The use of PDSA methodology to evaluate and optimise an inner city memory clinic: a quality improvement project.

The Memory Services National Accreditation Programme states that memory services should provide "timely access to assessment and diagnosis" of dementia. We undertook a quality improvement project using Plan-Do-Study-Act methodology to improve patient access to an inner city memory service. This report focuses on the third Plan-Do-Study-Act cycle where, in 2012, we aimed to shorten the time from memory service referral to assessment and to diagnosis. The time from referral to assessment increased but the time from referral to diagnosis and to treatment decreased. Other memory clinics could use Plan-Do-Study-Act to enable faster diagnosis and better care for patients with dementia

A kapwa-infused paradigm in teaching Catholic theology/catechesis in a multireligious classroom in the Philippines

The increasing religious diversity in educational space has raised a legitimate question on how Catholic theology/ catechesis must be taught in Philippine Catholic universities given the institutional mandate to educate students “into the faith of the Church through teaching of Christian doctrine in an organic and systematic way” (Wuerl, 2013, 1). On this note, the paper makes reference to “centered plural- ism” (CP), a positional posture espoused by Georgetown University in dealing with this predicament. In an attempt to (re) appropriate CP into local context, there is a need to explore the Filipino conception of self/others as enveloped within the indigenous concept of kapwa. Hereon, the paper finds that CP is not just feasibly suitable in local context but with kapwa's more inclusive description of the relationship of self and others, a CP‐based teaching paradigm in theology/ catechesis is a promising project in the educational scene of the Philippines

Unravelling social constructionism

Social constructionist research is an area of rapidly expanding influence that has brought together theorists from a range of different disciplines. At the same time, however, it has fuelled the development of a new set of divisions. There would appear to be an increasing uneasiness about the implications of a thoroughgoing constructionism, with some regarding it as both theoretically parasitic and politically paralysing. In this paper I review these debates and clarify some of the issues involved. My main argument is that social constructionism is not best understood as a unitary paradigm and that one very important difference is between what Edwards (1997) calls its ontological and epistemic forms. I argue that an appreciation of this distinction not only exhausts many of the disputes that currently divide the constructionist community, but also takes away from the apparent radicalism of much of this work

Suicide, sentiment and crisis

A lack of clarity surrounds the precise nature of the transmission mechanism by which an economic crisis actually affects suicide. This study posits the hypothesis that this influence broadly translates as emotional reaction, ‘gut feelings’ and as such explicitly considers the use of subjective factors of economic performance to better explain variations in suicide rates. Alongside traditional economic indicators we use a 'consumer sentiment' measure, a sense of how economic factors are perceived to be impacting on individuals, to explain suicide rates. Furthermore, we explicitly consider the impact of the global financial crisis and test the impact of state public and health expenditures. Results show that consumer sentiment is found to offer a significantly greater explanatory role in exploring variations in the suicide rate compared to traditional economic indicators. Moreover, the effect of consumer sentiment is greater for females than for males, with some nuances in explaining this result. State public and health expenditures do not seem to have any significant influence on suicide rates

Generic bounds on dipolar gravitational radiation from inspiralling compact binaries

Various alternative theories of gravity predict dipolar gravitational radiation in addition to quadrupolar radiation. We show that gravitational wave (GW) observations of inspiralling compact binaries can put interesting constraints on the strengths of the dipole modes of GW polarizations. We put forward a physically motivated gravitational waveform for dipole modes, in the Fourier domain, in terms of two parameters: one which captures the relative amplitude of the dipole mode with respect to the quadrupole mode ($\alpha$) and the other a dipole term in the phase ($\beta$). We then use this two parameter representation to discuss typical bounds on their values using GW measurements. We obtain the expected bounds on the amplitude parameter $\alpha$ and the phase parameter $\beta$ for Advanced LIGO (AdvLIGO) and Einstein Telescope (ET) noise power spectral densities using Fisher information matrix. AdvLIGO and ET may at best bound $\alpha$ to an accuracy of $\sim10^{-2}$ and $\sim10^{-3}$ and $\beta$ to an accuracy of $\sim10^{-5}$ and $\sim10^{-6}$ respectively.Comment: Matches with the published versio

Laboratorial approach in the diagnosis of food allergy

OBJCTIVE: Review the available laboratory tests used to assist in the diagnosis of IgE-mediated and non-IgE-mediated food allergy. DATA SOURCES: Papers in English and Portuguese published in PubMed and Embase, in the last ten years. Terms searched were food allergy, diagnose and laboratory, isolated and/or associated. DATA SYNTHESIS: The diagnostic approach to food allergy reactions includes a good medical history, laboratory studies, elimination diets and blinded food challenges. More recently, the use of a quantitative measurement of food-specific IgE antibodies has been shown to be more predictive of symptomatic IgE-mediated food allergy. Food-specific IgE serum levels exceeding the diagnostic values indicate that the patient is greater than 95% likely to experience an allergic reaction if he/she ingests the specific food. Such decision point values have been defined just for some foods and inconsistent results were obtained when allergy to the same food was studied in different centers. Food challenges, in particular the double-blind placebo-controlled food challenge (DBPCFC), represent the most reliable way to establish or rule out food hypersensitivity. CONCLUSIONS: A number of recent developments are improving the predictive value of some laboratory tests for the diagnosis of food allergies. However, to date, no in-vitro or in-vivo test shows full correlation with clinical food allergy and the DBPCFC remains the gold standard for the definitive diagnosis of specific food allergies. There is an urgent need for new and fundamentally improved diagnostic approaches, which must be validated in patients with food allergy confirmed by a positive DBPCFC.OBJETIVO: Revisar os exames laboratoriais disponíveis utilizados no diagnóstico da alergia alimentar mediada ou não por IgE. FONTES DE DADOS: Artigos publicados em base de dados PubMed e Embase (língua inglesa e portuguesa) nos últimos dez anos. As palavras-chave utilizadas como fonte de busca foram alergia alimentar, diagnóstico e laboratório, isolados e/ou associados. SÍNTESE DOS DADOS: A abordagem diagnóstica das reações alérgicas a alimentos inclui história clínica completa, estudos laboratoriais, dietas de eliminação e desencadeamentos cegos com alimentos. Recentemente, a medida quantitativa de anticorpos IgE específicos a alimentos tem mostrado ser mais preditiva de alergia alimentar sintomática mediada por IgE. Níveis séricos de IgE específica a alimento que excedam os valores diagnósticos indicam que o paciente tem chance maior que 95% de apresentar uma reação alérgica se ingerir o alimento em questão. Estes valores de decisão foram definidos para alguns alimentos e resultados inconsistentes são obtidos ao se estudar diferentes populações. Os desencadeamentos com alimento, especialmente o duplo-cego controlado por placebo (DADCCP), representa a maneira mais confiável de estabelecer ou descartar o diagnóstico de hipersensibilidade alimentar. CONCLUSÕES: Número crescente de aquisições tem melhorado o valor preditivo de alguns testes laboratoriais empregados no diagnóstico de alergias alimentares. Entretanto, até hoje, não há teste in vitro ou in vivo que mostre correlação completa com a clínica da alergia alimentar. O DADCCP continua sendo o padrão-ouro no diagnóstico definitivo de alergia alimentar específica. São necessárias, urgentemente, novas abordagens diagnósticas válidadas em pacientes com alergia alimentar confirmada por DADCCP positivo.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUNIFESP-EPM Departamento de PediatriaUniversidade de São Paulo Faculdade de Medicina Departamento de PediatriaUniversidade Federal da Bahia Departamento de PediatriaUNIFESP-EPMUniversidade Federal do Paraná Departamento de PediatriaUNIFESP, EPM, Depto. de PediatriaUNIFESP, EPM Depto. de PediatriaUNIFESP, EPMSciEL

Practical allergy (PRACTALL) report: risk assessment in anaphylaxis

Effector mechanisms in anaphylaxis were reviewed. Current approaches to confirmation of the clinical diagnosis were discussed. Improved methods for distinguishing between allergen sensitization (which is common in the general population) and clinical risk of anaphylaxis (which is uncommon) were deliberated. Innovative techniques that will improve risk assessment in anaphylaxis in the future were described