A concept-based framework for retrieving evidence to support emergency physician decision making at the point of care

The goal of evidence-based medicine is to uniformly apply evidence gained from scientific research to aspects of clinical practice. In order to achieve this goal, new applications that integrate increasingly disparate health care information resources are required. Access to and provision of evidence must be seamlessly integrated with existing clinical workflow and evidence should be made available where it is most often required - at the point of care. In this paper we address these requirements and outline a concept-based framework that captures the context of a current patient-physician encounter by combining disease and patient-specific information into a logical query mechanism for retrieving relevant evidence from the Cochrane Library. Returned documents are organized by automatically extracting concepts from the evidence-based query to create meaningful clusters of documents which are presented in a manner appropriate for point of care support. The framework is currently being implemented as a prototype software agent that operates within the larger context of a multi-agent application for supporting workflow management of emergency pediatric asthma exacerbations. © 2008 Springer-Verlag Berlin Heidelberg.

A post-structural analysis of perceptions and experiences of continuity and change within the UK automotive supplier base

Firms acting as suppliers to the British automotive industry have a long history of so doing, with some evidencing histories that predate even the invention of the motor car. In exploring the challenges faced by the descendants of these firms in the 1990s, a review is undertaken of the bodies of literature surrounding the changes wrought through the increased globalisation of the industry; the impact of new manufacturing technologies and techniques; the rising levels of co-operation between firms; and the growing impact of the automotive 'service sector'. Moreover, an exploration is undertaken of the perceived 'realities' of the automotive industry as constructed through discourse, including the ways in which discourse effects a continual reinterpretation and re-evaluation of the historical evolution of the industry. Attention is focused on the implications of the above for the automotive supply chain, and the means for its rationalisation proposed by the major car manufacturers and their partner-suppliers. Post-structuralist approaches are introduced as part of an attempt to establish and appropriate research methodology that can explore and deconstruct the discourses surrounding 'modernity', 'supply chain rationalisation', 'flexible specialisation' and 'globalisation' within the automotive industry. Analytical research is conducted into the small- to medium-sized business that constitute the majority of the supplier base in the United Kingdom, and the findings of this research are compared with those of a similar study conducted a quarter-century ago. In this way, the relationships of these firms with their customers, suppliers, and peers are investigated, as are their perceptions of a changing marketplace and their reactions to the impact of policies such as the 'supply chain rationalisation' pursued by the major automotive manufacturers. Authoritative discourses of industry form, function, and structure are challenged, with voice being granted to the marginalised: small suppliers, 'service sector' firms, or those only partly involved in the automotive industry.

The sedimentology and diagenesis of the Pendleside limestone group in the Craven Basin of Northern England. Available in 2 volumes.

This thesis describes the stratigraphy, sedimentology and diagenesis of the Pendleside Limestone (Asbian age), a sequence of limestones, shales and dolostones in the Clitheroe area of N. W. England. Field study of 19 measured sections indicates that it was deposited in a rhythmically subsiding basin (Craven Basin) because of movements on the Mid-Craven Fault which was active in Dinantian times. The sequence is up to 190m thick and consists mostly of distal turbidite deposits which have been reworked at horizons when sediment accumulation built up to the wave base. The original depositional fabric and mineralogy of the Pendleside Limestone Group has been extensively modified by diagenetic processes including cementation, authi­genesis, dolomitization and silicification. These processes have been studied using a wide variety of laboratory techniques. The carbonate cements of the PendIeside Limestone consist predominantly of ferroan calcite and non-ferroan calcite with microdolomite incIusions. The former is probably a stable replacement of original-high-magnesian calcite. Cementation was accompanied by the formation of authigenic albite and quartz. Much of the upper part of the Pendleside Limestone has been extensively dolomitized and chertified. Several distinct zones of dolomitization are found which increase in thickness and intensity towards the top of the Pendleside Limestone Group. The dolostone horizons correspond to coarser-grained lithologies deposited during periods of shallow water sedimentation. The composition of the dolomites changes from ferroan dolomite in the lower part of the Group to non-ferroan dolomite in the upper part. The low strontium and sodium content of the dolostones in association with the other evidence suggests that the dolomitization was brought about in an open system by the mixing of marine and fresh water in phreatic lens which were established at periodic intervals. The dolomitization was closely associated with chertification although this was initiated by the dissolution of siliceous spicules which provided the necessary source of silica.

Motivational state and process within the sociolinguistic context : an Anglo-French comparative study of school pupils learning foreign languages

The aim of this study was to investigate the effect of the socio-cultural environment upon the motivation school children have to learn foreign languages. Motivation was therefore considered from a sociolinguistic, rather than from a psycholinguistic perspective, giving primary importance to contextual, as opposed to personal factors. In order to examine the degree of relationship between motivational intensity and the contextual factors of parental attitudes, amount of foreign language exposure and the employment related value of foreign language learning (FLL), data obtained from school children living in two distinct sociolinguistic environments (Mulhouse, France and Walsall, England) were compared and contrasted. A structured sample drawn from pupils attending schools in Mulhouse and Walsall supplied the data base for this research. The main thrust of the study was quantitative in approach, involving the distribution of almost 1000 questionnaires to pupils in both towns. This was followed up by the use of qualitative methods, in the form of in-depth interviews with an individually matched sample of over 50 French/English pupils. The findings of the study indicate that FLL orientations, attitudes and motivation vary considerably between the two sociolinguistic environments. Levels of motivation were generally higher in the French sample than in the English one. Desire to learn foreign languages and a commitment to expend effort in order to fulfil this desire were key components of this motivation. The study also found evidence to suggest that the importance accorded to FLL by the socio-cultural context, communicated to the child through the socialisation agents of the family, the mass media and prospective employers, is of key importance in FLL motivation.

Memantine combined with an acetyl cholinesterase inhibitor:hope for the future?

Background:Memantine and cholinesterase inhibitors (ChEI) have distinct pharmacological actions, and interest in the use of combination therapy for Alzheimer's disease (AD) is increasing. Objective: To assess the available data on the use of memantine–ChEI combination and to develop evidence-based recommendations.Method: A systematic literature review with detailed discussion of the current evidence base. Results: Available data are limited: five studies of which two were randomized, double-blind, placebo-controlled trials. One study indicated that memantine–ChEI combination is not significantly more effective than placebo–ChEI in mild to moderate AD, but data were published in abstract and poster form only. A second study indicated that the memantine–ChEI combination is significantly more effective than placebo–ChEI in moderate to severe AD. The calculated effect sizes of 0.36 on cognition and 0.12 on function, which were the primary outcomes, were small, indicating a clinically minimal effect on cognition and no effect on function. No data are available on whether combination treatment is more effective than memantine monotherapy. Conclusion: The available data do not justify the use of combination therapy. Future studies should include three arms (memantine–placebo, placebo–ChEI, and memantine–ChEI), be of an adequate size and duration, and use pragmatic measures. Clinicians should have full access to data from any future trials.

Developing a conceptual framework for investigating the resilience of construction SMEs and their supply chains against extreme weather events

Projections into future increasingly suggest that the intensity and frequency of Extreme Weather Events (EWEs) will increase in the future. This has demanded the business organisations as well to be prepared to face the increasing risk of EWEs, in order to ensure their business continuity. However, current evidence base suggests that businesses, especially SMEs, are not adequately prepared to face the threat of such events. Ability to adequately prepare them has been hindered by the lack of in depth studies addressing this issue. The paper presents a doctoral study designed to investigate the resilience of SMEs operating in the construction sector; which is said to be a highly vulnerable sector for the impacts of EWEs, and their supply chains to EWEs. A conceptual framework developed to investigate this issue is presented and explained. It is argued that the resilience of construction SMEs and their supply chains against EWEs can be improved by a combination of reducing their vulnerability, enhancing coping capacity and implementing coping mechanisms. Importance of undertaking a broader view to include the whole supply chain in making business decisions with regard to EWEs by SMEs is also highlighted.

A critical evaluation of the volume, relevance and quality of evidence submitted by the tobacco industry to oppose standardised packaging of tobacco products

OBJECTIVES: To examine the volume, relevance and quality of transnational tobacco corporations' (TTCs) evidence that standardised packaging of tobacco products 'won't work', following the UK government's decision to 'wait and see' until further evidence is available. DESIGN: Content analysis. SETTING: We analysed the evidence cited in submissions by the UK's four largest TTCs to the UK Department of Health consultation on standardised packaging in 2012. OUTCOME MEASURES: The volume, relevance (subject matter) and quality (as measured by independence from industry and peer-review) of evidence cited by TTCs was compared with evidence from a systematic review of standardised packaging . Fisher's exact test was used to assess differences in the quality of TTC and systematic review evidence. 100% of the data were second-coded to validate the findings: 94.7% intercoder reliability; all differences were resolved. RESULTS: 77/143 pieces of TTC-cited evidence were used to promote their claim that standardised packaging 'won't work'. Of these, just 17/77 addressed standardised packaging: 14 were industry connected and none were published in peer-reviewed journals. Comparison of TTC and systematic review evidence on standardised packaging showed that the industry evidence was of significantly lower quality in terms of tobacco industry connections and peer-review (p<0.0001). The most relevant TTC evidence (on standardised packaging or packaging generally, n=26) was of significantly lower quality (p<0.0001) than the least relevant (on other topics, n=51). Across the dataset, TTC-connected evidence was significantly less likely to be published in a peer-reviewed journal (p=0.0045). CONCLUSIONS: With few exceptions, evidence cited by TTCs to promote their claim that standardised packaging 'won't work' lacks either policy relevance or key indicators of quality. Policymakers could use these three criteria-subject matter, independence and peer-review status-to critically assess evidence submitted to them by corporate interests via Better Regulation processes.

A qualitative study of the clinical practice of graduates of a problem-based physical therapy program

The purpose of this study was to examine the perspectives of three graduates of a problem-based leaning (PBL) physical therapy (PT) program about their clinical practice. The study used the qualitative methods of observations, interviews, and journaling to gather the data. Three sessions of audiotaped interviews and two observation sessions were conducted with three exemplars from Nova Southeastern University PBL PT program. Each participant also maintained a reflective journal. The data were analyzed using content analysis. A systematic filing system was used by employing a mechanical means of maintaining and indexing coded data and sorting data into coded classifications of subtopics or themes. All interview transcripts, field notes from observations, and journal accounts were read, and index sheets were appropriately annotated. From the findings of the study, it was noted that, from the participants' perspectives, they were practicing at typically expected levels as clinicians. The attributes that governed the perspectives of the participants about their physical therapy clinical practice included flexibility, reflection, analysis, decision-making, self-reliance, problem-solving, independent thinking, and critical thinking. Further, the findings indicated that the factors that influenced those attributes included the PBL process, parents' value system, self-reliant personality, innate personality traits, and deliberate choice. Finally, the findings indicated that the participants' perspectives, for the most part, appeared to support the espoused efficacy of the PBL educational approach. In conclusion, there is evidence that the physical therapy clinical practice of the participants were positively impacted by the PBL curriculum. Among the many attributes they noted which governed these perspectives, problem-solving, as postulated by Barrows, was one of the most frequently mentioned benefits gained from their PBL PT training. With more schools adopting the PBL approach, this research will hopefully add to the knowledge base regarding the efficacy of embracing a problem-based learning instructional approach in physical therapy programs. ^

The National Institute of Justice guide for eyewitness identification evidence: Can it improve juror decision-making?

Mistaken eyewitness identifications of innocent lead to more false convictions in the United States than any other cause. In response to concerns about the reliability of eyewitness evidence, the National Institute of Justice (NIJ) in 1999 published a Guide for the gathering and preservation of eyewitness evidence by law enforcement personnel. Previous research has shown that eyewitness identifications are more accurate when obtained using procedures recommended in the NIJ Guide. This experiment assessed whether informing jurors about the Guide can improve their ability to discriminate between eyewitness identifications likely to be accurate and those likely to be inaccurate and, if so, how to most effectively provide jurors with such information. ^ Seven hundred sixteen U.S. citizens who reported for criminal jury duty participated. Half of the participant jurors read a summary of an armed robbery trial in which the police followed the NIJ Guide when obtaining an eyewitness identification of the defendant. The other half read about an identical case in which the police did not follow the Guide. Jurors received information about the Guide from a court-appointed expert witness, one of the attorneys in the case, the trial judge, the judge in combination with one of the attorneys, or from no one (in the control groups). Jurors then rendered a verdict in the case and answered questions about the evidence in the case. ^ When an expert witness or the judge (either alone or in combination with one of the attorneys) informed jurors about the Guide, the jurors voted to convict defendants likely to be guilty and to acquit defendants likely to be innocent more often than did uninformed jurors assigned to a control group. These data suggest that informing jurors about the NIJ Guide using expert testimony or instructions from a judge will improve the quality and accuracy of jurors' verdict decisions in cases involving eyewitness identification evidence. However, more research is needed to determine whether the judge will remain an effective source of information about the Guide in a longer, more detailed trial scenario and to learn more about the underlying psychological processes governing the effects observed in this experiment. ^

Jury decision making and the Story Model: How do deliberation style and evidence order influence the story that juries create?

This study investigated the utility of the Story Model for decision making at the jury level by examining the influence of evidence order and deliberation style on story consistency and guilt. Participants were shown a video-taped trial stimulus and then provided case perceptions including a guilt judgment and a narrative about what occurred during the incident. Participants then deliberated for approximately thirty minutes using either an evidence-driven or verdict-driven deliberation style before again providing case perceptions, including a guilt determination, a narrative about what happened during the incident, and an evidence recognition test. Multi-level regression analyses revealed that evidence order, deliberation style and sample interacted to influence both story consistency measures and guilt. Among students, participants in the verdict-driven deliberation condition formed more consistent pro-prosecution stories when the prosecution presented their case in story-order, while participants in the evidence-driven deliberation condition formed more consistent pro-prosecution stories when the defense's case was presented in story-order. Findings were the opposite among community members, with participants in the verdict-driven deliberation condition forming more consistent pro-prosecution stories when the defense's case was presented in story-order, and participants in the evidence-driven deliberation condition forming more consistent pro-prosecution stories when the prosecution's case was presented in story-order. Additionally several story consistency measures influenced guilt decisions. Thus there is some support for the hypothesis that story consistency mediates the influence of evidence order and deliberation style on guilt decisions.

Perceptions of alibi evidence as a function of the strength of incriminating *evidence

The current study investigated the exculpatory value of alibi evidence when presented together with various types of incriminating evidence. Previous research has reported that alibi evidence could weaken the effects of DNA evidence and eyewitness identification. The present study assessed the effectiveness of alibi evidence in counteracting defendant's confession (experiment 1) and eyewitness evidence (experiment 2). In experiment 1, three levels of alibi evidence (none, weak, strong) were combined with three levels of confession evidence (voluntary, elicited under low pressure, elicited under high pressure). Results indicated significant main effects of confession and alibi and an alibi by confession interaction. Of participants exposed to high-pressure confession, those in the strong alibi condition rendered lower guilt estimates than those in the no alibi condition. In experiment 2, three levels of alibi were combined with two levels of eyewitness evidence (bad view, good view). A main effect of alibi was obtained, but no interaction between alibi and eyewitness evidence. ^ An explanation of this pattern is based in part on the Story Model (Pennington & Hastie, 1992) and a novel “culpability threshold” model of juror decision-making. The Story Model suggests that jurors generate verdict stories (interpretations of events consistent with a guilty or not guilty verdict) based on trial evidence. If the evidence in favor of guilt exceeds jurors' threshold for perceiving culpability, jurors will fail to properly consider exonerating evidence. However, when the strength of incriminating evidence does not exceed the jurors' threshold, they are likely to give appropriate consideration to exculpatory evidence in their decisions. ^ Presentation of a reliable confession in Experiment 1 exceeded jurors' culpability threshold and rendered alibi largely irrelevant. In contrast, presentation of a high-pressure confession failed to exceed jurors' culpability threshold, so jurors turned to alibi evidence in their decisions. Similarly, in the second experiment, eyewitness evidence (in general) was not strong enough to surpass the culpability threshold, and thus jurors incorporated alibi evidence in their decisions. A third study is planned to further test this “culpability threshold” model, further explore various types of alibi evidence, and clarify when exculpatory evidence will sufficiently weaken the prosecution's “story.” ^

Compilation of planktonic foraminiferal census counts from the Southern Hemisphere Oceans

We present an improved database of planktonic foraminiferal census counts from the Southern Hemisphere Oceans (SHO) from 15°S to 64°S. The SHO database combines 3 existing databases. Using this SHO database, we investigated dissolution biases that might affect faunal census counts. We suggest a depth/[DCO3]2- threshold of ~3800 m/[DCO3]2- = ~-10 to -5 µmol/kg for the Pacific and Indian Oceans, and ~4000 m/[DCO3]2- = ~0 to 10 µmol/kg for the Atlantic Ocean, under which core-top assemblages can be affected by dissolution and are less reliable for paleo-sea surface temperature (SST) reconstructions. We removed all core-tops beyond these thresholds from the SHO database. This database has 598 core-tops and is able to reconstruct past SST variations from 2° to 25.5°C, with a root mean square error of 1.00°C, for annual temperatures. To inspect dissolution affects SST reconstruction quality, we tested the data base with two "leave-one-out" tests, with and without the deep core-tops. We used this database to reconstruct Summer SST (SSST) over the last 20 ka, using the Modern Analog Technique method, on the Southeast Pacific core MD07-3100. This was compared to the SSST reconstructed using the 3 databases used to compile the SHO database. Thus showing that the reconstruction using the SHO database is more reliable, as its dissimilarity values are the lowest. The most important aspect here is the importance of a bias-free, geographic-rich, database. We leave this dataset open-ended to future additions; the new core-tops must be carefully selected, with their chronological frameworks, and evidence of dissolution assessed.

Data compilation on the biological response to ocean acidification: environmental and experimental context of data sets and related literature

The exponential growth of studies on the biological response to ocean acidification over the last few decades has generated a large amount of data. To facilitate data comparison, a data compilation hosted at the data publisher PANGAEA was initiated in 2008 and is updated on a regular basis (doi:10.1594/PANGAEA.149999). By January 2015, a total of 581 data sets (over 4 000 000 data points) from 539 papers had been archived. Here we present the developments of this data compilation five years since its first description by Nisumaa et al. (2010). Most of study sites from which data archived are still in the Northern Hemisphere and the number of archived data from studies from the Southern Hemisphere and polar oceans are still relatively low. Data from 60 studies that investigated the response of a mix of organisms or natural communities were all added after 2010, indicating a welcomed shift from the study of individual organisms to communities and ecosystems. The initial imbalance of considerably more data archived on calcification and primary production than on other processes has improved. There is also a clear tendency towards more data archived from multifactorial studies after 2010. For easier and more effective access to ocean acidification data, the ocean acidification community is strongly encouraged to contribute to the data archiving effort, and help develop standard vocabularies describing the variables and define best practices for archiving ocean acidification data.

Should weight loss and maintenance programmes be designed differently for men? : A systematic review of long-term randomised controlled trials presenting data for men and women: The ROMEO project

Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved. Acknowledgements This review is one of a series of systematic reviews for the ROMEO project (Review Of MEn and Obesity), funded by the National Institute for Health Research, Health Technology Assessment Programme (NIHR HTA Project 09/127/01; Systematic reviews and integrated report on the quantitative and qualitative evidence base for the management of obesity in men http://www.hta.ac.uk/2545). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Department of Health. HERU, HSRU and NMAHP are funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The authors accept full responsibility for this publication. We would also like to thank the Men's Health Forums of Scotland, Ireland, England and Wales: Tim Street, Paula Carroll, Colin Fowler and David Wilkins. We also thank Kate Jolly for further information about the Lighten Up trial.

Should weight loss and maintenance programmes be designed differently for men? : A systematic review of long-term randomised controlled trials presenting data for men and women: The ROMEO project

Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved. Acknowledgements This review is one of a series of systematic reviews for the ROMEO project (Review Of MEn and Obesity), funded by the National Institute for Health Research, Health Technology Assessment Programme (NIHR HTA Project 09/127/01; Systematic reviews and integrated report on the quantitative and qualitative evidence base for the management of obesity in men http://www.hta.ac.uk/2545). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Department of Health. HERU, HSRU and NMAHP are funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The authors accept full responsibility for this publication. We would also like to thank the Men's Health Forums of Scotland, Ireland, England and Wales: Tim Street, Paula Carroll, Colin Fowler and David Wilkins. We also thank Kate Jolly for further information about the Lighten Up trial.