828 resultados para Level 3 evidence


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To evaluate the performance of ocean-colour retrievals of total chlorophyll-a concentration requires direct comparison with concomitant and co-located in situ data. For global comparisons, these in situ match-ups should be ideally representative of the distribution of total chlorophyll-a concentration in the global ocean. The oligotrophic gyres constitute the majority of oceanic water, yet are under-sampled due to their inaccessibility and under-represented in global in situ databases. The Atlantic Meridional Transect (AMT) is one of only a few programmes that consistently sample oligotrophic waters. In this paper, we used a spectrophotometer on two AMT cruises (AMT19 and AMT22) to continuously measure absorption by particles in the water of the ship's flow-through system. From these optical data continuous total chlorophyll-a concentrations were estimated with high precision and accuracy along each cruise and used to evaluate the performance of ocean-colour algorithms. We conducted the evaluation using level 3 binned ocean-colour products, and used the high spatial and temporal resolution of the underway system to maximise the number of match-ups on each cruise. Statistical comparisons show a significant improvement in the performance of satellite chlorophyll algorithms over previous studies, with root mean square errors on average less than half (~ 0.16 in log10 space) that reported previously using global datasets (~ 0.34 in log10 space). This improved performance is likely due to the use of continuous absorption-based chlorophyll estimates, that are highly accurate, sample spatial scales more comparable with satellite pixels, and minimise human errors. Previous comparisons might have reported higher errors due to regional biases in datasets and methodological inconsistencies between investigators. Furthermore, our comparison showed an underestimate in satellite chlorophyll at low concentrations in 2012 (AMT22), likely due to a small bias in satellite remote-sensing reflectance data. Our results highlight the benefits of using underway spectrophotometric systems for evaluating satellite ocean-colour data and underline the importance of maintaining in situ observatories that sample the oligotrophic gyres.

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To evaluate the performance of ocean-colour retrievals of total chlorophyll-a concentration requires direct comparison with concomitant and co-located in situ data. For global comparisons, these in situ match-ups should be ideally representative of the distribution of total chlorophyll-a concentration in the global ocean. The oligotrophic gyres constitute the majority of oceanic water, yet are under-sampled due to their inaccessibility and under-represented in global in situ databases. The Atlantic Meridional Transect (AMT) is one of only a few programmes that consistently sample oligotrophic waters. In this paper, we used a spectrophotometer on two AMT cruises (AMT19 and AMT22) to continuously measure absorption by particles in the water of the ship's flow-through system. From these optical data continuous total chlorophyll-a concentrations were estimated with high precision and accuracy along each cruise and used to evaluate the performance of ocean-colour algorithms. We conducted the evaluation using level 3 binned ocean-colour products, and used the high spatial and temporal resolution of the underway system to maximise the number of match-ups on each cruise. Statistical comparisons show a significant improvement in the performance of satellite chlorophyll algorithms over previous studies, with root mean square errors on average less than half (~ 0.16 in log10 space) that reported previously using global datasets (~ 0.34 in log10 space). This improved performance is likely due to the use of continuous absorption-based chlorophyll estimates, that are highly accurate, sample spatial scales more comparable with satellite pixels, and minimise human errors. Previous comparisons might have reported higher errors due to regional biases in datasets and methodological inconsistencies between investigators. Furthermore, our comparison showed an underestimate in satellite chlorophyll at low concentrations in 2012 (AMT22), likely due to a small bias in satellite remote-sensing reflectance data. Our results highlight the benefits of using underway spectrophotometric systems for evaluating satellite ocean-colour data and underline the importance of maintaining in situ observatories that sample the oligotrophic gyres.

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Introduction
This paper outlines an innovative approach to auditing and evaluating the content of a management and leadership module for undergraduate nursing students after their final management clinical placement. Normally evaluations of teaching in a module take place at the end of a teaching module and therefore do not properly reflect the value of the teaching in relation to practical clinical experience.
Aim
This audit and evaluation sought to explore both the practical value of the teaching and learning, and also the degree to which it the teaching reflected against the NMC Standards of Education and Learning (2010 domain 3).
Methods
Having piloted the evaluative tool with an earlier cohort of nursing students, this evaluation explored both a quantitative assessment employing a Personal Response System (n =172), together with a qualitative dimension (n=116), thus delivering paper-based comments and reflections from students on the value and practicality of the module teaching theory to their final clinical management experience. The quantitative audit data were analysed for frequencies and cross tabulation and the qualitative audit data were thematically analysed.
Results
Results suggest a significant proportion of the students, appreciated the quality of the standard of teaching, but more importantly, ‘valued or highly valued’ the teaching and learning in relation to how it helped to significantly inform their management placement experience. A smaller proportion of the students underlined limitations and areas in which further improvement can be made in teaching and learning to the module.
Conclusion
Significantly positive evaluation by the students of the practical value of teaching and learning, to the theoretical management module. This has proved a useful auditing approach in assessing the theoretical teaching to student’s Level 3 clinical experience, and facilitated significant recommendations as far as developing the teaching and learning to better reflect the practice needs of nursing students

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INTRODUCTION: Sleepiness is a cardinal symptom in obstructive sleep apnoea (OSA) but most patients have unspecific symptoms. Arterial stiffness, evaluated by pulse wave velocity (PWV), is related to atherosclerosis and cardiovascular (CV) risk. Arterial stiffness was reported to be higher in patients with OSA, improving after treatment with continuous positive airway pressure (CPAP). This study aims to assess whether the same effect occurs in patients with OSA and without sleepiness. METHODS AND ANALYSIS: This observational study assesses the CV effect of CPAP therapy on a cohort of patients with moderate-to-severe OSA; the effect on the subcohorts of sleepy and non-sleepy patients will be compared. A systematic and consecutive sample of patients advised CPAP therapy will be recruited from a single outpatient sleep clinic (Centro Hospitalar de Lisboa Central-CHLC, Portugal). Eligible patients are male, younger than 65 years, with confirmed moderate-to-severe OSA and apnoea-hypopnea index (AHI) above 15/hour. Other sleep disorders, diabetes or any CV disease other than hypertension are exclusion criteria. Clinical evaluation at baseline includes Epworth Sleepiness Scale (ESS), and sleepiness is defined as ESS above 10. OSA will be confirmed by polygraphic study (cardiorespiratory, level 3). Participants are advised to undertake an assessment of carotid-femoral PWV (cf-PWV) and 24 hours evaluation of ambulatory blood pressure monitoring (ABPM), at baseline and after 4 months of CPAP therapy. Compliance and effectiveness of CPAP will be assessed. The main outcome is the variation of cf-PWV over time.

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Social media tools are bringing a new dimension to dialogue and feedback for learners on a level 3 BTEC extended diploma in creative media production at Basingstoke College of Technology. Not only do blogging, networking and video-sharing tools engage their attention, learners find sharing their work on a public platform helps them achieve a higher standard of work through the continuous engagement with feedback from peers and industry professionals made possible by social media.

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Aim This paper will report findings from the first phase of an evaluation of a new e-health intervention designed to allow mothers to ‘see’ their baby in neonatal care (NNU) when they are not able to be with them. The intervention, MyLittleOne, involves a web-camera being placed over the incubator in NNU, which transmits a real-time video wirelessly to a coupled tablet device at the mother’s bedside. Guided by the MRC Framework for the Development and Evaluation of Healthcare Interventions (MRC, 2008), the aim was to explore parent and professional views of the technology and make recommendations for its future development, use and evaluation. Methods A qualitative approach was adopted, guided by a critical realist perspective (McEvoy and Richards, 2003). The study took place in a Level 3 NNU in Scotland. Participants were recruited purposively and included parents (n = 33) and a range of health professionals working in neonatal and postnatal care (n = 21). The data were collected during semi-structured individual, paired and small group interviews and were analysed thematically using NVivo v10. Results The majority of parents and professionals spoke positively about MyLittleOne. Perceptions were that: use of the technology assisted bonding and responsiveness; it promoted the recovery process following birth; and, for mothers who wished to breast-feed, being able to see their baby on the tablet device encouraged the ‘let-down’ reflex. An additional benefit was that siblings and others who may not be able to visit the NNU were able to see the baby. In contrast, for a small number of mothers, viewing their baby remotely appeared to increase their levels of anxiety. Switching off the camera during a medical procedure and back on after the procedure was completed was found to be problematic, at times and in different ways, for both parents and professionals. Conclusions Findings from this preliminary evaluation will guide future developments of the technology, including its use in family homes following the mother’s discharge. The findings will also inform the design of a feasibility study and subsequent RCT to assess the impact of MyLittleOne on a range of psychological indicators of postnatal adjustment.

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On the area in relation with the very wave battered made, the associations to be noted are: 1) association with Bangia sp., which is seasonal and located at the level of Brachytrichia maculans. 2) Association with Chthamalus stellatus, which is very well developed over under the oysters’ level. 3) Association with Dermonema frappieri, which form a narrow band over the Chnoospora minima band. At the same level are located the associations with Ectocarpus braeviarticulatus, with Centroceras clavulatum, with Gymnogongrus Sereneii and with Chaetomorpha antennina. The infralittoral level does not present any conspicuous different.

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This chapter discusses the consequences of open-access (OA) publishing and dissemination for libraries in higher education institutions (HEIs). Key questions (which are addressed in this chapter) include: 1. How might OA help information provision? 2. What changes to library services will arise from OA developments (particularly if OA becomes widespread)? 3. How do these changes fit in with wider changes affecting the future role of libraries? 4. How can libraries and librarians help to address key practical issues associated with the implementation of OA (particularly transition issues)? This chapter will look at OA from the perspective of HE libraries and will make four key points: 1. Open access has the potential to bring benefits to the research community in particular and society in general by improving information provision. 2. If there is widespread open access to research content, there will be less need for library-based activity at the institution level, and more need for information management activity at the supra-institutional or national level. 3. Institutional libraries will, however, continue to have an important role to play in areas such as managing purchased or licensed content, curating institutional digital assets, and providing support in the use of content for teaching and research. 4. Libraries are well-placed to work with stakeholders within their institutions and beyond to help resolve current challenges associated with the implementation of OA policies and practices.

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No desenvolvimento deste Trabalho de Investigação Aplicada, pretende-se responder à questão: Quais os requisitos necessários a implementar numa base de dados relacional de controlos de segurança da informação para Unidades, Estabelecimentos ou Órgãos militares do Exército Português? Deste modo, para se responder a esta questão central, houve necessidade de subdividir esta em quatro questões derivadas, sendo elas: 1. Quais as principais dimensões de segurança da informação ao nível organizacional? 2. Quais as principais categorias de segurança da informação ao nível organizacional? 3. Quais os principais controlos de segurança da informação a implementar numa organização militar? 4. Quais os requisitos funcionais necessários a implementar numa base de dados de controlos de segurança da informação a implementar numa organização militar? Para responder a estas questões de investigação, este trabalho assenta numa investigação aplicada, com o objetivo de desenvolver uma aplicação prática para os conhecimentos adquiridos, materializando-se assim numa base de dados. Ainda, quanto ao objetivo da investigação, este é descritivo, explicativo e exploratório, uma vez que, tem o objetivo de descrever as principais dimensões, categorias e controlos da segurança da informação, assim como o objetivo de explicar quais são os requisitos funcionais necessários a implementar numa base de dados de controlos de segurança da informação. Por último, tem ainda o objetivo de efetuar um estudo exploratório, comprovando a eficácia da base de dados. Esta investigação assenta no método indutivo, partindo de premissas particulares para chegar a conclusões gerais, isto é, a partir de análise de documentos e de inquéritos por entrevista, identificar-se-ão quais são os requisitos funcionais necessários a implementar, generalizando para todas as Unidades, Estabelecimentos ou Órgãos militares do Exército Português. No que corresponde ao método de procedimentos, usar-se-á o método comparativo, com vista a identificar qual é a norma internacional de gestão de segurança de informação mais indicada a registar na base de dados. Por último, como referido anteriormente, no que concerne às técnicas de investigação, será usado o inquérito por entrevista, identificando os requisitos necessários a implementar, e a análise de documentos, identificando as principais dimensões, categoriasou controlos necessários a implementar numa base de dados de controlos de segurança da informação. Posto isto, numa primeira fase da investigação, através da análise de documentos, percecionam-se as principais dimensões, categorias e controlos de segurança da informação necessários a aplicar nas Unidades, Estabelecimentos ou Órgãos militares do Exército Português, por forma a contribuir para o sucesso na gestão da segurança da informação militar. Ainda, através de entrevistas a especialistas da área de segurança da informação e dos Sistemas de Informação nas unidades militares, identificar-se-ão quais os requisitos funcionais necessários a implementar numa base de dados de controlos de segurança da informação a implementar numa organização militar. Por último, numa segunda fase, através do modelo de desenvolvimento de software em cascata revisto, pretende-se desenvolver uma base de dados relacional, em Microsoft Access, de controlos de segurança da Informação a fim de implementar em Unidades, Estabelecimentos ou Órgãos militares do Exército Português. Posteriormente, após o desenvolvimento da base de dados, pretende-se efetuar um estudo exploratório com vista a validar a mesma, de modo a comprovar se esta responde às necessidades para a qual foi desenvolvida.

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Purpose: To investigate the effect of Lycii fructus polysaccharides (LFPS) on ovulation failure. Methods: A rat model of ovulation failure was established by intragastric administration of hydroxyurea (300 mg/kg). Rats with ovulation failure then received LFPS via oral administration at doses of 100, 200, or 400 mg/kg. The body, uterus and ovary of each rat were weighed using electronic scales. The hypothalamic-pituitary-ovarian (HPO) axis hormones, including estradiol (E2) level, follicle-stimulating hormone (FSH) activity, and luteinizing hormone (LH) activity in the serum of each rat were determined by enzyme-linked immunosorbent assay (ELISA). The levels of pro-apoptotic proteins (Fas, FasL, FADD, c-caspase-8, c-caspase-10, c-caspase-3, c-caspase-6, and c-caspase-7) in the ovarian tissue of each rat were detected by western blot. Results: Hydroxyurea reduced significantly (p < 0.01) uterus and ovary indices (uterus or ovary weight/body weight) (0.119 and 0.026 %), E2 level (3.42 pmol/L), and FSH and LH activities (2.28 and 2.76 U/L), compared with those in the normal group (0.169 and 0.039 %; 6.72 pmol/L; 2.76 and 3.75 U/L). Hydroxyurea increased significantly (p < 0.01) the levels of the above-mentioned pro-apoptotic proteins relative to those in the normal group. LFPS (100, 200, or 400 mg/kg) reversed significantly (p < 0.05 or 0.01) the effect of hydroxyurea on all of the above indices. Conclusion: LFPS exhibits a protective effect on hydroxyurea-induced ovulation failure by regulating the HPO axis hormones and death receptor-mediated apoptotic pathway.

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Aims The objective of the 5th International Consultation on Incontinence (ICI) chapter on Adult Conservative Management was to review and summarize the new evidence on conservative management of urinary incontinence (UI) and pelvic organ prolapse (POP) in order to compile a current reference source for clinicians, health researchers, and service planners. In this paper, we present the review highlights and new evidence on female conservative management. Methods Revision and updates of the 4th ICI Report using systematic review covering years 2008–2012. Results Each section begins with a brief definition and description of the intervention followed by a summary, where possible, of both the state and level of evidence for prevention and treatment, and ends with a “grade of recommendation.” The paper concludes with areas identified as requiring further research. Conclusions For UI, there are no prevention trials on lifestyle interventions. There are, however, few new intervention trials of lifestyle interventions involving weight loss and fluid intake with improved levels of evidence and grade of recommendation. Outside of pre- and post-natal pelvic floor muscle training (PFMT) trials for the prevention of female UI, there is a dearth of PFMT prevention trials for women with UI. PFMT remains the first-line treatment for female UI with high levels of evidence and grades of recommendation. Bladder training levels of evidence and grades of recommendation are maintained. For POP, new evidence supports the effectiveness of physiotherapy in the treatment of POP and there are now improved levels of evidence and grades of recommendation.

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Paraffin has been used as surface protection of wood throughout the ages but its use for impregnation to improve wood resistance to biodegradation is recent. This study determined the main improvements on wood properties with paraffin impregnation. Healthy Pinus pinaster Ait. wood was impregnated with paraffin at different levels using a hot–cold process. Weight gain, equilibrium moisture content and dimensional stability (ASE) at 35 and 65 % relative humidity, termite durability against Reticulitermes grassei (Clément), bending strength, bending stiffness (MOE) and Janka hardness were determined. Density increased from 0.57 to 0.99, ASE ranged between 38–96 % and 16–71 % for 35 and 65 % relative humidity, respectively. Equilibrium moisture content decreased from 9.9 and 12.0 % to 0.8 and 3.6 % for 35 and 65 % relative humidity. Termite durability improved from level 4 to level 3 of attack, and higher termite mortality was found in treated wood (52 % against 17 %). Bending strength (MOR) increased with paraffin weight gain, reaching a 39 % increase. MOE also increased by about 13 % for wood with a weight gain around 80 %. Janka hardness increased significantly reaching about 40 % for wood with 80 % weight gain. Paraffin impregnated wood has improved properties with regard to equilibrium moisture content, dimensional stability and density, bending strength and Janka hardness, and resistance against termites.

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Aims The objective of the 5th International Consultation on Incontinence (ICI) chapter on Adult Conservative Management was to review and summarize the new evidence on conservative management of urinary incontinence (UI) and pelvic organ prolapse (POP) in order to compile a current reference source for clinicians, health researchers, and service planners. In this paper, we present the review highlights and new evidence on female conservative management. Methods Revision and updates of the 4th ICI Report using systematic review covering years 2008–2012. Results Each section begins with a brief definition and description of the intervention followed by a summary, where possible, of both the state and level of evidence for prevention and treatment, and ends with a “grade of recommendation.” The paper concludes with areas identified as requiring further research. Conclusions For UI, there are no prevention trials on lifestyle interventions. There are, however, few new intervention trials of lifestyle interventions involving weight loss and fluid intake with improved levels of evidence and grade of recommendation. Outside of pre- and post-natal pelvic floor muscle training (PFMT) trials for the prevention of female UI, there is a dearth of PFMT prevention trials for women with UI. PFMT remains the first-line treatment for female UI with high levels of evidence and grades of recommendation. Bladder training levels of evidence and grades of recommendation are maintained. For POP, new evidence supports the effectiveness of physiotherapy in the treatment of POP and there are now improved levels of evidence and grades of recommendation.