What is the best equation to estimate the basal energy expenditure of climacteric women?

Objectives The methods currently available for the measurement of energy expenditure in patients, such as indirect calorimetry and double-labelled water, are expensive and are limited in Brazil to research projects. Thus, equations for the prediction of resting metabolic rate appear to be a viable alternative for clinical practice. However, there are no specific equations for the Brazilian population and few studies have been conducted on Brazilian women in the climacteric period using existing and commonly applied equations. On this basis, the objective of the present study was to investigate the concordance between the predictive equations most frequently used and indirect calorimetry for the measurement of resting metabolic rate. Methods We calculated the St. Laurent concordance correlation coefficient between the equations and resting metabolic rate calculated by indirect calorimetry in 46 climacteric women. Results The equation showing the best concordance was that of the FAO/WHO/UNU formula (0.63), which proved to be better than the Harris & Benedict equation (0.55) for the sample studied. Conclusions On the basis of the results of the present study, we conclude that the FAO/WHO/UNU formula can be used to predict better the resting metabolic rate of climacteric women. Further studies using more homogeneous and larger samples are needed to permit the use of the FAO/WHO/UNU formula for this population group with greater accuracy.

Ways of using evidence-based medicine in general practice

General practitioners wanting to practise evidence-based medicine (EBM) are constrained by time factors and the great diversity of clinical problems they deal with. They need experience in knowing what questions to ask, in locating and evaluating the evidence, and in applying it. Conventional searching for the best evidence can be achieved in daily general practice. Sometimes the search can be performed during the consultation, but more often it can be done later and the patient can return for the result. Case-based journal clubs provide a supportive environment for GPs to work together to find the best evidence at regular meetings. An evidence-based literature search service is being piloted to enhance decision-making for individual patients. A central facility provides the search and interprets the evidence in relation to individual cases. A request form and a results format make the service akin to pathology testing or imaging. Using EBM in general practice appears feasible. Major difficulties still exist before it can be practised by all GPs, but it has the potential to change the way doctors update their knowledge.

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.

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.

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.

Sharing best practices in introducing and teaching ethics principles to public administration employees : research report

O projeto, financiado pelo Programa Aprendizagem ao Longo da Vida, decorreu entre 1 de agosto de 2011 e 31 de julho de 2013 e foi coordenado pelo Instituto de Administração Pública de Praga, tendo como parceiros a Escola de Economia e Direito de Berlim, a Escola Nacional de Administração Pública da Polónia e o INA, de Portugal. A coordenação portuguesa do estudo esteve a cargo da Prof. Doutora Helena Rato e da Dra. Matilde Gago, com a colaboração do Prof. Doutor César Madureira e da Dra. Margarida Quintela, ex investigadores do INA, atualmente na DGAEP.

The appraisal of anaerobic digestion in Ireland to develop improved designs and operational practice

Mesophilic Anaerobic Digestion treating sewage sludge was investigated at five full-scale sewage treatment plants in Ireland. The anaerobic digestion plants are compared and evaluated in terms of design, equipment, operation, monitoring and management. All digesters are cylindrical, gas mixed and heated Continuously Stirred Tank Reactors (CSTR), varying in size from 130m3 to 800m3. Heat exchanger systems heat all digesters. Three plants reported difficulties with the heating systems ranging from blockages to insufficient insulation and design. Exchangers were modified and replaced within one year of operation at two plants. All but one plant had Combined Heat and Power (CHP) systems installed. Parameter monitoring is a problem at all plants mainly due to a lack of staff and knowledge. The plant operators consider pH and temperature the most important parameters to be measured in terms of successful monitoring of an anaerobic digester. The short time taken and the ease at which pH and temperature can be measured may favour these parameters. Three laboratory scale pilot anaerobic digesters were operated using a variety of feeds over at 144-day period. Two of the pilots were unmixed and the third was mechanically mixed. As expected the unmixed reactors removed more COD by retention of solids in the digesters but also produced greater quantities of biogas than the mixed digester, especially when low solids feed such as whey was used. The mixed digester broke down more solids due to the superior contact between the substrate and the biomass. All three reactors showed good performance results for whey and sewage solids. Scum formation occurred giving operational problems for mixed and unmixed reactors when cattle slurry was used as the main feed source. The pilot test was also used to investigate which parameters were the best indicators of process instability. These trials clearly indicated that total Volatile Fatty Acid (VFA) concentrations was the best parameter to show signs of early process imbalance, while methane composition in the biogas was good to indicate possible nutrient deficiencies in the feed and oxygen shocks. pH was found to be a good process parameter only if the wastewater being treated produced low bicarbonate alkalinities during treatment.

Swiss clinical practice guidelines for skin cancer in organ transplant recipients.

Patients with a solid organ transplant have increased in numbers and in individual survival in Switzerland over the last decades. As a consequence of long-term immunosuppression, skin cancer in solid organ recipients (SOTRs) has been recognized as an important problem. Screening and education of potential SOTRs about prevention of sun damage and early recognition of skin cancer are important before transplantation. Once transplanted, SOTRs should be seen by a dermatologist yearly for repeat education as well as early diagnosis, prevention and treatment of skin cancer. Squamous cell carcinoma of the skin (SCC) is the most frequent cancer in the setting of long-term immunosuppression. Sun protection by behaviour, clothing and daily sun screen application is the most effective prevention. Cumulative sun damage results in field cancerisation with numerous in-situ SCC such as actinic keratosis and Bowen's disease which should be treated proactively. Invasive SCC is cured by complete surgical excision. Early removal is the best precaution against potential metastases of SCC. Reduction of immunosuppression and switch to mTOR inhibitors and potentially, mycophenolate, may reduce the incidence of further SCC. Chemoprevention with the retinoid acitretin reduces the recurrence rate of SCC. The dermatological follow-up of SOTRs should be integrated into the comprehensive post-transplant care.

Shaping the future: applying therapy research to practice

In these challenging financial times the use of research as a basis for effective health and social care cannot be overstated. 'Shaping the Future', a joint Public Health Agency and University of Ulster workshop (27 January) takes a fresh look at research within the Allied Health Professions (AHPs) to improve the care and experiences of people across Northern Ireland.The AHPs provide a wide range of services including physiotherapy, occupational therapy, radiography, podiatry, speech and language therapy and orthoptics.The nature of their work enables AHPs to carry out research that can rapidly benefit patient care and experience. 'Shaping the Future' will look at priorities for new AHP research and consider how existing research can be more effectively shared and used in health and social care development, rather than perhaps being limited to the academic world.Speaking at the event, Professor Bernie Hannigan, Director of Health and Social Care Research and Development (HSC R&D), aDivision of the PHA, said: "A sound base of evidence from research is vital for effective health and social care practice. I welcome this study as an important resource that will help generate new evidence and highlight the potential for existing evidence to be applied in practice. The evidence base points to beneficial innovations that use the most up-to-date knowledge and keep the service user at the centre of care practices. At this event, health and social care policy makers, commissioners, academics and researchers will be able to consider how they can do and use research to ensure our AHP services deliver the best outcomes for patients and are sufficiently cost-effective to be sustained."A recent study funded by HSC R&D was carried out by the University of Ulster working closely with leading AHPs, key stakeholders and service users* from throughout Northern Irealnd. Presenting the results of this study at the 'Shaping the Future' event will help to identify ways to gather evidence and contribute to innovative projects and programmes.Professor Suzanne McDonough, of the Health and Rehabilitation Sciences Research Centre at the University of Ulster, said: "In our study we used the Delphi technique, which is a structured process using a series of questionnaires, to gather information and gain consensus from AHP groups, stakeholders and service users."The results identified seven major priority areas for research. These ranged from: the need for more practice evaluation particularly in the areas of mental health, cancer, obesity; diabetes; chronic disease management (especially stroke and brain injury); the role of AHPs in health promotion; service delivery issues such as access to services and waiting times. This study provides an important road map for AHP research priorities. It is the first step in the process of identifying what research still needs to be undertaken, what research already exists but needs to be translated, and some of the processes that need to be in place to ensure that research is an integral part of the day-to-day practice of AHPs and of service delivery."

Diabetes in pregnancy: are we providing the best care?

This third and final report of the CEMACH national diabetes programme comes at an important time in the national drive to improve services for women with diabetes in pregnancy. The National Service Framework (NSF) for Diabetes requires the NHS to develop, implement and monitor policies that seek to empower and support women with diabetes to optimise the outcomes of their pregnancy. The CEMACH report shows that, whilst progress has been made in improving services for women with diabetes and their babies, there is much still to be done to meet the standards recommended by the NSF. Too many women continue to be poorly prepared for pregnancy in the critical areas of glycaemic control and folic acid supplementation. The report underlines the need for an increased focus on diabetes preconception care services and the development of strategies to educate women with diabetes of childbearing age. The growing proportion of women with type 2 diabetes during pregnancy, many of whom are from minority ethnic groups, presents an additional challenge for health services in developing responsive and accessible services.This CEMACH report has identifi ed several areas of good clinical practice during pregnancy in women with pre-existing diabetes. However, there continue to be areas where there is room for improvement, including antenatal fetal surveillance, glycaemic control during labour and delivery and postnatal diabetes care. The National Institute for Health and Clinical Excellence (NICE) is currently in the fi nal stages of development of its new guideline for the management of diabetes in pregnancy. This guideline, when taken together with the CEMACH report, will provide local health services with an unprecedented wealth of material on which to base their development of improved services for women with diabetes in pregnancy.��

Good practice in authoring manuscripts on geomorphology

This article aims to help potential authors of geomorphological articles to get their work published. It identifies the basic characteristics of a good manuscript in geomorphology in terms of: (a) originality and significance; and (b) rigour. It uses these characteristics to define how an author should structure a conventional' manuscript in geomorphology by successfully identifying and justifying the motivation for the research; clearly and fully explaining the methods used; and presenting and discussing the results obtained. The article considers the importance of published literature in sustaining all elements of a manuscript in geomorphology. It also presents the natural symmetry that should exist between parts of a manuscript. These practical elements regarding the form and content of a manuscript are then developed through: (a) flagging some of the common mistakes made by authors drawing upon my experience as Managing Editor of the journal Earth Surface Processes and Landforms; (b) discussing the ethical and legal issues, including plagiarism, that relate to manuscript submission; (c) exploring the review process from the perspective of an author, including guidance on how best to respond to review comments in revising a manuscript. Copyright (c) 2013 John Wiley & Sons, Ltd.

Substitutable Concrete Pavements: A Manual of Practice, August 2011

Developed as a more detailed follow up at a 2009 briefing document,Building Sustainable Pavement with Concrete, this guide provides a clear, concise and cohesive discussion of pavement sustainability concepts and of recommended practices for maximizing the sustainability of concrete pavements. The intended audience includes decisions makers and practitioners in both owner-agencies and supply, manufacturing consulting and contractor businesses. Readers will find individual chapters with the most recent technical information and best practices related to concrete pavement deign, materials, construction, use/operations, renewal and recycling. In addition, they will find chapters addressing issues specific to pavement sustainability in the urban environment and to the evaluation of pavement sustainability.

Sustainable Concrete Pavements: A Manual of Practice, January 2012

Sustainable Concrete Pavements: A Manual of Practice is a product of the National Concrete Pavement Technology Center at Iowa State University’s Institute for Transportation, with funding from the Federal Highway Administration (DTFH61-06-H-00011, Work Plan 23). Developed as a more detailed follow-up to a 2009 briefing document, Building Sustainable Pavement with Concrete, this guide provides a clear, concise, and cohesive discussion of pavement sustainability concepts and of recommended practices for maximizing the sustainability of concrete pavements. The intended audience includes decision makers and practitioners in both owner-agencies and supply, manufacturing, consulting, and contractor businesses. Readers will find individual chapters with the most recent technical information and best practices related to concrete pavement design, materials, construction, use/operations, renewal, and recycling. In addition, they will find chapters addressing issues specific to pavement sustainability in the urban environment and to the evaluation of pavement sustainability. Development of this guide satisfies a critical need identified in the Sustainability Track (Track 12) of the Long-Term Plan for Concrete Pavement Research and Technology (CP Road Map). The CP Road Map is a national research plan jointly developed by the concrete pavement stakeholder community, including Federal Highway Administration, academic institutions, state departments of transportation, and concrete pavement–related industries. It outlines 12 tracks of priority research needs related to concrete pavements. CP Road Map publications and other operations support services are provided by the National Concrete Pavement Technology Center at Iowa State University. For details about the CP Road Map, see www.cproadmap. org/index.cfm.

Joint Official Positions of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX(®). Executive Summary of the 2010 Position Development Conference on Interpretation and use of FRAX® in clinical practice.

The International Society for Clinical Densitometry (ISCD) and the International Osteoporosis Foundation (IOF) convened the FRAX(®) Position Development Conference (PDC) in Bucharest, Romania, on November 14, 2010, following a two-day joint meeting of the ISCD and IOF on the "Interpretation and Use of FRAX(®) in Clinical Practice." These three days of critical discussion and debate, led by a panel of international experts from the ISCD, IOF and dedicated task forces, have clarified a number of important issues pertaining to the interpretation and implementation of FRAX(®) in clinical practice. The Official Positions resulting from the PDC are intended to enhance the quality and clinical utility of fracture risk assessment worldwide. Since the field of skeletal assessment is still evolving rapidly, some clinically important issues addressed at the PDCs are not associated with robust medical evidence. Accordingly, some Official Positions are based largely on expert opinion. Despite limitations inherent in such a process, the ISCD and IOF believe it is important to provide clinicians and technologists with the best distillation of current knowledge in the discipline of bone densitometry and provide an important focus for the scientific community to consider. This report describes the methodology and results of the ISCD-IOF PDC dedicated to FRAX(®).

Iowa EHDI Best Practices Manual, November 2008

The purpose of the Iowa EHDI Best Practices Manual is to advance the development of a comprehensive statewide early hearing detection and intervention (EHDI) system in Iowa. This manual will assist hospitals, birth centers, Area Education Agencies (AEAs), health care providers and private practice audiologists in developing programs and written protocols for newborn hearing screening, follow up and intervention. The manual is based upon best practices within early hearing detection and intervention programs and Iowa EHDI law and rules.