The nature of medical evidence and its inherent uncertainty for the clinical consultation : qualitative study

Objective To describe how clinicians deal with the uncertainty inherent in medical evidence in clinical consultations. Design Qualitative study. Setting Clinical consultations related to hormone replacement therapy, bone densitometry, and breast screening in seven general practices and three secondary care clinics in the UK NHS. Participants Women aged 45-64. Results 45 of the 109 relevant consultations included sufficient discussion for analysis. The consultations could be categorised into three groups: focus on certainty for now and this test, with slippage into general reassurance; a coherent account of the medical evidence for risks and benefits, but blurring of the uncertainty inherent in the evidence and giving an impression of certainty; and acknowledging the inherent uncertainty of the medical evidence and negotiating a provisional decision. Conclusion Strategies health professionals use to cope with the uncertainty inherent in medical evidence in clinical consultations include the use of provisional decisions that allow for changing priorities and circumstances over time, to avoid slippage into general reassurance from a particular test result, and to avoid the creation of a myth of certainty

Lovin\u27 You

Contains advertisements and/or short musical examples of pieces being sold by publisher.https://digitalcommons.library.umaine.edu/mmb-vp/7180/thumbnail.jp

Assessment and learning outcomes: the evaluation of deep learning in an on-line course

Using an online learning environment, students from European countries collaborated and communicated to carry out problem based learning in occupational therapy. The effectiveness of this approach was evaluated by means of the final assessments and published learning outcomes. In particular, transcripts from peer-to-peer sessions of synchronous communication were analysed. The SOLO taxonomy was used and the development of deep learning was studied week by week. This allowed the quality of the course to be appraised and showed, to a certain extent, the impact of this online international course on the learning strategies of the students. Results indicate that deep learning can be supported by synchronous communication and online meetings between course participants.</p

The interpretation of magnetic anomalies North of the dartmoor granite"

The large negative magnetic Okehampton anomaly, northwest of the Dartmoor granite, and rock samples from the same locality, were studied to determine the cruse of the magnetic disturbances in this area. Mineralogical examination revealed that the ferromagnetic mineral pyrrhotite (Fe(_7)S(_8) has been developed in rocks within, and probably beyond, the metamorphic aureola. Magnetic measurements of the rock samples suggested that the Carboniferous sediments, notably shales, have a mean Q value of 3.57 and that the direction of magnetisation is near horizontal and reversed. Models made to define the profiles across the Okehampton Anomaly suggested that the casual body was composite, dipped north at 30º and had an undulating surface. This could be interpreted as faulted and folded lower Carboniferous rocks which disappear north from the exposed Meldon inlier under overlying upper Carboniferous sediments. The 30º dip of the slabs of magnetised rock is the same as the dip of the edge of the Permo-Carboniferous granite from which mineralising fluids emanted to deposit pyrrhotite in the lower carboniferous sediments. The directions of magnetisation used in the models correspond to typical early Permian directions suggesting that the magnetic properties of the rock could be attributed to pyrrhotite emplaced at the time of the granite intrusion. Comparison with other magnetic anomalies found around the northern edge of the Dartmoor granite, where it abets against Carboniferous sediments, showed that this explanation is tenable elsewhere. It was also noted that where pyroclastics are interbedded with the Carboniferous sediments the anomaly was the most pronounced. This was attributed to the abundant supply of sulphur and iron in the volcanics which could be a source for pyrrhotite developmen

Family health narratives : midlife women’s concepts of vulnerability to illness

Perceptions of vulnerability to illness are strongly influenced by the salience given to personal experience of illness in the family. This article proposes that this salience is created through autobiographical narrative, both as individual life story and collectively shaped family history. The paper focuses on responses related to health in the family drawn from semi-structured interviews with women in a qualitative study exploring midlife women’s health. Uncertainty about the future was a major emergent theme. Most respondents were worried about a specified condition such as heart disease or breast cancer. Many women were uncertain about whether illness in the family was inherited. Some felt certain that illness in the family meant that they were more vulnerable to illness or that their relatives’ ageing would be mirrored in their own inevitable decline, while a few expressed cautious optimism about the future. In order to elucidate these responses, we focused on narratives in which family members’ appearance was discussed and compared to that of others in the family. The visualisation of both kinship and the effects of illness, led to strong similarities being seen as grounds for worry. This led to some women distancing themselves from the legacies of illness in their families. Women tended to look at the whole family as the context for their perceptions of vulnerability, developing complex patterns of resemblance or difference within their families

Intensive Archeological Survey of four Alternate Locations for a Proposed Veterans\u27 Administration Facility in the City of Corpus Christi, Nueces County, Texas

The General Services !dministration (GS!) proposes to build a Veterans’ !dministration facility in Corpus Christi, Nueces County, Texas. Four locations in southwest Corpus Christi have been proposed for the facility. Cox|McLain Environmental Consulting, Inc (CMEC) subjected all four locations to archeological examination to assist the GSA in making a final selection of one location for acquisition and construction of the proposed facility. The four locations were identified as the Johnson site (13.4 acres) at the corner of Old Brownsville Road/Farm-to-Market (FM) 665 and Cliff Maus Drive, the JTW site (12 acres) at the northeast corner of Old Brownsville Road and Cliff Maus Drive, the Molasky site (11 acres) at 5102 Old Brownsville Road, and the USFP site (6.19 acres) at West Point Road and South Padre Island Drive/State Highway (SH) 358. The archeological area of potential effect (APE) includes all four parcels and has an acreage of 42.59 acres. The project is funded entirely by the GSA and, therefore, the project is subject to compliance with Section 106 of the National Historic Preservation Act (NHPA) of 1966, as amended (Public Law 89-665; 54 U.S.C. 300101 et seq) and requirements of 36 CFR Part 800. In May 2020, CMEC was contracted through Quaternary Resource Investigations, LLC to conduct archeological investigations at the four locations. Field methods complied with the requirements of the guidelines as set forth by the Council of Texas Archeologists and approved by the Texas Historical Commission (THC). Pedestrian survey with transects spaced 30 m apart and augmented with judgmental shovel tests was conducted. Ground surface visibility on all these sites was good at 80 to 90 percent as the fields were in young cotton plants with rows spaced 2.5 to 3 feet across. A total of 31 shovel tests (7 to 8 tests per site) were excavated within the 42.59-acre APE, exceeding the 1 shovel test per 2 acres required by the THC. As the project is subject to Section 106 of the NHPA, as amended, the APE was assessed for direct and indirect impacts to archeological resources. No archeological sites, deposits, features, or artifacts were recorded during the survey. No further work on any of the parcels is recommended prior to construction. However, if unanticipated buried cultural materials or features with archeological data potential are encountered during site clearing, construction, or other activities that disturb the ground surface, work would cease in the immediate area and the GSA Regional Historic Preservation Officer and staff from the THC’s !rcheological Division should be contacted immediately

The AROC annual report: the state of rehabilitation in New Zealand in 2015

This is the fourth comprehensive annual report describing discharge episodes from subacute inpatient rehabilitation programs provided by New Zealand facilities that are members of the Australasian Rehabilitation Outcomes Centre (AROC). The inaugural report was published in 2013 and described the 2012 data; this fourth instalment describes the 2015 data. This report is the first to use the version 4 AN-SNAP classification (to be implemented in Australia in July 2016). For more information about AN-SNAP classification please refer to the AROC website: http://ahsri.uow.edu.au/aroc This report also introduces an extended times series analysis, looking at change in various rehabilitation measures over the most recent five years. The provision of rehabilitation in New Zealand continues to grow in volume, with 2015 seeing a 1.4% real increase in inpatient episodes of rehabilitation provided. The majority of that volume growth is coming from the reconditioning and orthopaedic fractures impairment groups

The effects of immersive simulation on targeted collaboration skills among undergraduates in special education

The use of immersive simulation as a pedagogical tool has great potential for making a significant impact on student learning in higher education. In this study, the effect of immersive simulation was evaluated for a cohort of undergraduate special education majors. The investigation aimed to determine whether facilitating an immersive co-planning simulation would have an impact on targeted collaboration skills and whether vicarious observational learning would occur for students who observed the simulation. Pre-service teachers in special education were evaluated by their peers on their ability to demonstrate knowledge of (1) co-teaching and co-planning, (2) professional communication, and (3) supports for students with disabilities. The results indicate that they did a better job of facilitating a co-planning session after having first practiced doing so via immersive simulation during a previous class session. It was also discovered that vicarious observational learning during immersive simulation positively affected performance

Polar Bear (Ursus maritimus) Behavior near Icebreaker Operations in the Chukchi Sea, 1991

Increasing interactions of polar bears (Ursus maritimus) with human activity, combined with impacts of climate change, are of critical concern for the conservation of the species. Our study quantifies and describes initial reactions and behaviors of polar bears observed from an icebreaker during summer 1991 at two exploratory drilling sites (near sites drilled in 2015) located in the Chukchi Sea 175 km and 312 km west of Barrow, Alaska. Polar bear behavior was described using continuous sampling of six predetermined focal group behavior states (walking, running, swimming, resting, feeding or foraging, unknown) and six behavioral reaction events (no reaction, walking away, running away, approaching, vigilance [i.e., watching], unknown). Forty-six bears in 34 groups were monitored from the Robert LeMeur (an Arctic Class 3 icebreaker) for periods of five minutes to 16.1 hours. Significantly more bear groups reacted to icebreaker presence (79%) than not (21%), but no relationship was found between their reactions and distance to or activity of the icebreaker. Reactions were generally brief; vigilance was the most commonly observed reaction, followed by walking or running away for short (&lt; 5 minutes) periods and distances (&lt; 500 m). Eleven percent of bear groups approached the vessel. No significant difference was found between reactions when cubs were present and those when cubs were absent. Despite the limited sample sizes, these findings are relevant to assessing potential impacts of resource development and shipping activities on polar bears, especially given the sparsity of such information in the face of growing human activity in the Arctic offshore areas. Overall, climate change is leading to longer and more extensive open-water seasons in the Arctic and therefore to increasing marine traffic—more vessels (including icebreakers) for a longer time each year over a wider area. Les interactions de plus en plus grandes entre les ours polaires (Ursus maritimus) et l’activité humaine, alliées aux incidences du changement climatique, constituent une préoccupation critique en matière de conservation de l’espèce. Notre étude permet de quantifier et de décrire les réactions et les comportements initiaux des ours polaires observés à partir d’un brise-glace à l’été 1991 à deux sites de forage d’exploration (près de chantiers forés en 2015) dans la mer des Tchouktches, à 175 km et à 312 km à l’ouest de Barrow, en Alaska. Le comportement des ours polaires a été décrit en recourant à l’échantillonnage en continu de six états de comportement prédéterminés pour le groupe ciblé (marcher, courir, nager, se reposer, manger ou chercher de la nourriture et comportement inconnu) et de six réactions comportementales aux événements (aucune réaction, s’en aller à la marche, s’en aller à la course, s’approcher, faire preuve de vigilance [c’est-à-dire observer], réaction inconnue). Quarante-six ours faisant partie de 34 groupes ont été surveillés à partir du Robert LeMeur (un brise-glace de l’Arctique de classe 3) pendant des périodes allant de cinq minutes à 16,1 heures. Fait important, plus de groupes d’ours ont réagi à la présence du brise-glace (79 %) que pas réagi (21 %), mais aucune relation n’a pu être établie entre leurs réactions et la distance ou l’activité du brise-glace. De manière générale, les réactions étaient brèves. La vigilance était la réaction la plus souvent observée, suivie du fait de s’en aller en marchant ou de s’en aller à la course pendant de courtes (&lt; 5 minutes) périodes et distances (&lt; 500 m). Onze pour cent des groupes d’ours se sont approchés du vaisseau. Aucune différence importante n’a été relevée entre les réactions, qu’il y ait des oursons ou non. Malgré la taille restreinte des échantillons, ces constatations ont de la pertinence dans l’évaluation des incidences potentielles des activités de mise en valeur et de transport des ressources sur les ours polaires, surtout compte tenu de la rareté de telles données à la lumière de l’activité humaine croissante dans les zones extracôtières de l’Arctique. Dans l’ensemble, le changement climatique mène à des saisons navigables plus longues et plus étendues dans l’Arctique. Par conséquent, le trafic maritime s’accentue en ce sens qu’il y a plus de vaisseaux (brise-glace y compris) pendant de plus longues périodes chaque année, sur de plus grandes surfaces