Mesna in Otologic Surgery: Efficacy and Safety-A Scoping Review.

Objective: MESNA is a synthetic sulfur compound that produces mucolysis by disrupting disulfide bonds. This study aimed to address indications and technique of MESNA application in otologic surgery, especially in retraction pockets and adhesive otitis media. Methods: MESNA application was performed in 42 ears of 39 patients. The diagnoses were retraction pockets fixed to incudostapedial joint, stapes or promontorium, and adhesive otitis media in 24 and 17 ears, respectively. Calculations were performed according to 24 ears of 23 patients with follow-up data. Results: One or more of the following surgical interventions were performed: MESNA application alone and ventilation tube insertion, reinforcement or mastoidectomy in addition to MESNA application. Sensorineural hearing loss was not encountered after MESNA application. The operation was successful in 79.2%. Overall revision surgery was needed in 20.8% of the ears. In 71.4% of the ears treated with MESNA alone, revision surgery was needed. Conclusion: In the light of our experience, we advocate the use of MESNA in atelectatic ears, because it makes the operation easy and safe by allowing elevation of the tympanic membrane by its mechanical and chemical actions.

Sodium 2-mercaptoethanesulfonate (Mesna) has been proposed as a chemical aid in any surgical procedure, including cholesteatoma surgery. This review investigated the benefits and safety of Mesna during surgical management of cholesteatoma and adhesive otitis media. A systematic literature review was performed to identify clinical studies evaluating topical Mesna application during ear surgery (cholesteatoma or atelectasis). A qualitative analysis based on data extracted was conducted. From 27 articles, 5 retrospective studies were selected for a full analysis for a total of 607 patients (aged 5 to 72 years). Three studies evaluated cholesteatoma recidivism after Mesna application during cholesteatoma surgery, one study evaluated the surgical success rate of Mesna application for the treatment of atelectatic ears and adhesive otitis media, and one study evaluated potential ototoxicity of Mesna during cholesteatoma surgery. All the studies showed overall improvement in recurrence and residual cholesteatoma disease after Mesna application during surgery. Sensorineural hearing loss was not encountered after Mesna application. Mesna application in cholesteatoma surgery could represent a valid and safe support tool during surgical treatment carried out both with microscopy and endoscopy. More studies are required to confirm these promising results.

To investigate whether the use of mesna (sodium 2-mercaptoethanesulfonate), a mucolytic agent capable of breaking disulfur bonds, reduces the frequency of residual cholesteatoma in canal wall up tympanomastoidectomy. Retrospective study. Tertiary care otology and skull base centers. Two hundred fourteen patients operated on by means of canal wall up tympanomastoidectomy for a middle ear cholesteatoma. Planned staged canal wall up tympanomastoidectomy. In the study group, the cholesteatoma removal was performed with the support of chemically assisted dissection by using mesna. In the control group, the dissection of the disease was performed by means of a traditional mechanical technique alone. Prevalence of residual cholesteatoma at the second-stage operation in the 2 groups of study. One hundred eight patients were treated with the ancillary use of mesna and one hundred six without chemically assisted dissection. A residual cholesteatoma was found in 12 (11.1%) of the 108 patients treated with chemically assisted dissection and in 26 (24.5%) of the 106 patients treated with mechanical dissection. After adjusting for potential confounders, CADISS procedure was associated with a significantly lower risk of having residual cholesteatoma (OR, 0.39; 95% CI, 0.18-0.84, p = 0.02). This study showed that chemically assisted dissection by using mesna represents a valid support in reducing the frequency of residual disease in cholesteatoma surgery.

What is the most appropriate citation metric for a clinical journal?

<b>Introduction:</b> Surgery is still the method of choice in chronic otitis media with cholesteatoma. Except for some specific clinical situations, classic canal wall up technique (CWU), remains a gold standard as a primary treatment in most departments. Unfortunately, the risk of recurrence in such an approach is estimated at 9 to even 70%. This fact prompts researchers to look for ways to reduce those unfavourable statistics. One of the recognized methods supporting the removal of cholesteatoma is the intraoperative use of mesna (sodium 2-mercaptoethanesulfonate). This synthetic sulphur compound disrupts disulfide bridges in polypeptide chains, thanks to which it facilitates matrix preparation.</br></br> <b>Aim:</b> To evaluate the effect of intraoperative use of mesna on the treatment outcomes in patients with chronic otitis media with cholesteatoma operated on by means of the canal wall up technique (CWU).</br></br> <b>Material and methods:</b> 459 surgical reports of patients with middle ear cholesteatoma were analyzed. In total, 52 adult patients with no history of previous ear surgery operated on by means of the CWU technique by the same experienced otosurgeon with all follow-up data available were included in the study. Twenty-six were operated on with the use of mesna (mesna group) and 26 by means of the classic CWU technique (control / no-mesna group). There were 28 women and 24 men with a mean age of 41 years.</br></br> <b>Main Outcome Measure(s):</b> Postoperative hearing results and cholesteatoma recidivism rate.</br></br> <b>Results:</b> Overall recidivism rate was 21.15 %. It was higher in the no-mesna (26.9%) than in the mesna group (15.4%) - although the outcomes were better in the mesna group, the difference was not statistically significant (P = 0.49715). Hearing gain was better in the mesna than in the no-mesna group (10 dB vs 7 dB), but the difference was not statistically significant (P = 0.20089).</br></br> <b>Conclusions:</b> Our preliminary results show that mesna reduces recidivism rates in patients with cholesteatoma. Further study with the analysis of a larger group of patients is needed to prove it statistically.

To develop a measuring apparatus that has the ability to sweep both frequency and external auditory meatus static pressure and can display measurement results in a three-dimensional expression. To measure the middle ear dynamic characteristics of normal-hearing subjects and of patients with this apparatus. Investigate 275 ears of 153 normal-hearing subjects and 72 ears with middle ear diseases. The measurement results show fairly distinctive patterns depending on the middle ear conditions, i.e., normal, ossicular chain separation, ossicular chain fixation, secretory otitis media, tympanic membrane perforation, and tympanic membrane atelectasis. The evaluation of patients with ossicular diseases revealed that the rate of correct diagnosis of ossicular chain separation is 84% and that of ossicular chain fixation is 74%. These diagnoses were confirmed by surgery. Displaying the measurement results in a three-dimensional expression is helpful to make correct diagnosis in clinical practice. It is especially easy to make a distinction between the ossicular chain separation and ossicular chain fixation. Therefore, it is concluded that this apparatus has a high degree of clinical applicability to the diagnosis of these diseases.

Best practices in disinfection of noncritical surfaces in the health care setting: Creating a bundle for success

Over the last decade, researchers have become increasingly interested in students' beliefs about the nature of knowledge and how these beliefs develop. Although initial psychological accounts portrayed epistemic development as a domain-independent process of cognitive maturation, recent studies have found trajectories of epistemic development to vary considerably across contexts. However, few studies have focused on cultural context. This article examines the role community values and practices play in fostering particular epistemological orientations by comparing the epistemological beliefs of 5th, 8th, and 12th graders (N = 200) from General and Religious schools in Israel regarding 2 controversies: belief in God and punishment of children. In both controversies, older participants were less likely than younger participants to consider the controversy rationally decidable. However, this shift emerged earlier in the God controversy than in the punishment controversy. In the God controversy, General pupils were less likely than Religious pupils to consider the question rationally decidable or their own beliefs infallible. But no such school differences were observed in the punishment controversy. Qualitative and quantitative analyses linked these differences to divergent discourse practices at General and Religious schools, suggesting that the relations between learning and epistemic development are more intricate than has been assumed hitherto. Epistemology is an area of philosophy concerned with questions of what knowledge is and how it is justified. Although few people give these questions such detailed and sustained attention as professional philosophers, anyone attempting to acquire, produce, or evaluate knowledge relies, at least implicitly, on some set of epistemological beliefs. Such beliefs are of obvious interest to educators. To understand how students acquire, evaluate, and justify knowledge, we need to understand what they consider knowledge to be. And to help students become discerning consumers and responsible producers of knowledge, we need to understand how people learn to exercise reflective judgment in the face of competing claims. The psychological study of epistemic development is undergoing something of a renaissance. Interest in this area can be traced back to Piaget (1970) Piaget, J. 1970. Genetic epistemology New York: Columbia University Press. [Crossref] , [Google Scholar], Dewey (1933) Dewey, J. 1933. How we think Lexington, MA: D. C. Heath and Co. [Crossref] , [Google Scholar], and beyond (e.g., Plato's Theaetetus). But only recently have psychologists begun to draw together hitherto disparate strands of empirical inquiry to chart in detail the course of epistemic development from infancy to adulthood (see, e.g., Hallett, Chandler, & Krettenauer, 2002 Hallett, D., Chandler, M. J. and Krettenauer, T. 2002. Disentangling the course of epistemic development: Parsing knowledge by epistemic content. New Ideas in Psychology, 20(2-3): 285–307. [Crossref], [Web of Science ®] , [Google Scholar]; Kuhn, Cheney, & Weinstock, 2000 Kuhn, D. 2000. Metacognitive development. Current Directions in Psychological Science, 9(5): 178–181. [Crossref], [Web of Science ®] , [Google Scholar]; Wainryb, Shaw, Langley, Cottam, & Lewis, 2004 Wainryb, C., Shaw, L. A., Langley, M., Cottam, K. and Lewis, R. 2004. Children's thinking about diversity of belief in the early school years: Judgments of relativism, tolerance, and disagreeing persons. Child Development, 75(3): 687–703. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Initial research in this field was conducted largely within a neo-Piagetian paradigm. Epistemic development was characterized as a progression through discrete stages or levels of epistemological understanding, each following the other in invariant sequence and constituting a comprehensive transformation of the individual's conception of knowledge (see, e.g., Chandler, 1975 Chandler, M. J. 1975. Relativism and the problem of epistemological loneliness. Human Development, 18(3): 171–180. [Crossref], [Web of Science ®] , [Google Scholar]; Kitchener & King, 1981 Kitchener, K. S. and King, P. M. 1981. Reflective judgment: Concepts of justification and their relationship to age and education. Journal of Applied Developmental Psychology, 2: 89–116. [Crossref] , [Google Scholar]; Perry, 1970 Perry, W. G. 1970. Forms of intellectual and ethical development in the college years: A scheme Troy, MO: Holt, Rinehart & Winston. [Google Scholar]). Researchers differed somewhat in their nomenclatures and in their criteria for distinguishing levels of epistemological sophistication, but they concurred broadly in positing at least two major shifts in epistemological understanding (for recent reviews, see Hofer & Pintrich, 1997 Hofer, B. K. and Pintrich, P. R. 1997. The development of epistemological theories: Beliefs about knowledge and knowing and their relation to learning. Review of Educational Research, 67(1): 88–140. [Crossref], [Web of Science ®] , [Google Scholar], 2002 Hammer, D. and Elby, A. 2002. "On the form of a personal epistemology.". In Personal epistemology: The psychology of beliefs about knowledge and knowing Edited by: Hofer, B. K. and Pintrich, P. R. 169–190. Mahwah, NJ: Lawrence Erlbaum Associates, Inc. [Google Scholar]). Initially, the individual subscribes to an objectivist conception of knowledge, in which every question is believed to have a single, correct answer that is knowable with absolute certainty. Subsequently, in a radical shift, objectivism is abandoned in favor of subjectivism, and the individual equates all knowledge claims with matters of personal taste or preference. Finally, a balance is achieved in which objective and subjective aspects of knowing are coordinated. At this "evaluativist" stage (cf. Kuhn, 1991 Kuhn, D. 1991. The skills of argument Cambridge, , England: Cambridge University Press. [Crossref] , [Google Scholar]), the individual sees knowledge as something that is constructed tentatively by evaluating the evidence for and against competing beliefs and points of view. There was some debate about the precise relations of these stages to Piaget's stages of intellectual development (see, e.g., Boyes & Chandler, 1992 Boyes, M. C. and Chandler, M. 1992. Cognitive development, epistemic doubt, and identity formation in adolescence. Journal of Youth and Adolescence, 21(3): 277–304. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). However, they were viewed by most researchers as a kind of "post-formal operations" taking up the formal operational attainments of hypothetical thinking and perspective-taking and applying them wholesale to knowledge claims as such, in a form of meta-metacognition (see, e.g., Kitchener, 1983 Kitchener, K. S. 1983. Cognition, metacognition and epistemic cognition: A three-level model of cognitive processing. Human Development, 26: 222–232. [Crossref], [Web of Science ®] , [Google Scholar]; Kuhn, 2000 Kuhn, D. 2000. Metacognitive development. Current Directions in Psychological Science, 9(5): 178–181. [Crossref], [Web of Science ®] , [Google Scholar]; Moshman, 2003 Moshman, D. 2003. Intellectual freedom for intellectual development. Liberal Education, 89(3): 30–38. [Google Scholar]). Empirical support for this model of epistemic development came from several parallel research programs. Overall, these studies provided substantial evidence of development in the hypothesized direction (Hallett et al., 2002 Hallett, D., Chandler, M. J. and Krettenauer, T. 2002. Disentangling the course of epistemic development: Parsing knowledge by epistemic content. New Ideas in Psychology, 20(2-3): 285–307. [Crossref], [Web of Science ®] , [Google Scholar]; Hofer & Pintrich, 1997 Hofer, B. K. and Pintrich, P. R. 1997. The development of epistemological theories: Beliefs about knowledge and knowing and their relation to learning. Review of Educational Research, 67(1): 88–140. [Crossref], [Web of Science ®] , [Google Scholar]; King & Kitchener, 1994 King, P. M. and Kitchener, K. S. 1994. Developing reflective judgment San Francisco: Jossey-Bass. [Google Scholar]). However, the ages at which the key shifts in epistemological understanding were observed varied enormously from program to program. As Hallett et al. (2002) Hallett, D., Chandler, M. J. and Krettenauer, T. 2002. Disentangling the course of epistemic development: Parsing knowledge by epistemic content. New Ideas in Psychology, 20(2-3): 285–307. [Crossref], [Web of Science ®] , [Google Scholar] noted regarding the emergence of subjectivism, "one could read selectively from the literature and, with good reason, conclude that such abilities put in their appearance at either 4 or 6 or 8 or 12 or 16 or 20, or in receipt of a Ph.D." (p. 289). These vast discrepancies have led researchers to reexamine some of the assump-tions underlying their models and measures of epistemic development. In particular, researchers have begun to question the comprehensiveness of shifts in epistemological understanding and to attend more closely to the variety of contexts within which epistemic beliefs are held, employed, and articulated (cf.Elby&Ham-mer, 2001 Elby, A. and Hammer, D. 2001. On the substance of a sophisticated epistemology. Science Education, 85(5): 554–567. [Crossref], [Web of Science ®] , [Google Scholar]; Hammer&Elby, 2002 Hammer, D. and Elby, A. 2002. "On the form of a personal epistemology.". In Personal epistemology: The psychology of beliefs about knowledge and knowing Edited by: Hofer, B. K. and Pintrich, P. R. 169–190. Mahwah, NJ: Lawrence Erlbaum Associates, Inc. [Google Scholar], 2003 Hammer, D. and Elby, A. 2003. Tapping epistemological resources for learning physics. Journal of the Learning Sciences, 12(1): 53–90. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]). This attention to context has taken several forms. One line of research has sought to show that epistemic development is a some-what domain-dependent process that occurs with respect to some kinds of knowledge claim before others. For example, it has been proposed that subjectivism emerges in relation to aesthetic claims before it emerges in relation to claims about the physical world (e.g., Hallett et al., 2002 Hallett, D., Chandler, M. J. and Krettenauer, T. 2002. Disentangling the course of epistemic development: Parsing knowledge by epistemic content. New Ideas in Psychology, 20(2-3): 285–307. [Crossref], [Web of Science ®] , [Google Scholar]; Kuhn et al., 2000 Kuhn, D. 2000. Metacognitive development. Current Directions in Psychological Science, 9(5): 178–181. [Crossref], [Web of Science ®] , [Google Scholar]; Wainryb et al., 2004 Wainryb, C., Shaw, L. A., Langley, M., Cottam, K. and Lewis, R. 2004. Children's thinking about diversity of belief in the early school years: Judgments of relativism, tolerance, and disagreeing persons. Child Development, 75(3): 687–703. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Another line of research has sought to show that epistemological beliefs are multi di-mensional rather than unitary. For example, it has been proposed that people's beliefs about the complexity of knowledge develop more or less independently of their beliefs about its certainty (e.g., Schommer, 1990 Schommer, M. 1990. Effects of beliefs about the nature of knowledge on comprehension. Journal of Educational Psychology, 82(3): 498–504. [Crossref], [Web of Science ®] , [Google Scholar], 1993 Schommer, M. 1993. Comparisons of beliefs about the nature of knowledge and learning amongst post-secondary students. Research in Higher Education, 34(3): 355–370. [Crossref], [Web of Science ®] , [Google Scholar]). Although the accumulated empirical evidence is as yet suggestive rather than conclusive (see Elby&Hammer, 2001 Elby, A. and Hammer, D. 2001. On the substance of a sophisticated epistemology. Science Education, 85(5): 554–567. [Crossref], [Web of Science ®] , [Google Scholar]; Hallett et al., 2002 Hallett, D., Chandler, M. J. and Krettenauer, T. 2002. Disentangling the course of epistemic development: Parsing knowledge by epistemic content. New Ideas in Psychology, 20(2-3): 285–307. [Crossref], [Web of Science ®] , [Google Scholar], pp. 303–304; Kuhn et al., 2000 Kuhn, D. 2000. Metacognitive development. Current Directions in Psychological Science, 9(5): 178–181. [Crossref], [Web of Science ®] , [Google Scholar], pp. 321–322), both research programs hold out the possibility of disentangling the course of epistemic de-velopment by identifying elements of epistemological understanding that emerge at different points in the lifespan(cf.Hallett et al.,2002 Hallett, D., Chandler, M. J. and Krettenauer, T. 2002. Disentangling the course of epistemic development: Parsing knowledge by epistemic content. New Ideas in Psychology, 20(2-3): 285–307. [Crossref], [Web of Science ®] , [Google Scholar], p. 290; Wainryb et al. 2004 Wainryb, C., Shaw, L. A., Langley, M., Cottam, K. and Lewis, R. 2004. Children's thinking about diversity of belief in the early school years: Judgments of relativism, tolerance, and disagreeing persons. Child Development, 75(3): 687–703. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). However, "domains" and "dimensions" are not the only contexts within which epistemic beliefs are situated. Just as people's epistemic beliefs may be affected by the particular content of the knowledge claims being evaluated, so too may they be affected by the particular procedures of knowledge evaluation practiced in, and sanctioned by, the communities in which they participate (cf. Hammer & Elby, 2003 Hammer, D. and Elby, A. 2003. Tapping epistemological resources for learning physics. Journal of the Learning Sciences, 12(1): 53–90. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]). Few studies have directly examined cross-cultural variation in epistemological beliefs. And those that have done so have tended to focus on comparisons between U.S. and East Asian college students (e.g., Chan & Elliott, 2002 Chan, K. and Elliott, R. G. 2002. Exploratory study of Hong Kong teacher education students' epistemological beliefs: Cultural perspectives and implications on beliefs research. Contemporary Educational Psychology, 27(3): 392–414. [Crossref], [Web of Science ®] , [Google Scholar], 2004 Chan, K. and Elliott, R. G. 2004. Epistemological beliefs across cultures: Critique and analysis of beliefs structure studies. Educational Psychology, 24(2): 123–142. [Taylor & Francis Online] , [Google Scholar]; Nisbett, Peng, Choi, & Norenzayan, 2001 Nisbett, R. E., Peng, K., Choi, I. and Norenzayan, A. 2001. Culture and systems of thought: Holistic versus analytic cognition. Psychological Review, 108(2): 291–310. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; Zhang, 1999 Zhang, L. F. 1999. A comparison of U. S. and Chinese university students' cognitive development: The cross-cultural applicability of Perry's theory. Journal of Psychology, 133(4): 425–439. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]). Nonetheless, the findings of such studies are highly suggestive. Especially striking is Zhang's finding that Chinese students' epistemological beliefs shifted over the college years in exactly the opposite direction to those of their U.S. counterparts. Specifically, rather than moving from objectivist to subjectivist conceptions of knowledge, similar to their peers at U.S. universities, Chinese students appeared to shift from more subjectivist conceptions of knowledge to more objectivist ones. Such findings raise intriguing questions about the relations between culture and epistemic development, and about the relations between learning and epistemic development more generally. For a field of inquiry dominated by educational psychologists, remarkably little is known about these relations. As Hofer and Pintrich(1997) Hofer, B. K. and Pintrich, P. R. 1997. The development of epistemological theories: Beliefs about knowledge and knowing and their relation to learning. Review of Educational Research, 67(1): 88–140. [Crossref], [Web of Science ®] , [Google Scholar] noted, "there is little empirical evidence for precisely what fosters epistemological development or how epistemological beliefs are altered" (p. 123). Research has shown that schooling makes a difference(e.g. Bell&Linn, 2002 Bell, P. and Linn, M. C. 2002. "Beliefs about science: How does instruction contribute?". In Personal epistemology: The psychology of beliefs about knowledge and knowing Edited by: Hofer, B. K. and Pintrich, P. R. 321–346. Mahwah, NJ: Lawrence Erlbaum Associates, Inc. [Google Scholar]; King&Kitchener, 1994 King, P. M. and Kitchener, K. S. 1994. Developing reflective judgment San Francisco: Jossey-Bass. [Google Scholar]), but it has yielded little insight into how or why it makes a difference. Moreover, researchers have tended to equivocate between viewing epistemological beliefs as causes and effects of learning—as age-dependent constraints on instruction on one hand andasoutcomesof instructionon the other hand (cf. Kuhn, 1991 Kuhn, D. 1991. The skills of argument Cambridge, , England: Cambridge University Press. [Crossref] , [Google Scholar], 2003 Kuhn, D. 2003. Understanding and valuing knowing as developmental goals. Liberal Education, 89(3): 16–22. [Google Scholar]; Schommer, 1990 Schommer, M. 1990. Effects of beliefs about the nature of knowledge on comprehension. Journal of Educational Psychology, 82(3): 498–504. [Crossref], [Web of Science ®] , [Google Scholar], 1993 Schommer, M. 1993. Comparisons of beliefs about the nature of knowledge and learning amongst post-secondary students. Research in Higher Education, 34(3): 355–370. [Crossref], [Web of Science ®] , [Google Scholar]). Cross-cultural studies of age trends in epistemological belief are one way to investigate systematically the relations between age, learning, and epistemic development. If the nature and timing of age-related shifts in epistemological belief vary cross-culturally, then this is presumably because participants in different cultures learn, through participation in practices particular to their respective communities, to treat knowledge claims in different ways. To the extent that researchers can pinpoint such practices and measure their impact on individuals' epistemological beliefs, we can begin to characterize more precisely the relations between learning and epistemic development. However, in designing such studies, researchers must take great care to distinguish between reportage and editorial. "Development" is a value-laden term. Theoretical models of psychological development do more than describe a sequence; they attach values to different points along the sequence. Specifically, they define some psychological states or capacities as more mature, adequate, or sophisticated than others. When developmental studies are restricted to homogeneous cultural settings, within which there is little serious disagreement among experts about the relative adequacy of different psychological states or capacities, the risk of bias in diagnosing participants' levels of development is relatively slight. However, as the cultural heterogeneity of the sample increases, so too does the risk that the model on the basis of which participants' development is diagnosed is ethnocentrically biased against a portion of the sample. For example, beliefs that are defined as immature by the developmental model might be considered mature within one of the cultures from which the sample is drawn, or vice versa. These dangers exist to some extent in all cross-cultural studies of psychological development (see Cole & Scribner, 1974 Cole, M. and Scribner, S. 1974. Culture and thought: A psychological introduction New York: Wiley. [Google Scholar]; Greenfield & Bruner, 1966 Greenfield, P. M. and Bruner, J. S. 1966. Culture and cognitive growth. International Journal of Psychology, 1: 89–107. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]; Shweder, Mahapatra, & Miller, 1990 Shweder, R. A., Mahapatra, M. and Miller, J. G. 1990. "Culture and moral development.". In Cultural psychology: Essays on comparative human development Edited by: Stigler, J. W. 130–204. New York: Cambridge University Press. [Crossref] , [Google Scholar]). However, in cross-cultural studies of epistemic development the danger is even more clear and present. This is because there are at least four levels at which epistemological judgments can be made, and as one ascends from the first level to the fourth, the value assumptions implicit in these judgments become less visible to the naked eye but never quite disappear. At the first, most basic level, there arejudgments about the epistemic status of par-ticular claims, such as whether a given assertion (e.g., "Eating people is wrong") is known or merely believed (e.g., "John doesn't know that eating people is wrong; he merely believes that eating people is wrong"). At one level of abstraction up from such judgments, there are judgments about the epistemic status of general classes of claim, such as judgments about whether knowledge is possible about, say, matters of aesthetics or morality (e.g., "There are no such things as moral truths or moral knowledge; morality is a question of commitment—not of what is or is not the case"). At yet another level of abstraction up from such judgments, there are further judgments about the criteria by which epistemic states are distinguished one from another, such as judgments about what differentiates knowledge from belief or opin-ion (e.g., "Knowledge is justified true belief;if a belief is true but not justified, or jus-tified but not true, then it isn't known"). And beyond this third level, there is a fourth level of judgments about the relative adequacy of particular criteria for distinguishing between epistemic states, such as judgments about whether the subjectivist equation of knowledge with opinion is less adequate than the evaluativist's insistence that knowledge differs from opinion in being supported by evidence (e.g., "Subjectivism is inferior to evaluativism because it fails to account for our belief that some claims are better supported than others"). According to this analysis, authors of contemporary models of epistemic development are themselves exercising a form of epistemological judgment in articulating their models. Specifically, they are operating at the fourth level (outlined previously), expressing their own beliefs about the relative adequacy of particular epistemological orientations. This is all well and good as long as the beliefs in question are compatible with the epistemological beliefs, values, and practices of the communities to which the model is applied. However, in cross-cultural studies of epistemic development, such compatibility cannot be assumed in advance of the investigation itself. Accordingly, if one wishes to avoid ethnocentrism, one cannot conduct a cross-cultural study of epistemic development without suspending, at least temporarily, one's hierarchical assumptions about the relative adequacy of particular epistemological orientations. This is not to say that researchers are not entitled to opinions of their own about the relative adequacy of particular epistemological beliefs or that all talk of epistemic development is inherently ethnocentric. It is merely to point out that because standards of epistemological maturity may themselves vary across cultures, assumptions about the relative adequacy of particular epistemological beliefs must not be built into the design of cross-cultural studies. This study, therefore, departs from previous studies of epistemic development by dropping the assumption that some epistemological beliefs are inherently more adequate than others. By dropping this assumption, I do not affirm the contrary assumption that all epistemological beliefs are equally adequate. Rather, I adopt a form of methodological agnosticism to reduce the scope for ethnocentric bias in the study'sdesign. In the Discussion section, I return to the question of hierarchy and review the assumptions of contemporary models of epistemic development in light of my findings. This study investigates the relations between age, learning, and epistemic devel-opment by comparing the epistemological beliefs of pupil sat Religious schools and General schools in Israel about two controversies: one religious and the other nonre-ligious. Specifically, this study asks three questions. First, how do beliefs about the nature of religious claims vary with age and school? Second, to what extent are these age and school differences attributable to underlying group differences in religious commitment and general epistemological sophistication? Third, how are variations in epistemological belief across ages, schools, and controversies related to educational practices at Religious and General schools, respectively?

Arbutus unedo L.: From traditional medicine to potential uses in modern pharmacotherapy

A Nationwide Survey of Japanese Palliative Care Physicians' Practice of Corticosteroid Treatment for Dyspnea in Patients With Cancer

The purpose of this study was to make evidence-based recommendations regarding the mode, dosage and schedule of delivery of concomitant mesna (sodium-2-mercaptoethanesulfonate) to protect against ifosfamide-induced uroepithelial toxicity. A critical review of the literature from 1966 to 1996 was undertaken on mesna administration via the intravenous, oral, or combined modality routes. Outcome measures of urinary symptoms and macrohematuria were emphasized, since these endpoints of urotoxicity are most clinically relevant. The quality of evidence obtained from published clinical research was evaluated based on guidelines developed by the Canadian Task Force on the Periodic Health Examination. Recommendations are now made according to the strength of available evidence on the proper usage of mesna as a protective agent against ifosfamide-induced urotoxicity. There is good evidence that the use of mesna significantly reduces urinary symptoms of dysuria and frequency, as well as the incidences of macrohematuria and microhematuria, when administered concurrently with any dosage of ifosfamide regardless of tumor site. Mesna, given intravenously or orally, is superior to standard prophylaxis with vigorous hydration and alkalinization of urine. A commonly used schedule of intravenous mesna involves a dose equal to 60% of the total ifosfamide dose, divided into three aliquots and administered at 0 h, 4 h and 8 h after ifosfamide. Combined oral and intravenous mesna delivered in some tested schedules is equivalent to intravenous mesna alone, but the optimal schedule and dosage of combined formulation have not yet been established. There is fair indirect but no direct evidence that oral mesna alone is equivalent to intravenous mesna or combined modality use. Further research issues, such as patient compliance with oral mesna and other routes of mesna delivery, are discussed. Ongoing study in the appropriate use of mesna is needed to maximize its value as a uroprotective agent in the clinical setting.

To identify and analyse the main features of the top 100 most-cited randomized controlled trials, systematic reviews and meta-analyses published in endodontic journals from 1961 to 2018. The Clarivate Analytics' Web of Science 'All Databases' was used to search and analyse the 100 most frequently cited randomized controlled trials, systematic reviews and meta-analyses having 'randomized', 'randomised', 'randomized controlled', 'randomised controlled', 'randomized controlled trial', 'randomized controlled trials', 'clinical trial', 'systematic', 'systematic review', 'meta-analysis', and 'meta-analyses' in the title section. The 'International Endodontic Journal', 'Journal of Endodontics', 'Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology', 'Australian Endodontic Journal', 'Endodontics & Dental Traumatology', 'Endo-Endodontic Practice Today' and 'European Endodontic Journal' were included in the publication name section. After ranking the articles in a descending order based on their citation counts, each article was cross-matched with the citation counts in Elsevier's Scopus and Google Scholar. The articles were analysed, and information on citation counts, citation density, year of publication, contributing authors, institutions and countries, journal of publication, study design, topic of the article and keywords was extracted. The citation counts of the 100 most-cited articles varied from 235 to 20 (Web of Science), 276 to 17 (Scopus) and 696 to 1 (Google Scholar). The year in which the top 100 articles were published was 2010 (n=13). Among 373 authors, the greatest number of articles was associated with three individuals namely Reader A (n=5), Beck M (n=5) and Kvist T (n=5). Most of the articles originated from the United States (n=24) with the greatest contribution from Ohio State University (USA) (n=5). Randomized controlled trials were the most frequent study design (n=45) followed by systematic reviews (n=30) with outcome studies of root canal treatment being the major topic (n=35). The Journal of Endodontics published the largest number of included articles (n=70) followed by the International Endodontic Journal (n=27). Among 259 unique keywords, meta-analysis (n=23) and systematic review (n=23) were the most frequently used. This study has revealed that year of publication had no obvious impact on citation count. The bibliometric analysis highlighted the quantity and quality of research, and the evolution of scientific advancements made in the field of Endodontology over time. Articles before 1996, that is prior to the CONSORT statement that encouraged authors to include specific terms in the title and keywords, may not have been included in this electronic search.

To analyse the main characteristics of the top 50 most-cited articles published in the International Endodontic Journal from 1967 to 2018. The Clarivate Analytics' Web of Science 'All Databases', Elsevier's Scopus, Google Scholar and PubMed Central were searched to retrieve the 50 most-cited articles in the IEJ published from April 1967 to December 2018. The articles were analysed and information including number of citations, year of publication, contributing authors, institutions and countries, study design, study topic, impact factor and keywords was extracted. The number of citations of the 50 selected papers varied from 575 to 130 (Web of Science), 656 to164 (Elsevier's Scopus), 1354 to 199 (Google Scholar) and 123 to 3 (PubMed). The majority of papers were published in the year 2001 (n=7). Amongst 102 authors, the greatest contribution was made by four contributors that included Gulabivala K (n=4), Ng YL (n=4), Pitt Ford TR (n=4) and Wesselink PR (n=4). The majority of papers originated from the United Kingdom (n=8) with most contributions from King's College London Dental Institute (UK) and Eastman Dental Hospital, London. Reviews were the most common study design (n=19) followed by Clinical Research (n=16) and Basic Research (n=15). The majority of topics covered by the most-cited articles were Outcome Studies (n=9), Intracanal medicaments (n=8), Endodontic microbiology (n=7) and Canal instrumentation (n=7). Amongst 76 unique keywords, Endodontics (n=7), Mineral Trioxide Aggregate (MTA) (n=7) and Root Canal Treatment (n=7) were the most frequently used. This is the first study to identify and analyse the top 50 most-cited articles in a specific professional journal within Dentistry. The analysis has revealed information regarding the development of the IEJ over time as well as scientific progress in the field of Endodontology.

ObjectivesThis study aimed to analyze the main features of the 25 most-cited articles in minimally invasive access cavities.Materials and MethodsAn electronic search was conducted on the Clarivate Analytics' Web of Science ‘All Databases’ to identify the most-cited articles related to this topic. Citation counts were cross-matched with data from Elsevier's Scopus and Google Scholar. Information about authors, contributing institutions and countries, year and journal of publication, study design and topic, access cavity, and keywords were analyzed.ResultsThe top 25 most-cited articles received a total of 572 (Web of Science), 1,160 (Google Scholar) and 631 (Scopus) citations. It was observed a positive significant association between the number of citations and age of publication (r = 0.6907, p < 0.0001); however, there was no significant association regarding citation density and age of publication (r = −0.2631, p = 0.2038). The Journal of Endodontics made the highest contribution (n = 15, 60%). The United States had the largest number of publications (n = 7) followed by Brazil (n = 4), with the most contributions from the University of Tennessee and Grande Rio University (n = 3), respectively. The highest number of most-cited articles were ex vivo studies (n = 16), and ‘fracture resistance’ was the major topic studied (n = 10).ConclusionsThis study revealed a growing interest for researchers in the field of minimally invasive access cavities. Future trends are focused on the expansion of collaborative networks and the conduction of laboratory studies on under-investigated parameters.

Bibliography of the Publications of R. W. Southern