938 resultados para Evidence-focused practice


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Although ways of thinking about the past have changed, in Britain the reporting of excavations has followed a series of shared conventions for nearly 100 years. This article considers two of them. It investigates the relationship between accounts of stratigraphic evidence and the publication of the associated artefacts and ecofacts and suggests that it results from the combination of two separate intellectual traditions in the late nineteenth century. It also identifies certain widely shared proportions between the separate components of excavation monographs published over a long period of time. Their existence has never been acknowledged. The excavation report has become a well-established literary genre and authors who are familiar with such texts unconsciously reproduce the same structures in their writing.

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Objectives - To assess the general public's interpretation of the verbal descriptors for side effect frequency recommended for use in medicine information leaflets by a European Union (EU) guideline, and to examine the extent to which differences in interpretation affect people's perception of risk and their judgments of intention to comply with the prescribed treatment. Method - Two studies used a controlled empirical methodology in which people were presented with a hypothetical, but realistic, scenario about visiting their general practitioner and being prescribed medication. They were given an explanation that focused on the side effects of the medicine, together with information about the probability of occurrence using either numerical percentages or the corresponding EU verbal descriptors. Interpretation of the descriptors was assessed. In study 2, participants were also required to make various judgments, including risk to health and intention to comply. Key findings - In both studies, use of the EU recommended descriptors led to significant overestimations of the likelihood of particular side effects occurring. Study 2 further showed that the "overestimation" resulted in significantly increased ratings of perceived severity of side effects and risk to health, as well as significantly reduced ratings of intention to comply, compared with those for people who received the probability information in numerical form. Conclusion - While it is recognised that the current findings require replication in a clinical setting, the European and national authorities should suspend the use of the EU recommended terms until further research is available to allow the use of an evidence-based approach.

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Natural resource-dependent societies in developing countries are facing increased pressures linked to global climate change. While social-ecological systems evolve to accommodate variability, there is growing evidence that changes in drought, storm and flood extremes are increasing exposure of currently vulnerable populations. In many countries in Africa, these pressures are compounded by disruption to institutions and variability in livelihoods and income. The interactions of both rapid and slow onset livelihood disturbance contribute to enduring poverty and slow processes of rural livelihood renewal across a complex landscape. We explore cross-scale dynamics in coping and adaptation response, drawing on qualitative data from a case study in Mozambique. The research characterises the engagements across multiple institutional scales and the types of agents involved, providing insight into emergent conditions for adaptation to climate change in rural economies, The analysis explores local responses to climate shocks, food security and poverty reduction, through informal institutions, forms of livelihood diversification and collective land-use systems that allow reciprocity, flexibility and the ability to buffer shocks. However, the analysis shows that agricultural initiatives have helped to facilitate effective livelihood renewal, through the reorganisation of social institutions and opportunities for communication, innovation and micro-credit. Although there are challenges to mainstreaming adaptation at different scales, this research shows why it is critical to assess how policies can protect conditions for emergence of livelihood transformation. (C) 2008 Elsevier Ltd. All rights reserved.

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Weed control strategies for field beans were studied in North-eastern Croatia. This study focused on how different weed management practices affect weed community composition. The recommended pre-emergence herbicide application was compared to different treatments of post-emergence herbicide (broadcasted or banded over crop rows) and mechanical weed control in order to explore the response of a weed community to different management practice. Weed density data were used to compare total community densities by weed management strategies and to calculate diversity indices (Shannon's H', Shannon's E and Margalef's D-MG). Data were analyzed using ANOVA and multivariate technique. Weed community structure was generally similar in the post-emergence herbicide treatments, which were dominated by a few species that had high relative abundance values, while most of the species were of lower abundance. Notable fluctuations in weed communities corresponded with variation in weather patterns and management practice.

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Background: Meta-analyses based on individual patient data (IPD) are regarded as the gold standard for systematic reviews. However, the methods used for analysing and presenting results from IPD meta-analyses have received little discussion. Methods We review 44 IPD meta-analyses published during the years 1999–2001. We summarize whether they obtained all the data they sought, what types of approaches were used in the analysis, including assumptions of common or random effects, and how they examined the effects of covariates. Results: Twenty-four out of 44 analyses focused on time-to-event outcomes, and most analyses (28) estimated treatment effects within each trial and then combined the results assuming a common treatment effect across trials. Three analyses failed to stratify by trial, analysing the data is if they came from a single mega-trial. Only nine analyses used random effects methods. Covariate-treatment interactions were generally investigated by subgrouping patients. Seven of the meta-analyses included data from less than 80% of the randomized patients sought, but did not address the resulting potential biases. Conclusions: Although IPD meta-analyses have many advantages in assessing the effects of health care, there are several aspects that could be further developed to make fuller use of the potential of these time-consuming projects. In particular, IPD could be used to more fully investigate the influence of covariates on heterogeneity of treatment effects, both within and between trials. The impact of heterogeneity, or use of random effects, are seldom discussed. There is thus considerable scope for enhancing the methods of analysis and presentation of IPD meta-analysis.

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Cranial sensory placodes are focused areas of the head ectoderm of vertebrates that contribute to the development of the cranial sense organs and their associated ganglia. Placodes have long been considered a key character of vertebrates, and their evolution is proposed to have been essential for the evolution of an active predatory lifestyle by early vertebrates. Despite their importance for understanding vertebrate origins, the evolutionary origin of placodes has remained obscure. Here, we use a panel of molecular markers from the Six, Eya, Pax, Dach, FoxI, COE and POUIV gene families to examine the tunicate Ciona intestinalis for evidence of structures homologous to vertebrate placodes. Our results identify two domains of Ciona ectoderm that are marked by the genetic cascade that regulates vertebrate placode formation. The first is just anterior to the brain, and we suggest this territory is equivalent to the olfactoty/adenohypophyseal placodes of vertebrates. The second is a bilateral domain adjacent to the posterior brain and includes cells fated to form the atrium and atrial siphon of adult Ciona. We show this bares most similarity to placodes fated to form the vertebrate acoustico-lateralis system. We interpret these data as support for the hypothesis that sensory placodes did not arise de novo in vertebrates, but evolved froth pre-existing specialised areas of ectoderm that contributed to sensory organs in the common ancestor of vertebrate and tunicates. Published by Elsevier Inc.

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Purpose – This paper seeks to examine the nature of “service innovation” in the facilities management (FM) context. It reviews recent thinking on “service innovation” as distinct from “product innovation”. Applying these contemporary perspectives it describes UK case studies of 11 innovations in different FM organisations. These include both in-house client-based innovations and third-party innovations. Design/methodology/approach – The study described in the paper encompasses 11 different innovations that constitute a mix of process, product and practice innovations. All of the innovations stem from UK-based organisations that were subject to in-depth interviews regarding the identification, screening, commitment of resources and implementation of the selected innovations. Findings – The research suggested that service innovation is highly active in the UK FM sector. However, the process of innovation rarely followed a common formalized path. Generally, the innovations were one-shot commitments at the early stage. None of the innovations studied failed to proceed to full adoption stage. This was either due to the reluctance of participating organisations to volunteer “tested but unsuccessful” innovations or the absence of any trial methods that might have exposed an innovations shortcomings. Research limitations/implications – The selection of innovations was restricted to the UK context. Moreover, the choice of innovations was partly determined by the innovating organisation. This selection process appeared to emphasise “one-shot” high profile technological innovations, typically associated with software. This may have been at the expense of less resource intensive, bottom-up innovations. Practical implications – This paper suggests that there is a role for “research and innovation” teams within larger FM organisations, whether they are client-based or third-party. Central to this philosophy is an approach that is open to the possibility of failure. The innovations studied were risk averse with a firm commitment to proceed at the early stage. Originality/value – This paper introduces new thinking on the subject of “service innovation” to the context of FM. It presents research and development as a planned solution to innovation. This approach will enable service organisations to fully test and exploit service innovations.

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Formal and analytical models that contractors can use to assess and price project risk at the tender stage have proliferated in recent years. However, they are rarely used in practice. Introducing more models would, therefore, not necessarily help. A better understanding is needed of how contractors arrive at a bid price in practice, and how, and in what circumstances, risk apportionment actually influences pricing levels. More than 60 proposed risk models for contractors that are published in journals were examined and classified. Then exploratory interviews with five UK contractors and documentary analyses on how contractors price work generally and risk specifically were carried out to help in comparing the propositions from the literature to what contractors actually do. No comprehensive literature on the real bidding processes used in practice was found, and there is no evidence that pricing is systematic. Hence, systematic risk and pricing models for contractors may have no justifiable basis. Contractors process their bids through certain tendering gateways. They acknowledge the risk that they should price. However, the final settlement depends on a set of complex, micro-economic factors. Hence, risk accountability may be smaller than its true cost to the contractor. Risk apportionment occurs at three stages of the whole bid-pricing process. However, analytical approaches tend not to incorporate this, although they could.

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The article considers the perceived prevalence of special educational needs in English primary schools and changes in this prevalence over two decades and relates these to issues in education policy, teacher practice and the concept of special educational needs. The studies considered are two major surveys of schools and teachers, the first conducted in 1981 and the second conducted in the same schools in 1998. Important features of both studies were their scale and the exceptionally high response rates achieved. Two central findings were the perception of teachers that special educational needs were widespread and of an increase in special educational needs over time: perceived levels of special educational needs were one in five children in 1981, which had risen to one in four children in 1998. Learning difficulties were by far the most common aspects of special educational needs but many children had multiple difficulties, and behavioural difficulties were seen by teachers as the main barriers to inclusion. The very high figures for prevalence raise questions about the continued usefulness of the concept of special educational need distinct from broader issues of achievement.

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This article examines the definitions of literacy in operation in secondary schools, and the relationship between official literacy policy and the practices of the agents responsible for implementing this policy. We trace the history of national policy back to the Language Across the Curriculum movement of the 1970s as it provides an illustrative point of comparison with the first five years of the National Literacy Strategy. Drawing on empirical data which illuminate the views, perceptions and practices of key agents on a number of levels, we critically review the concept of 'school literacy' promoted in government policy, defining it as 'school-centric literacy' and question its ability to facilitate participation in the practices associated with the media and technological literacies which are increasingly a feature of school life. There is evidence of some unplanned effects of the current national policy but also that levels of agency, for literacy teachers in particular, may be rapidly diminishing.

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The past decade has seen considerable growth in the evidence base of cognitive behavioural therapy for psychosis. Consistent reports of moderate effect sizes have led to such interventions being recommended as part of routine clinical practice. Most of this evidence is based on a generic form of CBT for psychosis applied to a heterogeneous group. An increase in the effectiveness of cognitive behavioural interventions may require new protocols. Such therapeutic developments should be based on the theoretical understanding of the psychological processes associated with specific forms of psychotic presentation. The current evidence base of CBT for psychosis is reviewed, and barriers that have held back the development of this research are discussed.

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Background: Preventing childhood overweight and obesity has become a major public health issue in developed and developing countries. Systematic reviews of this topic have not provided practice-relevant guidance because of the generally low quality of research and the heterogeneity of reported effectiveness. Aim: To present practice-relevant guidance on interventions to reduce at least one measure of adiposity in child populations that do or do not contain overweight or obese children. Design: Systematic review of eligible randomized, controlled trials or controlled trials using a novel approach to synthesizing the trial results through application of descriptive epidemiological and realistic evaluation concepts. Eligible trials involved at least 30 participants, lasted at least 12 weeks and involved non-clinical child populations. Results: Twenty-eight eligible trials were identified to 30 April 2006. Eleven trials were effective and 17 were ineffective in reducing adiposity. Blind to outcome, the main factor distinguishing effective from ineffective trials was the provision of moderate to vigorous aerobic physical activity in the former on a relatively 'compulsory' rather than 'voluntary' basis. Conclusions: By using a novel approach to synthesizing trials, a decisive role for the 'compulsory' provision of aerobic physical activity has been demonstrated. Further research is required to identify how such activity can be sustained and transformed into a personally chosen behaviour by children and over the life course. (C) 2007 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.

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This paper investigates whether and to what extent a wide range of actors in the UK are adapting to climate change, and whether this is evidence of a social transition. We document evidence of over 300 examples of early adopters of adaptation practice to climate change in the UK. These examples span a range of activities from small adjustments (or coping) to building adaptive capacity, implementing actions and creating deeper systemic change in public and private organisations in a range of sectors. We find that adaptation in the UK has been dominated by government initiatives and has principally occurred in the form of research into climate change impacts. These actions within government stimulate a further set of actions at other scales in public agencies, regulatory agencies and regional government (or in the devolved administrations), though with little real evidence of climate change adaptation initiatives trickling down to local government level. The water supply and flood defence sectors, requiring significant investment in large scale infrastructure such as reservoirs and coastal defences, have invested more heavily in identifying potential impacts and adaptations. Economic sectors that are not dependent on large scale infrastructure appear to be investing far less effort and resources in preparing for climate change. We conclude that while the government-driven top-down targeted adaptation approach has generated anticipatory action at low cost, it may also have created enough niche activities to allow for diffusion of new adaptation practices in response to real or perceived climate change. These results have significant implications for how climate policy can be developed to support autonomous adaptors in the UK and other countries.

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Local Agenda 21 seeks the meaningful involvement of a wide range of local groups and stakeholders in the formulation and implementation of public policy and a free flow of communication and discussion between them and their respective local authorities (and other areas and levels of decision-making). This paper explores the reality of this process using case study evidence from local planning practice in Liverpool (in the north of England) and Reading (in the south of the country). It concentrates on the interaction between LA21 groups and local planning authorities around the preparation of local land use plans and other policy initiatives and the day-to-day regulation of development permits. The paper builds on ‘New Institutionalist’ theory to explore the constraints and opportunities for significant transformations in social, political and economic ‘structures’ or ‘ways of doing things’ through the LA21 process. It concludes that the two cases provide evidence of mixed success in achieving such changes in established planning practices.

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This article is a case study of how English teachers in England have coped with the paradigm shift from print to digital literacy. It reviews a large scale national initiative that was intended to upskill all teachers, considers its weak impact and explores the author’s involvement in the evaluation of the project’s direct value to English teachers. It explores how this latter evaluation revealed how best practice in English using ICT was developing in a variable manner. It then reports on a recent small scale research project that investigated how very good teachers have adapted ICT successfully into their teaching. It focuses on how the English teachers studied in the project are developing a powerful new pedagogy situated in the life worlds of their students and suggests that this model may be of benefit to many teachers. The issues this article reports on have resonance in all English speaking countries. This article is also a personal story of the author’s close involvement with ICT and English over 20 years, and provides evidence for his conviction that digital technologies will eventually transform English teaching.