Usage of Evidence Based Medicine Resources in Clinically Practicing Athletic Trainers

Context: Evidence based medicine (EBM) is a commitment to utilizing a combination of the best available evidence, clinical expertise, and patient preferences to inform clinical decisions. The primary goal of EBM is to provide the highest quality care to patients. Clinicians who do not utilize an evidence-based approach to clinical practice run the risk of denying patients potentially beneficial treatment options. Efficient access to evidence based resources is a crucial part of appropriately implementing EBM in athletic training practice. Therefore, poor accessibility could be a major barrier to implementing an evidence-bases approach to clinical practice in athletic training. Objective: The purpose of this study is to examine the how practicing athletic trainers\u27 (ATs) access literature within the participant\u27s clinical setting. Additionally, a second purpose is to determine the AT\u27s ability to formulate clinical research questions in order to find information related to participant\u27s patient population. Lastly, to examine whether ATs are utilizing evidence based sources (Journal Articles, Databases, and Textbooks) and non-evidence based sources (colleagues, internet forums, and anecdotal evidence) when looking for information to assist clinical decision making. Patients and Other Participants: A total of 155 (15.5% returned) clinically practicing ATs participated in the study. Participants were selected from a randomized list of 1,000 National Athletic Trainers\u27 Association (NATA) members who are certified membership status. Results: Nearly all of ATs surveyed did have access to current research through professional journals (96.8%, n=150) internet, and applicable databases (91.6%, n=142). Of those who did not have sufficient access, between (65.2%, n =101) of participants cited most commonly no subscription to medical or allied health journals as the barrier to applicable research. Of the internet resources utilized for across all 5 scenarios, the most commonly utilized internet resources included: Google (36.0%, n=56) and PubMed (33.4, n=52). The number of keywords selected were very comparable amongst four of the scenarios for clinical question 1 (3.72+/- 1.50), clinical question 2 (3.37+/-1.06), clinical question 3 (3.71+/-7.23) and clinical question 4 (3.42+/-1.10). Clinical question 5 demonstrated an average of (3.53+/-1.738) which is consistent with the forced choice options for the other four scenarios. Chi Squares were conducted to determine relationships between EBM training, accessibility, perceived confidence, and employer support. There was a significant relationship between availability of evidence based resources via professional journals and employment settings. Training in EBM and PICO both had a significant relationship on access to internet and internet databases. There was a statistically significant relationship between employer support and access to internet and internet databases but no significant relationship in access to professional journals. A significant difference was found between confident in finding EBM resources and internet and internet databases. PubMed, Ebsco Host, and Cochrane were valued at +1 for an EBM resource. Google and Internet Forums were -1 for a non-evidence based resource. Other was valued at 0 as the responses were both EBM and non-EBM resources. The scenarios that reflected the highest amount of evidence based resources was scenario 2 (0.13) and scenario 5 (0.12) regarding concussions and chronic ankle instability, respectively. Conclusions: Based on this information gathered through this prospective exploratory study, the majority of ATs have sufficient access to professional literature and knowledge of EBM concepts, but EBM is still not being utilized in the clinical setting. Despite high levels of accessibility to evidence-based resources the usage of non-evidence based resources remains high among ATs in all clinical settings. Resources such as Google and internet forums are most convenient but often do not contain high levels of evidence. Athletic trainers must be cautioned when utilizing non-evidence based resources and encouraged to seek out the best possible evidence available when looking for guidance for clinical decision making. This is suggestive that obstacles exist between EBM education and clinical application. Further education is required to educate ATs about the importance of EBM, translating conceptual EBM to practical applications, for the primary purpose of improving patient care and encouraging the growth of the athletic training profession. (Abstract shortened by UMI.)

Turnover in the hospitality industry: can reciprocity solve the problem?

Las pérdidas de empleados es uno de los principales problemas para la industria del turismo, con muchos impactos negativos en las empresas. Las prácticas de gestión de recursos humanos, en particular, el compromiso organizacional y la satisfacción en el trabajo, a menudo, se indican como posibles instrumentos para que las tasas de rotación no sean más bajas. La reciprocidad puede ser un poderoso instrumento de gestión de la relación de trabajo. Cuando los empleados perciben el compromiso como elemento clave, que puede superar sus expectativas, los empleados estarán más dispuestos a demostrar un mayor compromiso para con su organización. El objetivo principal de este artículo teórico es mostrar cómo la reciprocidad puede fortalecer la relación de trabajo, lo que aumenta la satisfacción laboral y el compromiso, y así contribuir a disminuir las tasas de rotación

Effects of temperature distribution and elastic properties of materials on gas-turbine-disk stresses

Calculations were made to determine the influence of changes in temperature distribution and in elastic material properties on calculated elastic stresses for a typical gas-turbine disk. Severe temperature gradients caused thermal stresses of sufficient magnitude to reduce the operating safety of the disk. Small temperature gradients were found to be desirable because they produced thermal stresses that subtracted from the centrifugal stresses in the region of the rim. The thermal gradients produced a tendency for a severe stress condition to exist near the rim but this stress condition could be shifted away from the region of blade attachment by altering the temperature distribution. The investigation of elastic material properties showed that centrifugal stresses are slightly affected by changes in modulus of elasticity, but that thermal stresses are approximately proportional to modulus of elasticity and to coefficient of thermal expansion

Geologic and Hydrologic Effects of a Catastrophic Flood in the Cold River, Southwestern New Hampshire

Guidebook for field trips in Vermont: New England Intercollegiate Geological Conference, 79th annual meeting, October 16, 17 and 18, 1987: Trips A-2; C-

Just because you are different: Understanding the treatment of people with disabilities in organizations through the scapegoating framework

The study aims at developing a theoretical model to understand discriminatory behaviors directed toward people with disabilities in organizational contexts by using René Girard’s scapegoating framework. Despite the wide range of labels that try to define disability and theories that explain discriminant behaviors, the literature suffers from an ableist prejudice and lacks an explanation of mechanisms that underlie the rise of different inclusion paths in organizations. Indeed, the need to find instruments and tools to reduce or solve discrimination overshadowed conceptual and theoretical matters. By broadening the spectrum of social sciences beyond managerial and organizational studies, we propose to use René Girard’s scapegoating framework to shed new light on the phenomenon. The scapegoating framework allows us to fully understand the collective and social dimensions of discriminatory behaviors, catching all the relevant elements that characterize this phenomenon, even those that are less evident from organizational studies. The scapegoating mechanism, in a Girardian sense, is like a trap that every human society falls into, and discrimination against disabled people is just a clear exemplification of this mechanism. For Girard, a human group or society can fall into a spiral of reciprocal violence because of the mimetic desire mechanism, risking a conflict escalation: violence begets more violence, putting at risk the stability or even the existence of this group or society. Scapegoating is a way to overcome reciprocal violence by uniting against a single victim who cannot reciprocate this violence. Starting from the analysis of the four stereotypes of Girard’s framework, this study shows that it is possible to imagine a way to escape the scapegoating trap by shaping organizational identity and using strategies for inclusion. Indeed, it is possible to decline the managerial practices related to the construction of the organizational identity around the four stereotypes avoiding the trap of scapegoat

Volumen de negocios en la industria de la hospitalidad: la reciprocidad puede resolver el problema?

Las pérdidas de empleados es uno de los principales problemas para la industria del turismo, con muchos impactos negativos en las empresas. Las prácticas de gestión de recursos humanos, en particular, el compromiso organizacional y la satisfacción en el trabajo, a menudo, se indican como posibles instrumentos para que las tasas de rotación no sean más bajas. La reciprocidad puede ser un poderoso instrumento de gestión de la relación de trabajo. Cuando los empleados perciben el compromiso como elemento clave, que puede superar sus expectativas, los empleados estarán más dispuestos a demostrar un mayor compromiso para con su organización. El objetivo principal de este artículo teórico es mostrar cómo la reciprocidad puede fortalecer la relación de trabajo, lo que aumenta la satisfacción laboral y el compromiso, y así contribuir a disminuir las tasas de rotación.Turnover is one of the major problems for the hospitality industry, with many negative impacts on the organizations. Human resources management practices, in particular organizational commitment and job satisfaction, are often indicated as possible instruments to make turnover rates lower. Reciprocity could be a powerful instrument of governance of the employment relationship. When employees perceive their employers’ sincere commitment to them exceeding their expectations, the employees will be more likely to demonstrate stronger commitment to their organizations. The main aim of this theoretical article is to show how reciprocity can strengthen the employment relationship, so increasing job satisfaction and commitment, and so contributing to decrease turnover rates

Messing Up the Cancer Stem Cell Chemoresistance Mechanisms Supported by Tumor Microenvironment

Despite the recent advances in cancer patient management and in the development of targeted therapies, systemic chemotherapy is currently used as a first-line treatment for many cancer types. After an initial partial response, patients become refractory to standard therapy fostering rapid tumor progression. Compelling evidence highlights that the resistance to chemotherapeutic regimens is a peculiarity of a subpopulation of cancer cells within tumor mass, known as cancer stem cells (CSCs). This cellular compartment is endowed with tumor-initiating and metastasis formation capabilities. CSC chemoresistance is sustained by a plethora of grow factors and cytokines released by neighboring tumor microenvironment (TME), which is mainly composed by adipocytes, cancer-associated fibroblasts (CAFs), immune and endothelial cells. TME strengthens CSC refractoriness to standard and targeted therapies by enhancing survival signaling pathways, DNA repair machinery, expression of drug efflux transporters and antiapoptotic proteins. In the last years many efforts have been made to understand CSCTME crosstalk and develop therapeutic strategy halting this interplay. Here, we report the combinatorial approaches, which perturb the interaction network between CSCs and the different component of TME