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Selected AbstractsGuidelines for treatment of neonatal jaundice.ACTA PAEDIATRICA, Issue 3 2001Is there a place for evidence-based medicine? Treatment of neonatal jaundice continues to be a controversial issue. Arguments that traditional practice results in over-treatment have led to the adoption of more liberal guidelines in some countries. The importation of liberal guidelines from one country to the next, however, is fraught with danger, because differences in epidemiology, sociology and healthcare delivery systems between countries may not be adequately reflected. The unreflected extension of liberalization to non-target groups of patients can expose the latter to significant risk. It is not clear that the evidence on which guidelines for treatment of neonatal jaundice are based satisfy the requirements for evidence-based medicine. Evidence of adequate quality may be hard to obtain. Conclusions: Introduction of more liberal guidelines for the treatment of neonatal jaundice, if at all contemplated, must be adapted to local circumstances, and any available evidence pertaining to local epidemiology, sociology and healthcare organization has to be carefully weighed and incorporated. The time is ripe for a joint international effort to secure adequate funding for basic and applied research within the mechanisms of bilirubin encephalopathy in the newborn. [source] Use of Hyaluronidase in the Treatment of Granulomatous Hyaluronic Acid Reactions or Unwanted Hyaluronic Acid MisplacementDERMATOLOGIC SURGERY, Issue 8 2005Harold J. Brody MD Background. In the past, reactions or misplacement of soft tissue fillers has been fraught with anxiety because time has been the main thrust for improvement in spite of ancillary treatments. Hyaluronidase is an enzyme that dissolves hyaluronic acid in the skin and also assists in the management of granulomatous foreign-body reactions to hyaluronic acid. These reactions may be caused by allergy to the material or immunologic response to the protein contaminants in the hyaluronic acid preparations. Dissolution of material in erroneous placement of material and in allergic reactions can be a time saver and a deterrent to patient dissatisfaction. Objective. To evaluate the use of hyaluronidase in the treatment of both allergic reactions and the erroneous misplacement of hyaluronic acid in the skin. Methods. A case of persistent granulomatous reaction to injectable hyaluronic acid and a case of hyaluronic acid erroneous misplacement with their successful subsequent treatments using intracutaneous hyaluronidase are reported, along with illustrative examples of hyaluronidase use. Results. The use of hyaluronidase reduced the patient discomfort within 24 to 48 hours, deterring any patient anxiety or patient dissatisfaction. Conclusions. Hyaluronidase has a place in the treatment of allergic reactions to hyaluronidase and in the erroneous misplacement of the material. [source] Complications of Expanded Polytetrafluoroethylene (e-PTFE) Facial ImplantDERMATOLOGIC SURGERY, Issue 9 2001Harold J. Brody MD Implantation of the expanded polytetrafluoroethylene (e-PTFE) implant to achieve correction of nasolabial folds or thinning lip has been fraught with complications in spite of patient acceptance since its introduction in 1997. The four most frequent postoperative complications are extrusion, movement, infection, and swelling. In examination of 86 insertions of the 3.2 mm tubular implants, these sequelae are generally manageable for the physician and patient. If the patient understands possible courses of healing, both physician and patient satisfaction may be achieved. [source] Ultrasound as an outcome measure to assess disease activity in disorders of skin thickening: an example of the use of radiologic techniques to assess skin diseaseDERMATOLOGIC THERAPY, Issue 2 2007Sandra E. Bendeck ABSTRACT:, Good outcome measures are required to determine whether a therapy is effective, both in routine clinical practice and in experimental clinical trials. In disorders of skin thickening such as morphea and scleroderma, more commonly used outcome measures that use a subjective score based on palpated skin thickening are fraught with error. By contrast, measurements made by ultrasound have great promise as outcome measures that are quantitative, valid, reproducible, and responsive. Further studies should establish its role in the field. In this paper, the present authors used ultrasound to illustrate the criteria that are required to establish a technology-based outcome measure. [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] Anatomy of an overfill: a reflection on the processENDODONTIC TOPICS, Issue 1 2007ALAN H. GLUSKIN The design and implementation of shaping, cleaning and sealing objectives in root canal therapy are fraught with real and potential pitfalls when the anatomic complexity of the space and technical considerations for its instrumentation, disinfection and obturation are contemplated. This review will focus on the genesis of results that lead to endodontic overfills. We will look at how the literature defines overfill and overextension; attempt to address the consensus opinion on the definition of working length; and determine the effects of shaping geometry on overfill as well as the biological impact of obturation materials that go beyond the root canal space. In addition, this manuscript will highlight evidence for the prevention of overfills as well as focus on the local factors that affect repair and healing. [source] Justifying the expense of the cancer Clinical Nurse SpecialistEUROPEAN JOURNAL OF CANCER CARE, Issue 1 2010C.A. POLLARD ba POLLARD C.A., GARCEA G., PATTENDEN C.J., CURRAN R., NEAL C.P., BERRY D.P. & DENNISON A.R. (2009) European Journal of Cancer Care19, 72,79 Justifying the expense of the cancer Clinical Nurse Specialist In order to maximise patient care, assessment of the adequacy of the service provision by the Clinical Nurse Specialist (CNS) must be regularly undertaken. This study attempted to determine whether CNSs were providing an adequate service via retrospective and prospective audit. The results of a comprehensive audit of the work of the CNS within a tertiary referral Hepatobiliary Unit are presented. The audit involved postal and telephone questionnaires as well as prospective collection of data. The majority of responses from patients were positive, with many finding the CNS a useful and well-utilised contact. Overall, the CNSs performed well in each of their designated tasks; however, areas were still identified which could be further improved. Audit is essential in providing feedback to the CNS and to identify areas which require improvement. The CNS has evolved to meet a clinical gap in patient care, and as a result, the role of a CNS is frequently nebulous or poorly defined. This renders evaluation of the CNS problematic and fraught with difficulties. However, a thorough assessment can still be made using carefully constructed audit looking at each task of the CNS. [source] Lesion studies targeting food-anticipatory activityEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 9 2009Alec J. Davidson Abstract Behavior ablation remains a powerful, if not cutting-edge, approach for localization of function within the nervous system. The initial discovery of the suprachiasmatic nuclei as the site of the mammalian light-entrainable circadian pacemaker is owed to this approach. Food-anticipatory activity (FAA), an output of a putative feeding-entrainable circadian pacemaker, is a behavior that has been surprisingly resilient to elimination by surgical lesion. Here we review this literature, with particular attention paid to recent studies aimed at defining the role of the dorsomedial hypothalamus in the generation of FAA. This literature is fraught with examples of inconsistent results among lesion studies, which in some cases can be accounted for by varied endpoint measures. The site of the feeding-entrainable circadian pacemaker, if it resides in a discrete structure at all, remains unknown. [source] Self-reports, peer ratings and construct validityEUROPEAN JOURNAL OF PERSONALITY, Issue 3 2010Sampo V. Paunonen Abstract Self-reports of behaviour have been criticized as fraught with problems that seriously undermine the construct validity of conventional personality measures. The problems are related to a putative absence of, or distortion of, a person's knowledge about himself or herself. A proposed solution is to use peer reports of personality instead, because such observer ratings are presumably more impartial and free of the distorting influences affecting self-reports. We review some past research on moderators of the agreement between self-reports and peer ratings of personality, arguing that those findings support the validity of self-ratings. We conclude that peer ratings, although highly useful as adjuncts to other methods of assessment, are no substitute for self-reports as a source of personality information. Copyright © 2010 John Wiley & Sons, Ltd. [source] Research Ethics: Ethical Issues of Data Reporting and the Quest for AuthenticityACADEMIC EMERGENCY MEDICINE, Issue 6 2000Catherine A. Marco MD Abstract. The search for truth and its unbiased reporting are ultimate goals of conducting scientific research. Ideally, the reporting of research data ought to be an objective task. In practice, however, it is fraught with numerous statistical and ethical pitfalls, seldom addressed in formal emergency medicine training. The lure of academic celebrity and related influences may persuade researchers to report results in ways that make data appear more interesting, or worthy of publication. Several examples of potentially misleading data reporting are illustrated, including using inappropriate statistical tests, neglecting negative results, omitting missing data points, failing to report actual numbers of eligible subjects, using inappropriate graph labels or terminology, data dredging, and others. Although potentially inaccurate or inflated methods of data reporting may not constitute overt scientific misconduct, the intentional misrepresentation of data is a form of fraud or deception. Publicly funded academic inquiry is a privilege and honor enjoyed by a trusted few. Regardless of outcome, every effort should be made to report data in the most scientifically accurate method. To this end, the Society for Academic Emergency Medicine Code of Conduct and American College of Emergency Physicians Code of Ethics provide important guidance toward the accurate, compassionate, competent, impartial, and honest conduct of scientific research. Accuracy and authenticity in data reporting are first and foremost a matter of individual integrity, and are crucial to the preservation of academic credibility, the protection of future patients, and the public's trust in the medical research enterprise. [source] Diabetes hyperglycemia and recovery from strokeGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 1-2 2001Christopher S Gray Strokeis a major cause of death and severe disability in older people. Despite the burden of disease, there is still no safe, simple and proven medical therapy for the treatment of acute stroke. Advances in acute stroke treatment have been either consistently disappointing (neuroprotective therapy) or fraught with controversy regarding risk/benefit (thrombolysis), and attention is once again being directed towards physiological variables that may influence outcome. Both insulin-dependent and non-insulin-dependent diabetes mellitus are major risk factors for stroke. Diabetes mellitus has also been shown to be associated with increased mortality and reduced functional outcome after stroke. Hyperglycemia is a frequent finding following stroke and may reflect the metabolic stress of the acute event, so-called stress hyperglycemia, and/or underlying impaired glucose metabolism. Several large clinical studies have now demonstrated a positive association between a raised blood glucose and poor outcome from stroke; greater mortality and reduced functional recovery. What is not clear is to what extent hyperglycemia is a ,normal' physiological response to stroke or whether hyperglycemia per se increases cerebral damage in the acute phase. There are many potential mechanisms by which hyperglycemia can exert a harmful effect upon cerebral tissue and it is probable that an important relationship exists, not only between glucose and stroke outcome, but also between insulin and neuroprotection. It remains to be determined whether lowering and maintaining ,normal' glucose levels in the immediate aftermath of stroke, combined with the administration of insulin as an acute treatment, can modify this outcome. [source] Functional connexin "hemichannels": A critical appraisalGLIA, Issue 7 2006David C. Spray Abstract "Hemichannels" are defined as the halves of gap junction channels (also termed connexons) that are contributed by one cell; "hemichannels" are considered to be functional if they are open in nonjunctional membranes in the absence of pairing with partners from adjacent cells. Several recent reviews have summarized the blossoming literature regarding functional "hemichannels", in some cases encyclopedically. However, most of these previous reviews have been written with the assumption that all data reporting "hemichannel" involvement really have studied phenomena in which connexons actually form the permeability or conductance pathway. In this review, we have taken a slightly different approach. We review the concept of "hemichannels", summarize properties that might be expected of half gap junctions and evaluate the extent to which the properties of presumptive "hemichannels" match expectations. Then we consider functions attributed to hemichannels, provide an overview of other channel types that might fulfill similar roles and provide sets of criteria that might be applied to verify involvement of connexin hemichannels in cell and tissue function. One firm conclusion is reached. The study of hemichannels is technically challenging and fraught with opportunities for misinterpretation, so that future studies must apply rigorous standards for detection of hemichannel expression and function. At the same time there are reasons to expect surprises, including the possibility that some time honored techniques for studying gap junctions may prove unsuitable for detecting hemichannels. We advise hemichannel researchers to proceed with caution and an open mind. © 2006 Wiley-Liss, Inc. [source] Plant growth functions and possible spatial and temporal scaling errors in models of herbivoryGRASS & FORAGE SCIENCE, Issue 1 2001A. J. Parsons Recent studies have provided detail of the mechanisms by which plants and animals interact, but attempts to apply this knowledge to understand function at the scale of whole fields or grazed ecosystems can be fraught with difficulties. Faced with a plethora of detail, and yet demands to make models more comprehensive, modellers face pressure to revert to simplified accounts for what are assumed to be well-established biological phenomena, for example, for describing plant growth and intake, but this raises the risk that important insights may be lost, or that the analyses may face errors of scaling. The predictions of a previously described spatial model are compared with those of a non-spatial rendition of the same model to identify the differences in predictions and the sources of these differences. In particular, the use of the conventional empirical growth functions and their interaction with temporal and spatial scaling errors are examined. The comparison exposed how substantial errors could be made in predicting yield and stability under grazing. It is proposed that such errors might be avoided by ensuring that the functional responses used capture the insights of more detailed studies, and by recognizing the difficulties of scaling-up from the level of processes to the field scale and beyond. [source] The emotions in war: fear and the British and American military, 1914,45HISTORICAL RESEARCH, Issue 185 2001Joanna Bourke In modern warfare, technological innovations are applied to terrifying effect. On the machine-dominated battlefields of the twentieth century, the ability of individuals to master their emotions is crucial to the whole martial enterprise. Fear has widely been recognized as the most fraught of all emotions: it may stimulate combatants to fight and it may cause them to flee. This article examines the proliferation of theories about the nature of this emotion within the British and American forces during the First and Second World Wars. The military recognized the impact of new technologies upon human physiology and psychology, elaborated ways of interpreting the particular threat posed by ,fear' in modern conflicts, and prescribed ways of disciplining the emotional lives of combatants. [source] The Courts of the Prior and the Bishop of Durham in the Later Middle AgesHISTORY, Issue 278 2000Cynthia J. Neville The operation of the common law in late medieval county Durham was characterized by several unique features. Among these were the independence of episcopal officials from interference from royal agents in the execution of the law, and the great variety of temporal courts found there. Within the lands of the palatinate, jurisdiction over suspects accused of felony was shared by both the bishop and the prior of Durham. The origins of this unusual division of judicial authority was an agreement dated c.1229, known as Le Convenit. It defined the relationship between the bishop, the temporal lord of the palatinate, and the prior of the Benedictine monastery in Durham who, as a landholder second only to the bishop, held a separate court for the suit of his free tenants. That relationship was often fraught with tension, for both lords were jealous of the prestige , and the revenues , incumbent on the exercise of judicial authority in their lands. This article examines the origins of Le Convenit, and the consequences of the agreement on criminal legal procedure in late medieval Durham. Successive priors of the monastery struggled tirelessly against the bishops to preserve the privileges they won in 1229, and Le Convenit remained throughout this period a potent weapon in their determination to give expression to lordly power and authority. [source] Pitfalls of Ability ResearchINTERNATIONAL JOURNAL OF SELECTION AND ASSESSMENT, Issue 4 2001Thomas R. Carretta Ability research in psychology can be fraught with pitfalls that lead to inappropriate conclusions. We identify several issues that lead to potential misinterpretation of results and suggest corrective solutions. These issues include lack of construct validity of the measures, misinterpretation of correlations and regression weights, lack of statistical power, failure to estimate cross-validation effects, and misinterpretation of factor analytic results. [source] Knowledge is a Dangerous Thing: Authority Relations, Ideological Conservatism, and Creativity in Confucian-Heritage CulturesJOURNAL FOR THE THEORY OF SOCIAL BEHAVIOUR, Issue 1 2008DAVID YAU FAI HO ABSTRACT Throughout history, the generation, exercise, and dissemination of knowledge are fraught with dangers, the root causes of which are traceable to the definition of authority relations. The authors compare Greek myths and Chinese legends, setting the stage for a metarelational analysis of authority relations between teacher and students and between scholar-teachers and political rulers in Confucian-heritage cultures. These two relations are rooted in ideological conservatism. They are related in a higher-order relation or metarelation: Political control and the definition of the teacher-student relationship reinforce each other in consolidating authoritarian values. Thus, ideological conservatism shapes educational philosophy and socialization. It conflicts with present demands for creativity in the service of knowledge-based economies. Hence, a major issue in cultural change to be addressed concerns the dilemma between maintaining authoritarian control and enhancing creativity. [source] Skeletal Myoblast Transplant in Heart FailureJOURNAL OF CARDIAC SURGERY, Issue 4 2003Eugene K.W. Sim F.R.C.S. Heart transplantation has emerged as a viable option but is fraught with problems of supply. Mechanical assist devices are extremely expensive and dynamic cardiomyoplasty has shown only limited success in the clinical setting. Recent insights into the pathogenesis of myocardial diseases and the progress made in the field of molecular biology have resulted in the development of new strategies at molecular as well as cellular levels for cardiac muscle repair. One such strategy is to augment ventricular function by means of cellular cardiomyoplasty through intracardiac cell grafting using adult and fetal cardiomyocytes, stem cells, and autologous skeletal myoblasts. (J Card Surg 2003; 18:319-327) [source] Taking stem cells to the clinic: Major challengesJOURNAL OF CELLULAR BIOCHEMISTRY, Issue 6 2008Ariff Bongso Abstract Stem cell therapy offers tremendous promise in the treatment of many incurable diseases. A variety of stem cell types are being studied but human embryonic stem cells (hESCs) appear to be the most versatile as they are pluripotent and can theoretically differentiate into all the tissues of the human body via the three primordial germ layers and the male and female germ lines. Currently, hESCs have been successfully converted in vitro into functional insulin secreting islets, cardiomyocytes, and neuronal cells and transfer of such cells into diabetic, ischaemic, and parkinsonian animal models respectively have shown successful engraftment. However, hESC-derived tissue application in the human is fraught with the problems of ethics, immunorejection, tumorigenesis from rogue undifferentiated hESCs, and inadequate cell numbers because of long population doubling times in hESCs. Human mesenchymal stem cells (hMSC) though not tumorigenic, also have their limitations of multipotency, immunorejection, and are currently confined to autologous transplantation with the genuine benefits in allogeneic settings not conclusively shown in large controlled human trials. Human Wharton's jelly stem cells (WJSC) from the umbilical cord matrix which are of epiblast origin and containing both hESC and hMSC markers appear to be less troublesome in not being an ethically controversial source, widely multipotent, not tumorigenic, maintain "stemness" for several serial passages and because of short population doubling time can be scaled up in large numbers. This report describes in detail the hurdles all these stem cell types have to overcome before stem cell-based therapy becomes a genuine reality. J. Cell. Biochem. 105: 1352,1360, 2008. © 2008 Wiley-Liss, Inc. [source] Efficacy and safety of DALI LDL-apheresis at high blood flow rates: A prospective multicenter studyJOURNAL OF CLINICAL APHERESIS, Issue 4 2003T. Wendler Abstract Direct adsorption of lipids (DALI) is the first LDL-apheresis method compatible with whole blood. Usually, the blood flow rate is adjusted at 60,80 ml/min, which results in session times of about 2 hr. The present study was performed to test the safety and efficacy of low-density lipoprotein cholesterol (LDL-C) and lipoprotein (a) [Lp(a)] removal by DALI at high blood flow rates in order to reduce treatment time. Thirteen chronic DALI patients in seven centers suffering from hypercholesterolemia (LDL-C 162 ± 42 mg/dl at baseline) and coronary artery disease were treated on a weekly or biweekly basis by DALI apheresis. The blood flow rate QB was held constant for at least two sessions, respectively, and was increased from 60 to 80, 120, 160, 200, and 240 ml/min. All patients had pre-existing av-fistulas. The anticoagulation was performed by a heparin bolus plus ACD-A at a ratio of citrate: blood ranging from 1:20 to 1:90. Clinically, the sessions were well tolerated and only 26/201 sessions (12%) of the treatments were fraught with minor adverse events. Acute LDL-C reductions (derived from LDL-C levels determined by lipoprotein electrophoresis) averaged 72/66/60/53/50/48% for QB = 60/80/120/160/200/240 ml/min. Lp(a) reductions were 68/67/62/60/58/56%, whereas HDL-C losses were ,10%. Routine blood chemistries and blood cell counts remained in the normal range. Treatment times averaged 142/83/45 min at Qb = 60/120/240 ml/min. On average, DALI LDL-apheresis could be performed safely and effectively at high blood flow rates up to at least 120 ml/min in patients with good blood access, which significantly reduced treatment time from 142 to 83 min (,42%). J. Clin. Apheresis 18:157,166, 2003. © 2003 Wiley-Liss, Inc. [source] A multidegree-of-freedom manipulator for curtain-wall installationJOURNAL OF FIELD ROBOTICS (FORMERLY JOURNAL OF ROBOTIC SYSTEMS), Issue 5 2006Chang Soo Han Recently, the trend in architectural forms has been towards larger and taller buildings. Building materials are, therefore, also becoming larger and heavier. Typical construction machineries are not adequate for handling such materials, and most construction works are still managed by a human operator. Construction processes are, therefore, fraught with a number of problems, including frequent accidents, high construction cost, and heterogeneous construction quality depending on the experience of the workers. Automation has been introduced at various sites to address these construction problems. In this paper, the process of a curtain-wall installation in a skyscraper is analyzed, and the prototype of a construction robot for curtain-wall installation (CRCWI) is proposed. Use of the proposed CRCWI can reduce the need for manpower and the construction period and cost, and can assure safety in the curtain-wall construction site. The performance of the proposed CRCWI was verified with a real application test in a skyscraper construction site. © 2006 Wiley Periodicals, Inc. [source] Detecting predator,prey relationships in the seaJOURNAL OF FISH BIOLOGY, Issue 2003N. K. Dulvy Understanding the strength and diversity of predator-prey interactions among species is essential to understand ecosystem consequences of population-level variation. Directly quantifying the predatory behaviour of wild fishes at large spatial scales (>100 m) in the open sea is fraught with difficulties. To date the only empirical approach has been to search for correlations in the abundance of predators and their putative prey. As an example we use this approach to search for predators of the keystone crown-of-thorns starfish. We show that this approach is unlikely to detect predator,prey linkages because the theoretical relationship is non-linear, resulting in multiple possible prey responses for single given predator abundance. Instead we suggest some indication of the strength and ecosystem importance of a predator,prey relationship can be gained by using the abundance of both predators and their putative prey to parameterize functional response models. [source] Personal Identification Using the Frontal Sinus,JOURNAL OF FORENSIC SCIENCES, Issue 3 2010Joanna L. Besana M.Sc. Abstract:, The frontal sinuses are known to be unique to each individual; however, no one has tested the independence of the frontal sinus traits to see if probability analysis through trait combination is a viable method of identifying an individual using the frontal sinuses. This research examines the feasibility of probability trait combination, based on criteria recommended in the literature, and examines two other methods of identification using the frontal sinuses: discrete trait combinations and superimposition pattern matching. This research finds that most sinus traits are dependent upon one another and thus cannot be used in probability combinations. When looking at traits that are independent, this research finds that metric methods are too fraught with potential errors to be useful. Discrete trait combinations do not have a high enough discriminating power to be useful. Only superimposition pattern matching is an effective method of identifying an individual using the frontal sinuses. [source] Persistent isolationist or collaborator?JOURNAL OF NURSING MANAGEMENT, Issue 3 2010The nurse's role in interprofessional collaborative practice orchard ca. (2010) Journal of Nursing Management18, 248,257 Persistent isolationist or collaborator? The nurse's role in interprofessional collaborative practice Aim, The present study explores current understanding about interprofessional collaborative client-centred practice and nursing's role in this form of care delivery. Background, A profession-only focus on nursing practice has been challenged at professional, national governmental and World Health Organization levels stressing for more interprofessional patient-centred collaborative teamwork. Evaluation, Moving to patient-centred collaborative practice is fraught with barriers. Enablers can result in building trust, power sharing and shared decision-making. Changing current workplace environments requires institutional commitments to support collaborative team development. Key issue(s), Nurses can become collaborative members of teams through: (1) re-socialize; (2) understanding and articulating nurses roles, knowledge and skills to others; (3) other health providers sharing the same to nurses; (4) identifying where shared roles, knowledge and skills exist; and (5) learning to work in collaborative teams. Nurses must address some fundamental issues about practice that negate collaboration and patient-centred care. Conclusions, All professionals, including nurses, must move away from a service-oriented delivery to a patient-centred collaborative approach to care. Implications for nursing management, The values within health organizations need to be underpinned by collaborative interprofessional patient-centred practice. To accomplish this goal, administrators and managers must support assessment of employees and visiting physicians as to their conformance with agency established expectations for such practice. [source] Three metaphors and a (mis)quote: thinking about staffing-outcomes research, health policy and the future of nursingJOURNAL OF NURSING MANAGEMENT, Issue 2 2009FAAN, SEAN P. CLARKE RN Conducting research on nurse staffing and outcomes is very challenging, and the application of staffing-outcomes research in practice is both fraught with controversy and vitally important for the safety of our patients and the future of the profession. As I stand back and think about being involved in staffing-outcomes research for nearly a decade and sharing many of my thoughts about this rapidly growing literature in reviews and commentaries in print, certain metaphors for trends in this field come to mind. I won't claim originality for the insights that follow or attempt to thoroughly trace the genealogy of the stories and metaphors here, but offer them to provide what I hope is a fresh perspective to material that I and many of my colleagues have visited and revisited on numerous occasions. [source] On the business value and technical challenges of adopting Web servicesJOURNAL OF SOFTWARE MAINTENANCE AND EVOLUTION: RESEARCH AND PRACTICE, Issue 1-2 2004S. Tilley Abstract This paper provides a balanced perspective of the business value and technical challenges of adopting Web services. Technology adoption is a continual challenge for both tool developers and enterprise users. Web services are a prime example of an emerging technology that is fraught with adoption issues. Part of the problem is separating marketing hype from business reality. Web services are network-accessible interfaces to application functionality. They are built using Internet technologies such as XML and standard protocols such as SOAP. The adoption issues related to Web services are complex and multifaceted. For example, determining whether this technology is a fundamental advance, rather than something old under a new name, requires technical depth, business acumen, and considerable historical knowledge of past developments. A sample problem from the health care industry is used to illustrate some of the adoption issues. Copyright © 2004 John Wiley & Sons, Ltd. [source] How dogs dream: Amazonian natures and the politics of transspecies engagementAMERICAN ETHNOLOGIST, Issue 1 2007EDUARDO KOHN Under the rubric of an "anthropology of life," I call for expanding the reach of ethnography beyond the boundaries of the human. Drawing on research among the Upper Amazonian Runa and focusing, for heuristic purposes, on a particular ethnological conundrum concerning how to interpret the dreams dogs have, I examine the relationships, both intimate and fraught, that the Runa have with other lifeforms. Analytical frameworks that fashion their tools from what is unique to humans (language, culture, society, and history) or, alternatively, what humans are commonly supposed to share with animals are inadequate to this task. By contrast, I turn to an embodied and emergentist understanding of semiosis,one that treats sign processes as inherent to life and not just restricted to humans,as well as to an appreciation for Amazonian preoccupations with inhabiting the points of view of nonhuman selves, to move anthropology beyond "the human," both as analytic and as bounded object of study. [source] Impact of Age on Associations Between Weight and MortalityNUTRITION REVIEWS, Issue 5 2000June Stevens Ph.D. The effect of age on the weight associated with the lowest mortality and the effect of age on the mortality risk associated with obesity are issues fraught with methodologic complexities. Current evidence supports the notion that the body mass index associated with the lowest mortality falls within the range of 18.5 to 24.9 in men and women between the ages of 30 and 74. The impact of age on the mortality risk associated with obesity changes with age, however, and the direction of the trend depends upon the measure used. [source] A Brief History of the American Economic AssociationAMERICAN JOURNAL OF ECONOMICS AND SOCIOLOGY, Issue 5 2008Michael A. Bernstein The 20th -century American economics profession and its leading professional organization,the American Economic Association (AEA),were privileged and shaped by the federal government's need to direct resources and to call on experts. Bureaucratic tendencies to classify and count had an impact on the discipline's self-concept, the articulation of subdisciplines, and the establishment of multiple research agendas. They also powerfully framed the strategies for growth and development formulated and deployed by the AEA itself. A consensus of professional opinion and the standardization of curriculums emerged out of the involvement of economists and the AEA with governmental affairs. At the same time, such public engagement was fraught with risks and contradictions,posing challenges and difficulties with which the AEA and the profession would have to contend for decades to come. [source] Elevated levels of IgG3 and IgG4 subclass in paediatric cases of kala azarPARASITE IMMUNOLOGY, Issue 8 2008N. A. ANSARI SUMMARY Visceral leishmaniasis (VL) or Kala azar (KA) is a systemic disease caused by the parasites of the Leishmania donovani complex. Control measures rely on treatment with antileishmanial agents, however, fraught with problems such as toxicity or drug resistance. The incidence rate is on the rise for children, for reasons yet undefined. Previously we have shown significantly elevated level of IL-10 in children compared to adult KA cases. Here, antileishmanial antibody and C-reactive protein (CRP) levels were investigated in paediatrics and adult patients of KA and post-KA dermal leishmaniasis (PKDL). Level of IgG4 was significantly elevated in PKDL compared to KA, although total IgG and IgG1 were significantly lower. The antileishmania antibody levels of subclass IgG3 and IgG4 were found significantly elevated in paediatrics, however, levels of IgG, IgG1, IgG2 and CRP were comparable in paediatric and adult KA cases. In case of PKDL, levels of IgG and it subclass were similar in the two groups. No significant difference in antileishmanial antibody level was noticed between macular or polymorphic cases of PKDL. The differential antibody intensity in paediatric cases, together with significant level of circulating IL-10, could be considered as a marker of differential disease susceptibility. 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