Prefeeding Pathways: A Clinical Framework for Goal-Directed Prefeeding Habilitation.

Purpose The purpose of this paper is to examine how a performance measurement system (PMS) can be designed for small- and medium-sized enterprises (SMEs) operating in a turbulent environment. The current models and frameworks for the design and implementation of a PMS are for large companies; these traditional design and implementation processes are too multi-stage and long term for SMEs operating in a rapidly changing environment. Design/methodology/approach The study constructs a conceptual framework based on the performance measurement and management literature and empirical evidence from a longitudinal case study. Interviews, an analysis of strategic documents and documentation of the prevailing measurement system were conducted. Findings The study results reveal the framework for a flexible PMS design. In the framework, the PMS consists of core permanent measures that control the profitability of the company and supportive measures of the realisation of strategic targets. The supportive measures change and develop along with the strategy. Originality/value The study provides new understanding about the performance measurement design process in SMEs operating in a turbulent environment. The existing literature presents performance measurement design and implementation process models for large organisations, but these frameworks are too multi-stage and long term for SMEs.

Numerous challenges exist in effectively bridging theory and practice in the teaching and assessment of clinical reasoning, despite an abundance of theoretical models. This study compares clinical reasoning practices and decisions between medical students and expert clinicians using a problem-solving framework from the learning sciences, which identifies clinical reasoning as distinct, observable actions in clinical case solving. We examined students at various training stages against expert clinicians to address the research question: How do expert clinicians and medical students differ in their practices and decisions during the diagnostic process?. We developed a questionnaire about a pediatric infectious disease case based on the problem-solving framework from the learning sciences to probe clinical reasoning decisions. The questionnaire had four sections: medical history, physical examination, medical tests, and working diagnosis. The questionnaire was administered at Stanford University between January 2019 and June 2023 to collect data from 10 experts and 74 medical students. We recruited participants through maximum variation sampling. We applied deductive content analysis to systematically code responses to identify patterns in the execution of the practices and decisions across the questionnaire. This research introduces a highly detailed, empirically developed framework that holds potential to bridge theory and practice, offering practical insights for medical instructors in teaching clinical reasoning to students across various stages of their training. This framework involves nine practices, with a total of twenty-nine decisions that need to be made when carrying out these practices. Differences between experts and students centered on ten decisions across the practices: Differential diagnosis formulation, Diagnostic plan and execution, Clinical data reassessment, and Clinical solution review. We were able to identify nuanced differences in clinical reasoning between students and expert physicians under one comprehensive problem-solving framework from the learning sciences. Identifying key clinical reasoning practices and decision differences could help develop targeted instructional materials and assessment tools, aiding instructors in fostering clinical reasoning in students.

El algodon es una de las fibras textiles de mayor uso en el mundo. Su utilizacion en la industria textil se ha visto reducida en algunos periodos por el desarrollo de fibras sinteticas sustitutas de bajo costo como el nylon y el polyester; sin embargo, la demanda de prendas de vestir esta volviendo a lo natural por lo que la demanda de algodon se ha recuperado (Espinoza et al., 2009). La actividad algodonera no solamente provee a la industria textil sino tambien a la aceitera, jabonera, de alimentos balanceados para el ganado y ha sido la base para el desarrollo economico y social de algunas regiones del pais (Fernandez, 2001; Grijalva, 2014). La produccion de algodon en Mexico registra altibajos con una tendencia a la baja; en la decada de los noventa la superficie registro una drastica caida debido, en gran parte, al ataque de plagas, llegando a un record, en 1993, de 42,539 has, cuando en los ochentas se llegaron a sembrar mas de 300 mil (SIAP, 2015).

No need to match: a comment on Bach, Nicholson and Hudson's “Affordance-Matching Hypothesis”

Mobile Patient Monitoring Systems (MPMS) enable the patients with chronic diseases to monitor themselves during their daily lives. However, the development of MPMS is very complex. To overcome this problem, the MPMS framework was introduced as an ideal reuse technique to overcome the development complexity of MPMS. While a few studies have designed such frameworks, reusability was neither considered in the design of these frameworks nor evaluated. This is despite the fact that reusability is among the primary characteristics that distinguish successful frameworks. Therefore, the primary objective of this paper is to investigate the design of MPMS framework taking into account the reusability concept and to evaluate the reusability of a presented MPMS framework. To achieve this objective, the framework reusability evaluation method was used. The results show that the framework reusability is satisfied.

Current views of the control of complex, purposeful movements acknowledge that organizational processes must reconcile multiple concerns. The central priority is of course accomplishing the actor's goal. But in specifying the manner in which this occurs, the action plan must accommodate such factors as the interaction of mechanical forces associated with the motion of a multilinked system (classical mechanics) and, in many cases, intrinsic bias toward preferred movement patterns, characterized by so‐called “coordination dynamics.” The most familiar example of the latter is the symmetry constraint, where spatial trajectories and/or temporal landmarks (e.g., reversal points) of concurrentlymoving body segments (limbs, digits, etc.) exhibit mutual attraction. The natural coordination tendencies that emerge through these constraints can facilitate or hinder motor control, depending on the degree of congruency with the desired movement pattern. Motor control theorists have long recognized the role of classical mechanics in theories of movement organization, but an appreciation of the importance of intrinsic interlimb bias has been gained only recently.Although detailed descriptions of temporal coordination dynamics have been provided, systematic attempts to identify additional salient dimensions of interlimb constraint have been lacking. We develop and implement here a novel method for examining this problem by exploiting two robust principles of psychomotor behavior, the symmetry constraint and the Two‐Thirds Power Law. Empirical evidence is provided that the relative spatial patterns of concurrently moving limbs are naturally constrained in much the same manner as previously identified temporal constraints and, further, that apparent velocity interference is an indirect, secondary consequence of primary spatial assimilation. The theoretical implications of spatial interference are elaborated with respect to movement organization and motor learning. The need to carefully consider the appropriate dimensions with which to characterize coordination dynamics is also discussed.

[Extract] Clinical reasoning may be defined as the cognitive processes involved in arriving at a diagnosis or treatment plan. It is central to effective medical practice, yet it remains elusive and continues to present a challenge to clinical teachers and learners. The antemortem misdiagnosis rate at autopsies and audits of adverse events in hospitals attest to the continuing importance of clinical reasoning, despite the introduction of guidelines and advances in technology. The level of quality and accuracy of the clinical reasoning that underlies diagnostic and management decisions is the difference between trainees and expert clinicians. The process of learning clinical reasoning may be assisted by using think aloud.

The representational dynamics of the brain is a subsymbolic process, and it has to be conceived as an “agent-free” type of dynamical self-organization. However, in generating a coherent internal world-model, the brain decomposes target space in a certain way. In doing so, it defines an “ontology”: to have an ontology is to interpret a world. In this paper we argue that the brain, viewed as a representational system aimed at interpreting the world, possesses an ontology too. It decomposes target space in a way that exhibits certain invariances, which in turn are functionally significant. A challenge for empirical research is to determine which are the functional regularities guiding this decomposition process. What are the explicit and implicit assumptions about the structure of reality, which at the same time shape the causal profile of the brain's motor output and the representational deep structure of the conscious mind arising from it (its “phenomenal output”)? How do they constrain high-level phenomena like conscious experience, the emergence of a first-person perspective, or social cognition? By reviewing a series of neuroscientific results, we focus on the contribution the motor system makes to this process. As it turns out, the motor system constructs goals, actions, and intending selves as basic constituents of the world it interprets. It does so by assigning a single, unified causal role to them. Empirical evidence now clearly shows how the brain actually codes movements and action goals in terms of multimodal representations of organism–object relations. Under a representationalist analysis, this process can be interpreted as an internal representation of the intentionality relation itself. We try to show how such a more complex form of representational content, once it is in place, can later function as the building block for social cognition and a for more complex, consciously experienced representation of the first-person perspective as well. The motor system may therefore play a decisive role in understanding how the functional ontology of the human brain could be gradually extended into the subjective and social domains.

Recent findings in cognitive neuroscience shed light on the existence of a common neural mechanism that could account for action and intention to understand abilities in humans and non-human primates. Empirical evidence on the neural underpinnings of action goals and on their ontogeny and phylogeny is introduced and discussed. It is proposed that the properties of the mirror neuron system and the functional mechanism describing them, embodied simulation, enabled pre-linguistic forms of action and intention understanding. Basic aspects of social cognition appear to be primarily based on the motor cognition that underpins one's own capacity to act, here defined as motor abstraction. On the basis of this new account of the motor system, it is proposed that intersubjectivity is the best conceived of as intercorporeity.

Evidence-based practice involves basing clinical decisions and practice on the best available evidence. What do nurses need to think about when seeking to pursue evidence-based practice? What challenges do practitioners face in blending clinical reasoning with evidence-based practice? In this article, the authors argue against basing clinical practice on narrow definitions of evidence, relying solely on experimental findings or, even more exclusively, on randomized controlled trials. Instead of defining best practice narrowly by the strength of the current empirical evidence used to guide clinical decisions, it should be defined broadly by what is the best information to use to make decisions for a given patient in a particular setting. Credible and accountable clinical decisions rely on a number of forms of knowledge and evidence. This evidence includes findings from across the range of research methods, including experimental, interpretive, and action research. In nursing, it also includes evidence that has arisen from the depth of practice knowledge of expert clinical nurses. Professionals, particularly advanced and expert clinicians such as critical care nurses, use clinical reasoning to guide their practice in the uncertainty of clinical practice contexts. This reasoning helps the nurse make judgments about the relevance of particular research and clinical evidence for a specific patient and setting.

This year's article on health information technology (HIT) illustrates the use of digital technology to prevent and treat diabetes by enabling consumer engagement, behavior change, and impact analytics. It provides a snapshot of current thinking about digital technology's capabilities and capacity to deliver personalized interventions at scale. Early results are promising. A growing number of digital programs are clinically proven to improve health and lower the cost of care. And pioneering health-care organizations are offering these programs to members and patients as part of their new models for value-based care. Their success will drive other organizations—payers, providers, and employers—to make similar investments in health. In the modern health-care world, experts agree that “value” will be created by enabling health, not just delivering care. With today's epidemic of diabetes, patients who use digital health technologies can benefit greatly from both short-term health improvements and long-term health self-management. The foundations have been laid with evidence-based programs. Now, more health-care organizations must embrace this population management strategy for health. As adoption increases, the next technology challenge will arise: consumer engagement at scale. This engagement will be digital: content-rich programs filled with social support to activate, educate, and engage consumers. Most of the articles included in this and prior ATTD Yearbook articles address the specifics of digital interventions once the person enrolls. But before enrollment, consumers must engage. And to engage consumers, one must understand their reasons for engaging and their expectations for results. These insights fall into the realm of digital marketing, rather than the domain of clinical programs. Using a multidisciplinary approach, digital engagement will be the next variable to solve in the equation for scalable digital health. Not for a lack of trying, we have been unable to find noteworthy articles presenting best practices for consumer engagement from outreach to enrollment. But the future looks quite bright for the science of marketing digital health interventions. Increasingly, “big data” is providing scientists, innovators, entrepreneurs, educators, health-care providers, and administrators with the insights they need to predict consumer interests and personalize experiences throughout the entire behavior change process—from outreach to outcomes. Over the coming year, we will continue to search the health-care landscape to bring more innovations in digital health and diabetes prevention, from consumer engagement to population impact.

The purpose of this study was to apply the concept area cross by replacing the actual goal with rubber througharea cross game. This is done to reduce the fear of injury and the students will create a learning becomes fun.This type of research is a class act using metode practice test. Subject of research is student class five elementaryschool 11 Jambu numbered 29 students. Instrument that use to observation test and observation. Technicanalysis the data used in this research is as statistically descriptive comparative. From analysis result on cycle Iis knowed percentage of mastery learning numbered 24 % by 7 students, experienced improve in cycle IInumbered 100 % by mastery learning 29 students. Conclusions based on the results of research a class act,learning by approaching play area cross game, can improve student learning for kanga escape.

We are pleased that our article ( [1][1] ) has stimulated Butte and Ellis ( [2][2] ) to ask the question, “How much change in energy balance would be required to prevent weight gain in children?” The primary point of our article was that we need to set more realistic and specific goals for combating obesity at a broad public health level, including setting specific targets for how much we need to modify energy balance in order to achieve these goals. We suggested the figure of 100 kcal/day as the energy gap that needs to be addressed for the majority of adult Americans. This estimation was based on analysis of adult population surveys, and assumed a very conservative value of 50% for the efficiency of excess energy storage. Our proposed 100 kcal/day energy gap did not include an analysis of weight gain data in children, and we would welcome application of similar reasoning to estimating an energy gap for children in general as well as special subgroups of children that may be at special risk for weight gain. For example, it was unclear from their comment whether the sample of Hispanic children studied by Butte and Ellis ( [2][2] ) is representative of Hispanic children in general or whether their subjects represent a special high-risk group. In either case, it would be useful to have a specific target for preventing excess body weight gain among different populations of children. Butte and Ellis estimate that the energy gap that accounts for weight gain in 90% of their population would be 204 to 263 kcal/day ( [2][2] ). Surprisingly, they then go on to conclude that the energy gap in this group of Hispanic children (which may represent an extreme at-risk group) cannot be achieved with small changes in diet and physical activity. Rather, they suggest the lofty goal of changing society instead. We would like to make several points about this conclusion. First, we think that modifying energy balance by this amount is a very achievable challenge. For example, we are piloting an intervention in adults that aims to increase energy expenditure by 100 kcal/day (by more walking) and to reduce energy intake by 100 kcal/day, for a total of 200 kcal/day reduction in positive energy balance. This still seems to represent a relatively small and more achievable life-style change for people compared with the dramatic alterations in food intake and exercise patterns often recommended. It is possible to burn an extra 100 kcal a day by walking an extra 20 min and to reduce energy intake by 100 kcal by, for example, substituting one noncaloric beverage for a caloric one. These are small changes that should be achievable and sustainable, even in children. Second, it seems inappropriate to dismiss our proposed strategy of making small lifestyle changes when current public health recommendations that endorse much larger changes have not been at all successful in stemming the increase in obesity among adults and children. Are Butte and Ellis saying that we shouldn't even try to make small changes because they won't be enough? Wouldn't children be better off with these small changes than where they are today? Wouldn't this likely prevent some weight gain for some children? Third, the solution offered by the authors is to change society, but they offer no advice or specific details about how that might be accomplished. In our article ( [1][1] ), we advocated the need to frame obesity as a societal issue, and we agree this should be pursued as a long-term goal. However, we have a long way to go to build widespread support for this strategy, and there is little agreement on how society should be changed. Advocating for changing society is admirable, but in the meantime, children and adults are gaining more excess weight each year. We need to do something now to prevent further weight gain. Having general strategies to eat less and exercise more have not worked. We believe that setting small, actionable goals is a promising way to start dealing with this epidemic now, while we continue to work together on a long-term vision for a future state in which weight management is easier for us all. It is certainly possible that modifying energy balance by 200 kcal/day will not be enough to have a major impact on obesity in the United States. However, it seems a reasonable approach to try. 1. [↵][3] J. O. Hill, H. R. Wyatt, G. W. Reed, J. C. Peters, Science 299, 853 (2003). [OpenUrl][4][Abstract/FREE Full Text][5] 2. [↵][6] N. F. Butte, K. J. Ellis, Science 301 , 598 (2003); [www.sciencemag.org/cgi/content/full/301/5633/598b][7]. [1]: #ref-1 [2]: #ref-2 [3]: #xref-ref-1-1 View reference 1 in text [4]: {openurl}?query=rft.jtitle%253DScience%26rft.stitle%253DScience%26rft.issn%253D0036-8075%26rft.aulast%253DHill%26rft.auinit1%253DJ.%2BO.%26rft.volume%253D299%26rft.issue%253D5608%26rft.spage%253D853%26rft.epage%253D855%26rft.atitle%253DObesity%2Band%2Bthe%2BEnvironment%253A%2BWhere%2BDo%2BWe%2BGo%2Bfrom%2BHere%253F%26rft_id%253Dinfo%253Adoi%252F10.1126%252Fscience.1079857%26rft_id%253Dinfo%253Apmid%252F12574618%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [5]: /lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6Mzoic2NpIjtzOjU6InJlc2lkIjtzOjEyOiIyOTkvNTYwOC84NTMiO3M6NDoiYXRvbSI7czoyNDoiL3NjaS8zMDEvNTYzMy81OTguMy5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30= [6]: #xref-ref-2-1 View reference 2 in text [7]: http://www.sciencemag.org/cgi/content/full/301/5633/598b

Doing the Right Thing: Aligning Plans With Goals and Values for Pediatric Patients.

Physiotherapy students' perceptions of how the Cervical Framework influences their clinical reasoning: A qualitative single case study of a Canadian university.