719 resultados para Practice Based Research


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Climate change is expected to profoundly influence the hydrosphere of mountain ecosystems. The focus of current process-based research is centered on the reaction of glaciers and runoff to climate change; spatially explicit impacts on soil moisture remain widely neglected. We spatio-temporally analyzed the impact of the climate on soil moisture in a mesoscale high mountain catchment to facilitate the development of mitigation and adaptation strategies at the level of vegetation patterns. Two regional climate models were downscaled using three different approaches (statistical downscaling, delta change, and direct use) to drive a hydrological model (WaSiM-ETH) for reference and scenario period (1960–1990 and 2070–2100), resulting in an ensemble forecast of six members. For all ensembles members we found large changes in temperature, resulting in decreasing snow and ice storage and earlier runoff, but only small changes in evapotranspiration. The occurrence of downscaled dry spells was found to fluctuate greatly, causing soil moisture depletion and drought stress potential to show high variability in both space and time. In general, the choice of the downscaling approach had a stronger influence on the results than the applied regional climate model. All of the results indicate that summer soil moisture decreases, which leads to more frequent declines below a critical soil moisture level and an advanced evapotranspiration deficit. Forests up to an elevation of 1800 m a.s.l. are likely to be threatened the most, while alpine areas and most pastures remain nearly unaffected. Nevertheless, the ensemble variability was found to be extremely high and should be interpreted as a bandwidth of possible future drought stress situations.

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This paper considers how and why an Asian enclave of small businesses has appeared in a poor neighborhood characterized by Puerto Rican and other Latino immigration in the post-industrial city of Worcester, Massachusetts. We begin by examining the role of the US in the world system, and argue that the US hegemonic role and specific political economic aspects of global capitalism (ie. deindustrialization) account for some of the migration stream. Next, using socioeconomic and historical data, interviews, and observations, we outline the history of Worcester’s economy and immigration patterns. We demonstrate that the increasing economic inequality leaves few promising employment options for newcomers to Worcester. Drawing on existing literature on immigrant entrepreneurs and ethnic enclaves, we argue that some aspects of the literature appear to shed light on the Vietnamese enterprises which have so visibly appeared (e.g., ethnic niches), while others, (e.g., middle-man minority theory) are not now reflected in local conflict. We conclude by considering the prospects for immigrants to this neighborhood in light of its political economic context.

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Supporting Worcester’s ongoing effort to understand and address youth and young adult homelessness, the Community Roundtable on Youth Homelessness in conjunction with the Compass Project and Clark University conducted the fourth annual Point-in-Time Survey during October of 2012. Young people were surveyed at city shelters, youth programs, outside of schools, in parks, and on the streets of Worcester. Out of the 753 young people (ages 13to 25) surveyed, 120 (16%) dentified as homeless. We define homeless to include young people in shelters, staying with others temporarily (i.e. couch surfing) or on the streets. In addition to these 120 young people, another 220 youth who were housed reported that they had a friend who was homeless. As in prior years, when compared to their housed counterparts in the study, homeless youth: Have experienced more residential instability and family conflict; Have more precarious income situations; Are more likely to have children; Are more likely to have had involvement with the foster care and/or juvenile justice systems; and Have faced more barriers accessing services.

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OBJECTIVE: To evaluate the effectiveness of a practice nurse led strategy to improve the notification and treatment of partners of people with chlamydia infection. DESIGN: Randomised controlled trial. SETTING: 27 general practices in the Bristol and Birmingham areas. PARTICIPANTS: 140 men and women with chlamydia (index cases) diagnosed by screening of a home collected urine sample or vulval swab specimen. INTERVENTIONS: Partner notification at the general practice immediately after diagnosis by trained practice nurses, with telephone follow up by a health adviser; or referral to a specialist health adviser at a genitourinary medicine clinic. MAIN OUTCOME MEASURES: Primary outcome was the proportion of index cases with at least one treated sexual partner. Specified secondary outcomes included the number of sexual contacts elicited during a sexual history, positive test result for chlamydia six weeks after treatment, and the cost of each strategy in 2003 sterling prices. RESULTS: 65.3% (47/72) of participants receiving practice nurse led partner notification had at least one partner treated compared with 52.9% (39/68) of those referred to a genitourinary medicine clinic (risk difference 12.4%, 95% confidence interval -1.8% to 26.5%). Of 68 participants referred to the clinic, 21 (31%) did not attend. The costs per index case were 32.55 pounds sterling for the practice nurse led strategy and 32.62 pounds sterling for the specialist referral strategy. CONCLUSION: Practice based partner notification by trained nurses with telephone follow up by health advisers is at least as effective as referral to a specialist health adviser at a genitourinary medicine clinic, and costs the same. Trial registration Clinical trials: NCT00112255.

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BACKGROUND AND AIMS: There are few standardised questionnaires for the assessment of respiratory symptoms in preschool children. We have developed and tested the short-term repeatability of a postal questionnaire on respiratory symptoms for 1-year-old children. METHODS: A newly developed postal questionnaire for the assessment of wheeze and other respiratory symptoms was sent to parents of a population-based random sample of 4300 children aged 12-24 months. After an interval of 3 months, a random sample of 800 respondents received the questionnaire a second time. The responses were compared using Cohen's kappa (kappa) to assess agreement corrected for chance. RESULTS: The first questionnaire was returned by 3194 (74%) families, the second one by 460/800 (58%). Repeatability was excellent (kappa 0.80-0.96) for questions on household characteristics, environmental exposures and family history, good (kappa 0.61-0.80) for questions on prevalence, severity and treatment of wheeze, and moderate (kappa 0.39-0.66) for chronic cough and upper respiratory symptoms. CONCLUSIONS: This short postal questionnaire designed for use in population-based studies has excellent repeatability for family and household characteristics and good repeatability for questions on wheeze. Short-term changes in symptom status might be responsible for variable answers on recent chronic cough and upper respiratory symptoms. Overall, the questionnaire is a valuable instrument for community-based research on respiratory symptoms in 1 to 2-year-old children.

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Water springs are the principal source of water for many localities in Central America, including the municipality of Concepción Chiquirichapa in the Western Highlands of Guatemala. Long-term monitoring records are critical for informed water management as well as resource forecasting, though data are scarce and monitoring in low-resource settings presents special challenges. Spring discharge was monitored monthly in six municipal springs during the author’s Peace Corps assignment, from May 2011 to March 2012, and water level height was monitored in two spring boxes over the same time period using automated water-level loggers. The intention of this approach was to circumvent the need for frequent and time-intensive manual measurement by identifying a fixed relationship between discharge and water level. No such relationship was identified, but the water level record reveals that spring yield increased for four months following Tropical Depression 12E in October 2011. This suggests that the relationship between extreme precipitation events and long-term water spring yields in Concepción should be examined further. These limited discharge data also indicate that aquifer baseflow recession and catchment water balance could be successfully characterized if a long-term discharge record were established. This study also presents technical and social considerations for selecting a methodology for spring discharge measurement and highlights the importance of local interest in conducting successful community-based research in intercultural low-resource settings.

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In the realm of computer programming, the experience of writing a program is used to reinforce concepts and evaluate ability. This research uses three case studies to evaluate the introduction of testing through Kolb's Experiential Learning Model (ELM). We then analyze the impact of those testing experiences to determine methods for improving future courses. The first testing experience that students encounter are unit test reports in their early courses. This course demonstrates that automating and improving feedback can provide more ELM iterations. The JUnit Generation (JUG) tool also provided a positive experience for the instructor by reducing the overall workload. Later, undergraduate and graduate students have the opportunity to work together in a multi-role Human-Computer Interaction (HCI) course. The interactions use usability analysis techniques with graduate students as usability experts and undergraduate students as design engineers. Students get experience testing the user experience of their product prototypes using methods varying from heuristic analysis to user testing. From this course, we learned the importance of the instructors role in the ELM. As more roles were added to the HCI course, a desire arose to provide more complete, quality assured software. This inspired the addition of unit testing experiences to the course. However, we learned that significant preparations must be made to apply the ELM when students are resistant. The research presented through these courses was driven by the recognition of a need for testing in a Computer Science curriculum. Our understanding of the ELM suggests the need for student experience when being introduced to testing concepts. We learned that experiential learning, when appropriately implemented, can provide benefits to the Computer Science classroom. When examined together, these course-based research projects provided insight into building strong testing practices into a curriculum.

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Objective: Cognitive problems and biases play an important role in the development and continuation of psychosis. A self-report measure of these deficits and processes was developed (Davos Assessment of Cognitive Biases Scale: DACOBS) and is evaluated in this study. Methods: An item pool made by international experts was used to develop a self-report scale on a sample of 138 schizophrenia spectrum patients. Another sample of 71 patients was recruited to validate the subscales. A group of 186 normal control subjects was recruited to establish norms and examine discriminative validity. Results: Factor analyses resulted in seven factors, each with six items (jumping to conclusions, belief inflexibility bias, attention for threat bias, external attribution bias, social cognition problems, subjective cognitive problems and safety behavior). All factors independently explained the variance (eigenvalues > 2) and total explained variance was 45%. Reliability was good (Cronbach's alpha = .90; split-half reliability = .92; test–retest reliability = .86). The DACOBS discriminates between schizophrenia spectrum patients and normal control subjects. Validity was affirmed for five of seven subscales. The scale ‘Subjective Cognitive problems’ was not associated with objective cognitive functioning and ‘Social cognition problems’ was not associated with the Hinting task, but with the scale measuring ideas of social reference. Conclusions: The DACOBS scale, with seven independent subscales, is reliable and valid for use in clinical practice and research.

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Im Wettstreit systemtheoretischer Ansätze für klinische und psychotherapeutische Arbeit, sei es in Praxis oder Forschung, wird oft der synergetische Ansatz als »naturwissenschaftlich« gekennzeichnet – nicht selten mit einem pejorativen Unterton, dass er damit für nicht-naturwissenschaftliche Fragen weniger gut geeignet sei. Die Autoren zeigen hingegen auf, dass synergetische Systemtheorie als Strukturwissenschaft zu verstehen ist: Sie kann zwar auf Gegenstände des naturwissenschaftlichen Bereiches angewendet werden, genauso gut aber auch auf Prozesse, bei denen es um Sinn, Bedeutung, Narration, Interaktion etc. geht. Dialogisch erarbeiten die Autoren dabei Aspekte, die ihnen an der synergetischen Systemtheorie besonders wichtig sind, und erörtern, welche zentralen Fragen damit beantwortet bzw. untersucht werden können. Insbesondere wird diskutiert, was eine »strukturwissenschaftliche« Perspektive eigentlich meint und warum ein solcher Ansatz sowohl für Fragen der Forschung als auch der Praxis besonders geeignet erscheint.

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The observations of Michel Foucault, noted Twentieth Century French philosopher, regarding modern power relations and orders of discourse, form the framework utilized to analyze and interpret the power struggles of AIDS activists and their opponents--the religious and radical right, and the administrative agencies of the 'Liberal' welfare State. Supported by the tools of sociolinguistic inquiry, the analysis highlights the success of a safer sex campaign in Houston, Texas to illustrate the dynamics of cultural and political change by means of discursive transformations initiated by the gay micro-culture. The KS/AIDS Foundation, allied with both the biomedical community and gay entertainment spheres, was successful in conveying biomedical cautions that resulted in altered personal behavior and modified public attitudes by using linguistic conventions consonant with the discourse of the Houston gay micro-culture. The transformation of discursive practices transgressed not only the Houston gay micro-culture's boundaries, but the city boundaries of Houston as well. In addition to cultural and political change, moderate and confrontational gay activists also sought to change the cognitive boundaries surrounding 'the gold standard' for clinical research trials.^ From a Foucauldian perspective, the same-sex community evolved from the subordinated Other to a position of power in a period of five years. Transformations in discursive practices and power relations are exemplified by the changing definitions employed by AIDS policy-makers, the public validation of community-based research and the establishment of parallel track drug studies. Finally, transformations in discursive practices surrounding the issues of HIV antibody testing are interpreted using Foucault's six points of power relations. The Montrose Clinic provides the case study for this investigation. The clinic turned the technical rationalities of the State against itself to achieve its own ends and those of the gay micro-culture--anonymous testing with pre and post test counseling. AIDS Talk portrays a dramatic transformation in discursive practices and power relations that transcends the historical moment to provide a model for future activists. Volume 2 contains copies of fugitive primary source materials largely unavailable elsewhere. Original documents are archived in the Harris County Medical Archives in the Houston Academy of Medicine located in the Texas Medical Center Library, Houston, Texas. ^

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OBJECTIVE To assess the indication and timing of soft tissue augmentation for prevention or treatment of gingival recession when a change in the inclination of the incisors is planned during orthodontic treatment. MATERIALS AND METHODS Electronic database searches of literature were performed. The following electronic databases with no restrictions were searched: MEDLINE, EMBASE, Cochrane, and CENTRAL. Two authors performed data extraction independently using data collection forms. RESULTS No randomized controlled trial was identified. Two studies of low-to-moderate level of evidence were included: one of prospective and retrospective data collection and one retrospective study. Both implemented a periodontal intervention before orthodontics. Thus, best timing of soft tissue augmentation could not be assessed. The limited available data from these studies appear to suggest that soft tissue augmentation of bucco-lingual gingival dimensions before orthodontics may yield satisfactory results with respect to the development or progression of gingival recessions. However, the strength of the available evidence is not adequate in order to change or suggest a possible treatment approach in the daily practice based on solid scientific evidence. CONCLUSIONS Despite the clinical experience that soft tissue augmentation of bucco-lingual gingival dimensions before orthodontic treatment may be a clinically viable treatment option in patients considered at risk, this treatment approach is not based on solid scientific evidence. Moreover, the present data do not allow to draw conclusions on the best timing of soft tissue augmentation when a change in the inclination of the incisors is planned during orthodontic treatment and thus, there is a stringent need for randomized controlled trials to clarify these open issues.

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To test the hypothesis on prolonged survival in glioblastoma cases with increased subventricular zone (SVZ) radiation dose. Sixty glioblastoma cases were previously treated with adjuvant radiotherapy and Temozolamide. Ipsilateral, contralateral and bilateral SVZs were contoured and their doses were retrospectively evaluated. Median follow-up, progression free survival (PFS) and overall survival (OS) were 24.5, 8.5 and 19.3 months respectively. Log-rank tests showed a statistically significant correlation between contralateral SVZ (cSVZ) dose > 59.2 Gy (75th percentile) and poor median PFS (10.37 [95% CI 8.37-13.53] vs 7.1 [95% CI 3.5-8.97] months, p = 0.009). cSVZ dose > 59.2 Gy was associated with poor OS in the subgroup with subtotal resection/biopsy (HR: 4.83 [95% CI 1.71-13.97], p = 0.004). High ipsilateral SVZ dose of > 62.25 Gy (75th percentile) was associated with poor PFS in both subgroups of high performance status (HR: 2.58 [95% CI 1.03-6.05], p = 0.044) and SVZ without tumoral contact (HR: 10.57 [95% CI 2.04-49], p = 0.008). The effect of high cSVZ dose on PFS lost its statistical significance in multivariate Cox regression analysis. We report contradictory results compared to previous publications. Changing the clinical practice based on retrospective studies which even do not indicate consistent results among each other will be dangerous. We need carefully designed prospective randomized studies to evaluate any impact of radiation to SVZ in glioblastoma.

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Quantification of protein expression based on immunohistochemistry (IHC) is an important step in clinical diagnoses and translational tissue-based research. Manual scoring systems are used in order to evaluate protein expression based on staining intensities and distribution patterns. However, visual scoring remains an inherently subjective approach. The aim of our study was to explore whether digital image analysis proves to be an alternative or even superior tool to quantify expression of membrane-bound proteins. We analyzed five membrane-binding biomarkers (HER2, EGFR, pEGFR, β-catenin, and E-cadherin) and performed IHC on tumor tissue microarrays from 153 esophageal adenocarcinomas patients from a single center study. The tissue cores were scored visually applying an established routine scoring system as well as by using digital image analysis obtaining a continuous spectrum of average staining intensity. Subsequently, we compared both assessments by survival analysis as an end point. There were no significant correlations with patient survival using visual scoring of β-catenin, E-cadherin, pEGFR, or HER2. In contrast, the results for digital image analysis approach indicated that there were significant associations with disease-free survival for β-catenin, E-cadherin, pEGFR, and HER2 (P = 0.0125, P = 0.0014, P = 0.0299, and P = 0.0096, respectively). For EGFR, there was a greater association with patient survival when digital image analysis was used compared to when visual scoring was (visual: P = 0.0045, image analysis: P < 0.0001). The results of this study indicated that digital image analysis was superior to visual scoring. Digital image analysis is more sensitive and, therefore, better able to detect biological differences within the tissues with greater accuracy. This increased sensitivity improves the quality of quantification.