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Little Consensus (little + consensus)
Selected AbstractsStudent Conflict Resolution, Power "Sharing" in Schools, and Citizenship EducationCURRICULUM INQUIRY, Issue 2 2001Kathy Bickmore One goal of elementary education is to help children develop the skills, knowledge, and values associated with citizenship. However, there is little consensus about what these goals really mean: various schools, and various programs within any school, may promote different notions of "good citizenship." Peer conflict mediation, like service learning, creates active roles for young people to help them develop capacities for democratic citizenship (such as critical reasoning and shared decision making). This study examines the notions of citizenship embodied in the contrasting ways one peer mediation model was implemented in six different elementary schools in the same urban school district. This program was designed to foster leadership among diverse young people, to develop students' capacities to be responsible citizens by giving them tangible responsibility, specifically the power to initiate and carry out peer conflict management activities. In practice, as the programs developed, some schools did not share power with any of their student mediators, and other schools shared power only with the kinds of children already seen as "good" students. All of the programs emphasized the development of nonviolent community norms,a necessary but not sufficient condition for democracy. A few programs began to engage students in critical reasoning and/or in taking the initiative in influencing the management of problems at their schools, thus broadening the space for democratic learning. These case studies help to clarify what our visions of citizenship (education) may look and sound like in actual practice so that we can deliberate about the choices thus highlighted. [source] Methods to Test the Spatial Mismatch HypothesisECONOMIC GEOGRAPHY, Issue 4 2005Donald S. Houston Abstract: The spatial mismatch hypothesis postulates that employment deconcentration within U.S. metropolitan areas goes some way toward explaining higher unemployment and lower wages among ethnic minority groups, since these groups are more likely to reside in central-city areas. However, little consensus has emerged on the importance of spatial mismatch in explaining disadvantage in the labor market. This article argues that conflicting evidence is the result of the variety of methods that have been used to test the spatial mismatch hypothesis. Moreover, it draws attention to a number of hitherto uncovered flaws in some of these methods that introduce systematic biases against finding evidence in support of the hypothesis. In light of these flaws, favored methods for future research are highlighted. Drawing on evidence from British conurbations that display similar spatial inequalities to U.S. metropolitan areas despite much smaller ethnic minority populations, the article contends that race does not lie at the heart of the spatial mismatch problem. Three areas in which the spatial mismatch hypothesis should be reconceptualized are identified: first, its emphasis should be on spatial, not racial, inequalities; second, it needs to differentiate between residential immobility and residential segregation, which are quite different; and third, it needs to recognize that the extent and the effect of spatial mismatch are distinct and should be measured separately. [source] Size-Related Advantages for Reproduction in a Slightly Dimorphic Raptor: Opposite Trends between the SexesETHOLOGY, Issue 12 2007Fabrizio Sergio Despite many comparative analyses and more than 20 proposed hypotheses, there is still little consensus over the factors promoting the evolution of reversed sexual dimorphism (RSD) in raptorial species. Furthermore, intrapopulation studies, which may elucidate how RSD is maintained once evolved, have been surprisingly scarce and only focused on a handful of species with medium to high dimorphism. We examined the reproductive advantages associated with body size and condition, measured in the pre-laying period, in a diurnal raptor with low sexual dimorphism, the black kite (Milvus migrans). The study population was essentially monomorphic in size. For females, there was an evidence of reproductive benefits associated with larger size and/or with better body condition. Larger females had also access to higher quality partners and territories, consistent with the ,intrasexual selection' hypothesis, by which members of the larger sex enjoy size-related advantages in intrasexual competition over a scarce resource, the smaller sex. Opposite trends emerged for males: smaller, leaner males had higher breeding output, consistent with the ,small efficient male' hypothesis. Overall, the fact that we observed in an essentially monomorphic population the same selection pressures previously found in species with marked dimorphism suggests that such reproductive advantages may be counterbalanced in our study model by opposite selection pressures during other stages of the life cycle. This casts some doubts on the evolutionary significance of studies focusing exclusively on reproduction and calls for the need of more comprehensive analyses incorporating trait-mediated differentials in survival and recruitment. [source] The inpatient management of physical activity in young people with anorexia nervosaEUROPEAN EATING DISORDERS REVIEW, Issue 5 2008Sarah Davies Abstract This study investigates the management of physical activity in young inpatients with anorexia nervosa. Through telephone interviews and postal surveys inpatient units across the UK were asked about written documents regarding physical activity management, how they viewed healthy exercise, how they assessed physical fitness to engage in activity, the management approaches taken, provision of education and support around this issue and range of activities provided. Results indicated that a variety of approaches were taken, with little consensus between units, although the majority of approaches did involve some form of restriction, frequently determined by weight criteria. There were few substantial written documents to guide practice and a range of interpretations of healthy exercise. The findings are discussed and suggestions made for research to explore this area further and to inform the development of effective interventions. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source] EFNS guideline on the diagnosis and management of alcohol-related seizures: report of an EFNS task forceEUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2005G. Bråthen Despite being a considerable problem in neurological practice and responsible for one-third of seizure-related admissions, there is little consensus as to the optimal investigation and management of alcohol-related seizures. The final literature search was undertaken in September 2004. Consensus recommendations are given graded according to the EFNS guidance regulations. To support the history taking, use of a structured questionnaire is recommended. When the drinking history is inconclusive, elevated values of carbohydrate-deficient transferrin and/or gammaglutamyl transferase can support a clinical suspicion. A first epileptic seizure should prompt neuroimaging (CT or MRI). Before starting any carbohydrate containing fluids or food, patients presenting with suspected alcohol overuse should be given prophylactic thiamine parenterally. After an alcohol withdrawal seizure (AWS), the patient should be observed in hospital for at least 24 h and the severity of withdrawal symptoms needs to be followed. For patients with no history of withdrawal seizures and mild to moderate withdrawal symptoms, routine seizure preventive treatment is not necessary. Generally, benzodiazepines are efficacious and safe for primary and secondary seizure prevention; diazepam or, if available, lorazepam, is recommended. The efficacy of other drugs is insufficiently documented. Concerning long-term recommendations for non-alcohol dependant patients with partial epilepsy and controlled seizures, small amounts of alcohol may be safe. Alcohol-related seizures require particular attention both in the diagnostic work-up and treatment. Benzodiazepines should be chosen for the treatment and prevention of recurrent AWS. [source] Cognitive control processes during an anticipated switch of taskEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 3 2003G. R. Wylie Abstract For successful negotiation of our environment, humans must be readily able to switch from one task to another. This ability relies on ,executive control' processes and despite extensive efforts to detail the nature of these processes, there is little consensus as to how the brain achieves this critical function. Behavioural studies show that as subjects are given more time to prepare to switch task, performance improves; yet even with the longest preparation intervals, there remains an ineradicable performance cost on switch trials. As such, some elements of the switching process must wait until the stimulus to be acted upon has actually been presented. Here, using the methods of high-density mapping of brain potentials, we show that early visual processes are substantially different on switch trials than on later trials. Our data show that while there is clearly a degree of preparatory processing that occurs prior to a predictable switch of task, some elements of switching are only achieved after the switch stimulus has been presented. Our findings are discussed in the context of a new model of executive control processes that suggests that preparing to switch task may not be a separate (control) process per se, but rather, the beginning of a competition between the potentially relevant tasks, a competition that is ultimately resolved during the switch trial. [source] A comparison of various authoritarianism scales in Belgian FlandersEUROPEAN JOURNAL OF PERSONALITY, Issue 2 2007Alain Van Hiel Abstract The present study compared in a Flemish adult sample (N,=,480) four recently developed authoritarianism scales as well as the widely used Right-Wing Authoritarianism (RWA) scale. Results revealed that all these measures were strongly related and that they showed relationships of comparable magnitude with various indicators of right-wing ideology such as conservatism and racism, as well as with political party preferences. Analyses confirmed the superior fit of a multidimensional model for the scales that are assumed to have an explicit underlying multidimensional structure, but it was also revealed that there was little consensus on what these dimensions exactly mean. Finally, the results indicated serious problems of overlap between cultural conservatism and authoritarianism for some of the scales. Having relied exclusively on an empirical method for comparing the utility of these scales, the use of other criteria for a final assessment of the authoritarianism scales is elaborated upon. Copyright © 2007 John Wiley & Sons, Ltd. [source] Development of fire-retarded materials,Interpretation of cone calorimeter dataFIRE AND MATERIALS, Issue 5 2007B. Schartel Abstract There is little consensus within the fire science community on interpretation of cone calorimeter data, but there is a significant need to screen new flammability modified materials using the cone calorimeter. This article is the result of several discussions aiming to provide guidance in the use and interpretation of cone calorimetry for those directly involved with such measurements. This guidance is essentially empirical, and is not intended to replace the comprehensive scientific studies that already exist. The guidance discusses the fire scenario with respect to applied heat flux, length scale, temperature, ventilation, anaerobic pyrolysis and set-up represented by the cone calorimeter. The fire properties measured in the cone calorimeter are discussed, including heat release rate and its peak, the mass loss and char yield, effective heat of combustion and combustion efficiency, time to ignition and CO and smoke production together with deduced quantities such as FIGRA and MARHE. Special comments are made on the use of the cone calorimeter relating to sample thickness, textiles, foams and intumescent materials, and the distance of the cone heater from the sample surface. Finally, the relationship between cone calorimetry data and other tests is discussed. Copyright © 2007 John Wiley & Sons, Ltd. [source] A comparison of the relative contributions of temporal and spatial variation in the density of drifting invertebrates in a Dorset (U.K.) chalk streamFRESHWATER BIOLOGY, Issue 8 2008MARTIN W. NEALE Summary 1. Invertebrate drift is commonly investigated in streams, with the majority of studies focussed on temporal (typically diel) variation. In comparison, few studies have investigated spatial variation in drift and there is little consensus among them. We tested the hypothesis that spatial variation in invertebrate drift is as important as temporal variation. 2. The density of drifting invertebrates in a chalk stream was sampled using an array of nets arranged to determine vertical, lateral and longitudinal variation. Samples were collected at dawn, during the day, at dusk and by night, on four separate monthly occasions. Insecta and Crustacea were analysed separately to identify the effect of differing life history strategies. The density of drifting debris was also recorded, to act as a null model. 3. Time of day and vertical position together explained the majority of the variance in invertebrate drift (79% for Insecta and 97% for Crustacea), with drift densities higher at dusk and night, and nearer the stream bed. Independently, time of day (38%, Insecta; 52%, Crustacea) and vertical position (41%, Insecta; 45%, Crustacea) explained a similar amount of the observed variance. Month explained some of the variance in insect drift (9%) but none for Crustacea. 4. Variation in the density of drifting debris showed little in common with invertebrate drift. There was little variation associated with time of day and only 27% of the observed variation in debris could be explained by the factors investigated here, with month explaining the largest proportion (20%). We suggest the difference in drifting debris and invertebrates provides further evidence for a strong behavioural component in invertebrate drift. 5. Spatial variation in invertebrate drift can be of the same order of magnitude as the much-described diel temporal variation. The extent of this spatial variation poses problems when attempting to quantify invertebrate drift and we recommend that spatial replication should be incorporated into drift studies. [source] Revaccination of bone marrow transplant recipients: a review of current practices in AustraliaINTERNAL MEDICINE JOURNAL, Issue 4 2009Adrienne Torda Abstract Background: Vaccination following bone marrow transplant (BMT) is an important part of ongoing care and disease prevention. The aim of the study was to investigate vaccination procedures in BMT recipients and identify what systems are in place throughout Australia to remind and alert patients concerning their need for vaccination. Methods: Questionnaires were sent to haematologists managing BMT recipients in Australia to examine post-BMT vaccination practices in hospitals and outpatient clinics. Questionnaires were also sent to BMT recipients in New South Wales, who had their transplants (either allogeneic or autologous) in the past 5 years to determine what vaccinations they had received and what vaccination reminder systems had been used. Results: Vaccine recommendations and practices by BMT physicians showed little consensus. They also differed greatly between autologous and allogeneic transplant recipients. Only just more than half of the physicians had an effective reminder system in place and only 12 of 34 patients had received vaccination reminders. One-third of all patients were not aware of any need for revaccination. Conclusion: The disparity in physician practice regarding revaccination is significant and may reflect the lack of data available regarding efficacy of revaccination in this setting and/or a lack of knowledge about recommendations. Because of this, a national immunization schedule for post-BMT patients founded on evidence-based studies is required to provide optimal patient care. The lack of effective follow up and reminder systems ensuring patient completion of vaccination schedules is also an area needing improvement. [source] Monetary Policy Design: Institutional Developments from a Contractual PerspectiveINTERNATIONAL FINANCE, Issue 3 2000Carl E. Walsh Twenty years ago, most industrialized economies were just starting the costly process of disinflation. There was little consensus that these disinflations would be successful, or that low inflation once achieved could be maintained. While the USA achieved low inflation without changing its policy making institutions, many other countries did reform their central banking institutions, making them more independent of political influences. In this paper, I address three questions. First, is independence enough? Second, how do the details of an institution's structure translate, through their impact on incentives, into different policy outcomes? And third, can institutions serve as commitment mechanisms? [source] Modelling current trends in Northern Hemisphere temperaturesINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 7 2006Terence C. Mills Abstract Fitting a trend is of interest in many disciplines, but it is of particular importance in climatology, where estimating the current and recent trend in temperature is thought to provide a major indication of the presence of global warming. A range of ad hoc methods of trend fitting have been proposed, with little consensus as to the most appropriate techniques to use. The aim of this paper is to consider a range of trend extraction techniques, none of which require ,padding' out the series beyond the end of the available observations, and to use these to estimate the trend of annual mean Northern Hemisphere (NH) temperatures. A comparison of the trends estimated by these methods thus provides a robust indication of the likely range of current trend temperature increases and hence inform, in a timely quantitative fashion, arguments based on global temperature data concerning the nature and extent of global warming and climate change. For the complete sample 1856,2003, the trend is characterised as having long waves about an underlying increasing level. Since around 1970, all techniques display a pronounced warming trend. However, they also provide a range of trend functions so that extrapolation far into the future would be a hazardous exercise. Copyright © 2006 Royal Meteorological Society. [source] Mapping capacity in the health sector: a conceptual frameworkINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2002Anne K. LaFond Abstract Capacity improvement has become central to strategies used to develop health systems in low-income countries. Experience suggests that achieving better health outcomes requires both increased investment (i.e. financial resources) and adequate local capacity to use resources effectively. International donors and non-governmental agencies, as well as ministries of health, are therefore increasingly relying on capacity building to enhance overall performance in the health sector. Despite the growing interest in capacity improvement, there has been little consensus among practitioners and academics on definitions of ,capacity building' and how to evaluate it. This paper aims to review current knowledge and experiences from ongoing efforts to monitor and evaluate capacity building interventions in the health sector in developing countries. It draws on a wide range of sources to develop (1) a definition of capacity building and (2) a conceptual framework for mapping capacity and measuring the effects of capacity building interventions. Mapping is the initial step in the design of capacity building interventions and provides a framework for monitoring and evaluating their effectiveness. Capacity mapping is useful to planners because it makes explicit the assumptions underlying the relationship between capacity and health system performance and provides a framework for testing those assumptions. Copyright © 2002 John Wiley & Sons, Ltd. [source] Uncovering the Truth: Examining Truth Commission Success and ImpactINTERNATIONAL STUDIES PERSPECTIVES, Issue 1 2007ERIC BRAHM While there is growing interest in examining what long-term impact truth commissions have on society, our understanding has been hampered by a number of empirical problems. Specifically, most studies focus on a small biased subsample of cases, rely on anecdotal evidence and normative conviction, and fail to follow the truth commission's legacy beyond its immediate reception. What is more, although a range of purposes have been put forward for truth commissions, there is little consensus on what criteria might be used to assess them. These issues are further compounded by a growing chorus of critics who see truth commissions as either ineffectual or dangerous. This article fleshes out the nature of these problems and outlines how a multimethod strategy might be effective in addressing them. Furthermore, it suggests two potential means of assessing the impact of truth commissions, specifically their effect on subsequent human rights practices and democratic development. The article concludes by suggesting how some problems with this strategy can be overcome by further iterations of a multimethod approach. [source] Ecological opportunity and the origin of adaptive radiationsJOURNAL OF EVOLUTIONARY BIOLOGY, Issue 8 2010J. B. YODER Abstract Ecological opportunity , through entry into a new environment, the origin of a key innovation or extinction of antagonists , is widely thought to link ecological population dynamics to evolutionary diversification. The population-level processes arising from ecological opportunity are well documented under the concept of ecological release. However, there is little consensus as to how these processes promote phenotypic diversification, rapid speciation and adaptive radiation. We propose that ecological opportunity could promote adaptive radiation by generating specific changes to the selective regimes acting on natural populations, both by relaxing effective stabilizing selection and by creating conditions that ultimately generate diversifying selection. We assess theoretical and empirical evidence for these effects of ecological opportunity and review emerging phylogenetic approaches that attempt to detect the signature of ecological opportunity across geological time. Finally, we evaluate the evidence for the evolutionary effects of ecological opportunity in the diversification of Caribbean Anolis lizards. Some of the processes that could link ecological opportunity to adaptive radiation are well documented, but others remain unsupported. We suggest that more study is required to characterize the form of natural selection acting on natural populations and to better describe the relationship between ecological opportunity and speciation rates. [source] Understanding the Judicial Role in Addressing Gender Bias: A View from the Eighth Circuit Federal Court SystemLAW & SOCIAL INQUIRY, Issue 2 2002Kimberly A. Lonsway The role of trial judges in the litigation process is frequently debated. Are judges to be dispassionate adjudicators, disengaged referees in a sport in which attorneys compete? Or are they charged with a more active role in promoting the substance, form, and process of justice? In the present paper, we explore the judicial role in addressing gender bias in federal litigation, using data gathered for the Eighth Circuit Gender Fairness Task Force. The federal judges of this circuit were surveyed about their experiences, observations, and opinions of gender-biased conduct. Results indicated that although judges viewed judicial intervention as an appropriate response to gender bias, they had little personal experience with intervention in such a situation. Fur thermore, when specific hypothetical scenarios were presented, they generally agreed that the described conduct was inappropriate but offered little consensus regarding the best course of action for an attorney or judge confronted with such behavior. The Eighth Circuit data thus provide the basis for expanded understanding of the conduct at issue, the options for action in response, and the persistent discrepancy in viewpoints on gender bias and the judicial role. [source] Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs,LIVER TRANSPLANTATION, Issue 2 2008Mary Amanda Dew For patients receiving liver or other organ transplants for diseases associated with substance use, risk for relapse posttransplantation is a prominent clinical concern. However, there is little consensus regarding either the prevalence or risk factors for relapse to alcohol or illicit drug use in these patients. Moreover, the evidence is inconsistent as to whether patients with pretransplantation substance use histories show poorer posttransplantation medical adherence. We conducted a meta-analysis of studies published between 1983 and 2005 to estimate relapse rates, rates of nonadherence to the medical regimen, and the association of potential risk factors with these rates. The analysis included 54 studies (50 liver, 3 kidney, and 1 heart). Average alcohol relapse rates (examined only in liver studies) were 5.6 cases per 100 patients per year (PPY) for relapse to any alcohol use and 2.5 cases per 100 PPY for relapse with heavy alcohol use. Illicit drug relapse averaged 3.7 cases per 100 PPY, with a significantly lower rate in liver vs. other recipients (1.9 vs. 6.1 cases). Average rates in other areas (tobacco use, immunosuppressant and clinic appointment nonadherence) were 2 to 10 cases per 100 PPY. Risk factors could be examined only for relapse to any alcohol use. Demographics and most pretransplantation characteristics showed little correlation with relapse. Poorer social support, family alcohol history, and pretransplantation abstinence of ,6 months showed small but significant associations with relapse (r = 0.17-0.21). Future research should focus on improving the prediction of risk for substance use relapse, and on testing interventions to promote continued abstinence posttransplantation. Liver Transpl 14:159,172. 2008. © 2008 AASLD. [source] Non-surgical treatment of hepatocellular carcinomaALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2002A. M. Alsowmely Primary hepatocellular cancer is a disease with a poor prognosis for which there is little consensus on treatment and a paucity of comparative trials. The coexistence of cancer with cirrhosis complicates treatment, and also confers a high risk for the development of further tumours. Surgery, either by hepatic resection or orthotopic liver transplantation, is only a feasible option in a minority of patients. This article surveys the non-surgical approaches to the treatment of hepatocellular cancers,local ablation techniques, arterial embolization with and without chemotherapy, conventional chemotherapy and hormonal modulation, and targeted and external irradiation. [source] Survey of epidural analgesia management in general intensive care units in EnglandACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2002J. H. S. Low Background: The management of epidural analgesia is controversial. Many intensive care unit (ICU) patients may benefit from this form of analgesia but have one or more contraindications to its use. Sepsis, coagulopathy, insertion in a sedated, ventilated patient, and lack of consent are common problems in ICU patients. Little has been published to help guide practice in this area. I wished to establish the current practice of the management of epidural analgesia in general ICUs in England when relative or absolute contraindications occur, in order to determine the current standard of care for placement and use of epidural analgesia in ICU patients. Methods: A postal questionnaire survey of the management of epidural analgesia in critically ill patients was sent to the named clinical director of all (216) general ICUs in England. Results: Responses were received from 159 (75%) units: 89% of responding units use epidural analgesia but only 51(32%) have a written policy covering its use. Anesthetists or intensivists with an anesthetic background sited all epidural catheters; 68% of units would not site an epidural in a patient with positive blood cultures; but only 52% considered culture negative sepsis (systemic signs of sepsis with no organism isolated) to be a contraindication. Neither lack of consent nor the need for anticoagulation after the catheter had been sited were considered contraindications to inserting an epidural catheter by the majority of respondents. Although 71% of the units would remove an epidural catheter if a patient developed positive blood cultures after it had been sited, the majority of the ICUs did not consider culture negative sepsis and the need for anticoagulation contraindications to maintain a previously sited epidural. Conclusions: Practice varied considerably with little consensus. Although all the respondents use epidural analgesia in critically ill patients, the indications and contraindications to epidural analgesia remain controversial, and further research is required to help define the role of epidural analgesia in this high-risk group. [source] Which links in which theories shall we evaluate?NEW DIRECTIONS FOR EVALUATION, Issue 87 2000Carol Hirschon Weiss If there is little consensus about the assumptions underlying a program, theory-based evaluators can collect data relevant to more than one theory, selecting for study the specific links in those theories that answer key questions. [source] Interactions between dispersal, competition, and landscape heterogeneityOIKOS, Issue 7 2007Ace North It is widely acknowledged that space has an important role in population regulation, yet more specific knowledge into how the relevant factors interact attains little consensus. We address this issue via a stochastic, individual based model of population dynamics, in a continuous space continuous time framework. We represent habitat quality as a continuously varying surface over the two-dimensional landscape, and assume that the quality affects either fecundity (rate of propagule production) or probability of propagule establishment. We control the properties of the landscape by two parameters, which we call the patch size (the characteristic length scale in quality variation), and the level of heterogeneity (the characteristic quality difference between poor quality and high quality areas). In addition to such exogenous variability, we also account for endogenous factors causing spatial variation by assuming localised dispersal and competition. We find that heterogeneity has a general positive effect on population density, and hence it is beneficial to improve best quality habitat at the expense of worst quality habitat. With regards to patch size, we find an intermediate optimum, due to a conflict between minimising the loss of propagules to low quality regions and maximising the benefits of heterogeneity. We address the consequences of regional stochasticity by allowing the environmental conditions change in time. The cost of having to continuously track where the favourable conditions have moved to ultimately reduces population size. [source] Thoracic epidural anaesthesia and analgesia: United Kingdom practiceACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2000F. O'Higgins Background: Thoracic epidural analgesia has become increasingly practised in recent years. Complications are rare but potentially serious and, consequently, careful evaluation is required before undertaking this technique. The practice surrounding this procedure varies widely amongst anaesthetists. Methods: A postal survey to examine the practice of thoracic epidural analgesia was sent to all Royal College of Anaesthetists tutors in the United Kingdom. Results: Responses were received from 240 tutors, representing a return rate of 83%. When obtaining consent for thoracic epidural cannulation, 42% of respondents mentioned risk of a dural tap complication and 11% mentioned neurological damage. Fifty percent of respondents performed epidural cannulation following induction of general anaesthesia. The practice of epidural insertion in patients with abnormal coagulation varied, although over 80% of respondents did not consider concurrent treatment with either aspirin or non-steroidal anti-inflammatory drugs a contraindication. Sterile precautions for epidural insertion also varied between anaesthetists. Postoperatively, 95% of respondents used an opioid-based bupivacaine solution for epidural infusions, and these were most commonly nursed on general surgical wards (63%). Seventy-eight percent of hospitals provided an acute pain team to review epidural analgesia. Conclusion: In the United Kingdom, there is little consensus in the practice of thoracic epidural analgesia relating to the issues of informed consent, epidural cannulation in patients with deranged clotting and the sterile precautions taken prior to performing epidural insertion. Most respondents use an opioid-based bupivacaine solution to provide postoperative epidural analgesia. Most hospitals in the UK now provide an acute pain service for thoracic epidural follow-up. [source] Chronic Pain in the Cancer Survivor: A New FrontierPAIN MEDICINE, Issue 2 2007Allen W. Burton MD ABSTRACT Objective., This monograph is intended to clarify the clinical problem of chronic pain in cancer patients. Design., A pertinent literature review on chronic pain syndromes in cancer patients was undertaken using Medline. Further, the treatment strategies for cancer versus chronic pain are contrasted and clarified. Results., With increasing cancer survivorship come new challenges in patient care. In the United States, the cancer-related death rate has dropped by 1.1% per year from 1993,2002. Seventy-five percent of children and two out of three adults will survive cancer, whereas 50 years ago just one out of four survived. The net effect of these trends and opportunities is a large and rapidly growing population of persons living longer with cancer and/or as cancer survivors. While agreement exists on the best strategies for assessment and treatment of most acute cancer pain syndromes, little consensus exists on the treatment of chronic pain in the patient with slowly progressive cancer or the cancer survivor. Conclusions., The landscape of "cancer pain" is shifting quickly into a chronic pain situation in many instances, thereby blurring previous lines of distinction in treatment strategies most suited for "chronic" versus "malignant" pain. Adopting chronic pain treatment strategies including pharmacologic and other pain control techniques, rehabilitation care, and psychological coping strategies may lead to optimal outcomes. Lastly, as cancer evolves into a chronic illness, with co-morbid conditions, recurrent cancer, and treatment toxicities from repeated antineoplastic therapies, pain management challenges in the oncologic patient continue to increase in complexity. [source] Use of premedication for intubation in tertiary neonatal units in the United KingdomPEDIATRIC ANESTHESIA, Issue 7 2009RAJIV CHAUDHARY MBBS MRCPCH Summary Background:, Endotracheal intubation and laryngoscopy are frequently performed procedures in neonatal intensive care. These procedures represent profoundly painful stimuli and have been associated with laryngospasm, bronchospasm, hemodynamic changes, raised intracranial pressure and an increased risk of intracranial hemorrhage. These adverse changes can cause significant neonatal morbidity but may be attenuated by the use of suitable premedication. Aims:, To evaluate current practices for premedication use prior to elective intubation in UK tertiary neonatal units. Methods:, Telephone questionnaire survey of all 50 tertiary neonatal units in the UK. Results:, Ninety percent of units report the routine use of sedation prior to intubation and 82% of units routinely use a muscle relaxant. Morphine was the most commonly used sedative and suxamethonium was the most commonly used muscle relaxant. Approximately half of the units also used atropine during intubation. Seventy seven percent of units had a written policy for premedication. Ten percent of the units did not routinely use any sedatives or muscle relaxants for elective intubation. Conclusions:, In comparison with data from a 1998 survey, our study demonstrated an increase in the number of units that have adopted a written policy for premedication use, and in the number routinely using premedication drugs for elective intubation. There remains little consensus as to which drugs should be used and in what dose. [source] Cryotherapy after total knee replacement: a survey of current practicePHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2003Simon Barry Abstract Background and Purpose Cryotherapy is commonly used during physio-therapeutic rehabilitation after total knee replacement (TKR). Evidence for treatment effectiveness is contradictory and there are no clinical guidelines to inform treatment protocols within this patient group. The present survey investigated current cryotherapy practice after TKR throughout the United Kingdom (UK). Method A postal survey, containing open and closed questions, was distributed to senior inpatient orthopaedic physiotherapists (n = 453). Results The response rate was 67% (304/453) and 58% (263/453) of the responses were completed by physiotherapists who treated TKR patients in the acute phase. Of these, 33% (85/263) routinely applied some form of cryotherapy after TKR. Physiotherapists working in the private sector were more likely to use cryotherapy and had greater access to Cryocuff equipment. The two main methods of cryotherapy application were the Cryocuff device, 59% (155/263) and crushed ice, 30% (79/263). Treatments were applied most frequently between 24 and 48 hours post-surgery, for 20 minutes, twice a day. Lack of proven efficacy was the most frequently stated reason for not applying cryotherapy treatment, and swelling was the most common indicator for treatment. There was particular uncertainty about the physical management of the Cryocuff device. Conclusions There was little consensus with regard to treatment indicators, method of application and the management of cryotherapy after TKR. The results highlight a lack of consistency in the application of cryotherapy after TKR, indicating a need for further research. Copyright © 2003 Whurr Publishers Ltd. [source] Health Interventions and Health Equity: The Example of Measles Vaccination in BangladeshPOPULATION AND DEVELOPMENT REVIEW, Issue 2 2001Michael A. Koenig Although the existence of socioeconomic differentials in infant and childhood mortality in developing countries is well established. little consensus exists as to the most effective approaches to reducing such differentials. This article utilizes longitudinal data from the Matlab study area in rural Bangladesh to investigate the impact of an efficacious child survival intervention,measles vaccination,on reductions in gender and socioeconomic differentials in childhood mortality. The article analyzes data from 16,270 vaccinated children and randomly matched controls, and evaluates their subsequent mortality risks. Proportional hazards analysis demonstrates that unvaccinated children from very poor families face more than a threefold higher risk of subsequent early child mortality, compared to vaccinated children from families of high economic status. While measles vaccination has little impact on mortality risks among children of higher economic status, the improvement in survival among children from poorer households is pronounced. The provision of measles vaccination markedly reduces mortality risks for poorer children,from over three times higher to just over 1.5 times higher relative to vaccinated children from wealthier families. The findings of this study are evaluated in terms of the potential of child survival interventions such as measles vaccination to promote greater health equity. [source] Children's Self-Reports About Violence Exposure: An Examination of the Things I Have Seen and Heard ScaleAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 3 2007Richard Thompson PhD Children's exposure to violence is often found to be an important predictor of child outcomes. The measures most frequently used to assess it have not been systematically examined, and there is little consensus about how to use these measures. This study examined a version of the Things I Have Seen and Heard Scale in a sample of 784 children who completed the scale at both age 6 and 8. There was only modest support for the use of the scale as a set of single-item measures or as a simple sum of items. Exploratory factor analyses suggested that the scale consisted of two factors: a global/community violence scale and a home violence scale. The evidence for validity of the scales was stronger at age 8 than at age 6. These findings suggest that there may be some limits to the utility of self-reports of violence exposure in very young children. However, there is initial evidence that the global/community scale is a reliable and valid indicator of young children's exposure to violence. Further use and exploration of the subscales is warranted. [source] Outcome Effectiveness of Community Health Workers: An Integrative Literature ReviewPUBLIC HEALTH NURSING, Issue 1 2002Susan M. Swider Ph.D. Community health workers (CHWs) are promoted as a mechanism to increase community involvement in health promotion efforts, despite little consensus about the role and its effectiveness. This article reviews the databased literature on CHW effectiveness, which indicates preliminary support for CHWs in increasing access to care, particularly in underserved populations. There are a smaller number of studies documenting outcomes in the areas of increased health knowledge, improved health status outcomes, and behavioral changes, with inconclusive results. Although CHWs show some promise as an intervention, the role can be doomed by overly high expectations, lack of a clear focus, and lack of documentation. Further research is required with an emphasis on stronger study design, documentation of CHW activities, and carefully defined target populations. [source] SURVEY OF MANAGEMENT OF ACUTE, TRAUMATIC COMPARTMENT SYNDROME OF THE LEG IN AUSTRALIAANZ JOURNAL OF SURGERY, Issue 9 2007Christopher J. Wall Background: Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency and is associated with significant morbidity if not diagnosed promptly and treated effectively. Despite the urgency of effective management to minimize the risk of adverse outcomes, there is currently little consensus in the published reports as to what constitutes best practice in the management of acute limb compartment syndrome. Methods: A structured survey was sent to all currently practising orthopaedic surgeons and accredited orthopaedic registrars in Australia to assess their current practice in the management of acute, traumatic compartment syndrome of the leg. Questions were related to key decision nodes in the management process, as identified in a literature review. These included identification of patients at high risk, diagnosis of the condition in alert and unconscious patients, optimal timeframe and technique for carrying out a fasciotomy and management of fasciotomy wounds. Results: A total of 264 valid responses were received, a response rate of 29% of all eligible respondents. The results indicated considerable variation in management of acute compartment syndrome of the leg, in particular in the utilization of compartment pressure measurement and the appropriate pressure threshold for fasciotomy. Of the 78% of respondents who regularly measured compartment pressure, 33% used an absolute pressure threshold, 28% used a differential pressure threshold and 39% took both into consideration. Conclusions: There is variation in the management of acute, traumatic compartment syndrome of the leg in Australia. The development of evidence-based clinical practice guidelines may be beneficial. [source] Genetic improvement of marine fish , which method for industry?AQUACULTURE RESEARCH, Issue 1 2000W. Knibb Aquaculture industries and research organizations usually fail to exploit genetics as a tool for enhancing productivity and competitiveness. Yet, there is now some awareness among aquaculturists of the benefits from genetics. There remains little consensus about the types of genetic approaches that are most beneficial for the aquaculture industry. Discord arises because genetics comprises many subdisciplines, each with advocates promoting one field or another as the best method to develop commercially valuable strains. Here, I examine retrospectively the various genetic approaches in aquaculture to assess their commercial benefit. [source] | ||||||||||||||||||||||||||||