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Tools Used (tool + used)
Kinds of Tools Used Selected AbstractsA Review of Psychometric Properties of Feeding Assessment Tools Used in NeonatesJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2008Tsu-Hsin Howe ABSTRACT Objective:, To appraise the psychometric properties of clinical feeding assessment tools used in a neonatal population. Data sources:, PubMed, OvidMedline, CINHAL, and PsycINFO databases from 1980 to 2007. Reference lists of all identified articles were also reviewed. Study selection:, Research reports written in English that utilized or validated clinical feeding assessment tools. Data extraction:, In total, 941 articles were reviewed. Seven neonatal clinical feeding assessment tools were identified and categorized into three groups: tools used for assessing either bottle-feeding or breastfeeding behaviors, tools used only for assessing bottle-feeding behaviors, and tools used only for assessing breastfeeding behaviors. Results:, The psychometric properties of none of the seven assessment tools identified were satisfactory, and the limited representativeness of the samples of the psychometric research was noted in all assessment tools identified. The Neonatal Oral-Motor Assessment Scale appeared to have been examined more thoroughly and showed more consistent results in psychometric properties than the others, despite its own limitations. Conclusions:, A psychometrically sound neonate feeding assessment tool has not yet been empirically validated. Clinicians who use these tools for clinical and research purposes should take into account this lack of evidence of psychometric soundness and interpret results of assessment with precautions. Well-designed research is needed to study the scientific integrity of these instruments for program evaluations in neonatal care. [source] The ,pros' and ,cons' of joint EMS and group certification: a Swedish case studyCORPORATE SOCIAL RESPONSIBILITY AND ENVIRONMENTAL MANAGEMENT, Issue 3 2007Thomas Zobel Abstract Small and medium-sized enterprises (SMEs) are collectively responsible for a significant portion of the total environmental burden worldwide. A common tool used by SMEs to improve their environmental performance is the environmental management system (EMS), which has the disadvantage that it has been developed with larger organizations in mind. A common approach used by Swedish SMEs to facilitate the implementation of an EMS is joint EMS and group certification. This paper evaluates this approach by means of a case study. It is found that the approach is effective for small and micro-sized companies in achieving ISO 14001 certification as fast and cost effectively as possible. A few short cuts including joint environmental policy and objectives and insufficient environmental organization are however threatening to undermine the trustworthiness of the approach. Notwithstanding these flaws, however, it must be concluded that the joint EMS approach is a good alternative for small and micro-sized companies. Copyright © 2006 John Wiley & Sons, Ltd and ERP Environment. [source] The Diabetes UK Mozambique Twinning Programme.DIABETIC MEDICINE, Issue 8 2010Results of improvements in diabetes care in Mozambique: a reassessment 6 years later using the Rapid Assessment Protocol for Insulin Access Diabet. Med. 27, 855,861 (2010) Abstract Objective, To assess improvements in diabetes care in Mozambique between 2003 and 2009 following the implementation of the Diabetes UK Twinning Programme. Methods, As in 2003, a Rapid Assessment Protocol was implemented from August to September 2009 in order to assess the improvements in diabetes care and impact of the Diabetes UK Twinning Programme. One hundred and eighty-four interviews were carried out at different levels of the health system in different areas of Mozambique. Results, The Diabetes UK Twinning Programme in Mozambique allowed the development of the first comprehensive non-communicable disease plan in sub-Saharan Africa. The other main improvements include a strengthening of the diabetes association with an 8-fold increase in membership, 265 health workers trained in diabetes care in all provinces, the development of patient education materials inspired by some Diabetes UK tools and the expansion of public awareness, particularly from events associated with World Diabetes Day. Conclusions, Much progress has been made in Mozambique with regard to diabetes and non-communicable diseases. Besides the direct impact of specific activities supported by Diabetes UK, this project allowed for ,collateral' benefits in the overall provision of diabetes care. As diabetes and non-communicable diseases have a low profile on the global health agenda, twinning partnerships based on rigorous needs assessment have the capacity to make significant improvements in diabetes care at a relatively low level of investment. Moreover, this study suggests that the tool used might be of value in assessing progress in health system strengthening as well as in conducting the initial needs assessment. [source] Resting Echocardiography for the Early Detection of Acute Coronary Syndromes in Chest Pain Unit PatientsECHOCARDIOGRAPHY, Issue 6 2010Vito Maurizio Parato M.D. Aim: The purpose of this study is to assess the ability of resting echocardiography to detect an acute coronary syndrome (ACS) before the occurrence of ischemic electrocardiogram (ECG) changes or troponin-T elevations. Methods: Four hundred and three patients who presented to the emergency room (ER) with chest pain, normal ECGs, and normal troponin-T levels were admitted to the cardiologist-run Chest Pain Unit (CPU) for further monitoring. They underwent serial resting echocardiography for monitoring of left ventricle wall motion (LVWM), ECG telemetry monitoring, and serial troponin-T measurements. Results: An ACS was detected in 49 patients (12.1%). These 49 patients were then subdivided into three different groups based on the initial mode of detection of their ACS. In group A, 16 of 49 (32.6%) patients had ACS shown by echocardiographic detection of LVWM abnormalities. In group B, 24 of 49 (48.9%) patients had an ACS detected by ischemic ECG changes. In group C, 9 of 49 (18.3%) patients had an ACS detected by troponin-T elevations. The shortest time interval between CPU-admission and ACS-detection occurred in group A (A vs. B, P < 0.003; A vs. C, P < 0.0001). In group A, cardiac angiogram showed that the culprit coronary lesion was more frequent in the circumflex artery (11 out of 16; 68.7%) (LCx vs. LAD, P < 0.02; LCx vs. RCA, P < 0.001) and of these 11 patients with circumflex lesions, the ECG was normal in eight (72.7%) patients. Conclusion: This study demonstrates the utility of LVWM monitoring by serial echocardiography as part of a diagnostic protocol that can be implemented in a CPU. Furthermore, echocardiography could become an essential tool used in the diagnosis of ACS secondary to circumflex lesions. (Echocardiography 2010;27:597-602) [source] A Case Study of Soil-Gas Sampling in Silt and Clay-Rich (Low-Permeability) SoilsGROUND WATER MONITORING & REMEDIATION, Issue 1 2009Todd A. McAlary Soil-gas sampling and analysis is a common tool used in vapor intrusion assessments; however, sample collection becomes more difficult in fine-grained, low-permeability soils because of limitations on the flow rate that can be sustained during purging and sampling. This affects the time required to extract sufficient volume to satisfy purging and sampling requirements. The soil-gas probe tubing or pipe and sandpack around the probe screen should generally be purged prior to sampling. After purging, additional soil gas must be extracted for chemical analysis, which may include field screening, laboratory analysis, occasional duplicate samples, or analysis for more than one analytical method (e.g., volatile organic compounds and semivolatile organic compounds). At present, most regulatory guidance documents do not distinguish between soil-gas sampling methods that are appropriate for high- or low-permeability soils. This paper discusses permeability influences on soil-gas sample collection and reports data from a case study involving soil-gas sampling from silt and clay-rich soils with moderate to extremely low gas permeability to identify a sampling approach that yields reproducible samples with data quality appropriate for vapor intrusion investigations for a wide range of gas-permeability conditions. [source] Metabolic phenotyping of mouse mutants in the German Mouse ClinicINTEGRATIVE ZOOLOGY (ELECTRONIC), Issue 3 2006Ralf ELVERT Abstract The German Mouse Clinic was established as a phenotyping center to provide the scientific community with systematic standardized phenotyping of mouse models from various genetic backgrounds. We found metabolic phenotypes in nine out of 20 mutant lines screened in a primary screen. Based on these findings, the mutants were analyzed in secondary and tertiary screens. Mice of a sample mutant line, isolated from the ENU-screen at the National Research Center for Environment and Health in Munich, were found to have lower body weight, consume less food, but have higher ratios of metabolized energy per unit body weight compared with their wild-type littermates. Basal metabolic rate and heat production were simultaneously increased by 16,18%, whereas body fat content was reduced by 11,16%. The combination of various parameters of energy consumption, expenditure and energy storage illustrate the metabolic demands of the sample mutant mouse line and demonstrate the utility of the powerful phenotyping tool used at the German Mouse Clinic. [source] Introduction to the updated Australian and New Zealand consensus guidelines for the use of antifungal agents in the haematology/oncology setting, 2008INTERNAL MEDICINE JOURNAL, Issue 6b 2008M. A. Slavin Abstract The process for development of these consensus Australasian antifungal guidelines for use in adult patients with haematological malignancy is described. New features included, how the guidelines should be applied, the risk assessment tool used and the grading system for evidence and strength of recommendation are discussed. [source] Development of a minimally invasive epidermal abrasion device for clinical skin sampling and its applications in molecular biologyINTERNATIONAL JOURNAL OF COSMETIC SCIENCE, Issue 1 2009J.-M. Lee Synopsis A new abrasion tool (US patent US7087063 B2) has been developed for collecting skin epidermal samples. This device includes a central shaft that holds the probe in a split chuck. Of the variety of probe designs tested, the laser-cut hollow tube (HT) probe abraded the basal layer of the epidermis most consistently, resulting in representative epidermal skin samples. Compared with traditional clinical methods, the abrasion method allows for high-throughput epidermal skin collection with minimal invasiveness to the volunteer subjects. A large number of abrasion samples have been collected in various clinical studies with no adverse effects observed. Epidermal abrasion, when used appropriately and with the optimized probes, can yield high quality tissue samples that are representative of the epidermis. A sufficient quantity of RNA and protein can be obtained for many subsequent molecular and biochemical applications. Because of its minimal invasiveness and high-throughput nature, the abrasion method can be a valuable tool used to investigate the efficacy of topical applications of skin care products. Resume Un nouvel outil d'abrasion (US Patent US 7 087 063 B2) a été développé pour collecter des échantillons de peaux épidermiques. Cet instrument est constitué d'une tige centrale qui tient la sonde dans un mandrin fendu. Parmi tous les modèles de sondes testées, celle constituée d'un tube creux (HT) coupé au laser, abrase la couche basale de l'épiderme le plus régulièrement, conduisant ainsi à des échantillons de peaux épidermiques représentatifs. Comparée aux méthodes classiques, la méthode d'abrasion permet un prélèvement de peaux épidermiques haut débit avec un minimum d'invasion des sujets volontaires. Un grand nombre d'échantillons a été collecté dans diverses études cliniques sans qu'aucun effet adverse n'ait été observé. L'abrasion épidermique, quand elle est utilisée de façon appropriée et avec une sonde appropriée, peut conduire à des échantillons de haute qualité qui sont représentatifs de l'épiderme. Une quantité suffisante d'ARN et de protéines peut être obtenue en vue de tests moléculaires et biochimiques. Du fait de sa faible agressivité et de sa nature haut débit, la méthode d'abrasion peut être un outil précieux utilisé pour étudier l'efficacité des applications topiques de produits de soins cutanés. [source] Beyond bone mineral density: can existing clinical risk assessment instruments identify women at increased risk of osteoporosis?JOURNAL OF INTERNAL MEDICINE, Issue 5 2004L. E. Wehren Abstract. Objective., Although osteoporosis and fragility fracture are common amongst postmenopausal women, the extent of risk varies, and measurement of bone mineral density (BMD) is the standard tool used to diagnose and assess fracture risk. Rates of diagnosis remain relatively low, and several groups have developed instruments to help identify individuals who would most benefit from BMD testing. In this paper, we review and compare the performance of these instruments to identify those most useful in the primary care setting. Design., Review of screening instruments comprised osteoporosis clinical risk factors and comparison of the sensitivity and specificity of these algorithms. Results., Validated instruments have varying complexity, but similar sensitivity and specificity for identifying individuals who are likely to have low BMD. The area under the receiver operating characteristic curve ranges from 0.75 (SOFSURF) to 0.81 (SCORE). The simplest of the instruments (OST) uses only age and weight and has an AUC of 0.79. Conclusions., The Osteoporosis Self-assessment Tool, the simplest of the instruments, performs as well as more complex tools and, because of its simplicity, may be the most useful means for the busy clinician to identify postmenopausal women who would most benefit from BMD testing. [source] Increased melatonin concentrations in children with growth hormone deficiencyJOURNAL OF PINEAL RESEARCH, Issue 2 2007Michal Karasek Abstract:, A relationship between melatonin and growth hormone (GH) is poorly understood. We compare circadian melatonin rhythms in short children with normal and decreased GH secretion. The analysis included 22 children (20 boys and 2 girls) aged 11.1,16.9 yr (mean ± S.E.M. = 14.1 ± 0.3 yr) with short stature (height SDS below ,2.0). Based on the GH peak in stimulation tests patients were divided into two groups: idiopathic short stature (ISS, n = 11; GH peak , 10 ng/mL) and GH deficiency (GHD, n = 11; GH peak < 10 ng/mL). In all patients the circadian melatonin rhythm was assessed on the basis of nine blood samples, collected in 4-hr intervals during the daytime and 2-hr intervals at night, with dark period lasting from 22:00 to 06:00 hr. Magnetic resonance imaging examination excluded organic abnormalities in central nervous system in all patients. Melatonin concentration at 24:00, 02:00 and 04:00 hr as well as the area under curve of melatonin concentrations (AUC) were significantly higher in the patients with GHD than in individuals with ISS. Significant correlations between GH secretion and melatonin concentrations at 24:00, 02:00 and 04:00 hr, and AUC were also observed. On the basis of these data it seems that the assessment of nocturnal melatonin secretion might be a valuable diagnostic tool used for the improvement of the difficult diagnosis of short stature in children. [source] Impact of Mental Health Training for Frontline Staff Working With Children With Severe Intellectual DisabilitiesJOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES, Issue 1 2008Teresa Whitehurst Abstract, The risk factors for young people with intellectual disabilities developing a mental health disorder are higher than those found in the general population, yet training is very rarely available to frontline staff. A recent study in the United Kingdom cited prevalence rates of mental ill health among adults with intellectual disabilities ranging from 35.2 to 40.9%, depending upon the sensitivity of the diagnostic tool used (Cooper et al., 2007). The ability to identify mental health problems is crucial to early intervention, but is particularly difficult when the symptoms of intellectual disability often mask emerging problems and confound differential diagnosis. The literature relating to mental health training focuses largely on changes in knowledge base and attitude, falling short of considering the primary focus of training,its impact upon practice and how this ultimately benefits people with intellectual disabilities. This study highlights the need for training, considers a training package provided to all frontline (direct care) staff in a residential school in the United Kingdom, catering to young people between the ages of 6 and 19 with severe intellectual disabilities, and investigates the impact of training upon practice and its influence upon the organization. [source] From need to choice, welfarism to advanced liberalism?LEGAL STUDIES, Issue 1 2005Problematics of social housing allocation Drawing on studies in governmentality, this paper considers the ways in which the selection and allocatioii of households for social housing have been conceptualised and treated as problematic. The paper urgues that the notion of ,need' emerged relatively slowly over the course of the twentieth century as the organising criterion of social housing. Yet ,need' became established as a powerful tool used to place those seeking social housing in hierarchies, and around which considerable expertise developed. While the principle of allocation on the basis of need has come to occupy a hegemonic position, it has operated it continual tension with competing criteria based on notions of suitability. As a consequence, this paper identifies risk management as a recurrent theme of housing management practices. By the 1960s need-based allocation was proving problematic in terms of who was being prioritised; it was also unuble to resist the challenge ofdeviant behaviour by tenunts and the apparent unpopularity of the social rented sector. We argue that the tramition to advanced liberalism prefaced a shift to new forms of letting accommodation bused on household choice, which have been portrayed as addressing core problems with the bureaucratically-driven system. We conclude by reflecting on the tensions inherent in seeking to foster choice, while continuing to adhere to the notion of need. [source] Investigation of the Thermal Behaviour of Non-metallic Curved-Face-Width Spur GearsLUBRICATION SCIENCE, Issue 4 2004L. Andrei Abstract This paper describes a curved-face-width spur gear, specially designed for manufacture from non-metallic materials. The benefits of this gear are the higher contact ratio, bending and Hertzian contact resistance, and greater tooth stiffness compared to standard spur gears. A modified geometry is proposed for the gear tooth, the height of which varies along the gear face width. Due to the reduction in tooth height, in sections away from the gear centre, lower sliding friction is expected, with consequences for the gear's thermal behaviour. The complex gear geometry makes the design of a die difficult; therefore the gears were cut on a milling machine, using a special kinematic generation process and related equipment. The tooth flank profile, an involute or near involute in sections away from the gear half-width plane, as well as the flank surface quality determined by the single-cutter tool used for gear manufacture, influence the meshing condition, and can be detrimental to the thermal behaviour of the gear. Experimental tests were carried out to examine the influence of load and speed on the temperature of the curved-face-width spur gears with modified geometry. The measured temperature of the non-standard gear is further compared with the predicted temperature of plastic standard spur gears of the same specification. [source] Sheep blowfly strike risk and management in Great Britain: a survey of current practiceMEDICAL AND VETERINARY ENTOMOLOGY, Issue 4 2008B. BISDORFF Abstract The methods used for the control of sheep blowfly strike (ovine cutaneous myiasis) and the farm management factors associated with strike prevalence were examined using data from questionnaire survey returns provided by 966 sheep farmers in Great Britain, based on the period between March 2003 and February 2004. Overall, 91% of participants treated prophylactically with insecticides against blowfly strike; 39% treated twice and 11% treated more than three times in the year. Insect growth regulators (IGRs) were the most commonly chosen product (40%), especially the IGR cyromazine. Only 12% of farmers opted to dip their sheep in organophosphate insecticide against fly strike and 2% of farmers reported applying inappropriate products against strike to their sheep, such as ivermectin or ,drenches'. Farmers worming their ewes more often were 0.8 times less likely to report blowfly strike, but those who wormed their lambs more often were 1.2 times more likely to report strike. Pure-breed flocks were 0.7 times less likely to record an outbreak of blowfly strike than cross-breed flocks. Strike was less likely in ewe flocks grazed at higher altitude; however, this relationship with altitude was not seen in lambs. The results show that insecticides remain the primary tool used by almost all farmers to prevent strike and that the type of insecticides used and means of application have altered dramatically over the past 15 years. However, the prevalence of strike has remained almost unchanged over this period. Clearly careful attention to the type and timing of insecticide application, in association with a detailed understanding of the husbandry factors that predispose sheep to higher strike risk, is essential to allow the optimal management of strike problems. [source] Item response theory: applications of modern test theory in medical educationMEDICAL EDUCATION, Issue 8 2003Steven M Downing Context Item response theory (IRT) measurement models are discussed in the context of their potential usefulness in various medical education settings such as assessment of achievement and evaluation of clinical performance. Purpose The purpose of this article is to compare and contrast IRT measurement with the more familiar classical measurement theory (CMT) and to explore the benefits of IRT applications in typical medical education settings. Summary CMT, the more common measurement model used in medical education, is straightforward and intuitive. Its limitation is that it is sample-dependent, in that all statistics are confounded with the particular sample of examinees who completed the assessment. Examinee scores from IRT are independent of the particular sample of test questions or assessment stimuli. Also, item characteristics, such as item difficulty, are independent of the particular sample of examinees. The IRT characteristic of invariance permits easy equating of examination scores, which places scores on a constant measurement scale and permits the legitimate comparison of student ability change over time. Three common IRT models and their statistical assumptions are discussed. IRT applications in computer-adaptive testing and as a method useful for adjusting rater error in clinical performance assessments are overviewed. Conclusions IRT measurement is a powerful tool used to solve a major problem of CMT, that is, the confounding of examinee ability with item characteristics. IRT measurement addresses important issues in medical education, such as eliminating rater error from performance assessments. [source] Ventilator treatment in the Nordic countries.ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2002A multicenter survey Background: A 1-day point prevalence study was performed in the Nordic countries to identify ventilator-treatment strategies in the region. Material and methods: On 30 May 30 2001 all mechanically ventilated patients in 27 intensive care units (ICUs) were registered via the internet. The results are shown as medians (25th, 75th percentile). Results: ,One hundred and eight patients were included (69% male) with new simplified acute physiology score (SAPS) 48 (37,57) and 4.5 d (2,11) of ventilator treatment. The most frequent indication for ventilator treatment was acute respiratory failure (73%). Airway management was by endotracheal tube (64%), tracheostomy (32%) and facial mask (4%). Pressure regulated ventilator modes were used in 86% of the patients and spontaneous triggering was allowed in 75%. The tidal volume was 7 ml/kg (6,9), peak inspiratory pressure 22 cmH2O (18,26) and positive end-expiratory pressure (PEEP) 6 cmH2O (6,9). FiO2 was 40% (35,50), SaO2 97% (95,98), PaO2 11 kPa (10,13), PaCO2 5.4 kPa (4.7,6.3), pH 7.43 (7.38,7.47) and BE 2.0 mmol/l (, 0.5,5). The PaO2/FiO2 ratio was 220 mmHg (166,283). The peak inspiratory pressure (r=0.37), mean airway pressure (r=0.36), PEEP (r=0.33), tidal volume (r=0.22) and SAPS score (r=0.19) were identified as independent variables in relation to the PaO2/FiO2 ratio. Conclusion: The vast majority of patients were ventilated with pressure-regulated modes. Tidal volume was well below what has been considered conventional in recent large trials. Correlations between the parameters of gas exchange, respiratory mechanics, ventilator settings and physiological status of the patients was poor. It appears that blood gas values are the main tool used to steer ventilator treatment. These results may help to design future interventional studies of ventilator treatment. [source] The Environmental Civil Society and the Transformation of State-Society Relations in China: Building a Tri-level Analytical FrameworkPACIFIC FOCUS, Issue 2 2007Teh-chang Lin State-society relations is a conventional tool used in analyzing the relational behavioral pattern of between the state and the society. In China, market reforms and open policy since 1978 have engendered the growth of environmental civil society organizations and thereby enhanced the changes in the nature of state-society relations. However, the analysis of Chinese state-society relations has in the past largely been two-dimensional, focusing on domestic relations. However, changing patterns of state-society relations in China has called for a more elaborate tri-level analytical framework of the state, its main civil society representative, domestic non-governmental organizations, and international non-governmental organizations. Through the study of environmental protests such as anti-dam construction demonstrations, we have found that domestically, Chinese environmental nongovernmental organizations not only act as a challenger to the state, but at times collaborate with the state. From an external perspective, international non-governmental organizations not only directly challenge the Chinese state, but also network with local Chinese NGOs in their protests. This article thus adds a new level to the conventional analysis of state-society relations in China. [source] Addiction-Related Assessment Tools and Pain Management: Instruments for Screening, Treatment Planning, and Monitoring CompliancePAIN MEDICINE, Issue 2008Steven D. Passik PhD ABSTRACT Objective., To review and critique the various assessment tools currently available to pain clinicians for assessing opioid use and abuse in patients with chronic noncancer pain to allow pain clinicians to make informed selections for their practices. Methods., A literature search on PubMed was conducted in June 2006 using the search terms opioid plus screening or assessment with or without the additional term risk, and opioid-related disorders/prevention and control in order to identify clinical studies published in English over the previous 10 years. Additional studies were identified using the PubMed link feature and Google. When abstracts described or referred to a tool for opioid abuse screening, the corresponding publication was acquired and reviewed for relevance to the pain treatment setting. Results., Forty-three publications were selected for review from the abstracts identified, and 19 were rejected because they did not describe a specific tool or provide adequate information regarding the screening tool used. The remaining 24 publications described relevant screening tools for opioid abuse risk and were reviewed. Conclusions., A variety of self-administered and physician-administered tools differing in their psychometrics and intended uses have been developed, but not all have been validated for use in chronic pain patients seen in a clinical practice setting. Some tools assess abuse potential in patients being considered for opioid therapy, whereas other tools screen for the presence of substance abuse. By recognizing the psychometrics of each tool, clinicians can select the ones most appropriate for their patient population and screening needs. [source] An Automated System for Argument Invention in Law Using Argumentation and Heuristic Search Procedures,RATIO JURIS, Issue 4 2005DOUGLAS WALTON Argumentation schemes are forms of argument representing premise-conclusion and inference structures of common types of arguments. Schemes especially useful in law represent defeasible arguments, like argument from expert opinion. Argument diagramming is a visualization tool used to display a chain of connected arguments linked together. One such tool, Araucaria, available free at http://araucaria.computing.dundee.ac.uk/, helps a user display an argument on the computer screen as an inverted tree structure with an ultimate conclusion as the root of the tree. These argumentation tools are applicable to analyzing a mass of evidence in a case at trial, in a manner already known in law using heuristic methods (Schum 1994) and Wigmore diagrams (Wigmore 1931). In this paper it is shown how they can be automated and applied to the task of inventing legal arguments. One important application is to proof construction in trial preparation (Palmer 2003). [source] Effects of food supplementation on home-range size, reproductive success, productivity and recruitment in a small population of Iberian lynxANIMAL CONSERVATION, Issue 1 2010J. V. López-Bao Abstract In a conservation context, food supplementation is a management tool used to reverse the decline of food-limited populations by means of positive changes in behaviour and fitness that may be reflected in population parameters. The critically endangered Iberian lynx Lynx pardinus has suffered a dramatic decline primarily because of the severe drop of its main prey, the European wild rabbit Oryctolagus cuniculus. To reverse this situation, a food supplementation programme has been implemented in Doñana, south-west Spain, since 2002. In this study, we assess the utility of providing artificial food to reduce home-range (HR) size, and to increase productivity, survival and recruitment in a scenario of low lynx density, as compared with reference data from the same population in the absence of extra food. Food supplementation produced a significant contraction of core areas, but not of complete lynx HRs. We did not detect any significant change in productivity or dispersal rates, but supplementation could have helped transient adult lynx to settle down. The positive effects of food supplementation may have been partly countered by factors such as inbreeding, Allee effects and disease outbreaks, whose effects may have been exacerbated in this small lynx population. Food supplementation, however, proved useful to retain individuals, to keep range sizes within their normal range of values, thus maintaining spatial organization, and to allow lynx reproduction and kitten survival in areas with very low prey density. Therefore, we recommend keeping an extensive and intensive supplementary feeding programme until the density of wild rabbits will enable the viability of this endangered lynx population. [source] Reliability and Validity of the Emergency Severity Index for Pediatric TriageACADEMIC EMERGENCY MEDICINE, Issue 9 2009Debbie A. Travers PhD Abstract Objectives:, The Emergency Severity Index (ESI) triage algorithm is a five-level triage acuity tool used by emergency department (ED) triage nurses to rate patients from Level 1 (most acute) to Level 5 (least acute). ESI has established reliability and validity in an all-age population, but has not been well studied for pediatric triage. This study assessed the reliability and validity of the ESI for pediatric triage at five sites. Methods:, Interrater reliability was measured with weighted kappa for 40 written pediatric case scenarios and 100 actual patient triages at each of five research sites (independently rated by both a triage nurse and a research nurse). Validity was evaluated with a sample of 200 patients per site. The ESI ratings were compared with outcomes, including hospital admission, resource consumption, and ED length of stay. Results:, Interrater reliability was 0.77 (95% confidence interval [CI] = 0.76 to 0.78) for the scenarios (n = 155 nurses) and 0.57 (95% CI = 0.52 to 0.62) for actual patients (n = 498 patients). Inconsistencies in triage were noted for the most acute and least acute patients, as well as those less than 1 year of age and those with medical (rather than trauma) chief complaints. For the validity cohort (n = 1,173 patients), outcomes differed by ESI level, including hospital admission, which went from 83% for Level 1 patients to 0% for Level 5 (chi-square, p < 0.0001). Nurses from dedicated pediatric EDs were 31% less likely to undertriage patients than nurses in general EDs (odds ratio [OR] = 0.31, 95% CI = 0.14 to 0.67). Conclusions:, Reliability of the ESI for pediatric triage is moderate. The ESI provides a valid stratification of pediatric patients into five distinct groups. We found several areas in which nurses have difficulty triaging pediatric patients consistently. The study results are being used to develop pediatric-specific ESI educational materials to strengthen reliability and validity for pediatric triage. [source] Pax Democratica: The Gospel According to St. DemocracyAUSTRALIAN JOURNAL OF POLITICS AND HISTORY, Issue 2 2003Mathurin C. Houngnikpo The thaw of the Cold War ended the chess game between the superpowers and seemingly gave new momentum to the revival and spread of liberal democracy and its corollary, capitalism. Just as missionaries once offered Christianity to "save" colonised peoples, democracy has become the new gospel promising "salvation". Both donor and recipient countries appeal to democracy, hoping that it will reverse decades of misfortune. Donor nations and multilateral financial institutions preach democratic governance. "Born again democratic" national leaders in the South who are intent on clinging to power attend to their sermons. None appear to have a genuine faith in democracy. While some nations and NGOs do give altruistically, most use foreign aid as another means of pursuing their national interest. Democracy is an elastic concept. Indeed it seems, at least at this point, that the new gospel of democracy is but a convenient tool used by different players for they own selfish reasons. [source] Information provision to clients with stroke and their carers: Self-reported practices of occupational therapistsAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 3 2010Louise Gustafsson Background:,The literature promotes the use of a wide range of educational materials for teaching and training clients with chronic conditions such as stroke. Client education is a valuable tool used by occupational therapists to facilitate client and carer ability to manage the stroke-affected upper limb. The aim of this study was to identify what information was provided to clients and carers, how this information was delivered, when the information was delivered and the client factors that influenced the method of information provision. Methods:,Convenience and snowball sampling was used to recruit occupational therapists working in stroke. Twenty-eight participants completed the study questionnaire anonymously and their responses were summarised descriptively. Results:,There was a clinically important trend for carers to receive less information than clients. Written and/or verbal information was the favoured method for delivering information related to handling (57%), soft-tissue injury minimisation (46.4%) and oedema management (50%). Information was delivered with decreasing frequency from admission (86%) to discharge (64%). More than 90% of participants indicated that the client's cognitive ability, visual ability, level of communication, primary language and perceptual ability were considered prior to the delivery of information. Discussion:,Participants regularly conveyed information to clients and carers with respect to management of the stroke-affected upper limb. However, an increased emphasis on the development of practical self-management skills, awareness of the impact of personal factors and a timeline for information provision may prove useful. [source] Lesson plan for protein exploration in a large biochemistry class,BIOCHEMISTRY AND MOLECULAR BIOLOGY EDUCATION, Issue 5 2003David W. Honey Abstract The teaching of structural concepts plays a prominent role in many chemistry and biology courses. When it comes to macromolecular systems, a thorough understanding of noncovalent interactions lays a strong foundation for students to understand such things as protein folding, the formation of protein-ligand complexes, and the melting of the DNA double helix. The incorporation of computer-based molecular graphics into the biochemistry curriculum has given students unique opportunities in visualizing the structure of biological molecules and recognizing the subtle aspects of noncovalent interactions. This report describes a series of visualization-based assignments developed to facilitate protein exploration in a large biochemistry class. A large enrollment can present special challenges for students to benefit from hands-on use of visualization software. Three of the assignments are described in detail along with a description of an on-line teaching tool used to manage the assignments and to coordinate the student groups participating in these exercises. [source] Anteroposterior patterning in the limb and digit specification: Contribution of mouse geneticsDEVELOPMENTAL DYNAMICS, Issue 9 2006Benoît Robert Abstract The limb has been a privileged object of investigation and reflection for scientists over the past two centuries and continues to provide a heuristic framework to analyze vertebrate development. Recently, accumulation of new data has significantly changed our view on the mechanisms of limb patterning, in particular along the anterior-posterior axis. These data have led us to revisit the mode of action of the zone of polarizing activity. They shed light on the molecular and cellular mechanisms of patterning linked to the Shh-Gli3 signaling pathway and give insights into the mechanism of activation of these cardinal factors, as well as the consequences of their activity. These new data are in good part the result of systematic Application of tools used in contemporary mouse molecular genetics. These have extended the power of mouse genetics by introducing mutational strategies that allow fine-tuned modulation of gene expression, interchromosomal deletions and duplication. They have even made the mouse embryo amenable to cell lineage analysis that used to be the realm of chick embryos. In this review, we focus on the data acquired over the last five years from the analysis of mouse limb development and discuss new perspectives opened by these results. Developmental Dynamics 235:2337,2352, 2006. © 2006 Wiley-Liss, Inc. [source] Prevalence of responsible hospitality policies in licensed premises that are associated with alcohol-related harmDRUG AND ALCOHOL REVIEW, Issue 2 2002JUSTINE B. DALY Abstract This study aimed to determine the prevalence of responsible hospitality policies in a group of licensed premises associated with alcohol-related harm. During March 1999, 108 licensed premises with one or more police-identified alcohol-related incidents in the previous 3 months received a visit from a police officer. A 30-item audit checklist was used to determine the responsible hospitality policies being undertaken by each premises within eight policy domains: display required signage (three items); responsible host practices to prevent intoxication and under-age drinking (five items); written policies and guidelines for responsible service (three items); discouraging inappropriate promotions (three items); safe transport (two items); responsible management issues (seven items); physical environment (three items) and entry conditions (four items). No premises were undertaking all 30 items. Eighty per cent of the premises were undertaking 20 of the 30 items. All premises were undertaking at least 17 of the items. The proportion of premises undertaking individual items ranged from 16% to 100%. Premises were less likely to report having and providing written responsible hospitality documentation to staff, using door charges and having entry/re-entry rules. Significant differences between rural and urban premises were evident for four policies. Clubs were significantly more likely than hotels to have a written responsible service of alcohol policy and to clearly display codes of dress and conditions of entry. This study provides an indication of the extent and nature of responsible hospitality policies in a sample of licensed premises that are associated with a broad range of alcohol related harms. The finding that a large majority of such premises appear to adopt responsible hospitality policies suggests a need to assess the validity and reliability of tools used in the routine assessment of such policies, and of the potential for harm from licensed premises. [source] Oxygen sensing in hypoxic pulmonary vasoconstriction: using new tools to answer an age-old questionEXPERIMENTAL PHYSIOLOGY, Issue 1 2008Gregory B. Waypa Hypoxic pulmonary vasoconstriction (HPV) becomes activated in response to alveolar hypoxia and, although the characteristics of HPV have been well described, the underlying mechanism of O2 sensing which initiates the HPV response has not been fully established. Mitochondria have long been considered as a putative site of oxygen sensing because they consume O2 and therefore represent the intracellular site with the lowest oxygen tension. However, two opposing theories have emerged regarding mitochondria-dependent O2 sensing during hypoxia. One model suggests that there is a decrease in mitochondrial reactive oxygen species (ROS) levels during the transition from normoxia to hypoxia, resulting in the shift in cytosolic redox to a more reduced state. An alternative model proposes that hypoxia paradoxically increases mitochondrial ROS signalling in pulmonary arterial smooth muscle. Experimental resolution of the question of whether the mitochondrial ROS levels increase or decrease during hypoxia has been problematic owing to the technical limitations of the tools used to assess oxidant stress as well as the pharmacological agents used to inhibit the mitochondrial electron transport chain. However, recent developments in genetic techniques and redox-sensitive probes may allow us eventually to reach a consensus concerning the O2 sensing mechanism underlying HPV. [source] Vulnerability of African mammals to anthropogenic climate change under conservative land transformation assumptionsGLOBAL CHANGE BIOLOGY, Issue 3 2006WILFRIED THUILLER Abstract Recent observations show that human-induced climate change (CC) and land transformation (LT) are threatening wildlife globally. Thus, there is a need to assess the sensitivity of wildlife on large spatial scales and evaluate whether national parks (NPs), a key conservation tools used to protect species, will meet their mandate under future CC and LT conditions. Here, we assess the sensitivity of 277 mammals at African scale to CC at 10, resolution, using static LT assumptions in a ,first-cut' estimate, in the absence of credible future LT trends. We examine the relationship between species' current distribution and macroclimatic variables using generalized additive models, and include LT indirectly as a filter. Future projections are derived using two CC scenarios (for 2050 and 2080) to estimate the spatial patterns of loss and gain in species richness that might ultimately result. We then apply the IUCN Red List criteria A3(c) of potential range loss to evaluate species sensitivity. We finally estimate the sensitivity of 141 NPs in terms of both species richness and turnover. Assuming no spread of species, 10,15% of the species are projected to fall within the critically endangered or extinct categories by 2050 and between 25% and 40% by 2080. Assuming unlimited species spread, less extreme results show proportions dropping to approximately 10,20% by 2080. Spatial patterns of richness loss and gain show contrasting latitudinal patterns with a westward range shift of species around the species-rich equatorial zone in central Africa, and an eastward shift in southern Africa, mainly because of latitudinal aridity gradients across these ecological transition zones. Xeric shrubland NPs may face significant richness losses not compensated by species influxes. Other NPs might expect substantial losses and influxes of species. On balance, the NPs might ultimately realize a substantial shift in the mammalian species composition of a magnitude unprecedented in recent geological time. To conclude, the effects of global CC and LT on wildlife communities may be most noticeable not as a loss of species from their current ranges, but instead as a fundamental change in community composition. [source] Effectiveness of routine follow-up of patients treated for T1,2N0 oral squamous cell carcinomas of the floor of mouth and tongueHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2006Matthias Adrianus Wilhelmus Merkx MD Abstract Background. The duration of follow-up after treatment for head and neck cancer, the depth of the routine visits, and the diagnostic tools used are determined on the basis of common acceptance rather than evidence-based practice. Patients with early-stage tumors are more likely to benefit from follow-up programs, because they have the best chance for a second curative treatment after recurrence. The purpose of this study was to determine the benefit of our 10-year follow-up program in patients with stage I and II squamous cell carcinoma (SCC) of the floor of mouth and tongue. Methods. In a longitudinal cohort study involving 102 patients who were treated with curative intent for a pT1,2N0M0 SCC of the floor of mouth and tongue from 1989,1998 with a minimum follow-up of 5 years, we evaluated the effect of routine follow-up. Results. During the follow-up (mean, 61 months; SD, 4 months), 10 patients had a recurrence, and 20 patients had a second primary tumor. No regional lymph node recurrences in the neck were detected. Location, T classification of the primary tumor, choice of therapy, or measure of tumor-free margins in the resection did not significantly affect the occurrence of a secondary event (p , .1). The secondary event was discovered during a patient-initiated visit for complaints in 14 patients and was found during routine follow-up visits in 16 patients. Only seven second primary tumors were detected after 60 months, four on routine follow-up and three on a self-initiated visit. The mean disease-free survival time after treatment of the secondary event was 72 months (SD, 17 months) in the "own initiative" group and 65 months (SD, 13 months) in the routine follow-up group; this difference was not statistically significant (p = .3). Conclusions. The effectiveness of a 10-year routine follow-up, even in patients with early-stage oral SCC, is very limited. These visits on routine basis can be stopped after 5 years. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] A framework for continuous design of production systems and its application in collective redesign of production line equipmentHUMAN FACTORS AND ERGONOMICS IN MANUFACTURING & SERVICE INDUSTRIES, Issue 1 2002Françoise Darses The continuous design of production systems is a major challenge facing companies, and one that requires organization and systematization. This article describes one of the continuous design endeavors implemented in a factory manufacturing steel tubes. We have studied the collective redesign of production line equipment. For 2 years, we followed the operations of a multioccupational group composed of the various actors involved in manufacturing (including the operators). Their task was to redesign the tools used in their production line. Our analysis is focused on the cognitive side of the activity and especially on the collective redesign processes. From the transcripts of the meetings, we have examined how the codesigners come to an agreement about the redesigned equipment. We show that the criteria spontaneously used for the evaluation of the solution are far wider (quantitatively and qualitatively) than the list of functional criteria prescribed to the codesigners for the decision-making process. This analysis leads us to propose three conditions that have to be met to guarantee success: (a) a true systemic view of the production system must be developed by all the continuous design actors, (b) there must be support for the collective decision-making process, and (c) new forms of knowledge must be institutionalized. © 2002 John Wiley & Sons, Inc. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||