Multidisciplinary Undertaking Research Articles

Picking Your Next Ventilator

Selection of new ventilator systems for the neonatal intensive care unit (NICU), once a simple process due to the limited number of products available, is now a time-consuming, complex, and multidisciplinary undertaking. Making the best selection involves input from all clinical partners as well as hospital administration. Because ventilator systems now often may be used across the age spectrum, it is necessary to consider whether these devices will be used outside of the NICU. The selection process involves first choosing a multidisciplinary committee, followed by determination of performance and data handling standards. Costs and implementation strategies play a critical role in this process. A request for proposals is prepared and vendors selected for device presentation. Bench testing, either inhouse or by review of others' data, is required, and a clinical evaluation may be part of the process. Finally, the selection is made and the real work begins.

How to enhance physician and public acceptance and utilisation of colon cancer screening recommendations

Colorectal Cancer (CRC) screening delivery is a multidisciplinary undertaking, aiming at reducing mortality from and incidence of CRC without adversely affecting the health status of participants. The adoption of a public health perspective involves commitment to ensure equity of access and sustainability of the program over time. We reviewed available evidence concerning predictors of CRC screening uptake and the impact of interventions to improve adoption of screening using conceptual frameworks defining the role of determinants of preventive behaviours and the reach and target of interventions. The results of this review indicate that policy measures aimed at supporting screening delivery, as well as organisational changes, influencing the operational features of preventive services, need to be implemented, in order to allow individual's motivation to be eventually realised. To ensure coverage and equity of access and to maximise the impact of the intervention, policies aimed at implementing organised programs should be adopted, ensuring that participation in screening and any follow-up assessment should not be limited by financial barriers. Participants and providers beliefs may determine the response to different screening modalities. To achieve the desired health impact, an active follow-up of people with screening abnormalities should be implemented, supported by the introduction of infrastructural changes and multidisciplinary team work, which can ensure sustainability over time of effective interventions. Continuous monitoring as well as the adoption of plans to evaluate for program effectiveness represent crucial steps in the implementation of a successful program.

Women Writing Music in Late Eighteenth-Century England: Social Harmony in Literature and Performance (review)

Reviewed by: Women Writing Music in Late Eighteenth-Century England: Social Harmony in Literature and Performance Ellen T. Harris Leslie Ritchie, Women Writing Music in Late Eighteenth-Century England: Social Harmony in Literature and Performance (Aldershot, Hampshire: Ashgate, 2008). Pp. xi, 269. $114.95. The place of women in eighteenth-century music-making has generally been relegated in modern scholarship to that of domestic performer or, in the realm of professional music, to ardent fan or patron. Leslie Ritchie seeks to overturn this long-held conviction, in part by expanding the definition of “women writing music.” She lays out the five tenets underlying her argument in the introduction: first, the assumed connection between social harmony and music harmony was not absolute (4–11); second, performance was part of the creative process; third, public and private performances were less differentiated than previously thought (“to speak radically, there is no such thing as private music” [19]); fourth, “derogatory assumptions . . . underlie the modern distinction between art songs and popular songs,” which existed on a continuum (21); and fifth, eighteenth-century music-making was “profoundly multidisciplinary” (24). Then limiting her discussion to vocal music, Ritchie includes not only composers but authors of song texts and singers as part of the process of writing music. Ritchie rebuts the belief that women who participated in making music shied away from public notice and desired anonymity. Her examination of the list of compositions registered at Stationers’ Hall during the eighteenth century shows that of the composers only 8 percent were women, but of these, 73 percent identified themselves by name, “rather than as ‘A Lady’ or ‘A Woman of Quality’ or a similar denomination” (72). Indeed, the desire for recognition and a kind of copyright led some women (and men) to claim registration without having actually done so. Further, the importance of the role of women in the creation of music can be seen in the statistic that 42 percent of the performers named on registered musical compositions were women. Ritchie also seeks to complicate the notion that music harmony and social harmony were synonymous. Although she acknowledges the place of music in the [End Page 538] lives of many eighteenth-century women, especially as described by their male contemporaries, as a useful discipline, a reinforcement (through text) of social mores, and an important part of courtship ritual, she argues that “women’s pleasure in music can be understood as both subservient to and, sometimes, subversive of moral discipline and the social purposes that musical practice was thought to serve” (31). She divides women’s song repertoire into three “dominant categories” of charity (Caritas), pastoral (Arcadia), and politics/nation (Britannia), and discusses specific examples that demonstrate “the ways in which women strategically exploited these categories’ boundaries” (28). There is a great deal of value in Ritchie’s evidence and argument. As a musicologist working with both musical and literary materials, I know the pitfalls of a multidisciplinary undertaking, and Ritchie handles the terrain with some panache. She certainly does not slight the music: her book is rich with musical example and facsimile, and she doesn’t shy away from musical analysis. In fact, I wonder what readers will think of the sentence: “Harmonically, the tune is set in D major, and uses various inversions of the chords of D major, b minor, G major and A major (as well as an E major chord that functions as an applied dominant for A major) in its simple accompaniment” (122–3). Unfortunately, Ritchie does not provide the music for this example. I can only assume that difficulties in acquiring the necessary permissions led to the situation whereby some of the most detailed analyses are not accompanied by examples, but simpler songs given less detailed discussions are provided in full (e.g., the modified strophic song, “Crazy Jane” [112–5]). There are more serious problems, however. The conclusions drawn by Ritchie are too often unwarranted from the evidence she provides. She claims that James Grassineau in his Musical Dictionary of 1740 defines “harmony” with a set of binary opposites (“one / many; pleasing / codified; natural / scientific” [4]), which simply are not there. Similarly, she draws from Grassineau’s definition of “testo...

SOCIAL, ECONOMIC AND CULTURAL DIMENSIONS OF SENSORY EVALUATION AND ITS POSSIBLE APPLICATIONS TO THE VARIOUS DISCIPLINES OF HOME ECONOMICS IN THE PHILIPPINES

ABSTRACT Sensory evaluation is a scientific method that deals with precision, accuracy and sensitivity. Its basic principles are in large part anchored on the natural sciences, such as biology, chemistry, mathematics and physics. However, sensory evaluation goes beyond such platforms and has its own social, economic and cultural facets. Sensory evaluation has been extensively used in the study of consumer items such as food and clothing, and lately on behavioral and physiological reactions. It has been an integral part of the food science curriculum in various universities. However, the other disciplines of home economics, such as clothing technology, family life and child development, home economics education, hotel, restaurant and institution management, interior design and community nutrition, which deal with the needs of families and consumers, have not fully maximized the use of sensory evaluation. The multidisciplinary nature of home economics will push sensory evaluation to a more diverse level of relevance and purpose. This paper presented the social, economic and cultural dimensions of sensory evaluation along with its possible applications in the various disciplines of home economics in the Philippines. PRACTICAL APPLICATIONSThe paper provided a wholistic view of sensory evaluation not merely as a scientific method but its important social, cultural and economic dimensions. This document can serve as a guide for students, teachers and professionals in the conduct of sensory assessments. Likewise, this will help home economists not only in the Philippines but also in other countries to maximize the use of sensory evaluation in improving the quality of life of families and consumers. Moreover, this can drive multidisciplinary undertakings utilizing sensory evaluation as the key concept and thus enrich the pool of knowledge both in the natural and social sciences and their interaction.

Foreword

The publication of the Kidney Disease Outcomes Quality Initiative (KDOQI™) Clinical Practice Guideline for Nutrition in Children with Chronic Kidney Disease: Update 2008 represents the first update of the K/DOQI Nutrition and Chronic Renal Failure guidelines that were published in 2000. The number of pediatric patients with chronic kidney disease (CKD) continues to grow. Patients with CKD are at significant risk of protein-energy malnutrition (PEM). Nutritional status in these children is especially important because it has a significant impact on linear growth, neurocognitive development, and sexual development. The effect of nutrition is especially important in infants because deficits in either linear growth or development that are acquired during infancy may not be fully correctable. This guideline was developed to assist practitioners in Pediatric Nephrology in assessing the nutritional status of children with CKD, including patients on dialysis therapy or who have a kidney transplant; providing adequate macronutrient and micronutrient intake; and monitoring and treating complications of CKD, including bone mineral, vitamin D, fluid, and electrolyte derangements. This guideline will be of great importance to a broad audience of pediatric caregivers who endeavor to mitigate the effects of CKD on nutritional status and thus on the growth and development of these children. This guideline has been developed by involving multiple disciplines from both US and international sources. These perspectives have been invaluable in ensuring a robust document with broad perspective. Each statement is graded based on the strength of recommendations (see the Reference Key on page S6 and Appendix 6). As for all KDOQI guidelines, these suggested interventions have been thoroughly discussed by all members of the Work Group to ensure they reflect state-of-the-art opinion on diagnosis, and management of these nutritional disorders. This final version of the document has undergone revision in response to comments during the public review process, an important and integral part of the KDOQI guideline process. Nonetheless, as with all guideline documents, there will be a need in the future for revision in the light of new evidence and, more importantly, a concerted effort to translate the guidelines into practice. The recommendations are intended to serve as starting points for clinical decision making, and it is emphasized that the clinical judgment of the health care provider must always be included in the decision-making process and in the application of these recommendations. They are not to be considered as rules or standards of clinical practice, in keeping with the objectives of KDOQI. It is hoped that the information in this guideline document and the research recommendations provided will help improve the quality of care provided to children who have CKD and will stimulate additional research that will augment and refine this guideline in the future. KDOQI is moving into an exciting new phase of activities. With the publication of the Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease in February 2007, KDOQI achieved its primary goal of producing evidence-based guidelines for the 12 aspects of CKD care most likely to improve patient outcomes. We now seek to apply the knowledge acquired in the development and refinement of the KDOQI processes to improve clinical practice through a broader range of activities that include directed research, public policy, guideline updates, commentaries on Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, publication forums, and new guidelines, if not being addressed by KDIGO or other guideline developers. We are looking forward to working with various members of the kidney health care community regarding these new and continuing KDOQI activities. In a voluntary and multidisciplinary undertaking of this magnitude, many individuals make contributions to the final guideline document. It is impossible to acknowledge each of these individuals here, but to each and every one of them, I extend my sincerest appreciation. This limitation notwithstanding, the members of the Nutrition in Children with CKD Work Group and the Methods Consultants are to be commended for all their time and effort in reviewing the literature on pediatric nutrition since the release of the first nutrition guidelines in 2000 and for providing this update. Special thanks are given to the Co-Chairs, Dr Bradley Warady and Dr Donna Secker, for coordinating the activities of the Work Group. It is their commitment and dedication to the KDOQI process that has made this document possible.

Hydrodynamics Of Dolphin Skin AndOther Compliant Surfaces

The research on the hydrodynamics of compliant walls was originally inspired by dolphins. In particular, much research on the use of wall compliance for drag reduction was motivated by Gray’s Paradox, namely the belief that specific power output of the propulsive muscles must greatly exceed the mammalian norm in order to achieve the observed swimming speeds if some sort of laminar-flow control were not involved. The full assessment of Gray’s Paradox is a highly multidisciplinary undertaking and remains controversial. Here the emphasis will be placed on the hydrodynamics of compliant walls and its bearing on the possible laminar-flow and turbulencesuppression properties of the dolphin epidermis. The mechanics of the various types of compliant wall and their equations of motion will then be considered. This is followed by a discussion of the hydrodynamics of compliant walls, including hydroelastic instabilities and the effect of wall compliance on laminar-turbulent transition and fully turbulent flow. Finally the structural features of dolphin skin of possible hydrodynamic significance will be considered together with their relationship with analogue dolphin skins with possible technological applications.

Foreword

Foreword

Severe Traumatic Brain Injury in Childhood—Guidelines

Source: Carney NA, Chesnut R, Kochanek PM, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. J Trauma. 2003;54(suppl):S235–S310.Evidence-based guidelines for the management of severe head injury among adults first appeared in 1995 at the initiative of the Brain Trauma Foundation, the American Association of Neurological Surgeons, and the Joint Section on Neurotrauma and Critical Care. Skeptics initially viewed this effort (“The Guidelines” in neurosurgical conversation) as an academic edifice built on a foundation of weak clinical research, but although there has been no dispute about the need for more and better research, the Guidelines have, nevertheless, moved the practice of trauma care forward. The Guidelines have spotlighted important research questions, stimulated examination of practice variation in traumatic brain injury (TBI) care, and discouraged antiquated and potentially harmful interventions such as dehydration, steroid administration, and indiscriminate hyperventilation. There is even some evidence that compliance with the Guidelines has improved outcomes.1Guidelines for the management of severe TBI in childhood have now appeared. Unlike the earlier general document, these guidelines are the product of a genuinely multidisciplinary undertaking that reflected the perspectives of pediatric emergency physicians and intensivists as well as neurosurgeons. They have been endorsed by a variety of national and international specialty societies representing critical care, pediatric critical care, pediatric neurology, pediatric neurosurgery, and trauma surgery. For the widest possible dissemination, they have been published simultaneously in Critical Care Medicine, Pediatric Critical Care Medicine, and the Journal of Trauma.2,3 Treatment recommendations were labeled “Options,” “Guidelines,” and “Standards” in order of increasing confidence provided by increasing quality of the supporting evidence. No recommendations rose to the level of Standards because of the lack of large, properly designed, prospective, randomized, controlled trials—an eloquent commentary on the scientific underpinnings of contemporary practice.This substantial piece of work cannot be summarized briefly. The literature on a broad spectrum of topics was reviewed, ranging from various aspects of pre-hospital care and resuscitation, through many issues in intensive care, to the value of trauma systems. Not surprisingly, the management of elevated intracranial pressure (ICP) received a great deal of attention and the document provides algorithms that sequence and prioritize the available therapies. Several therapies deserve special mention because of current active research interest.Hypertonic (3%) saline has been shown in an open, prospective, randomized trial to reduce intensity of therapy for elevated ICP, to shorten ICU stay, to shorten duration of ventilatory support, and to reduce the frequency of complications in comparison to lactated Ringer’s solution.4 There was no effect on patient out-come, however. Other prospective observational studies have confirmed similar benefits from hypertonic saline for ICP control.Neurosurgical management of elevated ICP received a tentatively favorable review as well. A single-center, randomized, controlled trial of early bitemporal de-compressive craniectomy demonstrated impressive trends toward superior ICP control and superior out-comes at 6 months, but significance was not achieved after allowance for multiple statistical comparisons.5 Two other single-center, case-control studies also showed improved outcomes after decompressive craniectomy; one of these studies was expressly limited to abused infants.6 The pediatric experience complements a favorable adult literature, all of which, nevertheless, requires careful reading because of variations in timing and technique from one report to another.“The Pediatric Guidelines,” as they will soon come to be known in the culture of pediatric trauma care, are necessary and edifying reading for neurosurgeons, intensivists, pediatric surgeons, trauma surgeons, emergency physicians, and pediatricians involved in the initial stabilization or subsequent management of injured children. The paucity of clinical evidence on many important matters will leave readers dissatisfied, but hopefully this document will become a stimulus to rigorous clinical research and uniform, protocol-driven care like its adult predecessor.

Mass spectrometry as a tool for protein crystallography.

Atomic resolution structure determinations of proteins by X-ray crystallography are formidable multidisciplinary undertakings, requiring protein construct design, expression and purification, crystallization trials, phase determination, and model building. Modern mass spectrometric methods can greatly facilitate these obligate tasks. Thus, mass spectrometry can be used to verify that the desired protein construct has been correctly expressed, to define compact domains in the target protein, to assess the components contained within the protein crystals, and to screen for successful incorporation of seleno-methionine and other heavy metal reagents used for phasing. In addition, mass spectrometry can be used to address issues of modeling, topology, and side-chain proximity. Here, we demonstrate how rational use of mass spectrometry assists and expedites high resolution X-ray structure determination through each stage of the process of protein crystallography.

USING TRADITIONAL ECOLOGICAL KNOWLEDGE IN SCIENCE: METHODS AND APPLICATIONS

Advocates of Traditional Ecological Knowledge (TEK) have promoted its use in scientific research, impact assessment, and ecological understanding. While several examples illustrate the utility of applying TEK in these contexts, wider application of TEK- derived information remains elusive. In part, this is due to continued inertia in favor of established scientific practices and the need to describe TEK in Western scientific terms. In part, it is also due to the difficulty of accessing TEK, which is rarely written down and must in most cases be documented as a project on its own prior to its incorporation into another scientific undertaking. This formidable practical obstacle is exacerbated by the need to use social science methods to gather biological data, so that TEK research and application becomes a multidisciplinary undertaking. By examining case studies involving bowhead whales, beluga whales, and herring, this paper describes some of the benefits of using TEK in scientific and management contexts. It also reviews some of the methods that are available to do so, including semi-directive interviews, questionnaires, facilitated workshops, and collaborative field projects.

Sustainable economic development: A criminal justice challenge for the 21st century

The environmental challenges of the 21st century require co-operation between criminal justice experts and economists. Three different economics perspectives are relevant for the discipline of criminal justice in general and for adressing environmental problems in particular: neo-classical econoics, political economics and the economics of sustainable development. Criminal justice pays a role in the effort to attain sustainable development because the limitations of market based decision making necessitate a role for law and regulation in addressing environmental degradation. Sustainable development itself is relevant to the general discussion of crime. Issues of sustainable development are already discussed in criminal justice literature. While criminal law has limitations as a tool against environmental crime, it will necessarily suplement the tools of the market and civil regulation in coping with environmental problems. The inherently multidisciplinary undertaking of sustainable development will be most effectively met if experts in both economics and criminal justice understand more of one another's fields. Suggestions for including the three perspectives of economics in the criminal justice curriculum are provided.

Positron emission tomography

The potential of the coincidence technique in positron imaging was recognized early on and pilot experiments were performed as early as the 1950s. In combination with the tomographic technique, it was possible in the late 1970s to demonstrate a new principle for medical diagnosis, positron emission tomography (PET). In more recent years PET has matured and has become an important clinical research tool, as well as a routine diagnostic modality. PET is a multidisciplinary undertaking. However, in this paper we mainly emphasize the contribution from nuclear physics, radionuclide production and detector development. New crystal materials with high density, high light output and short pulse length will, in the near future, improve the resolution and counting properties of PET instrumentation. The experience gained in the development of -detectors in nuclear and particle physics is applied to increase the solid angle and hence the sensitivity. Other factors must also be considered. There is interest in using positron-emitting nuclides with longer half-lives than those mainly associated with PET. Many of these long-lived nuclides, e.g. ( h) and ( h), emit high-energy gamma radiation in coincidence with the positron radiation, which will affect the detection and quantification abilities of PET. PET primarily yields functional and physiological information, and anatomical structures are sometimes difficult to identify. High-quality PET data usually have to be combined with an anatomical method like CT or MRI. The future will, besides highly sophisticated and dedicated PET systems for research, probably see clinically suited rotating gamma cameras integrated with CT or MR, which can efficiently be used both for SPECT and PET.

Nutrition and Bone Health: Nutrition Education for Youth

LEARNING OUTCOME: Fifth graders wil1 be able to select appropriate foods to maximize bone mass. Nutrition and Bone Health is the topic of a nutrition education curriculum for fifth graders based on a collaborative project funded by NASA through the Arkansas Space Grant Consortium. The multi-disciplinary undertaking has many facets. It began with a group of Arkansas educators touring NASA's Johnson Space Center; the group was composed of university nutrition faculty, state department of education staff, secondary biology and home economics teachers, and an elementary teacher. Increased awareness of the impact of space travel on today's society was a major outgrowth of the tour, with the importance of nutrition and nutrition research emphasized. The premise that travel in space, or the experience of microgravity, results in bone loss in astronauts and the continual search for appropriate foods to decrease this bone loss provided a springboard for the nutrition and bone health education project. Fifth graders were selected for the curriculum project because they are progressing toward middle school where more freedom of choice is allowed in school lunch and soft drinks as well as fast foods are realistic meal options. The purpose of the project is to teach appropriate dietary choices which maximize bone mass. As a part of the curriculum, slides of NASA and astronauts are viewed along with slides of rats involved in a nutrition research project utilizing the hind limb suspension method, as well as illustrations of bone loss associated with aging. The students have a tasting party, using appropriate foods, and are given a take-home activity packet on nutrition and bone health. The multi-disciplinary project has had many phases. The nutrition curriculum has been enhanced at the elementary, secondary, and university levels in Arkansas. The major benefits of the project include working with a variety of health care specialists as well as educators in teaching nutrition.