaining the use of objective data to gauge institutional performance. This use of local data has the advantage of increasing the data set available and provides a more stringent test of the effect of social capital because social capital is likely to vary less at lower levels of government. The results,based on an empirical analysis of 305 Flemish municipalities in 2000,support the view that social capital leads to government (out)performance also at the local level of government. [source] The nature and extent of landscape change under land resettlement programmes in ZimbabweLAND DEGRADATION AND DEVELOPMENT, Issue 5 2006J. A. Elliott Abstract Issues of land and further resettlement are central within the inter related crises that Zimbabwe is currently understood to be experiencing. This paper presents objective data that has not been available to date, concerning the landscape outcomes of the resettlement programme in Zimbabwe as it was implemented in the first two decades after independence. Sequential aerial photograph interpretation and GIS techniques are used to document and explore spatial patterns of resource use, landscape structure and change. Based on 21 resettlement villages across three scheme areas, the analysis explicitly considers the role of national drivers (of the relatively consistent policy and procedures during that time), of agro-ecology and of multidirectional transformations at the village level to raise understanding of these outcomes. The implications of these findings and the value of the methodological techniques for the design and monitoring of further resettlement in the country and the wider region are suggested. Copyright © 2006 John Wiley & Sons, Ltd. [source] Population genetics of Galápagos land iguana (genus Conolophus) remnant populationsMOLECULAR ECOLOGY, Issue 23 2008ATHANASIA C. TZIKA Abstract The Galápagos land iguanas (genus Conolophus) have faced significant anthropogenic disturbances since the 17th century, leading to severe reduction of some populations and the extinction of others. Conservation activities, including the repatriation of captive-bred animals to depleted areas, have been ongoing since the late 1970s, but genetic information has not been extensively incorporated. Here we use nine species-specific microsatellite loci of 703 land iguanas from the six islands where the species occur today to characterize the genetic diversity within, and the levels of genetic differentiation among, current populations as well as test previous hypotheses about accidental translocations associated with early conservation efforts. Our analyses indicate that (i) five populations of iguanas represent distinct conservation units (one of them being the recently discovered rosada form) and could warrant species status, (ii) some individuals from North Seymour previously assumed to be from the natural Baltra population appear related to both Isabela and Santa Cruz populations, and (iii) the five different management units exhibit considerably different levels of intrapopulation genetic diversity, with the Plaza Sur and Santa Fe populations particularly low. Although the initial captive breeding programmes, coupled with intensive efforts to eradicate introduced species, saved several land iguana populations from extinction, our molecular results provide objective data for improving continuing in situ species survival plans and population management for this spectacular and emblematic reptile. [source] The risk of lower urinary tract symptoms five years after the first delivery,NEUROUROLOGY AND URODYNAMICS, Issue 1 2002Lars Viktrup Abstract Aim of the study To estimate the prevalence and 5-year incidence of lower urinary tract symptoms (LUTS) after the first delivery and to evaluate the impact of pregnancy per se and delivery per se on long-lasting symptoms. Materials and methods A longitudinal cohort study of 305 primiparae questioned a few days, 3 months, and 5 years after their delivery. The questionnaire used was tested and validated, and the questions were formulated according to the definitions of the International Continence Society (ICS). Maternal, obstetric, and neonatal data concerning every delivery and objective data concerning surgeries during the observation period were obtained from the records. From the sample of 278 women (91%) who responded 5 years after their first delivery, three subpopulations were defined: 1) women without initial LUTS before or during the first pregnancy or during the puerperal period, 2) women with onset of LUTS during the first pregnancy, and 3) women with onset of LUTS during the first puerperium. The risk of LUTS 5 years after the first delivery was examined using bivariate analyses. The obstetric variables in the bivariate tests with a significant association with long-lasting urinary incontinence were entered into a multivariate logistic regression. Results The prevalence of stress and urge incontinence 5 years after first delivery was 30% and 15%, respectively, whereas the 5-year incidence was 19% and 11%, respectively. The prevalence of urgency, diurnal frequency, and nocturia 5 years after the first delivery was 18%, 24%, and 2%, respectively, whereas the 5-year incidence was 15%, 20%, and 0.5%, respectively. The prevalence of all LUTS except nocturia increased significantly during the 5 years of observation. The risk of long-lasting stress and urge incontinence was related to the onset and duration of the symptom after the first pregnancy and delivery in a dose-response,like manner. Vacuum extraction at the first delivery was used significantly more often in the group of women with onset of stress incontinence during the first puerperium, whereas an episiotomy at the first delivery was performed significantly more often in the group of women with onset of stress incontinence in the 5 years of observation. The prevalence of urgency and diurnal frequency 5 years after the first delivery was not increased in women with symptom onset during the first pregnancy or puerperium compared with those without such symptoms. The frequency of nocturia 5 years after the first delivery was too low for statistical analysis. Conclusion The first pregnancy and delivery may result in stress and urge incontinence 5 years later. Women with stress and urge incontinence 3 months after the first delivery have a very high risk of long-lasting symptoms. An episiotomy or a vacuum extraction at the first delivery seems to increase the risk. Subsequent childbearing or surgery seems without significant contribution. Long-lasting urgency, diurnal frequency, or nocturia cannot be predicted from onset during the first pregnancy or puerperium. Neurourol. Urodynam. 21:2,29, 2002. © 2002 Wiley-Liss, Inc. [source] Prevalence of obesity in DenmarkOBESITY REVIEWS, Issue 3 2007P. Due Summary There has been a pronounced, distinctive increase of the prevalence of obesity within almost all age groups of the Danish population, during the last 25,30 years. The largest increase has been documented in studies based on objective data from total populations and the latest data show the increase will continue. The Danish studies show heterogeneity in the development of the obesity epidemic. A close association with birth cohorts indicates a need for further aetiological research, not only into behavioural factors, but also into early life factors that may explain some of this developmental pattern. [source] Soft reliability: an interdisciplinary approach with a user,system focusQUALITY AND RELIABILITY ENGINEERING INTERNATIONAL, Issue 1 2009A. Koca Abstract A recent trend in technological innovation is towards the development of increasingly multifunctional and complex products to be used within rich socio-cultural contexts such as the high-end office, the digital home, and professional or personal healthcare. One important consequence of the development of strongly innovative products is a growing market uncertainty regarding ,if', ,how', and ,when' users can and will adopt such products. Often, it is not even clear to what extent these products are understood and interacted with in the intended manner. The mentioned problems have already become an evident concern in the field, where there is a significant rise in the numbers of seemingly sound products being complained about, signaling a lack of soft reliability. In this paper, we position soft reliability as a growing and critical industrial problem, whose solution requires new academic expertise from various disciplines. We illustrate potential root causes for soft reliability problems, such as discrepancy between the perceptions of users and designers. We discuss the necessary approach to effectively capture subjective feedback data from actual users, e.g. when they contact call centers. Furthermore, we present a novel observation and analysis approach that enables insight into actual product usage, and outline opportunities for combining such objective data with the subjective feedback provided by users. Copyright © 2008 John Wiley & Sons, Ltd. [source] Ethics and Genetic Selection in Purebred DogsREPRODUCTION IN DOMESTIC ANIMALS, Issue 1 2003VN Meyers-Wallen Contents There is an ongoing revolution in medicine that is changing the way that veterinarians will be counselling clients regarding inherited disorders. Clinical applications will emerge rapidly in veterinary medicine as we obtain new information from canine and comparative genome projects (Meyers-Wallen 2001: Relevance of the canine genome project to veterinary medical practice. International Veterinary Information Service, New York). The canine genome project is described by three events: mapping markers on canine chromosomes, mapping gene locations on canine chromosomes (Breen et al. 2001: Genome Res. 11, 1784,1795), and obtaining the nucleotide sequence of the entire canine genome. Information from such research has provided a few DNA tests for single gene mutations [Aguirre 2000: DNA testing for inherited canine diseases. In: Bonagura, J (ed), Current Veterinary Therapy XIII. Philadelphia WB Saunders Co, 909,913]. Eventually it will lead to testing of thousands of genes at a time and production of DNA profiles on individual animals. The DNA profile of each dog could be screened for all known genetic disease and will be useful in counselling breeders. As part of the pre-breeding examination, DNA profiles of prospective parents could be compared, and the probability of offspring being affected with genetic disorders or inheriting desirable traits could be calculated. Once we can examine thousands of genes of individuals easily, we have powerful tools to reduce the frequency of, or eliminate, deleterious genes from a population. When we understand polygenic inheritance, we can potentially eliminate whole groups of deleterious genes from populations. The effect of such selection on a widespread basis within a breed could rapidly improve health within a few generations. However, until we have enough information on gene interaction, we will not know whether some of these genes have other functions that we wish to retain. And, other population effects should not be ignored. At least initially it may be best to use this new genetic information to avoid mating combinations that we know will produce affected animals, rather than to eliminate whole groups of genes from a population. This is particularly important for breeds with small gene pools, where it is difficult to maintain genetic diversity. Finally, we will eventually have enough information about canine gene function to select for specific genes encoding desirable traits and increase their frequencies in a population. This is similar to breeding practices that have been applied to animals for hundreds of years. The difference is that we will have a large pool of objective data that we can use rapidly on many individuals at a time. This has great potential to improve the health of the dog population as a whole. However, if we or our breeder clients make an error, we can inadvertently cause harm through massive, rapid selection. Therefore, we should probably not be advising clients on polygenic traits or recommend large scale changes in gene frequencies in populations until much more knowledge of gene interaction is obtained. By then it is likely that computer modelling will be available to predict the effect of changing one or several gene frequencies in a dog population over time. And as new mutations are likely to arise in the future, these tools will be needed indefinitely to detect, treat and eliminate genetic disorders from dog populations. Information available from genetic research will only be useful in improving canine health if veterinarians have the knowledge and skills to use it ethically and responsibly. There is not only a great potential to improve overall canine health through genetic selection, but also the potential to do harm if we fail to maintain genetic diversity. Our profession must be in a position to correctly advise clients on the application of this information to individual dogs as well as to populations of dogs, and particularly purebred dogs. [source] Nasal Provocation Testing as an International Standard for Evaluation of Allergic and Nonallergic RhinitisTHE LARYNGOSCOPE, Issue 3 2005Jan Gosepath MD Abstract Standardized nasal provocation testing (NPT) has been shown to be a safe and very useful tool in the diagnosis of allergic and nonallergic rhinitis. However, in the United States, its use has been mostly limited to scientific investigations, and it has not yet been widely accepted as a standard diagnostic procedure in clinical practice. NPT aims to identify and quantify the clinical relevance of inhalant allergens or occupational irritants. During NPT, nasal respiratory mucosa is exposed to an airborne substance suspected to cause symptoms in the respective individual. Clinical reactions are monitored in a controlled and standardized fashion. Nasal secretions, symptoms such as itching, sneezing and, most importantly, nasal obstruction are assessed as well as ocular, bronchial, cutaneous, and systemic reactions. To achieve objective data on changes in nasal airflow and patency after the challenge, anterior rhinomanometry and acoustic rhinometry have been included in the standard protocol of NPT. By monitoring changes of nasal airflow on one hand and of nasal geometry on the other hand, these methods display nasal function in a graphic way just as speech and pure tone audiometry do for auditory function. Also, by their objective nature, these methods offer a clear and internationally comparable standard. This review outlines a protocol for NPT and discusses practical applications and clinical indications. The use of rhinomanometry and acoustic rhinometry as objective diagnostic tools is emphasized. For the diagnosis of allergic and occupational rhinitis, standardized NPT should be regarded as an international diagnostic standard. [source] Implicit Value Judgments in the Measurement of Health InequalitiesTHE MILBANK QUARTERLY, Issue 1 2010SAM HARPER Context: Quantitative estimates of the magnitude, direction, and rate of change of health inequalities play a crucial role in creating and assessing policies aimed at eliminating the disproportionate burden of disease in disadvantaged populations. It is generally assumed that the measurement of health inequalities is a value-neutral process, providing objective data that are then interpreted using normative judgments about whether a particular distribution of health is just, fair, or socially acceptable. Methods: We discuss five examples in which normative judgments play a role in the measurement process itself, through either the selection of one measurement strategy to the exclusion of others or the selection of the type, significance, or weight assigned to the variables being measured. Findings: Overall, we find that many commonly used measures of inequality are value laden and that the normative judgments implicit in these measures have important consequences for interpreting and responding to health inequalities. Conclusions: Because values implicit in the generation of health inequality measures may lead to radically different interpretations of the same underlying data, we urge researchers to explicitly consider and transparently discuss the normative judgments underlying their measures. We also urge policymakers and other consumers of health inequalities data to pay close attention to the measures on which they base their assessments of current and future health policies. [source] The impact of trained assistance on error rates in anaesthesia: a simulation-based randomised controlled trial,ANAESTHESIA, Issue 2 2009J. M. Weller Summary Trained assistance for the anaesthetist appears likely to improve safety in anaesthesia. However, there are few objective data to support this assumption, and the requirement for a trained assistant is not universally enforced. We applied a simulation-based model developed in previous work to test the hypothesis that the presence of a trained assistant reduces error in anaesthesia. Ten randomly selected anaesthetists, five trained anaesthetic technicians and five theatre nurses without training in anaesthesia participated in two simulated emergencies, with anaesthetists working alternately with a technician or a nurse. The mean (SD) error rate per scenario was 4.75 (2.9). There were significantly fewer errors in the technician group than the nurse group (33 vs 62, p = 0.01) and this difference remained significant when errors were weighted for severity. This provides objective evidence supporting the requirement for trained assistance to the anaesthetist, and furthermore, demonstrates that a simulation-based model can provide rigorous evidence on safety interventions in anaesthesia. [source] Behavioral change related to Wenchuan devastating earthquake in miceBIOELECTROMAGNETICS, Issue 8 2009Yonghong Li Abstract It has been suggested that some animals are much more capable of perceiving certain kinds of geophysical stimuli which may precede earthquakes than humans, but the anecdotal phenomena or stories about unusual animal behaviors prior to an earthquake should be interpreted with objective data. During the Wenchuan magnitude 8.0 earthquake that happened in Wenchuan county (31.0° north latitude, 103.4° east longitude) of Sichuan province, China, on May 12, 2008, eight mice were monitored for locomotor activity and circadian rhythm in constant darkness with temperature 22,24 °C and humidity 55,65% for 38 days. The ongoing monitoring of locomotor activity of mice in our laboratory made it possible to design a posteriori study investigating whether the earthquake was associated with any change in animal behavior. Based on analyzing the recorded data with single cosinor, we found that the locomotor activity dramatically decreased in six of these eight mice on day 3 before the earthquake, and the circadian rhythm of their locomotor activity was no longer detected. The behavioral change lasted for 6 days before the locomotor activity returned to its original state. Analyses of concurrent geomagnetic data showed a higher total intensity during the span when the circadian rhythm in locomotor activity weakened. These results indicated that the behaviors, including circadian rhythm and activity, in these mice indeed changed prior to the earthquake, and the behavioral change might be associated with a change of geomagnetic intensity. Bioelectromagnetics 30:613,620, 2009. © 2009 Wiley-Liss, Inc. [source] Methodological considerations of measuring disability in bipolar disorder: validity of the Multidimensional Scale of Independent FunctioningBIPOLAR DISORDERS, Issue 1-2 2007Stefanie Berns Objective:, Recent studies have highlighted the prevalence, severity and persistence of the disability associated with bipolar disorder (BPD). Reliable instruments are needed to support research into the factors associated with disability and treatment response. Contextual factors (e.g., availability of supported employment programs) can affect functionality, posing a challenge to such investigations. We present preliminary findings regarding the validity of the Multidimensional Scale of Independent Functioning (MSIF) in BPD. The MSIF provides discrete ratings of support separate from both role responsibility and performance quality in work, residential and educational environments. These distinctions allow the ,correction' for variability explained by contextual factors that allows the comparison of studies conducted in different environments and time. Methods:, Participants with BPD were administered the MSIF, the Social Adjustment Scale II (SAS-II) and an interview recording objective data regarding work, school and residential activities as part of an ongoing longitudinal study of BPD disability. Results:, Construct validity estimated using standardized Cronbach's alpha coefficient was 0.76 (n = 58). MSIF global ratings were significantly lower (reflecting higher functionality) for subjects engaged in productive activity compared with participants who were not active (t = ,3.6, p = 0.001) demonstrating external validity. Inter-rater reliability estimates ranged from 0.86 to 0.99 (n = 49). Significant, high correlations were demonstrated between comparable MSIF and SAS-II global ratings (criterion validity = 0.70,0.79) and low correlations were found between non-comparable ratings (discriminant validity = ,0.07 to ,0.35) (n = 14). Conclusion:, We conclude that the MSIF is a valid and reliable instrument optimally designed for studying determinants of disability and treatment response in BPD. [source] Health-related aspects of objectively measured daily physical activity in childrenCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 3 2008Magnus Dencker Summary It is well established that physical inactivity in adults is associated with increased mortality and morbidity. Whether daily physical activity level is related to risk factors for cardiovascular disease (CVD) in children has been debated. Furthermore, objective data on the habitual daily physical activity in children have at large been scarce in the literature. The main reason for this is the fact that daily physical activity is very difficult to measure in children. In recent years, a new device, the accelerometer, has emerged as a frequently used instrument for the measurement of daily physical activity. This review summarizes recently published studies that have used accelerometers to measure daily physical activity in children and related activity data to known risk factors for CVD. [source] | |||||||||||||||||||||||||||||||