Improving Critical Thinking and Clinical Reasoning With a Continuing Education Course

Background: Continuing education courses related to critical thinking and clinical reasoning are needed to improve the accuracy of diagnosis. Method: This study evaluated a 4-day, 16-hour continuing education course conducted in Brazil. Thirty-nine nurses completed a pretest and a posttest consisting of two written case studies designed to measure the accuracy of nurses` diagnoses. Results: There were significant differences in accuracy from pretest to posttest for case 1 (p = .008) and case 2 (p = .042) and overall (p = .001). Conclusion: Continuing education courses should be implemented to improve the accuracy of nurses` diagnoses. J Contin Educ Nurs 2009;40(3):121-127.

Physiological and perceived exertion responses at intermittent critical power and intermittent maximal lactate steady state

Okuno, NM, Perandini, LAB, Bishop, D, Simoes, HG, Pereira, G, Berthoin, S, Kokubun, E, and Nakamura, FY. Physiological and perceived exertion responses at intermittent critical power and intermittent maximal lactate steady state. J Strength Cond Res 25(7): 2053-2058, 2011-The aim of this study was to compare the power outputs of the intermittent critical power (CPi) with the intermittent maximal lactate steady state (MLSSi) and to compare the physiological and perceptual responses exercising at CPi and MLSSi. Ten subjects performed intermittent trials on a cycle ergometer to determine CPi and MLSSi using 30: 30 seconds of effort and pause. The oxygen uptake ((V) over dotO(2)), heart rate (HR), blood lactate concentration ([Lac]), and rating of perceived exertion (RPE) responses were compared during 30-minute cycling at CPi and MLSSi. The CPi (267 6 45 W) was similar to MLSSi (254 6 39 W), and they were correlated (r = 0.88; p<0.05). The (V) over dotO(2) and HR responses stabilized throughout exercising at CPi (2.52 +/- 0.52 L.min(-1); 156 +/- 8 b.min(-1)) and MLSSi (2.41 +/- 0.32 L.min(-1); 152 +/- 10 b.min(-1)). These physiological variables were similar between conditions. However, the [Lac] and RPE were higher from the middle to the end of exercise duration at CPi ([Lac] = 6.9 +/- 2.6 mM; RPE = 17.1 +/- 2.1 a.u.) compared to MLSSi ([Lac] = 5.1 +/- 0.9 mM; RPE = 15.7 +/- 1.8 a.u.). Therefore, CPi intensity determined from 30: 30 seconds of effort and rest periods on a cycle ergometer is equivalent to the MLSSi, and there is a physiological steady state throughout both exercise intensities, although the [Lac] and RPE responses at CPi are higher than at MLSSi. Thus, the CPi and MLSSi may be used as tools for intermittent training evaluation and prescription.

Effective Electromechanical Coupling Coefficients of Piezoelectric Adaptive Structures: Critical Evaluation and Optimization

This work presents a critical analysis of methodologies to evaluate the effective (or generalized) electromechanical coupling coefficient (EMCC) for structures with piezoelectric elements. First, a review of several existing methodologies to evaluate material and effective EMCC is presented. To illustrate the methodologies, a comparison is made between numerical, analytical and experimental results for two simple structures: a cantilever beam with bonded extension piezoelectric patches and a simply-supported sandwich beam with an embedded shear piezoceramic. An analysis of the electric charge cancelation effect on the effective EMCC observed in long piezoelectric patches is performed. It confirms the importance of reinforcing the electrodes equipotentiality condition in the finite element model. Its results indicate also that smaller (segmented) and independent piezoelectric patches could be more interesting for energy conversion efficiency. Then, parametric analyses and optimization are performed for a cantilever sandwich beam with several embedded shear piezoceramic patches. Results indicate that to fully benefit from the higher material coupling of shear piezoceramic patches, attention must be paid to the configuration design so that the shear strains in the patches are maximized. In particular, effective square EMCC values higher than 1% were obtained embedding nine well-spaced short piezoceramic patches in an aluminum/foam/aluminum sandwich beam.

On the relationship between the critical temperature and the London penetration depth in layered organic superconductors

We present an analysis of previously published measurements of the London penetration depth of layered organic superconductors. The predictions of the BCS theory of superconductivity are shown to disagree with the measured zero temperature, in plane, London penetration depth by up to two orders of magnitude. We find that fluctuations in the phase of the superconducting order parameter do not determine the superconducting critical temperature as the critical temperature predicted for a Kosterlitz–Thouless transition is more than an order of magnitude greater than is found experimentally for some materials. This places constraints on theories of superconductivity in these materials.

Overview, critical assessment, and conservation implications of koala distribution and abundance

Regional and national surveys provide a broadscale description of the koala's present distribution in Australia. A detailed understanding of its distribution is precluded, however, by past and continuing land clearing across large parts of the koala's range. Koala population density increased in some regions during the late 1800s and then declined dramatically in the early 1900s. The decline was associated with habitat loss, hunting, disease, fire, and drought. Declines are continuing in Queensland and New South Wales. In contrast, dense koala populations in habitat isolates in Victoria and South Australia are managed to reduce population size and browse damage. Current understanding of koala distribution and abundance suggests that the species does not meet Australian criteria as endangered or vulnerable fauna. Its conservation status needs to be reviewed, however, in light of the extensive land clearing in New South Wales and Queensland since the last (1980s) broadscale surveys. Consequently, we recommend that broadacre clearing by curtailed in New South Wales and Queensland and that regular, comprehensive, standardized, national koala surveys be undertaken. Given the fragmentation of koala habitat and regional differences in the status of the koala, we recommended that studies on regional variation in the koala be intensified and that koala ecology in fragmented and naturally restricted habitats be developed. More generally, the National Koala Conservation Strategy should be implemented.

Neutrophils recruitment during sepsis: Critical points and crossroads

The mechanisms that initiate an inflammatory systemic response to a bacterial infection lead to a high mortality and constitute the first cause of death in Critical Care Units (ICU`s). Sepsis is a poorly understood disease and despite life support techniques and the administration of antibiotics, not much more can be done to improve its diagnosis and treatment. The present article has as main objective to discuss the role of neutrophils recruitment in sepsis, dissecting the molecular mechanisms implicated in this complex process and its importance to the pathogenesis of this outstanding cause of death.

Factors influencing job valuation: a comparative study of critical care and mon-critical care nurses

This study sought to identify the relationship between three predictor variables. perceived collaboration with medical staff, autonomy and independent actions and an outcome. the value hospital nurses placed on their work. In total 189 critical care and 366 non-critical care nurses completed a mailed survey. Critical cure nurses perceived themselves to have a mure collaborative relationship with the medical staff. described performing actions independent of medical orders more frequently and perceived their jobs to have more value than non-critical care nurses. However the latter group perceived themselves to have more autonomy in their work. Within both groups collaboration and autonomy were significantly, but weak to moderately correlated with job valuation. Simply expanding the work hospital nurses do is unlikely to result in nurses valuing their jobs more. however promoting an environment of respect and sharing between the medical and nursing staff and supporting nurses when they act in an autonomous fashion may positively influence nurses' perceptions of their work. (C) 2001 Elsevier Science Ltd. All rights reserved.

Marx as a Critical Discourse Analyst: The genesis of a critical method and its relevance to the critique of global capital

In this paper we identify elements in Marx´s economic and political writings that are relevant to contemporary critical discourse analysis (CDA). We argue that Marx can be seen to be e n gaging in a form of discourse analysis. We identify the elements in Marx´s historical materialist method that support such a perspective, and exemplify these in a longitudinal comparison of Marx´s texts.

Risk criteria in occupational environments: critical overview and discussion

The current work can be seen as a starting point for the discussion of the problematic on risk acceptance criteria in occupational environments. Some obstacles to the quantitative acceptance criteria formulation and use were analyzed. A look to the long tradition of major hazards accidents was also performed. This work shows that organizations can have several difficulties in acceptance criteria formulation and that the use of pre-defined acceptance criteria in risk assessment methodologies can be inadequate in some cases. It is urgent to define guidelines that can help organizations in the formulation of risk acceptance criteria for occupational environments.

Comprehensive treatments for social cognitive deficits in schizophrenia: A critical review and effect-size analysis of controlled studies

Recent advances in psychosocial treatments for schizophrenia have targeted social cognitive deficits. A critical literature review and effect-size (ES) analysis was conducted to investigate the efficacy of comprehensive programs of social cognitive training in schizophrenia. Results revealed 16 controlled studies consisting of seven models of comprehensive treatment with only three of these treatment models investigated in more than one study. The effects of social cognitive training were reported in 11/15 studies that included facial affect recognition skills (ES=.84) and 10/13 studies that included theory-of-mind (ES=.70) as outcomes. Less than half (4/9) of studies that measured attributional style as an outcome reported effects of treatment, but effect sizes across studies were significant (ESs=.30-.52). The effect sizes for symptoms were modest, but, with the exception of positive symptoms, significant (ESs=.32-.40). The majority of trials were randomized (13/16), selected active control conditions (11/16) and included at least 30 participants (12/16). Concerns for this area of research include the absence of blinded outcome raters in more than 50% of trials and low rates of utilization of procedures for maintaining treatment fidelity. These findings provide preliminary support for the broader use of comprehensive social cognitive training procedures as a psychosocial intervention for schizophrenia.

Respiratory viruses in lung transplant recipients: a critical review and pooled analysis of clinical studies.

Lung transplant recipients present an increased risk for severe complications associated with respiratory infections. We conducted a review of the literature examining the clinical relationship between viral respiratory infection and graft complications. Thirty-four studies describing the clinical impact of influenza, respiratory syncytial virus, parainfluenza, human metapneumovirus, rhinovirus, enterovirus, coronavirus, bocavirus or adenovirus were identified. The detection rate of respiratory viral infection ranged from 1.4% to 60%. Viruses were detected five times more frequently when respiratory symptoms were present [odds ratio (OR) = 4.97; 95% CI = 2.11-11.68]. Based on available observations, we could not observe an association between respiratory viral infection and acute rejection (OR = 1.35; 95% CI = 0.41-4.43). We found a pooled incidence of 18% (9/50) of bronchiolitis obliterans syndrome (BOS) in virus-positive cases compared to 11.6% (37/319) in virus-negative cases; however, limited number of BOS events did not allow to confirm the association. Our review confirms a causal relationship between respiratory viruses and respiratory symptoms, but cannot confirm a link between respiratory viruses and acute lung rejection. This is related in part to the heterogeneity and limitations of available studies. The link with BOS needs also to be reassessed in appropriate prospective studies.