Concepts for critical appraisal of an original research paper.

With the ever-growing evidence base it is more difficult to keep abreast of relevant issues in health care. Studies are also becoming more complex in order to address specific research and clinical questions. Appropriate interpretation of these studies is paramount to a progressive practice in health care. This article presents an intellectual framework for the critical appraisal of an original research article. (author abstract)

The acquisition of movement skills: Practice enhances the dynamic stability of bimanual coordination

During bimanual movements, two relatively stable inherent patterns of coordination (in-phase and anti-phase) are displayed (e.g., Kelso, Am. J. Physiol. 246 (1984) R1000). Recent research has shown that new patterns of coordination can be learned. For example, following practice a 90 degrees out-of-phase pattern can emerge as an additional, relatively stable, state (e.g., Zanone & Kelso, J. Exp. Psychol.: Human Performance and Perception 18 (1992) 403). On this basis, it has been concluded that practice leads to the evolution and stabilisation of the newly learned pattern and that this process of learning changes the entire attractor layout of the dynamic system. A general feature of such research has been to observe the changes of the targeted pattern's stability characteristics during training at a single movement frequency. The present study was designed to examine how practice affects the maintenance of a coordinated pattern as the movement frequency is scaled. Eleven volunteers were asked to perform a bimanual forearm pronation-supination task. Time to transition onset was used as an index of the subjects' ability to maintain two symmetrically opposite coordinated patterns (target task - 90 degrees out-of-phase - transfer task - 270 degrees out-of-phase). Their ability to maintain the target task and the transfer task were examined again after five practice sessions each consisting of 15 trials of only the 90 degrees out-of-phase pattern. Concurrent performance feedback (a Lissajous figure) was available to the participants during each practice trial. A comparison of the time to transition onset showed that the target task was more stable after practice (p = 0.025). These changes were still observed one week (p = 0.05) and two months (p = 0.075) after the practice period. Changes in the stability of the transfer task were not observed until two months after practice (p = 0.025). Notably, following practice, transitions from the 90 degrees pattern were generally to the anti-phase (180 degrees) pattern, whereas, transitions from the 270 degrees pattern were to the 90 degrees pattern. These results suggest that practice does improve the stability of a 90 degrees pattern, and that such improvements are transferable to the performance of the unpractised 270 degrees pattern. In addition, the anti-phase pattern remained more stable than the practised 90 degrees pattern throughout. (C) 2001 Elsevier Science B.V. All rights reserved.

Research commentary: Information systems and conceptual modeling - A research agenda

Within the information systems field, the task of conceptual modeling involves building a representation of selected phenomena in some domain. High-quality conceptual-modeling work is important because it facilitates early detection and correction of system development errors. It also plays an increasingly important role in activities like business process reengineering and documentation of best-practice data and process models in enterprise resource planning systems. Yet little research has been undertaken on many aspects of conceptual modeling. In this paper, we propose a framework to motivate research that addresses the following fundamental question: How can we model the world to better facilitate our developing, implementing, using, and maintaining more valuable information systems? The framework comprises four elements: conceptual-modeling grammars, conceptual-modeling methods, conceptual-modeling scripts, and conceptual-modeling contexts. We provide examples of the types of research that have already been undertaken on each element and illustrate research opportunities that exist.

Infusing the use of seasonal climate forecasting into crop management practice in North East Australia using discussion support software

Seasonal climate forecasting offers potential for improving management of crop production risks in the cropping systems of NE Australia. But how is this capability best connected to management practice? Over the past decade, we have pursued participative systems approaches involving simulation-aided discussion with advisers and decision-makers. This has led to the development of discussion support software as a key vehicle for facilitating infusion of forecasting capability into practice. In this paper, we set out the basis of our approach, its implementation and preliminary evaluation. We outline the development of the discussion support software Whopper Cropper, which was designed for, and in close consultation with, public and private advisers. Whopper Cropper consists of a database of simulation output and a graphical user interface to generate analyses of risks associated with crop management options. The charts produced provide conversation pieces for advisers to use with their farmer clients in relation to the significant decisions they face. An example application, detail of the software development process and an initial survey of user needs are presented. We suggest that discussion support software is about moving beyond traditional notions of supply-driven decision support systems. Discussion support software is largely demand-driven and can compliment participatory action research programs by providing cost-effective general delivery of simulation-aided discussions about relevant management actions. The critical role of farm management advisers and dialogue among key players is highlighted. We argue that the discussion support concept, as exemplified by the software tool Whopper Cropper and the group processes surrounding it, provides an effective means to infuse innovations, like seasonal climate forecasting, into farming practice. Crown Copyright (C) 2002 Published by Elsevier Science Ltd. All rights reserved.

Perceptions of evidence-based practice: A survey of Australian occupational therapists

Evidence-based practice (EBP) requires clinicians to access, appraise and integrate research literature with clinical experience and clients' perspectives. Currently, little is known about occupational therapists' attitudes to EBP, their perception of implementation barriers or their educational needs. A questionnaire reflecting these issues was sent to a proportionate random sample of 1491 members of the national professional occupational therapy association, OT AUSTRALIA. The questionnaire was completed by 649 (44%) participants. Occupational therapists were positive about EBP with most (96%) agreeing that EBP is important to occupational therapy. Although 56% used research to make clinical decisions, more relied on clinical experience (96%), information from continuing education (82%) and colleagues (80%). Lack of time, evidence and skills were identified as the main barriers to the implementation of EBP. Over half (52%) expressed strong interest in EBP skills training, and most (80%) indicated an interest in the availability of brief summaries of evidence. Targeted educational initiatives, resources and systems are needed to support EBP in occupational therapy.

Treatment approaches for clients with a stroke-affected upper limb: Are we following evidence-based practice?

Stroke rehabilitation is an area of practice that many occupational therapists encounter during their career. The literature promotes a wide range of management techniques and support devices for people who have a stroke-affected upper limb, but little is known about the validity of those that occupational therapists actually use in practice. A questionnaire was sent to occupational therapists working in Queensland and northern New South Wales facilities (n = 35), in which adults with a stroke were likely to be treated. Eighteen respondents answered questions about the management techniques and support devices used in their facility, and their perception of the benefit of these devices in the reduction of hemiplegic shoulder pain. Results are discussed with reference to evidence-based practice and indicate an urgent need for the collation and dissemination of the best current evidence available for the management techniques and support devices used in this area, as well as further research to extend this evidence.

Testamentary capacity and aphasia: A descriptive case report with implications for clinical practice

Background: Testamentary capacity (the capacity to make a will) is recognised in the literature as an important issue for speech-language pathologists' assessment of people with aphasia, but current guidelines for clinical practice lack an empirical base. Aims: The research aimed to suggest some guidelines for clinical practice based on information considered relevant for the court in determining testamentary capacity. Methods & Procedures: A recent legal case involving a challenge to the will of a woman with severe aphasia was critically examined with reference to current guidelines in the literature regarding assessment of testamentary capacity. Outcomes & Results: Examination of the information available on the case indicated that the judge gave priority to accounts of the everyday communication of the person with aphasia (including reported discourse samples) over the information provided by expert medical witnesses. The extent to which communication effectiveness could be maximised was found to be a matter of key significance to the determination of capacity. Conclusions: This study has implications for speech-language pathologists' assessment practices and reports, as well as for scope of practice with regard to legal decision making of people with aphasia. These issues are discussed in relation to the World Health Organisation's ICF framework of functioning for social participation.

Conselhos municipais de pol??ticas p??blicas: uma an??lise explorat??ria

Os Conselhos Gestores s??o f??runs h??bridos onde se viabiliza a participa????o popular no desenho das pol??ticas p??blicas, nas negocia????es de interesses da coletividade, na elabora????o de programas e projetos sociais e na fiscaliza????o das a????es governamentais. O significado e a dimens??o dos Conselhos para a democracia participativa s??o enormes, justificando a import??ncia da realiza????o deste estudo, que se baseou na an??lise explorat??ria de 12 Conselhos locais do munic??pio mineiro de Vi??osa, com o objetivo de avaliar o desempenho dos mesmos. A avalia????o do desempenho levou em considera????o os mesmos par??metros dimensionais, tanto para a coleta de dados prim??rios quanto para a coleta secund??ria. A coleta de dados prim??rios foi realizada a partir da aplica????o de question??rios semi-estruturados aos presidentes dos Conselhos em an??lise. Utilizou-se o programa SPSS, vers??o 15.0, para an??lise estat??stica das quest??es objetivas dos question??rios e a t??cnica de an??lise de conte??do para exame das quest??es abertas. Ap??s essa etapa, realizou-se um workshop com os presidentes dos Conselhos, visando ?? obten????o de novos dados e informa????es. Os Conselhos municipais analisados apresentaram resultados pouco discrepantes entre a teoria aplicada ao tema e a sua efetiva pr??tica no campo p??blico. Contudo, a pesquisa revelou que o grau de desenvolvimento institucional dos Conselhos n??o ?? homog??neo, ou seja, h?? alguns melhores gestores que outros. A escolha independente e democr??tica dos membros n??o-governamentais dos Conselhos em Vi??osa revelou o seu grau de independ??ncia do Poder Executivo. Por??m, a capacita????o de conselheiros precisa ser implementada para evitar uma desfigura????o dos Conselhos. No que tange ?? governan??a, destacouse em Vi??osa o seu grau e formas de aplicabilidade observadas na gest??o de v??rias pol??ticas. Da mesma forma, foi observado um n??vel de governabilidade que confere legitimidade ??s pol??ticas implementadas. Por fim, verificou-se que a efetividade da accountability societal tem sido instrumentalizada pelos Conselhos no ??mbito das diversas pol??ticas setoriais. J?? os dados secund??rios da an??lise foram obtidos por meio das s??nteses dos relat??rios de fiscaliza????o de munic??pios do Estado de Minas Gerais, realizadas pela Controladoria Geral da Uni??o. Foram identificados todos os registros pertinentes aos Conselhos Gestores Municipais do Estado de Minas Gerais, no per??odo de 2003 a 2006. Verificou-se que os maiores problemas se referem aos Conselhos Municipais de Sa??de e Assist??ncia Social. Entre as in??meras falhas apontadas, destacam-se problemas graves na constitui????o e operacionaliza????o dos Conselhos, resultando na inoper??ncia desses mecanismos nos munic??pios fiscalizados. A avalia????o do desempenho dos Conselhos locais de Vi??osa possibilitou concluir que esses mecanismos apresentaram um desempenho bem satisfat??rio na gest??o e controle das pol??ticas p??blicas no munic??pio.

Pr??-equidade de g??nero: incorporando pol??ticas de a????o afirmativa no mundo do trabalho

A institui????o do Programa Pr??-equidade de G??nero ?? o reconhecimento p??blico da desigualdade de tratamento e de oportunidades, que ainda permanece entre mulheres e homens. A implementa????o ?? consolidada com a coloca????o em pr??tica dos planos de a????es firmados entre a Secretaria Especial de Pol??ticas para as Mulheres (SPM) e as organiza????es aderentes. A pesquisa explorat??ria teve como objetivo apresentar o programa e discuti-lo com base no modelo "policy cycle como aprendizado", de Silva e Melo (2000). Os resultados subsidiar??o pesquisa futura sobre a avalia????o do programa. Dentro da estrat??gia adotada, a coleta de dados ocorreu em documentos institucionais e dados bibliogr??ficos em mar??o de 2009, com o seguinte resultado: a avalia????o n??o trata de forma clara da efetividade e da sustentabilidade do programa. Este trabalho est?? dividido em seis partes: descri????o do m??todo utilizado; apresenta????o do Programa Pro-equidade de G??nero; avalia????o de suas duas primeiras edi????es; breve contextualiza????o das pol??ticas p??blicas no Brasil e o modelo "policy cicle como aprendizado"; rela????es entre o programa e o modelo; e considera????es finais.

Proof in classroom social practice

How does the construction of proof relate to the social practice developed in the mathematics classroom? This report addresses the role of diagrams in order to focus the complementarity of participation and reification in the process of constructing a proof and negotiating its meaning. The discussion is based on the analysis of the mathematical practice developed by a group of four 9th grade students and is inspired by the social theory of learning

Research on using the decision tree method in order to select the best alternative for the pharmacies supply

Introduction / Aims: Adopting the important decisions represents a specific task of the manager. An efficient manager takes these decisions during a sistematic process with well-defined elements, each with a precise order. In the pharmaceutical practice and business, in the supply process of the pharmacies, there are situations when the medicine distributors offer a certain discount, but require payment in a shorter period of time. In these cases, the analysis of the offer can be made with the help of the decision tree method, which permits identifying the decision offering the best possible result in a given situation. The aims of the research have been the analysis of the product offers of many different suppliers and the establishing of the most advantageous ways of pharmacy supplying. Material / Methods: There have been studied the general product offers of the following medical stores: A&G Med, Farmanord, Farmexim, Mediplus, Montero and Relad. In the case of medicine offers including a discount, the decision tree method has been applied in order to select the most advantageous offers. The Decision Tree is a management method used in taking the right decisions and it is generally used when one needs to evaluate the decisions that involve a series of stages. The tree diagram is used in order to look for the most efficient means to attain a specific goal. The decision trees are the most probabilistic methods, useful when adopting risk taking decisions. Results: The results of the analysis on the tree diagrams have indicated the fact that purchasing medicines with discount (1%, 10%, 15%) and payment in a shorter time interval (120 days) is more profitable than purchasing without a discount and payment in a longer time interval (160 days). Discussion / Conclusion: Depending on the results of the tree diagram analysis, the pharmacies would purchase from the selected suppliers. The research has shown that the decision tree method represents a valuable work instrument in choosing the best ways for supplying pharmacies and it is very useful to the specialists from the pharmaceutical field, pharmaceutical management, to medicine suppliers, pharmacy practitioners from the community pharmacies and especially to pharmacy managers, chief – pharmacists.