808 resultados para Clinical problem-solving


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Children may be at higher risk than adults from pesticide exposure, due to their rapidly developing physiology, unique behavioral patterns, and interactions with the physical environment. This preliminary study conducted in Ecuador examines the association between household and environmental risk factors for pesticide exposure and neurobehavioral development. We collected data over 6 months in the rural highland region of Cayambe, Ecuador (2003–2004). Children age 24–61 months residing in 3 communities were assessed with the Ages and Stages Questionnaire and the Visual Motor Integration Test. We gathered information on maternal health and work characteristics, the home and community environment, and child characteristics. Growth measurements and a hemoglobin finger-prick blood test were obtained. Multiple linear regression analyses were conducted. Current maternal employment in the flower industry was associated with better developmental scores. Longer hours playing outdoors were associated with lower gross and fine motor and problem solving skills. Children who played with irrigation water scored lower on fine motor skills (8% decrease; 95% confidence interval 9.31 to 0.53), problem-solving skills (7% decrease; 8.40 to 0.39), and Visual Motor Integration test scores (3% decrease; 12.00 to 1.08). These results suggest that certain environmental risk factors for exposure to pesticides may affect child development, with contact with irrigation water of particular concern. However, the relationships between these risk factors and social characteristics are complex, as corporate agriculture may increase risk through pesticide exposure and environmental contamination, while indirectly promoting healthy development by providing health care, relatively higher salaries, and daycare options.

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To identify and describe the sociodemographic and nutritional characteristics associated with neurobehavioral development among young children living in three communities in the northeastern Andean region of Cayambe-Tabacundo, Ecuador. Women in the study communities who had a child 3 to 61 months of age completed a questionnaire about maternal and child health and sociodemographic characteristics. The Ages and Stages Questionnaire (ASQ) was directly administered to 283 children by two trained interviewers. Growth measurements and a hemoglobin finger-prick blood test were obtained in 2003–2004. Prevalence of developmental delay was calculated, and associations between child development and maternal, child, and household characteristics were explored. High frequencies of developmental delay were observed. Children 3 to 23 months old displayed delay in gross motor skills (30.1%), and children 48 to 61 months old displayed delay in problem-solving skills (73.4%) and fine motor skills (28.1%). A high frequency of both anemia (60.4%) and stunting (53.4%) was observed for all age groups. Maternal educational level was positively associated with communication and problem-solving skills, and monthly household income was positively associated with communication, gross motor, and problem-solving skills. The results suggest a high prevalence of developmental delay and poor child health in this population. Child health status and the child’s environment may contribute to developmental delay in this region of Ecuador, but sociodemographic factors affecting opportunities for stimulation may also play a role. Research is needed to identify what is causing high percentages of neurobehavioral developmental delay in this region of Ecuador.

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A generic Nutrient Export Risk Matrix (NERM) approach is presented. This provides advice to farmers and policy makers on good practice for reducing nutrient loss and is intended to persuade them to implement such measures. Combined with a range of nutrient transport modelling tools and field experiments, NERMs can play an important role in reducing nutrient export from agricultural land. The Phosphorus Export Risk Matrix (PERM) is presented as an example NERM. The PERM integrates hydrological understanding of runoff with a number of agronomic and policy factors into a clear problem-solving framework. This allows farmers and policy makers to visualise strategies for reducing phosphorus loss through proactive land management. The risk Of Pollution is assessed by a series of informed questions relating to farming intensity and practice. This information is combined with the concept of runoff management to point towards simple, practical remedial strategies which do not compromise farmers' ability to obtain sound economic returns from their crop and livestock.

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The experiments examine the influence of metacognitive experience on the transfer of logical processes in a problem solving setting. Subjects were presented with two versions of Wason's (1966) selection task. Although they were able to perform successfully on the concrete tasks (following a minimal explanation of the correct solution on an initial trial), the majority were not able to transfer a successful method to the abstract tasks. Verbalization during, or following, the concrete tasks produced substantial transfer effects however. It is suggested that verbalization may lead to an increased awareness of past behaviour, particularly of those aspects necessary for successful solution.

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The concept of “working” memory is traceable back to nineteenth century theorists (Baldwin, 1894; James 1890) but the term itself was not used until the mid-twentieth century (Miller, Galanter & Pribram, 1960). A variety of different explanatory constructs have since evolved which all make use of the working memory label (Miyake & Shah, 1999). This history is briefly reviewed and alternative formulations of working memory (as language-processor, executive attention, and global workspace) are considered as potential mechanisms for cognitive change within and between individuals and between species. A means, derived from the literature on human problem-solving (Newell & Simon, 1972), of tracing memory and computational demands across a single task is described and applied to two specific examples of tool-use by chimpanzees and early hominids. The examples show how specific proposals for necessary and/or sufficient computational and memory requirements can be more rigorously assessed on a task by task basis. General difficulties in connecting cognitive theories (arising from the observed capabilities of individuals deprived of material support) with archaeological data (primarily remnants of material culture) are discussed.

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Cardiovascular disease represents a major clinical problem affecting a significant proportion of the world's population and remains the main cause of death in the UK. The majority of therapies currently available for the treatment of cardiovascular disease do not cure the problem but merely treat the symptoms. Furthermore, many cardioactive drugs have serious side effects and have narrow therapeutic windows that can limit their usefulness in the clinic. Thus, the development of more selective and highly effective therapeutic strategies that could cure specific cardiovascular diseases would be of enormous benefit both to the patient and to those countries where healthcare systems are responsible for an increasing number of patients. In this review, we discuss the evidence that suggests that targeting the cell cycle machinery in cardiovascular cells provides a novel strategy for the treatment of certain cardiovascular diseases. Those cell cycle molecules that are important for regulating terminal differentiation of cardiac myocytes and whether they can be targeted to reinitiate cell division and myocardial repair will be discussed as will the molecules that control vascular smooth muscle cell (VSMC) and endothelial cell proliferation in disorders such as atherosclerosis and restenosis. The main approaches currently used to target the cell cycle machinery in cardiovascular disease have employed gene therapy techniques. We will overview the different methods and routes of gene delivery to the cardiovascular system and describe possible future drug therapies for these disorders. Although the majority of the published data comes from animal studies, there are several instances where potential therapies have moved into the clinical setting with promising results.

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Coronary artery disease is one of the most common heart pathologies. Restriction of blood flow to the heart by atherosclerotic lesions, leading to angina pectoris and myocardial infarction, damages the heart, resulting in impaired cardiac function. Damaged myocardium is replaced by scar tissue since surviving cardiomyocytes are unable to proliferate to replace lost heart tissue. Although narrowing of the coronary arteries can be treated successfully using coronary revascularisation procedures, re-occlusion of the treated vessels remains a significant clinical problem. Cell cycle control mechanisms are key in both the impaired cardiac repair by surviving cardiomyocytes and re-narrowing of treated vessels by maladaptive proliferation of vascular smooth muscle cells. Strategies targeting the cell cycle machinery in the heart and vasculature offer promise both for the improvement of cardiac repair following MI and the prevention of restenosis and bypass graft failure following revascularisation procedures.

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The disuse hypothesis of cognitive aging attributes decrements in fluid intelligence in older adults to reduced cognitively stimulating activity. This study experimentally tested the hypothesis that a period of increased mentally stimulating activities thus would enhance older adults' fluid intelligence performance. Participants (N = 44, mean age 67.82) were administered pre- and post-test measures, including the fluid intelligence measure, Cattell's Culture Fair (CCF) test. Experimental participants engaged in diverse, novel, mentally stimulating activities for 10-12 weeks and were compared to a control condition. Results supported the hypothesis; the experimental group showed greater pre- to post-CCF gain than did controls (effect size d = 0.56), with a similar gain on a spatial-perceptual task (WAIS-R Blocks). Even brief periods of increased cognitive stimulation can improve older adults' problem solving and flexible thinking.

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In his book Democratic Authority, David Estlund puts forward a case for democracy, which he labels epistemic proceduralism, that relies on democracy's ability to produce good – that is, substantively just – results. Alongside this case for democracy Estlund attacks what he labels ‘utopophobia’, an aversion to idealistic political theory. In this article I make two points. The first is a general point about what the correct level of ‘idealisation’ is in political theory. Various debates are emerging on this question and, to the extent that they are focused on ‘political theory’ as a whole, I argue, they are flawed. This is because there are different kinds of political concept, and they require different kinds of ideal. My second point is about democracy in particular. If we understand democracy as Estlund does, then we should see it as a problem-solving concept – the problem being that we need coercive institutions and rules, but we do not know what justice requires. As democracy is a response to a problem, we should not allow our theories of it, even at the ideal level, to be too idealised – they must be embedded in the nature of the problem they are to solve, and the beings that have it.

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Vertebral compression fractures are a common clinical problem and the incidence of them will increase with the ageing population. Traditionally management has been conservative; however, there has been a growing trend towards vertebroplasty as an alternative therapy in patients with persisting severe pain. NICE produced guidance in 2003 recommending the procedure after 4 weeks of conservative management. Recent high-quality studies have been contradictory and there is currently a debate surrounding the role of the procedure with no agreement in the literature. We examine the evidence in both osteoporotic and malignant vertebral compression fractures; we also describe the benefits and side effects, alternative treatment options and the cost of the procedure. Finally, we recommend when vertebroplasty is most appropriately used based on the best available evidence.

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The construction field is dynamic and dominated by complex, ill-defined problems for which myriad possible solutions exist. Teaching students to solve construction-related problems requires an understanding of the nature of these complex problems as well as the implementation of effective instructional strategies to address them. Traditional approaches to teaching construction planning and management have long been criticized for presenting students primarily with well-defined problems - an approach inconsistent with the challenges encountered in the industry. However, growing evidence suggests that employing innovative teaching approaches, such as interactive simulation games, offers more active, hands-on and problem-based learning opportunities for students to synthesize and test acquired knowledge more closely aligned with real-life construction scenarios. Simulation games have demonstrated educational value in increasing student problem solving skills and motivation through critical attributes such as interaction and feedback-supported active learning. Nevertheless, broad acceptance of simulation games in construction engineering education remains limited. While recognizing benefits, research focused on the role of simulation games in educational settings lacks a unified approach to developing, implementing and evaluating these games. To address this gap, this paper provides an overview of the challenges associated with evaluating the effectiveness of simulation games in construction education that still impede their wide adoption. An overview of the current status, as well as the results from recently implemented Virtual Construction Simulator (VCS) game at Penn State provide lessons learned, and are intended to guide future efforts in developing interactive simulation games to reach their full potential.

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Final year research projects are an important part of undergraduate chemistry courses, allowing students to enhance transferable skills in teamworking, problem solving and presentations, at the same time as learning valuable practical skills. Several recent reports have highlighted the importance of research based studies as part of undergraduate courses. ‘We need to encourage universities to explore new models of curriculum. They should all incorporate research based study for undergraduates to cultivate awareness of research careers, to train students in research skills for employment, and to sustain the advantages of a research teaching connection,’ wrote Paul Ramsden from James Cook University, Australia, in a 2008 report for the UK’s Higher Education Academy.1 A 2010 report published by the Biopharma Skills Consortium – that promotes collaboration across the higher education sector in the area of biopharma – also stated that: ‘Companies seek recruits well placed to acclimatise quickly to the work environment. They are looking for recruits who can deploy a range of generic skills in the application of their knowledge.’2

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Purpose – This paper aims to address the gaps in service recovery strategy assessment. An effective service recovery strategy that prevents customer defection after a service failure is a powerful managerial instrument. The literature to date does not present a comprehensive assessment of service recovery strategy. It also lacks a clear picture of the service recovery actions at managers’ disposal in case of failure and the effectiveness of individual strategies on customer outcomes. Design/methodology/approach – Based on service recovery theory, this paper proposes a formative index of service recovery strategy and empirically validates this measure using partial least-squares path modelling with survey data from 437 complainants in the telecommunications industry in Egypt. Findings – The CURE scale (CUstomer REcovery scale) presents evidence of reliability as well as convergent, discriminant and nomological validity. Findings also reveal that problem-solving, speed of response, effort, facilitation and apology are the actions that have an impact on the customer’s satisfaction with service recovery. Practical implications – This new formative index is of potential value in investigating links between strategy and customer evaluations of service by helping managers identify which actions contribute most to changes in the overall service recovery strategy as well as satisfaction with service recovery. Ultimately, the CURE scale facilitates the long-term planning of effective complaint management. Originality/value – This is the first study in the service marketing literature to propose a comprehensive assessment of service recovery strategy and clearly identify the service recovery actions that contribute most to changes in the overall service recovery strategy.