|
| ||
|
|
||
Careful Consideration (careful + consideration)
Selected AbstractsGROSS DIMENSIONAL ASSESSMENT OF CUTANEOUS WOUNDS AS AN INDICATOR OF HEALING: IMPORTANCE OF CAREFUL CONSIDERATIONINTERNATIONAL WOUND JOURNAL, Issue 1 2007Ramin Mostofi Zadeh Farahani No abstract is available for this article. [source] Measurement and data analysis methods for field-scale wind erosion studies and model validation,EARTH SURFACE PROCESSES AND LANDFORMS, Issue 11 2003Ted M. Zobeck Abstract Accurate and reliable methods of measuring windblown sediment are needed to con,rm, validate, and improve erosion models, assess the intensity of aeolian processes and related damage, determine the source of pollutants, and for other applications. This paper outlines important principles to consider in conducting ,eld-scale wind erosion studies and proposes strategies of ,eld data collection for use in model validation and development. Detailed discussions include consideration of ,eld characteristics, sediment sampling, and meteorological stations. The ,eld shape used in ,eld-scale wind erosion research is generally a matter of preference and in many studies may not have practical signi,cance. Maintaining a clear non-erodible boundary is necessary to accurately determine erosion fetch distance. A ,eld length of about 300 m may be needed in many situations to approach transport capacity for saltation ,ux in bare agricultural ,elds. Field surface conditions affect the wind pro,le and other processes such as sediment emission, transport, and deposition and soil erodibility. Knowledge of the temporal variation in surface conditions is necessary to understand aeolian processes. Temporal soil properties that impact aeolian processes include surface roughness, dry aggregate size distribution, dry aggregate stability, and crust characteristics. Use of a portable 2 tall anemometer tower should be considered to quantify variability of friction velocity and aerodynamic roughness caused by surface conditions in ,eld-scale studies. The types of samplers used for sampling aeolian sediment will vary depending upon the type of sediment to be measured. The Big Spring Number Eight (BSNE) and Modi,ed Wilson and Cooke (MWAC) samplers appear to be the most popular for ,eld studies of saltation. Suspension ,ux may be measured with commercially available instruments after modi,cations are made to ensure isokinetic conditions at high wind speeds. Meteorological measurements should include wind speed and direction, air temperature, solar radiation, relative humidity, rain amount, soil temperature and moisture. Careful consideration of the climatic, sediment, and soil surface characteristics observed in future ,eld-scale wind erosion studies will ensure maximum use of the data collected. Copyright © 2003 John Wiley & Sons, Ltd. [source] Assessing patient category/dependence systems for determining the nurse/patient ratio in ICU and HDU: a review of approachesJOURNAL OF NURSING MANAGEMENT, Issue 5 2004PG Dip., Renee Adomat BA (Hons) Background, A huge range of patient classification systems/tools are used in critical care units to inform workforce planning, however, they are not always applied appropriately. Many of these systems/tools were not originally developed for the purposes of workforce planning and so their use in determining the nurse:patient ratio required in critical care settings raises a number of issues for the organisation and management of these services. Aim, The aim of this paper is to review the three main assessment systems that are commonly used in critical care settings in the UK and evaluate their effectiveness in accurately determining nurse : patient ratios. If the application of these systems/tools is to enhance care, a thorough understanding of their origins and purpose is necessary. If this is lacking, then decisions relating to workload planning, particularly when calculating nurse : patient ratios, may be flawed. Conclusions, Patient dependency/classification systems and patient dependency scoring systems for severity of illness are robust measures for predicting morbidity and mortality. However, they are not accurate if used to calculate nurse : patient ratios because they are not designed to measure nursing input. Nursing intensity measures provide a useful framework for calculating the cost of providing a nursing service in critical care and can serve as a measure of nursing input, albeit a fairly basic one. However, many components of the nursing role are not ,accounted' for in these measures. Implications, The implications of these findings for the organization and management of critical care services are discussed. Careful consideration of these areas is vital if a cost efficient and cost-effective critical care service is to be delivered. [source] The HPV Vaccine: Framing the Arguments FOR and AGAINST Mandatory Vaccination of All Middle School GirlsJOURNAL OF SCHOOL HEALTH, Issue 6 2008Cheryl A. Vamos MPH ABSTRACT Background:, Human papillomavirus (HPV), the virus responsible for cervical cancer, is the most common viral sexually transmitted infection in the United States. A vaccine was approved in 2006 that is effective in preventing the types of HPV responsible for 70% of cervical cancers and 90% of genital warts. Proposals for routine and mandatory HPV vaccination of girls have become sources of controversy for parents of school-aged youth, legislators, members of the medical community, and the public at large. Methods:, The purpose of this article was to articulate the arguments used by advocates who either oppose or endorse routine, mandatory administration of the vaccine to school-aged girls, thereby assisting school health personnel in being effective participants in framing the relevant issues. Results:, Controversy is grounded in moral, religious, political, economic, and sociocultural arguments including whether concerns that the vaccine increases sexual risk taking, sends mixed messages about abstaining from sexual intercourse, usurps parental authority, and increases the potential for development of new health disparities are offset by the value of administering a cost-effective, age-appropriate public health measure targeting a life-threatening problem. Conclusions:, Careful consideration of the medical evidence and public health implications is critical but understanding the context of the debate is no less important to the task of responding to public concerns. School health personnel have a role in the discussion about HPV immunization. Being able to articulate the arguments presented herein can help authorities' responsiveness to parents and community groups as the dialogue about this particular health issue evolves further. [source] Optimizing the diffused regions of interdigitated backside buried contact solar cellsPROGRESS IN PHOTOVOLTAICS: RESEARCH & APPLICATIONS, Issue 3 2007Jiun-Hua Guo Abstract Recombination and a number of other important factors must be considered in the optimization of the diffused regions of high-efficiency silicon solar cells. In this paper, we examine issues related to the four types of diffusions used in rear-junction, interdigitated backside buried contact solar cells made on n-type silicon wafers: the phosphorus-diffused front-surface field (FSF), the boron-diffused emitter, and the boron and the phosphorus diffused contact regions. Dark saturation current density, effective lifetime, implied open-circuit voltage and sheet resistance are characterized for the optimization of the above-mentioned diffused regions. Diffusion uniformity and the avoidance of the diffusion-induced dislocations are also discussed for the heavily diffused, metal coated contact diffusions. It is found that the optimal sheet resistances of the FSF for planar and textured surfaces are 120,,/, and 105,,/, respectively, whereas the optimal post-processing sheet resistance for the boron emitter is approximately 100,,/,. Moreover, sheet resistance as heavy as 10,20,,/, for the boron groove diffusion and 5,10,,/, for the phosphorus groove diffusion have been achieved without introducing the diffusion-induced misfit dislocations. Careful consideration of the issues discussed here led to an absolute efficiency improvement on the planar n-type IBBC solar cell of more than 0·6%. Copyright © 2006 John Wiley & Sons, Ltd. [source] Outcome After Liver Transplantation for NASH CirrhosisAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2009S. M. Malik Nonalcoholic steatohepatitis (NASH) associated cirrhosis is an increasing indication for liver transplant (LT). The aim of this study was to determine outcome and poor predictive factors after LT for NASH cirrhosis. We analyzed patients undergoing LT from 1997 to 2008 at a single center. NASH was diagnosed on histopathology. LT recipients with hepatitis C, alcoholic or cholestatic liver disease and cryptogenic cirrhosis acted as matched controls. Ninety-eight LT recipients were identified with NASH cirrhosis. Compared to controls, NASH patients had a higher BMI (mean 32.3 kg/m2), and were more likely to be diabetic and hypertensive. Mortality after transplant was similar between NASH patients and controls but there was a tendency for higher earlier mortality in NASH patients (30-day mortality 6.1%, 1-year mortality 21.4%). Sepsis accounted for half of all deaths in NASH patients, significantly higher than controls. NASH patients ,60 years, BMI ,30 kg/m2 with diabetes and hypertension (HTN) had a 50% 1-year mortality. In conclusion, patients undergoing LT for NASH cirrhosis have a similar outcome to patients undergoing LT for other indications. The combination of older age, higher BMI, diabetes and HTN are associated with poor outcome after LT. Careful consideration is warranted before offering LT to these high-risk patients. [source] Diagnosis And Treatment Planning Are Essential Prior To Commencing Endodontic Treatment: Discuss This Statement As It Relates To Clinical Endodontic ManagementAUSTRALIAN ENDODONTIC JOURNAL, Issue 1 2005Ms Trudy Stewart Diagnosis and treatment planning are essential to the practice of endodontics. Diagnosis aims to determine whether pathological involvement of the dental pulp has or is occurring. Treatment planning meanwhile, involves appropriately selecting cases, determining how difficult the treatment may be to perform on a specific individual and sequencing treatment procedures to achieve a healthy and functional dentition. In endodontic management, this may involve establishing whether the tooth is restorable and periodontally sound, the patient is able to tolerate the treatments and the clinician has the skills to perform the required treatment procedures. Careful consideration of these issues must be given prior to commencing treatment. [source] Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one-step and two-step methodsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2010SJ Meltzer Please cite this paper as: Meltzer S, Snyder J, Penrod J, Nudi M, Morin L. Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one-step and two-step methods. BJOG 2010;117:407,415. Objective, To conduct a cost minimisation analysis of three methods of gestational diabetes mellitus (GDM) screening and diagnosis. Design, Prospective randomised controlled trial. Setting, University teaching hospital. Population, Pregnant women (n = 1594) presenting for GDM screening. Methods, Women presenting for GDM screening, who consented to participate, were randomised to GR1 [1-hour, 50-g glucose screen (GS) ± 3-hour, 100-g oral glucose tolerance test (OGTT)], GR2 (50-g GS ± 2-hour, 75-g OGTT) or GR3 (2-hour, 75-g OGTT). Demographics, health and time/travel cost information were assessed for each glucose testing visit. Main outcome measures, Costs (direct and indirect) and prevalence of GDM diagnosis. Results, The direct sampling costs of the glucose tests per woman were as follows: GS, CAN$12.57; 75-g OGTT, $36.10; 100-g OGTT, CAN$48.13. Among women in the two-step method groups diagnosed with GDM, 39% of the GR1 and 61% of the GR2 groups were diagnosed at the first step by GS , 10.3 mmol/l, according to the Canadian Diabetes Association recommendations, contributing to a lower total cost in these groups. The total costs per woman screened were as follows: GR1, CAN$91.61; GR2, CAN$89.03; GR3, CAN$108.38. The GDM prevalence was similar (3.7%, 3.7% and 3.6%, respectively). The higher costs of GR3 were related to more blood draws and the time required for all women to undergo the 2-hour OGTT. Conclusions, Careful consideration should be given to an internationally recommended method of universal screening for GDM which minimises the burden and cost for individual women and the healthcare system, yet provides diagnostic efficacy. The two-step method (GS ± OGTT) accomplished this better than the one-step method (75-g OGTT). [source] Economics and quality of care for patients with acute coronary syndromes: The impending crisisCLINICAL CARDIOLOGY, Issue S1 2002Eric J. Topol M.D. Abstract Several factors are placing significant financial burdens on the health care system today. These include the growing older population, the obesity and type II diabetes epidemics, and the attendant increased prevalence of heart disease, which remains the leading cause of death in the United States. In response, cardiovascular medicine is undergoing sweeping change in the use of advanced technology and interventions. In addition, biomarkers, such as troponin, are emerging as critical predictors of responses to therapy, particularly for coronary stenting. Future trends in the treatment of acute coronary syndromes (ACS) will embrace the use of genomic solutions, such as gene expression profiling, to predict therapeutic outcomes. Careful consideration will need to be given to these innovative approaches to ensure they are cost effective. [source] Biodiversity Conservation in Agricultural Landscapes: Challenges and Opportunities of Coffee Agroforests in the Western Ghats, IndiaCONSERVATION BIOLOGY, Issue 2 2010CLAUDE A. GARCIA agroforestería de café; Ghats Occidentales; medios de vida; mosaicos paisajísticos; proyectos integrados de conservación y desarrollo Abstract:,The new approaches advocated by the conservation community to integrate conservation and livelihood development now explicitly address landscape mosaics composed of agricultural and forested land rather than only protected areas and largely intact forests. We refer specifically to a call by Harvey et al. (2008) to develop a new approach based on six strategies to integrate biodiversity conservation with sustainable livelihoods in Mesoamerican landscape mosaics. We examined the applicability of this proposal to the coffee agroforests of the Western Ghats, India. Of the six strategies, only one directly addresses livelihood conditions. Their approach has a clear emphasis on conservation and, as currently formulated risks repeating the failures of past integrated conservation and development projects. It fails to place the aspirations of farmers at the core of the agenda. Thus, although we acknowledge and share the broad vision and many of the ideas proposed by this approach, we urge more balanced priority setting by emphasizing people as much as biodiversity through a careful consideration of local livelihood needs and aspirations. Resumen:,Los nuevos enfoques recomendados por la comunidad de conservación para integrar la conservación y el desarrollo ahora abordan explícitamente los mosaicos paisajísticos compuestos de tierras agrícolas y forestales en lugar de solo áreas protegidas y bosques casi intactos. Basado en seis estrategias para integrar la conservacion de la biodiversidad con modos de vida sustentables en los mosaicos paisajisticos de Mesoamerica. Nos referimos específicamente a la llamada de Harvey et al. (2008) para desarrollar un enfoque nuevo basado en seis estrategias para congraciar la conservación de la biodiversidad con modos de vida sustentables en los mosaicos paisajísticos de Mesoamérica. Examinamos la aplicabilidad de esta propuesta en los agrobosques de café de los Ghats occidentales en la India. Solo una de las seis estrategias mencionadas aborda directamente las condiciones de vida. La propuesta tiene un claro énfasis en la conservación y, tal como está formulada actualmente, falla en colocar las aspiraciones de los campesinos en el centro de la agenda. Corre pues el riesgo de repetir los fracasos de pasados proyectos integrados de conservación y desarrollo. Por lo tanto, aunque reconocemos y compartimos la amplia visión y muchas de las ideas de esta llamada, insistimos en una definición de prioridades balanceada que enfatice a la gente tanto como a la biodiversidad mediante una consideración cuidadosa de las necesidades y aspiraciones de los habitantes locales. [source] Not all roads lead to Rome,a review of quality of life measurement in adults with diabetesDIABETIC MEDICINE, Issue 4 2009J. Speight Abstract Aims Quality of life (QoL) is recognized widely as an important health outcome in diabetes, where the burden of self-management places great demands on the individual. However, the concept of QoL remains ambiguous and poorly defined. The aim of our review is to clarify the measurement of QoL in terms of conceptualization, terminology and psychometric properties, to review the instruments that have been used most frequently to assess QoL in diabetes research and make recommendations for how to select measures appropriately. Methods A systematic literature search was conducted to identify the ten measures most frequently used to assess QoL in diabetes research (including clinical trials) from 1995 to March 2008. Results Six thousand and eight-five abstracts were identified and screened for instrument names. Of the ten instruments most frequently used to assess ,QoL', only three actually do so [i.e. the generic World Health Organization Quality of Life (WHOQOL) and the diabetes-specific Diabetes Quality of Life (DQOL) and Audit of Diabetes-Dependent Quality of Life (ADDQoL)]. Seven instruments more accurately measure health status [Short-Form 36 (SF-36), EuroQoL 5-Dimension (EQ-5D)], treatment satisfaction [Diabetes Treatment Satisfaction Questionnaire (DTSQ)] and psychological well-being [Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Well-Being Questionnaire (W-BQ), Problem Areas in Diabetes (PAID)]. Conclusions No single measure can suit every purpose or application but, when measures are selected inappropriately and data misinterpreted, any conclusions drawn are fundamentally flawed. If we value QoL as a therapeutic goal, we must ensure that the instruments we use are both valid and reliable. QoL assessment has the proven potential to identify ways in which treatments can be tailored to reduce the burden of diabetes. With careful consideration, appropriate measures can be selected and truly robust assessments undertaken successfully. [source] Reconstructing ancestral ecologies: challenges and possible solutionsDIVERSITY AND DISTRIBUTIONS, Issue 1 2006Christopher R. Hardy ABSTRACT There are several ways to extract information about the evolutionary ecology of clades from their phylogenies. Of these, character state optimization and ,ancestor reconstruction' are perhaps the most widely used despite their being fraught with assumptions and potential pitfalls. Requirements for robust inferences of ancestral traits in general (i.e. those applicable to all types of characters) include accurate and robust phylogenetic hypotheses, complete species-level sampling and the appropriate choice of optimality criterion. Ecological characters, however, also require careful consideration of methods for accounting for intraspecific variability. Such methods include ,Presence Coding' and ,Polymorphism Coding' for discrete ecological characters, and ,Range Coding' and ,MaxMin Coding' for continuously variable characters. Ultimately, however, historical inferences such as these are, as with phylogenetic inference itself, associated with a degree of uncertainty. Statistically based uncertainty estimates are available within the context of model-based inference (e.g. maximum likelihood and Bayesian); however, these measures are only as reliable as the chosen model is appropriate. Although generally thought to preclude the possibility of measuring relative uncertainty or support for alternative possible reconstructions, certain useful non-statistical support measures (i.e. ,Sharkey support' and ,Parsimony support') are applicable to parsimony reconstructions. [source] Methodology for preliminary seismic design of extended pile-shafts for bridge structuresEARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 14 2006S. T. Song Abstract Seismic design of extended pile-shafts requires a careful consideration of the influence of the surrounding soil on the overall response of the soil,pile system. In this paper, a procedure that incorporates soil properties into the process is developed for preliminary seismic design of extended pile-shafts. The method follows the well-accepted approach of using a force reduction factor to determine the lateral strength of the structure. The procedure involves an iterative process to arrive at the required amount of longitudinal reinforcement. Other outcomes of the procedure include the appropriate lateral stiffness and strength, as well as an estimation of the local curvature demand and ultimate drift ratio that can be used to ensure a satisfactory lateral response. The design procedure is capable of providing reliable results for a practical range of structural and soil properties. The versatility of the procedure is illustrated using two numerical examples of extended pile-shafts constructed in different soil sites. Copyright © 2006 John Wiley & Sons, Ltd. [source] Disposition of perfluorinated acid isomers in sprague-dawley rats; Part 2: Subchronic doseENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 3 2009Amila O. De Silva Abstract Two major industrial synthetic pathways have been used to produce perfluorinated acids (PFAs) or their precursors: Telomerization and electrochemical fluorination (ECF). Products of telomer and ECF origin can be distinguished by structural isomer profiles. A mixture of linear and branched perfluoroalkyl isomers is associated with ECF. Telomer products characteristically consist of a single perfluoroalkyl geometry, typically linear. In biota, it is unclear if the isomer profile is conserved relative to the exposure medium and hence whether PFA isomer profiles in organisms are useful for distinguishing environmental PFA sources. A companion study suggested isomer-specific disposition following a single oral gavage exposure to rats. To confirm these findings under a more realistic subchronic feeding scenario, male and female rats were administered PFA isomers by diet for 12 weeks, followed by a 12-week depuration period. The diet contained 500 ng/g each of ECF perfluorooctanoate (PFOA, ,80% n -PFOA), ECF perfluorooctane sulfonate (PFOS, ,70% n -PFOS), and linear and isopropyl perfluorononanoate (n - and iso -PFNA). Blood sampling during the exposure phase revealed preferential accumulation of n -PFOA and n -PFNA compared to most branched isomers. Female rats depurated all isomers faster than males. Both sexes eliminated most branched perfluorocarboxylate isomers more rapidly than the n -isomer. Elimination rates of the major branched PFOS isomers were not statistically different from n -PFOS. Two minor isomers of ECF PFOA and one branched PFOS isomer had longer elimination half-lives than the n-isomers. Although extrapolation of these pharmacokinetics trends in rats to humans and wildlife requires careful consideration of dosage level and species-specific physiology, cumulative evidence suggests that perfluorocarboxylate isomer profiles in biota may not be suitable for quantifying the relative contributions of telomer and ECF sources. [source] Assessing the joint effects of chlorinated dioxins, some pesticides and polychlorinated biphenyls on thyroid hormone status in Japanese breast-fed infantsENVIRONMETRICS, Issue 2 2003Takashi Yanagawa Abstract Joint effects of dioxin related chemicals (DXNs), hexachlorocyclohexanes (HCHs), DDT, dieldrin, heptachlor-epoxide (HCE), chlordane and polychlorinated biphenyls (PCB) on the levels of triirodothyronine (T3), thyroxine (T4), thyroid stimulating hormones (TSH) and thyroid binding globulin (TBG) in the peripheral blood of 101 breast-fed infants are studied. The statistical issue involved is how to estimate the effects based on data from volunteer subjects with possible measurement errors. A chain independent graph is applied for modeling the associations among factors, and dicotomizations of selected factors are performed for estimating the effects. Use of nonparametric methods with careful consideration of over-adjustment is suggested. It is shown that the estimated odds ratios of DXNs,DDT, the first principal component of DXNs and DDT, relative to TSH are 3.02 (p -value=0.03) and 7.15 (p -value=0.02), respectively, when PCB is not adjusted and adjusted for, respectively. Copyright © 2003 John Wiley & Sons, Ltd. [source] Importance of implementation and residual risk analyses in sediment remediationINTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 1 2006Richard J Wenning Abstract Management strategies for addressing contaminated sediments can include a wide range of actions, ranging from no action, to the use of engineering controls, to the use of more aggressive, intrusive activities related to removing, containing, or treating sediments because of environmental or navigation considerations. Risk assessment provides a useful foundation for understanding the environmental benefits, residual hazards, and engineering limitations of different remedy alternatives and for identifying or ranking management options. This article, part of a series of panel discussion papers on sediment remediation presented at the Third International Conference on Remediation of Contaminated Sediments held 20,25 January 2005 in New Orleans, Louisiana, USA, reviews 2 types of risk that deserve careful consideration when evaluating remedy alternatives. The evaluation of remedy implementation risks addresses predominantly short-term engineering issues, such as worker and community health and safety, equipment failures, and accident rates. The evaluation of residual risks addresses predominantly longer-term biological and environmental issues, such as ecological recovery, bioaccumulation, and relative changes in exposure and effects to humans, aquatic biota, and wildlife. Understanding the important pathways for contaminant exposure, the human and wildlife populations potentially at risk, and the possible hazards associated with the implementation of different engineering options will contribute to informed decision making with regard to short- and long-term effectiveness, implementability, and potential environmental hazards. [source] Ethical suicide research: A survey of researchersINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 1 2009Richard Lakeman ABSTRACT Research is needed to better understand and respond effectively to people who are suicidal. Involving people who are suicidal in research poses some ethical and pragmatic problems. The ethical problems and difficulties in obtaining approval to involve people who are suicidal in research has contributed to the current paucity of research that explores the suicidal experience. To explore some of these problems, a web-based survey of suicide researchers was undertaken. Researchers identified from published reports were contacted by email and invited to participate in a web-based survey. Researchers were asked to describe any problems they encountered, how ethical problems were negotiated or resolved, and any advice received from human research ethics committees. The main problems identified were accessing the population, maintaining confidentiality, the extent of care owed by the researcher to participants, and the facilitation of support to participants. As with clinical practice, ethical research involving people who are suicidal involves a process of sensitive engagement, and careful consideration and remediation of risk. [source] Consumer attitudes towards self-referral with early signs of cancer: implications for symptom awareness campaignsINTERNATIONAL JOURNAL OF NONPROFIT & VOLUNTARY SECTOR MARKETING, Issue 4 2007Douglas Eadie Traditionally, secondary prevention programmes have employed mass screening approaches to assess for asymptomatic signs of cancer. It has been suggested that early detection strategies, involving public education and self-referral may prove more cost-effective, with low-risk populations for cancers with symptomatic presentation. The success of public education approaches is dependent on careful consideration of the psycho-social factors of self-examination and referral. This paper presents the findings from an exploratory study, using qualitative methods with an at-risk population of older people living in deprived communities in west-central Scotland. The study examines consumer perceptions of the early detection of cancer and the cultural barriers to self-referral, as well as response to aspects of communication strategy. The implications for design of symptom awareness campaigns, including use of message appeals, specification of target symptoms, identification of target audience and selection of communication channels, are discussed. Copyright © 2007 John Wiley & Sons, Ltd. [source] The management of professional roles during boundary work in child welfareINTERNATIONAL JOURNAL OF SOCIAL WELFARE, Issue 3 2010Christopher Hall Hall C, Slembrouck S, Haigh E, Lee A. The management of professional roles during boundary work in child welfare Int J Soc Welfare 2010: 19: 348,357 © 2010 The Author(s), Journal compilation © 2010 Blackwell Publishing Ltd and International Journal of Social Welfare. This article examines the ways in which child welfare professionals negotiate their roles and those of other professionals in home visits with clients, in this case the parents of young children. The concept of boundary work is developed within the context of the professional,client encounter. Drawing on Goffman's concept of ,footing', the analysis examines how professionals attend to ways of constructing family problems in terms of appropriate professional interventions , both from themselves and others. It is argued that the careful consideration of how problems merit interventions displays an adherence to the development of the supportive relations which move beyond strict professional remits. The article adds to the research evidence, which sees inter-professional coordination as a complex matter, located in everyday practice rather than as advocating more tightly monitored procedure. [source] Methodological issues in online data collectionJOURNAL OF ADVANCED NURSING, Issue 5 2007Mary Ann Cantrell Abstract Title.,Methodological issues in online data collection Aim., This paper is a report of a study to evaluate the use of an online data collection method to survey early survivors of childhood cancer about their physical and psychosocial characteristics and health-related quality of life. Background., A major advantage in conducting web-based nursing research is the ability to involve participants who are challenging to study because of their small numbers or inaccessibility because of geographic location. As paediatric oncology patients and early survivors of childhood cancer are often not easily accessible because of their small numbers at single institutions, web-based research methods have been proposed as a potentially effective approach to collect data in studies involving these clinical populations. Method., Guided by published literature on using the Internet for data collection, an online protocol was developed; this included construction of a website, development of a homepage and interactive HyperText Markup Language pages and the posting of the study link on various websites. Data collection occurred over a 6-month period between December 2005 and May 2006. Findings., Despite using strategies in conducting online research cited in published literature, the recruitment of subjects was very prolonged and the volume of missing data among many respondents excluded them from the study and created bias within the study's results. Conclusion., Web-based, online data collection methods create opportunities to conduct research globally, especially among difficult to access populations. However, web-based research requires careful consideration of how the study will be advertized and how data will be collected to ensure high quality data and validity of the findings. [source] Regression modelling of correlated data in ecology: subject-specific and population averaged response patternsJOURNAL OF APPLIED ECOLOGY, Issue 5 2009John Fieberg Summary 1.,Statistical methods that assume independence among observations result in optimistic estimates of uncertainty when applied to correlated data, which are ubiquitous in applied ecological research. Mixed effects models offer a potential solution and rely on the assumption that latent or unobserved characteristics of individuals (i.e. random effects) induce correlation among repeated measurements. However, careful consideration must be given to the interpretation of parameters when using a nonlinear link function (e.g. logit). Mixed model regression parameters reflect the change in the expected response within an individual associated with a change in that individual's covariates [i.e. a subject-specific (SS) interpretation], which may not address a relevant scientific question. In particular, a SS interpretation is not natural for covariates that do not vary within individuals (e.g. gender). 2.,An alternative approach combines the solution to an unbiased estimating equation with robust measures of uncertainty to make inferences regarding predictor,outcome relationships. Regression parameters describe changes in the average response among groups of individuals differing in their covariates [i.e. a population-averaged (PA) interpretation]. 3.,We compare these two approaches [mixed models and generalized estimating equations (GEE)] with illustrative examples from a 3-year study of mallard (Anas platyrhynchos) nest structures. We observe that PA and SS responses differ when modelling binary data, with PA parameters behaving like attenuated versions of SS parameters. Differences between SS and PA parameters increase with the size of among-subject heterogeneity captured by the random effects variance component. Lastly, we illustrate how PA inferences can be derived (post hoc) from fitted generalized and nonlinear-mixed models. 4.,Synthesis and applications. Mixed effects models and GEE offer two viable approaches to modelling correlated data. The preferred method should depend primarily on the research question (i.e. desired parameter interpretation), although operating characteristics of the associated estimation procedures should also be considered. Many applied questions in ecology, wildlife management and conservation biology (including the current illustrative examples) focus on population performance measures (e.g. mean survival or nest success rates) as a function of general landscape features, for which the PA model interpretation, not the more commonly used SS model interpretation may be more natural. [source] Investigation of critical inter-related factors affecting the efficacy of pulsed light for inactivating clinically relevant bacterial pathogensJOURNAL OF APPLIED MICROBIOLOGY, Issue 5 2010H.P. Farrell Abstract Aims:, To investigate critical electrical and biological factors governing the efficacy of pulsed light (PL) for the in vitro inactivation of bacteria isolated from the clinical environment. Development of this alternative PL decontamination approach is timely, as the incidence of health care,related infections remains unacceptably high. Methods and Results:, Predetermined cell numbers of clinically relevant Gram-positive and Gram-negative bacteria were inoculated separately on agar plates and were flashed with ,60 pulses of broad-spectrum light under varying operating conditions, and their inactivation measured. Significant differences in inactivation largely occurred depending on the level of the applied lamp discharge energy (range 3·2,20 J per pulse), the amount of pulsing applied (range 0,60 pulses) and the distance between light source and treatment surface (range 8,20 cm) used. Greater decontamination levels were achieved using a combination of higher lamp discharge energies, increased number of pulses and shorter distances between treatment surface and the xenon light source. Levels of microbial sensitivity also varied depending on the population type, size and age of cultures treated. Production of pigment pyocynanin and alginate slime in mucoid strains of Pseudomonas aeruginosa afforded some protection against lethal action of PL; however, this was evident only by using a combination of reduced amount of pulsing at the lower lamp discharge energies tested. A clear pattern was observed where Gram-positive bacterial pathogens were more resistant to cidal effects of PL compared to Gram negatives. While negligible photoreactivation of PL-treated bacterial strains occurred after full pulsing regimes at the different lamp discharge energies tested, some repair was evident when using a combination of reduced pulsing at the lower lamp discharge energies. Strains harbouring genes for multiple resistances to antibiotics were not significantly more resistant to PL treatments. Slight temperature rises (,4·2°C) were measured on agar surfaces after extended pulsing at higher lamp discharge energies. Presence of organic matter on treatment surface did not significantly affect PL decontamination efficacy, nor did growth of PL-treated bacteria on selective agar diminish survival compared to similarly treated bacteria inoculated and enumerated on nonselective agar plates. Conclusions:, Critical inter-related factors affecting the effective and repeatable in vitro decontamination performance of PL were identified during this study that will aid further development of this athermal process technology for applications in health care and in industry. Very rapid reductions (c. 7 log10 CFU cm,2 within ,10 pulses) occurred using discharge energy of 20 J for all tested clinically relevant bacteria under study when treated at 8 cm distance from xenon light source. While no resistant flora is expected to develop for treatment of microbial pathogens on two-dimensional surfaces, careful consideration of scale up factors such as design and operational usage of this PL technique will be required to assure operator safety. Significance and Impact of the Study:, Findings and conclusions derived from this study will enable further development and optimization of this decontamination technique in health care and in food preparation settings, and will advance the field of nonthermal processing technologies. [source] To Replace or Not to Replace: A Systematic Approach to Respond to Device AdvisoriesJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2009Ph.D., SILVIA G. PRIORI M.D. Aim: The decision of whether and when to replace a device in response to an "advisory" letter requires careful consideration, because device replacement carries related risks and is influenced by the clinical characteristics of the patient. Methods and Results: The risk/benefit of device replacement depends on four parameters: expected annual sudden cardiac death rate; residual device life; difference in failure rate between the device listed on the advisory letter and the replacement device; and the replacement procedure mortality risk. Using these four factors, we have developed an equation that provides the "number needed to replace" (NNR) to save one life. Per our model, patients implanted with a device with a failure rate approaching 1% and a probability of requiring device intervention ,25% per year,in particular, pacemaker-dependent patients,have an NNR <250. Pacemaker-dependent patients, with devices having three or more years longevity, but with device failure rates ,0.5%, have an NNR <100. Patients with arrhythmic risk ,2.5% per year and those with devices having failure rates <0.1% have a high NNR and stand more risk to be harmed than benefited from device replacement. Conclusions: Pacemaker-dependent patients and those with high arrhythmic risk (,25% annually) when having "advisory" devices with high failure rate (,1%) have an NNR <250 and, hence, could be considered for device replacement. Conversely, patients with arrhythmic risk ,2.5% per year and those with devices having failure rates ,0.1% have a high NNR or even risk of "harm" from device replacement. In all the intermediate cases, the NNR will quantify the benefit/risk ratio of replacement, thus helping physicians and patients decide on the preferred approach. The NNR methodology proposed here is also applicable to advisory notices issued to leads, but the high morbidity associated with lead replacement will generally rule out interventions to replace leads. [source] Economic Efficiency and Frontier TechniquesJOURNAL OF ECONOMIC SURVEYS, Issue 1 2004Luis R. Murillo-Zamorano Abstract. Most of the literature related to the measurement of economic efficiency has based its analysis either on parametric or on non-parametric frontier methods. The choice of estimation method has been an issue of debate, with some researchers preferring the parametric and others the non-parametric approach. The aim of this paper is to provide a critical and detailed review of both core frontier methods. In our opinion, no approach is strictly preferable to any other. Moreover, a careful consideration of their main advantages and disadvantages, of the data set utilized, and of the intrinsic characteristics of the framework under analysis will help us in the correct implementation of these techniques. Recent developments in frontier techniques and economic efficiency measurement such as Bayesian techniques, bootstrapping, duality theory and the analysis of sampling asymptotic properties are also considered in this paper. [source] Applying Prochaska's model of change to needs assessment, programme planning and outcome measurementJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2001Kathryn Parker MA Abstract A major goal of continuing medical education (CME) is to enhance the performance of the learner. In order to accomplish this goal, careful consideration and expertise must be applied to the three primary ingredients of CME planning: assessing learner needs, programme design and outcome measurement. Traditional methods used to address these three components seldom result in CME initiatives that change performance, even in the presence of sophisticated CME formats and capable learners. In part, performance may not change because the learner is not ,ready to change'. Planners of CME are aware of this concept but have been unable to measure ,readiness to change' or employ it in assessing learner needs, and planning and evaluating CME. One theory that focuses on an individual's readiness to change is Prochaska's model, which postulates that change is a gradual process proceeding through specific stages, each of which has key characteristics. This paper examines the applicability of this model to all components of CME planning. To illustrate the importance of this model, this paper provides examples of these three components conducted both with and without implementation of this model. [source] Personalized nutrition for the prevention of cardiovascular disease: a future perspectiveJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2008J. A. Lovegrove Abstract Cardiovascular disease (CVD) is responsible for significant morbidity and mortality in the Western and developing world. This multi-factorial disease is influenced by many environmental and genetic factors. At present, public health advice involves prescribed population-based recommendations, which have been largely unsuccessful in reducing CVD risk. This is, in part, due to individual variability in response to dietary manipulations, that arises from nutrient,gene interactions (defined by the term ,nutrigenetics'). The shift towards personalized nutritional advice is a very attractive proposition, where, in principle, an individual can be given dietary advice specifically tailored to their genotype. However, the evidence-base for the impact of interactions between nutrients and fixed genetic variants on biomarkers of CVD risk is still very limited. This paper reviews the evidence for interactions between dietary fat and two common polymorphisms in the apolipoprotein E and peroxisome proliferator-activated receptor-, genes. Although an increased understanding of how these and other genes influence response to nutrients should facilitate the progression of personalized nutrition, the ethical issues surrounding its routine use need careful consideration. [source] Statistical issues in interpreting clinical trialsJOURNAL OF INTERNAL MEDICINE, Issue 5 2004D. L. DeMets Abstract. Randomized clinical trial is an important research tool in evaluating new therapeutic agents, devices and procedures. In order to obtain reliable and unbiased results, careful consideration must be given in the design and conduct of the trial. However, bias can be introduced in the analysis of the final data if certain principles are not followed. Several issues are described that make interpretation of analyses challenging. These include the intent-to-treat principle, the use of surrogate outcome measures, subgroup analyses, missing data and noninferiority trials. [source] Feasibility of diffusion-weighted MRI for defining placental invasionJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 3 2009Satoru Morita MD Abstract The purpose of this clinical note is to describe the feasibility of using diffusion-weighted imaging for diagnosing placental invasion with a case of placenta increta and six cases without it. Diffusion-weighted imaging (DWI) at a b-value of 1000 sec/mm2 can clearly define the border between the placenta and myometrium because only the placenta shows very high signal intensity. The corresponding image at a b-value of 0 sec/mm2 shows the myometrium with high signal intensity compared with the surrounding fat. Therefore, fusion of the two images can be used additionally to visualize thickness of the myometrium. As a result, DWI can be used to visualize the focal thinning of the myometrium caused by placenta increta, which has been difficult to diagnose on conventional magnetic resonance imaging sequences without contrast enhancement. However, the use of DWI for placental invasion should be determined following careful consideration of its risks and benefits, as fetus safety has not been established. J. Magn. Reson. Imaging 2009;30:666,671. © 2009 Wiley-Liss, Inc. [source] Improvement of vessel visibility in time-of-flight MR angiography of the brainJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2008Takaharu Shonai MD Abstract Purpose To improve vessel visibility in time-of-flight MR angiography (TOF-MRA) by careful consideration of coil choice, coil position, and frequency offset and profile of the nonspatially selective chemical shift selective (CHESS) presaturation pulse. Materials and Methods The effects of both the CHESS and the excitation radiofrequency (RF) pulses on flow signal and signals from stationary substances were evaluated by changing the spatial area where RF pulses were applied to upstream flow in a flow phantom and in human subjects. The difference between the eight-channel phased-array receive-only coil and the transmit,receive coil was evaluated. Results The CHESS pulse suppresses the flow signal over a wider frequency range than the signals from stationary substances, especially when using the body coil for transmission. Even without presaturation pulse, the excitation pulse slightly suppressed the flow signal. Adjusting the position of the transmit,receive coil relative to the head improved these TOF-MRA images. The results were better than those obtained with the eight-channel coil. Conclusion The excitation and the nonspatially selective CHESS pulses degraded the flow signal. Our results suggest that reduced spatial extent of RF pulse application to upstream flow can improve image quality of TOF-MRA. This result can be implemented on conventional scanners. J. Magn. Reson. Imaging 2008;27:1362,1370. © 2008 Wiley-Liss, Inc. [source] Experimental and model determination of human intervertebral disc osmoviscoelasticityJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 8 2008Y. Schroeder Abstract Finite element (FE) models have become an important tool to study load distribution in the healthy and degenerated disc. However, model predictions require accurate constitutive laws and material properties. As the mechanical properties of the intervertebral disc are regulated by its biochemical composition and fiber-reinforced structure, the relationship between the constitutive behavior of the tissue and its composition requires careful consideration. While numerous studies have investigated the annulus fibrosus compressive and tensile properties, specific conditions required to determine model parameters for the osmoviscoelastic model are unavailable. Therefore, the objectives of this study were (1) to complement the existing material testing in the literature with confined compression and tensile tests on human annulus fibrosus and (2) to use these data, together with existing nucleus pulposus compression data to tune a composition-based, osmoviscoelastic material constitutive law. The osmoviscoelastic material constitutive law and the experimental data were used to describe the fiber and nonfiber properties of the human disc. The compressive material properties of normal disc tissue were Gm,=,1.23 MPa, M,=,1.57, and ,,=,1.964,×,10,16 m4/Ns; the tensile fiber material parameters were E0,=,77.0 MPa; E,,=,500 MPa, and ,,=,1.8,×,103 MPa,s. The goodness of fit ranged from 0.88 to 0.96 for the four experimental conditions evaluated. The constitutive law emphasized the interdependency of the strong swelling ability of the tissue and the viscoelastic nature of the collagen fibers. This is especially important for numerical models to further study the load sharing behavior with regard to disc degeneration and regeneration. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:1141,1146, 2008 [source] | |||||||||||||||||||||||||||||||||||||||||||