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Poor Understanding (poor + understanding)
Selected AbstractsDesign management education: The UK experienceDESIGN MANAGEMENT REVIEW, Issue 3 2002Bill Hollins In the United Kingdom, the first courses in design management appeared almost three decades ago. Since then, there have been disappointments, as well as successes. Bill Hollins examines the record to highlight promising initiatives, along with the problems,including a poor understanding of design among business professionals, a lack of teachers, and accreditation issues,that thwart academic momentum in this arena. [source] Errors in patient perception of caloric deficit required for weight loss,observations from the Diet Plate Trial,DIABETES OBESITY & METABOLISM, Issue 5 2010G. A. Kline Persons with obesity may be poor estimators of caloric content of food. Health care professionals encourage patients to consult nutritional labels as one strategy to assess and restrict caloric intake. Among subjects enrolled in a weight loss clinical trial, the objective is to determine the accuracy of subjects' estimates of caloric deficit needed to achieve the desired weight loss. A 6-month controlled trial demonstrated efficacy of a portion control tool to induce weight loss in 130 obese people with type 2 diabetes. All subjects had previously received dietary teaching from a dietician and a nurse. At baseline, patients were asked how much weight they would like to lose and to quantitatively estimate the caloric deficit required to achieve this weight loss. The stated amount of weight loss desired ranged from 4.5 to 73 kg, with an average of 26.6 kg (n = 127 respondents). Only 30% of participants were willing to estimate the required caloric deficit to lose their target weight. Subjects' per kilograms estimate of caloric deficit required ranged from 0.7 to 2 000 000 calories/kg with a median of 86 calories/kg. Nearly half of subjects (47.4%) underestimated the total required caloric deficit to achieve their target weight loss by greater than 100 000 calories. Despite attendance at a diabetes education centre, this population of obese individuals had a poor understanding of the quantitative relationship between caloric deficit and weight loss. Educational initiatives focused upon quantitative caloric intake and its impact on weight change may be needed to assist obese patients in setting appropriate weight loss goals and achieving the appropriate daily caloric restriction required for success. [source] Review of Policies and Guidelines on Infant Feeding in Emergencies: Common Ground and GapsDISASTERS, Issue 2 2001Andrew Seal Recent crises in regions where exclusive breastfeeding is not the norm have highlighted the importance of effective policies and guidelines on infant feeding in emergencies. In 1993, UNICEF compiled a collection of policy and guideline documents relating to the feeding of infants in emergency situations. In June 2000 Save the Children, UK, UNICEF and the Institute of Child Health undertook a review of those documents, updating the list and identifying the common ground that exists among the different policies. The review also analysed the consistency of the policy framework, and highlighted important areas where guidelines are missing or unclear. This article is an attempt to share more widely the main issues arising from this review. The key conclusions were that, in general, there is consensus on what constitutes best practice in infant feeding, however, the lack of clarity in the respective responsibilities of key UN agencies (in particular UNICEF, UNHCR and WFP) over issues relating to co-ordination of activities which affect infant-feeding interventions constrains the implementation of systems to support best practice. Furthermore, the weak evidence base on effective and appropriate intervention strategies for supporting optimal infant feeding in emergencies means that there is poor understanding of the practical tasks needed to support mothers and minimise infant morbidity and mortality. We, therefore, have two key recommendations: first that the operational UN agencies, primarily UNICEF, examine the options for improving co-ordination on a range of activities to uphold best practice of infant feeding in emergencies; second, that urgent attention be given to developing and supporting operational research on the promotion of optimal infant-feeding interventions. [source] Trends in the state of nature and their implications for human well-beingECOLOGY LETTERS, Issue 11 2005Andrew Balmford Abstract Two major international initiatives , the Convention on Biological Diversity's target to reduce the rate of biodiversity loss by 2010, and the Millennium Ecosystem Assessment , raise the profile of ecological data on the changing state of nature and its implications for human well-being. This paper is intended to provide a broad overview of current knowledge of these issues. Information on changes in the status of species, size of populations, and extent and condition of habitats is patchy, with little data available for many of the taxa, regions and habitats of greatest importance to the delivery of ecosystem services. However, what we do know strongly suggests that, while exceptions exist, the changes currently underway are for the most part negative, anthropogenic in origin, ominously large and accelerating. The impacts of these changes on human society are idiosyncratic and patchily understood, but for the most part also appear to be negative and substantial. Forecasting future changes is limited by our poor understanding of the cascading impacts of change within communities, of threshold effects, of interactions between the drivers of change, and of linkages between the state of nature and human well-being. In assessing future science needs, we not only see a strong role for ecological data and theory, but also believe that much closer collaboration with social and earth system scientists is essential if ecology is to have a strong bearing on policy makers. [source] Towards ice-core-based synoptic reconstructions of west antarctic climate with artificial neural networksINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 5 2005David B. Reusch Abstract Ice cores have, in recent decades, produced a wealth of palaeoclimatic insights over widely ranging temporal and spatial scales. Nonetheless, interpretation of ice-core-based climate proxies is still problematic due to a variety of issues unrelated to the quality of the ice-core data. Instead, many of these problems are related to our poor understanding of key transfer functions that link the atmosphere to the ice. This study uses two tools from the field of artificial neural networks (ANNs) to investigate the relationship between the atmosphere and surface records of climate in West Antarctica. The first, self-organizing maps (SOMs), provides an unsupervised classification of variables from the mid-troposphere (700 hPa temperature, geopotential height and specific humidity) into groups of similar synoptic patterns. An SOM-based climatology at annual resolution (to match ice-core data) has been developed for the period 1979,93 based on the European Centre for Medium-Range Weather Forecasts (ECMWF) 15-year reanalysis (ERA-15) dataset. This analysis produced a robust mapping of years to annual-average synoptic conditions as generalized atmospheric patterns or states. Feed-forward ANNs, our second ANN-based tool, were then used to upscale from surface data to the SOM-based classifications, thereby relating the surface sampling of the atmosphere to the large-scale circulation of the mid-troposphere. Two recorders of surface climate were used in this step: automatic weather stations (AWSs) and ice cores. Six AWS sites provided 15 years of near-surface temperature and pressure data. Four ice-core sites provided 40 years of annual accumulation and major ion chemistry. Although the ANN training methodology was properly designed and followed standard principles, limited training data and noise in the ice-core data reduced the effectiveness of the upscaling predictions. Despite these shortcomings, which might be expected to preclude successful analyses, we find that the combined techniques do allow ice-core reconstruction of annual-average synoptic conditions with some skill. We thus consider the ANN-based approach to upscaling to be a useful tool, but one that would benefit from additional training data. Copyright © 2005 Royal Meteorological Society. [source] The El Niño,southern oscillation and AntarcticaINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 1 2004John Turner Abstract This paper reviews our understanding of how the effects of the El Niño,southern oscillation (ENSO) might be transmitted from the tropical Pacific Ocean to the Antarctic, and examines the evidence for such signals in the Antarctic meteorological, sea ice, ice core and biological records. Many scientific disciples concerned with the Antarctic require an understanding of how the climatic conditions in the tropical and mid-latitude regions affect the Antarctic, and it is hoped that this review will aid their work. The most pronounced signals of ENSO are found over the southeast Pacific as a result of a climatological Rossby wave train that gives positive (negative) height anomalies over the Amundsen,Bellingshausen Sea during El Niño (La Niña) events. However, the extra-tropical signature can sometimes show a high degree of variability between events in this area. In West Antarctica, links between ENSO and precipitation have shown variability on the decadal time scale. Across the continent itself, it is even more difficult to relate meteorological conditions to ENSO, yet analyses of the long meteorological records from the stations do indicate a distinct switch in sign of the pressure anomalies from positive to negative across the minimum in the southern oscillation index. The oceanic signals of ENSO around the Antarctic are less clear, but it has been suggested that the Antarctic circumpolar wave could be forced by the phenomenon. Ice-core data offer the potential to help in understanding the long-term relationship between ENSO and the climate of the Antarctic, but there are difficulties because of the need to smooth the ice-core data to overcome the mixing of snow on the surface. Nevertheless, analysis of methylsulphonic acid in a South Pole core has shown high variability on ENSO time scales. It is clear that some evidence of ENSO can be found in the Antarctic meteorological and ice-core records; however, many of the relationships tend not to be stable with time, and we currently have a poor understanding of the transfer functions by which such signals arrive at the Antarctic from the tropical Pacific. Copyright © 2004 Royal Meteorological Society [source] Cotylea (Polycladida): a cladistic analysis of morphologyINVERTEBRATE BIOLOGY, Issue 2 2008Kate A. Rawlinson Abstract. Polyclad flatworms are acoelomate bilaterians found in benthic communities worldwide, predominantly in marine environments. Current polyclad systematics is unstable, with two non-concordant classification schemes resulting in a poor understanding of within-group relationships. Here we present the first phylogenetic framework for the suborder Cotylea using a morphological matrix. Representatives of 34 genera distributed among all cotylean families (except four, excluded due to their dubious taxonomic status) were investigated. The number of families included ranges from a conservative eight to a revisionary 11. Outgroup analysis indicated that the suborder is monophyletic and defined by the presence of a ventral adhesive structure, a short posteriorly positioned vagina, and cement glands. Of the eight to 11 families included, we confirmed that three were monophyletic: Boniniidae, Prosthiostomidae, and Pseudocerotidae. Boniniidae was consistently recovered as the sister group to other Cotylea, based on the retention of the plesiomorphic Lang's vesicle. The clade consisting of Anonymus, Marcusia, and Pericelis is sister to the Boniniidae and the rest of the Cotylea. Above this clade there is little resolution at the base of the sister group. The Euryleptidae are found to be paraphyletic and give rise to the Pseudocerotidae. Neither classification scheme received unequivocal support. The intrafamilial relationships of the diverse Pseudocerotidae and Euryleptidae were examined. Color pattern characters (used for species identification) were highly homoplasious but increased cladogram resolution within genera. The monophyly of seven genera within the Pseudocerotidae and Euryleptidae was not supported and many genera showed no autapomorphies, highlighting the need for taxonomic revision of these families. [source] Communicating and judging the quality of qualitative research: the need for a new languageJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 3 2003S. A. Fade Abstract Background Traditionally UK dietitians have tended to take a more quantitative approach to research. Qualitative research which gives an in-depth view of people's experiences and beliefs is also now being used to help answer some important dietetic research questions. Review A review of the limited number of qualitative research papers in the Journal of Human Nutrition and Dietetics 1990,2002 (nine papers in all), revealed a lack of specific discussion of the quality strategies commonly used in qualitative research. This could indicate a less than robust approach, but might also reflect a different perspective on quality, or simply the difficulties associated with disseminating qualitative research to a profession whose members lack familiarity with the language. The fact that qualitative research seems to be used rarely may also indicate a poor understanding of its role. Purpose of this paper This paper seeks to clarify the potential role of qualitative research and draws on previously published guidelines for demonstrating quality. It is hoped that this will offer dietitians a framework for carrying out qualitative research and a language for reporting it, as well acting as a stimulus for discussion. [source] Radiation: Facts, fallacies and phobiasJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 1 2007DR Wigg Summary There is frequent debate in the media and the scientific published reports about the use of radiation for diagnosis and treatment, the benefits and risks of the nuclear industry, uranium mining and the storage of radioactive wastes. Driving this debate is increasing concern about reliance on fossil fuels for power generation for which alternatives are required. Unfortunately, there is generally a poor understanding of the relevant basic sciences compounded by widespread irrational fear of irradiation (radiation phobia). Radioactivity, with special reference to uranium and plutonium is simply described. How radiation affect tissues and the potential hazards to individuals and populations are explained. The origins of radiation phobia and its harmful consequences are examined. Whether we like it or not, Australia is heavily involved in the uranium industry by virtue of having one-third of the world's known reserves, exports of which are worth approximately $470m annually. As this paper has been written as simply as possible, it may also be of interest to readers who may have had little scientific training. It may be downloaded from the web using references provided in this article. It is concluded that ignorance and fear are major impediments to rational debate on radiation issues. [source] Calculated phase equilibria in K2O-FeO-MgO-Al2O3 -SiO2 -H2O for silica-undersaturated sapphirine-bearing mineral assemblagesJOURNAL OF METAMORPHIC GEOLOGY, Issue 4 2005D. E. KELSEY Abstract Silica-undersaturated, sapphirine-bearing granulites occur in a large number of localities worldwide. Such rocks have historically been under-utilized for estimating P,T evolution histories because of limited experimental work, and a consequent poor understanding of the topology and P,T location of silica-undersaturated mineral equilibria. Here, a calculated P,T projection for sapphirine-bearing, silica-undersaturated metapelitic rock compositions is constructed using THERMOCALC for the FeO-MgO-Al2O3 -SiO2 (FMAS) and KFMASH (+K2O + H2O) chemical systems, allowing quantitative analysis of silica-undersaturated mineral assemblages. This study builds on that for KFMASH sapphirine + quartz equilibria [Kelsey et al. (2004) Journal of Metamorphic Geology, vol. 22, pp. 559,578]. FMAS equilibria are significantly displaced in P,T space from silicate melt-bearing KFMASH equilibria. The large number of univariant silica-undersaturated KFMASH equilibria result in a P,T projection that is topologically more complex than could be established on the basis of experiments and/or natural assemblages. Coexisting sapphirine and silicate melt (with or without corundum) occur down to c. 900 °C in KFMASH, some 100 °C lower than in silica-saturated compositions, and from pressures of c.,1 to ,12 kbar. Mineral compositions and composition ranges for the calculated phases are consistent with natural examples. Bulk silica has a significant effect on the stability of sapphirine-bearing assemblages at a given P,T, resulting in a wide variety of possible granulite facies assemblages in silica-undersaturated metapelites. Calculated pseudosections are able to reproduce many naturally occurring silica-undersaturated assemblages, either within a single assemblage field or as the product of a P,T trajectory crossing several fields. With an understanding of the importance of bulk composition on sapphirine stability and textural development, silica-undersaturated assemblages may be utilized in a quantitative manner in the detailed metamorphic investigation of high-grade terranes. [source] Students' levels of explanations, models, and misconceptions in basic quantum chemistry: A phenomenographic studyJOURNAL OF RESEARCH IN SCIENCE TEACHING, Issue 5 2009Christina Stefani We investigated students' knowledge constructions of basic quantum chemistry concepts, namely atomic orbitals, the Schrödinger equation, molecular orbitals, hybridization, and chemical bonding. Ausubel's theory of meaningful learning provided the theoretical framework and phenomenography the method of analysis. The semi-structured interview with 19 second-year chemistry students supplied the data. We identified four levels of explanations in the students' answers. In addition, the scientific knowledge claims reflected three main levels of models. By combining levels of explanations with levels of models, we derived four categories. Two of the categories are shades of variation in the rote-learning part of a continuum, while the other two categories are in the meaningful-learning part. All students possessed alternative conceptions some of which occurred within certain categories, while others spanned more categories. The insistence on the deterministic models of the atom, the misinterpretation of models, and the poor understanding of the current quantum concepts are main problems in the learning of the basic quantum chemistry concepts. © 2009 Wiley Periodicals, Inc. J Res Sci Teach 46: 520,536, 2009 [source] Fight or flight: antipredator strategies of baleen whalesMAMMAL REVIEW, Issue 1 2008JOHN K. B. FORD ABSTRACT 1The significance of killer whale Orcinus orca predation on baleen whales (Mysticeti) has been a topic of considerable discussion and debate in recent years. Discourse has been constrained by poor understanding of predator-prey dynamics, including the relative vulnerability of different mysticete species and age classes to killer whales and how these prey animals avoid predation. Here we provide an overview and analysis of predatory interactions between killer whales and mysticetes, with an emphasis on patterns of antipredator responses. 2Responses of baleen whales to predatory advances and attacks by killer whales appear to fall into two distinct categories, which we term the fight and flight strategies. The fight strategy consists of active physical defence, including self-defence by single individuals, defence of calves by their mothers and coordinated defence by groups of whales. It is documented for five mysticetes: southern right whale Eubalaena australis, North Atlantic right whale Eubalaena glacialis, bowhead whale Balaena mysticetus, humpback whale Megaptera novaeangliae and grey whale Eschrichtius robustus. The flight strategy consists of rapid (20,40 km/h) directional swimming away from killer whales and, if overtaken and attacked, individuals do little to defend themselves. This strategy is documented for six species in the genus Balaenoptera. 3Many aspects of the life history, behaviour and morphology of mysticetes are consistent with their antipredator strategy, and we propose that evolution of these traits has been shaped by selection for reduced predation. Fight species tend to have robust body shapes and are slow but relatively manoeuvrable swimmers. They often calve or migrate in coastal areas where proximity to shallow water provides refuge and an advantage in defence. Most fight species have either callosities (rough and hardened patches of skin) or encrustations of barnacles on their bodies, which may serve (either primarily or secondarily) as weapons or armour for defence. Flight species have streamlined body shapes for high-speed swimming and they can sustain speeds necessary to outrun pursuing killer whales (>15,20 km/h). These species tend to favour pelagic habitats and calving grounds where prolonged escape sprints from killer whales are possible. 4The rarity of observed successful attacks by killer whales on baleen whales, especially adults, may be an indication of the effectiveness of these antipredator strategies. Baleen whales likely offer low profitability to killer whales, relative to some other marine mammal prey. High-speed pursuit of flight species has a high energetic cost and a low probability of success while attacks on fight species can involve prolonged handling times and a risk of serious injury. [source] REHABILITATION AND RELEASE OF MARINE MAMMALS IN THE UNITED STATES: RISKS AND BENEFITSMARINE MAMMAL SCIENCE, Issue 4 2007Michael Moore Abstract Rehabilitation of stranded marine mammals elicits polarized attitudes: initially done alongside display collections, but release of rehabilitated animals has become more common. Justifications include animal welfare, management of beach use conflict, research, conservation, and public education. Rehabilitation cost and risks have been identified that vary in degree supported by data rather than perception. These include conflict with fisheries for resources, ignorance of recipient population ecology, poor understanding of long-term survival, support of the genetically not-so-fit, introduction of novel or antibiotic-resistant pathogens, harm to human health, and cost. Thus facilities must balance their welfare appeal against public education, habitat restoration, human impact reduction, and other conservation activities. Benefits to rehabilitating marine mammals are the opportunity to support the welfare of disabled animals and to publish good science and so advance our understanding of wild populations. In specific cases, the status of a population may make conservation the main reason for rehabilitation. These three reasons for rehabilitation lead to contrasting, and sometimes conflicting, management needs. We therefore outline a decision tree for rehabilitation managers using criteria for each management decision, based on welfare, logistics, conservation, research, and funding to define limits on the number of animals released to the wild. [source] Double-stranded RNA-mediated gene silencing of cysteine proteases (falcipain-1 and -2) of Plasmodium falciparumMOLECULAR MICROBIOLOGY, Issue 5 2002Pawan Malhotra Summary Malaria remains a public health problem of enormous magnitude, affecting over 500 million people every year. Lack of success in the past in the development of new drug/vaccines has mainly been attributed to poor understanding of the functions of different parasite proteins. Recently, RNA interference (RNAi) has emerged as a simple and incisive technique to study gene functions in a variety of organisms. In this study, we report the results of RNAi by double-stranded RNA of cysteine protease genes (falcipain -1 and -2) in the malaria parasite, Plasmodium falciparum. Using RNAi directed towards falcipain genes, we demonstrate that blocking the expression of these genes results in severe morphological abnormalities in parasites, inhibition of parasite growth in vitro and substantial accumulation of haemoglobin in the parasite. The inhibitory effects produced by falcipain double-stranded (ds)RNAs are reminiscent of the effects observed upon administering E-64, a cysteine protease inhibitor. The parasites treated with falcipain's dsRNAs also show marked reduction in the levels of corresponding endogenous falcipain mRNAs. We also demonstrate that dsRNAs of falcipains are broken into short interference RNAs , 25 nucleotides in size, a characteristic of RNAi, which in turn activates sequence-specific nuclease activity in the malaria parasites. These results thus provide more evidence for the existence of RNAi in P. falciparum and also suggest possibilities for using RNAi as an effective tool to determine the functions of the genes identified from the P. falciparum genome sequencing project. [source] Spatial separation of litter decomposition and mycorrhizal nitrogen uptake in a boreal forestNEW PHYTOLOGIST, Issue 3 2007Björn D. Lindahl Summary ,,Our understanding of how saprotrophic and mycorrhizal fungi interact to re-circulate carbon and nutrients from plant litter and soil organic matter is limited by poor understanding of their spatiotemporal dynamics. ,,In order to investigate how different functional groups of fungi contribute to carbon and nitrogen cycling at different stages of decomposition, we studied changes in fungal community composition along vertical profiles through a Pinus sylvestris forest soil. We combined molecular identification methods with 14C dating of the organic matter, analyses of carbon:nitrogen (C:N) ratios and 15N natural abundance measurements. ,,Saprotrophic fungi were primarily confined to relatively recently (< 4 yr) shed litter components on the surface of the forest floor, where organic carbon was mineralized while nitrogen was retained. Mycorrhizal fungi dominated in the underlying, more decomposed litter and humus, where they apparently mobilized N and made it available to their host plants. ,,Our observations show that the degrading and nutrient-mobilizing components of the fungal community are spatially separated. This has important implications for biogeochemical studies of boreal forest ecosystems. [source] Molecular characterization of tumour heterogeneity and malignant mesothelioma cell differentiation by gene profilingTHE JOURNAL OF PATHOLOGY, Issue 1 2005Xiaojuan Sun Abstract Malignant mesothelioma is an aggressive tumour, characterized by a variable differentiation pattern and poor prognosis. At present, the clinical outcome in patients with malignant mesothelioma is mainly predicted by the morphological phenotype of the tumour. However, this conventional clinicopathological parameter is of limited value, partly because of the biological heterogeneity of this tumour and poor understanding of the regulatory mechanisms underlying the various patterns of growth. To elucidate the intrinsic molecular programmes that determine tumour differentiation, oligonucleotide arrays were used in an in vitro model of mesothelioma differentiation. The analysis of 2059 genes detected 102 genes that were significantly deregulated. Clustering of these genes into functional categories showed distinctive patterns for the two phenotypes, namely epithelioid and sarcomatoid. The molecular fingerprint of the sarcomatoid tumour component indicates overrepresentation of growth factor receptors and growth factor binding proteins, whereas epithelioid mesothelioma cells express other tumour-promoting factors involved in differentiation, metabolism, and regulation of apoptosis. These differences in the molecular phenotype may give a better basis for diagnosis and for designing novel therapies. Copyright © 2005 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [source] Adenosine Deaminase Enzyme Therapy Prevents and Reverses the Heightened Cavernosal Relaxation in PriapismTHE JOURNAL OF SEXUAL MEDICINE, Issue 9 2010Jiaming Wen MD ABSTRACT Introduction., Priapism featured with painful prolonged penile erection is dangerous and commonly seen in sickle cell disease (SCD). The preventive approaches or effective treatment options for the disorder are limited because of poor understanding of its pathogenesis. Recent studies have revealed a novel role of excess adenosine in priapism caused by heightened cavernosal relaxation, and therefore present an intriguing mechanism-based therapeutic possibility. Aim., The aim of this study was to determine the therapeutic effects of adenosine deaminase (ADA) enzyme therapy to lower adenosine in priapism. Methods., Both ADA-deficient mice and SCD transgenic (Tg) mice display priapism caused by excessive adenosine. Thus, we used these two distinct lines of mouse models of priapism as our investigative tools. Specifically, we treated both of these mice with different dosages of polyethylene glycol,modified ADA (PEG,ADA) to reduce adenosine levels in vivo. At the end points of the experiments, we evaluated the therapeutic effects of PEG,ADA treatment by measuring adenosine levels and monitoring the cavernosal relaxation. Main Outcome Measures., Adenosine levels in penile tissues were measured by high-performance liquid chromatography, and cavernosal relaxation was quantified by electrical field stimulation (EFS)-induced corporal cavernosal strip (CCS) assays. Results., We found that lowering adenosine levels in penile tissues by PEG,ADA treatment from birth in ADA-deficient mice prevented the increased EFS-induced CCS relaxation associated with priapism. Intriguingly, in both ADA-deficient mice and SCD Tg mice with established priapism, we found that normalization of adenosine levels in penile tissues by PEG,ADA treatment relieved the heightened EFS-induced cavernosal relaxation in priapism. Conclusions., Our studies have identified that PEG,ADA is a novel, safe, and mechanism-based drug to prevent and correct excess adenosine-mediated increased cavernosal relaxation seen in two independent priapic animal models, and suggested its therapeutic possibility in men suffering from priapism. Wen J, Jiang X, Dai Y, Zhang Y, Tang Y, Sun H, Mi T, Kellems RE, Blackburn MR, and Xia Y. Adenosine deaminase enzyme therapy prevents and reverses the heightened cavernosal relaxation in priapism. J Sex Med 2010;7:3011,3022. [source] Men's Sexual Health: Evaluating the Effectiveness of Print- and PDA-based CMETHE JOURNAL OF SEXUAL MEDICINE, Issue 9 2009Gregory A. Broderick MD ABSTRACT Introduction., Personal digital assistant (PDA)-based continuing medical education (CME) activities have become widely available. Aims., To evaluate the effectiveness of print- and PDA-based CME materials in erectile dysfunction (ED). Methods., CME materials describing links between ED and comorbid medical conditions, effects of certain lifestyle modifications on ED, and treatment of ED with phosphodiesterase 5 (PDE5) inhibitors were distributed as a print supplement and as electronic modules, viewed with PDAs. We evaluated how effectively these materials improved evidence-based clinical choices, using survey questions about case vignettes and comparing responses of CME participants (N = 85) and matched nonparticipants (N = 94). Main Outcome Measures., Effect size, measuring the difference in evidence-based clinical scores between participants and nonparticipants. Results., CME certificates were awarded to 3,557 participants (459 print, 3,098 PDA). Among survey respondents, significantly more CME participants recognized that ED was associated with greater risk for myocardial infarction (61% participants; 34% nonparticipants; P , 0.001) and was a strong marker for diabetes mellitus (37% participants; 9% nonparticipants; P , 0.001). In contrast, participants and nonparticipants both displayed a good understanding of the relationships of smoking, obesity, and sedentary lifestyle with ED and of using PDE5 inhibitors to treat ED in patients with prostate cancer or benign prostatic hyperplasia; this likely reflects a good baseline understanding of these topics. Participants and nonparticipants each displayed a poor understanding of the recommendations regarding nonarteritic anterior ischemic optic neuropathy and PDE5 inhibitor use. Patient reluctance to discuss sexual concerns was perceived as the most significant barrier to optimal ED management. Conclusions., Given patient reluctance to discuss sexual concerns, future CME activities should focus on educating health-care providers and patients that ED is a risk factor for cardiovascular disease and diabetes. Both print- and PDA-based CME on ED were effective; the large number of lesson completers suggests a trend toward on-demand, self-selected CME is positive. Broderick GA, and Abdolrasulnia M. Men's sexual health: Evaluating the effectiveness of print- and PDA-based CME. J Sex Med 2009;6:2417,2424. [source] The Growing Pains of Integrated Health Care for the Elderly: Lessons from the Expansion of PACETHE MILBANK QUARTERLY, Issue 2 2004DIANE L. GROSS The early success of the demonstration Program of All-Inclusive Care for the Elderly (PACE) led to its designation as a permanent Medicare program in 1997. But the growth in the number of programs and enrollment has lagged and does not meet expectations. This article offers insights into the mechanisms influencing the expansion of PACE, from information obtained in interviews and surveys of administrators, medical directors, and financial officers in 27 PACE programs. Sixteen barriers to expansion were found, including competition, PACE model characteristics, poor understanding of the program among referral sources, and a lack of financing for expansion. This experience offers important lessons for providing integrated health care to the frail elderly. [source] IS INFORMED CONSENT IN CARDIAC SURGERY AND PERCUTANEOUS CORONARY INTERVENTION ACHIEVABLE?ANZ JOURNAL OF SURGERY, Issue 7 2007Marco E. Larobina Background: Medical and legal published work regularly discusses informed consent and patient autonomy before medical interventions. Recent discussions have suggested that Cardiothoracic surgeons' risk adjusted mortality data should be published to facilitate the informed consent process. However, as to which aspects of medicine, procedures and the associated risks patients understand is unknown. It is also unclear how well the medical profession understands the concepts of informed consent and medical negligence. The aims of this study were to evaluate patients undergoing coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) to assess their understanding of the risks of interventions and baseline level of understanding of medical concepts and to evaluate the medical staff's understanding of medical negligence and informed consent. Methods: Patients undergoing CABG or PCI at a tertiary hospital were interviewed with questionnaires focusing on the consent process, the patient's understanding of CABG or PCI and associated risks and understanding of medical concepts. Medical staff were questioned on the process of obtaining consent and understanding of medicolegal concepts. Results: Fifty CABG patients, 40 PCI patients and 40 medical staff were interviewed over a 6-month period. No patient identified any of the explained risks as a reason to reconsider having CABG or PCI, but 80% of patients wanted to be informed of all risks of surgery. 80% of patients considered doctors obligated to discuss all risks of surgery. One patient (2%) expressed concern at the prospect of a trainee surgeon carrying out the operation. Stroke (40%) rather than mortality (10%) were the important concerns in patients undergoing CABG and PCI. The purpose of interventions was only partially understood by both groups; PCI patients clearly underestimated the subsequent need for repeat PCI or CABG. Knowledge of medical concepts was poor in both groups: less than 50% of patients understood the cause or consequence of an AMI or stroke and less than 20% of patients correctly identified the ratio equal to 0.5%. One doctor (2.5%) correctly identified the four elements of negligence, eight (20%) the meaning of material risk and four (10%) the meaning of causation. Thirty doctors (75%) believed that all complications of a procedure needed to be explained for informed consent. Less than 10% could recognize landmark legal cases. Conclusion: Patients undergoing both CABG and PCI have a poor understanding of their disease, their intervention, and its complications making the attaining of true informed consent difficult, despite their desire to be informed of all risks. PCI patients particularly were highly optimistic regarding the need for reintervention over time, which requires specific attention during the consent process. Medical staff showed a poor knowledge of the concepts of material risk and medical negligence requiring much improved education of both junior doctors and specialists. [source] Impairments on "open-ended" executive function tests in autismAUTISM RESEARCH, Issue 3 2009Sarah J. White Abstract The executive function (EF) theory of autism has received much support recently from a growing number of studies. However, executive impairments have not always been easy to identify consistently and so novel "ecologically valid" tests have been designed which tap into real-life scenarios that are relevant to and representative of everyday behavior. One characteristic of many of these tasks is that they present the participant with an "ill-structured" or "open-ended" situation. Here, we investigated the possibility that tasks with greater degrees of open-endedness might prove more sensitive to detecting executive impairment in autism. Forty-five children with autism spectrum disorder (ASD) were compared to 27 age- and IQ-matched control children on a range of cognitive tests of EF. Group differences were found on half of the tasks, with the greatest degree of impairment detected on the more open-ended tasks. The ASD group also performed more poorly on a simple control condition of a task. Detailed consideration of task performance suggested that the ASD group tended to create fewer spontaneous strategies and exhibit more idiosyncratic behavior, which particularly disadvantaged them on the more open-ended tasks. These kinds of behaviors have been reported in studies of neurological patients with frontal lobe involvement, prima facie suggesting a link between the scientific fields. However, we suggest that this behavior might equally result from a poor understanding of the implicit demands made by the experimenter in open-ended test situations, due to the socio-communicative difficulties of these children. [source] Contact allergy: the role of skin chemistry and metabolismCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 2 2003C. K. Smith Pease Summary Chemical reactivity plays the driving role in the biological processes that result in the induction of allergic contact dermatitis. This paper presents an overview of the chemical basis of allergic contact dermatitis, including the physicochemical parameters governing skin penetration, chemical reaction mechanisms associated with haptenation of skin proteins, (quantitative) structure,activity relationships (Q)SARs for contact allergens and prohaptens/skin metabolism of contact allergens. Despite the complexities and poor understanding of some of the metabolic processes leading to skin sensitization, it is possible to describe some of the relationships between chemical structures and the ability to form covalent conjugates with proteins. This knowledge, which relates chemical structure to a specific endpoint, can be programmed into an expert system. The Deductive Estimation of Risk from Existing Knowledge (DEREK) is one such expert system which is described in further detail. [source] | |||||||||||||||||||