Intercultural competence for the nutrition professional

Diversity training for nutrition care professionals is essential in order to provide patients with culture-specific strategies that allow them to succeed with their health program. Nutritionists are faced with the challenge of understanding the dietary preferences of their cross-cultural patients, as well as appreciating a patient\u27s religious beliefs regarding dietary selections by identify foods that will or won\u27t support a prescribed nutritional program. Knowledge of intercultural nonverbal and verbal behaviors is becoming increasingly necessary, as is who ultimately makes medical decisions for the patient

The epistemology of the SARS-CoV-2 test

We investigate the epistemological consequences of a positive SARS-CoV-2 test for two relevant hypotheses: (i) V is the hypothesis that an individual has been infected with SARS-CoV-2; (ii) C is the hypothesis that SARS-CoV-2 is the sole cause of flu-like symptoms in a given patient. We ask two fundamental epistemological questions regarding each hypothesis: First, given a positive SARS-CoV-2 test, what should we believe about the hypothesis and to what degree? Second, how much evidence does a positive test provide for a hypothesis against its negation? We respond to each question within a formal Bayesian framework. We construe degree of confirmation as the difference between the posterior probability of the hypothesis and its prior, and the strength of evidence for a hypothesis against its alternative in terms of their likelihood ratio. We find that for realistic assumptions about the base rate of infected individuals, P(V)≲20%, positive tests having low specificity (75%) would not raise the posterior probability for V to more than 50%. Furthermore, if the test specificity is less than 88.1%, even a positive test having 95% sensitivity would only yield weak to moderate evidence for V against ¬V. We also find that in plausible scenarios, positive tests would only provide weak to moderate evidence for C unless the tests have a high specificity. One has thus to be careful in ascribing the symptoms or death of a positively tested patient to SARS-CoV-2, if the possibility exists that the disease has been caused by another pathogen

Emergence and evidence: a close look at Bunge’s philosophy of medicine

In his book “Medical Philosophy: Conceptual issues in Medicine“, Mario Bunge provides a unique account of medical philosophy that is deeply rooted in a realist ontology he calls “systemism”. According to systemism, the world consists of systems and their parts, and systems possess emergent properties that their parts lack. Events within systems may form causes and effects that are constantly conjoined via particular mechanisms. Bunge supports the views of the evidence-based medicine movement that randomized controlled trials (RCTs) provide the best evidence to establish the truth of causal hypothesis; in fact, he argues that only RCTs have this ability. Here we argue that Bunge neglects the important feature of patients being open systems which are in steady interaction with their environment. We show that accepting this feature leads to counter-intuitive consequences for his account of medical hypothesis testing. In particular, we point out that (i) the confirmation of hypotheses is inherently stochastic and affords a probabilistic account of both confirmation and evidence which we provide here; (ii) RCTs are neither necessary nor sufficient to establish the truth of a causal claim; (iii) testing of causal hypotheses requires taking into account background knowledge and the context within which an intervention is applied. We conclude that there is no “best” research methodology in medicine, but that different methodologies should co-exist in a complementary fashion

Emergence and evidence: a close look at Bunge’s philosophy of medicine

In his book “Medical Philosophy: Conceptual issues in Medicine”, Mario Bunge provides a unique account of medical philosophy that is deeply rooted in a realist ontology he calls “systemism”. According to systemism, the world consists of systems and their parts, and systems possess emergent properties that their parts lack. Events within systems may form causes and effects that are constantly conjoined via particular mechanisms. Bunge supports the views of the evidence-based medicine movement that randomized controlled trials (RCTs) provide the best evidence to establish the truth of causal hypothesis; in fact, he argues that only RCTs have this ability. Here, we argue that Bunge neglects the important feature of patients being open systems which are in steady interaction with their environment. We show that accepting this feature leads to counter-intuitive consequences for his account of medical hypothesis testing. In particular, we point out that (i) the confirmation of hypotheses is inherently stochastic and affords a probabilistic account of both confirmation and evidence which we provide here; (ii) RCTs are neither necessary nor sufficient to establish the truth of a causal claim; (iii) testing of causal hypotheses requires taking into account background knowledge and the context within which an intervention is applied. We conclude that there is no “best” research methodology in medicine, but that different methodologies should coexist in a complementary fashion

The epistemology of a positive SARS-CoV-2 test

We investigate the epistemological consequences of a positive polymerase chain reaction SARS-CoV test for two relevant hypotheses: (i) V is the hypothesis that an individual has been infected with SARS-CoV-2; (ii) C is the hypothesis that SARS-CoV-2 is the cause of flu-like symptoms in a given patient. We ask two fundamental epistemological questions regarding each hypothesis: First, how much confirmation does a positive test lend to each hypothesis? Second, how much evidence does a positive test provide for each hypothesis against its negation? We respond to each question within a formal Bayesian framework. We construe degree of confirmation as the difference between the posterior probability of the hypothesis and its prior, and the strength of evidence for a hypothesis against its alternative in terms of their likelihood ratio. We find that test specificity – and coinfection probabilities when making inferences about C – were key determinants of confirmation and evidence. Tests with 8) for V against ¬V regardless of sensitivity. Accordingly, low specificity tests could not provide strong evidence in favor of C in all plausible scenarios modeled. We also show how a positive influenza A test disconfirms C and provides weak evidence against C in dependence on the probability that the patient is influenza A infected given that her symptoms are not caused by SARS-CoV-2. Our analysis points out some caveats that should be considered when attributing symptoms or death of a positively tested patient to SARS-CoV-2

The epistemology of the SARS-CoV-2 test

We investigate the epistemological consequences of a positive SARS-CoV-2 test for two relevant hypotheses: (i) V is the hypothesis that an individual has been infected with SARS-CoV-2; (ii) C is the hypothesis that SARS-CoV-2 is the sole cause of flu-like symptoms in a given patient. We ask two fundamental epistemological questions regarding each hypothesis: First, given a positive SARS-CoV-2 test, what should we believe about the hypothesis and to what degree? Second, how much evidence does a positive test provide for a hypothesis against its negation? We respond to each question within a formal Bayesian framework. We construe degree of confirmation as the difference between the posterior probability of the hypothesis and its prior, and the strength of evidence for a hypothesis against its alternative in terms of their likelihood ratio. We find that for realistic assumptions about the base rate of infected individuals, P(V)≲20%, positive tests having low specificity (75%) would not raise the posterior probability for V to more than 50%. Furthermore, if the test specificity is less than 88.1%, even a positive test having 95% sensitivity would only yield weak to moderate evidence for V against ¬V. We also find that in plausible scenarios, positive tests would only provide weak to moderate evidence for C unless the tests have a high specificity. One has thus to be careful in ascribing the symptoms or death of a positively tested patient to SARS-CoV-2, if the possibility exists that the disease has been caused by another pathogen

As-Built and Post-treated Microstructures of an Electron Beam Melting (EBM) Produced Nickel-Based Superalloy

The microstructures of an electron beam melted (EBM) nickel-based superalloy (Alloy 718) were comprehensively investigated in as-built and post-treated conditions, with particular focus individually on the contour (outer periphery) and hatch (core) regions of the build. The hatch region exhibited columnar grains with strong 〈001〉 texture in the build direction, while the contour region had a mix of columnar and equiaxed grains, with no preferred crystallographic texture. Both regions exhibited nearly identical hardness and carbide content. However, the contour region showed a higher number density of fine carbides compared to the hatch. The as-built material was subjected to two distinct post-treatments: (1) hot isostatic pressing (HIP) and (2) HIP plus heat treatment (HIP + HT), with the latter carried out as a single cycle inside the HIP vessel. Both post-treatments resulted in nearly an order of magnitude decrease in defect content in hatch and contour regions. HIP + HT led to grain coarsening in the contour, but did not alter the microstructure in the hatch region. Different factors that may be responsible for grain growth, such as grain size, grain orientation, grain boundary curvature and secondary phase particles, are discussed. The differences in carbide sizes in the hatch and contour regions appeared to decrease after post-treatment. After HIP + HT, similar higher hardness was observed in both the hatch and contour regions compared to the as-built material

Development of yttria-stabilized zirconia and graphene coatings obtained by suspension plasma spraying: Thermal stability and influence on mechanical properties

This study investigated the feasibility of depositing graphene nanoplatelet (GNP)-reinforced yttria-stabilized zirconia (YSZ) composite coatings. The coatings were deposited from an ethanol-based mixed YSZ and GNP suspension using suspension plasma spraying (SPS). Raman spectroscopy confirmed the presence of GNPs in the YSZ matrix, and scanning electron microscopy (SEM) analysis revealed a desired columnar microstructure with GNPs distributed predominantly in the inter-columnar spacing of the YSZ matrix. The as-deposited YSZ-GNP coatings were subjected to different isothermal treatments—400, 500, and 600 \ub0C for 8 h—to study the thermal stability of the GNPs in the composite coatings. Raman analysis showed the retention of GNPs in specimens exposed to temperatures up to 500 \ub0C, although the defect concentration in the graphitic structure increased with increasing temperature. Only a marginal effect on the mechanical properties (i.e., hardness and fracture toughness) was observed for the isothermally treated coatings

Revealing the structure of the outer disks of Be stars

Context. The structure of the inner parts of Be star disks (20 stellar radii) is well explained by the viscous decretion disk (VDD) model, which is able to reproduce the observable properties of most of the objects studied so far. The outer parts, on the ther hand, are not observationally well-explored, as they are observable only at radio wavelengths. A steepening of the spectral slope somewhere between infrared and radio wavelengths was reported for several Be stars that were previously detected in the radio, but a convincing physical explanation for this trend has not yet been provided. Aims. We test the VDD model predictions for the extended parts of a sample of six Be disks that have been observed in the radio to address the question of whether the observed turndown in the spectral energy distribution (SED) can be explained in the framework of the VDD model, including recent theoretical development for truncated Be disks in binary systems. Methods. We combine new multi-wavelength radio observations from the Karl. G. Jansky Very Large Array (JVLA) and Atacama Pathfinder Experiment (APEX) with previously published radio data and archival SED measurements at ultraviolet, visual, and infrared wavelengths. The density structure of the disks, including their outer parts, is constrained by radiative transfer modeling of the observed spectrum using VDD model predictions. In the VDD model we include the presumed effects of possible tidal influence from faint binary companions. Results. For 5 out of 6 studied stars, the observed SED shows strong signs of SED turndown between far-IR and radio wavelengths. A VDD model that extends to large distances closely reproduces the observed SEDs up to far IR wavelengths, but fails to reproduce the radio SED. ... (abstract continues but did not fit here)Comment: 20 pages, 8 figure