Evidence-based medicine and values-based medicine : partners in clinical education as well as in clinical practice

The best clinical decisions are based on both evidence and values in what is known as the ‘twofeet principle’. Anecdotally, educationalists find teaching clinicians to become more evidence based is relatively simple in comparison to encouraging them to become more values based. One reason is likely to be the importance of values awareness. As valuesbased practice is premised on a mutual respect for the diversity of values, clinicians need to develop the skills to ascertain patient values and to get in touch with their own beliefs and preferences in order to understand those at play in any consultation. Only then can shared decision-making processes take place within a shared framework of values. In a research article published in BMC Medicine, AltamiranoBustamante and colleagues highlight difficulties that clinicians face in getting in touch with their own values. Despite finding that healthcare personnel’s core values were honesty and respect, autonomy was initially low ranked by participants. One significant aspect of this work is that this group has demonstrated that the extent to which clinicians value ‘autonomy’ and ‘openness to change’ can both be positively influenced by well designed education

Adrenalectomy alters the sensitivity of the central nervous system melanocortin system

Removal of adrenal steroids by adrenalectomy (ADX) reduces food intake and body weight in rodents and prevents excessive weight gain in many genetic and dietary models of obesity. Thus, glucocorticoids appear to play a key role to promote positive energy balance in normal and pathological conditions. By comparison, central nervous system melanocortin signaling provides critical inhibitory tone to regulate energy balance. The present experiments sought to test whether glucocorticoids influence energy balance by altering the sensitivity to melanocortin receptor ligands. Because melanocortin-producing neurons are hypothesized to be downstream of leptin in a key weight-reducing circuit, we tested rats for their sensitivity to leptin and confirmed reports that the hypophagic response to third ventricular (i3vt) leptin is increased in ADX rats and is normalized by glucocorticoid replacement. Next we tested rats for their sensitivity to the melanocortin agonist melanotan II and found that, as for leptin, ADX enhanced the hypophagic response via a glucocorticoid-dependent mechanism. The central nervous system melanocortin system is unique in that it includes the endogenous melanocortin receptor antagonist, AgRP. The orexigenic effect of i3vt AgRP was absent in ADX rats and restored by glucocorticoid replacement. We conclude that the potent weight-reducing effects of ADX likely involve heightened responsiveness to melanocortin receptor stimulation

Wind Energy Resource Assessment of the Caribbean and Central America

A wind energy resource assessment of the Caribbean and Central America has identified many areas with good to outstanding wind resource potential for wind turbine applications. Annual average wind resource maps and summary tables have been developed for 35 island/country areas throughout the Caribbean and Central America region. The wind resource maps highlight the locations of major resource areas and provide estimates of the wind energy resource potential for typical well-exposed sites in these areas. The average energy in the wind flowing in the layer near the ground is expressed as a wind power class: the greater the average wind energy, the higher the wind power class. The summary tables that are included with each of the 35 island/country wind energy maps provide information on the frequency distribution of the wind speeds (expressed as estimates of the Weibull shape factor, k) and seasonal variations in the wind resource for the major wind resource areas identified on the maps. A new wind power class legend has been developed for relating the wind power classes to values of mean wind power density, mean wind speed, and Weibull k. Guidelines are presented on how to adjust these values to various heights above ground for different roughness and terrain characteristics. Information evaluated in preparing the assessment included existing meteorological data from airports and other weather stations, and from ships and buoys in offshore and coastal areas. In addition, new data from recent measurement sites established for wind energy siting studies were obtained for a few areas of the Caribbean. Other types of information evaluated in the assessment were climatological data and maps on winds aloft, surface pressure, air flow, and topography. The various data were screened and evaluated for their usefulness in preparing the wind resource assessment. Much of the surface data from airports and other land-based weather stations were determined to be from sheltered sites and were thus not very useful in assessing the wind resource at locations that are well exposed to the winds. Ship data were determined to be the most useful for estimating the large-scale wind flow and assessing the spatial distribution of the wind resource throughout the region. Techniques were developed for analyzing and correcting ship wind data and extrapolating these data to coastal and inland areas by considering terrain influences on the large-scale wind flow. In areas where extrapolation of ship wind data was not entirely feasible, such as interior areas of Central America, other techniques were developed for estimating the wind flow and distribution of the wind resource. Through the application of the various innovative techniques developed for assessing the wind resource throughout the Caribbean and Central America region, many areas with potentially good to outstanding wind resource were identified that had not been previously recognized. In areas where existing site data were available from exposed locations, the measured wind resource was compared with the estimated wind resource that was derived using the assessment techniques. In most cases, there was good agreement between the measured wind resource and the estimated wind resource. This assessment project supported activities being pursued by the U.S. Committee for Renewable Energy Commerce and Trade (CORECT), the U.S. government's interagency program to assist in overseas marketing and promote renewable energy exports. An overall goal of the program is to improve U.S. competitiveness in the world renewable energy market. The Caribbean and Central America assessment, which is the first of several possible follow-on international wind energy resource assessments, provides valuable information needed by the U.S. wind energy industry to identify suitable wind resource areas and concentrate their efforts on these areas

Global impacts of a Foreshock Bubble: Magnetosheath, magnetopause and ground-based observations

This research at Imperial College London was funded by STFC Grants ST/I505713/1, ST/K001051/1 and ST/G00725X/1. D.L. Turner is thankful for funding from NASA (THEMIS mission and Grant NNX14AC16G). We acknowledge NASA Contract NAS5-02099 and V. Angelopoulos for the use of data from the THEMIS Mission, specifically C.W. Carlson and J.P. McFadden for the use of ESA data; D. Larson and R.P. Lin for the use of SST data; J.W. Bonnell and F.S. Mozer for the use of EFI data; and K.H. Glassmeier, U. Auster and W. Baumjohann for the use of FGM data provided under the lead of the Technical University of Braunschweig and with financial support through the German Ministry for Economy and Technology and the German Center for Aviation and Space (DLR) under Contract 50 OC 0302

Evaluation of the London Measure of Unplanned Pregnancy in a United States population of women

Copyright @ 2012 Morof et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Objective: To evaluate the reliability and validity of the London Measure of Unplanned Pregnancy (a U.K.-developed measure of pregnancy intention), in English and Spanish translation, in a U.S. population of women. Methods: A psychometric evaluation study of the London Measure of Unplanned Pregnancy (LMUP), a six-item, self-completion paper measure was conducted with 346 women aged 15–45 who presented to San Francisco General Hospital for termination of pregnancy or antenatal care. Analyses of the two language versions were carried out separately. Reliability (internal consistency) was assessed using Cronbach’s alpha and item-total correlations. Test-retest reliability (stability) was assessed using weighted Kappa. Construct validity was assessed using principal components analysis and hypothesis testing. Results: Psychometric testing demonstrated that the LMUP was reliable and valid in both U.S. English (alpha = 0.78, all item-total correlations .0.20, weighted Kappa = 0.72, unidimensionality confirmed, hypotheses met) and Spanish translation (alpha = 0.84, all item-total correlations .0.20, weighted Kappa = 0.77, unidimensionality confirmed, hypotheses met). Conclusion: The LMUP was reliable and valid in U.S. English and Spanish translation and therefore may now be used with U.S. women.The study was funded by an anonymous donation

The Universal Plausibility Metric (UPM) & Principle (UPP)

<p>Abstract</p> <p>Background</p> <p>Mere possibility is not an adequate basis for asserting scientific plausibility. A precisely defined universal bound is needed beyond which the assertion of <it>plausibility</it>, particularly in life-origin models, can be considered operationally falsified. But can something so seemingly relative and subjective as plausibility ever be quantified? Amazingly, the answer is, "Yes." A method of objectively measuring the plausibility of any chance hypothesis (The Universal Plausibility Metric [UPM]) is presented. A numerical inequality is also provided whereby any chance hypothesis can be definitively falsified when its UPM metric of ξ is < 1 (The Universal Plausibility Principle [UPP]). Both UPM and UPP pre-exist and are independent of any experimental design and data set.</p> <p>Conclusion</p> <p>No low-probability hypothetical plausibility assertion should survive peer-review without subjection to the UPP inequality standard of formal falsification (ξ < 1).</p

Systematic review of antiepileptic drugs’ safety and effectiveness in feline epilepsy

Understanding the efficacy and safety profile of antiepileptic drugs (AEDs) in feline epilepsy is a crucial consideration for managing this important brain disease. However, there is a lack of information about the treatment of feline epilepsy and therefore a systematic review was constructed to assess current evidence for the AEDs’ efficacy and tolerability in cats. The methods and materials of our former systematic reviews in canine epilepsy were mostly mirrored for the current systematic review in cats. Databases of PubMed, CAB Direct and Google scholar were searched to detect peer-reviewed studies reporting efficacy and/or adverse effects of AEDs in cats. The studies were assessed with regards to their quality of evidence, i.e. study design, study population, diagnostic criteria and overall risk of bias and the outcome measures reported, i.e. prevalence and 95% confidence interval of the successful and affected population in each study and in total