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Appropriate Actions (appropriate + action)
Selected AbstractsAnalysis of multilocus fingerprinting data sets containing missing dataMOLECULAR ECOLOGY RESOURCES, Issue 2 2006PHILIPP M. SCHLÜTER Abstract Missing data are commonly encountered using multilocus, fragment-based (dominant) fingerprinting methods, such as random amplified polymorphic DNA (RAPD) or amplified fragment length polymorphism (AFLP). Data sets containing missing data have been analysed by eliminating those bands or samples with missing data, assigning values to missing data or ignoring the problem. Here, we present a method that uses random assignments of band presence,absence to the missing data, implemented by the computer program famd (available from http://homepage.univie.ac.at/philipp.maria.schlueter/famd.html), for analyses based on pairwise similarity and Shannon's index. When missing values group in a data set, sample or band elimination is likely to be the most appropriate action. However, when missing values are scattered across the data set, minimum, maximum and average similarity coefficients are a simple means of visualizing the effects of missing data on tree structure. Our approach indicates the range of values that a data set containing missing data points might generate, and forces the investigator to consider the effects of missing values on data interpretation. [source] Assessing teratogenicity of antiretroviral drugs: monitoring and analysis plan of the Antiretroviral Pregnancy Registry,,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 8 2004Deborah L. Covington DrPH Abstract This paper describes the Antiretroviral Pregnancy Registry's (APR) monitoring and analysis plan. APR is overseen by a committee of experts in obstetrics, pediatrics, teratology, infectious diseases, epidemiology and biostatistics from academia, government and the pharmaceutical industry. APR uses a prospective exposure-registration cohort design. Clinicians voluntarily register pregnant women with prenatal exposures to any antiretroviral therapy and provide fetal/neonatal outcomes. A birth defect is any birth outcome ,20 weeks gestation with a structural or chromosomal abnormality as determined by a geneticist. The prevalence is calculated by dividing the number of defects by the total number of live births and is compared to the prevalence in the CDC's population-based surveillance system. Additionally, first trimester exposures, in which organogenesis occurs, are compared with second/third trimester exposures. Statistical inference is based on exact methods for binomial proportions. Overall, a cohort of 200 exposed newborns is required to detect a doubling of risk, with 80% power and a Type I error rate of 5%. APR uses the Rule of Three: immediate review occurs once three specific defects are reported for a specific exposure. The likelihood of finding three specific defects in a cohort of ,600 by chance alone is less than 5% for all but the most common defects. To enhance the assurance of prompt, responsible, and appropriate action in the event of a potential signal, APR employs the strategy of ,threshold'. The threshold for action is determined by the extent of certainty about the cases, driven by statistical considerations and tempered by the specifics of the cases. Copyright © 2004 John Wiley & Sons, Ltd. [source] The Origin of IntentionsPHILOSOPHICAL INVESTIGATIONS, Issue 4 2006Richard Scheer Professor Emeritus In contemporary discussions of the concept of intention, the assumption is made that an intention results from a person's decision, or resolution, or plan, or the like. And the intention persists, generally, until the appropriate action is carried out. However, intentions cannot be said to have temporal duration, or beginnings, or endings. And it is not necessary for a person who is intending to do something to have made a decision to do it, or a resolution, or anything else. It may be that a person acquires an intention because of the circumstances that he finds himself in. If one sees that a tricycle is in front of his car, he will move it. No decision is necessary, obviously, because running over it would be contrary to common sense. Or one may gradually come to realise that he is obliged to do something and thereupon acquires the intention to do it. By focusing on one kind of intention, the "desire-belief" theories have failed to realise that intentions originate in various ways, and for various reasons. [source] MEN'S HEALTH PROMOTION BY GENERAL PRACTITIONERS IN A WORKPLACE SETTINGAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2002Samar Aoun ABSTRACT:A project to promote men's health through diabetes education and screening was undertaken throughout rural industries in 1999/2000 in the south-west of Western Australia. Five hundred and twenty-five men aged 40,65 years participated from 27 industries. Sixty-four per cent of these men were identified at high-risk of developing diabetes and were referred to their general practitioner (GP) for follow-up. Seventy-six per cent of those at-risk visited their GP and hence the strategy adopted has been appropriate in engaging men in the preventive concept of seeking care, that is, getting them to attend their GP when they only have the risk factors but not the disease. However, men were left short of knowing how to achieve a change in their lifestyle behaviour and take appropriate action. Given the constraints of rural practice and the need to prioritise those with disease and gaps in service provision for both health services and GPs, there are two challenges: identifying those at-risk and modifying their behaviour. [source] Review of the first 1502 cases of ECG-ST waveform analysis during labour in a teaching hospitalBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2007V Doria Objective, To assess the impact of introduction of the STAN monitoring system. Study design, Prospective observational study. Setting, Tertiary referral labour ward, St George's Hospital, London. Population, High-risk term pregnancies. Methods, We report all consecutive cases of intrapartum monitoring using the STAN S 21 fetal heart monitor. Cases with adverse neonatal outcome were evaluated in relation to the ST waveform analysis and cardiotocography (CTG). Main outcome measures, Cord artery metabolic acidosis, neonatal encephalopathy (NNE) and reasons behind cases with poor outcome. Results, Between 2002 and 2005, there were 1502 women monitored by STAN. Based on combined STAN analysis in the 1502 women, action was indicated in 358 women (23.8%), while in 1108 women (73.8%) no action was indicated. Traces were not interpretable in 36 women (2.4%). Of the 836 cases (55.7%) where cord blood gases were available, there were 23 cases (2.8%) of metabolic acidosis and 16 of these (70%) were identified by STAN. Overall, there were 14 cases of NNE monitored by STAN. Retrospective analysis of these highlights human errors, such as poor CTG interpretation, delay in taking appropriate action and not following the guidelines. Conclusions, Our experience suggests the need for more intense training on interpretation of CTG and strict adherence to guidelines. [source] Environmental motivations: a classification scheme and its impact on environmental strategies and practicesBUSINESS STRATEGY AND THE ENVIRONMENT, Issue 7 2009Antony Paulraj Abstract Ecological deterioration has significantly changed the role of businesses in society and the way they are perceived. In fact, consumers are more aware of environmental issues and are demanding that the businesses take appropriate action in preserving the environment. Extant research suggests that stringent regulations had been instrumental to the timing and direction of many firms' responses to environmental preservation. In addition to these legislative requirements, firms also adopt ecologically responsive practices for various other reasons. Therefore, understanding the different motivations of environmental initiatives is pertinent. Additionally, it is also important to determine whether environmental strategies and practices differ significantly across firms with different motivations. With the above ambition in mind, this manuscript addresses the crucial issues related to corporate environmental strategy through the development of an empirical taxonomy of environmental motivations and the subsequent testing of any significant differences in corporate environmental strategy and green practices across the clusters. Copyright © 2008 John Wiley & Sons, Ltd and ERP Environment. [source] Why is the management of glucocorticoid deficiency still controversial: a review of the literatureCLINICAL ENDOCRINOLOGY, Issue 5 2005Anna Crown Summary All endocrinologists would like to make glucocorticoid replacement therapy for their hypoadrenal patients as physiological as possible. Many would like the reassurance of a method of monitoring such treatment to confirm that they are achieving this aim. Advances in our knowledge of the normal physiology are relevant to our attempts to do this. The cortisol production rate in normal subjects is lower than was previously believed. The normal pattern of glucocorticoid secretion includes both a diurnal rhythm and a pulsatile ultradian rhythm. Glucocorticoid access to nuclear receptors is ,gated' by the 11-,-hydroxysteroid dehydrogenase enzymes, which interconvert active cortisol and inactive cortisone. Such complexities make the target of physiological glucocorticoid replacement therapy hard to achieve. The available evidence suggests that conventional treatment of hypoadrenal patients may result in adverse effects on some surrogate markers of disease risk, such as a lower bone mineral density than age-sex matched controls, and increases in postprandial glucose and insulin concentrations. Although the quality of life of hypoadrenal patients may be impaired, there is no evidence of an improvement on higher doses of steroids, although quality of life is better if the hydrocortisone dose is split up, with the highest dose taken in the morning. Thus the evidence suggests that most patients may safely be treated with a low dose of glucocorticoid (e.g. 15 mg hydrocortisone daily) in two or three divided doses, with education about the appropriate action to take in the event of intercurrent illnesses. [source] Cognitive subprocesses and schizophrenia.ACTA PSYCHIATRICA SCANDINAVICA, Issue 2001Objective:,The aim of the study is to demonstrate that deficits of information processing in schizophrenic patients can be isolated with reaction-time (RT) decomposition paradigms. Method:,Three types of visually presented tasks were applied: simple, disjunctive and choice RT-tasks. RT were split into movement latency and time necessary to execute movements. Comparisons of three samples of schizophrenic patients (295.3) with individually matched (age, sex, education and handedness) healthy controls are presented: Sample 1: 10 drug-naive first-onset patients, Sample 2: 10 neuroleptically treated first-onset patients, Sample 3: 10 neuroleptically treated chronically ill patients. Results:,Findings indicate that schizophrenia affects primarily subprocesses in which percepts are translated into appropriate actions (response-selection). Neuroleptic treatment improves processing at this stage but is accompanied by slowing of movement execution. Conclusion:,Response-selection is selectively impaired in first-onset patients. This disturbance, which might be specific for schizophrenia, can be regarded as indication of a disconnection between frontal and posterior areas. [source] Overdose training and take-home naloxone for opiate users: prospective cohort study of impact on knowledge and attitudes and subsequent management of overdosesADDICTION, Issue 10 2008John Strang ABSTRACT Aim To examine the impact of training in overdose management and naloxone provision on the knowledge and confidence of current opiate users; and to record subsequent management of overdoses that occur during a 3-month follow-up period. Design Repeated-measures design to examine changes in knowledge and confidence immediately after overdose management training; retention of knowledge and confidence at 3 months; and prospective cohort study design to document actual interventions applied at post-training overdose situations. Method A total of 239 opiate users in treatment completed a pre-training questionnaire on overdose management and naloxone administration and were re-assessed immediately post-training, at which point they were provided with the take-home emergency supply of naloxone. Three months later they were re-interviewed. Results Significant improvements were seen in knowledge of risks of overdose, characteristics of overdose and appropriate actions to be taken; and in confidence in the administration of naloxone. A 78% follow-up rate was achieved (186 of 239) among whom knowledge of both the risks and physical/behavioural characteristics of overdose and also of recommended management actions was well retained. Eighteen overdoses (either experienced or witnessed) had occurred during the 3 months between the training and the follow-up. Naloxone was used on 12 occasions (a trained client's own supply on 10 occasions). One death occurred in one of the six overdoses where naloxone was not used. Where naloxone was used, all 12 resulted in successful reversal. Conclusions With overdose management training, opiate users can be trained to execute appropriate actions to assist the successful reversal of potentially fatal overdose. Wider provision may reduce drug-related deaths further. Future studies should examine whether public policy of wider overdose management training and naloxone provision could reduce the extent of opiate overdose fatalities, particularly at times of recognized increased risk. [source] Expert system for nuclear power plant accident diagnosis using a fuzzy inference methodEXPERT SYSTEMS, Issue 4 2002rey Lee Huge and complex systems such as nuclear power generating stations are likely to cause the operators to make operational mistakes for a variety of inexplicable reasons and to produce ambiguous and complicated symptoms in the case of an emergency. Therefore, a safety protection system to assist the operators in making proper decisions within a limited time is required. In this paper, we develop a reliable and improved diagnosis system using the fuzzy inference method so that the system can classify accident symptoms and identify the most probable causes of accidents in order for appropriate actions to be taken to mitigate the consequences. In the computer simulation, the proposed system proved to be able to classify accident types within only 20,30 s. Therefore, the corresponding operation guidelines can be determined in a very short time to put the nuclear power plant in a safe state immediately after the accident. [source] Nutritional care: the effectiveness of actively involving older patientsJOURNAL OF CLINICAL NURSING, Issue 2 2005Preben Ulrich Pedersen RN PhD Aims and objectives., The purpose of the study was to test the effectiveness of nursing care based on active involvement of patients in their nutritional care. It was hypothesized that this type of care could improve energy and protein intake in elder orthopaedic patients. Background., Protein and energy malnutrition and deterioration in nutritional status is a common but neglected problem in hospital patients. Methods., The design was quasi-experimental with an intervention and control group. The study included 253 patients aged 65 and above admitted for hip fracture, hip or knee replacement. Food intake was recorded on a daily basis during the hospital stay. Results., The daily intake of energy increased with 23% (P = 0.001) and of protein with 45% (P = 0.001). The intake increased from the very first day after the operation. The intake of energy and protein was not correlated with the patient's age, body mass index or type of surgery. Conclusions., The care based on patients' active involvement in their own nutritional care and was found to be an effective method to raise the intake of energy and protein among elder orthopaedic patients. Relevance to clinical practice., This way of organizing the care identifies patients who do not consume enough energy and protein according to their current requirements and to take appropriate actions to prevent further malnutrition. [source] Perspectives on Therapeutic Jurisprudence in Dependency Court in Cases Involving Battered MothersJUVENILE AND FAMILY COURT JOURNAL, Issue 1 2008Candice L. Maze ABSTRACT A qualitative study was conducted involving clients, victim advocates, and judges participating in one of Miami-Dade County's (Florida) "therapeutic" juvenile court based programs, the Dependency Court Intervention Program for Family Violence (DCIPFV). The primary objective of this study was to assess how battered mothers' perceptions of the dependency court judges' actions impacted the women's motivation to take appropriate actions to promote their own, and their child(ren)'s safety. [source] Work-related carpal tunnel syndrome in Washington State workers' compensation: Temporal trends, clinical practices, and disabilityAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 4 2005William E. Daniell MD Abstract Background Work-related carpal tunnel syndrome (CTS) is a leading cause of disability. There is a need for information about temporal trends, clinical practices, and treatment outcomes. Methods A population based, retrospective cohort study of Washington State workers' compensation claims for CTS was initiated focusing on claims filed during 1990,1994, followed through 2000 (n,=,16,710). Results Half of the claims were filed for conditions other than CTS, but were eventually identified to be or include CTS. The first CTS diagnosis occurred more than 3 months after claim filing in 20% of claims. The longer that the CTS diagnosis occurred after claim filing, the more likely that CTS was accompanied by other problems, and disability tended to be longer. Conclusions Making an accurate diagnosis of CTS and initiating appropriate actions earlier than might otherwise occur could reduce the disability and costs in a large fraction of claims that are ultimately determined to involve CTS. © 2005 Wiley-Liss, Inc. [source] The dental implications of bisphosphonates and bone diseaseAUSTRALIAN DENTAL JOURNAL, Issue 2005A. Cheng Abstract In 2002/2003 a number of patients presented to the South Australian Oral and Maxillofacial Surgery Unit with unusual non-healing extraction wounds of the jaws. All were middle-aged to elderly, medically compromised and on bisphosphonates for bone pathology. Review of the literature showed similar cases being reported in the North American oral and maxillofacial surgery literature. This paper reviews the role of bisphosphonates in the management of bone disease. There were 2.3 million prescriptions for bisphosphonates in Australia in 2003. This group of drugs is very useful in controlling bone pain and preventing pathologic fractures. However, in a small number of patients on bisphosphonates, intractable, painful, non-healing exposed bone occurs following dental extractions or denture irritation. Affected patients are usually, but not always, over 55 years, medically compromised and on the potent nitrogen containing bisphosphonates, pamidronate (Aredia/Pamisol), alendronate (Fosamax) and zolendronate (Zometa) for non-osteoporotic bone disease. Currently, there is no simple, effective treatment and the painful exposed bone may persist for years. The main complications are marked weight loss from difficulty in eating and severe jaw and neck infections. Possible preventive and therapeutic strategies are presented although at this time there is no evidence of their effectiveness. Dentists must ask about bisphosphonate usage for bone disease when recording medical histories and take appropriate actions to avoid the development of this debilitating condition in their patients. [source] Understanding the potential role of mobile phone-based monitoring on asthma self-management: qualitative studyCLINICAL & EXPERIMENTAL ALLERGY, Issue 5 2007H. Pinnock Summary Background National and international healthcare policy increasingly seeks technological solutions to the challenge of providing care for people with long-term conditions. Novel technologies, however, have the potential to change the dynamics of disease monitoring and self-management. We aimed to explore the opinions and concerns of people with asthma and primary care clinicians on the potential role of mobile phone monitoring technology (transmitting symptoms and peak flows, with immediate feedback of control and reminder of appropriate actions) in supporting asthma self-management. Methods This qualitative study recruited 48 participants (34 adults and teenagers with asthma, 14 asthma nurses and doctors) from primary care in Lothian (Central Scotland) and Kent (South East England). Thirty-nine participated in six focus groups, which included a demonstration of the technology; nine gave in-depth interviews before and after a 4-week trial of the technology. Results Participants considered that mobile phone-based monitoring systems can facilitate guided self-management although, paradoxically, may engender dependence on professional/technological support. In the early phases, as patients are learning to accept, understand and control their asthma, this support was seen as providing much-needed confidence. During the maintenance phase, when self-management predominates, patient and professionals were concerned that increased dependence may be unhelpful, although they appreciated that maintaining an on-going record could facilitate consultations. Conclusion Mobile phone-based monitoring systems have the potential to support guided self-management by aiding transition from clinician-supported early phases to effective self-management during the maintenance phase. Continuing development, adoption and formal evaluation of these systems should take account of the insights provided by our data. [source] | |||||||||||||