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Practical Issues (practical + issues)
Selected AbstractsDefinitional and Practical Issues in the Assessment of Treatment IntegrityCLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 4 2005Keith S. Dobson Perepletchikova and Kazdin discuss the issue of establishing treatment integrity in the context of treatment outcome research. They offer important insights into the potential explanations for the conflicting results and suggest directions for future assessment and research designs. This commentary, in the context of Perepletchikova and Kazdin's paper, discusses (a) issues related to the definition and assessment of treatment integrity and its components and (b) the scientific, practical, and clinical applications of assessing treatment integrity. [source] Living with a terminal illness: patients' prioritiesJOURNAL OF ADVANCED NURSING, Issue 6 2004Helen Carter BSc MD MBChB MPH Background., Our understanding of terminal illness and its consequences has been predominantly based on models derived from expert definition, rather than the patient's perspective. More recently, quality of life tools have been developed to enable patient choice in responses. However, an even broader approach may be needed to help identify goals for care for patients who are terminally ill. Aim., The aim of this paper is to report on an exploratory, qualitative study exploring what people living with terminal illness considered were the areas of priority in their lives. Methods., Ten people living with terminal cancer were interviewed. Analysis of the interviews incorporated principles of narrative analysis and grounded theory. Findings., Over 30 categories were identified and collated into five inter-related themes (personal/intrinsic factors, external/extrinsic factors, future issues, perceptions of normality and taking charge) encompassing the issues of importance to all participants. Each theme focused on ,life and living' in relation to life as it was or would be without illness. Practical issues of daily living and the opportunity to address philosophical issues around the meaning of life emerged as important areas. The central theme, ,taking charge', concerned with people's levels of life engagement, was integrally connected to all other themes. Conclusions., The findings suggest that the way in which health professionals manage patients' involvement in matters such as symptom relief can impact on existential areas of concern. Understanding patients' perspectives in relation to each theme may assist health professionals to develop management strategies appropriate to their needs. The findings challenge some aspects of traditional ,expert-defined' outcome measures. As this was an exploratory study, further work is needed to test and develop the model presented. [source] Practical issues drawn from the implementation of the integrated test for Down syndrome screening into routine clinical practiceBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2007B Weisz We have evaluated a cohort of women booked for antenatal care at University College London Hospitals. The uptake of screening was 64.4% and was significantly higher (73 versus 46%) in women who booked before 14 weeks. Of the women who booked before 14 weeks, 96.8% opted for the integrated test (IT). Overall, 5.3% failed to attend for the second blood test. The false-positive rate in the women who had the IT was 2.9%. All 11 cases of Down syndrome were detected prenatally. Our study is the first to evaluate implementation of the IT into routine clinical practice. [source] Ethics Seminars: Withdrawal of Treatment in the Emergency Department,When and How?ACADEMIC EMERGENCY MEDICINE, Issue 12 2006Kelly Bookman MD Abstract Although increasing discussion has occurred within emergency medicine about indications for withholding cardiac life support and other resuscitative interventions, emergency physicians (EPs) may be less familiar with the ethical, legal, and practical issues surrounding withdrawal of life support that has already been initiated. Both physicians and out-of-hospital personnel must act rapidly in critical situations and must assume that the patient has the desire to be resuscitated, unless clear evidence exists to the contrary. Often, only after initial life-saving actions have stabilized the patient is there time to reflect and determine a patient's desires regarding such interventions. When the EP can clearly discern a patient's previously stated wishes during the emergency department (ED) stay, these wishes should be honored in the ED. Respecting a patient's request to avoid unwanted, invasive treatments near death may involve withdrawing interventions that could not be withheld during the first few minutes of care. In this article, the authors use a case of out-of-hospital stabilization of a patient as a springboard to review the ethical and legal framework for withdrawal of life-sustaining care, as well as the practical issues involved with withdrawal of such care in the ED. [source] The Making of "America on the Move" at the National Museum of American HistoryCURATOR THE MUSEUM JOURNAL, Issue 1 2004Steven Lubar This case study examines the curatorial challenges of producing a very large exhibition at the Smithsonian's National Museum of American History from 1999 to 2003. This is an insider's look at how a cross-functional exhibition team worked to produce a compelling new exhibition. Among the issues addressed are: development of a theme; choice and use of artifacts; presentation organization and techniques; issues of truth, authenticity and accuracy in history exhibitions; and practical issues of exhibition team organization and contract management. [source] A national retinal screening programme for diabetes in ScotlandDIABETIC MEDICINE, Issue 12 2003G. P. Leese Abstract The Health Technology Board Scotland (HTBS) have issued recommendations for eye screening in patients with diabetes. These are based on evidence-based clinical studies. Evidence-based studies do not answer all the practical issues, and some conclusions have thus been extrapolated from the known evidence base. Other factors such as patient issues, organizational issues and cost effectiveness have also been incorporated into the recommendations. HTBS recommend single-field digital retinal photography. Retinal photography best addresses the issues of adequate sensitivity and accountable quality assurance. Non-mydriatic photography is recommended, followed by immediate use of dilating eye drops if it is unsuccessful, followed by slit-lamp examination if both of these approaches fail. An independent grading scheme has been established, which is similar to the ,Global', and compatible with the National Screening Committee (NSC) grading scheme. The rationale for these recommendations, and debate behind some of the decisions, is laid out in this article. [source] Statistical Analysis of Microarray DataADDICTION BIOLOGY, Issue 1 2005Mark Reimers Microarrays promise dynamic snapshots of cell activity, but microarray results are unfortunately not straightforward to interpret. This article aims to distill the most useful practical results from the vast body of literature availalable on microarray data analysis. Topics covered include: experimental design issues, normalization, quality control, exploratory analysis, and tests for differential expression. Special attention is paid to the peculiarities of low-level analysis of Affymetrix chips, and the multiple testing problem in determining differential expression. The aim of this article is to provide useful answers to the most common practical issues in microarray data analysis. The main topics are pre-processing (normalization), and detecting differential expression. Subsidiary topics include experimental design, and exploratory analysis. Further discussion is found at the author's web page (http://discover.nci.nih.gov, Notes on Microarray Data Analysis). [source] Getting ready for user involvement in a systematic reviewHEALTH EXPECTATIONS, Issue 2 2009Elizabeth Smith BSc MSc PhD Abstract Objective, This paper aims to support the critical development of user involvement in systematic reviews by explaining some of the theoretical, ethical and practical issues entailed in ,getting ready' for user involvement. Background, Relatively few health or social care systematic reviews have actively involved service users. Evidence from other research contexts shows that user involvement can have benefits in terms of improved quality and outcomes, hence there is a need to test out different approaches in order to realize the benefits of user involvement and gain a greater understanding of any negative outcomes. Design, Setting up a service-user reference group for a review of user involvement in nursing, midwifery and health visiting research involved conceptualizing user involvement, developing a representation framework, identifying and targeting service users and creating a sense of mutuality and reciprocity. Setting and participants, Recruitment was undertaken across England by two researchers. Members from 24 national consumer organizations were selected to participate in the review. Main variables studied, Learning was gained about finding ways of navigating consumer networks and organizations, how best to communicate our goals and intentions and how to manage selection and ,rejection' in circumstances where we had stimulated enthusiasm. Results and conclusions, Involving service users helped us to access information, locate the findings in issues that are important to service users and to disseminate findings. User involvement is about relationships in social contexts: decisions made at the early conceptual level of research design affect service users and researchers in complex and personal ways. [source] Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: Selected practical issues in their evaluation and management,HEPATOLOGY, Issue 1 2009Raj Vuppalanchi Nonalcoholic fatty liver disease (NAFLD) is among the most common causes of chronic liver disease in the western world. It is now recognized that these patients have myriad of important co-morbidities (e.g., diabetes, hypothyroidism and metabolic syndrome). The workup of patients with suspected NAFLD should consist of excluding competing etiologies and systemic evaluation of metabolic comorbidities. NAFLD is histologically categorized into steatosis and steatohepatitis, two states with fairly dichotomous natural history. While significant progress has been made in terms of noninvasively predicting advanced fibrosis, insufficient progress has been made in predicting steatohepatitis. Currently, liver biopsy remains the gold standard for the histological stratification of NAFLD. While sustained weight loss can be effective to treat NASH, it is often difficult to achieve. Foregut bariatric surgery can be quite effective in improving hepatic histology in selected patients without liver failure or significant portal hypertension. Thiazolidinediones have shown promise and the results from the ongoing, large multicenter study should become available soon. Large multicenter studies of CB, receptor anatagonists are also underway but their results will not be available for several years. Several recent studies have highlighted that cardiovascular disease is the single most important cause of morbidity and mortality in this patient population. Conclusion: Health care providers should not only focus on liver disease but also concentrate on aggressively modifying and treating their cardiovascular risk factors. (HEPATOLOGY 2009;49:306-317.) [source] Negotiating Children's Social Contexts in Jamaica: Ethics, Practicalities and Research MethodologiesIDS BULLETIN, Issue 3 2009Joy Moncrieffe Conducting research in contexts of violence requires sensitivity and prudence, particularly when the study involves children. This article outlines some of the ethical and practical issues that influenced ,how' researchers worked with children in selected inner-city Jamaican communities. It demonstrates the importance of self-reflection, recognising that researcher's social backgrounds may have much more weight than they acknowledge on the research process and product. [source] The ,fresh start' for individual debtors: social, moral and practical issues,INTERNATIONAL INSOLVENCY REVIEW, Issue 1 2008Jan C. van Apeldoorn The concept of a "fresh start" for individual debtors has been introduced in the Netherlands in 1998. Until then a natural person could be pursued for the debts he could not pay indefinitely. Their position was not different from the unfortunate debtors in many European countries to day. The entrance to the "fresh start- procedure" in the Netherlands is surrounded by impediments, the access is linked to the debtor in good faith, but after three years the fresh start comprises all debts (except student loans), none excluded. In the United States the fresh start doctrine is long established law, the entrance is easy, but many debts may be excluded. Because of public dissatisfaction in both countries the concept has changed. In the Netherlands many debts may now be excluded from the fresh start and in the United States a means test has been introduced. The two concepts of a fresh start for the natural person in both countries, originally so differnt in approach, now converged. Will the twain meet? Copyright © 2008 John Wiley & Sons, Ltd. [source] On the design of bandwidth efficient signalling for indoor wireless optical channelsINTERNATIONAL JOURNAL OF COMMUNICATION SYSTEMS, Issue 3 2005Steve HranilovicArticle first published online: 15 MAR 200 Abstract It is well known that indoor wireless optical channels are limited not only in transmitted optical power, but also in signalling bandwidth. This bandwidth constraint arises due to multipath dispersion in indoor settings as well as due to response time limitations of optoelectronic components. This paper presents an overview of theoretical and practical issues in the design of signalling for bandwidth constrained intensity modulated, direct detection wireless optical channels. A brief overview of the salient qualities of the wireless optical channel are presented to highlight the amplitude constraints which arise. A survey of modulation design is then presented which includes the review of a general technique to represent optical intensity modulation in a signal space and to construct optical intensity lattice codes. Results on the channel capacity of indoor wireless optical channels are surveyed and particular emphasis is placed on recently derived asymptotically exact bounds. The use of multiple emitters and receivers in wireless optical channels is also presented and particular emphasis is placed on techniques which exploit spatial dimensions to improve spectral performance. The paper concludes with some remarks regarding the status of the research area and suggestions for future work. Copyright © 2005 John Wiley & Sons, Ltd. [source] Distribution-based anomaly detection in 3G mobile networks: from theory to practiceINTERNATIONAL JOURNAL OF NETWORK MANAGEMENT, Issue 5 2010Alessandro D'Alconzo The design of anomaly detection (AD) methods for network traffic has been intensively investigated by the research community in recent years. However, less attention has been devoted to the issues which eventually arise when deploying such tools in a real operational context. We designed a statistical based change detection algorithm for identifying deviations in distribution time series. The proposed method has been applied to the analysis of a large dataset from an operational 3G mobile network, in the perspective of the adoption of such a tool in production. Our algorithm is designed to cope with the marked non-stationarity and daily/weekly seasonality that characterize the traffic mix in a large public network. Several practical issues emerged during the study, including the need to handle incompleteness of the collected data, the difficulty in drilling down the cause of certain alarms, and the need for human assistance in resetting the algorithm after a persistent change in network configuration (e.g. a capacity upgrade). We report on our practical experience, highlighting the key lessons learned and the hands-on experience gained from such an analysis. Finally, we propose a novel methodology based on semi-synthetic traces for tuning and performance assessment of the proposed AD algorithm. Copyright © 2010 John Wiley & Sons, Ltd. [source] Stroke units: many questions, some answersINTERNATIONAL JOURNAL OF STROKE, Issue 1 2009Blanca Fuentes Background The development of specialized stroke units has been a landmark innovation in acute stroke care. However, the high scientific evidence level for the recommendation for stroke units to provide clinical attention for acute stroke patients does not correspond to the level of stroke unit implementation. A narrative, nonsystematic review on published studies on stroke units was conducted, with special emphasis on those demonstrating their efficacy and effectiveness. We also attempt to provide some answers to several open questions regarding practical issues of stroke units. Summary of review Stroke units represent the most efficacious model for care provision compared with general ward care and stroke teams. Every stroke patient can benefit from stroke unit care. These units are efficient, cost-effective and their benefits are consistent over time. Compared with other specific stroke therapies such as aspirin or intravenous thrombolytic agents, stroke units have a higher target population and higher benefit in terms of number of deaths and/or dependencies avoided. New approaches in stroke unit management such as the implementation of noninvasive monitoring or alternative clinical pathways could improve their benefit even further. Conclusion Stroke units are cost-effective and need to be considered as a priority in health-care provision for stroke patients. [source] Learning to Support Children With Complex and Continuing Health Needs and Their FamiliesJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2007Helen Farasat PURPOSE.,This paper reports on the evaluation of a pilot placement for preregistration child health nursing students focused on supporting children with complex needs in their homes. CONCLUSIONS.,This type of placement can be beneficial in enabling students to develop practical skills, attitudes, and values that will assist them to provide appropriate support for this client group. The pilot placement clarified some of the major organizational and practical issues that must be considered. PRACTICE IMPLICATIONS.,Developing opportunities for preregistration nursing students to learn to support children with complex needs and their families is possible and potentially beneficial. [source] Researching ethnic diversity in the British NHS: methodological and practical concernsJOURNAL OF ADVANCED NURSING, Issue 4 2000Kate Gerrish BNurs MSc PhD RGN RM DN Cert Researching ethnic diversity in the British NHS: methodological and practical concerns The collection of data on ethnic groupings has become an increasingly pervasive feature of contemporary health policy and research in the United Kingdom, with attention concentrating primarily on monitoring access to and utilization of services by different ethnic groups, together with epidemiological data on morbidity and mortality. At the same time, the collection of data on ethnic populations by census and health agencies has been the subject of a wide-ranging and contentious debate and there is a growing critique that challenges the collection and use of such data on political, methodological and practical grounds. This paper explores the nature of these debates as they apply to health research. Issues of validity and reliability arising from the application of pre-defined ethnic categories, such as those used within the National Health Service derived from the 1991 census, are considered and alternative approaches which utilize a range of variables such as language, religion and length of residency in a country suggested. Experiences derived from an ethnographic study of the provision of district nursing care to patients from different ethnic backgrounds are used to illustrate some of the practical issues of researching ethnic diversity. Strategies for addressing some of the methodological and practical concerns are proposed. [source] Evaluating the power of monitoring plot designs for detecting long-term trends in the numbers of common guillemotsJOURNAL OF APPLIED ECOLOGY, Issue 3 2006MICHELLE SIMS Summary 1In recent years concerns have been raised regarding the status of the common guillemot Uria aalge in the UK. Numbers have declined in several regions, highlighting the need for continued monitoring of this internationally important population. However, the extent to which the current monitoring scheme is capable of detecting declines and options for improving efficiency has received little attention. 2We investigated the power of different monitoring design options for detecting long-term trends in abundance at a colony of guillemots. The ability to detect trends in abundance was reduced by the large temporal and spatial variability in colony attendance. Taking a linear mixed model approach, we obtained details on the sources and sizes of the variance components using count data collected from monitoring plots on the Isle of May, Scotland, and assessed how best to allocate sampling effort in the light of the count variability structure. 3Our results indicated that trend detection will be improved by counting birds in more plots rather than by increasing the number of counts at existing plots. 4The revisit pattern of counts at the monitoring plots during the seasonal counting period had little effect on trend detection power. However, given the practical issues associated with counting guillemots, alternative revisit patterns to the current approach are preferred. 5For a fixed number of visits per plot, power is strongly influenced by the choice of revisit design if the day-to-day variation in colony attendance is increased. 6Synthesis and applications. Aspects of the UK seabird monitoring scheme can be improved. Changes to the allocation of sampling effort and the plot-revisit pattern will improve both the statistical power to detect long-term trends and the efficiency of conducting the survey. We stress the importance of considering the structure and magnitude of the count variation in a power analysis because judicious design decisions depend on the relative magnitude of these variance components. [source] Computation and analysis of multiple structural change modelsJOURNAL OF APPLIED ECONOMETRICS, Issue 1 2003Jushan Bai In a recent paper, Bai and Perron (1998) considered theoretical issues related to the limiting distribution of estimators and test statistics in the linear model with multiple structural changes. In this companion paper, we consider practical issues for the empirical applications of the procedures. We first address the problem of estimation of the break dates and present an efficient algorithm to obtain global minimizers of the sum of squared residuals. This algorithm is based on the principle of dynamic programming and requires at most least-squares operations of order O(T2) for any number of breaks. Our method can be applied to both pure and partial structural change models. Second, we consider the problem of forming confidence intervals for the break dates under various hypotheses about the structure of the data and the errors across segments. Third, we address the issue of testing for structural changes under very general conditions on the data and the errors. Fourth, we address the issue of estimating the number of breaks. Finally, a few empirical applications are presented to illustrate the usefulness of the procedures. All methods discussed are implemented in a GAUSS program. Copyright © 2002 John Wiley & Sons, Ltd. [source] Staff Morale in Day Care Centres for Adults with Intellectual DisabilitiesJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 3 2007Katerina Mascha Background, Levels of burnout, job satisfaction and intended turnover of staff working in day care centres for adults with intellectual disabilities are investigated in relation to role clarity, staff support and supervision, and coping strategies used by staff. Materials and methods, Thirty six direct-care staff of four day care centres in the UK were administered the Maslach Burnout Inventory, The Staff Support Questionnaire (SSQ), and The Shortened Ways of Coping (Revised) Questionnaire (SWC-R). Results, Although staff reported high levels of job satisfaction, they experienced moderate degrees of emotional exhaustion and personal accomplishment and reported a high propensity to leave the service. Factors identified as relating to staff morale were staff support and supervision, role clarity, wishful thinking, staff cooperation, and other practical issues regarding the day-to-day running of the service. Conclusions, Staff in day care services for people with intellectual disabilities experience similar stressors to those experienced by staff in residential facilities with the informal culture of the service being of most importance to staff morale. Suggestions for the enhancement of staff morale are provided. [source] Psychological issues and treatments for people with diabetesJOURNAL OF CLINICAL PSYCHOLOGY, Issue 4 2001Richard R. Rubin This article examines psychological issues and their treatment among people with diabetes. The paper contains two main sections, one dealing with diagnosable clinical disorders, and the other with more mundane but nevertheless important subclinical problems in living with diabetes. We review the published literature on prevalence, manifestation, consequences, and treatment of psychological disorders in persons with diabetes, primarily depression, anxiety, and eating disorders. In describing everyday problems in living with diabetes we expand our sources beyond the published literature to include our own clinical and consulting experiences as well as our unpublished qualitative research. These problems include dietary restrictions, self-monitoring of blood glucose, taking insulin injections, and lack of support from family and health care professionals. We describe methods for dealing with such problems and discuss the tension between focusing on emotional distress versus practical issues of disease management. Finally, we briefly present some potentially positive consequences of living with diabetes so that readers can be aware of the inspirational aspects of personal experience with this disease. © 2001 John Wiley & Sons, Inc. J Clin Psychol 57: 457,478, 2001 [source] The place and function of power in community psychology: philosophical and practical issuesJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 4 2007Adrian T. Fisher Abstract Much of the training of psychologists in the western world follows a logical positivist, scientist-practitioner model based in scientific objectivity and removed from politics. In this paper, we explore issues around alternative understandings of the role and place of psychologists and psychological actions. In so doing, we discuss a number of issues of ontology, epistemology and pragmatics to demonstrate that the role and function of power in our society need to be addressed more directly and more politically in order for us to successfully achieve our roles as community psychologists. Copyright © 2007 John Wiley & Sons, Ltd. [source] Perspectives of parents and tutors on a self-management program for parents/guardians of children with long-term and life-limiting conditions: "a life raft we can sail along with" ,JOURNAL OF COMMUNITY PSYCHOLOGY, Issue 7 2008Julie Barlow The lay-led, community-based Supporting Parents Programme (SPP) aims to assist parents caring for children with long-term or life-limiting conditions through support and cognitive behavioral techniques. The value of the SPP from the perspectives of parent participants and tutors was examined in focus groups and telephone interviews. Data were analyzed using framework analysis. Parents perceived a commonality of emotions and practical issues, valued meeting similar others, felt less isolated, more positive, motivated, and more calm; some had found the "real me again." Changes were attributed to techniques learned. Parents were anxious of being cast adrift at the end of SPP. Tutors needed more support and additional training around child protection and confidentiality. © 2008 Wiley Periodicals, Inc. [source] Assessing Goodness of Fit of Item Response Theory Models: A Comparison of Traditional and Alternative ProceduresJOURNAL OF EDUCATIONAL MEASUREMENT, Issue 4 2003Clement A. Stone Testing the goodness of fit of item response theory (IRT) models is relevant to validating IRT models, and new procedures have been proposed. These alternatives compare observed and expected response frequencies conditional on observed total scores, and use posterior probabilities for responses across , levels rather than cross-classifying examinees using point estimates of , and score responses. This research compared these alternatives with regard to their methods, properties (Type 1 error rates and empirical power), available research, and practical issues (computational demands, treatment of missing data, effects of sample size and sparse data, and available computer programs). Different advantages and disadvantages related to these characteristics are discussed. A simulation study provided additional information about empirical power and Type 1 error rates. [source] Putting information back into biological communicationJOURNAL OF EVOLUTIONARY BIOLOGY, Issue 4 2010P. CARAZO Abstract At the heart of many debates on communication is the concept of information. There is an intuitive sense in which communication implies the transfer of some kind of information, probably the reason why information is an essential ingredient in most definitions of communication. However, information has also been an endless source of misunderstandings, and recent accounts have proposed that information should be dropped from a formal definition of communication. In this article, we re-evaluate the merits and the internal logic of information-based vs. information-free approaches and conclude that information-free approaches are conceptually incomplete and operationally hindered. Instead, we propose a functional notion of information that follows logically from previous adaptationist accounts. The ensuing definition of communication provides a wider, more inclusive theoretical scope that reflects more accurately the evolutionary scenario shaping animal signals. Additionally, it is a definition better equipped to deal with the extraordinary diversity of animal signals, facilitates the distinction of honest and deceptive signals at a proximate level and accommodates a number of conceptual and practical issues (e.g. redundancy, alerting components) that are lost when we fail to acknowledge the informative content of animal signals. [source] Dynamic modeling, stability, and energy efficiency of a quadrupedal walking machineJOURNAL OF FIELD ROBOTICS (FORMERLY JOURNAL OF ROBOTIC SYSTEMS), Issue 11 2001Ben Sheng Lin In the past, the dynamics of walking machines was studied based on very simple or simplified leg structures. A more complete dynamic model is essential for the further development of a practical walking machine. In this paper, the dynamic model of a realistic quadrupedal walking machine is derived for simulation and real-time control purposes. The walker has four cylindrical pantograph legs, and the whole system consists of twenty-nine links. The walking gait is wave gait with at least three feet on the ground at any time. Significant efforts have been made to improve the computational efficiency of the inverse dynamics, and the required CPU time is less than 10 ms on an IBM 3090. The derived dynamic model is then applied to study two practical issues of walking: dynamic stability and mechanical efficiency of different legs and gaits. Simulation results show clear advantages of one leg type over another, and of some walking strategies in terms of adjusting velocities, strokes, and duty factors for greater efficiency. © 2001 John Wiley & Sons, Inc. [source] Hierarchical related regression for combining aggregate and individual data in studies of socio-economic disease risk factorsJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 1 2008Christopher Jackson Summary., To obtain information about the contribution of individual and area level factors to population health, it is desirable to use both data collected on areas, such as censuses, and on individuals, e.g. survey and cohort data. Recently developed models allow us to carry out simultaneous regressions on related data at the individual and aggregate levels. These can reduce ,ecological bias' that is caused by confounding, model misspecification or lack of information and increase power compared with analysing the data sets singly. We use these methods in an application investigating individual and area level sociodemographic predictors of the risk of hospital admissions for heart and circulatory disease in London. We discuss the practical issues that are encountered in this kind of data synthesis and demonstrate that this modelling framework is sufficiently flexible to incorporate a wide range of sources of data and to answer substantive questions. Our analysis shows that the variations that are observed are mainly attributable to individual level factors rather than the contextual effect of deprivation. [source] Coating selection and tribological testing for engineering equipment applicationsLUBRICATION SCIENCE, Issue 2 2008S.E. Franklin This paper considers the process of selecting and testing coatings for parts in professional engineering equipment applications in relation to the needs of design engineers in industry and the practical issues encountered. A methodology for pre-selection of potential coating solutions is discussed and consideration is given to the practical implementation of testing strategies in order to obtain results that are pertinent to the application. Two example case studies are described and the results are discussed in terms of their practical relevance and use. Copyright © 2007 John Wiley & Sons, Ltd. [source] Traumatic axonal injury: practical issues for diagnosis in medicolegal casesNEUROPATHOLOGY & APPLIED NEUROBIOLOGY, Issue 2 2000J. F. Geddes In the 25 years or so after the first clinicopathological descriptions of diffuse axonal injury (DAI), the criterion for diagnosing recent traumatic white matter damage was the identification of swollen axons (,bulbs') on routine or silver stains, in the appropriate clinical setting. In the last decade, however, experimental work has given us greater understanding of the cellular events initiated by trauma to axons, and this in turn has led to the adoption of immunocytochemical methods to detect markers of axonal damage in both routine and experimental work. These methods have shown that traumatic axonal injury (TAI) is much more common than previously realized, and that what was originally described as DAI occupies only the most severe end of a spectrum of diffuse trauma-induced brain injury. They have also revealed a whole field of previously unrecognized white matter pathology, in which axons are diffusely damaged by processes other than head injury; this in turn has led to some terminological confusion in the literature. Neuropathologists are often asked to assess head injuries in a forensic setting: the diagnostic challenge is to sort out whether the axonal damage detected in a brain is indeed traumatic, and if so, to decide what , if anything , can be inferred from it. The lack of correlation between well-documented histories and neuropathological findings means that in the interpretation of assault cases at least, a diagnosis of ,TAI' or ,DAI' is likely to be of limited use for medicolegal purposes [source] Opioids and the Management of Chronic Severe Pain in the Elderly: Consensus Statement of an International Expert Panel with Focus on the Six Clinically Most Often Used World Health Organization step III Opioids (Buprenorphine, Fentanyl, Hydromorphone, Methadone, Morphine, Oxycodone)PAIN PRACTICE, Issue 4 2008Joseph Pergolizzi MD ,,Abstract Summary of consensus: 1.,The use of opioids in cancer pain:, The criteria for selecting analgesics for pain treatment in the elderly include, but are not limited to, overall efficacy, overall side-effect profile, onset of action, drug interactions, abuse potential, and practical issues, such as cost and availability of the drug, as well as the severity and type of pain (nociceptive, acute/chronic, etc.). At any given time, the order of choice in the decision-making process can change. This consensus is based on evidence-based literature (extended data are not included and chronic, extended-release opioids are not covered). There are various driving factors relating to prescribing medication, including availability of the compound and cost, which may, at times, be the main driving factor. The transdermal formulation of buprenorphine is available in most European countries, particularly those with high opioid usage, with the exception of France; however, the availability of the sublingual formulation of buprenorphine in Europe is limited, as it is marketed in only a few countries, including Germany and Belgium. The opioid patch is experimental at present in U.S.A. and the sublingual formulation has dispensing restrictions, therefore, its use is limited. It is evident that the population pyramid is upturned. Globally, there is going to be an older population that needs to be cared for in the future. This older population has expectations in life, in that a retiree is no longer an individual who decreases their lifestyle activities. The "baby-boomers" in their 60s and 70s are "baby zoomers"; they want to have a functional active lifestyle. They are willing to make trade-offs regarding treatment choices and understand that they may experience pain, providing that can have increased quality of life and functionality. Therefore, comorbidities,including cancer and noncancer pain, osteoarthritis, rheumatoid arthritis, and postherpetic neuralgia,and patient functional status need to be taken carefully into account when addressing pain in the elderly. World Health Organization step III opioids are the mainstay of pain treatment for cancer patients and morphine has been the most commonly used for decades. In general, high level evidence data (Ib or IIb) exist, although many studies have included only few patients. Based on these studies, all opioids are considered effective in cancer pain management (although parts of cancer pain are not or only partially opioid sensitive), but no well-designed specific studies in the elderly cancer patient are available. Of the 2 opioids that are available in transdermal formulation,fentanyl and buprenorphine,fentanyl is the most investigated, but based on the published data both seem to be effective, with low toxicity and good tolerability profiles, especially at low doses. 2.,The use of opioids in noncancer-related pain:, Evidence is growing that opioids are efficacious in noncancer pain (treatment data mostly level Ib or IIb), but need individual dose titration and consideration of the respective tolerability profiles. Again no specific studies in the elderly have been performed, but it can be concluded that opioids have shown efficacy in noncancer pain, which is often due to diseases typical for an elderly population. When it is not clear which drugs and which regimes are superior in terms of maintaining analgesic efficacy, the appropriate drug should be chosen based on safety and tolerability considerations. Evidence-based medicine, which has been incorporated into best clinical practice guidelines, should serve as a foundation for the decision-making processes in patient care; however, in practice, the art of medicine is realized when we individualize care to the patient. This strikes a balance between the evidence-based medicine and anecdotal experience. Factual recommendations and expert opinion both have a value when applying guidelines in clinical practice. 3.,The use of opioids in neuropathic pain:, The role of opioids in neuropathic pain has been under debate in the past but is nowadays more and more accepted; however, higher opioid doses are often needed for neuropathic pain than for nociceptive pain. Most of the treatment data are level II or III, and suggest that incorporation of opioids earlier on might be beneficial. Buprenorphine shows a distinct benefit in improving neuropathic pain symptoms, which is considered a result of its specific pharmacological profile. 4.,The use of opioids in elderly patients with impaired hepatic and renal function:, Functional impairment of excretory organs is common in the elderly, especially with respect to renal function. For all opioids except buprenorphine, half-life of the active drug and metabolites is increased in the elderly and in patients with renal dysfunction. It is, therefore, recommended that,except for buprenorphine,doses be reduced, a longer time interval be used between doses, and creatinine clearance be monitored. Thus, buprenorphine appears to be the top-line choice for opioid treatment in the elderly. 5.,Opioids and respiratory depression:, Respiratory depression is a significant threat for opioid-treated patients with underlying pulmonary condition or receiving concomitant central nervous system (CNS) drugs associated with hypoventilation. Not all opioids show equal effects on respiratory depression: buprenorphine is the only opioid demonstrating a ceiling for respiratory depression when used without other CNS depressants. The different features of opioids regarding respiratory effects should be considered when treating patients at risk for respiratory problems, therefore careful dosing must be maintained. 6.,Opioids and immunosuppression:, Age is related to a gradual decline in the immune system: immunosenescence, which is associated with increased morbidity and mortality from infectious diseases, autoimmune diseases, and cancer, and decreased efficacy of immunotherapy, such as vaccination. The clinical relevance of the immunosuppressant effects of opioids in the elderly is not fully understood, and pain itself may also cause immunosuppression. Providing adequate analgesia can be achieved without significant adverse events, opioids with minimal immunosuppressive characteristics should be used in the elderly. The immunosuppressive effects of most opioids are poorly described and this is one of the problems in assessing true effect of the opioid spectrum, but there is some indication that higher doses of opioids correlate with increased immunosuppressant effects. Taking into consideration all the very limited available evidence from preclinical and clinical work, buprenorphine can be recommended, while morphine and fentanyl cannot. 7.,Safety and tolerability profile of opioids:, The adverse event profile varies greatly between opioids. As the consequences of adverse events in the elderly can be serious, agents should be used that have a good tolerability profile (especially regarding CNS and gastrointestinal effects) and that are as safe as possible in overdose especially regarding effects on respiration. Slow dose titration helps to reduce the incidence of typical initial adverse events such as nausea and vomiting. Sustained release preparations, including transdermal formulations, increase patient compliance.,, [source] Molecular Contrast Optical Coherence Tomography: A Review,PHOTOCHEMISTRY & PHOTOBIOLOGY, Issue 2 2005Changhuei Yang ABSTRACT This article reviews the current state of research on the use of molecular contrast agents in optical coherence tomography (OCT) imaging techniques. After a brief discussion of the basic principle of OCT and the importance of incorporating molecular contrast agent usage into this imaging modality, we shall present an overview of the different molecular contrast OCT (MCOCT) methods that have been developed thus far. We will then discuss several important practical issues that define the possible range of contrast agent choice, the design criteria for engineered molecular contrast agent and the implementability of a given MCOCT method for clinical or biological applications. We will conclude by outlining a few areas of pursuit that deserve a greater degree of research and development. [source] | |||||||||||||||||||||||||||||||