Effects of arbitrary shear stress on unsteady free convection flow of Casson fluid past a vertical plate

This article studies the unsteady free flow of a Casson fluid over an infinite vertical plate with constant wall temperature. The Problem is modelled by employing equations of continuity, momentum and energy. Exact solutions for the dimensionless velocity and temperature are established by the Laplace transform technique. The solutions that have been obtained, uncommon in the literature, satisfy all imposed initial and boundary conditions and can generate huge number of solutions for any motion problem with technical relevance of this type. For illustration, some special cases are considered. The velocity solutions are presented as a sum of convective and mechanical parts. Pertinent results are discussed and displayed graphically

Reporting of measures of accuracy in systematic reviews of diagnostic literature

BACKGROUND: There are a variety of ways in which accuracy of clinical tests can be summarised in systematic reviews. Variation in reporting of summary measures has only been assessed in a small survey restricted to meta-analyses of screening studies found in a single database. Therefore, we performed this study to assess the measures of accuracy used for reporting results of primary studies as well as their meta-analysis in systematic reviews of test accuracy studies. METHODS: Relevant reviews on test accuracy were selected from the Database of Abstracts of Reviews of Effectiveness (1994–2000), which electronically searches seven bibliographic databases and manually searches key resources. The structured abstracts of these reviews were screened and information on accuracy measures was extracted from the full texts of 90 relevant reviews, 60 of which used meta-analysis. RESULTS: Sensitivity or specificity was used for reporting the results of primary studies in 65/90 (72%) reviews, predictive values in 26/90 (28%), and likelihood ratios in 20/90 (22%). For meta-analysis, pooled sensitivity or specificity was used in 35/60 (58%) reviews, pooled predictive values in 11/60 (18%), pooled likelihood ratios in 13/60 (22%), and pooled diagnostic odds ratio in 5/60 (8%). Summary ROC was used in 44/60 (73%) of the meta-analyses. There were no significant differences in measures of test accuracy among reviews published earlier (1994–97) and those published later (1998–2000). CONCLUSIONS: There is considerable variation in ways of reporting and summarising results of test accuracy studies in systematic reviews. There is a need for consensus about the best ways of reporting results of test accuracy studies in reviews

Audit changes clinical practice! impact on rate of justification of hysterectomy indication

After performing a baseline audit in 1986-89, an ongoing quality assurance process was initiated in January, 1990 and all hysterectomies performed over the next 2 year period were analyzed. Hysterectomy indications were divided into two groups: one in which the uterine specimen was expected to show pathology and another in which no pathology was expected. The hysterectomy was considered justified in the former if the pathology report verified the indication or showed a significant alternate pathology. In the latter, validation criteria showing documentation of certain prerequisite diagnostic procedures performed before reverting to hysterectomy, were used to ascertain justification. The overall rate of justification in the ongoing audit was 96%, being 97% for the group where hysterectomy indication was potentially confirmable by pathologic study and 93% for the one where it was not. Comparison with baseline analysis showed that the justification rates were higher for all indications not potentially confirmable by pathologic study (93% vs 89%, p \u3c 0.05), for recurrent uterine bleeding (90% vs 83%, p \u3c 0.05) and for leiomyoma (97% vs 95%, p \u3c 0.05). The improvement was associated with less frequent use of multiple indications in the ongoing study (10% vs 16%, p \u3c 0.05). The justification rates for hysterectomy indication can be improved by prospective audit and by avoiding use of multiple indications

Knowledge and beliefs concerning evidence-based practice amongst complementary and alternative medicine health care practitioners and allied health care professionals: A questionnaire survey

Background: Evidence-based practice (EBP) has become an important competency in many allied and complementary and alternative medicine (CAM) health care practitioners' professional standards of proficiency. Methods: To compliment an EBP course for allied health care professionals and CAM practitioners, we undertook a questionnaire survey to assess learning needs. We developed a questionnaire to measure allied health care professionals and CAM practitioners' basic knowledge, skills and beliefs concerning the main principles of EBP. The questionnaires were administered to all attendees of one-day EBP workshops. Results: During 2004–5 we surveyed 193 allied health care professionals and CAM practitioners who attended one-day EBP courses prior to commencement of teaching. Of the respondents 121 (62.7%) were allied health care professionals and 65 (33.7%) practitioners stated that they work in the CAM field Our survey found that the majority of the respondents had not previously attended a literature appraisal skills workshop (87.3%) or received formal training in research methods (69.9%), epidemiology (91.2%) or statistics (80.8%). Furthermore, 67.1% of practitioners specified that they felt that they had not had adequate training in EBM and they identified that they needed more training and education in the principles of EBM (86.7%). Differences in knowledge and beliefs concerning EBP amongst allied and CAM practitioners were found and length of time since qualification was also found to be an important factor in practitioner's beliefs. More CAM practitioners compared to allied health professionals accessed educational literature via the Internet (95.3% v 68.1%, p = 0.008). Whilst, practitioners with more than 11 years experience felt that original research papers were far more confusing (p = 0.02) than their less experienced colleagues. Conclusion: The results demonstrate that practitioner's learning needs do vary according to the type of profession, time since graduation and prior research experience. Our survey findings are exploratory and will benefit from further replication, however, we do believe that they warrant consideration by allied health care and CAM tutors and trainers when planning EBP teaching curricula as it is important to tailor teaching to meet the needs of specific subgroups of trainees to ensure that specific learning needs are met

Tests for predicting complications of pre-eclampsia: A protocol for systematic reviews

Background Pre-eclampsia is associated with several complications. Early prediction of complications and timely management is needed for clinical care of these patients to avert fetal and maternal mortality and morbidity. There is a need to identify best testing strategies in pre eclampsia to identify the women at increased risk of complications. We aim to determine the accuracy of various tests to predict complications of pre-eclampsia by systematic quantitative reviews. Method We performed extensive search in MEDLINE (1951–2004), EMBASE (1974–2004) and also will also include manual searches of bibliographies of primary and review articles. An initial search has revealed 19500 citations. Two reviewers will independently select studies and extract data on study characteristics, quality and accuracy. Accuracy data will be used to construct 2 × 2 tables. Data synthesis will involve assessment for heterogeneity and appropriately pooling of results to produce summary Receiver Operating Characteristics (ROC) curve and summary likelihood ratios. Discussion This review will generate predictive information and integrate that with therapeutic effectiveness to determine the absolute benefit and harm of available therapy in reducing complications in women with pre-eclampsia

Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis

Objective To evaluate the association between umbilical cord pH at birth and long term outcomes

Mary Crosse project: systematic reviews and grading the value of neonatal tests in predicting long term outcomes

<p>Abstract</p> <p>Background</p> <p>Events before birth, condition at birth, events immediately following birth, and condition in early childhood are linked together, and have implications for health and disease in adulthood. At present, there is lack of clarity about the tests that purport to link these various stages. This is partly because there is paucity of collated information about the best strategies for predicting longer-term outcomes before (using tests in fetal period) or after birth (using tests in neonatal period, infancy as well as early childhood).</p> <p>Methods/Design</p> <p>A series of systematic reviews and meta-analyses will be undertaken to determine, amongst neonates, the ability of various tests and measures to predict infant, childhood and adult outcomes. We will search Medline, Embase, Cochrane Library, MEDION, citation lists of review articles and eligible primary articles and will contact experts in the field. Independent reviewers will select studies, extract data and assess study quality according to established criteria. Language restrictions will not be applied. Data synthesis will involve meta-analysis (where appropriate), exploration of heterogeneity and publication bias. Evidence collated will be graded for its quality to support decision making.</p> <p>Discussion</p> <p>The project will collate, synthesise and evaluate the available evidence concerning the value of tests of neonatal wellbeing to predict long term outcomes. The systematic reviews will assess the quality of available evidence and identify tests with the strongest association with outcomes, and assess their economic value. The output of this project will help formulate practice recommendations.</p

Are non-diabetic women with abnormal glucose screening test at increased risk of pre-eclampsia, macrosomia and caesarian birth?

To determine, in non-diabetic women, the relationship of abnormal glucose screening test, with the incidence of pre-eclampsia, macrosomia and caesarian delivery, from 1988-92, 5646 consecutive women attending antenatal clinic were screened with a glucose challenge test (GCT) on their first visit (usually at 16-20 weeks); those with risk factors i.e., history of unexplained perinatal loss, macrosomia or family member with diabetes and an initial abnormal screening test were rescreened at 28-32 weeks, In 482 cases the GCT was abnormal (plasma glucose value was \u3e140 mg% 2 hours after 75g glucose challenge). Of these, 292 had one or more abnormal critical values at a 75g -3 hour oral glucose tolerance test (GTT) and they were treated to maintain euglycaemia. The rest (n=190) had no evidence of glucose intolerance with no abnormal values at the GTT. The subjects were divided into 3 groups based on GCT values; A, randomly selected subjects with a normal GCT (n=1000); B, those with abnormal GCT but normal GTT (n=190); and C, those with abnormal GTT (n=292). The variables studied were age, gravidity, parity, gestational age at delivery, pre-eclampsia, birth-weight and mode of delivery. The incidence of pre-eclampsia and caesarian birth varied, being the lowest in Group A (3.9% and 11.9% respectively) and then rising through group B (6.3% and 16.3% respectively) to the highest in Group C (12.6% and 26.0% respectively; test of linear trend, p\u3c0.05). For macrosomia, the incidence increased from Group A to B but there was a drop in Group C. The incidence of macrosomia was significantly higher for Group B as compared to A or C (9.5% and 3.3%,

Lessons learnt of the COVID-19 contact tracing strategy in Islamabad Capital Territory, Pakistan using systems thinking processes

The strategy of test, trace and isolate has been promoted and seen as a crucial tool in the fight against the COVID-19 pandemic. As simple as the slogan sounds, effectively implementing it turns into a complex endeavor with multiple moving parts and the need for multisector collaboration. In this study, we apply a systems thinking lens to analyse the design and implementation of the contact tracing strategy for COVID-19 in the district of Islamabad, Pakistan. The data collection included participatory observation, reflective exercises, key informant interviews and participatory workshops with district health managers and health providers. The information gathered was structured using process and stakeholder mapping to identify the lessons learned of the COVID-19 contact tracing strategy. The results showed that the elements crucial for implementation were, good coordination during a crisis, available resources mobilized effectively and establishment of early active surveillance for contact tracing. Furthermore, the main aspects to be improved were lack of preparedness and existing surveillance systems and task shifting leading to impact on regular health services. The results of this study highlight the importance of developing information systems that are coherent with existing processes and resources, even in times of crisis

Local anaesthesia for pain control during outpatient hysteroscopy: systematic review and meta-analysis

Objective To compare the effects of different types of local anaesthetic for pain control during outpatient hysteroscopy